USMLE week 3

Acanthocytes

"spur cells' liver dz, abetalipoproteinemia. Enterocytes containing clear or foamy cytoplasm which is more prominent at the tips of the villi. THese findngs occur due to accumulation of lipids in the absorptive cells of the intestinal epithelium and are typical of abetalipoproteinemia, a dz caused by impaired formation of apoliporptein B (apoB) containing lipoproteins. Abetalipoproteinemia is most commonly caused by an AR , loss of fuction mutation in the MTP gene. It manifests during the first year of life with sympotoms of malabsorption (abdomimal distension, foul-smelling stool). Laboratory studies show very low plama tiglyceride and cholesterol levels, and chylomicrons, VLDLs and apoB are entirely absent from the blood. Poor lipid absorption cause def of fat-solubale vitamins (Vit E) and essential fatty acids. This results in RBC with abnormal membranes and thorny projections called acanthocytes as well as multiple neurologic abnormalities (progressive ataxia, retinits pigmentosa)

Cytomegalovirus esophagitis

(HIV, transplant, immunosuppressant drugs). CMV esophagitis usually presents with odynophagia (pain with swallowing) or dysphagia (difficulty swallowing) that can be accompanie by fever or burning chest pain. Endoscopy typically shows linear and swallow ulcerations in the lower esophagus wthat sometimes diffusely involves the esophagus. Tissue bx: enlarged cells with basophilic or eosinopilic intranculear inclusion bodies.

Hemosdierin-containing macrophages in the aveoli

(Ie: siderophages, or heart failure cells) are suggestive of prior episode so f pulmonary congestion an edema that arose due to chronic left heart filure. When erythrocytes extravasate into the alveoli due to the increased intravascular pressure in the pulmonary capillary bed, hemosiderin accumulates in alveolar macrophages.

Sigmoidoscopy demonstrates white-yellow plaques on the colonic mucosa, and bx shows that the plaques on the clonic mucosa and bx shows the the plaques are composed of fibrin and inflammatory cells.

(Intestinal overgrowth) C. Difficile leads to toxin production: Enterotoxin A: Water diarrhea Cytotoxin B: Colonic epithelial cell necrosis and fibrin deposition. Leukocytosis, toxic megacolon. Pseudomembranes on sigmoidoscopy- characteristic white-yellow pseudomembranes. PCR detection of toxin genes in stool Antibiotic therapy that can cause C.Diff- fluoroquinolone for bacterial pnemonia Treat with Metronidazole or oral vancomycin.

When do you give B6

(def coz stomatitis, cheilosis) and irritability. Given with isoniazid, to decreased homocysteine levels.

The nucleolus contains

(dense round structure) contains ribosoal DNA coding for 28S, 5.8S,a d 18S ribosomal RNA (rRNA) components, as well as newly transcribed rRNA in association with ribosomal proteins that are translated in the cytoplasm from mRNA. The primary fuction of the nucleolus is the synthesis and assembly of immature 60S and 40S ribosomal subuntis that are exported from the nucleus to fully mature in the cytoplasm. All ribosoal RNA except 5S rRNA is transcribed in the nucleolus.

The Kozak consensus sequence occurs on eukaryotic mRNA and is defined by the following sequence:

(gcc)gccRccAUGG- which R is either adenine or guanine. This sequence helps initiate translation at the methionine start codon (AUG).

Diffuse large B-cell lymphoma

(most common NHL), typically presents with a rapidly enlarging nodal (neck, abdomen, mediastinum) or extra nodal symptomatic mass. The Waldeyer's ring (oropharyngel lymphoid tissue) and gastrointestinal tract are commonly involved and systemic B symptoms, feet, weight loss, drenching night sweats.

Sheehan syndrome

(panhypopituitarism) Ischemic necrosis- HIgh pregnancy estrogen causes enlarged pituitary is vulncerable to ischemia in the case of hypotension form peripartum hemorrhage. Failure of lactation due to prolactin def. Presents with headaches and visual field defects.

Peripheral pulmonary stenosis

(pulmonary brach stenosis) is common cause innocent murmur that is heard after the first day of life when the pda closes. The murmur results form the relative hypoplasia for brach pulmonary arteries compared to the relatively large main pulmonary artery. Ausculatation may reveal a low-grade, mid0systolic high pitched or blowing ejection murmur that is heard in the pulmonary area with radiation to the axilla and the back.

Meglitinides

(repaglinide, netglinide) are short acting glucose lowering medication that act by closing the ATP-depdendint K channel in the pancreatic beta cell membrane, inducing depolarization and stimulating insulin release. ATP depdent K channel in the pancreatic beta cell membrane, inducing depolarization and L-type calcim channel opening. The increased Ca influ stimulates beta cell insuline release. SE weigth gain

Chronic myelogenous leukemia

(uncontrolled mature granulocyte production, mostly neutrophils but also basophils and eosinophils) or leukeomid reaction (over-exuberant WBC response associated with bacterial infection or malignancy, among others). Both cause an elevated WBC count (>50,000/mm3) with an increIntrd in precursor forms (bands, metamyelocytes, myelocytes). However, the enzyme leukocytes (neutrophil) alkaline phosphatase is decreased in CML. CML are predominance of myelocytes compared to more mature forms such as metamyelocytes (myelocytic bulge) and the absolute basophilia and eosinopilia.

Nonsense Silent mutations Frame shift

-a nonsense mutation would not alter the mRNA size. -single base substituation in UCA and UCU which both code for the same AA (Serine). -Deletion or addition of a number of bases that is not divisible by 3 in the coding region of the gene will cause a frameshift.

Causes of dilated cardiomyopathy

-viral myocarditis (coxsackie B) -periartum cardiomyopathy -Alcohol abuse -Chronic supraventricular tachycardia -Cardiotoxic durgs (doxorubicin) -Thiamine deficiency (wet beriberi)

Cell surface receptor antibody: Chimeric monoclonal antibody: Humanized monoclonal antibody: Small-molecule receptor inhibitor: Soluble receptor decoy protein:

0-mouse U-human xi- chimeric zu-humanized xizu-chimeric/humanized hybrid monoclona antibody (mab), receptor molecule (cept), kinase inhibitor (nib) Cell surface receptor antibody: Rituximab Chimeric monoclonal antibody: Infliximab Humanized monoclonal antibody:Certolizumab Small-molecule receptor inhibitor: Imatinib Soluble receptor decoy protein: Entanercept (RA in pts that have failed methotrexate

Atherosclerosis

1) Chronic hemodynamic stress and hyper lipidemia which causes endotheilial cell injury 2) increaed expression of surface vacular cell-adhesion molecules VCAMs that allow adherence and migration of monocytes and T lymphocytes into the intima. 3) infiltrating leukocytes and dysfunctionaal endothelium release cytokines and growth factors (platelet-derived growth factor, fibroblast growh factor, endothelin-1 interleukin-1) that promote migration and proliferation of Vascular smooth muscle cells within the intima. 4) VSMCs are also stimulated to synthesize extracellular matrix proteins (collagen, elastin,proteoglycans) that form the fibrous cap typical of mature atheromas. Distruction of the fibrous cap with luminal thrombosis (atherosclerotic plaque rupture) has catastrophic clinical consequences and is responstible for the majority of actue coronary syndromecasesand sudden cardiac deaths. Aside: Macrophages produce matrixmetalloproteinases and tissue factors that degrade the extracellular matrix, causeing hte formation of a large, soft lipid-rich core with thinning of the fibrous cap. Increased propensity for rupture.

Life cycle strongyloides

1) Filariform larva penetrate the skin and migrate to the lungs 2) Filariform larva enter alveoli and travel to the pharynx whener they are swallowed and carried to the small intestine. 3) Filariform larva molt into adult and lay eggs withing intestinal mucosa. 4) Eggs hatch into noninfectious rhaditiform larva that are excreted in the stool. 5) Rhaditiform larva from adults that reproduce and lay eggs that hatch into more rhaditiform larva. 6) Non-infective rhaditiform larva molt into infectious filariform larva.

Steps to reduce Central venous catheter infection by Staph

1) Hand hygiene (alochol sanitizer or soap and water prior to donning sterile gloves. 2) Max barrier precautions during insertion (surgical mask, sterile gloves, long sleeved surgical gown, and a large sterile sheet) 3) Preparations of the insertion site with chlorhexidine antiseptic 4) Use of subclavian or internal jugular insertion site (femor vein has a higher rick of infection). 5) Prompt removal of the catheter when it is no longer needed.

There are three types of Asperigillius

1) Invasive aspergillous (immunosuppressed pts). Prolonged neutropenia associated with leukemia and lymphoma tx. Fever, pleuritic chest pain, and hemoptysis. Dprediection for blood vessles and can spreat hematogeously, causing infectio and infarcts. V0 shaped narrow sptete hyphae invading the tissue, Ampthotercine B to treat. 2) Aspergillomas and fungus ball- in old lug cavities by TB or branchiectasis. Surgically removed. 3) Allergic bronchopulmonary aspergillosis: pts with asthma, wheezing and migratory pumonary infiltrates. Increaed IgE and increased titers of antibodies against Aspergillis are characteristic. Tx with corticosteroids.

Drug toxicity that causes these: 1) Hematemesis and melena 2) Bradycardia, hypotension and hypoglycemia, complete heart block 3) Jaunice and elevated liver enzymes, 4) Sedation and respiratory depression, constricted pupils 5) Seizures and tachyarrhythmias

1) Iron poisoning direct damage to the gastric mucosal cells. 2) Beta locker toxicity, glucagon is the specific antidote as it increases intracellular cAMP and cardiac contractility. 3) Acetaminophen, Acetylcysteine, a glutathione donor, is used to treat acetaminophen toxicity. 4) Opiod, support or naloxone 5) Theophylline, nausea, vomiting, abdominal pain, diarrhea, cardiac arrhythmias. Activated charcoal. Beta blockers, benzo and barbiturates.

Different kinds of Mitocondrial diseases?

1) Leber hereditary optic neuropathy: leads to bilateral vision loss. 2) Myoclonic epilepsy with ragged-red fibers: myoclonic seizures and myopahty with exercise. 3) Mitocondrial encephalomyopathy with lactic acidosis and stroke-like episodes MELAS:.

Define 1)Holoprosencephaly is an example of? 2) Absence of one or both kidneys 3) uterine constraint on a fetus in breech position, hip dysplasia 4) Amniotic band amputate fetal limbs 5) Potters

1) Malformation: primary intrinsic defect in the cells or tissues that form a structure, leading to a chain of downstream defects. 2) Agenesis is the complete absence of an organ. 3) Deformations are fetal structural anomalies that occur due to extrinsic mechanical forces. 4) Distruption, secondary breakdown of a previously normal tissue or structure. 6) A sequence occurs when a number of abnormalities result from a singla primary defect.

Hepatitis B virus infection progresses through two phases:

1) Proliferative phase: (CD8+ T lymphocytes response to viral antigens on the cell surface resulting in hepatocyte damage) Hepatitis B virus does not have a cytotoxic effect itself, however, the presnsece tof viral HBsAG and HBcAG on the cell surface stimulate the host's cytotoxic CD8 T lymphocytes to destroy infected hepatocytes. The integrative phase, the HBV DNA is incorporated into the host genome of those hepatocytes that survived the immune response. Infectivity ceases and liver damage tapers off when the antiviral antibodies appear and viral replication stops. However Hepatocellular ca remains elevated.

Secondary structure of tRNA

1) The acceptor site: where rRNA is loaded with the appropriate aa by aminoacyl tRNA synthestase. The acceptor stem helps mediate correct tRNA recognition by the proper aminoacyl tRNA synthestase. 2) 3'CCA tail is added to the 3- end of the tRNA as a posttranscriptional modification in eukaryoties and most prokaryotes. Several enzymes ultilize this tail to help recognize the tRNA . 3) D loop: contains dihydrouridine residues, which are modified bases often present in tRNA. The D loop (along with the acceptor stem and anticodon loop) facilitates correct tRNA recognition by the proper amnoacyl tRNA synthestase. 4) anticodon: contains sequences that are complemetnary to the mRNA codon. During translation, the ribosome complex selects the proper tRNA based solue on this anticodon sequence. 5) T loop: contains the TYC sequence that is necessary for binding of tRNA to ribosomes. The TYC sequence refers to the presence of ribothymidine, pseuoduridine and cytidine residues.

What nerve does the pharyngeal arch give rise too? 1 2 3 4

1) Trigeminal nerve 2) facial nerve 3) 9 4 and 6) 10

muscle contraction

1) Tropomyosin prevents cross lining between actin and myosin. Myosin cross-bridge-ADP-phosphate complex. 2) Release Ca binds to troponin and removes the tropomysoin, this allows myosin cross-bridge ADP phospate complex to bind to actin. 3) ADP phosphate complex is released after the myosin crossbidge binds to actin. 3) A new ATP is required for the detachment of the myosin crossbridge from actin.

ACE inhibitor SE (1) Digitalis txicity

1) angioedema 2) AV conduction block

Penicillin resistance occurs by two mechansims

1) bacteria that produce beta-lactamse (penicillinase) are able to destroy the beta-lactam ring of penicillins and render them ineffective. 2)Cephalosporin, carbapenems and penicillinase resistant such as: nafcillin and methicillin are not susceptible to penicillinase. Therefore retian thei antimicrobial effect. SO bacteria modifiy the penicillin binding proteins in their peptidoglycan cell wall such as beta-lactam antibiotics are unable to bind and interfer with cell wall synthesis. IE MRSA

Aortic stenosis

1) calcific degeneration most common time 2) Rheumatic valve dz- fusion of valve commissures due to repetitive inflammation. also involves mitral valves.

Glucose-6-phosphate dehydrogenase is the rate-limiting enzyme in the pentose phosphate pathway, the major source of cellular NADPH. PPP is the main source of NADPH, the pathway is active in:

1) cells experiencing high oxidative stress (erythrocytes), where NADPH is used to regenerate reduced glutathione. 2) Organs (liver, adrenals) involved in reductive biosynthesis (FA, cholesterol, steroids and cytochrome P450 metabolism). 3) Phagocytic cells generating a respiratory burst (NADPH oxidase)

Brain tumors: 1) Cyst formation and rare mitoses 2) Necrosis and vascular proliferation 3) Inflammatory cell infiltrate and reticulin deposits 4) Microscopic to massive calcium deposition

1) colloid cyst, a pathologically benign tumor usually found in the third ventricle. Benign but can cause lethal obstruction hydrocephalus. 2) Glioblastoma multiforme, frontal or temporal tumor cells, pseudopalisading necrosis. 3) pleomorphic xanthoastrocytoma, an astrocytoma found in children and young adults. can progress to GBM. 4) Meningiomas are tumors of the meninges that have a whorled pattern of growth. Laminar calcifications called psammoma bodies are often present.

Importance of hepatitis B serological markers 1) HBsAg 2) anti-Hbs 3) Anti-Hbc IgM 4) Anti-Hbc IgG 5) HBeAg 6) anti-Hbe

1) detectable durin acute infection persistence after 6 month implies chronic infection 2) anti-Hbs- vaccination long-term immunity 3) Anti-Hbc IgM- window phase when oth hbsag and anti hbs are absent 4) Anti-Hbc IgG- present in oth acute and chronic infection, no present after vaccination 5) HBeAg- high infectability 6) anti-Hbe - low infectability

Atherosclerosis:

1) endothelial injury 2) accumulation of LDL (lipoproteins) 3) Monocyte adhesioins to the endothelium (transformation to foam cells) 4) Release of growh factors by adherent platelets, acticated macrophages and endothelial cells. 5) Recruitment of T cells and smooth muscle cell proliferation, which lead to extracellular matrix production. With age: Go from chronic inflammatory process from fatty streaks withing the intima into atherosclerotic plaques, such as fibrous cap atheromas and fibrous plaques.

Four major elements of acne

1) follicular epidermal hyperproliferation 2) excessive sebum prodcution 3) inflammation 4) proionibacterium acne after conversion of dihydrotestosterone, androgens promot both follicular epidermal hyperproliferation and excesssive sebum production. Other drugs that can cause acne is epidermal growth factor receptor inhibitors and lithium.

MM characteristics

1) normochromic normocytic anemia 2) Secretion of IL-1 (osteoclast activating factor) and IL-6 by neoplastic cells activates osteoclast and leads to bone resorption with resultant osteopenia. 3) Hypercalcemia (increased bone destruction): fatigue, confusion, and constipation. 4) increased infection. The presence of M prtoein (monoclonal immunoglobulin) in the serum and monoclonal light chains (Bence-Johnes protein) int he urine is characteristics for MM. HYPERIMMUNOGLOBULINEMIA also causes rouleaux formation on peripheral blood smear and an increaed ESR. 5) AL amyloid: light chain , apple green birefringence. Development of renal failure. Heart, tongue and nervous system. 6) Renal failure: Infiltration of the kidney by plasma cells, deposition of amyloid, Bence-Jones casts in the tubules, hypercalcemia leading to metastatic calc nd inflammation by macrophages and giant cells.

Where are three leads of a biventricular pacemaker and what veins do you go through?

1) right atrium and ventricle. (Left subclavian vein and superior vena cava. 2) Left venticule lead course through the coronary sinus which resides in the atrioventicular groove on the posterior aspect of the heart.

Iron def anemia

1. Decreased bone marrow iron stores (ferritin and hemosiderin) 2. Decreased serum ferritin 3. Increased seurm total iron binding capacitiy TIBC and increased serum transferrin. 4. Decreased serum iron concentration 5. Decreased blood hemoglobin 6. Appearance of microcytic (low MCV), hypochromic RBCs , normal folate levels, and no hypersegmented neurtrophils. Ferritin marker of iron stores. It is also an acute phase reactant and may be elvated in pts with infections of inflammatory dz.

Membranous glomerulopathy

1. systemic diseases: DM, solid tumors (lung and colon), and immunologic disorders (SLE) 2. Certain drugs - gold, penicillamine, NSAIDS 3. Infection - hepatitis B, Hepatitis C, malaria, syphillis

Depending on age and condition of host how many species is needed to be infected with Shigella? Entamoeba histolytica Giardia Then Salmonella vibrio, clostridium perfringens and E. coli?

10-500 1-10 1-10 10^4 to 10^8. really high.

Ischemic stroke in the brain 12-24 hours 24-72 hours 3-7 days 1-2 weeks >2 weeks

12-24 hours: Red neurons (eosinophilic cytoplasm) pyknotic nuclei, loss of Nissl substance. 24-72 hours: neurophils comes in 3-7 days: Macrophages, microglia infiltration and phagocytosis begin 1-2 weeks: Reactive gliosis and vascular porliferation aroudn the necrotic area, plus ligquefactive necrosis (1 week -1 month) >2 weeks: Glial scar formation- cystic area surround by dense glial fiber (>1 month)

Healthy bone marrow

1:1 ratio of fat to hematopoietic elements.

Erythrocytes and 2,3-BPG

2,3-BPG decreases hemoglobin's affinity for oxygen. Therefore, in the presence of lower blood oxygen concentrations, higher 2,3-BPG levels within erythrocytes enable increased oxygen delievery in the perifpheral tissues. 2,3-BPG is produced from 1,3-BPG by the enzyme bisphosphoglycerate mutase. This rxn bypasses an ATP-generating step of glycolysis, causing no net gain in ATP.

Acute cholecystitis

3 Fs, is caused by gallstone obstruction of the cystic duct.dx in ultrasound: identify signs of gallbladder inflammation (wall thickening, pericholecystic fluid) on us. NOT echogenic stuctures inside the gall bladder When us is inconclusive, nuc med hepatobiliary scanning cna be used to asses cystic duct patency.

Rolling occurs at

4 months

How many chromosome do complete moles have?

46 xx or xy paternal only p57 negative risk of malgnancy

Lichen panus

5 ps. Polygonal, planar, pruritic, purplishplaques ont eh writst hands, trucnk and legs. Fine white lines termed wickham striae amy be present on the plaque surface.

DNA synthesis occurs in what direction

5' to 3'

First sign of intoxication

5-10 hours after the pt's last drink. Tremor, autonomic dysfunction (Increased heart rate, respiration, and temperature), gastrointestinal distress (nausea, vomiting) and anxiety/agitation. 12-48: Tonic-clonic seizures. 12-24: visual hallucinations. 48-96: Fluctuating arousal, sympathetic hyperactivity, hallucinations, and confusion.

Sulasalzine

5-aminosalicylates (mesalamine) are used to treat inflammatory bowel dz such as Crohn's disease and ulcerative colitis. They work by inhibiting cytokine, prostaglandin and leukotriene synthesis during inflammation. This pt's diarrhea and weight loss are not caused by inflammation.

Meyloid cells with azurophilic rodslike granules (Auer rods)

65 years found in acute myeloid leukemias, which do not typically cause hepatosplenomegaly. 15-17 translocation responds to vitamin A increase circulating myeloblasts on peripheral smear DIC is a common presentation

how many chromosomes do partial moles have

69 xxx or xxy maternal and paternal p57 positive less risk of malgnancy- mother protects the baby

Acute pancreatitis

80% is caused by gallstones or chronic alcoholism 20% is caused by inherited or acquired hypertriglyceridemia with triglyceride exceed 1000. via tissue toxicity

Chromosomes: 8 11 14 18

8: c-myc 11: cyclin D1 14: heavy chain IgG 18: BCL-2 (inhibits apoptosis)

Pts enter hospice:

< or = to 6 months prognosis focus on quality of life not prolongation symptom control Interdisciplinary team Services provided at home, assisted living facility or dedicated facility.

Chonic HTN

>140/90 prior to conception or 20 weeks gestation Tx: a0methylodopa, labetalol, hydralazine, nifediine, delivery 37-39 weeks

Malignant melanoma

>5 mm, expand superificially and then verically into the dermus and subcutaneous tissues. Melanoma cells are larger, contain larger nuceli with prominent nucleoli, greater mitotic activity.

I cell dz

A golgi body phosphotransferase enzyme catalyzes the phosphorylation of mannose residues on lysosome-bound proteins, allowing them to traverse the Golgi networ and ultimately be transported to the lysosomes, where they serve as catalysts for degradation of cellular components. A defective phosphotransferase enzyme causes extracellular secretion of these proteins and accumulation of cellular debris in the lysosomes, forming the characteristic inclusion bodies seen in I-cell disease. Pts with this disorder typically present with failur to thrive and cognitivie deficits inthe first year of life along with characteristic physical features ( coarse facial features, corneal clouding). Usually fatal :(

A leukemoid reaction

A leukemoid reaction is a reactive increase in the white blood cell count, which can mimic leukemia.The reaction is actually due to an infection or another disease and is not a sign of cancer. Blood counts usually return to normal when the underlying condition is treated.

Red neuron

A neuron that is responding to irreversible injury. Characteristic changes become evident 12-24 hours after the injurious event and include shrinkage of the cell body, eosinophilia of the cytoplasm, pyknosis of the nucleus and loss of Nissl substance. pyknotic (shrunken and basophilic). Common cause of metabolic encephalopathy are hypoglycemia, hyperglycemia ad hepatic encephalopathy. Profound hypoglycemia may lead to irreversible neuronal injury.

Type 1 hypersensitivity

A number of medications, including opioids, radioconstrast agents, and some antibiotics (vancomyocin) can trigger IgE-independent mast cell degranulation. Common symptoms include diffuse itching and pain, bronchospasm, and localized swelling (urticaria) these medications induce mast cell degranulation by activation of protein kinase A and PI3 kinase. This results in release of several mediators including histamine, bradykinin, heparin, and a number of enzymes and chemotactic factors.

Stress incontinence when prego

A rise in glomerular filtration rate occurs with increased renal circulation mediate dby the hormone relaxin which in turn stimulated by b-hCG. Pregnancy hormones decrease urethral tone and relax the pelvic vloor muscles (levator ani, coccygeus), which maintain closure of the urethral valve. The gravid uterus causes uretal compression and nmay result in physiolgic hydronephrosis (dialtion of the ureter). It can result in urinary statis and breeding ground for bacteria and UTIs The sciatic nerve can become compressed due to increased joint laxity from circulating relaxin and changes in maternal posture (spinal lordosis). Sciatica commonly presents as low back pain radiating down one side of the hip to the leg/

MI risk

A slowly developing occlusion would allow for formation of collateals that could prevent myocardial necrosis. The total coronary artery ca contenct correlates modestly with the coronary artery atherosclerotic plaque burden. Pts with advance coronary calc may be increased risk for ischemic MI. Activated macrophages in the atheroma contibute to collagen degradationby secreting metalloproteinases. When there is a high degree of of intimal inflammation, realease of these metalloproteinases is increased, which can destabilize the mechanical integrity of the plaque. Statins (HMG-CO-A-Reductase inhibitiors) decrease this inflammation and are useful in acute coronary syndrome to stabilize the plaque)

Toxiod vac

A toxoid may be prepared by tx of the toxin with formalin or heat. The toxoid can then induce humoral immunity again the toxin withought producing seious effects in the vaccine.

What virus demonstates a phospholipid composition of the viral particle surface highly similar to that of the cell nuclear membrane?

A virion with a phospholipid-containing particle surface is likely an enveloped virus. Most enveloped nucleocapsid virus acquire lipid bilayer envelopes by budding through the plasma membrane of the host cell. However, the herpesviruses bud through and acquire the lipid bilayer envelope from the host cell nuclear membrane.

Mitral stenosis

A2-OS (A2 - aortic valve closure and Opening snap). A shorter interval indicates more severe stenosis. Other auscultatory findings can include a diastolic rumbing murmur and presystolic accentuation due to left atrial contraction.

With pituitary adenoma

ACTH production will produce excessive adrenal androgen production, however, the symptoms of excess cortisol production (cushing syndrome) will dominate.

42 male with DIC, and bone marrow bx that shows predominance of immature myeloid cells with azurophilic needle shaped cytoplasmic granules. Chromosomal analysis of these immature cells is most likely to show what translocation?

ACUTE PROMYELOCTYIC LEUKEMIA (AML/APL- M3 actue myeloid leukemia) reveals promyelocytes with intracytoplasmic Auer rods. APL (15;17) chromosomal translocation that causes fusion of retinoci acid receptor-a gene and promyelocyte leukemia gene. Azurophilic means Auer rods (fused lysosomal granules) which has an enzyme consisting of myeloperoxidiase. A classic presentation is bleeding in the setting of DIC, a consumptive coagulopathy characterized by decreased fibrinogen levels, increased fibrin degradation products and prolonged PT and PTT and thrombocytopenia.

Huntington dz, Marfan syndrome, MEN and Neurofibromatoses are an example of what inheritance?

AD

SLE

ANA Anti-dsDNA and anti SM Hypocomplementemia Thomboembolic events due to vasculitis and antiphospholipid antibodies. Associated with serosal inflammation such as pericarditis (sharp pain relieved with leaning forward, increases during inspiration, pericardial friction rub), Pleurisy, peritonitis Cardio also includes: pericardial effusion, verrucous (Libman-Sacks) endocarditii, and increased risk of CAD. Libman sacks- is non-bacterial endocarditis, refers to small, wart like fibrinous lesions and generalized thickening that can affect eh heart valves of pts with SLE.

Cycstic fribrosis, hemochromatosis, and sicle cell anemia are examples of what inheritance?

AR

Freidrich ataxia

AR children 5-15, difficulty walking (ataxia), hypertrophic cardiomyopathy, kyphoscoliosis, foot anormalities, and DM>

Cystinuria

AR, defect in aa transporter gene

Dubin-Johnson syndrome

AR, defective hepatic excretion of bilirubin glucuronides due to a mutation in the canlicular membrane transport protein. Develope episodes of Jaundice, illness, prego, OCP. Imparied excretion of direct (conjugated) hyperbilirubinemia- but liver function studies are normal. Liver appears black due to impaired excretation of epinephrine metabolites that accumulate within lysosomes.

Homocystinuria clinical findings? What should you treat them with

AR, optic lens dislocation, intellectual disability, marfanoid habitus, thromoembolic complications. Tx with B6 pyridoxine to improve residual enzymatic activity and reduces plasma homocystein levels. Treat with restriction of methionine.

ASD murmur

ASD does not have an audible murmur, thouse with an increased left to right shunt across the ASD may have a systolic ejection murmur from increased flow across the pulmonary valve.

In beta cells Glut 2, what substance binds directly to K+ channels to regulate their activitity?

ATP Oxidative metabolism of lucose in pancreatic beta cells generates ATP. ATP-induced closure of the ATP-sensitive K+ channel leads to membrane depolarization and subsequent insulin release.

Interatrial septum near the opening of the coronary sinus

AV node- located on the endocardial surface to ht art atrium, near the septal leaflet of the tricuspid valve and the price of the coronary sinus.

Mercaptopurine

Abdominal pain and jaundice may be seen. Mercaptopurine is an Sphase specific purine analogue that is associated with cholesterasis and hepatitis in a fair portion of pts.

Myotonic dystrophy

Abnormally slow relaxation of muscles is called myotonia. Such as a doorknob. second most common inherited muscle disorder. AD, abnormal trinucleotide expansion (CTG) of the gene that codes for myotonia-protein kinase. Myotonia (sustained muscle contraction) cataracts - frontal balding and gonadal atrophy o

Renal metabolism of which of the follwoing aa is most important for maximizing acid excretion?

Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in the urine and bicarbonate (buffers acid in the blood) that is absorbed in the blood. This process is responsible for the vast majority of renal acid excretion in chronic acidotic states.

Von Willebrand

Acts as a carrier molecule for factor 8. Menorrhagia can lead to frquent nosebleeds (epistaxis) as a child further suggests von Willebrand disease as the most likely etiology of her anemia. VWD- leading to defect in platelet binding, increase skin and mucosa site bleeding.

Auer rods

Acute Myelogenous leukemia (AML) blast cells- acute leukemia AML- 65 years pancytopenia

Pt presents with joint pains and recent holosystolic murmur

Acute Rheumatic fever- migratory arthritis, new oneset murmur, fever and postiive antistreptolysin O titer. JONES Joint pain (lower extremities first followed by upper extremities) O- heart (pancarditis : inflammation of the endocardium, myocardium, and epicardium). Inflammation of the mitral valve can lead to mirtal regurgitation, which is the likely cause of the new holosystolic murmur in this pt. Severe myocarditis can lead to cardiac dilation, HR and death in a small percentage of pts.

spongiosis (accumulaton of edema fluid in the intercellular spaces between keratinocytes and lymphocytic perivascular infiltrates.

Acute allergic contact dermatitis

Aspergillus

Acute branching

Bebesiosis

Acute febrile illness, thrombocytopenia, hemolytic anemia (indirect hyperbilirubinemia, elevated lactate dhydrogenase, low haptoglobin), abnormal liver function tests, and ccross-shaped intraerythrcytic inclusions. Tick bone illness in the NE states. Ixodems scapularis tick (lyme dz) Think blood smear Wright/giemsa: intraerythrocytic pleomorphic rings forms maltese cross Ixodes is also a vector for human granulocytic anaplasmosis.

What acid base physiology does heroin overdose have?

Acute respiratory acidosis. Hypoventilation causes an increase in arterial pCO2 and a decrease in the serum pH (respiratory acidosis). Acute respiratory acidosis presents with a low pH, a high pCO2 and a normal to mildly increased HCO3 because renal compensation requires at least 24 hours of persistent respiratory acidosis. Chronic respiatory acidosi is characterised by low normal pH, a high pCO2 and a high HCO3 > 30.

Patchy necrosis of tubular epithelium and loss of basement membrane

Acute tubular necrosis due to ischemia (prolonged hypotension), nephrotoxins (antibiotics), or pigment deposition (myoglobinuria) generally present with rising creatinine and muddy brown granular casts on urinalysis.

Pt presents with low-grade fever, anorexia/nausea, dark-colored urine and right upper quadrant abdominal tenderness is highly suggestive of?

Acute viral hepatits Hep A virus in endemic regions. Histo: hepatocyte necrosis and apoptosis and mononuclear infiltration. Hep necrosis is characterized by cellular swelling and cytoplasmic emptyming "balloongin degeneration" likely caued by ATP depletion and disruption of the intermediate filament network In severe cases, regions of adjacent lobules are interconnected by swath of dead hepatocytes called bridging necrosis. Hepatocyte apoptosis is characterized by cellular shrinkage and nuclear fragmentation with intense eosinophilia (councilman boides) is likely caused by mitochondrial oxidation damage. The presence of virually infected and dying hepatocytes promotes mononuclear inflmamation in the sinusoids and portal tracts.

Herpes simplex meningitis dx with PCR Tx

Acyclovir

A palpable but nontender gallbladder (courvoisier sign), wight loss and obstructive jaundice (associated with pruritus, dark urine and pale stoles) are indicative of

Adenocarcinoma at the head of the pancrease compressing the common bile duct. Cancers of the of the body and tail of the pancrease do not obstruct the common bile duct they do not produce symptoms until they invade the planchnic plexus and cause midepigastric abdominal pain.

Well-differentiated, dysplastic columnar cells that line the alveolar septa without vascular or stomal invasion. The tumor has a tendency to undergo aerogenous spread and can progress to invasive disease if not resected.

Adenocarcinoma in situ

Mu opioid SE

Admin of mu opioid analgesics, such as morphine, can cause contraction of smooth muscle cells in the sphincter of Oddi, leading to spasm and increase in common bile duct pressures. Although uncommon; pressure in the gallbladder can increase, potentially leading to biliary colic. Pts develop biliary colic will have severe pain and cramping in the right upper abdomen. UseNSAIDs (ketorolca, diclofenac instead) Can release histamine - leading to vasocilation of blood vessels and itching. Constipation by slowing bowel and slowing gut utility decrease parietal cell acid secretion.

Vector for Denge fever and chikungunya

Aedes

Transmigration:

After crawling the neutrophils migrate out the of vasculature by squeezing in between the cells via integrin attachemtns and adherence to platelet endothelial cell adhesion molecule 1 (PECAM-1). Protein found at hte peripheral intercellular junctions of endothelial cells.

Diabetic nephropathy

Albuminuria is the first manifestation of DN. Glomerular basement membrane thickening with resultant mesangial matrix expansion. GBM has negatively charged heparan suphate moieties that form a charge barrier preventing leakage of negatively charged proteins, like albumin into the Bowman's capsule. In DM, there there is progressive loss of this negative charge due to upregulation of heparanase expression by renal epithelial cells. Early admin of ACE inhbitors in pts with DM and albuminuria has been shown to reduce urinary albumin excretion and slow progression to over dn.

Alcohol and tobacco with ca risk

Alcohol increases risk of breast ca but not cervical ca. Tobacco increases risk of cervical ca

Common withdrawal syndromes: Alcohol Benzodiazepines Heroins Stimulants: Cocaine, amphetamines (opioids) Nicotine

Alcohol: Benzodiazepines: Tremors, anxiety, perceptual distrubance, psychosis, insomnia. Heroins: Nausea, vomiting, abdominal cramping, muscle aches- Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds. Stimulants: Cocaine, amphetamines: Increased appetitie, hypersomnia, intense psychomoto retardation, severe depression (crash) Nicotine: Dysphoria, irritability, anxiety, increased appetite.

Commonly used clinical disinfectants MOA Alcohols (isopropanol, ethanol) Chlorhexidine hydogen peroxide Iodine

Alcohols (isopropanol, ethanol): Disruption of cell membrane, denaturation of proteins (lipid stucture in membranes, causing them to to be leaky and denaturing cellular proteins)- No sporicidal, but they are bactericidial, tuberculocidal, fungicidal and virucidal but do not destroy bacterial spores. Chlorhexidine: Disruption of cell membrane, coagulation of cytoplasm- No sporicidal SE nephrotoxicity. hydogen peroxide: produces free radical that oxidie cellular components - YES sporicidal Iodine: Halogenation of protein and nucleic acids - YES sporicidal Formaldehyde and glutaraldehyde function by alkylating and cross-linking DNA and proteins. THey are most commonly used for sterilization of hospital instruments that cannont withstand autoclave temp.

Crohn's involves how many wall?

All three layers of the intestinal wall and noncaseating granulomas.

Friedriech ataxia

Also associated with DM

Fifth disease

Also know as parvovirus, als erythema infectiosum, reticular lacey slapped cheek rash that starts on your face and moves downward. Also, acute arthropahy- symmetric plyarthritis involves the proximal interphalangela, metacarpal, ness and ankle joints.

Cerebral cortex atrophy

Alzheimer: characterized by diffuse, mild cortical atrophy and progressive memory loss. and Pick dz: pronounced frontotemporal atrophy, illustrated by behavioral and emotional abnormalities.

Major side effects of Dihydropyridine ca channel blockers?

Amlodipine (safe in elderly), nifedipine (not safe in elderly can cause hypotension and precipitate myocardial ischemica)- headache, flushing, dizziness and peripheral edema.

How does Amlodipine differ from verapamil and amlodiine

Amlodipine is a dihydropyridine calcium channel blocer and is is sleective for vascular smooth muscle and does not affet the heart as verapmile does. Ca channel locers are particularly useful for pts with evidence of vasospasme such as Raynaud phenomenon and Prinzmetal angina.

Listeria menigitis (gram + rods with characteristic tumbing motility on light microscopy) Tx

Ampicillin

Alzheimer disease

Amyloid deposition can affect multiple organ systems, such as those involved in plasma cell tumors (amyloid light chain proteins) and chronic inflammatory diseases (amyloid-associated protein AA) Alzheimer disease0 these deposits contain beta-amyloid (AB),which is formed by cleavage of amyloid precursor protein (transmembrane glycoprotein), Early in the disease, neuritic (senile) plaques can be found in the medial temporal lob (hippocampus, amygdala, entorhinal cortex) and are composed of a central AB core surrounded by dystrophic neurites. AB deposition also occurs in the media/adventitia of cerbral vessels ( amyloid angiopathy) may cause vesll weaeknign and intracranial hemorrhage.

What antibotic do you use again anaerobic bacteria and parasites:

Anaerobic: clostidium difficile, Bacteroides) Parasites:Entamoeba histolytica, Giardia lamblia, Trichomonas vaginalis. Use Metronidazole

Polygenic inheritance

Andogenetic alopecia, pattern and severity of the baldness depends on both hormal and genetic factors and vary severity between males and females. Polygenic inheritance occurs when one characteristic is controlled by two or more genes. Often the genes are large in quantity but small in effect.

Difference between aneurysm and dissection

Aneurysm: is the media (muscular is broken down over time) - blogging out Dissection: damage to the intima layer - blood accumulates between the intima and media layer- sharp stabbing pain.

Malaria life cycle and drugs

Anopheles mosquiteo and then travel to the liver, where they infect hepatocytes and replicated. Lysis of infected hepatocytes releases merozoites into the the bloodstream. Merozoites go on the infect erythrocytes and t is the resultant erythrocyte lysis that causes relapsing fevers and sweating. P vivax and P ovale are unique in that they also establish a latent hepatic infection (exo-erythrocytic cycle) in the form of hypnoxoites, responsible for relapses. Chloroquine is effective in eradicating chloroquine-sensitive plsmodia from the blood stream, but it has no activity agains the latent hepatic infections estblished by P. vivax and P ovale. Primaquine must be added to regimen to completely eradicate the hypozoites. Chloroquine SE: Retinopathy is the most serious long-term SE. Primaquine has limited terapeutic activity again the erythrocytic forms of plasmodia, including trophozoites. Primaquine is not effective in treating chloroquine-resistant strains, which can be maganed with mefloquine and quinine. Primaquine is contraindicated in pts with glucose-6-phosphate dehydrogenase def as the medication can cause hemolysis.

Vector for malaria

Anophelese

Poliomyelitis

Anterior horns.

What is the origin of the anterior and posterior pituitary?

Anterior pituitary: out-pouchingof the pharyngeal roof called Rathke's pouch (diencephalon) Neoplasm in these pouches are called craniopharyngioma. (have 3 components: solid (actual tumor cells), cytsitc, and calcified) Posterior pituitary: extension of the hypothalamic neurons.

Leads V1-V3

Anteriorseptal region which is the LAD. `

What drug inhibits prober base pairing and hydrogen bond formation?

Anthracyclines daunorubicin and doxorubicin, intercalate between the bases, causing defective base pairing and splitting of the DNA strands. Transcription and replication failure and mutagenesis ultimately result.

Common medication to avoid in older adults (Beers criteria- Elderly) Anticholinergic: Cardiovascular: CNS: Endocrine: Pain:

Anticholinergic: First generation antihistamine, GI antispasmodics Cardiovascular: Antithrombotics (dipyridamole, ticlopindine), Alpha blockers, Central alpha blockers, Central alpha agonist, antiarrhythmics CNS: TCA, antipsychotcs, barbiturates, benzodiazepines Endocrine: Sliding cale insulin, sulfonylureas Pain: Indomethacin, muscle relaxants, meperidinepicm

Medications associated with osteoporotic fractures

Anticonvulsants that induce CYP450= phenobarbital, pnenytoin, carbamazepine (increase vitamin D catabolism) Aromatase inhibitors, medroxyprogesterone (decrease estrogen) GnRH agonist (decrease testosterone and estrogen) Proton pump inhibitors (decrease ca absorption) Glucocorticoids, unfractionated heparin, thiazolidinediones: (decrease bone formation)

Aromatase and gall stones

Aromatase catalyzes the conversion of androgens to estrong which increases hepatic cholesterol uptake. IN addition, estrogens upregulated HMG Co-A reductase, which increases cholesterol synthesis. This increases biliary excretion of cholesterol, favoring formation of cholesterol stones, no pigment stones.

Aromatase catalyzes the conversion of androgens to estrogens int he gonads and periperal tissues.

Aromatoase def presents with virilizaton of female infants, male pts are not affected henotypically.

What vitamins are absorbed in the distal small bowel

Ascorbic acid (Vitamin C) through active transport

In healthy ps, Gi bleeding can causes a rapid increase in BUN, howver in liver diz it is

Associated with decreased BUN because ammonia is not efficiently converted to urea.

Allergic bronchopulmonary aspergillosis

Asthma, CF and Bronchiectasis, high serum IgE levels, eosinophilia, an IgE plue IgG serum antibodies to Aspergillus.

What vascular beds carry the highest atherosclerotic burden with a type 2 DM, hyperlipidemia.

Atherosclerosis is a pathologic process involving the arterial walls and affects all major vascular beds including coronary, cerebral, and peripheral arteries. The lower abdominal aorta and coronary arteries develop the highest burden of atherosclerosis. Atherosclerotic lesions (intimal thickening, fatty streaks) occur in these vessels as early as the second decade of life.

A pt with DM, HTN, Smoker, and angina-like chest pain?

Atherosclerotic coronary artery disease. Would be treated with a beta blocker. Beta 1 blocker would decreases HR while beta-2 adrenergic blockade caues banchoconstriction and wheezing. Can cause increase bretathing in pts with asthma and COPD.

How are Sidenafil and ANP and BNP similar?

Atrial and BNP are poly hormones that exert their effect by binding ANP receptors. THese transmembrane receptors are linked to a guanylyl cyclase that converts GTP to cGMP. cGMP activates a downstream cGMP-dependent protein kinase, leading to relaxtion of vascular smooth muscle and subsequent vasodilation. NO (nitric oxide) activates the same cGMP second messenger system by binding a cytosoic guanylyl cyclase. Penile erection is initiated by release of acetylcholine and nitric oxide from parasympathetic fibers, leading to a rise in intracellular cGMP and vasodilation of arteries supplying the corpus cavernosum. Sildenafil is a phosphodiesterase -5 inhbitior that decreases degradation of cGMP, enhancing the effects of parasympathetic activation in erctile tissues. Becaue vasodilatory nitrates (nitroglycerin, isosorbide mononitrate) work by releasing NO, co administration of sildenafile with nitates can lead to excessive cGMP induces vasodilaation and severe hypotension.

Adenocarcinoma of the esophagus

Barrett's esophagus Gastroesphageal reflux dx Obesity Tobacco use Fat GERD

Behcet diease

Behçet's disease or Behçet disease (/bɛˈtʃɛt/), sometimes called Behçet's syndrome, Morbus Behçet, Behçet-Adamantiades syndrome,[1] or Silk Road disease, is a rare immune-mediated small-vessel systemic vasculitis[2] that often presents with mucous membrane ulceration and ocular problems. Behçet's disease (BD) was named in 1937 after the Turkish dermatologist Hulusi Behçet, who first described the triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems. This syndrome can be fatal due to ruptured vascular aneurysms or severe neurological complications.[3]

How do you treat panic disorders?

Benzodiazepines (immediate), SSRI or cognitive behavior therapy. Distinguish it from panic disorder by looking for episodic headaches, sweating, tachycardia and sustained or paroxysmal hypertension.

First line agents for anticonvulsants

Benzodiazepines/valporate

What node does Beta blockers act on

Beta blockers decrease AV nodal conduction, leading to an increased AV nodal refractory period. This correlates to the PR inteval prolongation on an ECG.

Glucagon is the antidote for?

Beta blockers overdose SE: depression of myocardial contractility, bradycardia, and varying degrees of AV block. Glucagon acts on Gs increasing release of intracellular ca during muscle contraction. THis increases HR and cardiac contractility (increase SA node firing)

Pts with coronary artery disease and heart failure along with hypertension will benefit from what drug?

Beta blockers.

Turns cardiac

Bicuspid aortic valve and coarctation of the aorta.

Brown Gallstones:

Biliary tract infections (E. Coli, liver fluke) lead to a release of microbial b-glucuornidases, increase unconjugated bilirubin, and calcium bilirubin precipitation (Gall bladder stones).

Amphotericin

Binds the ergosterol of fungal cell membranes to exert its antifungal effects. However, it also binds to cholesterol to some degree, causing toxicity to human tissues. The most important adverse effects of amphotericin are nephrotoxicty, hypokalemia and hypomagnesemia, anemia, thrombophleitis.

Kidney transplant

Blood supply is established by anastomosing the donor renal artery with the recipients's external iliac artery. The most distal portion may be susceptible to ischemia due to lack of anastomotic connections. The proximal ureter received its blood supply form the renal artery, whereas the distal ureter is supplied by the superior vesicle artery.

Medium to grown Bordet-Gengou

Bordeteela pertussis.

Middle cerebral artery

Broca aphasia (damageof the dominant frontal lobe), anosognosia and spatial neglect of the contraleteral side (nondominant parietal lob damage), conjugate gaze deviation toward the side of the stroke, and contralateal homonymous hemianopsia (due to damae f teh optic radiations in the subcortical temporoparietal lobe)

How do you tell the severity of MR murmurs?

By the left ventricular S3 gallop which refects an increased rate of left entricular filling due to a large volume of regurgitate flow re-entering the ventricle during mid diastole.

Burkitt lymphoma

C-MYC gene on chromosome 8, usually onto the Ig heavy chain region of chromosome 14.

Huntington

CAG repeats and abnormal HTT gene (chromosome 4p)

Most common renal neoplasm

CCC clear cell carcinoma homogenous sheeps or rows of cuboidal or low columnar cells with tranlucent centers on H and E stain.

What vascular tumor is associated with arsenic (exposure to pesticides), thorotrast (former radioactive contrast), and polyvinyl chloride (plastic widely used in industry). The tumor expresses CD 31:

CD 31 is an endothelial cell marker (is a PECAM1- platelet endothelial call adhesion molecule). PECAM1, a member of the immunoglobin family of proteins is expressed ont he surface of endothelial cells and functions in leukocytes migration throught he endothelium. Hepatic angiosarcoma: LIver angiosarcoma, is assoicated with carcinogen exposures.

Rituximab

CD20 glycoprotein on B cells (the monoclonal antibody rituximab) is used to treat various lymphomas and active RA.

PCP pneumocystis pneumonia

CD4 count less than 200 ground glass appearance bronchaveloar lavage silverstain Bactrim pentamadine

Non-caseating granuloma cytokines

CD4+, IL-2, and IFN-y, TH1

Loss of gag reflex

CN 9, 10

Loss of taste from the posterior 1/3 of the tongue

CN9

Chronic bronchitis

COPD- hyperplasia of mucus-secreting glands in bronchi -> Reid index (thickness of gland layer/total thickness of bronchial wall) >50% CO2 retention(hypercapnia) 2ndardy polycythemia

Snowstorm pattern

COmplete mole 46 xx or 46 XY Pre-eclampsia, hyperthyroidism, hyperemesis, and theca-lutein cysts may be present. Cells of the evacuated tissue have a 46, XX or 46, XY karyotype with only paternal DNA. (partial moles have both maternal and paternal)

CREST syndrome

Calcinosis, Raynauds, Esphophageal dysmotility, Sclerodactyly, telangiectasia chronic autoimmune inflammation, vascular endothelial injury resulting in chronic ischemic tissue damage (fingertip ulcers) and excessive activation of fibrolasts leading to progressive tissue fibrosis. Esophageal dysmotility is a rsedult of atrophy and fibrous replacement of the muscularis in the lower esophagus. The LES becomes atonic, dilated and GERD.

Bind dietary phosphate

Calcium acetate lower phosphate in pts with end-stage renal dz.

Polyhydramnios

Can be caused by two pathways: 1) Fetal gastrointestinal obstruction (esophageal, duodenal or intestinal atresia, anechephaly. WHICH leads to impaired fetal swallowing. 2) High fetal cardiac output (alloimmunization, parvovirus infection, fetomaternal hemorrhage). WHICH leads to increased fetal urination.

Schistocytes (helmet cells)

Can be formed from narrowing of the vascular spaces due to fibrin strand formation, as seen in DIC< HUS, TTP. Hemolytic anemai due to intravasuclar erthyrocyte destruction results in labs similary to other hemolytic anemias. - Increase in serum indirect bilirubin, hemoglobinemia, hemoglovinuria, increaed lactate dehydrogenase (LDH). Haptoglobin is a serum protein the bind to free hemoglobin and promotes its update by the reiculoendothelial system. Haptoglobin levels decrease when significant quantities of hemoglobin are released into the circulation. So labs will show decreaed Haptoglobin.

Esophagitis CD 100

Candida infection, odynophagia, below 4pH endocarditis: Tricupsid (heroin users) amphoterin, nystain, fluconasole, capsifungins

Why is the chloride content of erythrocytes much lower in arterial blood than in venous blood?

Carbonic anhydrase activity within erythrocytes forms bicarbonate from Co2 and water. Many of the bicarbonate ions diffuse out of the RBCs into the plasma. To maintain the electrical neutrality chloride ions diffuse into the RBC to take their place. This process is called "chloride shift" and it is the principal cause of high RBC chloride content in venous blood.

Pt has fatigue and shortness of breath, bilateral leg swelling an abdominal distention despite overall weight loss. Heart shows significant endocardial thickening with dense fibrous deposits around the tricuspid and pulmonary valves as well as moderate pulmonary valve stenosis. Left sided heart is fine.

Carcinoid syndrome Endocardial thickening and fibrosis of tricuspid and pulmonary valves- are characterisstic of carcinooid heart disea. It is a neuroendocrine tumor found most commonly in the distal small intestine and proximal colon, with a strong propensity for metastasis to the liver. These tumors secrete (histamine,serotonis, and vasoactive intestinal peptide) that are meabolized in the liver. IN pts with liver metastasis, these hormones are released directly into the systemic circulation, leading to carcinoid syndrome. Carcinoid heart disease is caused by excessive secretion of serotonin, which stimulates fibroblast growth and fibrogenesis. Pathognomonic plaque-like deposits of fibrous tissue occur most commonly on the endocardium, leading to tricuspid regurgitation, pulmonic valvuopathy, and right sided Heart failure (ascities, peripheral edema). Endocardial fibrosis and thickening are generally limited to the right heart heart as vascoactive products are inactivated distally bypulmonary vascular endothelial monoamine oxidase.

list of precursor proteins or peptides repsonsible for localized amyloidosis (confined to single specifc organ. Cardiac atria: Thyroid gland: Pancreatic islets: Cerebrum/cerebral blood vessels: Pituitary gland:

Cardiac atria: atrial natriuretic peptide (due to abnormally foled b-pleated sheet conformation) Thyroid gland: calcitonin (medullary carcinoma of the thyroid) Pancreatic islets: islet amyloid protien (amylin) (90% of DM Cerebrum/cerebral blood vessels: B-amyloid protein (4000 Dalton peptide found in the core of the cerebral plaques of Alzheimer dz) Pituitary gland: prolactin Immune globulin delta-light chains cause multi-organ amyloid deposition in primalry systemic amyloidosis. Primary systemic amyloidosis arises in assoication with monoclonoal B0cell proliferations (MM) and causes systmeic amyloid deposition involving the heart, as well as the skin, tongue, gi tract, kidney and peripheral nerves. Immunoglobulin light chiains of either the delta or the kappa vareiety (Bence joines proteins) may also be fournd int he serum and urine!

what can happen if a person falls on an outstretched hand due to dislocation of the lunate?

Carpal tunnel syndrome is caused by median nerve compression within the carpal tunnel.

Pneumococcal and H. influenzae meningitis tx:

Ceftriaxone

Gross painless hematuria in older adults

Cell cell ca, which arise formthe renal proximal tubulr cells. Rounded or plygonal cells with abundant celar sytoplasm are seen on light microscopy. Rounded plygonal cells with abundant clear cytoplasm. Standar tissue fixation and staining techniques typically dissovle glycogen and lipids from pathologic specimens, leaving clear spaces. Clear cells are genarlly those with high glycogen or lipid content that dissoves druign routin tissue preparation.

TB

Cell-mediated Primary TB causes the formation of Ghon foci in the lower lungs. Hilar lymph nodes forma a Ghon complex Later in life (immunosuppresion) bacteria can be reactivated and establish infection in the upper lungs (apexes)

Trypansoma cruzi

Chagas dz (American trypanosomiasis) Leads to cardiomyopathy, achalasia, megacolon and megaureter.

Ebstein's anomaly

Characterized by displacement of the malformed tricuspid valve in the right ventricle. Soon after birth it presentes with cyanosis and heart failure from severe tricuspid reg.

Charcot-Bouchard aneurysms vs saccular (berry) aneurysm

Charcot-Bouchard effects deep brain stuctures and present with acute neurologic deficits. EG: contralaterally weakness/numbneess and externsor plantar response is consistent with thalamic hemorrhage with edema/mass effect on the internal capsule. Main difference is: Charcot-Bouchard: deep intraparenchymal hemorrhage is most most commonly caused by hypertensive vasculopathy of the small penetrating branches of the cerebral arteries. Saccular aneurysmas: casue of subarachnoid hemorrhage.

Demyelination of peripheral nerves

Charcot-Marie Tooth dz is an AD disorder associated with demyelination of peripheral nerves. Typical findings include distal leg weakness/atrophy and sensory deficits, pes cavus and kyphoscoliosis.

Low potency antipsychotics: SE:

Cheating Thieves are low Chlorpromazine, Thioridazine. SE: Sedation (histaminergic blockade). Anticholinergic side effects (cholinergic blockade): Constipation, dry mouth and urinary hesitance, blurred vision and impaired cognitive function Orthostatic hypotension (alpha-1 adrenergic blockade): Dizziness and orthostatic hypotension.

Arnold-Chiari malformation

Chiari 2 malformation, is characterized by downward displacemnt of the cerebellar vermis and tonisls below the foramen magnum. Pts have spinal myelomeningocele (lumbarsacral meningomyelocele.

Gall stones

Cholesterol stones are yellow to pale gray and hard. Pigment stones are composed of calcium salts of unconjugated bilirubin and are soft and dark brown to black. Brown- E. Coli or heminthic (Ascaris lumbricoides, Clonorchis sinensis) infection of the biliary tract which results in the release of beta-glucuronidase by injured hepatocytes and bacteria. beta-glucuonidase hydrolyzes bilirbuin glucuronides and increases the amount of unconjugated bilirubin. The liver fluck C sinensis is a common cause of pigmented stones. Common in Asian populations. Pigmented stones may also be seen in chronic hemolytic anemia. These pts excreete large amounts of conjugated bilirubin into the bile, which is then deconjugated by beta-glucuronidase in the biliary tract.

Progressive mucosal atrophy

Chronic gastritis is most commonly associated with H. Pyloir ifection. Long-standing inflammation of the gastrtic mucosa can lead to diffuse gland atrophy and intestinal metaplasia. Chronic gastric inflammation increases the risk of gastic carcinomas.

Black Gallstones:

Chronic hemolysis: sickling cell anemia, b-thalassemia, herditary spherocytosis, increased enterohepatic cycling of bilirubin (ileal disease).

Vaculitis linked to asthma

Churg-Strauss syndrome, vascular lesion in this syndrome may be histologically similar to those of PAN but occur in smaller vessels. They have granulomas and eosinophilic necrosis Abdominal pain

gynecomastia with prolonged PTT

Cirrhoiss, in setting of alcohol abuse

Intermittent muscle pain reproducily caused y exercise and relieved by a brief period of rest defines:

Claudication. Is almost always a result of atherosclerosis of larger, named arteries. The ostruction of lood flow in these arteries is the result of fixed stenotic lesions projected by atheromas, which are lipid-filed intimal plaques that bulge into the arterial lumen. The stenoses prevent sufficient increases in blood flow to exercising muscles, resulting in ischemic muscle pain.

The liver synthesis clotting factors. What clotting factor has the shortest half life?

Clotting factors 2, 7, 9 and 10 are produced y te liver in an inactive form then activated y vi K dependent carboxylation. Factor 7 has the shortest half life. Prothrombin time is the first to become abnormal in liver disease.

Cardiac abnormality associated with Turners

Coarctation of the aorta

What drug do you use in acute gout with peptic ulcers?

Colchine (inhibition of microtubule formation) or NSAID (cox inhibitor) if no peptic ulcers.. CHRONIC gout: Glucocorticosteroids (inhibit phospholipase A2) or allopurinol (inhibits xanthine oxidase)

Paraoxysmal nocturnal hemoglobinuria

Complement-mediated intravascular hemolysis can result from autoantibodies (autoimmune hemolytic anemai) or from direct completment activation.

Weber syndrome

Complete ptosis from central lesions may result from injury to the oculomotor nerve fibers within the upper midbrain and is typically associated with contralateral hemiparesis due to adjacent corticospinal tract involvement. Weber's syndrome (superior alternating hemiplegia) is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. Not related so studge weber syndromes

VACTERL

Congenital anomalies: Vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal atresia, renal anomalies, and limb anomalies.

Primary hyperaldosteronism,

Conn's syndrome- an adrenal adenoma or bilateral adrenal hyperplasia causes excessive and unchecked aldosterone production that leads to feedback inhibition of renin secretion. Primary hyperaldosteronism can be excluded in this pts due to increased plasma renin activity.

What is the major cause of death for pts with DM?

Coronary heart disease.

5p deletion

Cri-du chat syndrome hypertonia, failure to thrive. microcephaly, low-set ears, hypertelorism (increased distance between eyes), broad nasal bridge.

Budding yeast with thick capsules

Cryptococcus neoformans, present in soil and prigeon droppings, it is transmitted by respiratory route but not acquired via person-to-person contact. Inhaled yeast forms enter the lungs, and are cleared by macrophages and T cells (in healthy people) In immunocompromised causes symptomatic dz, meningoencephalitis. India ink, serologic testing (latex agglutination) is used to detect the C. neoformans capsular antigen in the CSF, bronchopulmonary washing and lung tissue (red yeast on mucicarmine stain).

Promoting G1/S progression

Cyclin D is a protein that is synthesized during the G1 phase of the cell cycle and helps promote the G1/S phase transition. Increased expression of cyclin D can result in unchecked cellular proliferation.

Medium to grow Corynebacteria diphtheriae

Cysteine-tellurite agar- balck in color. Porduces intracellular polyphosphate granules, called metachromatic granules, that can be detected on microscop0y after methylene blue staining.

Typical antipsychotic drugs inhibit what?

D1, D2 receptors and also serotonergic and alpha adrenerigc pathways

Metabolic nerve damage

DM- hight gluose results in the formation of flycosylation productes (hemoglobin A1c) and accumulation of sorbital within the nerves.

DM2 have two mechanisms: What does increased waist circumference mean?

DM2 have two mechanisms: defective insulin secretion from pancreatic beta cells and insulin resistance in peripheral tissues. What does increased waist circumference mean? visceral obesity as measured by waist circumference or waist to hip ratio is an important predictor of insulin resistance. Dyslipidemia seen with insulin resistance is characterized by high triglyceride and low HDL levels. LDL levels do not increase with insulin resistance.

Drugs for RA

DMARDs (disease modifying antirheumatic drugs), methotrexate, sulfasalazine, hydroxychloroquine, minocycline and TNF alpha inhibitor.

BRCA-1, BRCA-2

DNA repair enzymes are associated with breast cancer, ovarian ca, lynch syndrome, seroderma pigmentosum, Fanconi anemia and many other dzs.

organophosphate poisioning mnemonic: Treatment:

DUMBELS D: diarrhea U: urination M: mitosis B: Bronchospasm E: Emesis L: Lacrimation S: Salivation Tx: Atropine and pralidoxime. Organophosphates stimulate both muscarinic and nicotinic cholinergic receptors. Atropine reverse muscarinic effects but does not prevetn the develoment of nicotinic effects such as muscle paralysis. Prlidoxime is the only medication that reverses both muscarinic and nicotinic effects of organophosphates by restoring cholinesterase from its bone with these substances.

Unfractioned and low molecular weight heparin

DVT prophylaxis in pts undergoing elective surgery of hip and knee. Heparin (a negatively charged chemical naturally present in mast cells) increases the effects of the naturally occurring anticoagulant antithrombin 3 (AT3) Unfractioned heparin: makes a conformational change of AT3, which subsequently inhibits factor 10a and neutralizes thrombin, promoting anticoagulation. LMWH which is better bioavailability and doe not need lab monitoroing when give therapeutically, acts predominantly on factor 10a, not thrombin.

Direct thrombin inhibitors

Dabigatran prevent the formation of thrombin facter 2a. increase PTT, PT, and TT

Neurosyphilis (tabes dorsalis)

Damage to the dorsal columns and dorsal roots of the spinal cord are characterisitic of tabes dorsalis. Loss of position and vibration sensation, ataxia, pain and paresthesia.

A women with Pulmonary hypertension from systemic sclerosis is a result of?

Damage to the pulmonary arterioles. It manifests with an accentuated pulmonary component of the second heart sound which means elevated pulmonary artery pressure, which is signs of right-sided heart failure due to cor pulmonale. Sclerodactyly (skin thickening and tightening over the fingers due to collagen deposition) CREST : Systemic sclerosis: Collagen deposition is thought to be triggered by increased proliferation and accumulation of monoclonal T cells in the affected tissues that secrete a variety of cytokines (TGF-B) which increase production of collagen and extracellular matrix proteins by fibroblasts. All tissues can be affected, but the earliest damage is seen in small arterioles and capillaries. Microvascular injury of pumonary arterioles lead to narrowing for the lumen and increased pressure in pulmonary circulation. It leads to hypertrophy of the right ventricle with subsequent development of right sided congestive heart failure.

Decerebrate posture Decorticate

Decerebrate posture the lesion is between the red nucleus and flexors. so the Extensors predominate. Decorticate posture: the lesions is between the cerebral cortex and the red nucleus so the Flexors predominate upper limb Damage tot eh brainstem at below the level of the red nucleus (midbrain tegmentum, pons) typically results i decreebrate (extensor) posturing. This due to the loss of descending excitation to the upper limb flexors via the ( rubrospinal tract) and predominance of the extensors (controlled by the vestibulospinalspinal tract. Extensors : vestibulospinal tract dominates decerebrate Flexors: Rubrospinal tract dominates decorticate.

Thrombotic thrombocytopenic purpura

Decrease ADAMTS13 activity leading to large vWF multimers and resulting in diffuse microvascular platelet-rich thrombi. PENTAD of fever, neurologic symptoms, kideny disease, MAHA (microangiopathic hemolytic anemia), thrombocytopenia. -Hemolytic anemia (increase LDH, decreased haptoglobin) with schistocytes. -Thrombocytopenia (increase bleeding time, normal PT/PTT) Can be with: Renal failure, neurologic manifestations, fever. Plasma exchange.

Describe the independent effects of simvastatin and cholestyramine, on hepatic cholesterol synthesis.

Decrease and Increase Statins: are first line therapy for most pts with hypercholesteerolemia, these drugs competitively inhbiti HMG CoA reductase, the enzyme responseible for the conversion of HMG CoA to mevalonate (the rate limitin step in hepatic cholesterol synthesis. This inhbition decreases hepatic choleserol synthesis the resulting upregulation of LDL receptors causes increased uptake of LDL from the circulation. Statins are very effective in reducing LDL cholesterol. Statins' effect on triglyceride and HDL levels are comparatively modest. ] Bile acid-bindingresins- work by binding bile acids in the gastrointestinal tract. Thereby interfering with the enterohepatic circulation of bile acids and causing increased bile acid exretion. THis resultins in hepatic synthesis f new bile acids, that conumes liver cholesterol stores. Hepatic uptake of LDL from the circulation is increased for continued bile acid sythesis. Bile acid production and secretion are increased by 10 fold due tthis interruption of the enteroheptaic ciruction of bile acids. Hepatic cholesterol reduction is an activating factor for HMG CoA reductase and subsequently resutls in increased hepatic cholesterol sythesis. This effect can be blocked with the addition of a statin drug to the treatment regimen,leading to a greater recuction of LDL levels than with use of either drug alone (synergistic action).

Squamous cell ca

Decreased activity of tumor suppressor p53 (molecular policeman)- controls cell division and apoptosis

Most common cause of Phenylketonuria is? If a pt has combined Phenylketonuria and increased prolactin then what def do they have?

Deficiency of phenylalanine hydroxylase Dihydrobiopterin reductase

Age related macular degeneration

Degeneration of macula (central area of retina) causes distortion (metamorphopisa) and eventually loss of central vision (scotomas) Dry ARMD: nonexudative- depostion of yellowish extracellular material in and beneath bruch membrane and retinal pigment epithelium "drusen" with gradual decrease in visiono. Prevent progression with multivit and antioxidant supplements. We- rapid loss of vision due to bleeding 2 to choroidal neovascularization. Tx with anti VEGF vascular endothelial growth factor) injections (Ranibizumab, and bevacizumab).

Dissociative disorders

Deperosnalization/derealization disorder: recurrent episodes of feeling detached from one's body and feelings of unreality. (intact reality testing) Dissociative identity disorder: Marked discontinuity in identity and loss of peronal agency with fragmention into 2> distinct personality states.

histologically microabscesses containing firin and neutrophils at the dermal papillae tips. THe overlying asal cells becoame vauolated and blisters form at the tips of the involved papillae

Dermatitis herpetiformis

Toxic Shock syndrome

Desquamation, particularly on the palms and soles, occurs 1-2 weeks after the onset of illness. Associated with nasal packing and tampons. Neutrophilia is common. Superantigens interact with major histocompatibility complex molecules on antigen-presenting cells and the varable region of the T lymphocyte receptor to cause nonspecific widespread activation of T cells. This results in the release of IL2 from T cells and IL1 and TNF from macrophages

Urge incontinene

Detrusor overactivity- smooth muscle lining the bladder wall that contract to release urine from the bladder. Detrusor overactivity results in urge incontinence. impairment of detrusor contractions from a sacral lesion or autonomic neuropathies will result in overflow incontinence.

Overflow incontinence

Diabetic autonomic neuropathy is common in type 1 diabetics, due to inability to sense a full bladder and incomplete emptying. Postvoid residual PVR testing with ultrasound or catheterization can confim inadequate bladder emptying.

Status epilepticus

Diazepam

Vitamin A deficiency can be caused by?

Diet, pancreatic insufficiency (chronic pancreatitis, CF), cholestatic liver dz, viliary obstruction, intestinal malabsorp. Primary biliary cirrhosis PBC - a common autoimmune dz characterized by destruction of smale bile ducts in the liver, important for the absorption of fats, ADEK, with generalized pruritus due to mild hyperbilirubinemia.

Alcholic with abdominal pain, chronic diarrhea, recent weight loss. Upright abdominal X-ray reveals calcifications in the epigastric area.

Digestive enzyme def Chronic Alcoholic pancreatitis The epigastric calcifcation and hx of alcohol use makes chronic alcoholic pancreatitis the most likely dx. Alcoho0induced secretion of protein-rich fluid. These proteinaceous secretions can precipitate within the pancreatic ducts, forming ductal plugs that may calcify and be detectable on Abdominal imaging. This causes exocrine insufficiency due to atropy of the pancreatic acinar cells and pancreatic fibrosis. Weight loss and bulky , frothy stools are typical clinical findings.

MR

Dilatation of left ventricle in response to increased preload can result in functional mitral regurgitation, which can be eliminated by preload reduction and reduced by afterload reduction

What kind of myopathy would be caused with nutritional def?

Dilated cardiomyopathy particular when there is thiamine def (wet beriberi heart disease) or chronic anemia.

What organisms use Transformation

Direct uptake of naked DNA from the environment by bacteria that are naturally competent. Strep pneumoniae H. influenzae Neisseria

Left-sided lesions of the Frontal lobe Right-sided lesions of the Frontal lobe

Dominant-have association with apathy and depression. Broca's area or the Broca area /broʊˈkɑː/ or /ˈbroʊkə/ is a region in the frontal lobe of the dominant hemisphere (usually the left) of the hominid brain[1] with functions linked to speech production. Nondominant-have dis-inhibited behavior. Personality changes, neuropsychological testing and structural brain imaging. Frontal lobe- executive function and personality.

Caberogoline and bromocriptine are:

Dopamine agonist.

Bleomycin

Dry cough and exertional dyspnea - progressive pulmonary fibrosis lead to death in minority of pts.

Bones are formed by 2 different processes:

Due defect in bone matrix formation Endochondral ossification: long bones, Mesenchymal cells differentiate into chondroblasts, with secrete cartilage matrix, ultimately forming a cartilage template. This cartilage then becomes calcified and later invaded by osteobalsts, osteoclasts, and blood vessels originating from the periosteum This results in the deposition of osteoid matrix over the septa of calcified cartilage matrix (woven bone), which then undergoes remodeling into compact bone. In intramembranous ossification, mesenchymal cells differentiate directly into osteoblasts and begin osteoid matrix secretion without the formation of cartilaginous bones.

how is glycogen broken down during muscle contraction?

During muscle contraction, glycogen is broken down via glycogen phosphorylase for energy production by the glycolytic pathway. Epinephrine causes cAMP mediated phosphorylation of glycogen phosphorylase, which activates this enzyme. Non-phosphorylation-dependent activation of glycogen phosphorylase can occur during muscle contration via increased intracellular ca concentrations and via AMP under exteme conditions.

Three weeks after wound- actin-containing fibroblasts and increaed metalloproteinase activity are detected at the site of injury?

During wound healing, excessive matrix metalloproteinase activity and myofibroblast accumulation in the wound margins can result in contracture. Contracture produce deformities of the the wound and surrounding tissues, most often on the palms, soles, anterior thorax, or at serious burn sites. Secreted by (fibroblast, macrophages, neutrophils, synovial cells, some epithelial cells), matrix metalloproteinase primarily function in the degradation of collage and tother proteins in the extracellular matrix. MMP activity is important in wound heading, as in encourages both myofibroblast accumulation at the wound edges and scar tissue remodeling. The amassed myofibroblasts initiate wound contraction during healing by second intention. Contracture may occur when unusually pronounced MMP activity results in excessive wound contractions.

Skin tumor cells producing keratin pearls is an example of what process?

Dysplasia (disorganized growth). That fact that they produce keratin means that the tumor cells are well differentiated.

Common serum tumor markers: Alpha fetoprotein CA 19-9 CA 125 Carcinoembryonic antigen Human chorionic gonadotropin PSA Elevated 5-hydroxyindoleacetic acid

Elevated 5-hydroxyindoleacetic acid: is a major breakdown product of serotonin. Elevated urine levels are seen in carcinoid tumors and certain neuroendocrine tumors. CA 125 : ovarian and also endometrial or endometriosis. CA-19-9: pancreatic ca or tumors int he biliary tract CEA: colorectal ca d

What kind of uptake is cholesterol by cells

Endocytosis, occurs by menas of receptor =mediated endocytosis (mediated by the LDL receptor).

Shiga-like toxin of E coli 0157: H7 go after what cells

Endothelial cells theat form the innermost lining of blood vessels. It can cause toxicity to renal endothelial cells, leading to renal insufficiency and uremia.

During the Tight adhesion and crawling what do the neutrophils become firmly attached to:

Endothelium via the binding of CD 18 beta 2 integrins (Mac-1 and LFA-1) to intercellular adhesion molecule -1 ICAM-1) on endothelial cells.

HIV fusion inhibitor

Enfuvirtide, inhibits HIV fusion with target cell membrane by bindnig t HIV gp41.

Epitheloid transformation of monocytes

Epitheloid transformation of macrophages can occur in a chronic ganuloma caused by infection with fungi or M. tuberculosis. This process occurs after the cellular mediated adaptive immune response begins. WHen Th1 activates macrophages consume a relatively indigestible agent (such as M. tub) they los their motility, accumulate at the site of injury, and transorm into epithelioid cells, with the nuclei arranged in an arc along the periphery. These Langhans giant cells are characteristic of granulomatous conditions.

Enveloped double stranded DNA virus

Epstein barr

What can allow fructose to be metabolized with Essential fructosuria?

Essential fructosuria is caused by fructokinase def. Some of the dietary fructose load is converted to hexokinase to fructose-6-phosphate, which can then enter glycolysis, this pathway is not significant in normal individuals.

Chronic myeloproliferative disorders that use the JAK2 STAT tyrosine kinase pathway

Essential thrombocytosis, polycythemia vera, primary myelofibrosis Characterized by the overproduction of myeloid cells. Cytoplasmic tyrosine kinase.

Ringed sideroblasts

Excess iron in mitochondria = pathologic Vit B6 def.

Celiac disease

Extraintestinal: -short stature and weight loss, iron def anemia, dermatitis herpetiformis. DX: increase tissue transglutaminase IgA, increase antiendomysial antibodies, duodenal bx showing increase in intraepithelial lymphocytes and flattened villi. The duodenum and jejunum are exposed to the highest concentration of gliadin and bx of these areas is required for the diagnonsis. Screening shows elevated level of IgA against tissue transfluatminase. Duodenal bx is confirmatory, showing villus flattening and intraepithelial lymphocyte infiltration.

Hypertrophic cardiomyopathy histo

Extreme myofiber disarray with interstitial fibrosis on cardiac histology strongly suggest hypertrophic cardiomyopathy (HCM). mutations in genes encoding cardiac sarcomere proteins (most commonly beta-myosin heavy chain). AD with variable expression.

Choroidal nevus

Eye freckle is a nonhereditary, usually benign pigmented area underneath the retina.

Fever versus heat stroke in children

FEVER: Circulating cytokines (infection) Elevated hypothalamic set point Febrile seizures are benign Acetaminophen or ibu for comfort - which decrease levels of prostaglandin E2. HEAT STOKE: Heat productoin exceeds heat dissipation (environmental, exposure, exertion) Normal hypothalamic set point Can cause permanent end-organ damage (oxidative phosphorylation ceases and ATP becomes rapidly depleted) Rapid external cooling.

Hypovolemia effect on FF

FF=GFR/RPF The decline in ciruclating blood volume is sensed by arterial and cardiac baroreceptors and triggers increased systemic arteriolar vasoconstriction. Renal vasoconstriction further lowers the RPF which is already decreased due to the decline in circulating blood voume. Decreased RPF causes glomerular perfusion pressure to drop, lowering the GFR and reducing distal tubule sodium delivery. This stimulates secretion of renin and increased angiotensin 2 production. Angioensin 2 preferentially constricts the efferent glomerular arteriole, which increase hydrostatic pressure in the glomerular capillaries and attempts to maintain the GFR (autoregulation). Due to this compensatory mechanism, the decrease in GFR is less pronounced than the decrease in RPF, resulting in an increased FF.

Hemophillia B (Christmas disease )

Factor 9 in hemophillia A and B PTT is long but PT and TT are normal TT measures the rate of conversion of fibrinogen to fibrin. It is prolonged in pts with deficient or defective fibrinogen, which can be congenital or acquired. The most common cause of acquried dysfibrinogenmia is liver dz.

Hep E and A are transmitted

Fecal orally

The PDA (posterior descending artery)

Feeds the AV nodal artery. In Right dominant people, the majority, the PDA comes from the Right coronary artery. In Left dominate people the PDA comes from the Left circumflex artery.

Flexion of the leg:

Femoral nerve: Psoas, iliacus, and sartorius,.

Tobacco causes what in terms of fetal development

Fetal growh restriction FGR and palcental insufficiency, decreased estriol levels.

maternal DM caues what in terms of fetal development?

Fetal heart defect

Pt with hyperinflated lungs, airway mucus plugging and cellular infiltration of the bronchial wall. Could have been prevented on a cellular level with that long-term asthma medication.

Fluticasone, is a corticosteriod that has the strongest amd nost predictable effects on the inflammatory component of asthma. INhaled corticosteroids from the cournerstone of chronic tx for pts with persitsent asthma and can reduce the number of severity of actue asthma exacerbations.

What is the function of thyroid peroxidase?

Following oxidation, idodine binds to tyrosine residues in thyroglobulin to form MIT and DIT (monoiodotyrosine and diiodotyrosine). 2 DIT = T4 throxine. 1 DIT + 1 MIT = T3 triiodothyronine. The thyroid follicular cells then engulf the thyroglobulin, this is now digested within lysosomes, releasing T3 and T4 into the circulation. ONly some amounts of DIT and MIT are secreted because iodotyrosine deiodinase removes the iodine groups from MIT and DIT for recycling. THYROID PEROXIDASE is a multifunctional enzyme responsible for catalyszing the oxidation of iodie, the iodination of thyroglobin, and the coupling rxn between 2 iodized tyrosine residues. Antibodies again thryoid peroxidase are present ino more than 90% of pts with autoimmune Hashimoto's thyroiditis.

Granulomas

Foreign bodies (retained sutures) can elicit a granulomatous response, seen clinically as tender erythematous brown or purple papule, nodule or plaque. Epithelioid appearance. They are often surrounded by a rim of lymphocytes that synthesize cytokines responsible for continued macrophage activation. Multinucleated giant cells, derived from fusion of several macrophages, can also be found in granulomas.

what drug do you use with a ganciclovir-resistant CMV infection?

Foscarent is an analog of pyrophosphate that can chelate calcium and promote nephrotoxic renal magnesium wasting. SE: hypocalcemia,hypomagnesemia and can cause seizures. Foscarnet can chelate calcium

Anticipation dzs?

Fragile X syndrome, myotonic dystrophy, Friedreich ataxia. AD

Intrafusal muscle fibers

GTO are in series, Intrafusal muscle fibers are in parallel with extrafusal fibers. They are innervated by group 1a and group 2 sensory axons and are sensistive to changes in muscle length. Muscle spindles mediate the stretch reflex (myotatic reflex), which is tested in deep tendon reflexes. When a muscle is stretched, there is monosynaptic reflex activation of the alpha (a) motor neuron, causing contraction that resists the stretch.

What can tx painful diabetic neuropathy and cause dedation, confusion, incoordination

Gabapentin

Decrease cellular dehydration for sickle cell pts?

Gardos channel blockers: The calcium-dependent (Gardos) potassium channel regulates the transport of potassium and water through the RBC membrane- when blocked, potassium and water efflux is reduced, reduced, preventing dehydration of erythrocytes and reducing the polymerization of Hb S.

Hyperemic mucosa seen during gastrointestinal endoscopy reveals hyperplasia of branched, tubular submucosal glands containing alkaline secretions. Which of the following areas is the most likely site of bx in this pts?

Gastric acid is neutralized by bicarb from the submucosal glands of the duodenum (Brunner glands) and from the pancreatic duct secretions. Chronic overproduction of gastric acid can lead to hyperplasia of the submucosal glands. First part of the duodenum. Tactile stimulation of the duodenal mucosa and increased parasympatheic activity following meals induce bicarbonate secretion from the submucosal glands. IN addition, the presence of acid in the duodenum and jejunum causes release of secretin from mucosa, stimulating secretion of bicarb from the submucosal glands and pancreas. Excess gastric acid secretion, such as seen in H. pyloir infection, can cause increased production of secretin, over time and lead to hyperplasia of the submucosal glands.

Genes and resistance

Genes encorind these enzymes are often located on plasmids and therefore can be transferred bwteen organisms an between different species through conjugation. Some have been incorporated into bacterial chromosomes. Carbapenem is usually the choice antibiotics.

Presents with jaw pain, and arterial bx shows multinuclear giant cells and internal elastic membrane fragmentation.

Giant cell arteritis is characterized by granulomatous inflammatin of the media, with fragmentation of the internal elastic lamina and medium and small ranches o the carotid artery. Irreversible blindness is a severe complication of GCA. Systemic: fever, fatigue, malaise, weight loss Headache Jaw claudication Visual disturbances (ischemic optic neuropathy) Polymyalgia rheumatica Dx: Elevated erythrocyte sedimentation rate and C-reactive protein. Temporal artery bx, intimal thickening, elastic lamina fragmentation and multinucleated giant cells. Tx glucocorticoids. Other optic complications; amaurosis fagax, central or ranch retinal artery occlusion and cerebral infarction leading to central visual field defects.

Glucagon is adminstered during a hypoglycemic attach (DM). What is it's MOA?

Glucagon stimualtes G protein-coupled receptors on hepatocytes, increasing intracellular cAMP concentration and activating protein kinase A. This increases serum gluose by increasing hepatic glycogenolysis and gluconeogenesis. Glucagon also stimulates insulin secretion from the pancreas. Unlike EP, glucagon has an insignificant effect on glucose homeostatsis in the skeletal muscle, adipose tissue, and renal cortex.

Genes upregulated by Thiazolidinedione (pioglitazone)

Glucose transporter-4 (GLUT4): an insulin responsive transmembrane glucose transporter expressed in adipocytes and skeletal myocytes that increases glucose uptake by target cells. Adiponectin: Cytokind decreted by fat tissue that increases the number of insulin-responsive adipocytes and stimulates fatty acid oxidation.

What is the reason for the lack of long-lasting immunity against the Neisseria gonorrhoeae bacteria despite antibody formation?

Gonococcal pili are protein polymers, the gonococci use their pili to mediate adherence to the mucosal epithelium. Through antigenic variation, each gonococcus can modify the pilus protein expressed, thereby avoiding host defenses (to some degree) making vaccination directed against the pilus protein difficult.

STD urethritis

Gonorrhea, chlamydia and Ureaplasma ureatlyticum.

What bacteria would survive in hypotonic solution?

Gram postiive organisms have a cytoplasmic membrane composed of a phospholipid bilayer as well as peptidoglycan cell wall provides the shape of the bacterium as well as resistance to osmotic stress. So if a gram + bacteria disintegrates in a hypotonic solution they must be exposed to an antibiotic that target's their cell wall. Penicillin, Vanco and cephalosporin disrupt the cell wall.

Candida vaginitis

Gram-positive lactobaccilli comprise a major part of the normal vaginal flora and exist in balance with other colonizers at a normal vaginal pH of 3.8-4.5. Antibiotic use is the most commmon cause of Candida vaginitis due to reduction of the lactobacilli population.

Antineutrophil cytoplasmic antibodies-associated vasculitides

Granulomatosis with polyangiitis, microscopic polyangiitis). Glomerular crecent formation with absent immunoglobin or complement depositis. Renal failure, pulmonary (cough, hemoptysis) and upper respiratory symptoms (mucosal ulceration, chronic sinusitis) are common due to underlying vasculitis.

Call-Exner bodies (coffee bean) cells arrange in a microfollicular pattern around a pink, eosinophilic center

Granulosa cell tumore increased estrogen (endometrial hyperplasia, precocious puberty) increased inhibin. post menopausal sex cord tumors Gross path because Yellow theca cells with lipid. Theca cells are plump with lipid contents which give the mass a yellow color on gross inspection.

Pharynx to lymph to meninges?

H. influenzae

Hereditary hemochromatosis

HFE protein interacts with the transferrin receptor on the cell surface to faciliatate endocytosis of the iron-transferrin complex. Mutation of HFE protein leads to educed iron uptake and causes enterocytes and hepatocytes to sense falsely low iron levels this increses 1) Enterocytes increase apical expression of divalent metal transporter 1 (DMT1), increasing intestinal iron absorption from the lumen. 2) Hepatocytes decrease hepcidin synthesis, which increases ferroportin expression on the basolateral surface of enterocytes and promotes iron secretion into circulation. Hereditary hemochromatosis is most commonly caused by a missense mutation in the HFE gene, resulting in excessive intestinal iron absorption and organ damage (cirrhosis, DM, cardiomyopathy, arthropathy) due to iron accumulation within parenchymal tissues.

Statin

HMG-CoA reductase inhibitors (statins) include muscle and liver toxictiy. Hepatic transaminase should be checked prior to initiating theratpy and reposted if symptoms of hepatic injury occur.

INSURANCE: Health maintenance organization (HMO): Medicaid: Medicare: Point-of-service: Preferred provider organization:

HMO: is an insurance plan with low monthly premiums, low copayments and deductibles, and low total cost for the patient. HMOs reduce utilization by confining pts to a limited panel of providers, requiring referral from a primary care provider prior to specilaist consultation and denying payment for services that do not meet established guidelines. Medicaid: a joint federal and state program to cover low-income pts. Medicare: federal health insurance program for pts who are >65, disabled or have end-stage renal disease. Point of service: plans are similar to HMOs in that they require pts to have a primary care provider and obtain referrals for speciality consultations. However, unlike an HMO, pts can see out of netwwork providers. POS plans typically have higher premiums than HMOs and significiant cost of pts choose to see out of network specialists. Preferred provider organization plans usually offer the most flexible choices for both in-network and out of network providers. However, PPOs typically have higher premiums and deductibles than MHO plans.

HIV male with hard mass in rectal area

HPV types 16 and 18 are strongly associated with anal and cervical squamous cell ca. HIV infection increases the prevalence of HPV infection and the risk of anal carcinoma, especially in men who have sex with men.

Tartrate resistant acid phophatase

Hairy cell leukemia stains positively for tartrate resistant acid phosphatase (TRAP). The neoplastic cells are B lymphocyte precursors are and are CD20. airily cell leukemia presents with splenomegaly, fatigue and pancytopenia.

Contact precautions with: MRSA, VRE, clostridium difficile, scabies?

Hand hygiene, nonsterile gloves, gown, private room is possible. Remember: Alcohol based hand sanitizers do not kill the bacterial spores.

Pts who are achlorhydria (inadequate gastric acid prodcution to maintain the normal gastric pH of <4) can have?

Have insufficient acid to kill the acteria so very few V cholerae organisms are needed to cause disease. Achlorhydria can be induced with long term proton pump inhibitor therapy.

Paget's dz osteoclasts

Have up to 100 nuclei and have macrophage colony-stimulating factor (M-CSF) and receptor for actiated nuclear factor kappa-B ligand (RANK-L). Osteoprotegerin OPG is a physiologic decoy receptor that decreases bidnign of RANK-L to RANK. Inhibit on of this interaction reduces the differentiation and survival of osteoclasts, resulting in juvenile Paget's disease. Paget's disease of bone is characterized by increased numbers of abnormal osteoclasts, excessie boen turnover and disorganized bone remodeling.

Difference in hemoglobin between HbS and HbC

HbS: contains valine (nonpolar) in place of glutamic at the 6th AA position of the B-globin chain. THis promots hydrophobic interaction among Hb molecules and results in HbS ploymerization and erythrocyte sickling. As a result hydrophobic interactions that occure cause aggregation of Hb molecules under anoxic conditions and which is promoted by low oxygen levels, increased aciditiy and dehydration.

2,3-BPG and hemoglobin binding

Hemoglobin A: postively charged histidine and lysine residues secure negatively charged 2,3-BPG to the binding pocket. HeCmoglobin F: replacement of histidine by serine in fetal hemoglobin reduces positive charge of the binding, limiting 2,3-BPG attachment.

HELLP

Hemolysis, elevated liver enzymes, low platelets tx immediate delivery.

HUS

Hemolytic uremic syndrome - microangiopathic hemolytic anemia, thrombocytopenia, actue renal failure generally 1-2 weeks after a diarrheal illness due to E. coli 0157:H7 Shiga toxin (verotoxin) enters the circulation front he bowl and induces capillary endothelial damage, resulting in platelet activation with the formation of micro thrombi. Platelet consumption causes thrombocytopenia whereas micro thrombi lead to erythrocyte damage (forming schistocytes) the resultant hemolytic anemia (pallor, weakness, tachycarida). Damage to glomerular endothelial cells also cause AKI (olguriaanuria, increased creatinin). Decrease in Hemoglobin and haptoglobin levels, increase in serum lactate dehydrogenase and unconjuagted bilirubin levels.

Laboratory characteristics of coagulopathies Hemophilia A and B: VWF: DIC: Uremic platelet deficiency: Heparin: Warfarin: Immunothrombocytopenia:

Hemophilia A and B: VWF: DIC: Uremic platelet deficiency: Heparin: prolongs PTT via antithromin-associated inhition of factors 2 and 10 (PT is usually normal due to the addition of heparin neutralizers int he PT reagent) Warfarin: Immunothrombocytopenia: Normal, normal, decrease platelets, increase bleeding time.

Anicteric "silent" with no jaundice observed,most become jaundice, and aversion to smoking,most adults have anti HAV IgG antibodies withou icteric illness. Liver failure and death due to HAV are extremely rare. If you have Anti-hepatitis A IgG, how does this differ then if you have it with HEP B

Hep A is self-limiting: acute, jaundice, malaise, fatigue, anorexia, nausea, vomiting, RUQ pain and aversion to smoking. Hep B has a window period between HBsAg and Anti-HBsAg.

Double-stranded DNA -->+RNA template -->double-stranded DNA progeny

Hep B

mass on the liver, and can cause hepatocellular carcinoma

Hep B

nonenveloped single stranded postiive sense RNA virus

Hep E- can causes hematopoietic depression and some measure of aplastic anemia. HIV is another eveloped single-stranded positivepsense RNA vius that can cause aplastic anemia. Fecal oral most concerning feature of hep E infection is the high mortality rate in infected pregnant women.

Pt with Hep C that is vomiting bright red blood. He has abdominal distendtion and gyncomastia,asterixis, and an altered mental status? Ataxia (gait disturbance) is associate with metabolic encephalopathies.

Hepatic encephalopathy ths was most likely precipitated by his recent GI bleeding. Hepatic encephalopathy refers to a reversible decline in neurologic function that occurs due to failure of the liver to metabolize wast products such as ammonia. Ammonia is normally produced by the GI tract as a result of enterocytic catabolism of glutamin and colonic bacterial catabolism of dietary protein. GI bleeding causes increased nitrogen delivery to the gut in the form of hemoglobin, which is then converted into ammonia and absorbed into the bloodstream. The ammonia then enters the liver through the portal vein and is detoxified to urea. In chronic liver failure, hepatocyte dysfunction and the shunting of blood through portosystemic collaterals impain the liver's detoxification ability. This leads to accumulation of ammonia and other neurotoxins in the circulation, causing altered aa transport across the blood-brian barrier, impaired neurotransmitter metabolism, and depressed cerbral glose metabolism. These and other factors result in increased inhibitory neurotransmisssion (y-aminobutyric GABA) and impaired excitatory neurotransmitter release (glutamate, catecholamines) Tx hepatic encephalopathy, lowering of blood ammonia levels is typically accomplished with oral admin of disaccharide (lactulose). Bacterial action on lactulose results in acidifcation of colonic contents, which then coverts absobable ammonia into nonabsorbable ammonium ions, trapying the ammonia in the stool.

iron hemostasis is maintained by multiple types of cells in the body. Which of the following cells secrete a substance that controls iron storage and release by other cells involved in iron hemostasis?

Hepatic parencymal cells. Hepcidin is an acute phase reactant synthesized by the liver that acts as the central regulator of iron homeostasis. High iron levels and inflammatory conditions increase the sytnhesis of hepcidin, while hypoxia an increased erythropoiesis act to lower hepcidine levels. Hepcidin influences body iron strage through its interaction with ferroportin, a transmembrane protein responsible for transferring intracellular iron to the circulation. Upon binding hepcidin, ferroportin is internalized and degraded, decreasing intestinal iron absorption and inhibiting the release of iron by macrophages. Iron absorption fomr the proximal small intestine is facilitated by the divalent metal transporter-1 (DMT-1)

The lesser omentums is made up of?

Hepatoduodenal ligament, hepatogastic ligament.

SE of Isoniazid

Hepatotoxic, Drug induced Lupus, neurotoxicity, decrease B6 (peripheral neuropathy and siderblastic anemia)

When a pt's rbi are incubated in a hypotonic solution with glycerol, hemoglobin is release.

Herediatry spherocytosis: results from Red cell cytoskeleton abnormalities, most commonly in the protein sprectrin and ankyrin. Increased osmotic fragility on acidified glycerol lysis testing confirms the diagnosis. Hemolytic anemia, Jaundice and splenomegaly are classic manifestations. Complications inlude pigmented gallstones and aplastic crises from parvovirus B19 infection. AD northern european Hemolytic anemia, jaundice, spenomegaly Increased mean corpuscular hemoglobin concentration spherocytes increase osmotic facility on acidified glycerol lysis test. Tx splenectomy compicatons: pigmented gallstone Aplastic crises from parvovrus B19

Pt has increased orotic acid crystals and an increased MCV RBCS?

Hereditary Orotic aciduria, which is a rare AR disorder of the de novo pyrimidine synthesis that occurs due to a defect in UMP synthase (5'-monophosphate synthase). Children present with phyiscal mental retardation, megaloblastic anemia, large amounts of urinary orotic acid. Uridine (UDP) supplementation can improve symptoms as uridine is converted to UMP via nucleoside kinase.

C1-inhibitor deficiency

Hereditary angioedema is a rare AD associated with painless episodes of swelling inoliing the face, lips, larynx and extremities.

Glanzmann thrombasthenia

Hereditary def of GP2b3a receptors, which manifests with mucocutaneous bleeding. Platelet aggregation in response to ristocetin is normal as levels of vWF and GP1b receptors are normal.

Single aa substiuation Glutamine to arginine near te protecin C cleavage site in her coagulation factor V gene product.

Heterozygot carries of factor V Leiden have five to ten times the risk of developing thrombosis, which homozygote carriers of factor V leiden have 55-100 times the risk of developing a thrombosis (pulmonary emboli) In normal hemostasis, activated protein C (APC) restricts clot formation by proteolytically inactivating factors 5a and 8a. Factor Va Leiden has reduced has reduced susceptibility to cleavage by APC, however. Because factor 5a is a cofactor in the conversion of prothrombin to thrombin, persistent circulating favor 5a Leiden results in increased thrombin production. Additionally, factor V Leiden is unable to support APC anticoagulant activity. This combination of increased coagulation and dersed anticoagu produces the hypoercoagulable state seen in those with facto 5 Leiden.

Dermatitis herpetiformis

Histologically characterized by microabscesses containing fibrin and neutrophils at the dermal papillae tips. The overlying basal cells become vacuolated, and coalescing blisters form at the tips of the involved papillae. Formation of IgA antibodies again gliadin (a protein unique to the gluten portion of wheat) or glidin/tissue transglutaminase complex in the intestine. These antibodies appear to cause clinical diease by cross-reacting with epidermal transgluatminase. Celiac disease. increased intraepithelial lymphocytes, variable loss of villus height, crypt hyperplasia, malabsorption steatorrhea.

Spongiosa filling the medullary canal with no mature trabeculae

Histologically, osteopetrosis is characterized byt he persistence of primary, unmineralized spongiosa in the medullary canals. In normal peeps the primary spongiosa is replaced by bone marrow.

Aortic dissection

Htn, Marfan and Ehlers- cystic medial necrosis of the aortic well. Hypertension is the single most important risk factor for the development of intimal tears leading to aortic dissection. Hypertension, smoking, DM and hypercholesterolemia are all major risk factors for atherosclerosis, which predisposes more to aortic aneurysm formation than aortic dissection.

Primary effusion lymphoma with large cells, big nuclei and prominent nucleoi

Human herpes virus 8 infection can causes kaposi sarcoma and pirmaly effusion lyphoma arising from B-cells, most commonly in HIV infected pts.

Essential hypertension drug?

Hydrochlorothiazide

Transplant rejection reaction

Hyperacute - minute to hours- preformed antibodies against graft in recipient's circulation. Gross mottling and cynaosis. Arterial fibrinoid necrosis and capillary thrombotic occlusion. Acute: <6 months - exposure to donor antigens induce humoral cellular actication of native immune cells. Humoral: C4d deposition, neutophilic infiltrate necrotizing vasculitis. Cellular: lymphocytic interstitial infiltrate and endotheliitis. tx mycophenolate and tacrolimus Chronic: months to years. Low grade immune response refractory to immunosuppressants. Vascular wasll thickening and luminal narrowing. Interstitial fibrosis and parenchyma atrophy.

Subperiosteal resorption with cystic degeneration

Hyperparathyroidism increases osteoclastic activity, which results in increased bone resorption. Bone resorption involves the cortical bones.

Vascular: Onion-like concentric thickening of arteriolar walls:

Hyperplastic arteriolosclerosis in renal arterioles can result from malinant hypertension Diastolic pressures >120-130. They are a result of laminated Smooth muscle cellls and redubplicated basement membranes. The renal areriolar stenosis of hyperplastic arteriolosclerosis dereases glomerular perfusion and GFR, thus activating the renin-angiotensin-aldosterone systtme. A further increase in bp, producing a vicious cycle and malignany nephrosclerosis. When the rise in pressure causes retinal hemorrhages, exudates, or papilledema, acclerated malignant htn is present. Pts have hypertensive encephalopathy characterized by headache, irritability, alterations in consciousness and other signs of CN dysfunction.

What doe the different levels correspond to? Hypocretin-1 5-hydroxyindol-acetic acid concentration 12-3-3 protein Dopamine, homovanillic acid Melatonin

Hypocretin-1 produced in lateral hypothalamus ad are measurable i the cerebrospinal fluid' Low CSF 5-hydroxyindol-acetic acid concentration is associate it impulsive, destructive behaviors, aggression, suicide and violence. detection of elevated 12-3-3 protein in CSF is helpful in dx creutzfeldt-Jakob dz, a neurodegenerative dz caused by prions. Dopamine metaboite, homovanillic acid are linked to pychiatric conditions, psychosis and mood disorders. homovanillic acid are decreased in pts with parkinson disea. Melatonin in CSF have been down to decrease the progression of Alzheimer dz

Staph aureaus can cause pneumonia after an

INFLUENZIA INFECTION

Wound healing:

INflammatory phones movement of neutrophils (24 hrs). Maturation phase of wound healing is characterized by fibrosis (scar formation) and startes the second week after injury. active fibroblasts synthesize collagen, elastin and other components of the connective tissue matrix.

Why give IV fluids in hypovolumic shock?

IV fluids increase the intraascular and left ventricular end-diastoic volumes. The increase in preload stretches the mycardium and increases the end-diastolic sarcomere length, leading to an increased in stroke olume and cardiac output by the frank-starling mechanism.

Renal damage with serum contains IgG4 antibodies to the phopholipase A2 receptor, a transmembraen protein abundant on podocytes?

Idiopathic membranous nephropathy

What is the steps of anaphylactic shock?

IgE produced by B-lymphocytes and plasma cells bind to IgE Fc receptors on basophils and mast cells. Reexposures to these been venom allergens will result in cross-linking of IgE molecules on the surface of basophils and mast cells. These will undergo degranulation and release histamine, proteases, heparin, leukotrienes and prostaglandins. These lead to degranulations lead to vascular permeability caussing vasodilation, bronchoconstrictionand inflammation leading to anaphylactic shock and potentially death.

MG is caused by

IgG autoantibodies.

Pemphigus vulgaris

IgG mediated skin disruption, can involve the pharynx and esophagus.

The primary immune response to a new antigen initially results in plasma cells that can only produce

IgM. Isotype switching later occurs in the germinal centers of the lymph node and requires interaction of the CD40 receptor on -cells and with the CD40 ligand (CD154) expressed y activated T-cells. IgG is the main serum immunoglobulin of the secondary response. B-cell precursors proliferate and mature in the one marrow. Marture -cells then leave the one marrow and migrate to lymphoid organs and peripheral tissues. During isoswitching light chains are antigen-specific and do not dtermine isotype. Isotype switching first requires interaction of the CD40 receptor on activated B-cells with the CD40 Ligand (CD154) expressed by activated T cells. Afterward, isotype swithcing can occur through genetic rearrangement of the heavy chain constant regions. THis process is modulated y Tcell cytokinds such as IL-2, IL-4, IL-5, IL-6 and IFN-y.

TCA SE

Imipramine is a TCA, sexual dysfunction and cardiotoxcity.

Crigler-Najjar and Gilbert:

Impaired bilirubin conjugation that results in an increase in indirect (unconjugated) hyperbilirubinemia.

Silicosis

Impaired macrophage function is distinguished by calcificatoins of the rim of hilar nodes (eggshell calcification) and birefriengent silica particles surrounded by fibrous tissue on histology. It have been associated with increased risk of tuberculosis. Silicosis impairs the macrophage effector arm of cell-mediated immunity, which is integral to the immune response against mycobacteria. Macrophage phagolysosomes may be disrupted by internalized silica particles, causing release of the particles and viable mycobacteria, and thereby inhibit the immune system;s ability to control the infection.

What vitamins are def in gastrojejunostomy?

In Gastrojejunostomy, the gastric antrum is removed to decrease gastrin production. So the Gastric body and the jejunum are attached. No duodenum or jejunum. Iron, B12, folate, fat-soluble vitamins (especially vit D), and calcium may also be observed.

Hematogenous osteomyelitis in children and in adults

In children it usually affects the metaphysis of long bones due to the slower lood flow and capillary fenestrae in this region. Withought proper tx, the infection can progress to chronic suppurative osteomyelitis. In adults the vertebral body is the most common location. Pott disease caused y mycobacertium tuberculosis. Pathology Seeding event causes acute cellulitis of the one marrow. disruption of the periosteal lood supply further contributes one ischemia, leading to necrosis. Without tx, the infection can progress to chronic suppurative osteomyeliti, a condition which necrotic one serves as a reservoir for infection and becomes covered y a poorly constucted shell of new bone called an involvucrum. One or more sinus tracts develop to drain the purlent material into the soft tissue or out of the skin surface. Prper tx inculde antiiotic therapy and derdement of necrotic one.

Where does Rotavirus replicate?

In epithelial cells. The infected and damaged enterocytes slough into the intestinal lumen, leading to profuse watery diarrhea.

Aldosterone in heart failure

In heart failure, aldosterone is also produced in the myocarium and acts locally, leading to fibrosis and myocardial hypertrophy. The resulting cardiac remodeling worsen left ventricular dysfunction in heart failure pts. spirolactone is an aldosterone antagonist blocking aldosterone's effects in in the heart. It also is structurally similar to androgens and exerts an antiandrogenic effect by acting as an androgen receptor antagonist and inhibiting testosterone synthesis.

cHEDIAK-hIGASHI SYNDROME

Include oculocutaneous albinism, periheral neuropathy, and immunodeficiency related to dystfucion of phagocyte phagosome-lysosome fusion.

How does left temporal lobe hemorrhage present as and what is the herniation that can develop?

Increased intracranial pressure, headache, impaired consciousness and Cushing triad (HTN, bradycardia, and bradypnea) due to hemorrhagic intracranial metastases involving the left temporal lobe. Expanding space can lead to Uncal herniation- compresses the ipsilateral third cranial nerve. Leading the oculomotor nerve palsy and fixed dilated pupil. ADVANCED transtentorial herniation include loss of vestibular-ocular reflexes and decorticate followed by decrebrate posturing.

Effects of Desmopressin therapy with hemophilia A and Type 1 von willebrand disease

Increases circulating factor 8 and endothelial secretion of vWF to stop bleeding.

What increases and decreases Hypertrophic cardiomyopathy murmurs?

Increases: Sudden standing (from sitting or supine position), Valsalva (straining phase), or Nitroglycerin administration decreases preload and will result in increased murmur intensity. Decreases: Squatting, handgrip, passive legraise will increase preload and or afterload and with decrease murmur intensity.

Uric acid kidney stones

Individuals with high serum uric acid levels are at increased risk of developing uric acid kidney stones. Hyperuricemia can be caused by uric acid underexcretion (thiazide diuretics) or overproduction (tumor lysis syndrome)

Extension of the thigh

Inferior gluteal nerve: Gluteus maximus muscle (exists through greater sciatic foramen below the piriformis)

Tricyclic antidepressants cause death from over does by?

Inhibiting fast sodium channel conduction, slowing down myocardial depolarization and leading to cardiac arrhythmia. Refractory hypotension resulting from decreased cardiac contractility and direct peripheral vasodilation (from peripheral alph1 adrenergic receptor antagonism) is also a major cause of mortalitiy in these patients. TCA also inhbits the reuptake of NE and serotonin. Have anticholyenergic effects, anti alpha-1 adrenergic receptors, block cardiac fast soidum channels, block presynaptic NE and E-HT.

Fluconazole

Inhibits 14a-demethylase, a cytochrome P450 enzyme.

Stages of ATN

Initial stage: Ischemic injury to renal tubules precipitated by hemorrhage, acute MI, sepsis, surgery. Maintenance stage: Decreased urine output, fluid overload, increasing creatinine-BUN, hyperkalemia, anion gap metabolic acidosis. Recovery phase: Gradual increase in urin output leading to high-bolume diuresis. Electrolyte abnormalities may include decreased concentrations of K, Mg, PO4, and (low Vit D) Ca due to slowly receiving tubular function. Dehydration.

Internal verses external hemorrhoids

Internal hemorrhoids orginate avove the dentate line and are covered by columnar epithelium. They ahve autonomic innervation from the inferior hypogastric plexus,w hich sensitive to streatch and not pain, temp or touch

Invasive mole vs Gestational choriocarcinoma

Invasive mole: malignant, Trophoblasts: diffusely hyperplastic with myometrial invasion, Villi: diffusely enlarged hydropic, not fetal parts Gestational choriocarcinoma: Malignant, Trophoblasts: diffusely anaplastic/necrotic with vascular invasion, Villi: Present or absent.

Microcytic hypochromic anemia

Iron def

Atrial fibrillation

Irregularly irregular (varying R0R intervals) absence of P waves Holiday heart QRS is narrow

Tosade de points

Is a form of polymorphic ventricular tachycarida characterized by QRS complexes of varying amplitude and cyclelenthygiving the appearance that the tip of QRS complex is twisting aroudn the ECG baseline. It is defferentiated from other forms of plymorphic venricular tachycardia becaue it is always assoicated with prolonged QT interval. It may terminate spontaneously or can degenerate into venticular fibrilation ans duden cariac death. QT prolongation is caused by electrolyte imbalances (hypokalemia, hypomagnesemia) and pharmacoloic agents suc as class 1A and 3 antiarrhythmics ( Quinidine, sotalol), antibiotics (macrolides, fluoroquinolone), methadone and antipsychotics (haloperidol). Sotalol is a class 3 antiarrhythmic agent (K+ channel blocking) used for treatment of atrial fibrillation. It prolongs action potential durationm, resulting in QT interval prolongation.

Cholangiocarcinoma

Is a rar malignancy that arise form the ntra and extra hepatic bile ducts. Intrahepatic cholangiocarcinoma appears grossly as a treelike mass that grows along the biliary system, typically resulting in extensive intrahepatic metastasis. Risk factors include primary scleosiing cholangitis, fibropolycystic lie dz, and infection with liver flukes in endemic area. The prognosis is very poor. Hemochromatosis is a risk factor.

Eosinophilc granuloatosis with polyangiitis (Churg-Strauss)

Is a small to medium vessel vaculitits characterized by late onset asthma, rhino sinusitis, eosinophilia. It can involve many other organ systems including the kidneys, GI tract, and cardiovascular system. Asymmetric multifocal neuopathy (mono neuritis multiplex) is particular common due to the vaculitis affecting the epineural vessels (wrist drop due to radial nerves involvement). Other common manifestations include skin nodules, migratory transient pulmonary infiltrates and paranasal sinus abnormalities. In addition to peripheral eosinophilia, a frequent laboratory finding is antibodies against neurtorphil myeloperoxidase, is most commonly have a pattern of nperinulcear staining (p-ANCA)

Conn's syndrome

Is an aldosterone secreting tumor (adenoma) leading to primary hyperaldosteronism. Hypertension, hypokalema, metbolic alkalosis, and decreased plasma renin activity. Tx with spirolactone or eplerenone.

BRCA-1

Is an anti-oncogene. It encodes BRCA protein, which suppresses the cell cycle. Mutation of the BRCA anti-oncogene increases risk of breast and ovarian ca.

Serotonin syndrome

Is characterized by a triad of autonomic instability (hypertermia, hypertension, tachycardia), altered mental status (agitation, confusion and neruomusclear hyperactivity (tremour, hyperreflexia, myoclonus) as well asGI symptoms and diaphoresis. IT may develop when a monoamine oxidase inhibitor (MAOI) antidepressant or non-antidepressant with MAOI activity (linezoild) is combined with serotonergic medication such as a selective serotonin reuptake inhibitor, serotonin-norepinephrine reuptake inhibitor, TCA.

CA 125

Is in epithelial ca of the ovary (serous, endometrioid, clear cell)

High serum PTH with low serum calcium?

Is seen in pts with vit D def, and renal failure

Charcot-Bouchard aneurysm

Is similar to Lacunar as it is caused by chronic hypertension, however hemorrhage would appear as a focus of intraparenchymal hyperdensity on the initial CT scan, making the dx less likely.

Cladribine

Is sued to treat hairy cell leukemia. It inhibits Adenosine deaminase and converts adenosine to inosine as part of purine metabolism. This enzyme is def in severe combined immune deficiency.

Partial pressure of oxygen and methemoglobin

Is the amount of oxygen dissolved in the plasma. It is unchanged in methemoglobinemia, which causes dusky discoloration of the skin (similar to cyanosis) and because methemoglobin is unable to carry oxygen a state of functional anemia is induced. Methemoglobin cannot bind to oxygen and therefore the oxygen content and oxygen carrying capacity of the arterial blood will be decreased.

Ischemia in the brain..

Ischemia lasting longer than five minutes causes irreversible damage to neurons. Most vulnerable are the pyramidal cells of the hippocampus and neocortex and the purkinji cells of the cereellum. The hippocampus is the first area damaged during global cerebral ischemia.

Type 1 DM

Islet leukocytic infiltration. autoimmune response against pancreatic beta cells that leads to progressive loss of beta cell mass. <90% of the beta cells are destroyed. Antiboides against islet antigens are detected in a large number of pts, they are thought to play a permissive role in disease pathogenesis, the destruction of beta cells occur primarily through cell0mediated immunity. INfiltration of islets by inflammatory cells is called insulitis and is more prominent during the early stages of disease.

Inhibits mycolic acid synthesis

Isoniazid

Hemagglutin in Influenza A

It is an antigen on the viral capsule that determines what cells it will infect. A humural response with antibodies directed again hemagglutinin is generally the most important source of protection. These antibodies can neutralize the virus and primarily block its binding to the host cells. Antibodies to neuroaminidase are the main source of protection against reinfection although they have some protective effect (decrease extent of viral invasion and shedding). Neuroaminidase cleave the sylatic acid to release the virus.Olestanvir/anamivir M2 needed to make the proper pH that enters the cell. Amantidine and Rimantidine prevent M2, which inhibits viral incoding.

Lactate dehydromgenase is increased in what?

It is an enzyme involved in anaerobic glycolysis. Althought increased LDH levels can occur with both seminomatous and nonseminomatous tumors of the testes, LDH does not interact with TSH receptors.

Barrett's metaplasia

It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract).

what is associated with 14;18

It is follicular lymphoma (a non-hodgkins lymphoma) It has overexpression of Bcr -2 which is anti-apoptotic (a protooncogene) from chromosome 18 near the immunoglobulin heavy chanin promoter region oon chromosome 14. Arise from B cells in Germinal centers Lymphanopathy and bone marrow involvement Effects Adults

What is Coagulase?

It is produced by Staphylococcus aureus that activates prothrombin resulting in the conversion of fibroinogen to fibrin. This process leads to fibrin-coated of the organism and resistance to phagocytosis.

How does timolol work?

It reduces intraocular pressure by acting on ciliary epithelium. It decreases the production of aqueous humor.

atypical antisychotics SE

It's atypical for old closets to quietly risper from A to Z. Olanzapine, clozapine, quetiapine, risperidone, aripirazole, zipraside. Clozapine: agranulocytosis Risperidone: prolactin and gynecomastia. may prolong QT duration. SE: hyperglycemia is a metabolic side effect

Treat Sporothrix schenckii

Itraconazole

Kussmaul sign

Jugular venous pressure is almost always increased in pts with constrictive pericarditis due to the restriction in right ventricular filling capacity. Although JVP normally drops during inspiration, pts with constrictive pericarditis frequently have a paradoxical rise in JVP. This is because volume-restriced right ventricle is unable to accommodate the inspiratory increase in venous return.

HHV 8

Kaposi sarcoma

Swollen lymph nodes and red eyes are seen in

Kawasaki dz: high fevers, strawberry tonue, perioral erythema and fissuring and periungual desquamation.

Tall male boy with gynecomastia

Klinefelter syndrome is caused by sex chromosome aneuploidy, which most commonly results in 47, XXY karyotype. These pts typically have atrophied hyalinized seminiferous tubules (resulting in low inhibin levels) and damaged Leydig cells (resulting in low testosterone levels). The lack of feedback inhibition results in excess gonadotropins (increased lH and FSH), whihc in turn increase estrogen levels.

Leukocyte adhesion deficiency (LAD)

LAD type 1 results from absence of CD18. This leads to the inability to synthesize the beta-2 integrins Mac-1 and LFA1, affecting tight adhesion, crawling and transmigration. Recurrent skin infections without pus formation, delayed detachemnt of the umbilical cord, and poor wound healing.

Temporal lobe injury

Language, sensory interpretation,and impaired memory. THese pts can exhibit behavioral changes (hyperorality, hyperseuality Kluver Bucy syndrome). Nondominant (right sided lesions) cana affect nonverbal memory, including musical ability. Dominant left sided lesions can affect verbal memory such as word recognition. Wernickes a region of the brain concerned with the comprehension of language, located in the cortex of the dominant temporal lobe.

Tennis elbow

Lateral epicondylitis: The lateral epicondyle serves as the primary attachem point for extensor carpi radialis breavis and extensor digitorum. Injury- angiofibroblastic tendinois (excessive fibroblast and neovascularization) at tits origin on the lateral epicondyle.

Wallenberg syndrome

Lateral medullary syndrome leads to contralateral loss of pain and temp sensation along with ipsilateral paralysis of CNV, 9,10 and 11.

What can increase MR?

Left ventricular afterload is a major determinant of the forward-to-regurgitant flow ratio pts with MR. Decreasing afterload will increase forward flow while reducing regurgitation flow. An increase in left ventricular end diastolic volume can contriute to or worsen mitral regurgitation when the degree of regurgitation is dependent on left ventricular size (eg: in dilated cardiomyopathy)

Doxorubicin

Leg swelling and orthopnea are symptoms of congestive heart failure. Of the chemotherapeutic agents, anthroacycline antibiotic and a chemotherapeutic intercalating agent, is commonly associated with CHF.

Recent travel (hospital or nursing home), with fever, bradycardia, headache, confusion and water diarrhea?

Legionella pneumonia Hyponatremia, sputum gram stain shows many neutrophils, but few or no organisms cause it is intracellular. Dx by: urinary antigen test buffered in charcoal yeast extract.

What can you use to treat Hep B and C virus, hairy cell leukemia, condyloma acuminatum and Kaposi sarcoma?

Leukocyte interferon-a

Microscopic polyangiits

Leukocytoclastic angiitis or hypersensitivy angiitis. Most common vasculitis associated with antibiotic use. Type 3 immune rxn

TP53

Li fraumani: breast, sacroma, brain tumors, leukemia, adenocortical carcinoma

pruritc purple papules and plaques involving the skin and mucous memrance. Showing lymphocytic infiltrate at the dermal epidermal junction with destruction of the basal epidermal cells.

Lichen planus

Digoxin toxicity

Life-threatining arrhythmias, cholineric effects, fatigue, confustions, weakness and COLOR VISION ALTERATIONS. Hyperkalemia causes increased vagal tone

Cephalosporin-resistant organisms

Listeria, MRSA, Enterococci: Resistant penicillin-binding proteins Atypicals: mycoplasma, chlamydia, Listeria: no cell wall.

Rubella vaccine

Live attenuated virus for children at 12-15 months and again at 4-6 years of age, or to NON PReggers women. The congenital rubella syndrome is predominantly characterized by neonatal defects of the head (microcephaly, mental retardation), eyes (cataracts- which pupils), ears (deafness) and heart/cardiovascular system (PDA, peripheral pumonic stenosis).

Crohns

Long serpiginous or linear ulcers with spared intervening mucosa and areas of nodular thickening lead t a cobblestone appearance. Inflammation o fthe intestinal wall almost universally leads to the narrowing of the invalid intestinal segment "string sign"

When does the myocardium stop contracting?

Loss of cardiomyocye contractility occurs within 60 seconds after the onset of total ischmia. When ischemia lasts less then 30 minutes, restoration of blood flow leads to reversible contractile dysfuction (myocaridal stunning), with contractility gradually returing to normal over the next several hours to days. However, after about 30 minutes of total ischemia, ichmic injury becomes irreversible. The depletion of ATP incritical cellular areas and the accumulation of toxins resultin in loss of contactility within about 60 seconds of toal myocardial ischmia. Under hypoxic conditions, ATP within cardiomyocytes is degraded to ADP, AMP and evenutally adenosin. Adenosine is able to cross the cell memrane and function as a vasodilator whinen coronay blood flow is insufficient to meet myocardial demain. However, persistent ischma can lead to depletion of massive amounts of adenoisine. After 30 minutes of total myocardial ischmia, aout half of the cellular adenine stores are lost. At this point, failure of cellular homeostatiss is inevitable and ischemic injury become irreversible.

Ataxia-telangiectaisa

Louis-Bar syndrome ) is a rare, neurodegenerative, autosomal recessive disease causing severe disability. Ataxia refers to poor coordination and telangiectasia to small dilated blood vessels, both of which are hallmarks of the disease.

21-hydroxylase deficiency

Low cortiosol and aldosterone precursors are diverted toward adrenal androgen biosynthesis. Low cortisol levels stimulate pituitary production of ACTH, which further increases the production of adrenal androgens. 21 hydroxylase deficiency also causes increased serum levels of 17 hydroxyprogesterone as it s coversion to 11-deoxycortisole is impaired by the enyzmatic defect. Salt wasting, hyperkalemia

Low dietary calcium

Low dietary calcium heps bind oxalate in the gut to form unabsorbable calcium oxalate. Low-calcium diets allow increaed amounts of free oxalate to be absorbed and then exreted in the kidney, thereby causing hyperoxaluria.

What drug do you treat delirium with?

Low-dose antipsychotics (haloperidol)

Rubella infection Maternal and infant

Low-grade fever, a maculopapular rash with cephalocaudal progression, and posterior auricular and suboccipital lymphadenopathy. Women pts develop polyarthritis and polyarthralgia. Congenial rubella syndrome is associated with sensorineural deafness, cataract, and cardiac malformations (PDA).

Lactulose

Lowers the colonic pH and increases the conversion of ammonia to ammonium. is used to eliminate ammonia in the blood stream. it does so by acidfiying the feces in the bowel, trapping ammonia, allowing it to be eliminated during defecation.

PE and pulmonary infarction

Lung infarction is a rare complication of pumonary embolism due to the collateral blood flow supplied by the pumonary and bronchial arteries. When a clot occludes the pumonary artery, the bronchial artery can continue to supply nutrients to tissue. The pulmonary artery is the major supplier of blood to the lungs and provides deoxygenated blood for gas exchange, the bronchial artery supplies nutrients and removes waste from the bronchi and provides collateral blood flow to the remainder of the lung parenchyma.

Fat emboli in the lungs in the cerebral white matter

Lungs: occlude pulmonary microvessles, impaining gas exchange. Cerebral white matter: microvascular occlusion in the cerebral white matter, brain stem, and spinal cord cause neurologic manifestations. Dysfunction: 1) Release of mediator from platelets which adhere to and coat the fat emboli (a phenomenon also resulting in thrombocytopenia) 2) Systemic activation of lipoprotein lipase and intravascular release of toxic levels of oleic acid. Anemia is due to increaed RBC aggreation and destruction, as well as pulmonary hemorrhage.

Right heart failure increases Cenral venous pressure CVP which leads to a rise in capillary hydrostatic pressure, net plasma filtration and in interstitial fluid pressure. THis can be caused by COPD. What helps stop edema from forming

Lymphatic drainage increases to compensate for moderate CVP elevation.

Hereditary cancer syndromes

Lynch syndrome (hereditary nonpolyposis colon cancer, or Lynch syndrome, and AD. DNA mismatch repair (inherited one, when the second allele is muated then the malignancy will develop). APC- also thryorid ca

Primary lung focus to blood to meninges

M. tuberculosis

Parasympathetic receptors

M1, M2, M3 M1: Brain: Memory formation/cognitive functioning: Confusion M2: Heart: Decreased hart rate and atrial contraction: Increased heart rate and contractility M3: Peripheral vasculature: smooth muscle relatxation, vasocdilation, hypotension Lung: Bronchoconstricton Bladder: Detrusor contraction (urinary release) Eyes: Pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accommodation) Gastrointestinal: increased peristalsis, increased salivary and gastric secretions. Skin: increased sweat production.

Pericarditis

MI, rheumatic fever or uremia - serofibrinous Viral - fibrinous

Selective estrogen receptor modulators Drugs:

MOA: competitive inhibitor of estrogen binding, mixed agonist/antagonist action Prevention of breast ca in high-risk pts. Tamoxifen: Adjuvant tx of breast ca endometrial hyperplasia and carcinoma Raloxifene: Postmenopausal osteoporosis Adverse effects: Hot lashes, venous thromboemboism, endometrial hyperplasia and carcinoma

Streptomycin

MOA: interfering with the 16s rRNA of the bacterial 30s ribosomal subunit, thereby preventing bacterial protein synthesis. Mutations of the genes that encode ribosomal proteins are responsisle for aminoglycoside resistance because they lead to modifications in the riosomal binding sites for these drugs. (Resistance: aminoglycoside-modifying enzymes (transferase) and mutated porins, alter structure of bacterial ribosomal proteins)

Methotrexate

MTX functions as a chemotherapeutif agent through inhbitionof DNA synthesis and as an anti-psoriasis agent throughout immunomodulatory effects on activated T Cells. Follinic acid (Leucovorin) can reverse MTX toxicity if given early. It rescues bone marrow and Gi and other mucosal cells from MTX toxicity. is a folic acid antagonist used to treat ectopic pregnancy. It competitively inhbits the enzyme dihydrofolate DHF reductase which catalyzes the synthesis of tetrahydrofolate. DHF reductase inhbition causes the intermediate DHF to accumulate intracellularly. It disrupts the synthesis of thymidine (and purines to a lesser extent) After entering the target cell, MTX undergoes polyglutamation, which prevents the movement of MTX out the cell, resulting in intracellular accumulation of MTX for later use. Folate and recycled DHF are stored within the cell via ployglutamation. Because MTX inhibits DHF reductase, folic acid and DHF polyglutamate will accumulate in cells.

Differential media

MacConkey and eosin methylene blue agars

What are the two most important factors in osteoclast differentiation include:

Macrophage colongy simulating factor (M-CSF) and receptor for activated nuclear factor kappa B ligand (RANK-L)- which stimulate the develoment of mature, multinucleated osteoclasts. Osteoprotegerin (OPG) blocks binding of RANK-L to RANK and reduces formation of osteoclasts. Low estrogen states cause osteoporosis y decreasing by decreasing osteoprotegerin production, increasing RANK-L production and increasing RANK expression in osteoclast precursors.

Schizoaffective disorder

Major depressive or manic episode concurrent with symptoms of schizophrenia. Lifetime history of delusions or hallucinations >2 weeks in the asence of major depressive or manic episode. Major depressive or bipolar disorder with psychotic features.

MHC class 2 antigens

Major histocompatibility complex MHC class 2 found on an antigen presetning cell normally interacts with processed antigens, presenting them to T-lymphocytes to initiate an immune response. In contrast, superantigens (enterotoxins, toxic shock syndrome toxin) interacts with MHC clas 2 and the T cell receptor outside of the standard antigen binding sites to initiate widespread and nonspecific activation of T lymphocytes. Although superantigens are synthesized by staphylococci they are not bound to peptidoglycan cell wall.

t(11;14)

Mantle cell lymphoma over expression of cyclin D which progress cells from G1 to S phase. CD5 positive and CD 19, CD 20 Seen in elderly men poor prognosis :(

11:14

Mantle cell lymphoma. Increased production of cyclin D1, a promoter of G1 to S phase transition during the cell cycle.

What is overactive as an intracellular enzyme that is susceptible to developing benz (o) pyrene-induced lung cancer?

Many chemicals can induce cancer in humans, with most such substances existing in an inactive, pro-carcinogenic state. Pro-carcinogens are metabolized by cytochrome P450 monooxygenase, an enzyme system present in hepatic microsomes and the endoplasmic reticula of varied other tissues. Cytochrome P450 monooxygenase metabolizes steroids, alcohol, toins and other foreign substances by redering them soluble and easier to excrete. Unfortunately, this metabolic processing also converts pro-carcinogens into carcinogens capable of causing mutations in human DNA.

CCR5 antagoinist

Maraviroc, inhibits HIV entry by allosteric blocking of HIV gp120 interaction with CCR5 (tropism testing required)

causes of angioedema

Mast cell activation: Type 1 hypersensitivity reaction (IgE-mediated), Direct mast cell activation (opioids)- associated with pruritius and urticaria. Excess bradykinin: - ACE inhibitors, C1 inhibitor deficiency- no pruritus or urticaria.

Enzyme that enhances tissue invasion and metastasis?

Matric metalloproteinases are proteases that degrade extracellular matrix proteins. They also modulate cell signaling by cleaving cell surface receptors, releasing apoptotic ligands and inactivating chemokines/cytokines. These enzymes generally incrase cell proliferation and allow for tissue invasion and metastasis.

Ostonecrosis of the femoral head is derived mainly from the ascending cervical and retinacular branch of what artery?

Medial circumflex artery

Superior vena cava syndrome vs Superior sulcus tumors (Pancoast tumor)

Mediastinal mass SVCS: Intrathoracic spread of bronchogenic carcioma (lung ca, or non-hodgkins lymphoma) may lead to compression of the superior vena cava, causing impaired venous return fromt he upper part of the body. Signs and symptoms include dyspnea, facial swelling and dilated collateral veins in the upper trunk. Superior Sulcus tumors (Pancoast tumors): arise at the lung apex and frequently cause shoulder pain due to compression of the brachial plexus. The cervical sympathetic ganglia are also commonly involved, leading to Horner's syndrome (ptosis, MIOSIS, and anhydrosis). Superior vena cava syndrome can sometimes occur with Pancoast rumors, but should pain and Horner's syndrome are most frequent manifestations.

Chest CT scan revealvs a right-sided pleural effusion and diffuse nodular thickening of the pleura. On thoracentesis, bloody fluid is obtained Pleural bx shows proliferation of epithelia-type cells that are joined by desmosomes, contain abundant tonofilaments and are sudden with very long microvilli.

Mesothelioma Hemorrhagic pleural effusions and pleural thichening are characteristic. Immunohistochemical marker- pancytokeratin

Bronchial epithelial cells producing keratin pearls is an example of what process?

Metaplasia. Bronchial epithelial cells can also produce keratin pearls after undergoining a switch from columnar epithelium to squamous epithelium. This is due to irritants (tobacco smoke or gastric acid)

Microglial nodules and multinucleated giant cells

Microglial nodules form when cells of microglia surround a neuron and phagocytize it. These structures, along with multinucleated giant cells, are seen in viral infections of CNS. They are found in HIV-associated encephalopathy.

Leukocytoclastic vasculitis

Microscopic polyangiitis, microscopic polyarteritis, hypersensitivity vasculitis- characterized by segmental fibrinoid necrosis of the small vessel. However, PAN and microscopic polyangiitis are similar.

Reprefused muscles in part due to over production of reactive oxygen species such as: also what help neutralize these toxic molecules?

Molecular oxygen reacts with xanthine oxidase, NADPH oxidase and nitric oxide synthase to form reactive oxygen species ROS such as superoxide, hydroxyl radicals and singlet oxygen. Antioxidant enzymes such as superoside dismutase, glutathione perosidase and catalase convert ROS to oxygen and water, neutralizing their capacity for cellular damage.

Medial band-like calcification

Monckeberg's medial calcific sclerosis, a condition characterized by calcific deposits in muscular arteries in people older than 50. These are radiographically visible, palpable calification s do not narrow the vessle lumen and are asymptomatic.

Atypical depression

Mood reactivity, leaden paralysis (heavy limbs), rejection sensitivity, and reversed vegativate signes increase sleep and appetite. Tx with MAOI if treatment resistant depression. Don't use MAOI with old cheese, other pills, hypertensive crisis or sertonin syndrome: Hyperthermia, hypertension, mycolonus, mydriasis, overactive bowels, menal agitation.

paranasal sinuses

Mucormycosis- stongly assoicated with DM and diabetic ketoaciosis. Aspergillosis fumigatus is another fungus that may cause sinusitis. right angle branching (90 degree, non septate rods) spore inhalation Raspergilus

how is beta hemoglobin subunit similar to myoglobin?

Myoglobin is a monomeric protein and the promary oxygen-storing protein in skeltal and cariac muscle tissue, it is only found int he bloodstream after muscle injury. The secondary and teritary stuctures of myoglobin and the hemoglobin beta subunit ar almost identical (the a subunit is also very simarly to myoglobin). Because individual hemoglobin subunits are structurally similar to myoglobin, their oxygen=binding behavior is also similar. THat is if the hemoglobin molecule is dissociated, the individual subunits wil have a hyperbolic oxygen-dissociation curve.

myotomes and reflexes of the upper extremity Myotomes: C4: C5: C5,C6: C7: C8: T1: Reflexes: C5, C6: C7, C8:

Myotomes: C4: Shoulder and scapula elevation C5: Shoulder abduction C5,C6: Elbow flexion, wrist extension C7: Elbow extension, finger extension C8: wrist flexion, finger flexion T1: Finger abduction Reflexes: C5, C6: Biceps and brachioradialis reflexes C7, C8: Triceps reflex

Ménière's disease vs Ménétrier disease

Ménière's disease /meɪnˈjɛərz/,[1] is a disorder of the inner ear that can affect hearing and balance. It is characterized by episodes of vertigo, tinnitus, and hearing loss. The hearing loss comes and goes for some time, alternating between ears, then becomes permanent. Ménétrier disease (also known as hypoproteinemic hypertrophic gastropathy; named after a French physician Pierre Eugène Ménétrier, 1859-1935), is a rare, acquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production. The disorder is associated with excessive secretion of transforming growth factor alpha (TGF-α).[1]

Staphylococci promote the growth of H. influenziae by supplementing which of the following substance?

NAD+ via satellite phenomenon H. influenzae is a lood loving organism that requires X (hematin) and V (NAD+) factors for growth. THis can e accomplished by b-hemolytic s. aureus colones that hemolysis RBCs producing factors X and V.

Blanching of a vein into which NE is being infused together with induration and pallor of the tissues surrounding the IV site are signs of

NE extravasation. THe NE causes intense a1 receptor mediated vasoconstriction which can lead to local tissue necrosis. Such necrosis can be prevented b infiltration (using a syringe with a fine hypodermic needle) throughout the affected area with 10-15 cc of sodium chloride solution containing 5-10 mg of phentolamine mesylate, an a receptor blocker. This antidote must be given within 12 hours of extravasation to be effective. Remember that phentolamine mesylate and other a recetpor blockers lead to vasodilation thus counteracting the a receptor mediated vasoconstriction of NE.

Receptor and their signal transduction system, and effects

NE/EPI: a1- increase IP3 - peripheral vasoconstriction a2- decrease in camp- decrease release of norepinephrine and insulin. b1- increase cAMP- increased contractility EPI: b2- increased cAMP - bronchodilation, vasodilation

Neuroleptic malignant syndrome versus serotonin syndrome

NMS: Antipsychotics, appears to be antagonist of central dopaminergic systems in the nigrostriatal pathway involved in thermoregulation and regulation of muscle tone and movement. The clinical presentaton of NMS consists of 4 primary features: hyperthermia, severe generalized "lead-pipe" rigidity, autonomic instability and altered mental status. Tx with dantrolene or bromocriptine Serotonin syndrome: mental status changes, hyperthermia and autonomic instability, NEUROMUSCULAR HYPERACTIVITY (shivering, clonus, and hyperreflexia) as oppposed to the diffuse rigidity and bradyreflexia in NMS. Nausea, vomiting and diarrhea are also common in serotonin syndrome, hypertermia and rigidity are present. HYPERREFLEXIA AND CLONUS (not in NMS) Tx with ciprohepadine

Difference between NRTI and NNRTIS

NRTIs: bine, sine, dine, tenofovir, and abacavir These are competitive nucleosides/tide RT inhibitors (inhibits HIV DNA synthesis from RNA template by terminating DNA chain elongation. NNRTIS: Vir in the middle Allosteric RT inhibitors.

Naproxen

NSAID- pain managmetn in pts with osteoarthritis.

NSAID EFFECT ON THE KIDNEY

NSAIDs concentrate in the renal medulla along the medullary osmotic gradient, with higher levels in the papillae. These drugs uncouple oxiative phosphorylation and are thought to cause glutatione depletion with subsequent lipid peroxidation resulting in damage to tubular and vascular endothelial cells. Prlonged use results in chronic interstitial nephritis, seen as patchy interstitial inflammation with subsequent fibrosis, tublar atrophy, papillary necrosis and scarring and caliceal architecture distortion. Ca may depoist in areas of chronic inflammation and this calcification is visible on renal imaging. NSAIDSs also decrease prostaglandin synthesis, causing constriction of medullary vasa recta and and ischemic papillary necrosis.

What does Nef and Tat do as HIV viral genes?

Nef decreases expression of MHC class 1 proteins on the surfaces of infected cells. Tat gene product plays a role in viral replication.

Gram - bean-shaped cocci in pairs Pharynx to blood to choroid plexus to meninges

Neisseria meningitidis

Pts with def of the MAC complex have increased infection of:

Neisseria species.

Pathophys of minimal change

Nephrotic syndrome can result from a number of different dz processes, the pathogenesis underlying its symptoms is consistent in the vast majority of pts. Ths process involves increased permeability of the glomerular capillary wall to lasma proteins, decreased plasma oncotic pressure of the blood, fluid shift into the interstitium, increased aldosterone synthesis and increased antidiuretic homrone release, with resultant sodium and water retention, hyperlipidemia and subsequent lipiduria.

Net filtration in terms of hydrostatic and oncotic pressure

Net filtration = (Hc-Hi) - (Oc-Oi)

Astrocytes, oligodendrocytes are what origin

Neuroectoderm (microglia-monocytes in the bone marrow.)

Measles its genome codes for several viral stuctural prteins, including membrane-boud hemagglutinin (mediates cell surface adhesion) and matix protein (important for viral assembly).

Neurologic: 1) Encephalitis (within days) 2) Acute disseminated encephalomyelitis (within weeks") 3) Subactue sclerosing panencephalitis (within years) Prevent: Live attenuated measles vaccine. Vit A is recommended, acute measles infection depletes vit A stores, resulting in a risk of complications. In addition, it reduces risk of other comorbidities (pneumonia, diarrhea, encephalitis), recovery time and length of hospital stay. Subacute sclerosiing panencephalitis: rare complication of measles thta occurs in children or young adults several years after the initial infection. Measles with muated or absent matrix protein that prevents mautre enveloped virion particles from forming.

What causes the green color of pus and sputum in bacterial infections?

Neutrophil myeloperoxidase, contains within azurophilic granules of neutrophils and catalyzes the production of hypochlorous acid (bleach) from hydrogen peroxide during the phagocytic respiratory burst.

Parkinson's and nigrostriatal degeneration

Nigrostriatal degeneration in Parkinson disease reduces activity of the thalamus and its projections to the cortex, resulting in bradykinesia and rigidity. Pts with medially intractable symptoms of parkinson disease may benefit from high-frequency deep brain stimulation of the globus pallidus internus or subthalamic nucleus as it promots thalamo cortical disinhibition with improved mobility.

Most important factors involved in coronary blood flow autoregulation:

Nitric oxide and adenosine. NO is the most important mediator of cornary vascular dilation in large arteries and pre=artiolar vessle. It is synthesized from arginine and oxygen by endothelial cells and causes vascuar smooth muscle relaxation by a guanylate cyclase-mediated cGMP second messenger system. Adenosine, a produc of ATP metabolism, acts as a vasodilatory element in the small coronary arterioles.

Verapamil has little effect on skeletal muscle. WHy?

No dependence on extracellular calcium influx. Skeletal muscle is resistant to the effect of calcium channel blockers as it does not require an initial influx of extracellular calcium for excitation-contraction coupling. There is a physcial interaction between the 2 channels that trigger sarcoplamic calcium release.Elaborate T tubules. WHERE AS: Cardiac and smooth muscle cells dependon on extracellular ca influx into the cells via L-type calcium channels for excitation-contraction coupling, and this calcium influx is blocked by calcium channel blockers. Cardiac: THe release of intracellular calcium binds to troponin, allowing actin and myosin to interact and cause muscle contraction. Elaborate T tubules. Vascular smooth muscle cells: have a similar sequence of events after initial depolarization, however a calcium-calmodulin complex (instead of calcium-troponin complex) faciliates the interaction between actin and myosin. No T tubules

Exposure to plants and soil can be assoicated with bacterial infections including:

Nocarida and fungal infections such as sporotichosis.

Opsoclonus-myoclonus (spasmodic jerky contraction of groups of muscles)

Non-rhytmic conjugate eye movements associate dwith myoclonus describe opsolcloun-myoclonus syndrome.Associated with neuroblastoma. This tumor is the most common extracranial childhood ca. It develops from neuroblast loacted in the adrenal medulla. N-myc amplification increased catecholamines in urine mean 2 years old Histo: soid sheets of small cells with dar nuclei and scant cytoplasm (small blue round cells)

Transketolase

Number 6. is an ezyme of the pentose phosphate pathway that uses thiamine B1 as a cofactor. ALl rxns of the pentose phosphate pathway occur int he cytoplasm.

Obesity and lung volumes

Obese patients typically have increased respiratory rates with reduced tidal volumes (rapid-shallow breathing). The most common indicator of obesity related disease is a reduction in expiratory reserve volume ERV, which is the maximum volume of air that can be expired after a normal tidal expiration. Obesity has minimal effect on residual volume RV, but functional residual capacity, which is the sum of RV an ERV, is reduced due to the marked reduction in RV.

Stimulation of what nerve helps pts with OSA?

Obstructive sleep apnea is a problem of the pharynx not larynx hypoglossal nerve helps move the tongue forward slightly, increasing the anteroposterior diameter of the airway.

Anterior hip dislocation

Obturator (thigh adduction)

What nerve causes Adduction of the Thigh and what can cause damage to it?

Obturator: Exists throught hte obturator foramen, supplies the obturator externurs muscle and the thigh adductor muscles (adductor longus, brevis and magnus) sensation to the distal medial thigh. Nerve injury compression due to: pelvic trauma, surgery, or tumor (bladder ca).

Somatostatin receptor agonists

Octreotide inhibit bioactive amine release and are used to tx diarrha in pts with carcinoid synrome and vasoactive intestinal peptide secreting tumors. THey are also used to treat esophageal variceal hemorrhatge.

Where are beta-1 receptors found?

On Cardiac tissue and on renal juxtaglomerular cells. Selective beta blockers metoprolol decreased heart rate and contractility and block catecholamine-induced renin release by the kidney.

Difference between open and closed angle glaucoa

Open-angle: chronic glaucoma, aqueous fluid doesn't drain well out tof the eye, the trabecular meshwork filter may have microscopic particles cloggin it. USe: Pilocarpine Timolol Carbachol: pupilary constriction. Closed angle: acute glaucoma, the iris bows forward and completely blocks fluid ac cess to the trabecular meshwork entirely. THe pressure builds up in the a positive feedback loop, the pt has excruciating eye pain, and vision is lost quickly. Tx Pilocarpine, Timolol. DONT use phenylephrine.`

In the US the majority of overdoses are from

Opioids (include prescrption pain meds and heroin)

Loperamide

Opitate, agent that decreases gastrointestinal motility can help decrease the volume of diarrhea by slowing intestinal transit time and allowing greater net fluid resorption, but it doesn't improve nutrient absorption.

Subperiosteal resorption with cystic degeneration?

Osteitis fibrosa cystica which caused by primary hyperparathryoidism. skeletal findings involve the cortical compact bone in appendcular skeleton (the pectoral girdle, pelvic girdle, and limbs). Subperiostel thinning is characterisc feature and ppears radiolgocially as subperiosteal erosions in phalanges of the hand, a granular salt and pepter skull and osteolytic cyst int he long bones.

Bone specific alkaline phosphatase reflect

Osteoblastic activity

Persistence of the primary spongiosa in the medullary cavity with no mature trabeculae is a classic finding in

Osteopetrosis (marble bone dz). Osteopetrosis is caused by decreased osteoclastic bone resorption, which results in accumulation of woven bone and diffuse skeletal thickening.

Trabecular thinning with few interconnections:

Osteoporosis (porous bones) represent loss of total bone mass. After menopause, declining estrogen levels accelerate the loss of bone mass mainly through a decrease in osteoblastic activity and an increase in osteoclastic activity. Osteoporois involves the trabecular bone, or spongy, bone. Seen in dorsolumbar vertebral bodies or the neck of the femor. Adult skeleton is made up of trabecular and corticol bones. Trabecular bones: are called spongy, or cancellous bones. It is metabolically more active because its large surface area. Cortical bones (long bones) contribute by serving as mechancal support and sites of muscle attachment. Most of the appendicular skeleton (the limbs) is cortical bone.

Crohn disease is associated with what kind of kidney stones and why?

Oxalate kidney stones, impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption. When the wall of the terminal ileum is inflamed, bile acids are lost in the feces. Loss of bile acids causes impaired fat absorption. The excess lipids in the bowel lumen bind calcium ions, and these are excreted with the feces. In healthy bowel, dietary calcium binds to dietary oxalate producing insoluble calcium oxalate salts that promote oxalate excretion. In crohn disease, ca binds to lipids instead and become unabailable for complexiing with oxalate. As a result oxalate abotion is increased promoting the formation of oxalate kideny stones.

Pyruvate decarboxylation

Oxidative decarboxylation of pyruvate by pyruvate dehydrogenase requires thamine pyrophosphate (TPP), a derivative of thiamine (B1). Alcoholics may be prone to thiamine def.

ECG P wave PR QRS T ST QT

P wave: atrial depolarization PR interval:period from the beginning of atrial depolarization to the begining of ventricular depolarization. Beta blockers prolong the PR interval QRS: ventrical depolarization. not affected by beta-adrenergic blockers. A widened QRS complex can occur in the setting of ventricular automaticity, left or right bundle branch blocks or ventricular pacemakers, T: wave represents ventricular repolarization. MI causes T wave inversion. ST : ST is a period of inactivity between ventricular depolarization and repolarization. STdepression or elevation = MI QT= ventricular electrical systole. Long QT can be caused by antiarrhythmics such as quinidine and sotalol.

Difference between Pilocytic astrocytomas and medulloblastoma?

P. A. has both cytic and solid components, where medulloblastoma are always solid.

Amiodarone and trimethoprim are

P450 inhibitors

Metastasis to the bone

PB/KTL : prostate, breast, kidney, thyroid, and lung.

AMA

PBC (primary biliary cirrhois. presents with cholestatic symptoms (pruritis, jaundice, malabsorption

PTH MOA

PTH stimulates the formation of cyclic AMP via the G protein/adenylyl-cyclase pathway. The main action of PTH on bone is increased bone resorption. PTH acts on osteoclasts by an indirect method. It is osteoblasts that have PTH Receptors. PTH causes osteoblasts to increase the production of RAN-ligand and monocyte colony-stimulating factor. these two factors stimulate osteoclastic precursors to differentiate into bone-reabsorbing, mature osteoclasts. Also PTH decreses the release of osteoprotegerin OG which is a decoy receptor for the RANK-ligand. OPG decreases the interaction of RAN-ligand on osteoclasts. Lower levelsof OPG allow more interaction between the RANK0ligand and its osteoclastic receptor, causing an inccrease in bone turnover.

High calcium levels with low PTH

PTH-independent causes of hyper hypercalcemia (PTH is appropriately suppressed by high calcium levels). This could be caused y PTH-independed hypercalcemia uch as humoral hypercalcemia of malignancy, Vit D toxicity, excessive ingestion of ca, thyrotoxicosis and immobilization.

What is innervated by the myelinated A-beta fibers and mediate touch, proprioception, and vibratory sensation?

Pacinian and Ruffini Pacinian corpusules are rapidly adapting mechanorectpors located int he subcutaneous tissue of the skin, mesenter, peritoneum and join capsule. Ruffini is slowly adapting mechanoreceptors that exist int he skin, subcutaneous tissue, and joint capsule.

Disorganized lamellar bone structure in a mosaic pattern

Paget dz of bone. Serum ca and phosphorous are norma.

Lambellar bone structure resembling a mosaic

Paget's dz of the bone involves only focal areas of skeleton. The disease process starts as marked osteoclastic activation in particular locations, followed by increased osteoblastic activity. The net result is a focal fromation of abnormal bone. The new collagen is laid down in a haphazard manner, in leiu of the linear deposition in normal bones. The end product is a mosaic pattern of lamellar bone, where irregular sections of lamellar bone are linked by cement lines. Cement lines respresent previous ares of bone resorption.

Pancreatic development

Pancreas divisum occurs when the ventral and dorsal pancreatic buds fail to fuse, the dominant dorsal duct opens into the duodenum via the minor papilla (drains the majority of the pancreas). The smaller ventral duct opens into the major papilla, dreans the inferior posterior portion of the head and uncinate process. Ventral pancreatic bud: uncinate process, inferior/posterior portion of thehead, and the major pancreatic duct of wirsung. Dorsal: body tail, most of the head.

pancreatic pseudocyst

Pancreatic pseudocyst is a common complication ofo acute apncreatitis. It is a collection of luis rich in enzymes and inflammatory debris. Its wall consist of granulation tissue and fibrosis. Unlike true cysts, pseudocyts are not lined by epithelium.

Paneth cells

Paneth cells, which occur in small groups at the base of intestinal crypts, are both pagocytic and secretory, thereby providing first line immune defense again microoganisms. They secrete lysozymes (an enzyme that dissolves the cell walls of many bacteria and defensins (polypeptides with antimicrobial properties)

Cervical cytology is also called the:

Panpanicolaou test (used for HPV test)

What parasite has dx with this: Parasite eggs in the stool: Perianal egg deposition: Proglottids in the stool: Rhabditiform larvae in the stool: Trophozoites and cysts in the stool:

Parasite eggs in the stool: Schistosoma mansoni or S. japonicum Perianal egg deposition: Enterobius vermicularis Proglottids in the stool: Multi segements are called proglottids. They are sheld from the distal end of the worm and can be detected in the stool of infected individuals. Taenia solium, T saginata, Diphyllbothrium latum are flatworms made up of multiphle segments. Rhabditiform larvae in the stool: Stronglyoides Trophozoites and cysts in the stool: Intestinal protoxal infections Giardia lamlia and Entamoeba histolytica.

Nonenveloped single-stranded DNA virus

Parvovirus B19. aplastic crisis (anemia) limited to affecting erythrocytes not aplastic anemia (bone marrow failue manifesting as pancytopenia).Parvovirus B19 infects erythrocyte precursors and can cauese an aplatic crisis (red cell aplasia only) in patients with preexcisting hematologic disease (sickle cell anemia, hereditary spherocytosis)/

Aplastic anemia

Parvovius B19, epstein-barr virus Drugs: Carbamazepine, chlorampenicol, sulfonamides pancytopenia and spenomegaly AA are acquired from a direct toxic insult or T-cell response leading to apoptosis of pluipotent stem cells. Etiology usually unknown (Chemotherapy, benzene (gasoline, tobacco smoke), carbamazepine (anti epileptic) and viral infections (hepatitis, epstein-barr virus).

Organisms causing soft-tissue infections

Pasteurella, streptococci and staphylococci.

Epithelial ovarian cancer

Pathologic findings include anaplasia of epithelial cells with invasion into the ovarian stroma along with multiple papillary formations with cellular atypia.

Adult male swelling in the face and ankels, proteinuria and large RBC cast, light microscopy reveals cellular proliferation, focal necrosis, and cresecent formation of most golmeruli. Immunofluorescent microscopy, there are no immunoglobulin or complement deposits.

Paui immune RPGN

Acantholysis

Pemphigus vulgaris

how do you treat GAS

Penicillin

Treat GAS

Penicillin to prevent acutte rheumatic fever\mitral valve is most commonly affected and gradually thickens fibroses and calcified, eventually requiring valvotomy and more invasive surgical interents.

What do you use to treat Pneumocystis pneumonia

Pentamidine.

Lymphangiosarcoma

Persistent lymphedema (chronic dilatation of lymphatic channels) predisposes to the development of lymphangiosarcoma, a rare malignant neoplasm of the endothelial lining of lymphatic channels. 10 years after radical matectomy with axillary lymph node dissection for breast ca.

Tonic-clonic seizures

Phenobarbital treat tonic-clonic seizure (grand mal) is what most people think of when they think of a convulsive seizure. A person loses consciousness, muscles stiffen, and jerking movements are seen. These types of seizures usually last 1 to 3 minutes and take much longer for a person to recover.

Transmural inflammation with fibrinoid necrosis, black stools, muscle pain,homogeneous eosinophilic arterial wall necrosis, and areas of internal elastic lamina disruption:

Polyarteritis Nodosa (Medium-vessel vasculitis) ABD Pain

Transmural inflammation of the arterial wall with fibrinoid necrosis

Polyarteritis nodosa.

Virulence factors of S. pneumoniae

Polysaccharide capsule, IgA protease (inactivates secretory IgA), adhesins (adhesion to epithelial cells), and pneumolysin(cytotoxin that causes pore in cell membrane and cell lysis. WITHOUT the polysaccharide capsule that inhbitis phagocytosis.

T cell maturation

Positive selection takes place in the cortex Negative selection takes place in the medulla.

Lesions of the occipital cortex

Posterior cerebral artery occlusion can produce contalateal homonymous hemianopia with macular sparing.

What should you give someone who was exposed to radioactive iodine isotopes?

Potassium iodide competitively inhibits thryoid uptake of radioactive iodine isotops and is administered follwing nuclear accidents to protect the thyroid and prevent development of tradiation-induced thyroid ca.

Immune response of corticosteroids

Prednisone. Neutrophilia (neutrophil demargination), immunosuppression, increase risk of infection. Increased surfactant production. Corticosteroid receptors also have widespread physioloic effects, including those on circulating leukocytes and vascular endothelial cells. Neutrophil counts increase following administration of the durg as a result of demargination of neutrophils previously attached to the vessel wall. THerefore, neutrophil recruitment to fight infection in tissues is decreased potentially contributing to the increased infection risk. Increased neutrophil count and decreased lymphocyte, monocyte, basophil and eosinophil counts.

What are specific features of hyperthyroidism due to Grave's dz?

Pretibial myxedema and exophthalmos, infiltrative dermopathy, periorbial edema and eye movements. This is caused by the autoimmune response directed against the TSH receptor distributed throughout the body, particularly on adipocytes and fibroblasts. Accumulation of glycosaminoglycans within the affected tissues.

Spongiform transformation of gray matter

Prion protein PrP is normally found in neurons and has a a-helical stucture. If the conversion of a-heliz into b-pleated sheet occurs, the protein becomes resistant to protease. Accumulation of this abnormal protein in gray matter is thought to cause prion diz. Affected gray matter undergoes spongiform change. Vacuoles form within the cytoplasm of neurons and neutrophils. Later they grow bigger and form cysts, involving larger area of the brain tissue. Characteristic micorscopic fidinding are vauooles in the grawy matter (spongiform encephalopathy with no inflammatory changes). spongiform: having, relating to, or denoting a porous structure or consistency resembling that of a sponge.

what drug decreases the renal clearance of penicilins by inhibiting the tubular organic acid secretion system?

Probenecid

IgA protease

Produced by strep pneumo and Neisseria gonorrhoeae. That cause cleavage of IgA antibodies, preventing them from interfering with bacterial adhesion to mucous membranes.

Glutamate dehydrogenase

Produces ammonia for use in the urea cycle

Cytoplasmic inclusions in oligodendrocytes

Progessive multifocal leukoencephalopathy PML

Why are pts treated with heparin or LMWH during initiation of warfarin tx?

Protein C and protein S are endogenous antithrombotic molecules that are also vit K dependent. Due to their short half-lives in circulation, these molecuels are depleted first during initiation of warfarin tx, causing a transient procoagulant state.

Lesions of thin stratum granulosum and prominent parakeratotic stratum corneum with occasional foci of neutrophil accumulation.

Psoriasis: Psoriasis appears to be caused by CD4+ T cells that activate CD8+ T cells in the epidermis after interacting with antigen-presenting cells in the skin. THe interactions between these two types of T cells, the dendritic cells and the neighboring keratinocytes result in the production of cytokines (TNF, IL-12, IFN-y) and keratinocytes growth factors. In response, keratinocytes proliferation inflammation and angiogenesis occur. Psoriasis is characterized y hyperparakeratosis, acanthosis, elongaton of rete ridges , mitotic activity aove the epidermal basal cell layer, and a reduced or asent stratum granulosum. The epidermal cell layer superir to the dermal papillae may e thinned and contain dilated blood vessels, a finding responsible for the pinpoint bleding evident when the scale is removed fromthe plaque (auspitz sign). Neutrophils may form spongiotic clusters in the superficial dermis and the parakeratotic strm corneum (Munro microabscesses).

Eisenmenger syndrome

Pulmonary vascular resistance contines to increase and eventually right to left shut

diagnosis chest pain

Pulmonary/Pleuritic (pleurisy, pneumonai, pericarditis (worse when laying flat, relieved by leaning forward), PE): sharp/stabbing pain, worse with inspiration.

Pulse pressure

Pulse pressure = Peak systolic arterial pressure - end diastolic arterial pressure

Anti-cyclic citrullinated peptide antibodies

RA, subcaneous nodule son legs ulcers.

Casts RBC Casts WBC Casts Fatty oval fat bodies Casts Muddy broud granular Casts

RBC Casts: malinant htn, glomerulonephritis (PDGN) WBC Casts: Acute pyelonephritis, transplant rejection, tubulointertitial inflammation Fatty oval fat bodies Casts: Nephrotic syndrome Muddy broud granular Casts: Acute tubular necrosis.

Megaloblastic anemia

RBC mean corpuscular volume of more than 100fL is suggestive of megalobastic anemia. Over RBC macrocytosis can also occur in liver z, hypothyroidism, and alcoholic liver did. MCVs greater than 110 fL are typically seen only with fit B12 and fold acid anemias. Neurological dysfunction is only seen in its with fit B12 def.

drugs for treatment of tuberculosis: MOA and SE

RIPE Rifampin- Inhibition of bacterial DNA dependent RNA plymerase- GI SE, rash, red-organce body fluids, cytopenias Isoniazid- Inhibition of mycolic acid synthesis- Neurotoxicity (give B6) hepatotoxicity Pyrazinamine- unknown- hepatotoxicy, hyperuricemia Ethambutol- inhbition of arbinosyl transferase- optic neuropathy

tPA

Recombinant tissue plasminogen activator can be used to tx PE in pts who are hemodynamically unstable. Endothelial-derived TPA is limited primarily to the bronchial circulation, and spontaneous recanalization of the pulmonary artery is a slow process.

increased hematocrit levels above 48% but normal RBC mass?

Relative erythrocytosis cozd by aggressive diuretic tx for HR exacerbation

RCC Location

Renal cell carcinoma (Clear Cell Carcinoma) appears as cuboidal or plygonal cells with clear abundant cytoplasm and eccentric nuclei. IT seems golden-yellow on macroscopic examination due tot he high glycogen and lipid contant. It is in the epithelium of the proximal renal tubules, pts 60-70 yrs old. Risk factors are smoking and obesity.

Pt who has flank pian, hematuria, elevated lactate dehydrogenase (cell necrosis), and a wedge-shaped right kideny lesion on CT,

Renal infartion Systemic thromboemboism commonly occurs with atrial fibrillation as the irregular heart contraction can lead to clot formation. Can occur following MI and endocarditis. Coagulative necrosis. The simulaneous development of stroke, intestinal or foot ischemia and renal infarction is an embolic phenomena. These emboli may arise from left atrial or ventricular clots or valvular vegetations among others.

What cells produce erthropoietin?

Renal peritubular cells.

ACE inhibitors dilate the glomerular efferent arteriole, lowering intraglomerular pressures and reducing the risk of Chronic glomerular injury.

Replacing an ACE inhibitor with an ARB will eliminate cough with providing the same long-term renovascular benefits.

Respiratory and gastic glands in Cystic fibrosis. Sweat glands in CF:

Respiratory and gastric glands: the CFTR protein is a chloride channel that normally fuctions to increase the salt and water content of mucus by secreting Cl- ions into the lumen and by inhiting the apical Na+ chennel (ENaC) that asorbs Na_ into the cell. Therefore, impaired CFTR functioning results in reduced luminal secretion of chloride and increased luminal sodium absorption, leading to dehydrated viscid mucus. Sweat glands: here, the CFTR channel acts to reduce the sald content of seat by absorbing luminal chloride and activiating ENaCto increase luminal sodium absorption. CFTR therefore result in the production of hypertonic sweat with high chloride content. Therefore in CF, increased ENaC activity along hte nasal mucosa larger aounts of soidum will e absorbed from the salt solution that is applied during measurement of the nasal transepithelial potential difference. This results in a nasal transepithelial potential difference that is more negative than normal due to the chloride ions retained at the mucosal surface.

Acute dystonic rxn (spasmodic torticollis)

Result from the antipyschotic property of D2 antagonism in the nigrostriatal pathway. Int he stiatum, the inhibitory effects of dopaminergic neurons (D2) are normally balanced by the excitatory actions of the muscarinic cholinergic neurons (M1). Strong dopaminergic blockade causes an excess of cholinergic activity, resulting in extrapyramial side effects (acute dystonic rxs, akathisia, parkinsonism). Medications with M1 receptor antagonist properties, such as benztropine or the antihistamine diphenhydramine, help re-establish the dopaminergic-cholinergic balance and effectively treat acute dystonia.

Diphenydramine moa

Reversible inhibition of H1 receptors, a sedating anti-histamine that may be used at nighttime to reduce the time to sleep onset and to increase the depth of sleep. However antihistamines are not thought to have significant muscle relaxants or anticonvulsant actions.

Interstitial pneumonitis and fibrosis

Rheumatoid arthritis can cause a variety of pulmonary manifestations, the most common is a form of interstitial lung disea similar to idiopathic interstitial pneumonia. Methotrexate is a durge frequently used for RA that can also cause intersititial pneumonitis and fibrosis.

Signs of colon cancer Right sided: Left sided: Rectosigmoid:

Right sided: anemia, weight loss and fatigue. Left sided: constipation Rectosigmoid: hematochezia (rectal adenocarcinoma) (Tebesmus- painful straining on defecation and small caliber stool.

Ristocetin in vWF and Bernard-Soulier syndrome

Ristocetin activates GP1b receptors on platelets and make them available for vWF binding. When the vWF level is decreased, there is poor platelet aggregation in the presence of ristocetin. When normal plasma that contains vWF is added, appropriate aggregation occurs. vWF vinds glycoprotein 1b receptors on platelets after endoendothelial damage and carries factor 8. In Bernard-Soulier syndrome (hereditary def of GP1b receptors) this is characterized by thrombocytopenia, enlarged platelets and mucocutaneous bleeding. Platelet aggregation to ristocetin will be abnomral. But will not normalize when normal plasma is added because vWF levels are already normal.

What is the microscopic examination of pilocytic astrocytoma?

Rosenthal fiber. "Pass out Roses fibers to all the animals in the kingdom"

Rash disruption disquisition between Rubella and Roseola?

Roseola infantum (HHV-6) - high fever, (some febrile seizures), then 3-5 day follwed by an erythematous maculopapular rash. That starts on the trunk and spreads to the face and extremities. Rubella and measles: present as a maculopapular rash on the face and then spreads to the trunk and extremities. In addition, of have forchheimer spots ont he soft palate and measles is characterized by pathognomonic Koplik spots on buccal mucosa. also: Streptococcus pyogenes (GAS) can cause acute exudative pharyngitis that is associate with fever, headach and abdominal pain school age children. It can also be accompanied by scarlet fever, a diffuse "sandpaper" textured rash most prominent in skinfolds (groin, axillae, antecubital fossa)

Reoviridae

Rota virus and coltivirus are responsible for Colorado tick fever. This infection occurs primarily in the Rocky Mountain states and is characterized by fever, vomiting, myalgias, and weakness. A maculopapular rash is not seen.

Segmented viruses:

Rotavirus, orthomyxoviruse, reoviruses, bunyaviruses, and arenaviruses. Remember the BOAR mnemonic

Clear Cell Carcinoma

Rounded and polygonal cells with abundant clear cytoplasm. These finding fit the classic hitological description of clear cell carcinoma, the most common subtype of renal cell carcinoma. The cytoplasm appears clear due to the hight glycogen and lipid content of the tumor. For the same reason this neoplasm is often gold-yello on macroscopic examination. Erythrocytosis and polycythemia can occur due to constitutesecretion of erythropoietin (accounting for the its elevated hemaocrit). Hypercalcemia due to synthesis of parathyroid hormone-related peptide is also common. Renal cell carcinoma can metastasize to the lungs - most common spot, then bone, then lymph nodes, adrenal, liver, and over organs may be involved.

Rubella vs Rubeola

Rubella (German measles) both have a maculopapular rash that begins on the face and spreads to the trunk and extremities. Rubella rash spreads faster and darken or coalesce. Postauricular and occipital lymphadenopathy is particularly common in rubella (TOGAVIRUS) Rubeola (Measles): Paramyxovirus.

Eosinophil activation

Rxn to allergens and parasites, hypersensitivity rxns to drugs and some hematologic malignancies.

what cells secrete HCO3?

S cells- Secretin from the small intestine. THey increase pancreatic HCo3 and decrease gastic H+.

Middle ear to contiguous tissues to meninges

S.pneumoniae

What kind of heart sound does Left ventricular hypertrophy have?

S4. Just before S1. Decrease in left ventricular compliance. S4 in young pts is always pathologic. Associated with restrictive cardiomyopathy.

CT scan of the brain without contrast

SAH if CT scan does not who SAH, but clinical suspicion remains hight, a lumbar puncture need to be performed for evaluation - look for xanthochromia

Liver fluke infection

SE asisa present acutely with fever, right upper quadrant pain, jaundice and eosinophilia. Infection of the biliar tree is associated with the formation of brown pigment gallstones.

Major depressive disorder

SIGECAPS Sleep distrubance Loss of Interest Guilt or feeling of worthlesess Energy Concentration Appetiate Pyschomotor retardation or agitation Suicidal idealiation Tx with SSRI: which block the serotonin transporter. Target neurotransmitters are serotonin or norepinephrine

Antiphospholipid antibody syndrome

SLE increased PTT, hypercoagulable state. (anticardiolipin antibody, beta-2-glycoprotein-1, recurrent pregnancy loss.

SLE against blood cells vs against kidney

SLE- due to the formation of autoantibodies against blood cell (type 2 hypersensitivity). In contrast, lupus nephritis is caused by immune complex deposition within the glomerulus (type 3 hypersensitive) Anemia is SLE is caused by autoimmune hemolysis, which develops due to formation of warm IgG antibodies against erythrocytes. It is characterized by spherocytosis, a positive direct coombs test and extravascular hemolysis.

What stain is used for Cryptococcal meningoencephalitis? What do you use for treatment?

Sabouraud agar Amphotericin B, Flucytosine and fluconazole.

Vessels of the circle of willis

Saccular berry aneurysm are the most common cuase of subarachnoid hemorrhage. Ehlers-Danlos syndrome and ADPKD

Pt with polycystic kidney dz and mental confusion probably had a rupture of a berry aneurysm SAH

Saccular berry aneurysm are the most common cuase of subarachnoid hemorrhage. Ehlers-Danlos syndrome and ADPKD Symptoms of cerbral vasospasm include an altered mental status as well as focal neurological deficits. Calcium channel blockers following SAH in prevention of cerebral vascular spasm.

What to you use to dx Trichomonas?

Saline microscopy (wet mount) of the discharge.

What gram negative organisms grow at low temps and can gain access to the lymphatics and proliferate in the mesenteric lymph nodes?

Salmonella typhi and Yersinia enterocolitica (Y. E cozoes inflammation around the lymphoid tissue and round the appendix and terminal ileum "pseudoappendicitis" whic leads to lower quadrant pain that can be confused with actue appendicitis.

Ineffective intramedullary erythropoiesis results in:

Seen in beta-thalassemia, myelodysplasia and results in indirect hyperbilirubinemia.

What does vibrio cholera enterotoxin stimulate the release of?

Serotonin release from enterochromaffin cells int he GI tract, which contributes to the extreme fluid secretion seen in cholera.

Sertoli and Leydig cell with internal and external development?

Sertoli cells secrete mullerian-inhibiting factor (MIF) which causes the paramesonephric (mullerian)ducts to involute. Without Sertoli cells or MIF, the paramesonephric ducts go on to develop into the female internal genitalia. Leydig cells secreete testosterone which stimulates the mesonephric (Wolffian)ducts to develop into male internal genitalia (epididymis, vas deferens). Testosterone is converted into DHT, which induces male extenal genitalia.

Shigella go after what cells?

Shigella go after microfold (M) cells at the base of mucosal villi within a Peyer patch region of the ileal mucosa. M cells sample gut lumen contents and transfer antigens to their basal lamina within endosomes. At the base of the cell, macrophages and lymphcytles ready to mount an immune response await within a special pocket. Shigella penetrates the mucous membrane by passing through M cells via endocytosis. It subsequently lyses the endosome, multipiles an dspreaseds lateally into other epithelial cells.

Gram negative rod, non-motile, non-lactose fermenting organism tah does not produce H2S when grown on triple sugar iron agar?

Shigella, mucosal inasion of M cells that overlie Peyer's patches, escapes the phagosome and spread laterally to other epithelial cells via actin polymerization.

Where should a thoracentesis be preformed? Mid clavicular line: Mid axillary: Paravertebral line (posterior scapular):

Should be performed above the 8th rib in the midclavicular line, the 10th rib along the midaxilary line, and the 12th rib along the posterior scapular or paravertebral line. Insertion of the a needle lower than thees points increases the risk of penetrating abdominal stuctures and insertion of the need onthe inferior margin of the rib risk stricking the subcostal neurovascular bundle. The intercostal vein, artery, and nerve are located subecostal.

Livedo reticularis with normal pulses is a sign of what and how does this effect your kidney?

Sign of embolism, following an inasivie vascular procedure is suspicious for atherocembolic disea, in which cholesterol-containing debris gets dislodged from larger arteries and lodges in smaller vessels. This can causes Acute kidney injury (oliguria, azotmia) ****Cholesterol is dissoved during tissue preparation for microscopic evaluation, leaving needle-shaped clefts that partially or completely obstruct the arcuate or intralobular renal arteries.*** Other organs that may be involved are the gastrointestinal tract and the central nervous system, including the retinal vessels.

Acrochordons

Skin tags pedunculated ooutgrouwht of normal skin, seein in areas of friction.

What lung can is associated with Lambert-Eaton (can present with impotence, hyporeflexia or areflexia, autonomic symptoms and incremental response to repetitie stimulation.

Small cell ca

If a pt has both tonic clonic and absence seizures

Sodium Valproate

The lumbar spine is spared in what..but affected in what...

Spared in RA affected in OA (also affects the thoracic spine)

Mineralocorticoid receptor antagonists

Spironolactone, epleronone- improve survival in its with congestive heart failure and reduced left ventricular ejection fraction. They should not be used in its with hyperkalemia or renal failure.

Protein A

Staph aureas which is a structure anchored to the peptidoglycan cell wall. Protein A is an IgG binding protein that bins to the Fc region of the antibody and plays a role in inhibiting phagocytosis. Protein A is an IgG binding protein that binds to the Fc region of the antibody and plays a role in inhbiting phagocytosis.

Bx of a mass reveals uniform, round, medium sized tumor cells with basophilic cytoplasm and a proliferation fraction Ki-67 fraction of >99%. Diffuse medium-sized lymphocytes with high mitotic index.

Starry Sky appearance is usually seen. Epstein Barr virus, Burkitt lymphoma.

Thyroxine secretion

Struma ovarii is a germ cell tumor of the ovary that can cause hyperthyroidism by secreting thyroxine. mature thyroid tissue.

Saccular aneurysm prutpure is typically associated with

Subarachnoid hemorrhage as opposed to intraparenchymal hematoma. Thunder clap headache

Difference between sublingual no and long-acting isosorbide dinitrate

Sublingal has a rapid onset action within 205 mintues, oral mucosa to venous circulation. Isosorbide dinitrate is absorbed via the gastrointestinal tract and undergoes extensive first-pass metabolism in the liver prior to release in the systemic circulation. This leads to low bioavailability and the need for much higher dose of oral formulations as compared to sublingual nitroglycerin.

Hirschsprung disease

Submucosal (Meissner) and myenteric (Auerbach) autonomic plexi are absent in the affected segment. Failure of neural crest migration. If large area of bowel: failure to pass meconium, bilious vomiting and abdominal distention. If short area of bowel:constipation, abdominal distention, and falure to thrive are typical.

Para-aminobenzoic acid (PABA) is a folic acid precursor in prokaryotis.

Sulfonamids antibiotics are chemical analogues of PABA that inhibit the enzyme dihydropteroate synthestase, preventing bacterial conversion of PABA to folic acid. Humans lack the ability to convert PABA to folic acid and require dietary folate.

What nerve causes abduction ot hte thight

Superior gluteal nerve: Gluteus medium, gluteus minimus, tenso fascia lata. (Exists greater sciatic)

Iatrogenic (posterior hip dislocation or buttock injection)

Superior gluteal: Thigh abduction Inferior gluteal: Thigh extenstion

Shoulder abduction

Supraspinatus and deltoid

Tx of BPH

Tamsulosin and Finasteride

What refects osteoclast activity

Tartrate resistant acid phosphatase, urinoary hydroxyproline, and urinary deoxypyridinoline reflect osteoclastic activity, urinary deoxypyridinoline is the most reliable of the three. Pyridinioline covalently cross-links the collagen fivers, these cross-links are the most commonly used method in assessing osteoclastic activity.

Lymphoblasts ALL (Acute Lymphoblastic Leukemia)

TdT positive have high nuclear to cytoplasmic ratio, variable condensed nuclear chromatin and prominent nucleoli includes precurso B cell leukemia and T cell luekemia. You can tell the difference by looking at the CD marker CD 10 and 19 are B-ALL CD 1,2,5 are T-ALL Presents with lymphadenopathy, hepatosplenomegaly, fever, bleeding and bone pain. Neoplastic cells are pre-B or pre-T lymphoblasts.

Lactase def

Test the pH of the stool, undigested lactase causes acidification of the stool. So WILL SHOW A DECREASE IN stool pH. THe breath hydrogen content INCREASES by more than 20pm in lactase deficient pts after lactose load and can be measured in exhaled air by gas chromatography (breath hydrogen test) Indigested lactose causes an elevation INCREASE in stool osmotic gap (>125 mOsm/kg) indicating the presence of unmeasured anions in the stool. results in incomplete hydolysis of the disaccharide lactose in the monosaccharides glucose na galactose. THe hight amount of undigested lactose in the bowel attreact excess water in the bowel lumen, leading to osmotic diarrhea. In addition, bacterial fermentation of lactose produces short-chain fatty acids (acetate, butyrate and propionate), which lower stool pH (<6) and hydrogen gas, which causes flatulence.

Plactenta-like alkaline phosphatase (PLAP) is a nonspecific tumor marker that can e increased in:

Testicular seminoma and other malignancies.

How does Testosterone, DHT and estrogen affect sexual development

Testosterone- internal male genitalia, sprematogenesis, male sexual differenitaion at puberty (muscle mass, libido) DHT: development of external male genitalia, growth of prostate, male-pattern hair growth. Estrogen: endometrial proliferation, developmetn of ovarian granulosa cells, breast development.

Tetralogy of Fallot

Tet spells - better with squatting 1. Pulmonary stenosis 2. Right ventricular hypertrophy 3. Overriding aorta 4. VSD

Tetanis

Tetanospasmin is a prtein toxin produced by C. tetani that can travel by retrograde axonal tranport into the CNS, the tetanospasmin heavy chain inhibitis release of glycine and GABA from inhibitory interneurons. Absence of these inhibitory neurotransmitters causes sustained muscle contraction or tetanus.Tetanus is prvented by immunization with toxoid that triggers the production of antitoxin antibodies (active immunity).

Antibiotics contraindicated during pregnacy Tetracycline Chloramphenicol Trimethoprim/sulfamethoxazole Aminoglycoside

Tetracycline: Teeth staining (use amoxicillin instead) Chloramphenicol: Graybaby syndrome, vomiting, lethargy, cardiopulmonary collapse. Trimethoprim/sulfamethoxazole: Neural tube defect, for sulfa: use during the tird trimester can displace iliruin ound to serum albumin and theorectically increase the risk of kernicterus in the neonate. Aminoglycoside: Ototoxicity, vestibulotoxicity, ataxia ACE and ARB: impair renal function and cause fetal anuria and oligohydramnious. Opioids: withdrawal (neonatal abstinence syndrome) after birth- irritability, tremors, sweating, yawning and feeding difficulties.

Cardiovascular abnormalities with DiGeorges?

Tetralogy of fallot and interrupted aortic arch.

Omphalomesenteric vitelline duce normally obliterates when?

The 7th week of embryonic development. Both enterocysts and Meckel diverticula result from a failure of obliteration involving the omphalomesenteric duct.

The HMP shunt and Ribulose-5-phosphate

The HMP shunt is also responsible for theproductoin of ribose 5-phosphate needed for the synthesis of nucleotides. From one molecule of gluose, the HMP shunt forms a feive carbon sugar, two molecules of NADPH and C02. The HUMP shunt consists of two different ypes of rxns: oxidative (irreversible and nonoxidateve (reversible). Transketolase (needs B1 as cofactor) and transaldolase carry out the nonoxidative reactions of HMP shunt. SOme cells do not use the oxidative phase reactions to roduce cytosoic NADPH, but all cells can synthesize ribose from fructose-6-phosphate using the nonoxidative reactions.

When going to do a surgery for removal of a large ovarian neoplasm withing the true pelvis the surgeon can palpate the right ureter immediately anterior to what structure?

The Internal iliac artery

Nonseminomaous germ cell tumors, can secrete high levels of hCG which can cause what?

The alpha subunit of hCG, TSH, LH and FSH are identical, and the eat subuntics of hCG and TSH share significant sequence homology. because of structural similarity, hCG can ind to the TSH receptor (although with much lower affinity than TSH). As a result, very hight circulating levels fo hCG can over-stimulate the thyroid gland causing paraneoplastic hyperthyroidism.

Azygos veins

The azygos vein drains blood from the esophageal veins into the superior vena cava. The formation of esohageal varices in the setting of protal hypertension provides collateral drainage from the portal venous system to the azygos system. THe azygos vein also provides collateral circulation between the superior and inferior vena cava and can become enlarged with caval obstruction.

What bacteria has a plymer of D-glutamic acid residues and contibutes to virulence by inhibiting phagocytosis.

The capsule of Bacillus anthracis.

Carotid baroreceptor afferent and efferent nerves

The carotid sinus reflex has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the medullary via the Hering nerve, a branch of the glossopharyngeal nerve (1X). The efferent nerve is the carriers parasympathetic impulses via the vagus nerve CNX. Caroitd sinus pressure of massage stimulates the baroreceptors and increases the firing rate from the carotid sinus, leading to an increase in parasympathetic output and withdrawal of sympathetic output t othe heart and peripheral vascularture. The result is decreased blood pressure (peripheral vasodilation) and decreased cardiac output (decreased contractility/stroke voume and heart rate). In sensitive individuals, this response can cause severe bradycaria, hypotension and syncope.

What does a Carotid massage do?

The carotid sinus reflex has an afferent limb that arises from the baroreceptors in the sinus and travels tot he vagal nucleus and medullary centers via the glossopharyngeal nerve (9), whereas the efferent limb carries parasympathetic impulses to the SA and AV via the vagus nerve (10). Caroid sinus massage leads to increased afferent firing fro the carotid sinus, which in turn, increases vagal parasympathetic tone. This slows conduction through the AV node and prolongs the AV node refractory period, helping to terminate the reentrant tachycardia.

Chorda tympani

The chorda tympani is a branch of the facial nerve that originates from the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain. It joins the facial nerve (cranial nerve VII) inside the facial canal, at the level where the facial nerve exits the skull via the petrotympanic fissure.

Axillary nerver intervates

The deltoid and the teres minor muscle.

Sagittal sinus

The dural venous sinus are venous channels found between layers of dura mater in the brain. Certain conditions (malignancy, hypercoagulable states, and trauma) can result in thrombosis within the dural sinus.

Midproliferative phase

The glands are tuular, narrow and lined with pseudostratified, elongated mitotically active epithelial cells. The stratum functionale contains compact, nonedematous stroma. The uterine glands have ncreased in lenth and girth ut remina relatively straignt. No secretion are present in the glandular lumens. THe endometrium thickens, but the coiled spiral arteries remain limited to the deep layers. At the end of the proliferative phase, ovulation occurs. Endometrial bx at ovulation shows a late proliferative endometrium with coiled glands and occasional cytoplasmic vacuoles in the glandular epithelium.

Allergic Asthma finding

The granule-containing cells inthe sputum are most likely eosinophils and the crystalloid bodies are the most likely charcot-Leyden ctrystals (contian eosinophil membrane protein). Chronic eosinophilic brochitis in asthmatics involves bronchial wall infiltration by numerous activated eosinophils, largely in response to IL-5 released by allergen-activated TH2 cells.

Liquefactive necrosis

The infarcted CNS tissue is eventually replaced with a cystic astroglial scar. Lethal ischemic injury to CNS tissue results in liquefactive necrosis of affected cells, which involves the release of cytoplasmic contents and accompanying acute inflammation. Apoptosis is a programmed form of cell death that occurs in response to physiological stimuli or follwing irreparable sublethal cell injury, Liquefactive necrosis is characteristic for hypoxic injury to the CNS. Large amounts of lipids and lysosomal enzymes inthe nervous cells. The release of lysosomal enzymes from these ischemic neurons results in egration of the tissue in the ischemic region. Pgagocytic cells migrate to the area and remove the necrotic tissue leaving a cavity and astrocytes proliferate around the necrotic area to form the scar (Gliosis).

Deficiency of 5a-reductase type 2 results in diminished conversion of testosterone to DHT in the male urogenital tract. In the male fetus with this genetic defect...

The internal genitalia develop normally under the influence of testosteone, but the external genitalia do not develop properly due to the lack of DHT, resulting in male pseudohermaphroditism. The genitalia at birth can range form small phallus with hyposapdias to ambigouse or female type genitalia. Such chidlren are often raised as females until they reach puberty, when hight levels of testosterone and the action of 5a-reductase type 1 result in masculinization with male-pattern muscle mass, voice deepinging, penile and scrotal growth, and testicular descent.

Two types of gastric adenocarcinoma

The intestinal forms a solid mass that projects into the stomach lumen and is composted of grandular forming cuboidal or columnar cells. Closely resemble colon ca, showing well-formed glands. They tend to grow as nodular, polypoid, and well-demarcated masses that rapidly expand within the gastic lumen. These lesions often ulcerate/bleed and must be differentiated from peptic gastic ulcers by bx. Diffuse carcinoma (Linitis plastica) infiltrates the stomach wall and displays signet ring cells on light microscopy. Signet ring carcinoma consistt of cells that do not form glands. Cells often contian abundant mucin droplets that push the nucleus to one side and lead to the characteristic appearance of signet ring. Loss of the cell adhesion protein E-cadherin.

Afrial flutter

The isthmus between the inferior vena cava and the tricuspid annulus s the site of radio frequency ablation for atrial flutter

E. coli genome is required for the metabolism of lactose

The lac operon consists of a regulatory gene (i), promoter region (p), operator region (o), andthree structural genese (Z, Y, A). Z- codes for b-galactose, which is primarily responsible for hydrolysis of lactose to glucose and glactose. Y- gene codes for permease, a transmembrane enzyme that increases the permeability of the cell to lactose. A gene encodes for b-glactoside transacetylase, which transfersacetyle groups to b-galactosides and is unnecessary for lactose metabolism by E. Coli. Single mRNA molecule which codes for more than one protein is referred to as a polycistroinic mRNA, and while most prokaryotic mRNA molecule are ploycistronic, eurkaryotic mRNA is rarely polycistronic.

What does pulmonary capillary wedge pressure measure

The left atria Pulmonary capillary wedge pressure (PCWP) provides an indirect estimate of left atrial pressure (LAP)

What constant does demyelination effect?

The length constant, which is also known as the space constant, measure how far along an axon an electrical impulse can propagat. Distance at which the originating potential decreases to 37% of its original amplitude. Time constant-represents the time it takes for a change in membrane potential to acheive 63% of the new value. Lower time constants allow quicker changes in membrane potential, thus increasing axonal conduction speed. Myelination decreases membrane capacitance, which reduces the time constant. Demyelination would increased the time constant and lead to a slower impulse conduction.

M protein

The major virulence factor for streptococcus pyogenes (GAS), is present in the cell wall and has anti-phagocytic effects (inteferes with opsonization by the alternative complement pathway). It also binds to fibrinogen, resulting in inflammatory mediated release and vascular leakage.

Golgi tendon organ

The muscle spindle system is a feedback system that monitors and maintains muscle length, which the Golgi tendon system is a feedback system that monitors and maintains muscle force. GTO are sensitive to increases in muscle tension but relatively insensitive to passive stretch. The Golgi tendon organs are senory receptors located at the junction of the muscle and tendon that are innervated by group 1b sensory axons. GTO are connected in series with the contracting extrafusal skeletal muscle fibers. The 1b sensory axon from the FTOs contact inhibitory interneurons in the spinal cord, which in turn synapse with the alpha (a) motor neurons that innervate the same muscle. Thus the Glogi tendon circuit is a negative feedback system that regulates and maintains muscle tension. When a muscle exerts too much force, the GTOs inhibit contraction of the muscle, causing sudden muscle relaxation. This prevents damage to the musculoskeletal system.

What does minimal alveolar concentration (MAC) measure?

The potency of an inhaled anesthetic. It is the concentration of the anesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli (ED50). Potency is inversely proportional to MAC, the lower the MAC the more potent the anesthetic. The higher the arteriovenous concentration gradient the more increasing time it takes for the blood to become saturated which slows the onset of action.

What does the Central venous pressure measure?

The right atria The central venous pressure (CVP) is the pressure measured in the central veins close to the heart. It indicates mean right atrial pressure and is frequently used as an estimate of right ventricular preload. The CVP does not measure blood volume directly, although it is often used to estimate this.

What increase the concentration of Statins

The risk of severe myopathy is increased when statins are given concurrently with fibrates (gemfibrozil), which impair the hepatic clearance of statin and lead to the excessive bood levels. INcrease risk of myopathy is also increased with niacin or ezetimibe

Superior mesenteric artery syndrome

The transverse portion of the duodenum lies horizontally at the level of L3 between the aorta and superior mesenteric arteyr. Normally the AMA and aorta form an approximately 45 degree angle. Narrowing of the aortocmesenteric angle can occur with any condition that cuases diminshed mesenteric fat, including low body weight, recent weight loss, severe burns, prolonged bed rest, induces or catabolism a. It can also occur with pronouced lordosis or after surgical correction of soliosis, as this producedure lenthens the spine resulting in decreased mobility of the SMA.

Paroxysmal nocturnal hemoglobinuria

The triad of hemolytic anemia, hypercoagulability and pancytopenia. Acquired mutation in the PIGA gene that causes absence of the glycosylphosphatidylinositol anchor and associated deficiency of CD55 and CD59 complement inihbitor proteins. Absence of GPI anchor results in CD55 and CD59 deficiency and completment mediated hemolysis.

Chronic pancreatitis

The underlying biochemical feature of megalobastosis is a defect in DNA synthesis. In chronic alcoholics, megaloblastic macrocytic anemia can result from a nutritional def of Vit B12 or of flate, which impairs synthesis of purine and pyrimidine bases. Chronic pancreastitis, hepatomegaly, macrocytic anemia. Alcoholics often develop folic acid def within months or vit B12 within years Both def leads to megalobalstosis, the underling biochemical feature of which is a defect in DNA synthesis. Folic acid is a single carbon donor required for synthesis of purin and pyrimidine (thymidine) bases incorporated in DNA. RNA and protein synthesis may continue relatively unaltered, leading to a state of unbalanced cytoplamic growth with impaired cell division. Pancreatic insufficiency is also associated with Vit B12 def as pancreatic enzymes normally cleave R factor from B12 allowing B12 to bind to intrinsic factor and be absorbed.

Water under the bridge refers to?

The ureters course along the uterosacral ligament together with the vaginal artery before entering the bladder. The uterine artery courses within the cardinal ligament and crosses over the anterior surface of the ureter before reaching the uterus.

Difference between killed and live virus and examples?

The viral component or killed vaccine tend to induce only humoral immunity, wherease the live attenuated vaccine induce both humoral and cell mediated immunity. Hep A an rabies vaccines are examples of killed vaccines, whereas measles, mumps and rubella vaccines are live vaccines.

Protease inhibitor (PI)

These drugs reversibly inhibit viral protease, an enxyme responsible for HIV polyprotein cleavage to form mature viral proteins. SE: hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450. (Use Rifabutin and not rifampin)

Cardiac dilation can result from deficiency of

Thiamine (B1), a water-soluble vitamin.

Goes from Key to the suckers in the Kreb cycle it needs what vit cofactor? What other step of metabolism.

Thiamine. This in needed in pyruvate dehydrogenase, a-ketoglutarate dehydrogenase and transketolase. Chronic alcholism Wernicke encephalopathy (mamillary bodies)

Loop diuretics such as furosemide

Thick ascending limb of the loop of Henle.

Progesterin only Nerethindrone pill, Levonorgestrel IUD

Thickens cervial mucus and impairs sprem penetration

Paget's disease

Think increased in osteoclastic activity Elderly Three phases: 1) Osteolytic phase: osteoclasts dominant. 2) Mixed phage (osteoclasts + osteoblasts) = new bone formation 3) Osteosclerotic phase: (osteoblast dominant). Weak thicken woven bone. Increased serum alkaline phosphatase, bone bx haphazardly oriented segment of lamellar bone with prominent cement lines. Gene mutation affecting RANK, osteoprotegerin, resulting in excessive RANK signaling and NF-kB The adjacent marrow spaces are replaced by highly vascular stomal tissue as a result of increased endothelial cell and fibroblast proliferation due to cytokines secreted by osteoclast. Increased vascularity causes arteriovenous shunting that can result in high-output heart failure.

Hyaline arteriolosclerosis is a condition marked by homogeneous deposition of hyaline material in the intima and media of small arteries and arterioles. The underlying structure of vessel wall is mainted ut the intima is thickened and the arterial lumen narrowed.

This lesion is usually a component of diaetic microangiopathy

Constrictive pericarditis reduces ventricular compliance via an external fore.

This results in a pericardial knock, a sharper,more accentated sound heart earlier in diastole than the S3 sounds.

Vaculitis linked to smoking

Thromboangiits Obliterans (Buerger disease) causes inflammatory thrombosis and ischemia involving small to medium arteries of the extremitites. Symptoms include claudication, ulceration and gangrene.

Fever, neurologic symptoms, renal failure, anemia and thrombocytopenia int he setting for a gastric intestinal illness

Thrombocytopenic thrombotic purpura-hemolytic uremic syndrome, one ofthe thrombotic microangiopathy syndromes. - platelet activation in arterioles and capilaries -diffuse microvascular thrombosis (affecting the brain, kiney and heart) -Microangiopathic hemolytic anemia and schistocytes -thrombocytopenia. -PLATELET RICH THROMBI IN GLOMERULI AND ARTERIOLES

What ca is Myasthenia gravis associated with

Thymoma and thymic hyperplasia

What test should e routinely performed for amodarone and lithium?

Thyroid test

Minute ventilation

Tidal volumex RR

Leukoplakia

Tobacco use can cause leukoplakia, a precancerous lesion that manifests as white pateches or plaques on the oral mucosa.

Smoking metaplasia effects:

Trachea and bronchi of chronic cigarette smokers, columnar epithelial cells (ciliated) can undergo metaplasia and be replaced by stratified squamous epithelial cells. Metaplasia is when normal tissue type is replaced by a type that is not characteristic fo the organ.

Transitional Location

Transitional cell ca is responsible for 90% of tumors in the renal pelvis and it arises from the renal pelvis lining, tends to be multifocal in nuature and mores papillary tumors composed fo urothelium supported by a thin fibrovascular stalk.

The brush border of the proximal convoluted tubule is responsible for reabsorbing two thirds of the sodium and water filtered bt eh glomerulus

Transpor proteins found int he brush boarder reabsorb filtered gluose, aa, phosphate and lactate via con transport with sodium.

When is glucose an active transporter

Transport of glucose against the concentrationgradient occurs via the Na/Glucose symporter, which is foudn in the intestinal and renal tubular epithelium and is used to transfer glucose intracellularly from the lumen.

Incision of which of the following structures is most likely to improve this pt's symptoms?

Transverse carpal ligament (flexor retinaculum). The ligament attaches to the hamate and pisiform on the ulnar side and to the trapezium and scaphoid tuberosity on the radial side.

What three drugs prevent the reduction of folic acid to tetrahydrofolate by inhibiting dihydrofolate reductase.

Trimethoprim, methotrexate, and pyrimethamine.

45 yr old caucasian male with intestinal bx that show multiple macrophages loaded with PAS positive granules in the lamina propria

Tropheryma whippelii, Whipple disease is a raresystemic illness that involves the small intestine, joints and CNS. Classic histologic findings include small intestinal mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules (which consist of lysosomes and partially digested bacteria). malabsorption with diarrhea and wight loss. Arthropathy, ployarthritis and pwychiatric and cardiac abnormalities may be observed. Antibiotic tx.

High potency antipsychotics SE

Try to Fly High (Trifluoperazine, Fluphenazine, Haloperidol) Actue dystonia, akathisia, parkinsonism. due to potent D2 antagonism in the nigrostriatal pathway.

what does duodenal enteropeptidase activate

Trypsinogen is actived to trypsin. Trypsin is essential for protein digestion and absorption in two ways. It degrades complex peptides to dipeptides and aa, and it activates other proteases such as carboxypetidase, elastase, and chyrmotrypsin. Hydrolysis of polypeptides is accomplished by proteolytic enzymes such as pepsin and trypsin. These enzymes are secreted as the inactive proenzymes pepsinogen and trypsinogen fromt he stomach and pancreas, respectively.. Typical clinical manifestations of enteropeptidase def are diarrhea, growth retaardation and hypoproteinemia.

Carbamazepine

Txs complex partial seizures and is also effective in generalized tonic-clonic seizures. SE agranulocytosis and aplastic anemia. antiepileptic like phenytoin, carbamazepine, phenobarbital, associated with decreased bone mineral density an increased risk of osteoporosis.

Type 1 and type 2 pneumocytes line the aveloar ducts and alveoli.

Type 1 neumocytes are thin cells stretched across the alveolar wall that mediate gas exchange. Type 2 pneumocytes produce surfactant and divide the differentiate into type 1 pneumocytes to replace damaged cells.

Diabetes

Type 2 DM: Pancreatic Islet Amyloid deposition Two cardinal defects invovled in the pathophysiology of Type 2 dm are increaed insulin resistance and defective insulin secretion. Islet amyloid polypeptide (amylin) is one factor thought to be responsible for this beta cell dysfunction. AMylin is stored in the insulin secretory granules and is co-secreted with insulin from pancreatic beta cells. Deposits of amylin are universally seen in the pancreatic islets of pts with type 2 dm. Amlyin maypay a causative role in beta cell apoptosis and defective insulin secretion. TYPE 1: HLA-DQ are the most important determinants of type 1 dm.

Cell mediated hypersensitivity

Type 4 delayed type hypersensistivity, is mediated by sensitized TH1 cells that secreet sytokines attracting macrophages to a local area. TB or anergy (candida antigen).

Brain tumor cells forming giant cells is an example of what process?

Undifferentiated (Anaplastic) tumors bear no resemblance to the tissue of origin. THey are composed of pleomorphic cells with large, hyperchromatic nuclei that grown in disorganized fashion. Anaplastic tumors may also contain numerou, abnormal mitoses and giant tumor cells.

GBS in pregnant women

Universal prenatal screening for group B strep colonization by vaginal -rectal culture at 35-37 weeks gestation is recommended to identify colonized women who require INTRAPARTUM antibiotics, most frequently with penicillin or ampicillin to prevent neontal GBS, pneumonia and meningitis.

Lateral coricospinal tracts

Upper motor neuron signs

Stress urinary incontinence

Urethral hypermobility results in incomplete closure of the urethra and bladder neck against the anterior vaginal wall, which leads to stress urinary incontinence. When cough or sneeze

Acute post infectious glomerolnephritis

Urinalysis (protein, blood, red blood cell casts) decreased C3 and C4, increase serum creatinine, increased anti-DNAas B and increase AHase, increased ASO and anti NAD.

Vasoactive intestinal polypeptide is secreted by

VIPomas, pancreas tumor, pts have diarrhea and persists with fasting, achlorhydria and hypokalemia.

Streptococci verse staphylococcus aurea valve (endocarditis)

Valve is damaged y a distruption of normal endocardial surface, maximal turulence ot lood flow, atrial surface of AV valve and ventricle surface of semilunar vlaves. Strep: infect carica valves with preexisiting endothelial lesions. Vegetations are caused by bacterial colonizatio and growth on a sterile fibrin-platelet nidus that forms on teh damaged endothelial surface of the valvular apparatus. Staph- can adhere to damaged or normal endothelial cells. macroscopic vegetations consist of fibrin and platelets on the surface, with red lood cell debris, leukocytes and clusters of microorganisms embedded deep within the lesion.

What can vanillylmandelic acid by used to detect?

Vanillylmandelic acid is the byproduct of NE and Epi and can be used to detect neuroblastoma and other tumors of neural crest origin.

Herpesvirus

Varicella Zoster virus tends to produce a maculaopapular rash that begins on the trunk and spreads centrifugally to involve the face and extremitites. Immunocomprimised pt with headache and blindness in one eye think Herpes zoster opthalmicus Roseola HHV 6 causes exanthem subitum (roseola infantum), which is characerized by a transient maculopapular rash that appears for a few days on the check and trunk once the pts fever subsides. High temp that last for 4 days, seizures, and rash that spares the face.

Angiogenesis:

Vascular endothelial growth factor (VEGF): increases endothelial cell motility and prliferation, proinflammatory cytokines IL-1, INF-y can indirectly promote angiogenesis through VEGF expression. Fibroblast growth factor: involved in endothelial cell proliferation, migration and differentiation. Also important in embryogenesis by stimulating angioblast production. Contibute t angiogenesis, but also embryonic development, hematopoiesis, and wound repair (by recruting macrophages, fibroblasts, and endotheilal cells to damaged tissues). The laminin in basement membranse may pose a phycial barrier to the sprouting of new blood vessels.

HBV in infants

Viral replication occurs rapidly in infected infants due to imune system immaturity in newborns. The chance of progresion to chronic hep B id 90% without treatment. All children should be vaccinated for hep B at birth. Hep B immunoglobulin should be admin prophylactically to the newborn. HBV is not inherently cytotoxic and the neonatal immune system is still immature (limiting inflammatory damage). As a result, lab markers of liver injury (AST, and ALT) are usually only mildly elevated in HBV infected neonates.

Virchow's triad

Virchow's triad or the triad of Virchow (/ˈfɪrkoʊ/) describes the three broad categories of factors that are thought to contribute to thrombosis: Hypercoagulability Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction

The parallel chains (Serpentine cords) that mycobacteria correlates with what?

Virulence..cord factor establishes virulence through neutrophil inhibition, mitochondrial destruction,and the induced release of TNF. Sulfatides inhibit the fusion of lysosomes to phagosomes, permitting mycobacteria to persist as facultative intracellular organisms within phagoytes.

What antagonist are used for nausea in these different locations: Visceral nausea due to gastrointestinal insults (gastroenteritis, chemotherapy, general anesthesia) Vestibular nausea: Migraine nausea:

Visceral nausea due to gastrointestinal insults (gastroenteritis, chemotherapy, general anesthesia): -5-Ht antagonist (ondanstrone) Vestibular nausea: (H1 receptor antagonist (diphenydramine, meclizine), Muscarinic acetylcholine receptor antagonist (scopolmine) Migraine nausea: D2 antaonist (metoclopraminde, promethazine)

Visual impairment with VZV

Visual impairment can be a complication of herpes zoster ophthalmicus, a condition caused by VZV rxn at the level of the trigeminal ganglion of cranial nerve V1.

Tests for T. Pallidum (syphyliss)

Visualization of treponema palladium- dark-field microscopy, which reveals helical motile spirochetes. Ulcer exudate microscopy with dark-field illumination. VDRL- rapid plasma reagin- presence for antibody again cardiolipin. Treponemal (fluorescent treponemal antibody absorption)- detect antibodies to specific treponemal antigens and are not affected by antitreonemal therapy, they remain positive for life. Untreated syphili can infect the dorsal roots of the spinal column and lead to tertiary neuorsyphilis characterized by tabes dorsal is (locomotor ataxia) and general paresis.

Transaminase

Vit B6 catalyzes the transminase reacts by acting as a carrier of amino group. B6 def can cause an anemia that is hypo chromic, micorocytic (low MCV) and siderblastic

Vit K and neonates

Vit K is an essential cofactor for gamma-glutamyl carboxylase, the enzyme responsible for conversion of glutamyl residues to y-carboxyglutamates. Carboxylation is critical for the function of clotting factors 2 (prothrombin), 7, 9, 10 and allows for the creation of calcium-binding sites attract the clotting factors to negatively charged phospolipids on plateletes and endothelial cells, encouraging coagulation and thrombin formation. Healthy chldren and adults rarely need exogenous vit K2 supplementations. Endogenous colonic bacterial flora generates vit K (menaquinones), and leafy-green vegetables are rich in vit K1 (phylloquinone or phytonadione).

Osteoid matrix accumulation around trabeculate is seen

Vitamin D def. There is excessive un-mineralized osteoid with osteoid seams. Pts have low urinary ca.

Pt with CF with decreased proprioception an hyporeflexia in the lower extremities:

Vitamin E primarily serves to protect fatty acids from oxidation: Vit E def predisposes cell membranes to oxidative injury. THe cells that are most susceptible include neurons with long axons (due to large membrane surface area) and erythrocytes (due to high oxygen exposure). THe most common clinical manifestations of Vit E def are neuromuscular dz (skeletal myopathy, spinocerebellar ataxia, polyneruopathy) and hemolytic anemia. Involvement of the dorsal column in the spinal cord is associated with the loss of proprioception and vibratory sense. Spinocerebellar tact involvement causes ataxia and peripheral nerve dysfunction results in hyporeflexia.

Corticospinal (pyramidal) tracts

Voluntary muscle activity is mediate dby the corticospinal tracts. First-order neurons of these tracts are located int he premotor and motor cortex of the frontal lobe. Their efferent fibers descend through the internal capsule, midbrain and pons, and continue to form the pyramids on the anterior aspect of the medullar. THe medulla, 90%fibers decussate to form lateral corticospinal tracts. Fibers that do not decussate descendas anterior corticospinal tract. The axons of both tracts synapses onthe motor neurons of the anterior horn (second-order neurons). Damage to the corticospinal tract is divided into upper and lower motor neuron lesions. 1) Upper motor neuron (UMN) refers to anything above the anterior horn. Lesions to UMN (due to loss of descending inhibition over second order neurons in the anterior horn. 2)Damage to the motor neuron of the anterior horn is considered a lower motor neuron lesion. This type of injury leads to flaccid paralysis...Poliomyelitis and infantile spinal muscular atrophy are exams of LMN lesions.

Function of TNF-a and also drugs that treat it:

WBC recruitment, septic shock, activates endothelium, increase vascular leak, Cachexia. Produced by macrophages and mast cells, signal for apoptosis of tumor cells and activation of inflammatory cells. Elevated in RA and PS. Infliximab and Etanercept are anti TNF immunoglobulins and reduce inflammation in these condition. Common to be elevated in type 4 hypersensitivity

Warfarin-induced skin necrosis

Warfarin inhibits proteins C and S (anitcoagulant), which lead to skin necrosis and particularly in pts with protein C or S def. It also decreases 7 (which has a short half life like Protein C does). Therefore there is only 2, 9, and 10 still present for a while which increases the procoagulant effect. So it's important to dues a heparin bridge.

What do you treat Polycystic Ovary syndrome with?

Weight loss, combination hormonal contraceptives, Metformin (if hyperglycemia/DM) PCOS is characterized by elevated LH levels, excess androgen production, insulin resistant, and increased estrogen. Increased risk for DM and endometrial hyperplasia. LH levels are typically elevated, and pts may also have increased LH activity at the ovary (increased LH receptor expression).

Symptoms of DM1

Weight loss, polyuria, polydipsia, and fatigue are suggestive of DM1. Fasting glucose >126 random glucose >200 and a hemoglobin A1c >6.5

Wernicke syndrome is irreversible, but Korsakoff syndrome is not

Wernickes: Oculomotor, ataxia, mental status changes Korsakoff: damage tothe anterior and dorsomedial thalamic nuclei. Results in memory loss and a psychological phenomenon called confabulation.

What effect does systemic blood pressure have on the cerebral blood flow?

When systemic blood pressure is between 60-140mmHg, it has little effect on cerebral blood flow because autoregulation (via cerebral vlood vessel dilation and contraction) keeps blood flow constant. Blood pressure >150 will cause increase cerbral flow and increased ICP, <50 will cause hypoperfusion and cerebral ischemia.

Bladder and destrusor muscle

When the detrusor is contracted then a person can urinate. When the Detrusor is relaxed it leads to urinary retention.

Mitral regurgitation hemodynamics Acute mitral regurg: Compenstated MR:

With acute mitral regurg: increase in left atrial pressure and increased left ventricular end-diastolic volume (preload). Low resistance regurgitate pathway also decreases left ventricular afterload,end-systolic volume and forward stroke volume. Increased left atrial pressure and decreased cardiact output results in pumonary congestition and severe hypotension. Compenstated MR: increaed preload, normal afterload, normal contractile function, increased ejuection fraction, normal stroke volume. Decompensated increase prelad, increased afterload, decreased contractile function, decreased ejection fraction, decreased forward stroke volume.

How do you treat Alcohol withdrawal?

With benzodiazepines, which substitute the the action of alcohol on GABA receptors and are indicated for the treatmetn of alcohol withdrawal. Benzos without active metabolities (lorazepam, oxazepam, temazepam) are referred in pts with advance liver disease (do not undergo oxidative metabolism). Long acting benzos with active metabolities, such as diazepam or chlordiazepoxide are preferred in the majority of pts due to self-tapering deffects. Alcohol is a CNS depressant that binds to the GABA receptor complex, enhancing the inhibitory action of GABA (the major inhibitory neurotransmitter in the brain). Chronic alcohol consumption leads to decreaed GABA sensistivity and alcohol tolerance develops. Abrupt cessation decreases inhibitiry tone and results in CNS excitation (withdrawal). Alcohol withdrwal starts within 8-12 hours after the last dri that include insomnia, treulousness, anxiety and autonomic hyperactivity (variable blood pressure, diaphoresis, and tachycardia). Seizures- occur within 12-48 hours and delirium tremens (disorientation, severe agitation, fever) 48-96 hours.

Soft palate drop with deviationof uvula toward normal side Dysphonia, hoarseness

X

Enrichment media

X and V facters for Haemophilus or the anaerobic conditions needed by Clostridium species.

Duchenne Becker muscular dystrophy, hemophilia and G6PD, Chronic ganulomatous are examples of what inheritance?

X-linked recessive.

Tracheoesophageal fistula

X-ray will also show a stomach bubble, which results from air flow from the trachea through the fistula to the distal esophagus.

Sternocleidomastoid and trapezius muscle

X1 Assessory nerve

Where do you put the nerve block to anesthetize the skin and muscles of the anterior thigh (quad), femur and knee?

You put a femoral nerve block at the inguinal crease

Detailed structureal analysis shows that one of the proteins contains a 30 aa motif coordinating a zinc molecule

Zinc-finger structure represents the most commonly identified DNA-binding domain in humans. Zinc-finger motifs are composed of chains of AA bount together around a zinc atom via linkages with cysteine an histidine residues. They recognize specific DNA sequences and are used by many transcription factors to bind DNA and alter activity of targe genes. Intracellular receptors that bind steroids, thyroid, fat-solube vitamins.

Seborrheic keratosis is

a benign, tan or brown epidermal tumor commonly identifited onthe skin of middle-aged or elderly individuals, "stuck on". Velvety to greasy surface and well demarcated border. Rapid onset of numerous SK is offten associated with an undiagnosied internal malignancy (Leser-Trelat sign).

Status epilepticus tx:

a dangerous condition in which epileptic seizures follow one another without recovery of consciousness between them. - tx: intravenous benzodiazepines (enhance (postsynaptic chloride influx)

Klebsiella

a gram-negative lactose-fermenting bacillus. The presence of a thick capsule is seen as a clear zone on gram stain and also causes the characteristic mucoid growh in culture.

Angiotensinase

a group of enzymes foudn in multiple tissues and are responsible for the breakdown of angiotensin 2 and other structurally similar enzymes.

Bevacizumab

a humanized monoclonial antibody, interferes with VEGF receptor activation, thereby inhibiting angiogenesis.

Peripheral membrane proteins may be modified through

a lipidation process in which a hydrophobic lipid anchor is covalently attached to the protein. THis process facilitates protein interaction with the cell membrane.

The most common malignant hepatic lesion is

a metastasis form another primary site (breast, lung, coon), not hepatocellular carcinoma. The liver is the second most common site of metastatic spread (after the lymph nodes) because of it's large size, dual blood supply, high perfusion rate and the filtration function of Kupffer cell.s

Theophylline

a methylxanthines cause bronchial dilation by blockign phosphodiesterase activity, increasing the intracellular concentration of cAMP.

Mutations in frataxin

a mitochondrial protein importnat in iron homeostasis and respiratory funcion, cause Friedrecih ataxia. Spinocerebellar degeneration- hypertropic cardiomyopathy

Hepatic encephalopathy

a neurologic complication of cirrhoiss due in part to the liver's inability to convert ammonia (a neurotoxin) to urea. Ammonia crosses the bbb, leading to impaired neurotransmitter release, astrocyte dysfunction, neuroinflammation and edema, asterixis. Primary source of ammoina is degradation of nitrogen products by intestinal bacterial.. GI bleeding can preceipiatate HE as hemoglobin breakdown leads to increased nitrogen products in the gut. Excess dietary protein intake (large steak meal) can also cause it along with infection, sedatives, metabolic derangements (hypokalemia).

Acyclovir MOA

a nucleoside analog that once activated competes with deoxyguanosine triphosphate for viral DNA ploymerase, when acyclovir triphosphate becomes incorporated into the replicating viral DNA chain, viral DNA synthesis is terminated.

Reactivation of JC virus

a polyomavirus causes progressive multifocal leukoencephalopathy (PML). It occurs in severely immunocompromised pts. Causes progressive dementia, motor deficits, and visual impairment.

Vemurafenib

a potent inhibitor of mutated BRAF, has significant anti-tumor effects with improved survival and long-term outcomes in advanced stage V600E-positive melanoma pts.

Tetrodotoxin

a potent neurotoxin found in pufferfish functions by blocking the voltage gated sodium channels in here cells membranes. IT inhibits passive transport of sodium.

Features of glucagonoma

a rare alpha cells tumor of the pancratic islets of Langerhans. Presents with necrolytic migratory erythema, an elevated painful and pruritic rash typically affectign the face, groin and extremities. Over time, small eythematous papules/plaques coalesce to form large lesions with central clearing of bronze colored induration. BRONZE DIABETES -glucagon acts on liver to promote aa oxidation and gluconeogenesis from aa. so aa are low (coz erythema skin lesions) -

histiocytes

a stationary phagocytic cell present in connective tissue.

SE of piolitazone

a thiazolidinedione increases insuline sensitivity in pts with hype 2 dm by binding to peroxisome proliferator-activated receptors. Long-term use may be associated with urinary bladder ca.

Herpes simplex virus is dx by

a viral culture.

tRNA attachment

aa activation and attachment to the 3'end of tRNA are catalyzed by aminoacyl-tRNA synthetases. The amino acid sequence in a polypeptide chain is dictated byt he binding of a tRNA anticodon to its complementary codon on the mRNA molecle being translated. Erroneous amino acid/tRNA coupling by AA-rRNA synthetase causes the wrong amino acid to be incorporated into the growing polypeptide chain.

Acute appendix

abdominal pain tends to appear int he periumbilical area (visceral pain) and shift to the right lower quadrant a few hours later. Acute appendicitis is caused by an obstruction of the appendicuar luen. The more common obstructing agens are fecalith, hyperplastic lymphoid follicles, foreign bodies, or tumors may cause the obstruction. This causes necrosis of the wall with rupture and the inflammatory fluid and bacterial contents may spill into the peritoneal cavity, causing peritonitis.

Tetrology of Falot

abnormal neural crest cell migration leads to anterior and cephalad deviateion of the infundibular septum during embryologic development, resulting in a malaligned VDS and an overriding aorta. 1) VDS 2) overrriding aorta of the right and left ventricles 3) RVOT right ventricular outflow tract obstruction 4) Right ventricular hypertrophy

DM skin findings

acanthosis nigricans and necrobiosis lipoidica diabeticorum.

Cardiac tamonade

accumulation of fluid inthe pericardial space that prevents the heart form filling properly in diastole. dyspnea and tachypnea. distended neck veins, hypotension, diminished heart sounds, and pulsus paradoxus (drop in systolic blood pressure >10 mm Hg on inspiration.

Major side effects of Carbonic anhydrase inhibitor

acetazolamine metabolic acidosis

C.diphtheriae

acquires virulence via bacteriophage-mediated infection with Tox gene, which codes for the diphtheria AB exotoxin. The bacteriophage responsible is called corynephage beta. the phage tox gene incorporates into the bacterial chromosomes as a prophage and codes for toxin production by C. diphtheriae. This process, whereby a bacteriophage infects a host bacterium and integrates its genome into the host bacterium's genome, is termed lysogenization.

Skin tags

acrochordons

Centriacinar emphysema

activated macrophages and neutrophils release proteases (elastases, cathepsins, matrix metalloproteinases) that degrade the extracellular matrix and also generate oxygen free radicals that impair the function of protease inhibitors. The resultant protease-antiprotease imbalance leads to acinar wall destruction and irreversible airspace dilation distal to the terminal bronchioles.

What is responsible for IL-2 (aldesleukin) anti-tumor effects?

activation of T cells and NK cells. Immunotherapy for metastic melanoma and RCC.

Metformin

acts as a noncompetitive inhibitor of mitochondrial glycerol-3-phosphate dehydrogenase, an enzyme important ofr maintaining the hepatocellular redox state. Inhibition of this enzyme causes a significant reduction in hepatic glucose production.

Proximal tubualr cell ballooning and vacuolar degeneration in a pt with acute renal failure is consistent with:

acute tubular necrosis. Oxalate crystals in the tuular lumen is highly suggestive of ethylene glycol poisoning. Preceipates as calcium oxalate crystals. Antifreese (used in alcoholics) High anion gap metabolic acidosis and osmolar gap are also typically seen.

Double-stranded DNA --> Double0stranded DNA template--> double stranded DNA progeny

adenovirus, herpevirus, poxvirus

nonenveloiped double-stranded DNA virus can coz hematopoetic depression or aplastic anemia

adenovirus, papillomavirus, and polyomaviuses

Placenta accreta

adhere to the myometrium scar tissue from prior surgery can result in malformed or absent decidual layer betweent he placent and the myometrium aloowing for direct myometrial attachement by the villous tissue and preventing normal placental separation after delivery.

Guanethidine

adrenergic neuron blockers like guanethidine inhbiti noregpinephrine release lowering bp and HR.

First step of infection by pulmonary tuberculosis

aerosolized respiration secretion, the smaller droplets deposit organisms in the alveoli of lower lung fields. These organisms are engulfed by alveolar macrophages that allow for intracellular bacterial proliferation. The mycobacteria are then phagocytosed by alveolar macrophages, and the sulfatide virulene factor expressed by M. tuberculosis allows for intracellular bacterial poliferation. COntinued poliferation eventually kills the macrophage and causes cellular lysis allwoing it to e spread to different macrophages. Virulence factors expressed by mycobacterium promote the recruitment of additional natie, inactivated macrophages and also underminde the immunologic intracellular signaling between antigen presenting cells and helper T cells. Eventually, antigen carrying macrophages or dendritic cells migrate to the lymph nodes and induce a helper T cell resonse. However this occurs 2-4 weeks following infection.

Saccular aneurysms

affect the anterior and posterior communicating arteries of the circle of Willis. ACommunA aneurysms typically compress the central optic chiasm causing bitemporal heminanopia. PCommunitingA - usually compressed the oculomotor nerve, producing ipsilateral mydriasis,ptosis, and "down and out" deviation of the eye.

Junctional nevi

aggregates of nevus cells along the dermoepidermal junction

Small cell carcinoma of the lung

aggresive, SIADH, hormones or hormone-like substances (vasopressin), neuroendocrine markers, such a neural cell adhesion molecule (NCAM, also known as CD56), neuron-specificic enolast, chormogranin and synaptophysin.

SE of antipsychotic clozapine:

agranulocytosis

What kind of myopathy would be caused from toxic agents?

alcohol, cocaine, iron, doxorubicin may cause dilated cardiomyopathy which may occasionally progress to sudden cardiac death. The histologic changes seen in DCM are non-specific, potentially including interstitial fibrosis and variable myocyte hypertrophy or thinning.

Outer layer of adrenaocortical tumors

aldosterone/Conn syndrome, middle (cortisole/cushing syndrome) or inner (androgens/hirsutism and virilization) layters of adrenal cortex

Squamous cell carcinoma

also arise form major bronchi. Iaging will show a hilar mass. Keratinization wand intercellular bridges. Tumor can sometime present as a cavitary lung lesion.

Resection of the ileum can

also increase the risk of gallstones due to disruption of normal enteroepatic circulation of bile acides.

'Tx ulcerative colitis

aminosalicyclic acid derivates

Pts with hypothyroidism may be anemic because

an associated iron deficiency or pernicious anemia.

SJogren syndrome

an autoimmune disorder mainly affecting women, presents with dry eyes and dry mouth. (crackersin my eyes and mouth). Lack of normal saliva production can lead to enlarged salivary glands and dental caries. Antibodies: anti-Ro and anti La

Lack of fuit and vegetables or micorelements may cause esophagel SCC. Iron def can cause Plummer-Vinson Syndrome

an extremely rare disorder associated with esophageal SCC. Esophageal webs. Associated with glossitis.

Acute rheumatic fever

an immune meidated disease follwoing an untreated group A streptococcal GAS infection. Antibodies against GAS cross-react with host tissues due to molecular mimicry between GAS antigens and cardiac and CNS antigens. Antibodies directed agains FAS antigens, M protein and N-acetyl-beta-D-glucosamine, subsequentely attack myosin, a cardiac protein and lysogangliosdie, a neuronal cell surface protein. Symptoms: acute rheumatic fever include arthritis, carditis, sydenham chorea, erythema marginatum, and sugcautaneous nodules. THe pts murmur is due to acute mitral regurg/stenosis from pancarditis. Sydenham chorea presents with non-rhythmic movements of the hands, feet and face. Pts change in ptich and volume. Erythema marginatum- faintly erythematous, circular lesions with central clearing that come and go on the trunk the extremities. Prevent by txing streptococcal pharyngitis with penicillin.

Irritation of the esophageal mucosa leads to

an inflammatory rxn with epithelial regeneration. Mucosa erythema.edema can be observed macroscopically in the distal esophagus an erosions.ulcerations may deelp in several cases. basal zone hyperplasia, elongation of the lamina proria papillae and scattered eosinophils and neutrophils.

Tabes dorsalis

and Argyll Robertson pupil are manifestations of tertiary neurosyphilis. Tabes dorsalis affects the dorsal columns and dorsal roots of the spinal cord, resulting in loss of positional and virations sense and severe lancinating pains. Peripheral reflexes are absent. Argyll pupils manifest with a light near dissocation and are caused by damage to the midbrain tectum. Romberg sign (no balance with eyes closed)

Thymidine kinase-deficient

and therefore acyclovir resistant, varicella zoster virus isolates tend to be obtained almost exclusively from AIDS patients are treated best with either foscarnet (a pyrophosphate analog viral DNA plymerase inhibitr that does not require viral kinase activation or with cidofovir. Cidofovir is a broad-spectrum antiviral nucleotide analogue of cytidine monophosphate. Cidofovir can be converted to the active triphosphate moiety solely by cellular kinases thus its efficacy does not depend on the presence of a virally encoded kinase.

Surfactant is stored

and transported tot he cell surface by lamellar bodies (organelles containing paraellel stacks of membrane lamellae). It is normally released by exocytosis into the alveolar spaces, where the lamellar contents unravel and spread along the alveolar lining. As it degrades, sufactant is recycled back into the same type 2 pneumocytes by endocytosis for reprocessing.

Hemolytic anemia

anemia, elevated lactate dehydratogenase, and indirect hyperbilirubinemia

Chronic lymphedema is a risk factor for what that causes multiple firm violaceous nodules on upper arm?

angiosarcoma (stewart-treves syndromes) Angiosarcoma is a cancer of the inner lining of blood vessels, and it can occur in any area of the body. The disease most commonly occurs in the skin, breast, liver, spleen, and deep tissue.

Microsporum species

animal contact, fungus affect superificial keratinized skin layer, causing dermatophytosis.

Pts with recurrent episodes of abdominal pain and an episode of facial swelling likely has

anioedma due to C1 inhbitor (C1INH) deficiency. C1NH prevents C1 mediated cleavage of C2 and C4 thereby limiting the activation of the completment cascade. C1NH also blocks kallikrein-induced conversion of kininogen to bradykinin, a potent vasodilator tha talso causes increased vascular permeability. Ts with C1INH concentration or Kallikrein inhibitor.

Cryptogenic organizing pneumonia

another important type of interstitial pneumonai however presents more acutely and is associated with fever and with weight loss. Histo: intraluminal plugs of granulation tissue and inflammatory debris in the distal airways.

Costochondritis

anterior chest syndrome occurs with repetitive activity and pain can be reproducible with papatio and worsened with movement or changes in position.

Alemtuzumab

anti-CD52 antibody, used for chronic lymphocytic leukemia. Initiatis direct cytotoxic efect through complement fixation and antibody-dependent, cell-mediated cytotoxicity.

Gaba is the primary inhibitory neurotransmitter in the CNS it is involved in

antianxiety effect of benzodiazepines

Carbamazepine

antiepileptic like phenytoin, carbamazepine, phenobarbital, associated with decreased bone mineral density an dincreased risk of osteoporosis.

IFN-B

antiviral cytokine that is decreases inflammatory cell movement across the bbb. Can be used to tx MS.

Marfins heart

aortic root dilation and AR

Direct factor Xa inhibitors

apixaban, rivaroxaban

Serum iron is normal in

aplastic anemia

What can parvovirus B19 or chloramphenicol cause

aplastic anemia form the use of the antiribosomal antibiotic or parovovirus B19.

Superficial (infantile, capillary or stawberry) hemangiomas

appear during the first weeks of life. THey grow rapidly then regress sponstaneously by late childhood.

Glycogen

appears are clear cytoplasmic vacuoles and stains pinkish purple with the periodic acid schiff rxn. Abundant in the liver after meals.

Lacunar infarcts are: 1) Pure motor hemiparesis: 2) Pure sensory stroke: 3) Ataxia-hemiplegia syndrome: 4) Dysarthria-clumsy hand sndrome:

are a form of ischemic stroke involving the small penetrating vessles that supply the deep brain structures (basal ganglia, pons) and subcortical white matter (interal capsule, corona radiata). They are caused by chronic hypertension, which cause hypertensive arteriolar sclerosis. DM and smoking are risk factors. 1) posterior limb of the internal capsule or basal pons. 2) ventroposterolateral or ventroposteromedial thalamus. 3) posterior limb of the internal capsule or basal pons. 4) genu of the internal capsule or basal pons. CT image: may not show the expected hypodensity of ischemic stroke due to the small infarct size. After several weeks, these necrotic lesions turn into cavitary spaces filled with cerebrospinal fluid and surrounded by scar tissue called lacunas.

Distended macrophages in the intestinal lamina propira

are a typical finding in Whipple disease, which characteristically present with malabsorptive diarrhea, witht loss and joint pain.

Palpable purpura

are an indicator of leukocytoclastic vasculitis.

Direct acing alkylating agens and benzene exposure

are associated with acute leukemias

Hepatic angiosarcomas

are associated with recent or remote exposure to vinyl chloride, arsenic or Thorotrast. This tumor is extremely aggressive and is associated with proof prognosis, as most its die within a year.

Inferior phrenic arteries

are branches of the aorta that supply the diaphragm and pried branches to the suprarenal glands.

Osteoblasts

are cells with a single nucleus that arise from mesenchymal stem cells found in the periosteum and bone marrow.

Thyroid papillary carcinoma cells

are characteristically large with overlapping nuclei containing finely dispersed chromatin, giving them a ground-glass appearance (Orphan Annie eye). Numerous intranclear inclusions and grooves can e seen due to invagination of the nuclear memrane. Psammoma bodies (laminated cacium deposits) are also found within the tumor.

Chlamydia pneumoniae and Mycoplasma pneumoniae

are common causes of atypical community acquired pneumonia. These organisms are not visible on gram stain and do not grow in conventional culture.

Neuroblastomas

are common extracrainal solid tumors occuring in children. Undifferentiated neuroblastomas are small, round, blue-cell tumors. A neuritic process, also called neuropil, is a pathognomonic feature of neuroblastoma cells. NSE, chromogranin, synaptophysin,and S-100 immunohistochemical stains are usually positive. MOre than 90% of pts have elevated homovanillic acid and vanillylmandelic acid. THe most important biological marker is MYCN (N-MYC) of chromosome 2.

Atropine and scopolamine

are competitive antagonists of muscarinic ACh receptors, many medications plants. Anticholinergic. No effect on nicotinic ACh recptors controlling voluntary muscles.

Proteoglycans

are composed of glycosaminoglycans (GAGs) , which provide compressibiltity to tissues. Pts with def in lysosomal enzymes cannot break down GAGs, resulting in mucopolysaccharidoses (Hurler syndrome, Hunter syndrome) characterized by soft tissue and skeletal dz.

Choledochal cysts

are congenital dilations for the common bile duct that typically present in childhood (<10) with recurrent abdominal pain and jaundice.

Thalassemias

are disorders presenting with reduced or absent glob in chain production. Almost all thalassemia cases result in hypochromia and mcirocytosis (low MCV).

Adenomatous polyp

are either tubular, villous or tubulovillous. Villous adenomas tend to be larger, sessile and more severely dsplastic then dubular andenomas. Villous adenomas can cause bleeding, secretory diarrhea, and partial intestinal obstruction. Can have a velvety or cauliflower-like projection. Tubulovillous adenomas contain a mixure of the 2 types.

Proliferating astrocytes

are enlarged and obtain a large number of fibrils and glycogen granules. Their nuclei are large, vesicular and display prominent nucleoli.

Schistocytes

are formed from mechanical hemolysis via sheer force of blood flow, HUS, TTP, DIC.

Mononuclear interstitial pulmonary infiltrates

are found in the early stages of various interstitial lung disease.

Astrocytes

are glial cells (nonneural cells) that contribute to the blood brain barrie and play an important role in postassium buffering, neurotransmitter metabolism, and glial scar formation.

Alanine and Aspartate

are glucogenic aas. Alanine is metabolized in the liver to produce pyruvate and aspartate can be readily interconverted to oxaloacetate.

Laminins

are heterotrimeric glycoproteins that bind to type 4 collagen underlying epithelial cells. THey contribute to the organization and fuction of the basal lamina BM

Th2 cells

are important for mediating humoral immunity and combating parasitic infections.

Peptic ulcers that occur from gastrinomas

are in unusal areas such as the jejunum. Pts with gastrinomas have diarrha and abdominal pain.

Low molecular weight heparins (enoxaparin, dalteparin)

are indirect throbmin inhbitiors that bind with antithrombin and convert it from a slow to a rapid inactivator of throbin and factor 10a. They are used in acute coronary syndrome (unstable angina or myocardial infarction)

Neurofibrosarcomas

are malignantperipheral nerve sheath tumors that arise for neurofibomas, which are soft pink and flesh colored bengn nerve sheath tumors often found ont he turnk of pats with neurofibromatosis.

Carcinoid tumors

are neuroendocrine in nature- affect the GI and lungs,. They tend to involve the large bronchi and can appear histologically as sheets of uniform cells with a "salt and pepper" pattern (chromatin with fine and coarse clumps).

Rocky mountain spotted fever

are palmoplantar erythematous macules that migrate centripetally toward the trunk.

Tamoxifen and raloxifene

are partial estrogen receptor agonists in thw bone and can cause an increased in bone mineral density after menopause. They are competitive inhibitors of estrogen binding to estrogen receptor. Tamoxifen has a favorable effect on serum lipids, with a decrease in total and LDL cholesterol and no significant change in HDL. Serum triglycerides may increase in some pts.

Melanin and hemosiderin

are pigments commonly seen on histologic specimens. Hemosiderin is an iron oxide pigment that stains tissues at sites of bleeding.

Glucagonomas

are rare pancreatic alpha-cell tumors that present with DM and a raised erythematous rash that typically affects the groin (necrolytic migratory erythema).

Somatostainomas

are rare tumors to the pancreatic D cells that present with DM (down regulates insulin), cholelithasis (inhibition of cholecystokinin release) and diarrhea-steatorrhea (inhibition of pancreatic enzyme-bicarbonate secretion)

Waxy casts

are seen in advanced renal disease (chronic renal fialure)( They are formed in the dilated tubules of enlarged nephrons that undergo compensatory hypertrophy in response to reduced renal mass.

Atypical cells forming papillary projections

are seen in papillary variant of pancreatic adenomacarcinomma

Mutations in tuberin and harmartin

are seen in tuberous sclerosis. These its may develo cardia rhabdomyomas in ventricular walls and AV valves, cuaneous angiofibromas (adenoma sebeceum) CNS hamartomas, and renal cysts.

Rhabdoviridae

are single stranded RNA viruses enveloped by a bullet-shaped capsule, which is studded by glycoprotein spikes that bind to nicotinic acetylcholine receptors. ONce depositied in a wound the virus stays local for a perios of days or weeks before biengin to acetylcholine receptors on peripheral nerve axons and trevel retrograde to the central nervous system.

Lentigines

are small tan or brown macules see in sun-exposed skin of middle aged or elderly person.

Endocardial thickening and noncompliant ventricular walls

are suggestive of restrictive cardimyopathy, which may be idiopathic or due to conditions such as amyloidosis, sarcoidosis, or endomyocardial fibrosis.

HFE proteins

are the most common cause of primary heochromatosis. Inactivationof HFE protein results in decreased hepcidin synthesis by hepatocytes and increased DMT1 expression by enterocytes, leading to iron overload. Pts wit hemochromatosis are at an increased risk for liver cirrhosis and hepatocellular ca. Primary hemochromatosis is most comonly caued by mutations affecting the HFE protein.

Myxomas

are the most common pirmary cardiac neoplasm (80% left atrium). Produce large amounts of interleukin 6, thus pts frequently present with constitutioanl symptoms (weight loss and fever). Constituational symptoms, a mid-diastolic rumbling murmur heart at the paex, positional cardiovascular symptoms (dyspnea and syncope), embolic symptoms, mass in left atrium, abnormal blood vessels ad hemorrhaging.

Calcium sensing receptors

are transmembrane G-protein-coupled (metabotropic) receptors that help to regulatet he secretion of parathyroid hormone (PTH) in response to cahnges in circulating ca levels. Binding of ca to CaSR leads to inhibition of PTH release, whereas low c levels lead to increased PTH release.

Hepatic adenomas

are uncommon benign epithelial tumors of the liver tat usually arise as a solitary mass in the right hepatic lob. They are stingily associated with the use of oral contraceptives an anabolic serious. THye may rupture and cause intraabdominal hemorrhage.

NItrates such as nitrogen and isosorbide ononitrate

are used as vasodilators primarily for the treatment of angina pectoris.

Inhibitor of tumor necrosis factor-alpha

are used in many inflammatory autoimmune conditions, such as RA, IBD and seronegative spondyloarthropathy.

Octetreoide and b-blockers

are used to treat varicies.

Serum haptoglobin levels

are usually low in vit B12 def anemia as there is increased red cell breakdown due to ineffective erythropoiesis and enhanced peripheral destruction. However, the levels would normalize with therapy.

Pilocytic astrocytomas

are well-differentiated neoplasms comprised of spindle cells with hair-lke glial processes that are associated with microcysts. These cells are mixed with Rosenthal fivers and granular eosinophilic bodies.

Metalloproteinase

are zinc containing enzymes that degrade components of the extracellular matrix and basement membrane, which are composed primarily of laminin and dollagens 4 and 7. These eyxmes participate in many physiologic processes such as tissue remodeling and embryogenesis. They facilitate bm penetration, which distinguishes an invasive tumor for D in sit. 1) Tumor cells detach from surrounding cells decreases in Ecadherin 2) Tumor cell adhere to BM, facilitated by increased expression of laminin and other adhesion molecules. 3) Tumor cell invade the basement membrane via enhanced secretion of proteolytic enzymes ( metalloproteinase, cathepsin D protease)

Small cell ca

arise for the major bronchi., hilar mass. Path show flat, oval shaped cells with scant cytoplasm and hyper chromatic nuclei. Neurcendocrine markers such as chromogranin and synaptophin are usually positive.

Phyllodes

arise from the breast stroma and can progress to malignancy. Histo shows disorderly, diffusely hyper cellular onnective tissue with cellular atypic and leaf-like projections.

Budd-chiari

arise secondary to thrombotic occlusion of the hepatic veins and or supraheatpic inferior vena cava. THe venous occlusion cause the sinusoidal pressure to increase, ultimately leading to portal hypertension, ascites, hepatomegaly and splenomegaly.

Teres major

arises for the inferior scapula and inserts into the medial intertubercular suclcus of the humerus. Humeral extension and internal rotation.

Medullary thyroid cancer

arises from parafollicular c-cells and appears histologically as polygonal spindle-shaped cells with a slightly granular cytoplasm that stains for calcitonin. Adjacent amyloid deposits are typically seen. Medullary thyroid cancer is a component of MEN2A and 2B.

The ansa cervicalis

arises from the C1, C2 and C3 nerve roots and innervates the sternohyoid, sternothyroid and omohyoid muslces f the anterior neck. Penetrating trauma to the neck aover the cricoid cartilage can injure this nerve.

The inferior thyroid artery

arises from the thyrocervical trunk, a branch of the subclavian artery. As it approaches the thyroid, the artery comes in close proximity to the recurrent lryngeal nerver. THe recurrent laryngela nerve provdes motor inervation to the intrinsic muslces of the larynx (except the cricothyroid). Unilateral nerve injury causes hoarseness, wheras bilateral injuury may cause inspiratory stridor and respiratory distress due to complet vocal paralysis.

Trapezius

arises fromt he occipital bone and spinous processes of the cervial and thoracic verebrae and inserts int he scapular and clavicle. The muscle helps move the scapula and support the arm.

Ewing sarcoma

arises in the diaphysis of the long bones, espicailly the femur. Wnd more common malinant one tumor in children. it is neoplasm of neuroectodermal cells tat most commonly occur int he long and flat bones of children and adolescents.

B27 allele

arthritis of the sacroiliac joint are found in seronegative spondyloarthropathies. - Ankylosing spondylitis - Reactive arthritis - Arthritis associated with inflammatory bowel dz -Psoriatic arthritis

Pyridoxine is required for what

as a cofactor for the first step in heme synthesis. Therefore, pyridoxine def causes decreaed heme synthesis and microcytic, hypochromic pyridoxine-responsive anemia. SIderoblastic anemia.

Infundibulopelvic ligament

aska suspensory ligament of the ovary houses the ovarian nerve plexus. Rotatin in ovarian torsion. often due to the weight of a large adnexal mass.

Hemochromatosis

associated wit cirrhosis and increaed incidence of hepatocellular cancer, skin darkiening and insulin resitsance.

Brown gallstones

associated with biliary tract infections (microbes producing B-glucuronidases)

Necrotizing inflammation and pulmonary hemorrhage are

associated with granulomatosis with polyangiitis which involves both the lungs and kidneys. GPA present with subacute cough, dyspnea and hemoptysis and nephritic syndrome.

Succular aneurysm rupture

associated with subarachnoid hemorrhage. Present with abrupt onset of severe headache and heat CT shows hyperattenuations of the sulci and basal cisterns. Focal neurologic deficits are uncommon.

Aponeurosis of the flexor carpi ulnaris

at the elbow spans from the olecranon to the medial epicondyle and forms the roof of the cubital tunnel. The ulnar nerve runs through this space, and compression here can cause sensory symptoms involving the unlar aspect of the hand (fifth finger and ulnar half of the fourth)

cerebellar ataxia, telangiectasias and increaed risk of sinopulmonary infection constitutes a characteristic triad of

ataxia telangiectasias, which is due to mutation in ATM gene, responsible for DNA break repair. Hypersensitive to Xray radiation. Also manifests as an IgA deficiency and predisposes to infections of the upper and lower airways.

Falciform ligament contains the

attached the liver to the anterior portion of the body. It carries the round ligament, (remnant of the fetal umbilical vein).

Lightening strike

autonomic system and cause cause fixed and dilated or asymmetric pupils, there do not reflect the extent of neurologic injury and hsoulnot stop resuscitation. Respiratory and cardiac arrhythmia.

Bart

axillary lymphadenopathy red-purple paular skin lesions.

Vector for lyme dz

babesia (Ixodes ticks)

Causes of Travelers' diarrhea

bacteria (E. coli), virus (Rotavirus), parasite (cryptosporidum parvum)

Corynebacterium

bacterial toxin-mediated axonal damage occurs in infections secondary to Corynebacterium, a microorganism that classically causes pseudomembranous pharyngitis. C. diph synthesizes a potent exotoxin that is associated with cardiac and neural toxicity.

Why shouldn't you use TCA with elderly

because they coz confusion and urinary retention. Which elderly can have demention and BPH, also elder have decreased renal clearance

Bile acid synthesis

begins with the rate limiting step of 7a-hydroxylase. These bile acids are then conjated to either glycine or taurine (improving solubility and emulsifying ability) to creast the bile salts that are actively secreted into the bile canaliculi. As water-insoluble cholesterol is secreted in bile, it is rendered soluble in small amounts by detergent actions of these amphipathic bile salts and phophatidycholine (phospholipid) Elevated cholesterol concentrations increase the likelihood of cholesterol preceipitation and gallstone formation. High levels of bile salts and phosphatidylchoine increase cholesterol solubility and decrease the risk of gallstones.

External hemorrhoids

below dentate line are covered by squamous epithelium and have cutaneous (somatic nervous innervation from the inferior rectal nerve a branch of the pudendal nerve. It supplys the perineum and external genitalia in males and females and are very sensitive to touch, temp and pain.

Hamartomas

benign tumors "coin lesions" hyaline cartilage mixed with connective tissue, smooth muscle, and fat.

Mutations in cardiac cell sarcomere proteins

beta myosin heavy chain underlie hypertrophic cardiomyopathy HCM. Althought HCM may present as syncope in a previously asympotmatic young person, the syncope of HCM is typically provoked by exertion.

Mutation of beta globin chain results in

beta thalassemia - target cells.

Low molecular weight proteins

beta-2 micorglobulin, immunoglobulin light chains are normally filtered by the glomerulus and reabsorbed in the renal tubules. Damage to the tubular cells can cause loss of these tubular proteins in urin. Ischemic tubular damage may be seen in advanced DN.

Clavulanic acid, sulbactam, and tazobactam are?

beta-lactamase inhibitors.

Median nerve route

between the humeral and ulnar heads ot he pronator teres muscle and then runs between the flexor digitorum superficialis and the flexor digitorum profundus muscle before crossing the wrist withing hte carpal tunnel. Proximal median nerve lesions may occur with supracondylar humerus fractures or entraptment between the pronator teres

Flexion of forearm

biceps brachii, bachrialis, brachioradialis

What part of the brain is affected when a pt has significant behavioral symptoms and urinary incontinence if the frontal micturition center

bilateral anterior cerebral artery occusion (medial frontal lobe/cingulate gyrus)

Bile secretes

bile secretory IgA helps to prevent bacterial adherences.

Sucralfate

bind to the base of mucosal ulcers and protect them agains gastric acid. This process can help duodenal ulcers heal but would be less effective in preventing ulcer recurrence than using antibiotics against H. pylori.

Polymyxin

binds to, disrupts and interferes with the permeability of the cytoplasmic membrane

Hepatic adenoma

birth control can regress

Telangiectasia

blanch

Hemichoinuium

blocks choline uptake by the presynaptic neuron, preventing ACh synthesis through depletion of intracellular choline.

SAH

blood in the subarachnoid space (between the arachnid and pia mater) vasospasm 4-12 days after. Niodipine- a selective calcium channel blocker, is often prescribed to prevent this vasospasm.

SE of carbamazepineand volproate

bone marrow abnormalites

How do syringomyelia and Amyotrophic lateral sclerosis differ?

both degenerative disease of upper and lower motor, ALS does not have sensory loss.

Giant cell arteritis and Takayasu arteritis

both have granulomatous inflammation of the media. Difference is the location, Takayasu (aortic arterial branch involvements) Temporal Giant cell arteritis affects branches of carotid arteries.

Blastomyces dermatitidis

both lung and disseminated mycosis. Round yeast with road-seed budding and a thick, doubly reflective wall. Pulmonary blastomycosis is characterized by granuloma formation. Extrapulmonary disease (sin, bone, genitourinary system) occurs in immunocompromised pts. broad-based budding. Itraconazole is the preferred tx for balstocmycosis.

Beta blocker side effect

bradycardia and erectile dysfunction. Act ont he beta- receptors of the juxtaglomerular cells to reduce renine secretion.

Raphe nuclude

brainstems reticular formtion (medulla, pons, and midbrain). Many neurons in the nuclei are serotoergic. Serotonin is implicaed in the pathogens of anorexia, depression and sleep disorders.

DCIS

breast feeding is protective. Histo: demonstrates ducts distended by pleomorphic cells with prominent central necrosis without extension beyond the ductal basement membrane.

keratins are

broad grop do intermeidate filaments present in epithelial cells. Tumors that stain positive for keratin include carcinoma, mesotheliomas, thymomas, various sarcomas, trophoblastic tumors, and desmoplastic small round cell tumors.

Rhizopuz

broad ribbonn-like hyphae with rare septation

Niedipine

bronchodilation by blocking ca influx into the bronchial smooth muscle cells.

Parkinson dz

bx shows intracellular eosinophilic inclusions composed of a-synuclein (Lewy bodies)

Neurofibromatosis type 1and 2

cafe au laid spots, cutaneous neurofibromas, axillary or inguinal freckling, optic gliomas, iris hamartomas, and osseous lesions. NF2 (more central form) bilateral acoustic neuromas, brain meningiomas, and schwannomas or the dorsal root in the spinal cord.

Silicosis finding

calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrouned by fibrous tissue on histology.

Hardy-Weinberg equation

calculate the carrier frequency, disease frequency and gene/allele frequency.

Dystonia

can also causes spasmodic torticollis (cervical dystonia) Blepharospasm: involuntary forcible closure of the eyelids. The initial symptoms is often uncontrollable blinking. Writers cramp.

Ecchymoses

can arise superificaly without a hx of noticeable trauma, but they frequently indicate a deep hemorrhage hemorrhage (hematomoa) due to bony fracture, ligamentous rupture or muscular injury. These lesios do not blanch under pressure because the RBC are not contained within the vascularture. Ecchymoses often pass through an evolution of color change - blue, read to brown to green to yellow) which can estimate the ages.

Mineral bone dz

can be a complication of CKD due to secondary hyperparathyroidism, leading to calcium loss from bone.

Cushing syndome cause and effect

can be caused by cortisole excess, usually due to a hyperfunctiongin adrenal adenoma or an ACTH-producing pituitary adenoma. CS due to an adrenal adenoma may cause contralateral adrenal atrophy but not bilateral atrophy.

DIC

can be caused by retained dead fetus. Look for prolonged PTT and PT THrombocytopenia and microangiopathic hemolytic anemia Low fibrinogen Elevated fribrin split products (D-dimer) Low factor V and 8 levels.

late stage hemochromatosis

can be characterized by bronze diabetes. the triad of skin hyperpigmenation, DM and pigment cirrhosis with hepatomegaly.

Arteriovenous AV shunts

can be congenital or acquired. Acquired forms can result from medical interventions or penetrating injuries. AV shunts increase preload and decrease afterload by routing blood directly form the arterial system to the venous system, bypassing the arterioles. High-volume AV shunts can eventually result in high-output cardiac failure.

Prolong QT interval

can be congenital or acquired. It is associated with increaed risk of tosades de points (polymorphic ventricular tachycarida) and sudden cardiac death. QT interval can e prolonged with chronic, heavy alcohol use, but this would be unlikely in a pt who drinks only a few times a year.

ADH

can be elevated in pts with CHF, and the resulting tubular free water reuptake can lead tot he development of hyponatremia.

Endothelium

can be identified immunohistochemically with a special stain for CD34 and von WIlebrand's factor

Lymphocytes stain

can be identified immunohistochemically with a special stain for pan T cell markers CD3,

Extended-spectrum beta-lactamases

can be produced by gram-negative bacteria, rending cephalosporins and other beta-lactam antibiotics inactive. These genes can be transmitted between organisms through plamid conjugation.

Hydrogen breath test

can be used to dx lactose intolerance. Malabsorbed lactose is fermented by bacteria, thereby increasing the amount of hydrogen exhaled and ocnfiming the dx. IN patients with an elevated antibody against tissue transgluatminase, the gastrointestinal symptoms are attributed to celiac dz.

membrane lipidperoxidation

can be visualized using immunofluorescent microscopy. Lipid peroxidation is a form of ree radical damage and is associated with inflammation, atherosclerosis and tumorigenesis.

Candida albicans

can cause a variety of symptoms in immunosuppressed pts. Right sided endocarditis, renal abscesses, pneumonia and esophagitis are amount the most common.

Maternal htn

can cause asymmetric intrauterine growth restrict, characterized by a normal or almost normal head size with a reduced abdominal circumference.

Hamartomatous polyps

can cause bleeding and intussusception

high concentrations of serum ferritin found in hemochromatosis

can cause cirrhosis, pancreatic fibrosis and subsequent diabetes, cardiomyopthy and secondary hypogonadism.

Lipoprotein lipase def

can cause familiar hypertriglyceridemia (herozygous def) and chylomicronemia (homozygous def) syndromes.

Exogenous steroid use

can cause irreversible gynecomastia and testicular atrophy becaue increaed androsteneione levels. Exogenous steroid used leas to acne, male-pattern baldness, hastened epephyseal clousure (reduced height potential and aggressive behavior.

Taenia solium eggs

can cause neurocysticercosis, a condition where multiple larval cysts develop withing hte CNS. Common symptoms include headaches and seizures.

clozaine

can cause neutropenia and the potential for life-threatening agranulocytosis.

JC virus

can cause progressive multifocal leukoencephalopathy (PML), a central nervous system viral infection seen in immunocompromised pts. Hemiparesis, visual field defects (hemianopsia) and cognitive impairment.

Ribosome mutations

can confer resistance to ribosome-targeting antibiotics such as aminoglycosides and macrolides.

Gram negative sepsis or septic shock

can ensue as a result of the body's systemic reaction to lipopolysaccharide endotoxin (a component in some grame negative bacterial membranes). Signs of sepsis include hyper- or hypothermia, tachycardia, tachypnea (can lead to respiratory alkalosis), and leukocytosis.

Lobular breast tissue

can give rise to lobular breast carcinoma that typically presents as palpable great masses with orderly rows of cells organized in single file.

COPD in smokers

can have both Chronic bronchitis, and centrilobular emphysema. Chronic bronchitis causes hypoxia by decreasing the diameter of conducting airways, preventing adequeant airflow and epmphysema causes hypoxia by dilating the aveolar capillaries. Smoking can also independintly cause hypoxia by increaisng the concentration of carboxyhemoglobin in the blood. Hypoxia is sensed by cells in the renal cortex that synthesize and release erythropietin in response.

Hydronephrosis

can lead to hypertension, deteriorating renal function and sepsis. Sign and symptoms may include pain, lower extremity edema and palpable kidneys or bladder if the obstruction is low enough. Te most common causes is obstruction of the lower urinary tract.

Rheumatic mitral stenosis

can manifest in the 4th or 5th decade of life, with a diffused fibrous thickening and distortin of the mitral valve leaflets along with commissural fusion at the leaflets edges. Patients often present with diastolic murmur, dyspnea, and fatigue and are at increased risk of atrial fibrillation and throoembolism. Mid-diastolic murmur.

Isoproternol

can mediate vasodilation via B2 receptor activation particularly in striated muscle, renal and mesenteric vascular beds, leading to decreased peripheral vascular resistance with increaed cardiac output. Subcutaneous tissue blood vessels have a relatively low B2 receptor density compared to a1 receptors tus an alpha blocker would be more effective to mediate vasoconstriction.

Cyanide toxicity

can occur in patients treated with nitroprusside. Cyanide toxicity presents with altered mental status, seizures, cardiovascular collapse, lactic acidosis and bright red venous blood. Antidotal treatment of cyanide ions (hydrocobalmin), induction of methemolglobinemia (sodium nitrite) and use of detoxifying sulfur donors (sodium thiosulfate). Cyanide is a potent mitochondrial toxin that binds to Fe3+ in cytochromoe c oxidase, inhbiting the electron transport chian and haliting aeorbic respiration int he cell.

Hypercalcemia

can present as mental status changes, muscle weakness, constipation, plyuria/plydipsia and dehydration. Can be seen in hodgkin's dz

Hepatocellular carcinoma

can present unifocally, multifolclly or as a diffusely infiltrative cancer. tIt is more common in older its with a history of cirrhosis or infection with hep B or C.

Lidocaine

can relax smooth muscle via blocakde of Na current mediated action potentials but tend to be less effective in ischemic acidotic tissues.

Atrophic gastritis

can result in profound hypochlorhydria, inadequate intrinsic factor production, vitamine B12 def, and elvated methylmanonic acid and Homocystein leves. The reticulocyte count increases dramatically once vit B12 replacemnet tx is initiated in an individual with pernicious anemia. Hemoglobin and erythrocyte count levels rise more gradually.

Pituitary tumor with high ACTH secreting adenoma

can result in secondary hypterension due tot he mineralocorticoid activity of excess adrenal glucocorticoids. The resutlting hypertension suppresses the renin angiotenin aldosteron axis leading to loew levels of renina nd aldosterone.

Tertiary syphilis

can result in spirochetal endoarteritis that affects the vasa vasorum within the adventitia of the ascending thoracic aorta. The vasa vasorum (Latin, "the vessels of the vessels") is a network of small blood vessels that supply the walls of large blood vessels, such as elastic arteries (aorta) and large veins (vena cava).

Inhibition of cyclooxygenase 1 by aspirin ad NSAIDS

can trigger urticaria in its with chronic idiopathic urticaria. These medicate shunt arachidonic acid metabolites towards formatinof leukotrienes which increase vascular permeability.

Dopamine hydroxylase enzyme def

catalyzes the biosynthesis of NE from Dopamine. Deficiency of this enzyme causes a rare form of dysautonomia characterized by ptosis, orthostatic, hypotension, hypoglycemia and hypothermia.

What cofactor does Pyruvate carboxylase need

catalyzes the initial step in gluconeogenesis by converting pyruvate to oxalocetate. This enzyme requires biotin as a cofactor and functions within the mitochondria.

Aconitase

catalyzes the isomer isomerization of citrate to isocitrate in the TCA cycle.

Chi-square test

categorical dates. for example: mendelian inheritance

Huntingtons

caudate atrophy leads to the typical dilation of the frontal horns of the lateral ventricles, and microscopy of the atrophic areas reveals gliosis and neuronal loss. Loss of GABA - containing neurons leads to decreased GABA in the brain.

Cocksackie A virus

cause aseptic meningitis and herpangina (fever, posterior pharyngealgray vesicles/ulcers in children)

intestinal Carcinoid histology

cause diarrhea and symptoms flushing, wheezing, vascular telangiectasia when they metastasize. Histo monotonous small round cells with peripheral palisading, finely granular cyoplasm, small nucleoli, and salt and pepper chromatin.

Pseudomonas aeruginosa

cause malignant otitis externa in individuals using contaminated swimming pools and hot tubs.

Cryptococcus neoformans

cause meningoencephalitis, pulm, immunocompromised pts, in pts with HIV infection, large polysaccharide capsule inhibits pahgocytosis by macrophages.

Cushing syndrome

caused by pituitary adenoma or ectopic ACTH secretion will present with elevated ACTH levels. High-dose dexamethasone suppression testing will suppress ACTH and cortisone levels when Cushing syndrome is caused by a pituitary adenoma (Cushing dz) but not when it is caused by ectopic ACTH secretion (small cell carcinoma)

Idiopathic thrombocytopenic purpura

caused by platelet autoantibody formation, present with petchiae, ecchymoses and bleeding after minor trauma.

Scarlet fever

caused by the body's response to an erythrogenic toxin released by GAS. It presents with a diffuse, erythematous, "sanpaper" texutred rash most notable in skin folds (inguinal, axillary, antecubital areas). Scarlet fever can occur with pharyngitis and can lead to acute rheumatic fever if untreated. `

Drug induced parkinsonism

caused by: D2 receptor blockers: Antipsychotics, antiemetics/Gastric motility agents (prochlorperazine, metoclopramide) Tx: Decrease of discontinue offending medication. Anticholinergic (trihexyphenidyl, benztropine)

Retinal artery occlusion

causes acute, painless, monocular vison loss. It is usually caused by thromboembolic complications of atherosclerosis traveling from the internal carotid artery and through the ophthamic artery. The Renal artery is the first branch of the ophthalmic artery.

Gardernella

causes an increase in pH

Hypertensive nephrosclerosis

causes arterial intimal fibroplasia and arteriolar hyalinization, along with interstitial fibrosis. Anyother vascular dz, renal arterial stenosis produces marked renal tissue atrophy.

Amyotrophic lateral sclerosis

causes both upper and lower motor neuron lesions. Damage tot he lateral corticospinal tract leads to UMN damage. Damage to the anterior horn: LMN

Acetaminophen toxicity

causes centrilobular hepatic necrosis and liver failure 24-48 hours after. metabolic acidosis and renal failure.

Isospora belli

causes chronic, watery, profuse diarrhea in immunocompromised pts, especially those with AIDS

Pericardial effusion

causes dyspnea, distended neck veins, distant heart sounds, and pulsus paradoxus (decrease in systolic blood pressure >10 mmHg during inspiration)

Carbon tetrachloride

causes free radical injury it is oxidized by the P450 oxidase system in th eliver. and forms free radical CCL3, which reacts with structural lipids of the cell membranes. THe result is lipid degradation and hydrogen peroxide formation. THis process if called lipid peroxidation. The peroxides go on form new radicals continging the vicious circle of lipid degradations. It leads to cell injury by causing swelling of the endoplasmic reticulum, destruction of the mitochondia and increased permeability of cell membranes. The processes of culminate in hepatocyte necrosis.

Long distance running (aerobic exercise)

causes increased oxidative metabolism of glucose and fatty acids in skeletal muscle. Te active skeletal muscles increase their rate of both oxygen consumption and carbon dioxide production. These increases are balanced by increases of the cardiac output-skeletal muscle perfusion ad ventilation respectively. Hoemosttic mechanisms maintain arterial O2 and CO2 contents and arterial pH near normal resting values, but there are significant chagnes in the benous blood O2 and CO2 contents and pH. The venous blood CO2 content is increased due tot he increased CO2 production. Aterial pH is usually normal in moderate exercise but may decrease during strenuous exercise due to to lactic acidosis.

Trichomonas

causes increased pH >4.5

Def in C1 complement

causes increased susceptibility to encapsulated bacteria (Strep pneumoniae, H. Influ, Neisseria meningitis) and predisposes to developingin SLE. `

Congenital def of factor X11 (Hageman)

causes marked PTT prolongation without bleeding diathesis. Instead, pts may have a tendency for thomboembolic complications.

Gluten intolerance (celiac sprue)

causes microcytic anemia due to iron malabsorption. Lymphocytic infiltrates in the small intestinal mucosa and blunting of the small intetinal villi are seen, but the stomach should not be affected.

Pseudomonas

causes nosocomial infection that is generally seen in pts with structural lung dz, immunocompromisation or intesnsive care hopitalization. It is an encapsulated, gram-negative bacillus that can appear mucoid in culture and doe not ferment lactose.

Defective collagen synthesis

causes osteogensis imperfecta (brittle bone dz). Pts with the lethal variety usually die in utero or in early infancy due to severe fractures plymonary filarue or intracerbral hemorrhage.

Portal vein thrombosis

causes protal hypertension, splenomegaly and varicositeis at portocaval anastomoses. It does not cause hito changes to the hepatic parenchyma. Ascites is uncommon as the obstruction is presinusoidal. Portal vein thrombosis causes obstruction in portal venous flow upstream from the liver, causing portal hypertension while leaving the liver unaffected. Ascites is uncommon with portal vein thrombosis since sinusoidal hypertension does not develop.

Pneumocystis jiroveci

causes pulmonary dz in immunocompromiesed its particularly those with HIV.

Cysticercosis

causes y Taenia solium, the pork tapeworm, leading to CNS inflammatory cysts as well as any other bacterial or fungal cause of intracerebral or epidural abscess.

fibroadenomas

cellular or myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces. They are characterized by nodules that are well-demarcated, painless, mobile and spherical and ca be 1-10 cm in size. They often increase in size during pregnancy, lactation or with estrogen therapy and usually regress after menopause. T

Haemophilus ducreyi

chancroid- shallow painful gential ulcers with regional lymphadenopathy. Medium enriched with hematin (X factor)

Sublimation (mature)

channeling impulses into socially acceptable behaviors.

Henoch-Schonlein purpura (IA vasculitis)

characterized by IgA immune complex deposition. Typically manifests as palpable purpura, renal dz, and arthritis/arthralgias.

Binge eating

characterized by repeated episodes of binge eating, without the compensatory behaviors seen in bulimia.

Anterior 2/3 of tongue

chorda tympani- taste branch from facial nerve 7 general sensory/pain- trigeminal nerve 5 V3 ( mandibular nerve).

CML

chornic myelogenous leukemia is an adult leukemia that is part of the myeloproliferative disease that presents with elevated white count and platelet counts.

Black stones

chronic hemolytic anemia (sickle cell disease) and increased enterohepatic cycling of bilirubin (Crohn dz

Secondary hyperparathyroidism

chronic kidney disease PTH mobilizes calcium from bones by activating osteoclastic and osteocytic activity. THis highturn over osteodystrophy ncrases bone resorption more than bone formation, causing osteopenia and pathologic bone changes similar to those seen in primary hyperparathyroidism (osteitis fibrosa cystica). Pts can develop PTH resistance, resulting in low-turnover aplastic bone disease and osteomalacia. Deranged signaling between renal cells and bone osteoblasts and osteoclasts (FGF-23, Klotho) also contributes to the skeletal changes that occur in CKD.

Varicose veins

chronically elevated venous pressure in the lower extremities can lead to incompetent venous valves and venous dilation. Venous congestion and tissue ischemia can result in venous stasis dermatitis. Which is extravasation of RBC into the tissues lead to iron deposition and the characteristic brawny discoloration.

Methrotexate

cirrohosis.

Lidocaine

class IB antiarrhythic drug that acts by blocking sodium channels and inhbiting phase 0 depolarization. It does not prolong the QT interval.

Treat bacterial vaginosis with

clindamycin or metronidazole

Polycythemia vera

clonal myeloporlifrative dz of pluripotent hematopoietic stem cells. Increased RBC mass, increased plasma volume and low erythropoietin levels. Pts have Jak2 V617F mutation renderig hematopoietic stem cells more sensitive to growth factors. peptic ulcer and pruritis (from histamie release from basophils). Gouty arthritis from increased cell turnover.

If failed ADHD meds use

clonidine

Transtentorial (uncal) herniation

cn 3

Two-sample t test is a statistical method

commonly employed the means of 2 groups of subjects.

Psoriasis

commonly presents as hyperkeratotic plaques. Histo: clubbed rete ridges, hyperkeratosis, neutrophils in the stratum corneum, and perivascular lymphocytic infiltrates. psoriatic arthritis, nail pitting, and uveitis.

humoral immunity

complement, immunoglobulins

Down syndrome

complete atrioventricular (AV) canal septal defect is the most common defect.

Carbamazepine

complex parital seizures and generalized tonic clonic seizures. SE agranulocytosis and aplastic anemia.

Anterior spinal artery syndrome

compression/occlusion of the artery that runs along the front of the spinal cord. Compression may be from bone fragments or disc herniation. Have complete loss of strength below the level of injury with loss of pain and temp sensations but preserved vibratory senses.

Cystic hygromas

comprised of lympatic cyst lined by a thin endothelium. common in neonates with turners syndrome and downs syndrome.

E. coli bacteria acquire the ability to form pili via bacterial

conjugation. Genes for antibiotic resistance are often transmitted in this manner.

Uterosacral ligament

connect the posterior aspect of the uterus to the anterior portion of the sacrum. The loss of this support contribute to the uterine prolapse into the vagina.

Cavernous hemangiomas

consists of dilated vascular spaces within thinwalled endothelial cells. Soft blue, compressible masses up to a few centimeters in size. Cavernous hemangiomas of the brain and viscera are associated with VHL dz.

Femoral triangle (lateral to medial)

consists of the femoral nerve, femoral artery, femoral vein, and deep inguinal nodes/lymphatic vessels. Cannulation of the femoral vein should occur approximately 1 cm below the inguinal ligament and just medial to the femoral artery pulsation.

Hypercalciemia

constipation, polyuria-polydipsia, and muscle weakness. Thiazide diuretcs (chlorthalidone) Metastatic bone ca too much multivitamin Vit D

Achondroplasia

constitutive activation of fibroblast growth factor receptor 3.

The mucosal crypts in the jejunum

contain goblet cells (secrete mucus) and enterocytes (secrete water and electrolytes). These secretion have only minimal bicarbonate content.

Medial medullary syndrome

contalateral pastic paralysis contralateral sensory loss of vibration and proprioception and ipsilateral flaccid paralysis of the tongue CN12.

PDA

continuous murmur wide pulse pressures and bounding pulses metabolic acidosis signs of cardiovascular strain (tachycardia, cardiomegaly), Eisenmenger (right to left shunting)

MCA stoke

contralateral hemiparesis (arms) and hemisensory loss involving the face and upper limb due to infarction of the corresponding motor and sensory cortices. Features include anosognosia (lack of insight) and spatial neglect of the contralateral side (due to damage of the nondominant right parietal lobe) , contralateral gaze deviation toward the side of the stroke, and rhomonymous hemianopsia (due to damage of the optic radiations int he subcortical temporoparietal lobe) Left MCA (dominant) resutls in right sided hemiparesis and hemiseonry loss. Speech areas - aphasia.

Glucuronide transferase

converts bilirubin into soluble bilirubin diglucuronide in the hepatocytes. This enzyme is not involved in the metabolism of chemical carcinogens.

Superoxide dismutase

converts superoxide into oxygen and hydrogen peroxide during phagocytosis. This enzyme is not involved in the metabolism of chemical carcinogens.

Visual cortex

cortical blindness or visual impairment that can make reading and writing difficult. Spoken speech would be unaffected.

The ulnar nerver

courses between the olecranon and medial epicondyle of the humerus before entering hte forearm, whiher it lies between the flexor cari ulnaris and the flexor digitorum profundus.

Radial nerve

courses through the supinator muscle near the head of the radius.

Copper IUC

creats chonic cytotoxic inflammory response in uterus, impairing sperm migration.

subdural hematoma

crescent shape Elderly shaken baby syndrome Rupture of bridging veins

Middle meningeal artery that causese epidrual hematoma

cushing reflex brain herniation (uncal herniation with oculomoto nerve palsy and death

Most common cause of recurrent kidney stones in chidren

cystine stones tx with acetazolamide Cystinuria results from defective diasic amino acid transport in interstinal and prximal renal tuular epithelial cells. Hexagonal cystine crystals, and the sodium cyandie-nitroprusside test can e used to detect excess cystine in the urine.

Syringomyelia

cysts in spinal cord- destroys central portion of spinal cord. Lateal spinothalamic tracts (bilat loss of pian and temp) Anterior horns and motor neurons: flaccid paralysis and atrophy of intrinsic muscles of the hands.

Mitochondrial cytochrome oxidase

cytochrome a+a3 is a component of the electron transport chain that reacts withmolecular oxygen to prduce water. This enzyme is not involved in the metabolism of chimcal carcinogens.

INtranuclear basophilic

cytomegalovirus

Amyotrophic lateral sclerosis ALS

damage to the motor neurons of the anterior horn (LMN) and demyelination of the corticospinal tracts (UMN lesions) are present. Loss of motor nuclei 5, 9, 10,12 LMN: muscle weakness, atrophy and fasciculation UMN: spasticity, hyperreflexia, and pathologic reflexes. mutaton of the gene that codes for copper-zinc superoxide dismutase (SOD1) may e implicated. Tx:Riluzole decreases gluatmate release.

Basilar artery occlusion

damage tot he pons. (horizontal gaze palsy)

Ulcerative colits

dangerous toxic megaton (severe dilatation of the bowel) which can lead to perforation. Increases risk of adenocarcinoma. Inflammation is the mucosa and submucosa only mucosal damage isn continous

Biliary atresia

dark grin and achoic (pale stool) increased direct bilirubin and gamma-glutamyl transferase. Bx reveals intraheptaic bile duct proliferation, portal tract edema,and fibrosis.

vWF factor and thrombotic thrombocytopenic purpura

decrease ADAMTS13 activity leading to large vWF multimers and resultin in diffuse microvascular platelet-rich thrombi. Acquired (autoantibody) or hereditary. Hemolytic anemia (increase LDH, decrease hapatoglobin) with schistocytes. Thrombocytopenia (increase bleed time, normal PT/PTT) Renal failure, neurologic manifestations, fever TTP results from impaired function of ADAMS13, a von Willebrand factor -cleaving protease. vWF (produced by megakaryocytes and endothelial cells) is releasesd as large vWF multimers that are cleaved to their regular size by ADAMTS13. In TTP, the large uncleaved wWF multimers are signficantly more prothrombotic and result in diffuse microvascular thrombosis. Thrombocytopenia and hemolytic anemia and schistocyte formation occur as erythrocytes and sheared by platelet rich thrombi.

Aging heart

decrease in left ventricular chamber apex-to-base dimension, development of a sigmoid-shaped ventricular septum, myocardial atrophy with increaed collagen deposition, and accumulation of cytoplasmic lipfuscin pigment (the result of indigestible byproducts of subcellular membrane lipid oxidation) within cardiomyocytes.

Lead poisoining

decrease in vit metabolism, interstital nephritis, anemia, constipation, behavior problems. Lead binds to sulfhydryl groups on proteins, replaces calcium in calcium-dependent cellular funcions and a directly inhibits enzymes in heme synthesis. Dx: test blood lead level, urine a-aminolevulinic acid (heme synthesis substrate)

Thiazolidinediones

decrease insulin resistance by binding to peroxisome proliferator-activated receptor-y, a transcriptional regulator of genes involved in glucose and lipid metabolism. Because the medication is depending on alteration of gene expression and subsequent protein synthesis there can be a delay in action of several days to a few weeks.

Alpha-glucosidase inhibitors (AGIs) (acarbose and miglitol)

decrease the activity of diaccharidases on the intestinal brush border. Because carbohydrates are absorbed as monosaccharides, the inhibition of disaccharide breakdown by AGIs delays carbohydrate absorption.

SE of Ace inhibitors

decreased GFR, hyperkalemia and cough. Angiodema is rare, but life-threatening side effect.

Verapamil

decreases ca ion influx that occurs during phase 0 and the latter part of phase 4. It decreases the amount of intracellular ca available within cardiomyocytes (fast-response tissue), which can reduce myocardial contractility.

Maple syrup urine disease

defective breakdown of branched chain aa (leucine, isoleucine and valine). Degradation of these aa first involves transamination to their respective a-ketoacids, whihc are subsequentely metabolized by an enzyme complex referred to as branched-chain alpha-ketoacid dehydrogenase. MSUD can result from mutations in any of the 4 genes coding for the 3 catalytic subunits of this complex. Neurotoxicity results primarily from the accumulation of leucine in the serum and tissues. A metabolite of isoleucine gives the urine an sweet odor. Branched-chain a-ketoacid dehydrogenase, pyruvate and a-ketoglutarate dehydrogenase require several coenzymes: Tender Loving Care For Nancy Thiamine pyrophosphate, Lipoate, Coenzyme A, FAD, NAD

Amyotrophic lateral sclerosis

denervation muscle atrophy is caused by axonal destructio. t occurs due to trauma, ischemia or generalized disease. Denervation leads to muscle paralysis and atrophy.

Several months to years after ischemic brain infartction the necrotic atrea appears as cystic cavity surrounded by?

dense fibers formed by astrocytic processes (glial scar).

Contractile mechanism in skeletal muscle

depends on proteins (myosin 2, actin, tropomyosin, and troponin) as well as calcium ions. Troponin molecules are small globular proteins situated alongside the tropomyosin molecules. Troponin is composed of three subuntis: tropinin T, troponin I, and Troponin C. Troponin T binds the other tropoinin componentes to tropomysin, troponin I bind the troponin-troposmysin compact to actin. troponin C contains the binding sites for Ca. During excitation contraction coupling, ca is release from the sarcoplamsic reticulum. When Ca binds troponin C, trop myosin shifts to expose the actin binding sites for myosin, allowing contraction to occur

THe pelvic splanchnic nerve

derived from S2, S3, and S4 and provide parasympathetic innervation to the pelvic and genital organs.

Tachyphylaxis

describes decreased drug responsiveness in a short period following one or more doses (rapidly developing tolerance). Drug response over time is not shown in the graph and cannot be assessed.

Reassortment

describes the mixing of genome segments in segmented viruses that infect the same host cell.

Antiphospholipid antibodies

detected in pts with autoimmune disorders such as SLE and antiphopholipid syndrome.

Femoral neuropathy Caused by a pelvic fracture or mass involving the iliopsoas/iliacus muscle (hematoma or abscess).

develop weakness involving the quadricept muscle group and my have weakneing of the iliopsaoas with more proximal nerve injuries. Difficulty with stairs and frequent falling secondary to "knee buckling." On examination, the patellar reflex is genrally diminished in Addition sensory loss over the anterior and medial thigh and medial leg is typical. Acute, severe pain in the groin, lower abdomien or back can be caused by a retroperitoneal hematoma.

Brain arteriovenous malformation

developmental vascular lesions that present at age 10-30 with intracranial hemorrhage, seizure, headache or focal neurologic deficits.

Viral myocarditis

dilated cardiomyopathy resutls from direct viral injury as well as an aoutimmune reaction to virally altered myocytes. This myocardial inflammation leads to dilatation of all 4 cardiac chambers and a resultant decrease in contractility. Dilated cardiomyopathy excludes cardiac chamber dilation that is due to coronary arty disease, valvular pathology or congenital disorders. It is characterized by dilation of all 4 chambers of the heart, stystoic dysfunction, and myocardial failure. A systolic pressure gradient between the left ventricle and aorta would not be expected in dilated cardiomyopathy and is more suggestive of left ventricular outflow tract obstruction (AS).

eccentric means

dilated.

Pleural effusion

diminished breath sounds over the affected area would be found on physical examination

Histoplasma

dimorphic, smaller than RBC, found intracelluarly withi macrophages. H. Capsulatum is endemic in parts of the central and eastern US along the Ohio and Mississippi river valleys.

Thromboembolic events Apixaban Warfarin

direct factor of Xa inhibitor that prevents platelet activation and fibrin clot formation. inhibits an enzyme required for synthesis of active vit K, resulting in decreased synthesis of vit K dependent clotting factors (2,7,9,10)

Lepirudin and argatroban

direct throbmin inhibitors directly inhibit thrombin-mediated fibrin formation. THey are used primarily for management of heparin-induced thrombocytopenia. Dabigatran (oral) is used for DVT prevention and treatment and for stroke prevention in atrial fibrillation.

Lunate dislocation

dislocation can cause median nerve compression. A fall onto an outstretched, dorsiflexed hand FOOSH is common cause of upper extremity. The Scaphoid and the lunate articulate with radius.

meniere disease

disorder of the inner ear caused by increaed volume and pressure of endolymph. 1) Low frequency tinnitus, ringing, in the affected ear, accompanied by a feeling of fulness. 2) Vertigo, 3) Sensorineural hearing loss, which is variable in severity but usually worsens over time.

Coccidioides immitis

disseminated mycosis in immunocompromised pts. In tissue section it is visulaized as large, thick-walled spherules containing endospores.

Acanthosis nigricans

dm, obesity, visceral malignany or endocrinopathy.

Heparin

do not cross they placenta, In pregnancy advances there is a progressive shift toward hypercoagulability due to increases in factors 1,2,7,8, 9, 10. There is a drop in protein S levels.

An infection with Neisseria gonorrhoeae

doe not result in lasting immunity because of the ability of these bacteria to modify their outer membrane proteins, but the process of antigenic variation. Antibodies generated during one infection will only be specific for that single antigenic epitope. Repeat neisseria infections can be caused by terminal complement def leading to the inability to form the membrane attack complex. pts have been sown to have IgA and IgG antibody production, but hte antibodies are either highly strain specific or are poorly protective. resistant to penicillin and fluoroquinolones tx with ceftriaxone

Tx lyme disease with? Thress phases

doxycycline or penicillin-type antibiotic (ceftriaxone). Three phases of Lymes: 1) early: flu-like symptoms and erythema chronicum migrans. 2) Second stage: Lyme dz may involve AV block and facial palsy. 3) Late: chronic asymmetric large joint arthritis and encephalopathy.

DRESS syndrome

drug reaction with eosinophilia and systemic symptoms, 2-8 weeks after drug exposure. Common with anticonvulsants (phenytoin, carbamazepine), allopurinol, sufonamides and antibiotics (minocycline, vancomycin). Drug induced herpesvirus reactivation followed by clonal expansion of T cells that cross-react with the drug. Fever, lymphadenopathy, facial edema,and internal organ dysfunction. LABS: atypical lymphocytosis, eosinophilia and elevated serum alanine transaminase.

neurocysticercosis

due to Taenia solium (pork tapeworm) can cause multiple brain lesions but would be unlikely in this pt with no travel history to South or Central America. Mycobacterium tuberculosis CNS infection, which can cause similar lesions, is a consideration in developing countireis but is less likely in the US>

Horners

due to interruption of the sympathetic innervation and clinically present with ptosis, miosis, anhydrous, and enophthalmos (posterior displacement of the eye). Post-synaptic sympathetic axons travel in the perivacular plexus along the carotid arteries to reach and innervate the face.

Hypertrophic cardiomyopathy

due to mutations in genes encoding cardiac sarcomere proteins. common mutation include single-point missense mutations in the genes for beta-myosin heavy chain and myosin-binding protein C.

Exposure to Bats

during cave exploratio or bird dropping in the Ohio andMississippi Rivwer valley areas are associated with Histolplasma casulatum infection whch tyypically causes lung dz similar to TB

Lumbar puncture

dx meningitis

Wiskott-Aldrich syndrome

eczema, recurrent infections and thrombocytopenia. Decrease in IgM and increase in IgE and IgA. increased risk of pyrogenic infections and inability to mount hume respose against organisms with plysaccharide capsule such as N. Meningitidis, H. influenzae, and streptococcus phneumoniae. Tcell defect leads to infections with opportunistic patholgens such a p. jiroveci and herpeviridase. Infections worsen as the pts ages and beocme most apparent initally after transpacental maternal IgG and maternal mucosal IgA dervied from the colostrum are degraded at 6 motnhs of age. Tx is HLA matched bone marrow transplant.

West Nile

elderly pt, febrile, rash morbilliform rash, encephalitis (confusional state) associated with flaccid paralysis syndrom.WNV is a positive send RNA flavivrus transmitted by female mosquitoes.

How do you dx acute pancreatitis

elevated amylase and lipase levels.

Haptoglobin

elves are norma in aplastic anemia, they would be reduced in cases of intravascular hemolysis, once free hemoglobin binds haptoglobin, the resulting haptoglobin-hemoglobin complex is removed from circulation.

Erb-B2 gene

encodes a protein with tyrosine inase acticity related to the epidermal growh factor receptor.

Left recurrent laryngeal nerve

enlargement of left atrium, MS and impinge the left reccrunt laryngeal here (ortner syndrome). Innervates all of the intrinsic muscles of the larynx except the cricothyroid muscle. Paresis of the vocal cord muscles innervated by left recurrent laryngeal nerve can cause hoarseness.

Chest x-ray of pulmonary hypertension

enlargement of pumonary arteries and right ventricle.

Meta-analysis

epidemiologic method of analyzing pooled date from several studies, thereby increasing the statistical power beyond that of the individual studies.

Absence seizures

episodes of loss of awareness typically <10 sec associated with 3Hz generalized spike and slow wave EEG pattern, follwoed by abrupt return to full consciousness. Tx with: Ethosuximide or sodium valproate.

Most duodenal peptic ulcers are caused by H. Pylori infection. the most effective method to prevent disease recurrence is to

eradicate the ifection with antibiotic therapy (amoxicillin plus clarithromycin)

Epidermal growth factor receptor inhibitor

erlotinib and gefitinib are used to treat advanced non-samll cell lung ca.

Zinc deficiency

erythematous skin lesions occurringg mainly around body oricies that are predominantly vesicular and pustular without a central clearing. Other features -hypogonadism, azoospermia, hair loss, impaired taste, night blindness and impaired wound healing.

Seronegative spondyloarthropathy skin finding

erythematous, well demarcated papules and plaques with silveray scale are the common cutaenous manifestations of psoriasis. Seronegative" refers to the fact that these diseases are negative for rheumatoid factor,[4] indicating a different pathophysiological mechanism of disease than what is commonly seen in rheumatoid arthritis.

Erythropoiesis-stimulating agents (ESAs)

erythropoietin, darbepoetin alpha- can be used to rest anemia of chronic kindy disease, which usually develops at a gfr <30. Untreated anemia in CKD and dialysis its can lead to cardiac dysfunction, fatigue, weakness and possible mental status changes (decreased cognition). ESAs can substantially improve anemia, avoid the need for blood transfusions Many its also develop htn due to the activation of erythropoeitin rectpors on vascular endothelial and smooth muscle cells.

Poor maternal glucose control leads to

excessive transplacental glucose transfer to the fetus, which stimulates fetal insulin production. Chronic stimulation of the fetal beta cells leads to beta cell hyperplasia and hyperinsulinism. Elevated insulin levels contribute to increased fat deposition and enhanced fetal growth resulting in macrosomia. This can result in rapid development of profound hypoglycemia, and affected infants require frequent feedings or parenteral glucose to prevent hypoglycemia and subsequent neurologic injury.

Exchange of intraluminal sodium ion for potassium ions

exchanges intraluminal sodium for potassium ions and can lower serum potassium in pts with hyperkalemia.

Trigeminal nerve

excist the brainstem at the later aspect of the mi-pons a the level of the middle cerebellar peduncles. Infarcts in the anterior pons can affect the corticospinal tract (contralateral hemiparesis, Babinski sign) and corticobulbar tract (contralateral lower facial palsy, dysarthria).

Combined hormonal contraceptives

exhibit systemic effects by suppressing GnRH in the hypothalamus, which decreases synthesis of the gonadotropin FSH and LH in the anterior pituitary.

Facial nerve:

exists at the ventrolateral pontomedullary junction (below the middle cerebellar peduncles).

Tx of congenital adrenal hyperplasia involves low does

exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex, so that there is a decrease in androgen production.

Chronic Vitamin C overdose

facilitate the development of calcium oxalate kidney stones.

Glucose is transported into the cell by

facilitated diffusion Moves from areas of low concentration with the help of trans membrane glucose transporter proteins (GLUT). These carrier proteins are stereoselective and have preference for D-glucose. Transport across the cell membrane by carrier proteins (which undergo conformational changes as the substrate is transported, unlike channel proteins) is termed carrier-mediated transport. GLUT 4 is the insulin-sensitive transporter found in skeletal muscle cells and adipocytes. In these cells, the GLUT4 protein is stored in cytoplasmic vesicles. Under the influence of insulin, the transporter protein is incorporated into the cell membrane. An increased number of transpoter in the membrane leads to an increaed rate of gluose uptake by the cells. GLUT 2 facilitates export of glucose from the liver, small intestine, and kidneys into the circulation and helps to control insulin secretion in the pancreas.

Vitamin E def

fat malabsorptio and abetalipoproteinemia. Most notable manifestation include hemolysis and neurologic dysfunciton (due to free radical damage of cell membranse). Can minit Freidreich ataxia: Ataxia (due to degeneration of spinocerebrellar tracts. loss of position and vibration sense (due to degeneration of dorsal columns) loss of deep tendon reflexes (due to peripheral nerve degeneration)

Project

feeling angry and thinking that the surgeon was angry at her.

Displacement

feelings are transferred to someone else. The pts says the resident was terrible and unresponsive to her needs, but infact that's how she feels about the surgeon. a person expresses unacceptable feeling meant for someone in their present life toward a different safer person. (EG: resident belittled by an attending then goes and belittles a medical student).

Fibrates MOA

fenofibrate, gemfibrozile: upregulate lipoprotein lipase, resulting in incresed oxidation of fatty acids. In addition, fibrates inhibit cholesterol 7a-hydroxylase which catalyzes the rate-limiting step in the synthesis of bile acids. The reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol stones.

Acute Viral Hepatitis

fever, abdominal pain, and jaundice in a homeless man suggest acute viral hepatitis. Histo findings mononuclear infiltration, ballooning degeneration and apoptosis.

Infective carditis

fever, fatigue and new-onset cardiac murmur. Diffuse, proliferative glomerulonephritis secondary to ciruclating immune complex deposition may complicate IE and result in acute renal insufficiency.

Mononucleosis-like syndrome

fever, malaise, myalgia, atypical lymphocytosis and elevated liver transaminases. (CMV- negative monospot test) (EBV- monospot test)

Serum sickness

fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels. Serum sickness is a type 3 hypersensitivity rx to nonhuman proteins characterized by vasculitis resulting from tissue deposition of ciruculating immune complexes. Acute serum sickness, a condition caused by tissue deposition of circulating immune complexes type 3 hypersensitivity. arthralgia begin 7-14 days after exposure to an antigen. Lymphadenopathy and proteinuria may also occur in some pts. Histologic examination of affected tissues typically show small vessel vasculitis with fibrinoid necrosis and intesne neutrophil infiltration. Deposition of IgG or IgM complemtnet fixing antiboodes result in locatlized completment consumption and hypocomplementemia decreased serum C3 levels) Serum skickness can occur follwoing administration of antigenic herologous proteins such as chimeric monoclonal antibodies (rituximab and inflixmab) or nonhuman immunoglobulin (venom antitoxins). A serum sickness -like rxn is also associated with the use of certain nonprotein drugs (penicillin, cefaclor and trimethoprim-sulfamethoxazole)

hypersensitivity interstitial nephritis

fever, rash, and renal dysfunction due to drug reactions

Marfan syndrome

fibrillin -1 mutation is associated with cystic medial necrosis of the aorta, with may result in dissecting aortic aneurysms and aortic valve regurg. MVP is also common, but septal defects are not.

Healing process

fibroblast migration and proliferation are controlled by Platelet-derived growth factor and transforming growth factor-b. Keliod is caused by a persistent level of TGF-b level that increases fibroblast proliferation.

Connective tissue

fibromas (benign) Fibrosarcoma (malignant)

Acute rejection

first 6 months. histo: perivascular and interstitial mononuclear cell infiltrates.

If a pt is drug seeking

first determine which drugs have een prescried, y whom and at what frequency.

Proliferative phase

first half 1-14 estrogent stimulated proliferation of statum functional. nonbranching, nonbudding, uniform glands evenly distributed throughout a unifrm stroma.

Thiazide

fist line treatment for essential hyptertension

Squamous cell carcinoma histology

flattened plyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or "pearls" within or between cells, and intercellular bridging. Large hyperchromatic cells with bizarre nuclei and atypical mitoses are commonly observed. SCC is cigarretted and alcohol use. In asia it's betel nuts and consumption of foods containing Nntiroso. Also hot beverages but not the leading cause. Achalasia Diverticula esophageal web

Arthrocentesis

fluid sent for crystal analysis, cell count, gram stain and culture.

Niacin SE

flushing, hypeglycemia and hepatotoxicity.

Good pasture pulm histo

focal necrosis of alveolar walls and intraalveolar hemorrhages.

Vertebral osteomyelitis

focal tenderness, fevers and night sweats, recent infection, intravenous drug abuse or immune compromise. Should be suspected i its with new or worsening back pain, fever and recent endocaritis or bacteremia (especially Staphylococcus aureus). It should be suspected if there are new neuralgic findings and fever with or without back pain. MRI and blood cultures are the best dx methods.

C. perfringens

food poisoning that characterized by transient watery diarrhea. This gastroenteritis is caused by a toxin formed when large quantities of clastrical sponres are injected. Spoore germinate in the GI tract and begin to elaborate toxin, with explains the did delayed onset. Thi is in contrast to early food poisoning caused by the preformed toxins of staph aureus and bacillus cereus. S

Terminal deoxynucleotidyl transferase (TdT) is responsible

for adding nucleotide to V,D, J regions of the antigen for antibody diversity. It is a marker of immature lymphocytes, both B and T cells. Neoplastic cells i acute lyphobastic leukemia ALL are TdT positive. ALL mainly affect children.

Rhizopus and Mucor

form board, ribbon-shaped, non-septate hypae that branch at wide angles. They cause mucomycosis, which typically presents as a paranasal infection in immunocompromised pts or those with DM.

Progressive supranuclear palsy

form of parkinsonism resulting from neuodegeneration of the midbrain and frontal subcorical white matter. It presents with rapidly progressive gait dysfunction and falls, executive function loss, and vertical gaze palsy. Brain bx shows abnormally phosphorylated tau proteins.

Struvite stones

form only in association with upper urinary tract infections with urea-splitting bacteria (Klebsiella, Proteus)

The left ventricle

forms the apex of the heart and reaches as far as the fifth intercostal space at the left midclavicular line. All other chambers of the heart lie medial to the left midclavicular line. The lung overlaps much of the anterior surface of the heart.

Myeloperoxidase

found in neutrophils, serum levels of myeloperoxidase can increase following inflammation and infection but would not rise in response to an acute allergic reaction.

Peripheral cheoreceptors

found in the carotid and aortic bodies are the pirmary sites for sensing arterial PaO2 and are stimulate dby hypoxemia. THey are also stimulated by increaed PaCo2 levels and blood H+ concentration, but central chemoreceptors are far more important for the increaed respiratory response to hypercapnia.

Frontal eye field

found near the caudal end of the middle frontal gyrus immediately anterior to the precentral sulcus. Damage here would causes the eye to deviate to the ipsilateral side.

Coxiella burnetii

from animal waste can cause retroorbital and associated with photophobia. Pneumonia. Increased liber enzymes and thrombocytopenia. Infective endocarditis in pts with valvular disease. Zoonotic infection that occurs in farm workers.

Keloid histo

from excessive granulation tissue formation during tissue repair in susceptible individuals. Histo shows hapazard arrangement of thick, pink collagen bundles.

Ischemic ATN

from prolonged hypotension, present with renal failure, oliguria and anion gap metabolic acidosis.

Pick dz

frontotemoral dementia- silver staining shows round cytoplasmic inclusions contianing aggregates of tau protein (PIck bodies)

Penicillins and cephalosporins MOA

function by irreversibly binding to penicillin-binding proteins such as transpeptidases. S. pneumoniae can changed it's protein structure of penicillin-binding proteins that prevent cephalosporin binding is one mechanism of resistance.

Sickle cell its become

functionally asplenic, and thus are at an especially increased risk for infection by encapsulated organisms (Strep pneumonia and H. Influenza) It is recommended that all aspleinc its receive penicillin prophylaxis and pneumococal vaccination.

Ataxia

gait- spinocerebellar trats.

Law of segregation

gametogenesis results in the separation of paired chromosomes sot hat the offspring inherit only half of each parent's genetic composition.

Ionizing radiation

gamma rays and x-rays. 1) DNA double strand breakage. 2)Free radical formation: Reactive oxygen specidis are formed by ionization of water, oxygen free radicals are then able to cause cellular and DNA damage.

GERD

gastroesophageal reflux dz, presents with heartburn, regurg, and dysphagia, extraesophageal symptoms (nocturnal cough, hoarseness) and no heartburn.

Env

gene mutations enable escape from host neutralizing antibodies.

Measles Subacute scleroising panenchephalitis

genome codes for several viral stuctures: hemagglutinin (mediates surface hahdesion) and matrix protein (viral assembly) Subacute scleroising panenchephalitis, young children on adults, several years after inital infection. It is thought to be caued by a form of measles virus with a mutated or absent matrix protein that prevents mature (enveloped) virion particles form forming. The virus continue to replicate intracellularly, leading to a persitent, nonproductive nucleocapsids within neurons and oligodendrocyts results in the formation of intranuclear inclusions and eventually leads to inflammation, demyelination and gliosis in many cerebral areas. Pt will have high measle antibodies in serum, and CSF (detectable as oligoclonal bands). The disease causes various neurologic deficits and dementia,and is relentlessly progressive and fatal.

Smooth muscle cells

give rise to leiomyomas and leiomyscarcomes

Cells of the arachnoid villi

give rise to minigiomas, most of which are benign. These tumors are dx by imaging they do not stain for GFAP or synaptophysin.

What is the microscopic examination of Ependymomas?

gland-like stuctures called rosettes.

Glial cells can be stained for

glial fibrillary acidic protein.

Posterior 1/3 of tongue

glossopharyngeal nerve taste , pain, temp, touch

Inferior gluteal nerve innervates the

gluteus maxiums muscle, which is responsible for the extension and external rotation of the thick at the hip. Inferior gluteal nerve injury causes difficulty risking from a seated position and clubbing starers.

Estrogen def from premature ovarian failure or menopause can result in

glycogen def in vaginal epithelium. The resulting flattening of labial fols and vaginal rugae can cause dyspareunia.

Endotoxins

gram-negative bacteria consist primarily of lipopolysaccharide (LPS). LPS is a structural component of the gram-negative outer membrane, representing the somatoic O antigenic determinants. LPS can cause fever, hypotension, hemorrhage and DIC due to activation of the clotting systm.

Knee flexors

hamstring muscles (bicep femoris, semitendinosus, semimembranosus), gracilis, gastrocemius, and sartorius. Hamstring injury can decrease hp extension and knee flexion.

Lithium toxicity

has a narrow therapeutic index, actue toxicity is gastrointestinal (vomiting, diarrhea) late toxicity (neuromuscular excitability, delirium) as the drugon0 penetrates the CNS. Usually presents as gradual onset of neurologic symptoms, such as this pt's worsening involuntary movement, ataxia and tremor. Filtered and reabsorbed in the proximal tubules. So increase dosage with Thiazide (which limit sodium reabsorption int he distal tubule causing a increase proximal tubular sodium/lithium reabsorption, which then leads to lithium txicity over time. ACE inhibitors and NSAID, andnondihydropyridien calcium channel blockers.

Amyloid proteins

has a pale rose color after congo red staining. Cardiomyopathy, nephrotic syndrome.

smoking and asbestos

has a synergistic effect on the development of lung ca, increasing the risk of ca by 6 folds.

Epidermal growth factor (EGF):

has mitogenic influences on epithelial cells, hepatocytes, and fibroblasts.

LUPUS

has postitive ANA (anti-nulcear antibodies), anti-dsDNA and anti SM low complement levels, increased immune complexes anemia, leukopenia, thrombocytopenia. Ulcer on the palate. New onset SLE Autoantibody binding to self-antigens leads to the formation of circulating immune complexes that deposit invario9us organs and cause completment activation. Therefore SLE characterized by consumption of complement and reduced serum complement levels.

Schizophreniform

has the same symptoms as schizophrenia (delusions hallucinations, disorganized speech and behavior, negative symptoms) but the duration is more than one month and less than 6 months.

Acute aortic regurg

have a small left ventricular cavity and cannot significantly increase forward stroke volume to accommodate for the reguritant blood flow. This leads to a decline in cardiac output, along with a rapid increase in left ventricular end diastolic pressure, leading to acute pulmonary edema. ALso because of this decreased Co there is an increase in HR.

Second-generation antipsychotics

have comparatively less affinity for D2 recetpors and the additional property of serotonin 5HT2 receptor antagonism, which underlies their lower risk of extrapyramidal side effects.

infectious mononucleosis

have fatigue, lyphadenopathy, and splenomegaly. Thrombocytopenia can e complication f this infection. Peripheral blood smear will show few circutlign atypical lymphocytes but not blasts.

Pts with sickle cell trait

have normal RBC indices and reticulocyte counts

DNA polymerase 1 and 3

have proofreading ability (3' to 5' exonuclease activity), the proofreading function of these polymerase is not restricted to the leading or lagging strand.

malignant mesothelioma

havey asbestos exposure.

Gamma-glutamyl transpeptidase GGT

helps covert glutathione to glutamate. It can be found in many organs including the liver. GGT elevation suggests that alkaline phosphatase elevation is due to liver (not bone) pathology.

Vasopressin

helps to strengthen the corticomedullary interstitial osmotic gradient and is necessary to produce maximally concentrated urine.

Bruising (hematoma)

hemoglobin-containing erythrocytes escape into the periorbital tissues, giving the bruise its initial purple or bluish color. Erythrocyte destruction causes the release of iron-containing heme molecules. HEME OXYGENASE contained in macrophages degrades heme into biliverdin, carbon monoxide, and ferric iron while consuming oxygen and electrons provided by NADH and NADPH cytochrome P450 reductase. Biliverdin is green in color and is further reduced by the enzyme biliverdin reductase to the yellow pigment bilirubin which is then transported to the liver bound to albumin.

Paroxyamal nocturnal hemoglobinuria

hemolysis caused by a complement mediated mechanism. Leukopenia and thrombocytopenia (pancytopenia)

Low haptoglobin is a sign of

hemolytic anemia, also there will be increased indirect bilirubin and lactate dehydrogenase.

enveloped single-stranded positive sense RNA virus

hep C

Kupffer cells

hepatic macrophages that line the walls of the sinusoid and participate in RC breaksdown. Pts receiving regular transfusions should undergo routine iron chelation therapy to reduce the overall iron loan within the body and improve survival. Eventually, the iron burden will overwhelm the reticuloendothelial cells' capacity to sequester iron, resulting in parenchymal iron overload in the liver, myocardium, skin and pancreas (bronze diabetes)

Hep B, ca and aflatoxin exposure is associated with

hepatocellular carcinoma

Liver mass with increased alpha-fetoprotein level

hepatocellular carcinoma. Strongly associate dwith HBV infection, preceded by HBV induced cirrhosis, integration of the viral DNA into the cellular genome of the host is considered a trigger of neoplastic changes. The viral protein HBx activates the synthesis of insulin-like growht factor 2 and receptors of insulin-like growth factor 1, therby stimulating cell proliferation. Another effect of HBV gene products is suppression of the p53 tumor suppressor/cell cycle regulatory gene in host cells. It is believed that chronic inflammation and regeneration induced by HBV infection faciliatates accumulation of mutation in the hepatocytes leading to carcinogenesis. Result from integration of the viral genome into host cells.

Wilson dz

hepatolenticular degeneration is a AR disorder associated with liver failure, movement abnormalities and psychiatric symptoms.

Pyrazinamide

hepatotoxicity, hyperuricemia must be converted to an active form byt he mycobacteria enzyme pyrazinamidase, drug resistance can occur in those organisms that have modified their pyazinamidase to be structurally ineffective.

Intranuclear acidophilic inclusions

herpes simplex virus infection

nucleus

heterochromatin is not actively transcribed, euchromatin is DNA that is actively transcribed.

Monospot negative

heterophile antibody-negative mononucleosis likesyndrome, dx is cytomegalovirus (CMV) infection. Paryngitis and lymphadenopathy are seen less commonly than with EBV. CMV can be acquired during the transfustion of leukocyte-laden blood products, as the visu infects leukoctyes of granulocyte-macrophage lineage. Other cases of heterophile antibody negative monoclueosis like syndromes include human herpes virus 6, HIV and toxoplasmosis.

Gallbladder hypomotility

high spinal cord injuries, preggo, octretotide, rapid weight loss.

Injury to the inferior thyroid arter is commonly assoicated with

hoarseness because i runs adjacent to the recurrent layngeal nerve.

Middle cerebral artery stroke

homonymous hemianopia with macular involvement

Dm is the leading cause of end-stage renal dz what is the 2nd leading cause

htn

Pancreatic amylase

hydrolysis of complex carbohydrate to oligo, di and monosaccharides is carried out by pancreatic amylase. Lactase produced in the intestinal brush boarder is responsible for the conversion of lactose to glucose and galactose. Def of lactase is common and causes lactose intolerance.

CRAB of MM

hyperCalcemia Renal involvement (related to amyloid deposition and hypercalcemia) Anemia Bone lytic lesions.

Primary hyperparathyroidsim

hypercalcemia: mental changes, urinary stones, abdominal pain and constipation

Risk factors for nephrolithiasis

hypercalciuria crohn disease hyperoxaluria Distal renal tubular acidosis- hypocitraturia Gout- hyperuricosuria With hyperoxaluria B6 is recommended for calcium stones, because B6 decreases endogenous oxalate production and therefore decreases the rate of stone formation in these pts. Hypocitraturia: Low urinary citrate excretion is a known risk factor for the development of kidney stones. Citrate inhibits stone formation by complexing with calcium in the urine, inhibiting spontaneous nucleation, and preventing growth and agglomeration of crystals.

Antiphosopholipid syndrome

hypercoagulable state increase risk of thromboses.

hyperkeratosis, parakeratosis, and atypical keratinocytes are characteristics of actinic keratoses

hyperkeratosis (hyperplasia of the stratum corneum) parakeratosis (retention of nuclei in the stratum corneum), and atypical keratinocytes (with pleomorphic nuclie and multiple mitoses are characteristics of actinic keratoses. Which can turn in to squamous cell carcinoma. LAYERS OF SKIN COME LET'S GET SUN BURNED

Osmotic diuretic mannitol

hypernatremia, pulmonary edema

What are pts with adult coarctation of the aorta at risk for?

hypertension associated complications, including left ventricular failure, ruptured dissecting aortic aneurysm, and intracranial hemorrhage. THese pts are at increaed risk for ruptured intracranial aneurysms because of the increased incidence of congenital berry aneurysms of the circle of willis as well as aortic arch hypertension.

Renal artery stenosis

hypertension in older patients

Anxiety causing illness or drugs

hyperthyroidism, hypoglycemia, pheochromocytoma, hypercortisolism and cardiac arrhythmias. Benzo withdrawal

Keloids

hypertrophic scars in which excessive collagenous scar tissue dpositied by fibroblasts permanently extends beyound the margins of the original wound. Keloids are not known to be specifically related to excessive matrix metalloproteinase or myofibroblast activity.

Bulima nervous electrolyte abnormalities

hypokalemia, hypochloremia, metabolic alkalosis, increased salivary amylase and russel sign (calluses) hypotension, tachycardia, dry skin and mentrual irregularities.

Low PTH and hypocalcemia

hypoparathyroidism

What does PK causes in the brain?

hypopigmentation inolving the skin, hair, eyes, and catecholaminergic brain nuclei, which produce a dark pigment known as neuromelanin) results from the inhibitory effect of excess phenylalanine on melanin synthesis.

ARB overdose

hypotension, renal failure and hyperkalemia.

Signs of Cardiac tamponade (pericardial tamponade)

hypotension, tachycardia, elevated central venous pressure that produces jugular venous distension (JVD). Heart sounds are muffled on cardiac auscultation and systolic blood pressure may drop more than 10mmHg on inspiration (pulsus paradoxus).

The middle cerebral artery

i a branch of the internal carotid and supplies much of the parietal and temporal regions of the brain. Injury to this artery or its branches can cause subarachnoid or intracerebral hemorrhage.

ALzheimer disease

i a decrease in ach in hippcampus and nucleus basalis Meynert

Autoimmune hemolytic anemia

id due to an altered immune response and the production of antibodeis against erythrocytes. AIHA can occur from Mycoplasma pneumoniae, and Epstein Barr virus following a diarrheal illness.

Thoracic outlet syndrome

id due to compression of the lower trunk of the brachial plexus in the scalene triangle the space bordered by the anterior and middle scalene muscles and the first rib. Symptoms include upper extremity numbness, tingling and weakness. In addition, compression of the subclavian vein can cause upper extremity swelling, whereas compression of the subclavian artery can cause exertional arm pain. Scalene triangle, is formed by the anterior and middle scalene muscles and the first rib. Caused by an extra cervial rib scalene musclar anomalies, or injury (repetitive overhead arm movements, trauma).

Nitric oxide

if sound in the cortex, hippocampus, hypothalamus, cerebellum and olfactory system, and is thought to participate in formation of new memories. Freely diffuses across the cell membrane and doe not need to interact wtih other neurons via synapse (neurotransmitter)

DKA metabolic acidosis

if the PaCo2 is higer (24-28) than expected indicates that he has a mixed acid-base disturbance consisting of metabolic and respiratory acidoses. Reduce urinary bicarbonate loss.

Mesna- prevent hemoorrhagic cystitis de to cytlocphomphamide or

ifosfamide. Mesna bind acrolien, the toxic metabolite formed by these agents.

Levator Ani muscles

iliococcygeus, pubococcygeus, puborectalis- hold the bladder and the urethra in the appropriate anatomic position. Injury in these muscles results in urethral hypermobility and pelvic organ prolapse (cytocele)

Celiac dz

immune mediated enteropathy that effects the proximal small intestine.

Wilson disease

impaired incorporation of copper into cerulopasmin and defective extrection of excess copper into bile.

Aspirin

impairs prostaglandin synthesis by inhibiting CX (cyclooxygenase). Inhibition of COX-1 in platelets prevents synthesis of thromboxane A2, a potent stimulator of platelet aggregation and vasoconstriction.

Amantadine

impairs uncoating of the influenza A vision after host cell endocytosis.

Vagal nerve

implies that the medication works at the level of the parasympathetic nervous system. When the vagus nerve is stimuated, acetylcholine is released. In airways , acetylocholine produces bronchoconstriction by acting on muscarinic receptors. Ipratropium, an atnichoinergic agent and derivation of atropin blocks the action of acetylchoine at muscarinic receptrs prevening this effect.

Sydenham chorea

in Acute rheumatic fever- is a cased by a delayed onset autimmune rxn involving antistreptocolccal antibodies that cross-react with the basal ganglia.

Atrophy of the nuceus acuatus

in Huntingtons NMDA receptors are depleted.

Obstructive lesion

in a mainstem bronchus can preent ventilation of an entered lung, leading to obstructive atelectasis and complete lung loll apse. Characteristic finding on chest x-ray include unilateral pulmonary opacification and deviation of the mediastinum toward the opacfied lung.

Bordetella pertussis

in addition to pertussis toxi, an exotoxin called adenylate cylast toxin. Like edema factor, the toxin functions a a clamodulin-depdent adenylte cyclase that causes phagocyte dysfunction and edema. The immunosprression induced by pertussis toxin and adenylate cyclase toxin are important for successful respiratory tract colonization by B. pertussis.

Painless hematuria

in an adult should raise suspicion that a genitourinary malignancy exists.

Parovirus B19 replicates

in erythrocyt precursors it the bone marrow. These cells express blood group P antigen (globoside) which is the cellular receptor for parvovirus B19.

Mucus production from goblet cells increase

in inflammatory states, such as inflammatory diarrhea, giardiasis and crohn dz.

Tryptophan

in milk before bedtime has hypnotic action, as serotonin can be syntheized endogenously from tyrptophan. Typtophan doe not have anticonvulsant effect. But it increases synthesis of serotonin.

Cortisol

in normal individuals, serum cortisol levels are highest early in the morning and top significantly in the eventing hours. However, in Cushing syndrome , this normal circadian rhythm is lost. THus, measurement of cortisone levels in the benign is more sensitive and specific for Cushing syndrome screening, since level are normally the lowest at this time.

A decreased reticulocyte count

in presence of anemia is characteristic of aplastic anemia. In hemolytic anemias, the reticulocytes count is increased to compensate for the ncreaed destruction of RBCs.

Most mitochondrial proteins are synthesized where?

in the cytosol and contain specific mitochondrial targeting sequences. Translocases detect these sequences and shuttle the proteins into and between the different mitochondrial compartments.

Homogenous acellular thickening of arteriolar walls

in the intima and media of small arteries and arterioles characterizes hyaline arteriolosclerosis, a condition associated with lower levels of hypertension than hyperplastic arteriolosclerosis.

Where do osmotic diuretics such as monntol function

in the proximal tubule and the descending limb of the loop Henle.

Biotin (B7) pantothenic acid (vit B 5) are adsorbed where

in the small and large intestine via the sodium dependent multivitamin transporter. Def of either of these vits are rare.

Methicillin (nafcillin) resistance is typically mediated by alterations

in the structure of penicillin-binding proteins (PBP), the enzymes invovled in cell wall sytnhesis. Altered PBPs, especially PBP2a, have greatly reduced affinity for B-lactam antimicrobial agents (except ceftaroline).

Rabies:

inactivated vaccine

Ulceration

inadequate vascularization during healing and is not associated with ecessive matrix metalloproteinase or myofibroblast activity. COmmon site for ulceration is lower extremitiy wounds in conjunction with aterosclerotic peripheral vascular disease.

Acyclovir

include crystal nephropathy and neurotoxicity that man manifest as delirium and tremor.

Risk factors for gallstones:

include obestity or rapid weight loss, female sex, glucose intolerance and hypomotility of the gall bladder (pregnancy, prolonged fasting).

Systemic sclerosis

include skin edema ni the early stages of dz, telangiectasias and calcinosis are also typical. may involve the lower two-thirds of the esophagus, resulting in smooth muscle atrophy and gut wall fibrosis. Pts can develop dysphagia with acid-reflux. Manometry typically shows absent peristaltic waves with decreased lower esophageal sphincter tone

MAP-kinase signal transuction pathway

includes Ras protein, a G-protein that exists in inactive GDP-containing and active (GTP-containing)forms. Mutated permanently activated Ras is associated with he development of ca.

Folate def, elevated enzyme

increase homocysteine.

Example of hyperplasia

increase in the the number of cells of an organ, which results in an increase in organ size. Psoriasis is charachterized by an absent statum granulosum, overlying parakeratosis and hyperplastic epidermal thickening (acanthosis) with prolonged downward thickenindg between dermal papillae (rete ridges)

Sulfonylureas

increase insulin release from the pancreatic beta cells

Pulmonary edema

increase the rise in pressure. Increases permeability of capillary wall with disruption of the capillary endothelial and alveolar epithelial layers (blood-gas barrier). This in turn leads to extravasation of RBC and alveolar hemorrhage. The red blood cells are eventually phagocytosed by macrophages and the iron from hemoglobin is converted to hemosiderin. Prussian blue stain detects intracellular iron. Consistent with hemosiderin laden macrophages (siderophages)

Desmopression

increaseas plasma level of von Willebrand factor and factor 8, it is used in the management of hemophillia A and von Willebrand disease.

Osteoid matrix accumulation around trabeculae

increased deposition of unmineralized osteoid is very characteristic of vit D deficiency. Vit D is important fo the absorption of ca and phosphorus form the GI tract and for bone mineralization. Def results in excessive unmineralize ostoid and low mineral density.

Potassium levels with DKA

increased extracellularly and decreased intracellularly.

Statin MOA:

increased hepatocyte LDL receptor recycling They inhibit HMG-CoA reductase, preventing conversion of HMG0CoA to mevalonic acid (the rate-limiting step in cholesterol biosynthesis). Decreased liver cholesterol synthesis leads to increased hepatic clearance of LDL from the circulation by LDL receptors. After mediating endocytosis of LDL particles the LDL receptors are returned the cell curace for reuse (receptor recycling). LDL id digested and used for metabolic purposes. This increase in LDL receptor recycling allows intrahepatic cholesterol levels to remain at normal levels while blood levels are kept low.

What increases your risk of cholangiocarcinoma

increased in fibrotic disease of the bile ducts, such as primary sclerosing cholangitis, congential fibrospolycystic disease, and chronic infection with Opisthorchis sinensis (liver fluke),

Cincalcet

increased sensitivity to Ca 2+

Estrogen

increases cholesterold secretion and progesterone reduces bile acid secretion, ultimately causing bile to become supersaturated with cholesterol. Porgesterone also slows gallbladder emptying, which causes bile stasis and further promotes gallstone formation.

Stimulation of beta 2 receptors by catecholamines

increases extracellular potassium movement into cells. THis effect is blocked by beta-blockers (primarily non-selective agents such as propranolo or labetalol) which impair potassium entry into cells and cause minor elevatios in plasma potassium.

Exaggerated in exogenous andogen abuse

increases hematocrit in a dose-dependent manner.

Tnsion pneumothorax

increasing volume of air accumulates within the pleural spac, the lungs and mediastinum deviate to the oppositie side of the chest.

Sickling episodes result in hemolysis, which lead to an increase in?

indirect bilirubin and lactate dehydrogenase and decreased levels of haptoglobin. Haptoglobin binds circulating hemoglobin and reduces renal excretion of free hemoglobin, preventing tubular injury.

MEthylphenidate

indirect-acting sympathomimetic indicated in ADHD and narcoleopsy.

Leading cause of death in lung transpant recipients

infection. Cytomegalovirus causes the most significant opportunistic infection in transplant recipients.

Posterior Cerebral artery

infectiorn results in contralaterial heminanopia due to the infarction of the visual cortex. The macula is often spared due to collateral circulation from the MCA.

Bilateral facial nerve palsy

infectious causes seen in lyme dz and HIV

One stranded -RNA -> +RNA->one stranded -RNA progeny

influenza virus, measles virus, and rabies virus.

Bromoacetylchoine

inhbitis choline acetyltransferase, blocking the synthesis of ACh from acetate and choline.

Magneisum sulfate

inhbits calcium influx into airway smooth muscle and promotes branchodilateion when gien intravenously during an acute asthma flare-up. Magnesium also reduces infalmmation of stabilizing T cells and inhibiting mast degranulation.

Fanconi anemia

inherited cause of Aplastic anemia, that presents with short stature and absent thumbs and is associated with an increased risk of malignany (myelodysplastic syndrome, acute myeloid leukemia)

Clopidogrel and ticlopidine

inhibit ADP mediated platelet aggregration.

GABA receptor antagonist

inhibit Gaba and produce stimulant and pro0convulsant effects. Flumazenil, a benzodiazepine GABA receptor antagonist, is used to tx benzodiazepine overdose.

TCA and Cocaine

inhibit NE reuptake by presynaptic neurons. Cocain can actually precipitate angina and MI by inducing vasospasm via this mechanism.

Cimetidien, amiodarone, trimethoprime-sulfamethoxazole, methronidazole

inhibit warfarin metabolis increasers the risk of bleeding.

Tricyclic antidepressants

inhibition of NE and serotonin reuptake.

Ethambutol

inhibition of arabinosyl tranferase. (Resistance is increased activity of enzymes involved in cell wall polysaccharide synthesis is the means y which mycobacteria develop resistance to ethambutol. Ethambutol interferes specifically with mycobacterial peptidoglycan cell wall synthesis, possibly through inhibition of arabinosyl transferase. This drug is ineffective against organisms other then mycobacterium. SE Optic neuropathy.

Isoniazid

inhibition of mycolic acid synthesis Mycobacterial catalase-peroxidase is required for the initial enzymeatic conversion of INH to its active metabolite within the mycobacterial cells, which this enzyme, INH is unable to inhibit mycobacterial mycolic acid synthesis. (resistance is decreased activity of acterial catalase-peroxidase) SE neurotoxicity, hepatotoxicity.

Resperpine

inhibitis dopamine entry into presynaptic vesicles, essentially causing a chemical sympathectomy. This reduces bp and hr. May cause wheezing in some pts.

RIfampin

inhibits DNA-dependent RNA polymerase, prventing transcription and leading to a deficiency of proteins necessary for mycobacterial survival. Bacterial resistance alters structure of enzymes involved in bacterial RNA synthesis. (SO resistance testing is altered structure of enzyme involved in RNA synthesis) SE GI, rash, red-orange body fluids, cytopenias.

Zidovudine se

inhibits cleavage of the plypeptide precursor into mature viral proteins. SE bone marrow suppression.

Cycloserine

inhibits incorporation of D-alanine into the UDP-MUrNAc-oligopeptide during bacterial cell wall synthesis. This bacterial cell wall synthesis inhibitor has a high level of ototoxicity and is rarely used.

Sofosbuvir

inhibits nonstructural protein 5B (NS5B), an RNA dependent RNA polymerase needed for hep C virua replication. Adverse effecs associated with use include fatigue and nausea.

mETFORMIN

inhibits the mitochondrial enzymes required for gluconeogenesis, helping to reduce glucose levels by impairingn hepatic glucose production. INcreases peripheral glusoe uptake.

Cutaneous ranches of the saphenous nerve

innervate the skin of the medial leg. The saphenous nerve is a branch of the femoral nerve and course to the medial leg together with the great saphenous vein.

The superior gluteal nerve

innervates the gluteus medius, gluteus minimus, gluteus miniums and tensor fasciae latae muscles.

The accessory nerve (cranial nerve 11)

innvervates the sternocleidomastoid and trapezius muslces. This nerve may be injured during surgery involving the posterior triangle of the neck (a region bounded by the sternocleidomastoid muslce, trapezius muscle, and clavicle.

Organophosphates

insecticides is an acetylcholinesterase inhbitor used to prevent he ACh breakdown int he NM junction. Reflect: depolarizing blockade (muscle weakness, fasciculations, paralysis) CNS effects (lethargy, seizures) muscarinic overstimulation (miosis, bradycardia increaed lacrimation and salivation).

Lipofuscion

insoluble yellow-brown pigment composed of lipids and phospholipids complexed with protein. This pigment accumulates with age and wear and tear of multiple organs.

acanthosis nigricans

insulin resistance. Inslulin resistance in adipose cells hinders the antilipolytic effects of insulin leading to the lipolysis and release of release of free fatty acids. In turn, chronically elevated free fatty acid levels contrite to insulin resistance y impairing insulin-dependent glucose uptake in liver and muscle and increasing hepatic gluconeogenesis.

Histoplasma capsulatum

intacelluar within macrophages. can be disseminated in immunocompromised pts. Fever, weight loss, painful oral ulcers, lymphadenopathy, and hepatosplenomegaly.

gavir

integrase

Inflammatory cytokines

interleukin 1 and interleukin 6

Bilateral ligation of what artery can decrease uterine blood flow and control postpartum hemorrhage that is unresponsive to medical management (uterotonic mediation)

internal iliac artery.

Adduction of fingers

interosseous muscles

Both obstructive and nonobbstructive cholestasis are characterized byt he deposition of bile pigment within the hepatic parenchyma, often with green-brown plugs int he dilated bile cancliculi. There is a reduction in bile flow which can cause

intestinal malasorption of fats and fat-soluble vitamins (A,D,E,and K) which require bile salts for digestion.

Type 2 DM

intra-abdominal visceral fat is more strongly related to insulin resistance than is subcutaneous fat.

Atopic eczematous dermatous

intraepidermal vesicles, superficial epidermal hyperkeratosis producing scales, epidermal hyperplasia (acanthosis) and chronic inflammatory infiltrate within the dermis would not be expected. Tx with tropical corticosteroids which decrease the procution of exptracellular matrix colalgen and glycosaminoglycans. SE dermal atrophy, damage with loss of dermal collagen, drying, cracing and tightening of the sin. telangiectasias, ecchymoses from mild trauma, and atropic striae may be found.

What is the major immune mechanism against Giardia?

involve CD4+ T helper cells and secretory IgA production. Secretory IgA helps prevent and clear infection by binding to trohozoites and impairing their adherence to the upper small-bowel mucosa. Child with IgA def, X-linked agammaglobulinemia and common variable immune def.

Palate elevation and the gag reflex

involve the glossopharyngeal 9 and vagus nerve 10

BRCA1 and BRCA2

involved in double-stranded DNA breaks Mutations of BRCA1 and BRCA2 result in genetic instability; predisposing cells to and increased risk of malignant transformation Both BRCA mutations are inherited in an autosomal dominant manner with variable penetrance. Affected women have a 70-80% lifetime risk for developing breast ca. BRCA 2 is less likely to develop ovarian ca

Pulmonary parenchymal

involvement by systemic sclerosis (scleroderma) results in a chronic restrictive interstitial fibrosis. Antitopoisomerase I (Scl-70), anticentromere and anti-RNA polymerase 3 antibodies are highly specific for systemic sclerosis

Delusional disorder

involves >1 delusions in the absence of other psychotic symptoms (hallucination, disorganized speech and behavior)

Autoimmune hepatitis (not hepatitis B infection

involves antigen micmicry with generation of self antigen recognizing CD4+ T lympocytes that damage hepatocytes.

Breast milk jaunice

involves enzyme, beta-glucuronidase.

Clopidogrel

irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface and prevents platelet aggregation. Clopidogreal is as effective as aspirin for prevention of cardiovascular events and should be used in pts with aspirin allergy.

Essential temor

is AD - tx with alcohol or b-adrenergic antagonist propranolol.

Marfan syndrome

is AD connective tissue disorder associated with aortic dissection, mitral valve prolapse,octopi lentos, and skeletal findings (joint hyper mobility)

Maturity-onset dm of the young

is AD dz caused by mutations that impair glucose sensin and insulin secretion by pancreatic beta cells.

baclofen

is a GABA-B agonist that can treat muscle spasticity, which is characterized by increased muscle tone and muslce spasms.

Abciximab

is a GP 2b/3a receptor antagonist, inhibits binding of this receptor to fibrinogen. The GP 2b/3a is defective in pts with Glanzmann thrombasthenia. Useful in pts with Acute coronary syndrome, unstable angina, undergoing percutaneous coronary intervention.

Leuprolide

is a GnRH alalog with estrogen agonist properties when admin in a pulsatitle manner and an antagonist when administered continuously. Its use as an agonist increases estrogen and protects against osteoporosis. However, its use as an antagonist decreases estrogen, protecting against estrogen receptor-positive breast can.

BINE, SINE, DINE, Zidovudine, and tenofovir, abacavir

is a NRTI used to treat HIV, it competitively binds to reverse transcriptase and is incorporated into the viral genome as a thymidine analog. AT does not have a 3-OH group, making 3-5 phosphodiester bond formation impossible.

Chronic cholestatic processes

is a PBC, PSC- presents with prolonged pruritus and fatigue. Develop acholic stools and malabsorption of fat-soluble vitamins (due to reduced bile flow to the small intestine This can came fit de def and osteomalcia with bone pain.

Venlafaxine

is a SNRI that causes sexual side effects.

Dobutamine

is a b-adrenergic agonist with precominant activity on B1 receptors and weak activity on B2 and A1 receptors. Stimulation of B1 receptors lead to increaed prodcution of cAMP and increased cytosolic Ca concentration. Leads to enhanced Ca mediated facilitation of the actin myosin complex binding with troponin C, resulting in increased myocardal contractility.

Intraductal papilloma

is a benign tumor within the mammary duct of unknown etiology. It is the common cause of spontaneous nipple discharge, however, the discharge is unilateral and bloody or serosanguinous.

Tryphtophan

is a biochemical precursor of niacin and serotonin. Carcinoid tumor cells synthesize excessive amounts of serotonin, increased diversion of tryptophan toward serotonin so can cause niacin def (pellagra 3 D)

Facial artery

is a branch from the external carotid artery and courses ove rhte mandible anterior to the insertion of the masseter muscle to supple the oral, nasal, and buccal regions.

Pericardial knock

is a breif, high frequency, precordial sound hearten early diastole (shortly after S2) in its with constrictive (chronic) pericarditis. It occurs earlier than an S3 ventricular gallop and may be confused with MS. Also During inspiration, the jugual venus pressure and level of dissension normally decreases. Kusmaul sign is a paradoxical increase in the jugular venous pressure with inspiration. Kussmaul's sign is found most often in its with chronic constrictive pericarditis, a condition that takes month or years to develop. Kussmal is also in RT HF, TS, cardiac tamponade.

Histamine

is a bronchoconstrictor released by activated mast cells.

Mycoplasma pneumoniae

is a causative agent in walking pneumonia and many cases of tracheobronchitis. It is an organism with no peptidoglycan cell wall, only a phospholipid bilayer cell membrane. It shares antigens with human erythrocytes, when the body mounts a response against these antigens, it also lyses RBCs, leading to anemia. THe antibodies causing this RBC destruction are called cold agglutinins (cross-reacting IgM antibodies). After the immune response fades the anemia resolves.

Prominent inflammatory infiltrate

is a characteristic histologic feature of polymyositis and dermatomyositis. These conditions cause proximal muscle weakness without distal pseudo hypertrophy.

Primary biliary cirrhosis

is a chronic autoimmune disease characterized by destructio of intrahepatic, interlobular bile ducts byt granulomatous inflammation (infiltrating macrophages, lymphocytes, plasma cells and eosinophils. The disease typically presents insidiously with pruritus and fatigue in middle-aged women (worse at night). Pts may evenutlaly develop signs of cholestasis (jaundice, pale stool, dark urine) and hypercholesterolemia (Xanthelasmia)

Neuroblastoma

is a common childhood cancer that arise for sympathetic nervous tissue, most commonly nt he adrenal.

Pulmonary hypertension

is a common extradermal manifestation of scleroderma. Can cause right heart failure (cor pulmonale) and is sometimes associated with secondary plycythemia, causing increased blood viscosity.

Pulmonary fibrosis

is a comon extradermal manifestation of systemic sclerosis (scleroderma).

Atropine

is a competetive antagonist at post junctional muscarinic receptors in the heart (M2). Atropine increases the HR by blocking vagal influences and after pretreatment with atropine, epinephrine mediated tachycardia would increase.

Chronic severe aortic regurg

is a consequence of infective dndocarditis. Failure of the aortic valve leaflets to remain closed during diastole results in a portion of left ventricular stroke volume to leak from the aorta back into the left ventricle. The regurgitant blood flow increases left ventricular end-diastolic voume and wall stress, with resultant eccentric hypertrophy. THe graduatl increase in left ventricular chamber size due to eccentric hypertrophy increases stroke volume and maintains cardiac output. Rapid regurg of blood back into the left ventricle leads to sudden fall in aortic pressure during diastole, resulting in a wide pulse pressure in pts with chronic severe AR. This leads to overall decrease in left ventricular afterload.

Mycosis fungoides

is a cutaneous T cell lymphoma proliferating CD4 lymphocytes infiltrate the dermis and epidermis where they form Pautreier microabseccess. This condition manifests with plaques (often on trunk or buttocks) that may be confused with eczema and psoriasis. Generalized erythema and scaling and thickening of the skin (erythroderma) may result.

TNF-a (tumor necrosis factor-a)

is a cytokine secreted by activated macrophages and T cells that promotes leukocyte recruitment induces the systemic inflammatory response (fever, acute-phase proteins) and regulates apoptosis.

Amifostine

is a cytoprotective free-radical scavenger used to decrease nephrotoxicity associated with platinum containing and alkylating chemotherapeutic agents and to decrease xerostomia (dry mouth).

Danny-Walker malformation

is a developmental anomaly characterized by hypoplasia.absence of the cerebellar vermis and cystic dilation of the fouth ventricle with psoterior foss enlargmetn. Pts often present during infacny with developmetal dlay and progressive skull enlarment.

Hydralazine

is a direct vasodilator often used in combination of with isosorbide dinitrate for treatmetn of heart failure. Common side effects include tachycardia and orthostatic hypotension.

Fluphenazine

is a dopamine antagonist that can treat tourette syndrome a disorder characterized by motor and phonic tics.

Rivaroxaban

is a factor Xa inhibitor used to reduce the risk of cardioembolic stroke in pts with atrial fibrillation. Excess bleeding is the primary risk.

Hyperkalemia

is a frequent complication of acute kidney disease and CKD.

Valganciclovir

is a ganciclovir prodrug SE of ganciclovir is severe neutropenia, exacerbated by other bone-marrow suppressing agains (zidovudine, trimethoprim--sulfamthoxazole)

Vancomycin

is a glycopeptide antibiotic used to treat methicillin-resistant Staphylococcus aureus infections.

Leukocyte IFN-a

is a glycoprotein that inhbitis various stages of viral RNA and DNA synthesis. It is currently approved for the tx of hep B and C virus infection, hairy cell leukemia, condyloma acuminatum, and Kaposi's sarcoma.

Chlamydia trachomatis

is a gram negative bacterium that can infect the columnar epithelium of the cervix (cervicitis) and urethra in addition to the lungs and eyes. Dx with PCR and tx with azithromycin, a baceriostatic macrolide antibiotic.

Filgrastim

is a granulocyte colony-stiulating factor analog used to stimulate the proliferation and differentiation of granulocytes in its with neutropinea.

Acyclovir

is a guanosine chain analog

PCP

is a halucinogen that works as a N-methy-D-aspartate receptor antagonist, leading to the excess release of excitatory neurotransmitters. It can also inhibit the reupatke of NE, DA,a nd serotonin.

Homeobox gene

is a highly conserved DNA sequence that is usually about 180 nucleotide in length, it codes for transcription factors that bind to regulatory regions on DNA, altering the expression of genes involved int he segmental organization of the embryo. Proper morphogenesis ensures that tissues, organs and structural elements of the body are formed int he correct position along the cranio-caudal axis. Mutatios lead to skeletal malformation and improperly positioned limbs and appendages.

Fibrinoid necrosis

is a histologic pattern of injury seen in the walls of blood vessels affected by vasculitis syndromes (PNA), malignant htn, and DM.

perivascular infiltrate with abundant eosinophils

is a histopathologic presentaton consistent with hypersensitivity myocarditis. A large percentage of cases of hypersensitivity myocarditis are believe to occur due to initiation of a new drug therapy, against which the body mounts an atopic response.

Kaposi's sarcoma

is a hyperplasia or neoplasm of spindle-shaped cells with markers of both smooth muscle and vascular endothelial lineage. It is associated with HIV infection and other immunocompromised states, but not with lymphedema.

Furosemide

is a loop diuretic frequently used for treatment of pulmonary congestion and fluid retention in heart failure patients. Although lop diuretics improve symptoms significantly, they do not provide survival benefits (improved morbidity but not mortality in these pts.

Bumetanide

is a loop diuretic that works by inhibitin NK2CL symporters int he ascending limb of the loop of Henle. Used to tx pulmonayr edema, venous and plumonary congestion secodary to CHF and peripheral edema. SE hypokalemia, hypomagnesmia and hypocalcemia.

Fidaxomicin

is a macrocyclic antibiotic (related to marcolides) that inhibits the sigma subunit of RNA polymerase, leading to protein syntheisis impairment of cell death. Bacteriocidal Used to treat c. diff also vanco, and oral metronidazole can be used as well.

Pancreatitis

is a major risk factor for ARDS as it results in the release of large amounts of inflammatory cytokines and pancreatic enzymes, which lead to activation of neutrophils in the alveolar tissues. During the initial phase, interstitial and intraalveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes. These membranes consist of fibrin exudate and inspissated protein rich edema fluid mixed with the remnants of necrotic epithelial cells. Exudative

PaCO2

is a major stimulator of respiration in healthy people. Even a slight increase in PaCO2 results in increased pulmonary ventilation in pts with crhornic obstrctive pulmonary dz, response to PaCO2 is blunted and hypoxemia becomes an important contributor to the respiratory dirve. Peripheral chemoreceptors are primarily responsible for sensing arterial PaO2 and can be suppressed with oxygen administration .

Choriocarcinoma

is a malignant GTD (gestational trophoblastic dz) Presents with vaginal bleeding and pulmonary metastases. Pathology: sheets of anaplastic cytotrophoblasts and syncytiotrophoblasts and no villi.

3-Hydroxy-30methylglutaryl-CoA (HMG-CoA) lyase

is a mitochondrial enzyme that is responsible for ketogenesis from HMG CoA. HMG CoA results from the degradation of leucine, a strictly keogenic aa, from synthesis by HMG CoA synthase. This molecule is also an intermediate in the formation of cholesterol.

Rifaximin

is a nonabsorbable antibiotid work to decrease bacterial flora which would form ammonia in the gut. By removing these bacteria it decreases ammonia formation. It is also sometimes used for travelers's diarrhea, as it inhibits bacteral RNA synthesis through binding with DNA-dependent RNA polymerase.

Buspirone

is a nonbenzodiazepine anxiolytic used to treat generalized anxiety disorder. It has a slow onset of action, lacks muscle relaxant or aniconvulsant properties and carries no risk of dependence.

C-myc

is a oncogene located on chromosome 8. Translocation between chromosome 8 and chromosomes coding for the immunoglobulin heavy chain (14), the kappa light chain 2, the lambda light chain 22, result in Burkitt lymphoma.

Secrtin

is a peptide hormone secreted by S cells of the duodenum in response to low duodenal pH. Secretin stimulates the secretion of bicar formthe pancrease and gall bladder and reduces acid secretion in the stomach by reducing the production of gastrin.

Tenaospasmin

is a potent metalloprotease exotoxin

Clostridium botulinum toxin

is a preformed neurotoxin, that is heat-labile so the dz can be prevented by thoroughly heating food prior to consumption.

Nuclear factor Kappa B (NF-kB)

is a proinflammatory transcription factor that regulates cytokine production, adhesion molecule expression and cell survival. Increased NF-kB activity is found in many cancers and inflammatory diseases (RA, IBD)

Synaptophysin

is a protein found in the presynaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells. CNS tumors of neuronal origin frequently stain positively for synaptophysin on immunohistology. Neoplasms of glial origins (astrocytomas, ependymomas, and oligodendrogliomas) stain for GFAP. Synaptophysin is a transmembrane glycoprotein found int he presynaptic vesicles of neurons, neuroectodermal nd neuroendocrine cells.

Fibrinogen 1

is a protein synthesized by the liver. Thrombin mediated cleavage of fibrinogen to form fibrin, the main component of thrombi, therefore, without thrombin, fibrinogen admin alone would not be helpful.

Cyclin D

is a protein that regulates cell cycle. Its overexpression is seen in breat, lung, and esophageal cancers, and certain types of lymphomas.

RET

is a proto oncogene

Sis

is a proto-oncogene encodes platelet derived growth factor. Overexpression of sis is seen in astrocytomas and osteosarcomas.

Dermatitis herpetiformis

is a rare condition that presents with erythematous, pruritic papules, vesicles and ullae that appear bilaterally and symmetically on the extensor surfaces, elbows, knees, upper back and buttocks. Associate with celiacs.

Liver hemangiosarcoma

is a rare malignant vascular endothelial cell neoplsam associated with such carcinogens as arsenic (exposure to pesticides), thorotrast (a former radioactive contrast medium), and polyvinyl chloride (a plastic widely used in industries).

Encephalocele

is a rare neural tube defect caharacterized by protrusion of the brain and meninges through an abnormal opening in the skull.

Narcolepsy

is a rare neurologic disorder characterized by episodes of irresistible, refreshing sleep during the daytime and usually one or more REM sleep-releated phenomena such as cataplexy, hypnogogic-hypnopompic hallucinations and sleep paralysis The etiology of narcolepsy is believed to be due to low lees of stimulatory neurotransmitter orexin (hypocretin) which is involved in maintaining wakefulness and upression REM sleep related phenomena. Modafinil- a non-amphetamine stimulant, as become the first line agent because it is effective, well tolerated and drug abuse is rare. Its mechanism of action is not well described,but it is thought to enhance dopaminergic signaling. Amphetamines are second line agents due to their sympathomimetic side effects (HTN, arrhythmia, psychosis) and risk of dependency.

Endomyocardial firosis

is a restricive cardiomyoopathy characterized by thickening and fibrosis of apical endocardial surface. It occurs int he tropics (uganda)

Sarcoma botryoides

is a rhabodmyosarcoma that can occur in young girls. It has a jellylike cystic appearance bunch of grapes and arises from the bladder or vaginal mucosa. This pts pathology is from the trophoblastic tissue in the uterus.

Gastrocolic ligament

is a section othat stretches formthe greater curvature of the stomach to the transverse colon. It forms part of the anterior wall of the less sac and is often divided during surgery to provide access tot he anterior pancreas and posterior wall of the stomach

Atenolol

is a selective B1 adrenergic antagonist. B1 receptors are found in cardiac tissue and on renal juxtagomerular cells, but not in vascular smooth muscle. So it would decrease cAMP in the cardiac tissue and renal juxtagomerular cells, but not the vascular smooth muscle ones.

Eplerenone

is a selective aldosteron antagonist and has few side effects.

Clomiphene

is a selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen, resulting in increased gonadotropin production (FSH and LH) and ovulation.

Clomiphene citrate

is a selective estrogen receptor modulator that stimulates FSH and LH production, which in turn stimulates follicular development in the ovaries. Hs the opposite effect of systemically acting progestins and increase the change of pregnancy.

Escitalopram

is a selective serotonin reuptake inhibitor indeicated for tx of depression and generalized anxxity isdiorder. decrease bone density.

Trazodone

is a serotonin reuptake inhibitor that also blocks histamine (H1) and alpha-1 adrenetgic receptors. It should be used with caution in geriatric pt due to side effects (sedation) but may be continued in the pt until the indication for its use can be clarified.

SE of venlafaxine

is a serotonin-norepitnepherine resuptake inhibitor and has been associated with increased blood pressure, at higer doese.

Alpha-1antitrypsin

is a serum protein that through the inhibition of neutrophil elastase, reduces tissue damage caused by inflammation. Histologically, AAT def is associated with redish-pink, periodic achid-Schiff postiive granules of unsereted, polymerized AAT in the periportal hepatocytes. Panacinar emphysema- pulmonary dysfunction takes decades to develop, and so liver involvement is of greater concern during the first 2 decades of lie. ZLiver disease develops due to intrahepatocyte accumulation of polymerized AAT molecules and can progress to cirrhosis and hepatococellular ca. Histology, intracellular granules globules of unsecreted AA are seen with the periportal hepatocytes of afflicted individual.

Nitroprusside What does it look like on the cardiac pressure volume cycle

is a short-acting balanced venous and arterial vasodilator. It decreases left ventricular preload and afterload, allwing an adequate cardiac output to be delivered at a lower a LV end diastolic pressure.

High QRS voltage in the precordial leads

is a sign of ventricular hypertophy from untreated hypertension.

Dupuytren's contracture

is a slowly progressive fibroproliferative disease of the palmar fascia. Nodules form on the fascia, eventutally resulting in contractures that draw the fingers into flexion.

Left atrial appendages

is a small saclike structure int he left atrium that is particularly susceptible t thrombus formation. 0% of left atrial thrombi ar found within the LAA in pts with nonvlavular atrial fibrillation.

Octreotide

is a somatostatin analogue that decreases gut motility, blood flow, and endocrine and exocrine pancreatic function. Octreotide decreases secretion of pancreatic enzymes into the intestine and could therefore aggravate this pts malabsorptive diarrhea.

Myoclonus

is a sudden, brief, severe shock-like muscle contraction. Such as a hicuup and hypnic jerks (when falling asleep).

Alendronate

is a synthetic bisphosphonate. As a bone resorption inhibitor it prevents and treats osteoporosis in postmenopausal women.

Granulomatosis with polyangiitis (Wegener's)

is a systemic vasculitis of small and medium-sized arteries. It presents with involvement of upper respiratory tract (sinusitis, nasal obstruction, epistaxis, otitis), lung (hemoptysis), and kidneys (RPGN). cANCA

Arginine

is a urea cycle intermediate that helps to remove nitrogenous waste products (ammonium) from the blood. Hepatic metaboism of arginine results in the production of urea and ornitine.

Bronchioloalveolar caarcinoma

is a variant of adenocarcinoma. It almost always arises at the lung periphery and has a characteristic distribution along the alveolar septae without vascular or stromal invasion. On chest X-ray it appears as a peripheral mass or as a pneumonia like consolidation.

Protein A

is a virulence factor that forms part of the outer peptidoglycan layer of S aureus. Protein A binds with the Fc portion of IgG antibodies at the completment-binding site, preventing completment activation. Theis results in decreased productionof C3b, leadig to impaired opsonization and phagocytosis.

Cyptococcus neoformans

is a yeast that has an antiphagocytic polysaccharide capsule, a major virulence factor. Round narrow base buds. Polysaccharide capusle appears as a clear, unstained zone with india ink and stains RED with mucicarmine. Immunocompromised pts, respiratory route and most commoly presetns with suactue or chornic meningoencephalitis. Lung disea can occasionally cause pneumonia-like symptomes, including cough and scant sputum projection, pleuritic chest pain, dyspnea, and hemoptysis.

D-xylose

is absorbed in the proximal small bowel via passive diffusion and is used to differentiate pancreatic from intestinal malabsorption,

Right ventricular afterload in COPD

is actually increased due to chronic pulmonary hypertension. can cause increased jugual venous pressure and right heart failure (cor pulmonale)

Metyrapone

is an 11-beta-hydroxylase inhibitor, blocks synthesis of cortisol. The resulting increase in pituitary ACTH release leads to increased adrenal androgen projection and would worsen androgenic symptoms.

HCM

is an AD genetic disorder tat cause a mutation n one of several sarcomere genes and is characterized by massive myocardial hypertrophy, without ventricular dilation.

Naproxen

is an NSAID,

Telomerase

is an RNA depedent DNA polymerase that synthesizes telomeric DNA sequences that can replace the loss chromosomal ends of the telomerese. Ca cells typically contain increased telomerase activity (so do germ cells, stem cells)

Carnitine

is an aa derivative responsible for transporting fatty acids into the mitochondria for beta-oxidation. Carnitine is synthesiszed from lysine and methionine; vit C is essential for this synthesis.

Acute a calculous cholecystitis

is an acute inflammation of the gallbladder in the absence of all stone. It typically occurs in the critically ill its (those with sepsis, severe burns, trauma, immunosuppression) due to gallbladder stasis and ischemia. Clinically finding maybe subtle and include feet, right upper quadrant pain, and leukocytosis

Marjolin's ulcer

is an aggressivle ulcerating squmous cell ca that presents in an area previously traumatized, chronically inflamed or scarred skin. Malignant transformation often occurs long after the initial trauma >10 yrs.

Baclofen

is an agonist of GABA receptors and is used to treat spastic conditions.

Chloramphenicol

is an anti-ribosomal antibiotic that acts to inhibit the 50S bacterial ribosomal subunit. It prevents protein chain elongation via inhibition of peptidyltransferase activity of the 50S prokaryotic ribosomal subunit preventing peptide bond formation. Peptidyltransferase enzyme forms peptid bonds between adjancent aa using tRNA during the translation process of protein biosynthesis. Resistance: caused by plasmid encoded acetyltransferase, which inactivates choloamphenical by covalently linking an acetyl group to a hydroxyl group on the chloamphenicol molecule. The acetylation prevents the drug from binding to the ribosome.

Ranolazine

is an antianginal drug that inhibits late phase inward sodium channels in ischemic myocardial cells during cardiac repolarization. A decrease in intracellular sodium concentration reduces intracellular ca influx via sodium ca exchange and reduces myocardial oxygen consumption.

Gabapentin

is an anticonvulsant that works by blocking voltage gated ca channels, attenuating excitatory neurotransmitter release.

Dermatomyositits

is an autoimmune disorder that presents with proximal muscle weakness and skin involvement including a violaceous discoloration of the upper eyelids (heliotrope rash), and a raised, violaceous, scaling eruption on the knuckles (Gottron's signs). CPK levels are typically elevated.

Friedreich ataxia

is an autosomal recessive disorder caused by mutation of the frataxin (FXN) gene. This gene codes for an essential mitochondrial protein involved in the assembly of iron-sulfur enzymes. An increased number of trinucleotide repeats GAA is present in the mutated gene, causing and increaed oxidative stress, resulting in the degeneration of neural tracts and peripheral nerves. Gait ataxia, loss of poistiion and vibration, kyphoscoliosis and food abnormalities, hypertrophic cardiomyopathy and Congestive HR, DM

Gauchers dz

is an autosomeal recessive lysosomal storage disorder that presents as pancytopenia and hepatosplenomegaly

Hormone sensitive lipase

is an enzyme found in adipose tissue that catalyze the mobiliaxtion of stored triglycerides into free fatty acids and glycerol. HSL is activated in response to stress hormones (catecholamines, glucagon, ACTH), whereas it is inhibited by release of insulin. Stress horomon stimulated Gs protein-coupled receptors in adipocytes, increase cAMP production and activation of protein kinase A. PKA phosphoryalates and activated HSL, causing lipolyis. MOst tissues used FFA and ketones. Except the brain (ketones/glucose) and erythrocyes (only glucose) Ketones: acetoacetate and beta0dydroxybutyrate

Where is alkaline phosphatase found

is an enzyme that hydrolyzes and removes phosphate from other compounds (proteins, enzymes). IT is maily found int he bone, liver, bile ducts, and placenta. Alkaline phosphatase can be elevated in biliary conditions, bone dz (osteomalcia)and leukemia/.lymphoma.

What is Lecithinase (a toxin)

is an enzyme with phspholipase C activity and the major virulence factor produced by clostridium perfringens. The toxin increases platelet aggregation and adherence molecule expression on leukocytes and endothelial cells, resulting in vasoocclusion and ischemic necrosis of affected tissues.

Hamartoma

is an excessive grown of a tissue type native to the organ of involvement. Lung hamartomas often contain islands of mature hyaline cartilage, fat, smooth muscle and clefts lined by respiratory epithelium.

Eosinophilic esophagitis

is an immune/antigen mediate dz that typically presents with dysphagia an food impaction on atopic adults. numberous eosinophils.

Hairy cell leukemia

is an indolent B-cell neoplasm predominantly found in middle-aged men and characterized by bone marrow failure and infiltration into the reticuloendothelial system, causing massive splenomegaly. Other typical features include a dry tap and the presence of hairy cells. Adult, B cell tumor in the elderl, marrow fibrosis (dry tap), Stains TRAP (tartrate-resistant acid phophatase +) TRAP stain largely replace with flow cytometry. TX with cladribine ( purine (adenosine analog) and pentostatin.

Progressive multifocal leukoencephalopathy

is an infectious demyelinating disorder caused by JC virus, a double stranded DNA virus int he polyomavirus family. JC virus manifests with progressive neurologic deficits in immunocompromised ndividuals (lymphoma, Leukemia or HIV infection).

Retinitis pigmentosa

is an inherited degenerative eye disease that leads to severe vision impairment

Gilbert syndrome

is an inherited, benign condition with the reaction of glucuronyl transferase, a haeptaic enzyme responsible for glucuronidation (conversion of bilirubin to its excitable form). Pts are usually asymptomatic except at times for stress which presents mild, indirect hyperbilirubinemia and jaundice are present.

Mannitol

is an intravenous osmotic diuretic used primarily to lower intracranial pressure and treat acute glaucoma. It is not used to rest heart failure as i can cause an initial rise extracellular fluid volume, exacerbating pulmonary congestion and peripheral fluid retention.

dexrazoxane

is an iron-chelating gent that canprevetn anthracycline induce cardiotoxicity.

Morphine

is an opioid agonisst that works by selectively biendng to mu receptors. Mu opioid receptors belong to a family of G protein-linked receptors that activate and regulate ta number of secondary messaenger pathways. ONe of the major pathways involved potassium conductance. Upon binding to mu receptors, morphine causes G protein coupled activation of potassium channels to increase potassium efflux. Increased potassium efflux leads to hyperpolarization of postsynaptic neurons and termination of pain transmission. Mu receptor activatin includes inhibition of adenylyl cylcases, inhibition of ca conductance and inhibition of transmitter release.

Mannitol SE

is an osmotic diuretic that works by increaisng plasma and tubular fluid osmolality. Increased plasma and fluid osmolality causes extraction of water from the intersistial space into the vascular space or tubular lumen which subsequent diuresis. n the rain, water redistridubtrion from the tissues to the plsama helps reduce edema and intracrainal pressure in the setting for cerebral edema. ONe of the more severe txicities of aggresssive osmotic diuretics is pulmonary edema.

Hemophilia B

is an xlinked hereditary def of factor 9 that causes coagulopathy with prolonged PTT but shows normal bleeding time.

Pseudomonas aeruginosa

is anopportunistic, aerobic gram negative rod that can can be a pulmonary pathogen in cf and neutropenia.

Axillary nerve damage

is anterior dislocation, proximal humeral fracture

Mitral valve prolapse

is associate dwith a mid-systolic click and a mid-to-late systolic murmur.

Involvement of the gastric body in longstanding infection

is associate dwith an increased risk of gastric adenocarcarinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. H. pylori.

Dyspagia for liquids and difficulty belching in a man from Peru?

is associated with a dilated esophagus and absent peristalsis in the smooth muscle protion of the esophagus is dx of achalasia. Achalasia is most often a primary disorder (congential). It is alwyas caused by dysfunction of ganglion cells fo the myenteric plexus. Trypansoma cruzi (Chagas dz (american trypanosomiasis)) is a parasite transmitted by an insect that lives in the walls of rural huts- the reduviid bug. T. Curzi produces a nerotoxin that destroys the myenteric plexus and causes intramural, parasympathtic denervation of smooth muscle. In the esophags this neurotoxin incapacitates the lower esophageal sphincter, so that food gets stuck int eh esophagus. Proximal to the obstuction, the esophgus is markedly dilated. Destroys the myenteric plexi in the esophagus, intetine, and ureters, causing secondary achalsia, megacolon and megaureter respectively.

Menetrier disease

is associated with an over production of TGF-a, resulting in mucosal cell hyperplasia with gastric fold enlargement. However the condition causes hypoplasia of parietal/chief cells, resulting in glandular atrophy with reduced gastric acid secretion.

Animal contact

is associated with dermatophytoses caused by Microsporum species. Microsporum canis causes tinea capitis.

PSGN

is associated with increased antistreptolysin O titers

Porcelain gallbladder

is associated with increased risk of adenocarcinoma of the gall bladder gall bladder carcinoma

Rb

is associated with osteosarcoma white pupils leukocoria Chromosome 13 somatic - second mutation (occuring n the retinal cells only) Rb gene is a tumor suppressor = active - dephsosphorlyated. stops G1 to S stage. when the cell is stimulated by a grown factor, the RB protein is phosphorylate sand converted into the inactive state. ncactivation of the Rb protein permits cell division.

Femoral head osteonecrosis

is associated with vasculitis (lupus), corticosteroid tx, sickle cell dz, and alcoholism. In children (Legg-Clave-perthes dz)

A decreased serum albumin level

is assoicated with cirrhoiss (decreased production), nephrotic syndrome (urinary loss) and protein wasteing enteropathy (bowl loss)

Glutent enteropathy

is assoicated with dermatitis herpetiformis on buttocks and extensor surfaces of the extremities.

anterior cruciate ligament

is attached to the anterior tibia

posterior curciate ligament

is attached to the posterior tibia (medial) It orginates form the anterior lateral surfact of the medial femoral condyle . So medial.

Familial hypocalciuric hypercalcemia

is benign AD disorder caused by a defective CaSR inthe parthyroid gland and kidneys. Higer serum ca levels are required to suppress the scretion of PTH. This raises the set point of calcium-induced regulation of PTH secretion. Pts with FHH have mild asymptomatic hypercalcemia, reduced urinary excretion of ca and high normal or mildly elevated PTH.

Mastocytosis

is benign, pruritic infiltration of the skin by mast cells that is more common in children. Scrating of the lesions causes degranulation of the maist cells, urticaria and severe flushing or syncope.

Peptide bond formation

is catalyzed by peptide transferase, and RNA enzyme "robozyme" that resides in the large ribosomal subunit. A defect in rRNA coding for ribosomes would be required to interfere with this process.

Myelodystplastic syndrome

is caused by a defect in stem cell maturation leading to ineffective differentiation of cell lines and therefore pancytopenia. Bone marrow bx will be hypercellular with abnormally differentiated cells (misshapen nuclei) over the age of 65

Hemoglobin C

is caused by a missense mutation that results in a glutamate residue being substituted by lysine in the beta globin chain. This results in an overall decrease in negative charge for the hemoglobin molecule. The speed of Hb in gel electrophoresis is hbA>hbS>hbC.

Zollinger-Ellison syndrome

is caused by gastrin-secreting tumors (gastrinomas)involving the small intestine or pancreas. Pts typically have peptic ulcers (beyond the duodenal bulb), abdominal pain acid relax and diarrhea. Test for MEN1 and serum ca, and prolactin levels.

Systolic HF

is caused by primary decrease in myocardial contractility rather than ventricular compliance. As a result, styloic HF is characterixed by a reduced LVEF <50% along with progressive chamber dialtion with increased LV volume and elevated LVEDP>

Achalasia

is caused by reduced numbers of inhibitory ganglion cells int he esophageal wall. Esophageal manometry in achalasia shows decreased amplitude of peristalsis in the mid esophagus, with increaed tone and incomplete relaxation at the lower esophageal sphnicter.

A bifid carotid pulse with a brisk upstroke "spike and dome"

is characteristichypertrophic obstructive cardiomyopathy a condition associated withd ynamic left ventricular outflow tract obstruction during systole.

Ductal carcinoma in situ

is characterized by a malignant clonal cell prliferation contained by the surrounding ductal basement membrane.

Papillary thyroid ca

is characterized by branching papillary structure with concentric calcification (psammoma bodies)

Sclerosing adenosis

is characterized by central acinar proliferation and compression with surrounding fibrotic tissue and peripheral ductal dilation. Common finding in fibrocystic change.

Chonanal atreasis

is characterized by congenial obstruction of the posterior nasal passages. Infants with bilateral choanal atresia can present with upper airway obstruction and cyanosis with feeding, but not excessive drooling. Inability to pass a nasogastric tube through the nares is suggestive of the diagnosis.

Primary hypothyroidism

is characterized by decreased T4 levels increases TSH and normal T3 levels.

Hashimoto thyroiditis

is characterized by diffuse, painless thyroid enlargement often with sytpos of hypothyroidism (fatigue, cold intolerance). Bx reveals diffuse lymphocyte infiltration with formation of germinal centers

Riedel thyroiditis

is characterized by extensive fibrosis of the thyroid gland tat extends into surrounding it issues. The tyroid gland is hard and non-tender

Disseminated gonococcal infection

is characterized by fever, migratory polyarthritis, and skin lesions. Lesions are typically scattered pustules on the arms and legs.

Acute adrenal insufficiency

is characterized by mineralocorticoid def and hyperkalemia and mild hyperchloremic.

Subacute granulomatous (de Quervain) thyroiditis

is characterized by painful thyroid enlargement. it usually follows a viral illness. Bx is characterized by a lymphocytic infiltrate with macrophages and multinucleate giant cells.

Erythema nodosum

is characterized by painful, reddish nodules on the shins that arise in response to numerous factors, including oral contraceptives, other drugs, stretococcal pharyngitis, IBD or sarcoidosis.

Diffuse esophageal spasm

is characterized by periodic simultaneous and non-peristaltic contractions of the esophagus due to impaired inhibitory innervation within the esophageal myenteric plexus. Pts present with liquid solid dysphagia and chest pain due to inefficient propulsion of food into the stomach. Several segments of the esophagus contrat inappropriately at the same time.

Medullary carcinoma

is characterized by solid sheets of vesicular pleomorphic, mitotiically active cells with a significant lymphoplasmacytic infiltrate aroudn and within the tumor and a pushing noninfiltrating border.

Polymyalgia rheumatica

is characterized by sudden onset of stiffness, pain, and tenderness of the musculature. Associated with an elevated erythrocye sedimentation rate.

Acute promyleocytic leukemia

is characterized by the presence of promyelocytes with Auer rods (rod-shaped cytoplasmic inclusions). The cell cytoplasm also has numerous coarse azurophilic granules. This type of AML is characterized clinically by DIC (acquired hypercoagulability and and bleeding), which is not seen in this pt with normal PR and PTT time, immature white blood cell forms would also be present on peripheral smear.

Discoid lupus erythematosus

is characterized by tick, scaly, discoid plaques that erupt on unexposed skin and may result in sacrring. Systemic dz is not present in most pts with DLE.

Dx tetanus

is clinical. It is based on history of penetrating wound in a pt who has not been vaccinated, clinical features consistent with tetanus are trismus, sardonic smile and muscle spasm, and a high clinical suspicion. It can only e found locally at the wound into which they were inoculated.

Pyruvate kinase def

is common in chronic hemolytic anemia

Bicuspid aortic valve

is commonly associated with aortic stenosis, which classically causes a mid-systolic ejection murmur best heard over the right second intercostal space with raidation to the next.

Acanthosis nigricans

is commonly associated with insulin-resistant states (DM, acromegaly, obesity, and gastrointestinal malignancies)

Bronchioloalveolar ca

is composed of tall, columnar cells that spread along the alveolar septae and may form papillary projections in the alveolar spaces. architecture is preserved. Adenocarcinoma of lung.

Locus ceruleus

is considered to play a role in the pathogenesis of panic attacks and panic disorder. It is located in the caudal pontine central gray matter and contains large amounts of NE.

Bupropion

is contraindicated in pts with seizure disorders or current or prior dx of bulima or anorexia nervosa. Pts with possible food restriction or excessive exercise suggest the possibility of eating disorders. It is a first line tx for major depressive disorder that does not cause sexual dysfunction. It is classified as a ne-dopamine reuptake inhibitor and does not affect serotonin.

TGF-B (Transforming growth factor - b):

is critical for fibroblast migration, proliferation and connective tissue synthesis. Increased TGF-b activitiy is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney that occur with chronic inflammation.

6-mercaptopurine

is degraded by xanthine oxidase. Allopurinol, an OX inhbitor, can incrase the concentration of 6MP significantyle. Both 6MP and Mthioguanine are prodrugs that require activation of hypoxanthine-guanine phosphoribosyl transferase.

Histology of large-B-cell lymphoma

is diffuse sheets of large lymphocytes with nuclei at least 5 time the size of small lymphocytes.

Whipple disease

is distended macrophages in the lamina propria of the small intestine. Macrophages contain PAS-positive and diastase-resistant granules and rod-shaped Tropheryma whipplelii bacilli.

Isolated systolic hypertension (systolic blood pressure >140 Hg with diastolic blood pressure <90 mm Hg)

is due to age related stiffness and decrease in compliance of the aorta. Increased arterial stiffness caused by endothelial dysfunction and a change in extracellular matrix composition (decreased elastin, increased collagen deposition).

Renal dz in MM

is due to deposition of light chains (cast nephropathy)

That causes the delayed onset of action of regular insulin

is due to dimer and hezmer formation. Dimer and hexamer take time to diassociate after injection, causing some absorption delay.

Secondary lactase def

is due to other conditions, and is usually seen in association with other features of malabsorption (iron def, fit D def)

ACE

is endothelial bound angiotensin-converting enzyme in the lungs. Therefore levels of angiotensin 2 are highter in the pumonary vein when compared to the pulmonary artery. Angiootensin 2 is a potent vasoconstiriction of the systemic ciruclation and causes a rise in blood pressure (increased afterload) that worsens cardiac output. Angiotensin 2 also acts on the adrenal gland to stimulate aldosterone release, cuasing sodium retention and further worsening the afterload.

Protein degradation

is essential for regulation of cellular functions and is performed by the proteasome as well as cytosolic proteinase. Increased degration of protective proteins such as p53 or decreased breakdown of proteins that favor cell division can lead to malignancy.

Vit E def

is fat soluable- infertility and decreases in some serum phospholipids.

Citrate

is formed from the condensation of acetyl CoA with oxaloacetate in the first step of TCA cycle. INcreased citrate concentrations decrease glycolysis as citrate is a powerful allosteric inhibitor of PFK-1

Prostaglandin E1

is formed in endothelial cells, mast cells and macrophages. It is a potent vasodilator. It maintains patency of the ductus arteriosus and caused afferent arteriolar vasodilation in the kidneys.

Major basic protein

is found in eosinophil granules and help to defend against parasites.

Myeloperoxiase

is found in neutrophils and converts hydrogen peroxide to hypochlorous acid , a bactericidal compound that also causes oxidative damage to host cells.

Mixed cryoglobulinemia

is found in pts with hep C. THe renal dz is likely due to the IgM deposition in the glomerulus that leads to basement membrane thickening and cellular proliferation

Karyorrhexis

is fragmentation of pyknotic (condensed) nuclei during apoptotid cell death. The cells in this slide have intact nuclei.

Cleft lip

is from a failure of the maxillary and medial nasal processes to fus during development.

Chvostek sign and Trousseau sign

is from hypoarathryoidism (hypocalciema) - taking on the facial here anterior to the ear. These are signs of neuromuscular hperexcitability become clinically apparent with serum calcium levels <7.0 mgdL Perioral aresthesia

Loud P2

is heard with pulmonary htn

HPV

is incorporated into the DNA of anogenital epithelial cells.

Glutathione-S-transferase

is involved in the detox of some chemical carcinogens. Unlike cytochorme P450 oxidase, this enzyme converts toxic substances into inactive metabolities.

Vit 6

is involved in the synthesis of multiple neurotransmitters including GABA. Can cause peripheral neuropathy if def

The triquetrum bone

is located in the proximal medial wrist and together with the lunate forms the small articular surface between the distal ulna and the carpal bones.

The p02 in the left atrium and the ventricle

is lower than that in the pulmonary capillaries due to the mixing of oxygenated blood from the pulmonary veins with deoxygenated blood arising from the bronchial arteries and thebesian veins. The bronchial veins return only a portion of this blood to the right heart via the azygos and hemi-azygoes veins, most of the blood supplied by the bronchial arteries returns to the left heart via the pulmonary vein. The small cardiac thebesian veins that train into the left atrium and ventricle also contribute to normal anatomic shunting.

Hyperacute rejection

is mediated y preformed anti-donor antiodies in the recipient that attack the transplanted organ (type 2 hypersensitivity). Examples include anti-ABO and anti-HLA antiodies. THis form of rejection occurs immediately upon initial perfusion of the transplanted organ an dis often dx intraoperatively due to mottling and cyanosis of the organ.

Traumatic aortic rupture

is most often caused by the rapid deceleration that occurs in the motor vehicle collisions. The most common site of injury is the aortic isthmus, which is tethered by the ligamentum arteriosum and is relatively fixed and immobile compared to the adjacent descending aorta. A widented mediastinum may be seen on chest xray.

Small bowl mucosa of its with primary lactase def

is normal on histology.

Chromosome 16 inversion

is observed in the M4Eo (eosinophilic) subtype of AML.

Squamous cell ca

is ocmposed of polygonal cells with eosinophilic cytoplsm and distint boarders. well-differentiated squamous cell ca show keratin pearls on light microscopy.

Flunisolide

is one of the inhaled glucocorticoids used for the prophylactice treatment of bronchial asthma. Inhaled glucocorticoids are the most preferred drugs for prophylactic treatment of bronchial asthma.

Mucormycosis

is opportunistic infection caused by Rhizopus, Mucor and Absidea species.

Purkinje system

is pacemaker in pts with severe bradycarida <40 beats per minute, but it would not generate impulses in Af since the venticular rate is typically elevated.

Terminal ileum bx

is performed in the evaluation of crohn disease. Leukocytosis, elevated nflammatory markers, bx showing focal inflammation and ulceration.

Monspot test positive (serum heterophile antibodies) tat agglutinate

is positive in most cases of Epstein-Barr. It may be negative at the beginning of the infection and can be repeated later for confirmation. Mononucleosis-like syndrome: fever, fatigue, splenomegaly, atypical lympohcytois

Minimal change

is possibly due to abnormal T cell production of the glomerular permeability factor that affects the glomerular capillary wall, leasing to fusion of the food processes and marked proteinuria.

Allupurinol

is predominately noncompetitive inhibitors of xanthine oxidase. Allopurinol is used in the treatment of gout and for prevention of tumor lysis syndrome.

qGastric acid

is primarily secreted by the parietal cells of the oxyntic glands at the body and fundus of the stomach.

Testosterone

is produced by Sertoli-Leydig tumors

IL-17

is produced by Th17 and recurits neurtophils in addition to stimulating production of antimicrobial peptides. IL 17 improves host defense against fungi and bacteria at the epithelial and mucosal surfaces. Dysregulation is in autoimmune conditions.

RA cardiac

is rare y can develop pericarditis and myocarditis. Rheumatoid nodules can also develop in the cardiac tissues (valvular structures).

Folinic acid (Leucovorin)

is reduced form of folic acide that can rescule normal cells by competing with MTX for DHF reductase binding sites. It can reactivate DHF reductase therefore allowing reinitiation of DNA synthesis.

b-glucuronidase

is released by damaged hepatocytes and bacteria in infected bile. It deconjugates bilirubin, and the resulting free bilirubin precipitates with calcium in the bile to form pigmented gallstones. A decrease in this enzyme would reduce the formation of pigmented stones but would not affect the formation of cholesterol gallstones.

Digoxin

is renally cleared

Hep D

is replication defect and depends on the genetic information provided by HBV replication. This individual is not infected with HBV (HBsAg is negative) therefore she can't have HDV.

Dystrophin gene mutation

is responsible for X-linked familial dilated cardiomyopathy. Dystrophin mutations are also found in the common skeletal myopathies (Ducheene and Becker muscular dystrophy)

Islet amyloid polypeptide

is secreted along with insulin from pancreatic beta cells. Amyloid deposition occurs in the islets of pts with type 2 dm, although its role as a causative agent of beta cell dysfunction remains unknown. Pts with type 1 dm have low circulating levels of islet amyloid polypeptide due to extensive beta cell destruction.

y-inteferon

is secreted by helper T cells and functions to activate macrophages, thereby promoting adaptive immunity against intracellular pathogens. It is not directly chemotactic for eosinophiles.

Hemolysin

is secreted by staphylococci and caues hemolysis as well as desruction of neurophils, macro, and platelets. Not bound to cell well.

PTH

is secreted by the chief cells of the parathyroid gland and increases serum ca to maintain calcium homeostasis. PTH has effects on the kidney and bone but not elevated with parotits.

Glycogen-rich cuboidal epithelium

is seen in serous pancreatic neoplasms.

Pericarditis

is sharp and pleuritic, and may e exacerbated by swallwoing or relieved by leaning forward. Early-onset pericarditis develops in about 10-20% of pts between days 2 and 4 follwing a transmural myocardial infarction. It represetns an inflammatory reaction to cardiac muscle necrosis that occurs in the adjacent vierceral and parietal pericardium. Late-onset post myocardial infarction MI pericarditis (Dressler's syndrome) begins one week to a few months follwoing the MI and affects less than 4% of cases. Dressle's syndrome is thought to e an autoimmunue polyserositis and responds well to aspirin, NSAIDS and glucocorticoids.

Anti-smith antibodies

is specific for SLE. Smith protein normally complexes with small nuclear RNA (snRNA) in the cytoplasm, forming small nuclear ribonucleoprotein (snRNPs)/ RNA polymerase 2 in the nucleus and complexes with specific proteins to form small nuclear ribonuclueoproteins (snRNPs). snRNPs are an essential component of spliceosomes, which remove introns from pre-mRNA to form mature mRNA. Patients with SLE can have autoantibodies directed against snRNPs.

Interphase

is subdivided into the G1 phase (synthesis of RNA, protein lipid and carbohydrate), S phase (DNA replication) and G2 phase (ATP synthesis)

Hyponatremia and a lung mass

is suggestive of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) -CNS disruption (stroke infection, trauma and neurosurgery) -Malignancies (small cell lung carcinoma) -Drugs (desmoprssin, chlorpropamide, carbamazepine) -Pulmonary disorders (pneumonia, RB and ventilator use) Small cell lung ca. are neuroendocrine orgin, often release ADH independed of feedback inhibition (paraneoplastic effect). This inappropriate secreation of ADH leads to hyponatremia, decreased plasma osmolality and elevated urine osmolality (which normally should be <100 mOsm/kg given the degree of hyponatremia). This proound hyponatremia that occurs in SIADH can cause headaches, eakness, altered mental status and seizures. This mild increase in extracellular fluid volume suppresses the renin-aldosterone axis and stimulates the production of natriuretic peptides, leading to excretion of sodium in the urine (natriuresis). Pts with SIADH have a clinically normal body fluid volume and low plasma osmolality (euvolemic hyponatremia).

Elastin is synthesized by what? What is surrounded by?

is synthesized from the polypeptide precursor tropoelastin. Fibriliin-1 is a major component of the microfibrils that form a sheath around elastin. Microfibrils are abundantly present in blood vessels and in the suspensory ligaments of the lens. Defects in the fibrillin-1 gene cause classic AD Marfan syndrome.

Factor 12 (Hageman)

is synthesized inthe iver and is activated by endothelial injury. It triggers the intrinsic coagulation pathway by activating factor 9.

The cochlear cupula

is the apex of the cochlea and is distant from the oval window. The distal cochlea primarily registers low frequency sound

The opthalmic artery

is the first branch of the internal caroid arter, supplying the eye and orbial contents as well as the eyleids, forehead and nose.

Rectal suction bx

is the gold standard in dx Hirschsprung dz, or congenital aganglionic megacolon.

Alpha-1 antitypsin AAT

is the major serum inhibitor of neutrophil elastase. AAT deficiency can cause panacinar emphysema, which usually affect the lower lung lobes more severely

Cavernous hemangioma

is the most common benign liver tumor. Microscopically these tumors consist of cavernous, blood=filled vascular spaces of variable size lined by a single epithelial layer. The bx of a suspected hemangioma is not advisable as the procuedue is not to cause fatal hemorrhage and is of low diagnostic yield.

Cerebral amyloid angiopathy

is the most common cause of spontaneous lobar/cortical hemorrhage (occipital, parietal) in the elderly.The most common site of hemorrhage include the occipital and parietal lobes. Amyloid angiopathy is a consequence of b-amyloid deposition in the walls of small- to medium -sized cerebral arteries, resulting in vessel wall weakening and predisposition to rupture. Occipital lobe hemorrhage is typically associated with homonymous hemianopsia. Parietal - contralateral hemisoensory loss. Frongal = contralateral hemiparesis.

Hepatoblastoma

is the most common liver neoplasm of children and is associated with familial adenomatous polyposis and Beckwith-Wiedemann syndromes. This neoplasm is usually fate within a few years if not removed.

Retinoblastoma

is the most common ocular tumor of infancy and presents with absence of the red reflex on physical exam.

Basal cell carcinoma

is the most common skin cancer. perly papule with cental depresion or ulceration . BCC histo is nest of basaloid cells and peripheral palisading of nucli.

Colorectal carcinoma

is the most common type of malignant in its suffering from Inflammatory bowl disease, particularly ulcerative colitis. Affects younger its, after 10 years of colitis. Long standing ulcerative colitis is associated with an increased risk of colorectal ca. The duration and extend dog colitis are the most significant risk factors. nlie sporadic colorectal carcinomas, colitis-associated carcinomas are more likely to arise non-polypoid dysplastic lesions, be multifocal in nature, develop early p53 mutations and late APC gene mutations, and be of a higher histological grade.

Atria fibrillation site

is the opening of the pulmonary veins in the left atrium- often the target for radiofrequenc ablation

Mesosalpinx

is the portion of the broad ligament that connects the fallopian tube to the pelvic sidewall.

Neurophysin

is the posterior pituitary are carrier proteins ocytocin and vasopressin (ADH). Hereditary hypothalamic diabetes insipidus. Point mutations in neurophysin 2 underlie most cases of hereitary hypothalamic diabetes insipidus, a disorder resulting from insufficient ADH release into the systemic circulation.

Adenomyosis

is the presence of endometrial glands within the uterin myometrium. Abnormal uterine bleeding and painful menese are common, uterus is uniformally enlarged.

Wound dehiscence

is the rupturing of a previously closed wound, and can result from insufficient granulation and scar tissue formation, inadequate wound contraction, or excessive mechanical stress. Such would rupture most commonly occurs in abdominal wounds and are subject ot increased intrabdominal pressure.

Medulloblastoma

is the second most common brain tumor in children. It arise in the cerebellum and causes gait and limb ataxia.

Def of Ornithine transcarbamoylase

is the second steop of the urea cycle where ornithine and carbamoyl phosphate are combined to form cirulline. Txn occurs int he mitochondria. Def leads to hyperammonemia and mental retardation.

Transference

is the shifting of emotions or desires associated with a person from the past to another person in the present. Positive or negative transference.

Interosseous membrane

is the thick connective tissue sheet that runs between the radius and ulna. It serves as a muscular attachement point and contributes to stabilitiy of the forearm. Disruption can lead to instability of the forearm.

Sphenopaltine artery

is the third branch off the maxillary artery and supplies much of the nasal mucosa. It anastomoses with branches of the ophthalmic and facial arteirs within the anterior part of the nsala septum in a region known as Kiesselbach's plexus (site of nose bleeds)

Kawasaki disease

is the vasculitis most commonly associated with myocardial infarcton. It is seen in children with coronary aneurysms and subsequent thrombosis.

Colomnar mucinous epithelium

is typically found in mutinous cystic neoplasms of the pancreas.

Iron deficiency anemai

is typically hypo chromic and micorcytic (low MCV)

TATA box

is upstream promoter region associated with some genes win eukaryotic organisms. TATA binding protein binds to this promoter during transceiption, unwinding the DNA and initiating separation of the strands.

Phenytoin

is used for tonic-clonic and status epilepticus

Beta-naphthylamine

is used in aniline dyes and rubber industry, it is associated with increased incident of bladder carcinoma.

Trimethoprim-sulfamethoxazole

is used in pts with HIV form the prevention and treatment of pneumonia caused by pneumocystic jirovecii. SE megaloblastic anemia, steven johson syndrome and toxic epidermal necrolysis.

Protamine sulfate

is used to treat heparin overdose. It binds to heparin, forming a complex that has not anticoagulant activity.

Linezolid

is used to treat infections caused by Gram-positie bacteria, particularly vanomycin-resistant enterococcus and methicillin-resistant Staphyloccoccus aureus, Linezolid has MAOI activist and therefore can precipitate serotonin syndomre when used concomitantly with SSRI (paroxetine).

Subarachnoid hemorrhage

is usually caused by rupture saccular aneurysms.

Charcot-Bouchard aneurysm rupture

is usually due to chronic hypertension and typically causes hemorrhage involving deep brain structures (basal ganglia, cerebellar nuclei, thalamus, pons).

Lamotrigeine

it is an anticonvulsant used to tx bipolar depression Steven-Johnson syndrome

what does the splenorenal ligament contain?

it is derived from the peritoneum and lies between the left kidney and spleen. It contains the splenic vessels and the tail of the pancreas.

What affect does pCO2 have on cerebral vasculature

it's a potent vasodilator, tachypnea causes hypocapnia and cereral vasoconstriction thereby decreasing cerebral blood flow and intracranial pressure. Increasing cerebral vascular resistance. Tachypnea causes hypocapnia and cerebral vasoconstriction, thereby decreasing cerebral blood flow and intracranial pressure.

Takayasu arteritis

its may have lower blood pressure and pulses in the upper extremities as compared to the lower extremities, and cold or numb fingers.

Staph aureus and right sided endocarditits

iv drug users. This pt with fever with a holosystolic murmur that increases with inspiration (like tricupspid regurg) and multiple lung opacities (septic emboli).

Injury to femoral nerve

knee buckling and loss of patellar reflex

SE of metformin SE of atrovastatin

lactic acidosis hepatitis and myositis

CMV esophagitis

large Linear ulceration in distal esophagus, intranuclear and cytoplasmic inclusions.

Microcytic anemia, constipation, and mental status changes n the setting of construction work...

lead poisoning microcytic, hypochromic anemia, shortness of breath, with exertion, due to decreased oxygen delivery to peripeheral tissues. Causes basophilic stippling: also seen in thalassemias and myelodysplastic syndromes. 1) Bluish pigmentation :lead line at the gum-tooth line. 2) Wrist drop or food drop due to peripheral neuropathy. Ring sideroblasts are also caused by lead poisoning but are seen in Bone Marrow but the not he peripheral blood smear.

Anterior cerebral artery

leads to contralateral hemilateral hemiplegia with lower limb being affected more than upper limb. Bilateral ACA occlusions can causes significant behavioral symptomes (abulia), primitive (Moro, grasp), and urinary incontinence due to the damage of the prefrontal cortex.

Vit B12 def

leads to degeneration of dorsal columns and lateral cerebrospinal tracts. Loss of position and vibration sensation, spastic paresis and ataxia are typical.

Intussusception

leads to impaired venous return from the invaginated segment of the bowel, which can cause ischemia and subsequent necrosis of the intestinal wall. most common at the ileocolic junction.Most common in children less the 2 years- associated with viral infection. IN its older than 2 years of age, a lead pint, such as Meckel diverticulum, foreign body, or intestinal tumor should be sought. Present with "currant jelly" stool (that contain blood and mucus). A tubular mass may be papable in the lower right abdominal quadrant. Barium enema is diagnostic.

Occlusion of the posterior inferior cerebellar artery

leads to lateral medullary (Wallenberg) syndrome. It is characterized by contrralateral loss of pain and temp sensation, ipsilateral deficits of CN 5, 8, 9, 10, 11 and horners syndrome.

Diastolic heart failure is caued by decreased ventricular compliance and is charaterized by normal

left venticular LVejectionfranction, normal LV end diasetolic volune and elevated LV filling pressures.

Zileuton

leukotrienes are synthesized from arachidonic acid via the lipoxygenase pathway. Zileuton inhibits this pathway and therefore reduces leukotriene production.

Bronchospasm

leukotrienes: LTC4, LTD4, and LTE4 - and acetylcholine produce bronchospasm that is relieved by pharmacologic antagonists. Leukotrienes also promote mucosal edema and mucus hypersecretoin. Inhaled ipratropirum is an antimuscarinic agent that blocks M3 receptors in airway smooth muscle and submucosal glands. It may offer short term relief of bronchoconstricton in in allergic asthma.

Apoliprotein B

levels can quantity the LDL particle count

HSV

lies dormant in the sacral dorsal root ganglia

Wilson's dz

likely dx in young its with unexplained chronic hepatitis. Presence of low serum ceruloplamin and increased urinary copy excretion or Kayser fletcher rings provide dx confimation.

Intervention to reduce suicide risk

limit access to lethal methods, decreasing stress, increasing psychosocial support, treating psychiatric illness and substance use and managing pain.

plane xantomas

linear lesions in skin folds that are strongly associated with primary biliary cirrhosis.

MS

lipid laden macrophages containing the products of myelin breakdown are also seen within plaques. CDF of these its demonstrates increased concentration of gamma globulin (IgG). It is found as an oligoclonal band on protein electrophoresis. Astrocyte proliferation. Oligodendrocyte depletion is also seen in progressive multifocal leukoencephalopathy.

Entamoeba histolytic infection produces what kind of necrosis

liquefactive necrosis

. Alkaline phosphataase

liver cell, elevated in obstructive biliary process.

External urethral sphincter is a skeletal muscle Internal urethral sphincter

located at the distal end of the urethra and innervated by the pudendal nerve. Voluntary constriction of the external urethral sphincter maintains continence and prolonged labor can damage this muscle, resutling in urinary incontinence. So sphincters relax to release urine Destrustor constrict to release urine. The inernal urethral sphincter is a smooth muscle at the proximal junction of the bladder and the urethra. The sympathetic nervous system controls this sphincter to constrict and prevent urine leakage.

Central Chemoreceptors

located in the medulla are stimulated by decreases in pH of the surrunding cerebrospinal fluid. Because the blood brain barrier is relatively impermeable to H+, blood pH has little effect on central chemoreceptors. In contrast, CO2 readily diffuses through the blood brain barrier and forms H+ in the cerebrospinal fluid. Increased in PaCO2 is the major stimulate of central chemoreceptors, leading to an increae in respiration.

Upper motor neuron damage

loss of descending inhibiton over lower motor neurons in the anterior horn.

Anorexia

low body weight, intense fear of becming fat, and distorted body image. restricting and binge/eating Osteoporosis, amenorrhea, lanugo,enlarged parotid glands, hypotension, hypothermia, bradycardia, cardiac atrophy, cardiomyopathy, arrhythmias.

Asprin

low-dose aspirin is commonly used to prevent ischemic skroke in pts with TIA. It irreversibly acetylates/inhibiting the cyclooxygenase (COX) enzymes. At low doses, aspirin predominantly inhibits COX1, preventing platelet synthesis of thromboxane A2, which impairs pltelet aggregation and reduces vasoconstriction. It also inhibits prostaglandidn-dependent GI mucosal protection. The risk of upper GI bleeding increases with higher doses but is increased 2-3 fold even with low dose aspirin. Proton pump inhibitor can help reduce the risk of upper GI bleeding in pts taking aspirin.

lung abscess lung inflammation

lung abscess - pneumonia - aspiration of oral contents - foul smelling suputum. from anaerobic bacteria normally found int he oral cavity (fusobacterium, peptostreptococcus, bactericides) If aspiration occurs in the upright position, an abscess in the basal segment of th right lower lobe is likely. If aspiration occurs while supine, the postieror segment of the right upper lob or the superior segment of right lower lobe. lung inflammation- pneumonitis - aspiration of gastric contents-

Chronic rejection

lung transplant recipients, it affects small airways, causing bronchiolitis obliterans. It is characterized by lymphocytic inflammation, fibrosis, and destruction of the bronchioles.

AFP alpha-fetoprotein

lvels in a pregnant woman may suggest a fetal neural tuble defect. Other possible caues of an elevated AFP level include underestimation of gestational age, twin gestation and abdominal wall defects. AFP is a marker for yolk sac tumors of the ovaries and testes.

Hashimoto histology

lymphocytes infiltrating between thyroid follicles.

Common Ehlers-Danlos syndrome is a mutation in

lysyl hydroxylase and procollagen peptidase enzymes

The best method for determining whether a gene is being expressed is to analyze for the presence of what?

mRNA

Azithromycin se

macrolide antibiotic treat and prophylaxis of Mycobacterium avium complex infections in pts with HIV

Non-malinant infiltrative lesions such as sarcoidosis and histiocytosis X

mainly invove the suprasellar region, where they compress the hypothalamus and pituitary stalk. This disrupts the normal hypothalamic dopaminergic supression of prolactin secretion, leading to increased porlactin levels and galactorrhea, central diabete insipidus may also be seen with resulting hypernatremia.

Vit A

maintains orderly differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tracts and the pancreatic and other exocrine ducts. Avitaminosis can cause squamous metaplasia of such epithelia to keratinizing epithelium.

Round ligament

maintains the anteflexion of the uterus. It runs from the lower aspect of the uterus through the inguinal ring to the labia majora and is not connected to the ovaries. During pregnancy, a woman may experience intermittent sharp pain due to irritation from sudden movements of the stretching round ligament.

Clinical phenotypes of 21-hydroxylase deficiency

males with classic, non-salt wasting 2-hydroxylase deficience present at age 2-4 years with earl virilization, increased linear growth and elevated levels of 17-hydroxyprogesterone and androgens. Femalse with classic 21-hydroxylase deficience wpresent with ambiguouse genitalia. With all forms of 21-hydoroxylase deficiency, pts will have increased serum concentraton of 17-hydroxyprogesterone and androgens.

Prostatitis

manifests with fever, chills, dysuria, obstructive uringary tract symptoms, sponaneous purulent rethral discharge and pain (lower back or abdomen, perineum, rectum, testes, rurethra, suprapubic region). The prostate gland may be nodular or boggy and tender to palpation.

Giant cell (temporal) arteritis

many pts also have plymyalgia rheumatica, which cause achy pain in the shulders and hip girdles. If GCA is suspected, a C-reactive protein level or erthrocyte sedimentation rate should be determined promptly. If the ESR rate is high then undergo temporal artery biopsy.

Sublimation

mature- intense hostility and anger into boxing.

Inherited or acquired elevation of plasma homocysteine levels

may contibute to arterial or venous thrombosis and to the development of atherosclerosis.

Pericardial fibrosis

may lead to impaired ventricular dilation and decreased diastolic filling, and constrictive pericarditis may occur in systemic sclerosis. Physical examination reveals Kussmual sigh and pulsus paradoxus Kussmaul sign is a paradoxical rise in jugular venous pressure (JVP) on inspiration. It can be seen in some forms of heart disease and is usually indicative of limited right ventricular filling due to right heart failure. Pulsus paradoxus (PP), also paradoxic pulse or paradoxical pulse, is an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. When the drop is more than 10 mm Hg, it is referred to as pulsus paradoxus.

Dermatomyositis

may occure alone or as paraneoplastic syndrome associated with malignancy (especially adenocarcinoma)

H. pylori

may play a role in the development of gastrointestinal lymphomas, it more commonly causes chronic gastritis and peptic ulcer diseas. Lympphomas associated with H. pylori have a MALT lymphoma histology

Tertiary syphilis

may result in aortitis, aortic aneurysm, and aortic regurgitation. Mitral valve lesions are not commonly observed.

The tibial nerve

maybe injured at the level of popliteal fossa due to deep pentrating trauma or knee surgery. Pts typically have weakness on foot plantar fexion, foot inversion and toe flexion, with sensory loss over the sole. so if pt presents with the foot dorsiflexed and everted think tibial nerve injury.

Intrapartum

means during delivery.

Golfer: wrist flexors

medial epicondylitis

Anteriormedial humeral nerve damage

median

Alpha-methyltyrosine

mediaton used only in pts with pheochromocytoma, inhibits conversion of tyrosine to dihydroxyphenylalanine (DOPA) to tyrosine hydroxylase.

Posterior fossa mass in a child, gait and limb ataxia. Sheets of primitive cells with many mitotic figures:

medulloblastoma which are a part of a goupd called primtive neuroectodermal tumors. PNETs are composed of sheet os small cells with deeply asophilic nucleiand scant cytoplasm (small, round, blue cells). Poorly differentiated.

inhibits hepatic gluconeogenesis

metformin inhibits hepatic gluconeogenesis via inhibition of the mitochondrial isoform of glycerophosphate dehydrogenase in the liever. Typical side effects of metformin include gatrointestinal upset and diarrhea.

Iron def

micorcytic and hypochromic RBC. Is treated with iron preparation. Vit C as well.

Red blood cell fragments, burr cells and helmet cells are associated with

microangiopathic hemolytic anemia or mechanical red cell destruction. Helmet cells: Prosthetic valves- RBCS are exposed to excessive shear turbulence in circulation, causing damage from mechanical trauma. Burr cells: are erythrocytes with short, evenly spaced projections, They can occur as an artifact or in association with uremia, pyruvate kinase def, microangiopathic hemolytic anemia, or mechanical damage.

Edwards syndrome (18)

micrognathia, low-set ears, prominent occiput, and roocker bottom feet, hypertonia, clenched hands with overlapping fingers. cardiac: VSD, PDA Horseshow dkideny Mecke;s divericulum, malrotation.

Mutations of a calcium-binding sarcoplasmic reticuclum protein

might unlike some cases of arrhythmogenic right ventricular cardiomyopathy, a progressive fibrofatty replacement of the rigt ventricular myocardium of uncertain pathogenesis.

Pseudoallergic drug rxn

mimic immunologic rxns but occur via a non-immunologic mechanism (eg. direct immune cell activation, inhibitied prostaglandin synthesis). Examples include rhinitis with NSAIDs, anaphylaxis to radiocontrast media, and pruritius with opiates.

Osteoblasts

mineralized the bone. Osteocytes are derived from osteoblast.

serum protien electrophoresis

monoclonal gammopathies MM.

CMV in pregnancy complications:

mononucleosis-like illness with fever and mild hepatisis during pregnancy. Chorioretiitis (most common eye problem), sensorineural deafness, seizures, jaundice, hepatomegaly, splenomegaly and microcephaly. Chorioretinitis is an inflammation of the choroid (thin pigmented vascular coat of the eye) and retina of the eye. It is a form of posterior uveitis. If only the choroid is inflamed and not the retina, the condition is termed choroiditis.

NE is involved in

mood, anxiety, alertness, learning and memory. Decreased neurotransmission of NE and serotonin has been implicated in the pathophysiology of depression.

VSD

most common cardiac defect, and produces a holostolic murmur that is loudest over the left mid sternal boarder Presents in the neonatal period after pulmonary vascular resistance has declined. The clinical presentation depends on the size to the defect, which ranges an asymptomatic holosystolic murmur (small VSD) to heart failure (large VSD - failure to thrive, and diaphoresis with feeding)

Staph aureus

most common cause of osteomyelitis

Anal fissures are longitudinal tears in the mucosa

most fissures occur at the posterior midline, likely due to decreased blood flow in this area. slow healing Angerior midline fissures are due to mechanical stress related to alignment of muscular fibers int he external sphincter. Other fissures should be indicative of IBD, malignancy, infection)

Primary brain neoplasms

most often metastasize within the CNS, but the can rarely present with metastasis outside of the nervous system.

UC

mucosal and submucosal inflammation, pseudopolyps, toxic megacolon, bloody diarrhea.

Ulcerative colitis skin findings

mucosal inflammation, crypt abscesses and ulceration. Erythema nodosum and pyoderma gangrenosum.

Duchenne muscle

muscle fibers of distal extremities are later replaced by fat and connective tissue (pseudo hypertrophy) Deletion of dystrophin gene- x liked recessive - boys. Asymmetric weakening of the paraspinal muscles, leading to kyphoscoliosis. Fibrofatty change

Achondroplasia

mutation in FGFR3 is characterized by an exaggerated inhibition of chondrocyte proliferation in the growth plates of long bones. Flat bones (skull, ribs, pelvis) grow via intramembranous (not endochondral) ossification, defined as direct deposition of new bone cerasted by osteoblasts on top of formed bone. Chondrocytes, cells that produce cartilaginous matrix, within the physis (growth plate) are essential for nromal linear growth via a cyclical process of proliferation and apoptosis. The apoptotic area become mineralized and vascularized, allowing osteoblasts to create osteoid matrix at the base of the growth plate during childhood. Fibroblast growth factor receptor 3 (FGFR3) is responsible for normal, restrained inhibition of this process of process of this process of endochondral ossification.

CF

mutation is F508 impairs function of the CFTR channel protein. recurrent sinopulmonary infections with s. aureas and P. aeruginosa. DX: elevated sweat chloride levels, Nasal potential difference measurements, Genetic testing for CFTR

Transthyretin

mutations are responsible for herditary form of cardiac amyloidosis. Amyloid deposition in the myocardium results in infiltrative cardiomyopathy, present in adults with dyspnea, peripheral edema and ascites.

IK membrane potassium channel

mutations are seen in pts with congenital long QT syndrome. A decrease in repolarizing potassium current leads to prolgation of the QT interval, which predisposes to development of plymorphic ventricular tachycardia (tosades de points) and sudden carac death.

Histoplasmosis

mycotic infection found in the Ohio and Mississippi river basin. Bird and bat droppings (caving).

Pulmonary stretch receptors

myelinated and unmyelinated C fibers in the lungs and airways. These receptors regulate the duration of inspiration depending on the degree of lungb distension and act predominantly to protect the lung from hyperinflation.

Ion channel myopathies

myotonia and episodes of hypotonic paralysis (often associated with exercise). No muscle atrophy is seen on light microscopy. PAS positive intracytoplasmic vacuoules are found in these conditions.

The most common anatomical abnormality producing MR is

myxomatous degreneration MVP Afterload reduction with vasodilator decreases the average intraventircular systolic pressure required to generate a given stroke volume andwould tend to reduce MR due to any case

microangiopathic hemolytic anemia

n diseases such as hemolytic uremic syndrome, disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, and malignant hypertension, the endothelial layer of small vessels is damaged with resulting fibrin deposition and platelet aggregation. As red blood cells travel through these damaged vessels, they are fragmented resulting in intravascular hemolysis. The resulting schistocytes (red cell fragments) are also increasingly targeted for destruction by the reticuloendothelial system in the spleen, due to their narrow passage through obstructed vessel lumina. It is seen in systemic lupus erythematosus because the immune complex aggregates with platelets, which creates intravascular thrombi. Microangiopathic hemolytic anemia is also seen with cancer. ASSOCIATED WITH LOW PLATELETS

Myopia

near-sightness. Increased eye axial length, the image focuses in front of the retina.

N-MYC

neuroblastoma and small cell ca of the lung.

Alzheimers

neurofibrillary tangels are intracellular aggregates of hyperphosphorylated tau protein. Senile plauqes are extraceullar deposits composed of a b-amyloid core surrounded by dystrophic neurites. Amyloid angiopathy is characterized by b-amyloid deposition in the walls of cerebral arteries.

Waldenstrom macroglobulinemia

neurolgic symptoms due to hyperviscotisy, autoimmune hemolytic anemia.

Fabry dz

neuropathic pain, and hypohidrosis, small fiber nerve involvement results in severe distal extremity pian and burning as well as dital loss of hot/cold temp sensation. Angikeratomas, tenangiectasia. and not-blanching macules and papules that classically occur in clusters ove rthe buttocks, groin and umbillius. Cerbrovascular, cardiac, Gb3 buildup in the glomerulus and distal tubule results in proteinuria and plyuria and can progress to renal faiulaure in the absence of enzyme replacement tx.

Cauda equina syndrome

neurosurgical emergency resulting form compression of spinal cord nerve roots below the level of the conus medullaris. severe bilateral radicular pain, saddle anesthesia, and hyporeflexia. Bowel and bladder incontinence are late manifestations of cauda equina syndrome.

Side effects of Ganciclovir:

neutrophenia, anemia, throbocytopenia, and impaired renal function.

Mucor

neutrophenia, burns or DM.

Gestational hypertension

new-onset elevated blood pressure 140/90 and proteinuria and or signs of end-organ damage. Magnesium sulfat IV - to prevent seizures, and delivery

Pancuronium, tubocurarine

nicotinic receptor anagoinish

Pts with sickle cell anemia

no normal HbA will have elevated reticulocyte count but will maintain a normal mean corpuscular volume.

Chron's dz

non-caseating granulomas with transmural involvement.

Coarctation of the aorta

non-cyantotid with PDA, present with upper body hypertension and collateral intercostal vessels.

Follicular lymphoma

non-hodgkin's lymphoma. BCL-2 (antiapoptotic). Follicular lymphoma is a B-cell tumor composed predominantly of centrocytes (small cleaved cells) and fewer numbers of centroblasts (large noncleaved cells). At low mag, aggregates of packed follicles that obscure the normal lymph node architectue are seen. The t(14;18) translocation seen)

Crohn

noncaseating granulomas. Transmural linear mucosal ulcerations

Vesamicol

noncompetitively blocks the vesicular ACh transporter, preventing ACh from entering secretory vesicles int he presynaptic nerve terminal.

How does a pt present with CML?

nonspecific symptoms, abdominal fullness, leukocytosis. Low Alkaline phosphatase and splenomegaly, blast crisis 30-90 yrs old

alpha-fetoprotein

normally prodcued by the fetal liver and yolk sac, but are also in hepatocellular, nonseminomatous testicular or ovarian cacinomas.

Gall stone

normally, bile acids and phospholipids solubilize the cholesterol to prevent stone formation. Decreaed amounts of bile acids and phospholipids can cause the bile to become superstaurated with cholesterol, allowing it to crystallize and form cholesterol gallstones. Excess bile salt loss (terminal ileus disease) can cause gallstones as well. medication is hydrophilic bile acids (ursodeoxycholic acid) decrease biliary cholesterol secretion and increase biliary bile acid concentration, improving cholesterold solubility.

Duel identifiers to prevent wrong-site surgery

nurse and physician independently confirm that they have the correct pt, site, and procedure. Emergency operations, failure to mark the surgical site, poor communication, and surgeon fatigue are contributing factors. Independent verification of the pt, procedue and site by 2 health workers should be performed. Surgical timeout to have a final verification of the pt, procedure, and site.

Lymphedema

obstruction of the lymphoid capillaries, with marked swelling to the dorsum of the distal limb that may extend proximal. It is initially soft and picking but eventually becomes firm and non pitting due to progressive fibrosis and thickening of the overlying skin.

pineal gland mass

obstructive hydrocephalus from aqueductal stenosis (papilledema, headache, and vomiting) and dorsal midrain (Parinaud) syndrome (paralysis of upward gaze, ptosis,and pupillary anormalities) due to direct compression of the midbrain. Dx with MRIs Usually germinoma, a midline malignant tumor thought to arise form embryonic germ cells.

Inadequate calaization of what, is the most common causes of unilateral fetal hydronephrosis

obstructive- ureteropelvic junction- between the kidney and the ureter. The Vesicoureteral reflux- antegrade travel of urine, results from the incomplete closure at this vesicoureteral junction and can lead to chronic dilation of the ureter and renal pelvis. Non-obstructive.

Granulomatous reactions

occur in Mycobacterial infections resulting in caseous necrosis. This form of necrosis has a cheesy appearance and is surrounded by histiocytes and multinucleated giant cells. Noncaseous granulomatous inflammation occurs in sarcoidosis.

Aspergillomas

occur in the upper lobes. Unlike chronic aspergillosis, simple aspergillomas are not assoiced with systemic symptoms (fever, hemoptysis).

Chronic rejection in lung transplants

occur motnhs to years follwoing transplantation. In lung transplantation, the immune reaction affects the samll airways, causing bronchiolitis obliterans syndromes. dyspnea and wheezing.

Duodenal bulb ulcers

occur withing the first part of the duodenum, however ulcers beyond the duodenal bulb may be seen in pts with gastrinoma (non-beta islet cell tumor of the pancreas)

Centriacinar emphysema

occurs as the larger proximal bronchioles are destroyed. Affect the upper lung lobe by initially spares the superficial alveoli.

Vasovagal syncope

occurs due to concomitant withdrwal of sympathetic effect activity and enhanced parasympathetic (vagal) activity, which cozs bradycardia, vasodilation, and orthostatic hypotension.

Lumbosacral plexopathy

occurs during fetal descent as a result of direct compression of the lumbosacral trunk. Pts present with foot drop and numbness of the lateal aspect of the leg and the dorsum of the foot. This condition is typically transeient, and resolve within a year.

Hypoxic encephalopathy

occurs from global interruption of the cerebral blood supply due to cardiac arrest. Presents with decreased consciousness, coma, vegatative state, shows watershed infarts at he boarder of perfusion zones between the major cerebral arteries.

Coronary artery vasospasm

occurs in Prinzmetal's or variant angina, an ncommon condition of episodie angin that generally occurs at rest. It responds promptly to vasodilators, such as nitroglycerin. Pts unlikely to develop a transmural infarct.

Pernicious anemia

occurs in autoimmune atrophic chronic gastritis, which characteristically affects the body of the stomach rather than the antrum. Autoimmune destruction of parietal cells causes decreased intrinsic factor production and impaired vit B12 absorption.

Mesenteric adenitis

occurs in children age 5-14. Many cases are thought to be associated with Yersinia enterocolitica infection. Clinical manifestations may include fever, right lower quadrant abdominal pain and nausea/vomiting, but fistulas are not characteristically seen.

Staphylococcal scaled skin syndrome

occurs in infants and children due tot he producation of exotoxin exfoliatin by staphylococcus species. It causes widespread epidermal sloughing, especailly with gental pressure Nikolysky's sign.

Receptor internalization

occurs in the process of synaptic desensitization to excessive neurotransmitter stimulation. It also occurs in receptor mediated endocytoss of substances such as iron (transferrin receptor) and cholesterol (LDL receptor).

Iron absoprtion

occurs int he duodenum and proximal jejunum.

Panacinar emphysema

occurs more commonly in the lower zones and anterior margins of the lungs.

Permissiveness

occurs when one hormone allows another to exert its maximal effect. Cortisol can augment the vasoconstrictive effects of catecholamines and angiotensin 2. Cortisol can potentiate the effect of catecholamines by upregulating alpha-1 adrengeric receptors on vascular smooth muscle cells. IN adrenal insufficienty, low glucocorticoid levels can contibute to the hypotensive crisis by decreasing vascular responsiveness to angiotensin 2 and NE. Cortisol also increases vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.

Adjustment disorder

occurs within 3 months of the onset of the stressor and do not persist for more than 6 months after the stressor or its consequences have terminated.

First-pass metabolism

of a druge goes throught he gut wall and lumen as well the liver. Bioavailability refers tot he fraction of administered drug that reaches the systemic circulation in a chemically unchaned form. When a drug is absorbed byt he GI tract after oral admin, i first enters the portal circulation before gainng access to the systemic ciculation. If the drug is metabolized extensivily by the liver (high first pass metabolism) the amount that reaches the systemic circulation and therefore bioavailability will be low. Oral administration subjects a drug to a large amount of first pass metabolism, wherease IV, sublingual and rectal administration bypasses some or all of this process and allows more drug to reach the systemic circulation. Rectal drug admin: goes to teh superior, middle and inferior rectal vein. THe superior rectal vein drain to the portal portal circulation via the inferior mesenteric vein. The middle an inferior rectal veins, drain to the systemic circulation via the internal iliac and internal pudendal veins. So there is an increaed vioavailability of the drugs otherwise cleared byt eh liver after oral admin.

Segmental transmural necrotizing inflammation

of medium to small-sized arteries. In PAN the necrotic tissue and deposits of immune complexes, complement and polsma proteins pro due a smudgy eosinophilic deposit (fibrinoid necrosis) to give a histologic pattern consistent with immune complex vasculitis.

Dorsal columns

of the spinal cord, damage of these tracts lead to bilateral loss of position and vibration sensation. Gait abnormalities are typical, especially when the pt's eyes are closed (sensory ataxia)

Beta thalassmia major

often have chronic hemolytic anemia and develop iron overload due to repeated blood transfusions (secondary hemochromatosis).

ACL injury

often occurs due to sudden acceleration or deceleration in noncontact athletic injuries. Pts have laxity of forward movement of the tibia against a fixed femur (anterior drawer test)(.

Intradermal nevi

older lesions in which the epidermal nests of nevus cells have been lost. THe remianing dermal nevus cells lose tyrosinase activity and produce little or no pigment. INtradermal nevi are skin to tan colored, dome-shaped and sometimes pedunculated.

Creutzfeldt-Jakob

oler patients, brain bx show spongiform transformation of the cerebral cortex.

MS

oligodendrocytes T cell and antibody-mediated Helper T cells abnormally react to antigens in myelin, causing a release of inflammatory cytokines (IFN-gamma) that promote the infiltration of destructive macrophages/microglia and leukocytes. B cells may also play a role as most MS pts have oligoclonal immunoglobulin bands in the cerebrospinal fluid. Myelin degeneration leads to slowed nerve conductioon with neurologic deficits. Microglia function as the resident macrophages in the CNS. Althought hey participate in myelin destruction, they are not the target of immune response in MS.

ST elevation

on ECG is acute transmural myocaridal infarction. In the asence of associated arrhythmias, the heart rhythm is typically regular.

Pleiotrophy

one gene mutation that leads to multiple seemingly unreleated phenotypic abnormalities.

Rubella

one of the TORCh infections, is transmitted by the respiratory route and can cause severe birth defects, including mental retardation and congenital heart defects.

Poliomyeltis and west nile

only anterior horn (so LMN only)

Pencillium marneffei is an

opportunistic infection in immunocompromiesed pts primarily those with AIDS, in SE Asia.

NF1

optic gliomas

Coombs test

or direct antiglobulin test, detects autoantibodies agains RBC if they are present n the serum. Te hemolytic anemia of HUS syndrome is mechanical rather than autoimmune, therefore Coombs test is negative.

Endotoxin

or lipopolysaccharide, is a cell wall component of gram-negative bacteria. Endotoxin can cause tachycardia and hypotension in septic infants.

Mutation affecting cardiac cell cytoskeletal proteins

or mitochondrial enzymes of oxidative phosphorylation are though to cause the genetic form of dilated cardiomyopathy. Present with gradual onset of left-sided heart failures (with symptoms like dyspena on exertion initially), as opposed to the sudden syncopal episode in a previously asymptomatic pt described above.

Osteoclasts

orginate from the mononuclear phagocytic cell lineage and areultimately formed when several precursor cells fuse to creast a multinucleated mature cell.

biceps brachii

orginates for the scapula and forms a single belly that attaches on the upper arm. It controls elbow flexion and forearm supination.

Enveloped RNA negative sense

orthyomyxvirus (influenzia), paramyxovirus (measle and mumps), rhabdoviruses (rabies),

Stain that makes fat black

osmium tetroxide

Paroxysmal

outburst

BCL-2

overexpression is found in lymphomas. It is an antiapoptosis factor, and overexpression plasy a role in resistanceto chemotherapy.

Secondary hyperaldosteronism

overproduction of aldosterone occurs secondary to increased renin synthesis, resulting in elevated serum levels of both renin and aldosterone. Causes of secondary hyperaldosteronism include renal artery stenosis (typically associated with fibromuscular dysplasia or atherosclerosis), diuretic use, malignant hypertension (which leads to microvascular damage and renal ischemia), and renin-secreting tumors. Renin-secreting tumors (reninomas) are rare, small, solitary, benign juxtaglomerular hyperreninemia and hypertension who clearly do not have renovascular disease.

De Quervain tenosynovitis

overuse of abductor pollicis longus and brevis (thumb and wrist pain)

H. influenzae

oxidase positive, gram-negative rods is classified based on the antigens in the polysaccharide capsule, and strains of H influenzae that do not produce a capsule are referred to as nontypable. nontypable strains are part of the URT normal flora, but can cause otitis media, sinusitis and bronchitis.

Arterial blood gas effect on cerebral blood flow?

pCO2 is the most important regulator. drop in pCO2 due to hyperventilation causes vasoconstiction, reducing cerebral blood flow. Lowering pCO2 is one of the measures emplyed to reduce ICP in mechanically ventilate pts with cerebral edema. Brain receives 15% of the cardiac output.

Positive straight leg raise test

pain elicited in the supine pt when the leg is held straight while raised off the examining table- is a sign of sciatic nerve root L4-S3 irritation. The straight leg raise test his most sensitive to interverebralc disc herination causing sciatica.

Weight loss, abdominal discomfort, jaundice and an epigastic mass in an older woman

pancreatic ca

Acute respiratory distress syndrome ARDS

pancreatitis is major risk factor- diffuse injury to the pulmonary microvascular endothelium and alveolar epithelium, resulting in increased pulmonary capillary permeability and leaky aveolocapillary membrane. The intersitial and alveolar edemal and exudate formation in acute respiraty distress syndrome results from increased pulmonary capillary permeabiity. THis leasds to the decreased lung compliance, incared work of breathing and worventilation to perfusion mistaching. The pulmonary capillary wedge pressure is typically normal.

Acute pancreatitis

parenteral nutrition is appropriate if you need prolonged bowl rest. Increase amylase and lipase Normally pancreatic enzymes including trypsinogen are secreted into the small intestine. The are activated by the enzyme enterokinase (which is secreted from the mucosa). then Tyrpsin activates all the other enzymes. However with acute pancreatits, due tot damage of the pancreatic acinare cells either throgh a direct toxic insult or ischmeia resulting from pancreatic ductal obstruction. This triggers the abnormal activation of typsin inside the acinar cells by lysosomal enzymes. Then tyrpisn starts activing the other enzymes and this starts a cycle of pancreatic autodigestion (autolysis). This can result in acute necrotizing pancreatitis. This involves the develoment of gross areas of pancreatic necrosis with a hight propensity of sencondary bacterial infection. Protease: Pancreatic autodigestion Elastase: Vascular damage and hemorrhage Lipase and phospholipase: Fat necrosis Phospholipase A2: damage cell membranes

Tx for actinomyces israelii

parenteral penicillin and surgical debridement. Gram positive

One-stranded DNA-->Double stranded DNA template -> one-stranded DNA progeny

parovirus B19

Ulnar nerve

passes between the hoot of hamate and the pisifrom bone in the fibroosseous tunnel known as Guyon's canal.

Passive versis active transport

passive (long the concentration gradient) or active (against the concentration gradient). Synthesis of HCl by parietal cells of the gastric mucosa is dependent on the H-K ATPase, which is known as a proton pump.

The musculocutaneous nerve

penetrates the coracobrachialis muscle and initially course between the biceps brachii and coracobrachialis muscles beofre descending toward the elbos between the biceps brachii and brachialis muscles. Injury to this nerve causes paralysis of the elbow flexors (biceps, brachialis, coracobrachialis) and loss of sensation over the lateral forearm.

Local infection is th emost important cause of delayed wound healing.

persistent tissue injury an inflammation.

Cilostazol

phosphodiesterase inhbitor that is occasionally used in pts with symptomatic peripheral vascular dz (claudication)

Glycosuria

plasma glucose level of 200 mg/DL dur to staration of glucose transporters..doesn't sure renal damage.

Eptifibatide

platelet glycoprotein 2b/3a inhibitor that inhibits the final common pathway of platelet aggregation. acute coronary syndrome but not stable CHD.

Wright stain

platelet purple

Platelet-derived growth factor receptor mutations

play a role in chronic myelomonocytic leukemia.

Cytotoxic CD8 lymphocytes

play an important role in host defense again viral infections. They are capable fo destroying tumor cells and participate in rejection reactions.

Dysplasia

pleomorphic cells within disorderly architecture (melanoma)

Acute fibrinous pericarditis

pleuritic chest pain and pericardial friction rub. (Constrictive pericarditis- requires months to years to produce constriction sufficient to cause tamponade).

One stranded +RNA->-RNA template ->one stranded +RNA progeny

poliovirus

Fanconi syndrome

polyuria, acidosis, hypophosphatemia lead nephropathy- fancoini like syndrome

Glioblastoma

poorly-differentiated, often pleomorphic astrocytic cells with marked nuclear atypia and brisk mitotic activity. Necrosis is an essential dx feature and prominent microvascular proliferation is common.

Pseudomonas resistance

porin mutations can confere fiwht penicillinand aminoglycoside resistance and are particularly important in grame negaive organisms.

Essential tremor

porpanolol

Sicatic nerve

posterior compartments- divide into the fibula.common peroneal nerves which provides motor and sensory innvervation to the leg and foot.

Ependymomas

posterior fossa tumors in children. arise from the roof of the fouth ventricle in children, pseudorosettes with glial fibrillary acidic protein (GFAP)-postiive processes tapering toward blood vessels characterized ependymomas.

When does decreased thickness of the vaginal epitheilum and decreased amount of the glycogen in the epithelial cells result from?

postmenopausal and lactating women. These chanes are caused by low estrogen levels and lead to atrophic vaginitis.

Triamterene is

potassium sparing diuretic that works y locking sodium channels in the distal tuble and collecting duct, leading to increased sodium and fluid excretion.

Centriacinar emphysema

predominantl affects the upper lung lobes and has a strong association with smoking. Macrophages and neurtophils become activated by toxins in the smoke and release proteases that cause acinar wall destruction.

TH2 type CD4+ helper T cell

predominantly drie humoral immune responses. THeir products include IL-4, which promotes IgE antibody production by B cells and IL 5 which promotes the production and activation of eosinophils and B cell synthesis of IgA.

Eclampsia

preeclampsia and new-onset of mal seizures Tx: magneisum sulfate, antihypertensivie, immediate deliveray

Risk of secondhand smoke exposure

prematurity, low birth weight Sudden infant death syndrome Middle ear dz (otitis media) Asthma Respiratory tract infection (bronchitis, pneumonia)

Intraventricular hemorrhage

prematurity, originates in the germinal matrix, a highly cellular and vascularized layer int the subventricular zone from which neurons and glial cells migrate out during brain development. The matrix contains numerous thin-walled bessels lacking the glialfibers that support other blood vessel throught he vrain which contribute to the risk of hemorrhage. Present with an altered level of consciousness, hypotonia, and decreased spontaneous movements. Bulging anterior fontanelle, hypotension, decerebrate posturing, tonic-clonic seizures, irregular respiration and coma..

Most minors <18 can consent to

prenatal care, dx or tx of sexually transmited dz, contraception, and durg or alcohol rehabilitation without emancipation or parental consent or notification. Emancipated minor: homeless, parent, married, military, financially independent, high school graduate.

Ataxia-telangiectasia syndrome

presence of progressive ataxia together with telangiectasias and an immunodeficiency due to a combined defect of both B and T lymphocytes.

Schistosomia haematobium

present acutely as swimmer's itch (organism penetration into skin) or Katayama fever (fever, urticaria, angioedema, eosinophilia) can affect the bladder (terminal hematuria, fibrosis), chronic infection is a risk factor for bladder ca.

Hypertensive encephalopathy

present more with confusion after a progressive headache and nausea/vomiting followed by nonlocalizing neurologic symptomes.

Infectious Endocarditis

present with fever, new-onset murmur, and focal neurologic deficits. Janeway lesions, osler nodes and Roth spots are specific finidngs of infectious endocarditis. The more common pathogens are S aureus, viridans group streptococci and enterococci.

TMA primary thrombotic microangiopathy

present with hemolyticanemai awith schitocytes, thrombocytopenia, and organ injury (brain, kidney, heart)

Actinic Keratoses (AK)

presents as erythematous papules with overlying whitish scale. Felt more than seen, rough sandpaper-like texture on palpation. Hyperkeratosis may become prominent and form cuaneous horns. Premalignant to invasive squamous cell carcinoma. Chronically sun exposed.

Microangiopathic hemolytic anemia

presents with anemia and fragmented RBCs (schistocytes) on peripheral smear. Is associated with cancer chemotherapy drugs (cisplatin and cyclophosphamide) It can be HUS, TTP, DIC, malignant HTN, metastic carcinoma.

Medulloblastoma

presents with gait and limb ataxia, intention tremor and nystagmus (Cerebella) microscopic, cells are small and poorly differentiated, with scant cytoplsam and little stroma. A high mitotic index is common. Classic Homer-Wright rosettes can be seen in one fifth of cases.

Candida esophagitis

presents with odynophagia, do not have polysaccharide capsule.

Psoas muscle

primarily acts to flex the thgh at the hip and also contribute somewhat to lateral rotaton and abduction of the thigh.

High calcium, high PTH

primary hyperparathyroidism

Fatigue and a high alkaline phosphatase in a man with UC

primary sclerosing cholangitis.Histo: diffuse inflammation/fibrosis of the large ntra- and extrahepatic bile ducts with periductal concentric fibrosis (onion skin) and obstruction of the small ducts.

Creutzfeldlt Jakob dz

prion dz that presents with rapidly progressive demintal and myoclonic jerks of the extremities.

Strongest factor for predictive for suicide

prior history of attempted suicide is the stongest signle factor. Pts with previous attempts are 5-6 times more likely to make another attempt.

Rabies

prodromal phase of rbies infection is characterized y fever, pharyngitis, and pain around the ite site. Acute encephalitis develops later. Paralysis, confusion or hyperactivity focal neurologic deficits and coma occur.

Pulmonary venous hypertension

produces pulmonary interstitial edema in interlobalr septa, edematous widening of alveolar septa, and finally intra aveolar accumulation of edema fluid. Pulmonary edema resulting in orthopnea can be seen in the absence of left ventricular dysfunciotn in pts with MS.

Difference in histology from follicular/ proliferative phase to Luteal Phase (Secretory phase)

proliferative: straight, short endometrial glands and compact stroma that are oufn 4-7 days after the onset of menses. Luteal phase Decidual changes in the endometrium due to progesterone secretion, decidualized endometrium only, consistent with dilated, coiled endometrial glands and vascularized edematous stroma.

congenital QT syndrome

prolongation of QT interval predisposes to the development of life-threatening ventricular arrhythmias (torsades de pointes), which can present as recurrent palitations, syncope, seizures, or sudden cardiac death.

Persistne gallbladder outflow obstruction

promotes hydrolysis of luminal lecithins to lysolecithins, which disrupts the protective mucus layer. The luminal epithelium is then exposed to the to the detergent action of bile salts, resulting in chemical irritation and prostaglandin release. Inflammation of the mucosa and deep tissues cause gallbladder hypo motility. The increasing distention and internal pressure within the gallbladder eventually result in ischemia. FInally bacteria (E. coli, enterococcus, kelbsiella, enterobacter) invade the injured and necrotic gallbladder wall and cause infection.

Dorsal columon

proprioception and vibration

Lansopraxole

proton pump inhibitor used to tx gastroesophageal reflux and peptic ulcer. inhibits H-K-ATPase on gastric parietal cells and reduce gastric acid secretion. Decrease ca and mag absorption.

ras

protooncogene codes for a protein that participtes in signal transduction (MAP-kinase associated pathway).

Nitrates

provide free radical nitric oxide, which actives guanylate cyclase and increases guanosine monophosphate levels. This in turn leads to dephosphorylation of myosin light chains and causes vascular smooth muscle relaxation.

Tast of the posterior 1-3 of the tongue.

provided by the glossopharyngeal nerve.

Pudenal nerve

provides motor and sensory innervation to the perineal region. It orginates from the ventral rami S2-S4 . Vulnerable to stretch injury (ischial spine) during second stage labor. Injury leads to weakness of perineal musculature causing fecal and urinary incontinece, perineal pain and dysfunction.

Endothelial cells are not found in the wall of

pseudocytes

Respiratory epithelium

pseudostratified columnar ciliated epithelium that extends down to the levels of the bronchioles. At the bronchioles, the epithelium gradually becomes cuboidal and then transitions to a flat, single-celled alveolar lining of type 1 pneumocytes.

oxidase positive non-lactose fermenting gram-negative rod

psuedomonas aeruginosa- common cause of urinary tract infection in pts with indwelling cathethers.

What causes erectile dysfunction:

psychogenic stressors (sudden onset and presence of morning erections) Performance anxiety and depression Medication (SSRIs, sympathetic blockers: clonidine, methyldopa, beta-blocker) Vascular or neurological impairment Genitourinary trauma (prostatectomy,recent pelvic trauma, priapism.

Cocaine overdose

psychomotor agitation, htn, coronary vasoconstriction.

Atopic dermatitis

pts have hight serucm levels of IgE, peripheral eosinophilia and hight levels of cAMP phophodiesterase in their leukocytes.

Pancoast tumor

pts smoking his, upper limb pain/weakness and ipsilateral ptosis and miosis are hightly suggestive of a Pancoast tumor. Pancoast tumors are usually non-small cell lung cas (squamous cell ca, adenocarcinoma) that arise near the superior sulcus (groove produced byt he subclavian artery). Compression and invasion of the brachial plexus can cause ipsilateral shoulder pain, upper limb parestheisa and areflexic arm weakness. Involvment of the cervial sympathetic ganglia may lead to horner's synrome. Partial ptosis, miosis, anhydrosis

Large areas of encephalomalacia

pts with vascular dementia due to ischemic stroke. These pts are typically oder with cardivascular risk factors and often present with suddent/stepwise cognitive decline and focal neurologic deficits.

Insterstitial lung disease

pulmonary fibrosis with thickening and stiffening of the pulmonary interstitium. Reduced total lung capacity, reduced vital capacity, inspiratory capacity, functional reserve capacity, and residual volume. Also both forced vital capacity and forced expiratory volume in 1 second are decreased as well, however the FEV1/FVC ration is typically increased because the FEV1 decreases less than the FVC does. Decreased lung compliance. increased lung elastic recoil caused by fibrotic interstitial tissue. Increased radial traction (outward pulling) on airways, leading to increased expiratory flow rates when corrected for the low lung volume.

Focal necrosis of alveolar walls and intra-alveolar hemorrhages are more typical of

pulmonary hemorrhage syndromes such as Goodpasture syndrome and vasculitis-associated hemorrhage (as seen in hypersensitivity angiitis, granulomatos with polyangiitis (wegener's and lupus erthematosus).

Amiodarone toxicity

pulmonary toxicity, thyroid dysfunction, cardiac arrhythmias, elevated liver enymes and visual disturbances. NO VISUAL CHANGES

Distinctive features of selected primary immunodeficiency disorders

pyogenic infection:streptococcus pneumoniae, H. influenzae type B) DiGeorge: thymic displasia Severe combined immunodeficiency: Thymic displasia as well, Combined T and B cell dysfunction. It is life-threatening and can have severe bacterial and viral infections, mucocutaneous candidiasis, persistent diarrhea and failure to thrive. Terminal completment deficiency: Recurrent Neisseria infections Wiskott-ALdrick: easy bleeding, eczemia X-linked Bruton's agammaglobulinemia: is an immunodeficiency syndrome caused by insufficient production of mature B cells, which predispose mainly to reccurent infections with encapsulated pyogenic bacteria.

Malaria and toxoplasmosis

pyrimethamine

Anteriorlateral humeral nerve damage

radial

Another work for elastic recoil

radial traction

Compound nevi

raised papules with uniform brown to tan pigmentation. This pts lesions is a comound nevus and has both dermal and epidermal involvements

H2 blockers

ranitidine- reduce gastric acid secretion and can alleviate symptoms of gastroesophageal reflux but do not treat nausea and vomiting.

Renal oncocytomas Location

rare tumors that orginate iform the collecting duct sells. Lage, well differentiated neoplastic cells that contain numerous mitochondria. Brown on Macro

Hypercalciuria (sarcoidosis), hyperoxaluria (chron's dz), hyperuricosuria (gout), and hypocitraturia (distal renal tubular acidosis) are risk factors for

recurrent calcium stone formation,

PSNG

red cell casts

Functional hypothalamic amenorrhea

reduced circulating leptin levels as a result of diminished adipose tissue stores. The decreas in leptin levels inhibits pulsatile gonadoropin releasing hormone front he hypothalamus,, causing decrease pituitary LH and FSH secretion, low circulating estrogen levels and amenorrhea.

Oral medroxyprogesterone

reduces the incidence of endometrial hyperplasia and the risk of endometrial ca in postmenopausal women on estrogen replacement tx. Prolonged use of intramuscular medroxyprogesterone as a contraceptive is associated with decreased bone mineral density.

Crista terminalis

refers to a thick band of atrial muscle that separates the smooth sinus venosus from the right atrial appendage and atrium proper. This ist he site of origin of the atrial pectinate muscles and is not a significant region of thrombus formation in atrial fibrillation.

Recombination

refers to gene exchange that occurs through the crossing over of 2 double-stranded DNA molecules.

Locus heterogeneity

refers to the ability of one disease or trait to be causes by muations in mutlifple different genes, Family hypercholesteremia can be causes by different mutations affecting cholesterol metabolism genes (LDL receptor, apo B-100)

Negative selection

refers to the deletion of T-cell clones that strongly ind to self-MHC antigens. This process occurs in the fetal thymus and contriutes to the development of tolerance to one's own antigen.

S3 gallop

reflects an increased left ventricular filling rate during mid diastole and can be heard as a consequence of MR

Sympathetic nervous system

regulates visceral function via 2-neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons. Eccrine sweat glands and adrenal medullae are exceptions to this rule as they are both innervated by cholinergic neurons. The parasympathetic systems uses both preganglionic and postganglion neurons.

Reaction formation

reirection of unacceptable impulse into its opposite (angry pt sends physician a thank you note and lavish gift)

Ciliary muscle relaxes and contracts

relaxes, allowing zonular fibers to tighten and cause flattening of the lens. Contracts, relaxing the zonula fibers and causig thickening of the lens. Presbyopia: Inability to focus on near objects. Is the hardened lens is unable to thicken upon ciliary muscle contraction. This is liekly due tothe impaired lens elasticity form prtein denautration, lens curvature changes and diminished ciliary muscle stenth, the image focuses behind the retina.

When a ribosome encounters a stop codon,

releasing factor proteins bind to the ribosome and stimulate release of the formed polypeptide chain and dissolution of the ribosome-mRNA complex.

Acyclovir Se

renal

PSGN

renal damage is due to both immune complex deposition on the glomerular basement membrane and to complement activation (Causing massive inflammatory response and glomerular basement membrane structural damage). Type 3 hypersensitivity Histo deposits can be seen on elcron dense subepithelial humps on elctron microscopy ans as granular depostiions within the mesangium and glomerular capillary wallson IgG and C3 immunofluorescence.

MM

renal failure, anemia due to bone marrow replacement, or kidney injury.

Hallmarke of advanced liver dz

renal vasoconstriction

Radial nerve

repetitive pronation-supinator of the forearm (frequent screwdriver use), first trauma or dislocation of th radius. finger drop. Pts typically have weakness during finger and thumb extension fringier drop without write drop or sensory def.

Atypical dysplastic nevi

resemble melanoma but typically have less extreme fetures. The melanocytes commonly show cellular atypia and form coalescing nests that may fuse into a continuous layer at the dermoepidermal boader.

Subdural hematoma

result from rupture of the bridging veins in the subdural space (between the dura and arachnoid membranes) and is most commonly caused by head trauma.

Damage to corpus callosum

result in "split-brain" syndrome. Althoguht these pts may appear normal in general social situations, they lack interhemispheric transfer of information. (pt unable to retreive with one hand an object papated with the other)

Werdnig-Hoffman syndrome

results from antierior horn cell damage. Lower motor neuron lesion signs are present: faccid weakness areflexia, muscle atrophy and fasciculations (floppy child) syndrome.

Renal failure

results in accumulation of uremic toxins. Uremia can decrease peripheral tissue conversion of T3 to T4. This could causes functional hypothyroidsm.

Cardiac embolism and cartid atherosclerosis

results in occlusion of medium to large size cerbral vessel (MCA) causing large territory ischemic infarction of the cerebral cortex.

Prolongation of QRS

results of delay in intraventicular conduction due to fascicular or undle ranch lock. THe heart rhythm remains regular in pts with intraventicular conduction abnormalities.

Mutations of the RB protein

retinoblastoma, osteosarcoma, breast adenoarcinoma, small cell carcinoma of the lung and bladder carcinoma. hypophosp- active- no cell progression Hyperphosp - inactivated- cell progression

one stranded + RNA -> doulble stranded DNA -> one stranded + RNA progeny

retrovirus

Regression

return to an earlier level of functioning to alleviate psychological distress (if the pt sulked and refused to speak rather than maturely discussing this feelins with the psychiatrist)

Papillary thyroid carcinomas

reveals branching papillae which are composed of fibrovascular stalk covered by neoplastic cuboidal cells. the celloften have clear groudn glass nuclei. Psammoma bodies (laminated calcium deposits).

MS

rheumatic heart dz

Neuroleptic-induced parkinsonism:

rigidity, braddykinesia, and tremor.

Pigmented basal cell carcinoma

rolled border in sun-exposed areas. Tumor cells resemble basal epidermal cells but extend into the dermis an dform clusters of a palisade arrangement of peripheral cells.

Cryptococcus neoformans

round yeast with variable sizes and narrow-based buds. this polysaccharide capsule that appears clear with india ink staining and stains red with mucicarmines.

Lewy bodies

round, eosinophilic, intracytoplasmic inclusions seen in pts with Parkinson dz. Visual hallucinations

Pick bodies

round/oval, intracytoplasmic inclusions seen on silver stain in pts with frontotemporal dementia. Progressive personality changes (disinhibition, apathy, compulsive behavior)

Pol gene mutations are

rsonsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV protease inhibitors.

THe internal pudendal branch off the anterior trunk of the internal iliac artery

runs through the sciatic formina and supply blood to the perinuem. Injury to the pudendal artery during vaginal delivery can causes a vulvar hematoma.

Non-caseating granulomas

sarcoidosis: ACE, hypercalcemia, Hyper vit D.

Dopamine plays a major role in the pathophysiology of

schizophernia and parkinson dz

Secretory phase

second half of the menstrual cycle, which follows ovulation. Progesterone released y corpus luteum causes the uterine glands to coil and secrete glycogen-rich mucus in preparation for embryo implantation. The endometrial stroma becomes edematous and completely transversed y tortuous spiral arteries that extend from the deep layer to the uterine lumen. The glands increase in size and become more coiled and the cells linighthe glands acquire large cytoplasmic vacuoles. Glycogen-rich mucus is released into the glandular lumen.

Parietal cellsC-`

secrete IF and HCL. Stimulated by Histamine, Gastrin (by G cells in the stomach antrum), Acetylcholine, but inhibited by somatostatin, GIP, Prostaglandin, and secretin. Gastrin has a trophic ffect on paietal cells. It induces hypersecretion and also parietal cell hyperplasia, causing isible enlargement of gastric folds onendoscopy. This increased gastric acid secretion induced by excess gastrin also causes peptic ulcer disease, heartburn and diarrhea. Zollinger-Ellsion syndrome: develop peptic ulcer disease and parietal cell hyperplasia with gastric fold enlargement due to gastrin hypersecretion.

Glucagon-like polypeptide-1 (GLP-1) is

secreted by intestinal L cells in response to food intake and regulates glucose by decreasing gastric emptying and increasing insulin release. GLP-1 acts through cell surface receptors that are coupled with a G protein-adenylyl cyclase system. Long-acting GLP-1 agonsit (exenatide) are second-line agents in pts with suboptmal glucose control

Lipase

secreted from the exocrine pancreas is the most important enzyme for digestion of triglycerides. Chronic pancreatitis sis a painful condition that causes lipase def. This leads to opoor fat absorption and steatorrhea (foul smellng bulky stools containing undigested fat)

Lead intoxication

seen in children more often than adults. It manifests with irritability, loss of developmental milestones (in infants) or learning problems (in older children). Gastrointestinal symptoms (constipation, nausea, abdominal pain.

HSV and CMV esophagitis

seen in immunocompromised pts. HSV: punched out ulcers on endoscopy with eosinophilic nuclear inclusions on bx. CMV produce shallow/linear ulcres with nuclear/cytoplasmic viral inclusions.

Congenital cataract

seen in in-utero ruella

Basophilia

seen in myeloproliferative disorders and rarely certain parasitic infections.

Blastomyces dermatitidis is a dimorphic fungus

seen n tissue as round or oval yeast with thick walls and broad base budding (canon balls). It is in SE US, Ohio river valley, states east of the mississippi river. Lung are the primary site of involvement and skin and bone are major sites of dissemination. Present in soil and rotten organic matter. Lung infection or cause a flu-like illness (fever, chills, myalgia, headache, nonproductive cough) or pneumonia (fever, cough, pleuritic chest pain). Carpenter

Absent esophageal peristaltic movements

seen with achalasia an systemic sclerosis. The distinctive histopathologic finding of systmic sclerosis involving the esophagus include atrophy of the muscularis with collagenous fibrosis.

Milrinone is a

selective phosphodiesterase (PDE)-3 enzyme inhbitor that is occasionally used as an intropic agent in pts with refractory heart failure due to left ventricular systolic dysfunction. Increased cAMP levels in vasuclare tissues cause systemic arterial and venous dilation. This leads to decreased blood pressure, therefore limiting the use of milrinone in pts with significant hypotension.

Pharmacotherapy of panic disorders

selective serotonin reuptake inhibitors (SSRIs) and benzodiazeines (more subject to abuse).

ilioinguinal nerve

sensory L1- sensation from skin of the upper and medial part of the thigh, the root of the penis and upper part of the scrotum in males, and the mons pubis and labia majora in females.

Carcinoid tumor

serotonin, bradykinin, histamine and hormones gastrin found int he small intestine, rectum, appendix, and bronchopulmonary system.

4th to 5th midaxillary line

serratus anterior muscle inferior part of the muscle facilitates arm elevation by pulling the lower end of the scapula down. All 3 muscle parts can help wit respiration by lifting the ribs when the shoulder girdle is fixed.

Sinuses in breast

serve as collecting reservoirs for milk during citation. A blockage of this area can cure a galactocele and eventually lead to a great abscess.

Pulmonary symptoms in eosinophilic granulomatosis with polyangiiits (churg strauss)

severe asthma and poissbily obstructive features on pulmonary function testing. Histologically there is a necrosizing vasculuitis with granulomatous infalmmation and esoinophilic infiltration of vessels and perivascular tissues.

Metamphetamines and teeth

severe dental decay

CMV presentation

severe retinitis, pneumonia, esophagitis, colitits and hepatitis.

WPW

short PR interval, delta wave and widening of QRS.

Cells of adnenocarcinoma

show glandular or papillary elements, have short and plump microvilli that distinguish adenocarcioma

Pulmonary hyperplasia and COPD

show increased goblet cells and mucus gland hyperplasia.

Chronic luekemia- CML

show many mature granulocytes and few blasts. CLL- many mature lymphocytes.

Major causes of splenic infarction include

sickle cell anemia, infectious endocarditis, and myeloproliferative disorders.

Cortical follicles:

site of B lymphocyte localization and proliferation.In agammaglobulinemia, germinal centers and primary lymphoid follicles do not form due to an absence of B cells.

Sarcoidosis

skin involvement eis varied win presentation ranging from macules to plaques to erythema nodosum (painful skin nodules). It classically reveals bilateral hilar lymphadenopathy. Stage 2 is characterized by bilateral hilar lymphadenopathy along with pulmonary infiltrates commonly in the upper lobes. Pregression of the dz leads to disappearance of hilar lymphadenopathy, and the chest X ray in stage 3 dz shows lung infiltrates only, which stage 4 is characterized by lung fibrosis.

Collagen types 1,2,3, and 5 provide tensile strength to

skine, bones, carilage, tendons and blood vessels.

Dilitazem and metoprolol

slow the sinus node dischagre rate and AV nodal conduction. The agents prolong the PR inteval but do not affect the QT interval.

Digoxin

slows conduction through the AV node by augmenting vagal parasympathetic tone, and it increases cardiac contractility by inhibiting N/K-ATPase (increasing intracellular ca) It decreases the AP duration and can cause QT interval shortening.

Carcinoid

small intestine the metastasizes to the liver. Produce serotonin and bradykinin., resulting in diarrhea , episodic flushing, right sided vular heart disease and wheezing.

Cherry hemangiomas

small red, cutaneous papules common in aging adults. THey do not regress and increase in number with age. Light microscopy of these lesion show proliferation of capillares and post capillary venules in the papillary dermis.

Henoch-Schonlein purpura

small vessel vasculitis in children, preceded by viral or streptococcal URI. Weeks after illness resolves. Stimulates production of IgA antibodies and that IgA containg immune complexes then deposit on vessel walls, inducing an inflammatory reaction. GI: Bloody diarrhea, increased risk of intussusception. Kidney: IgA nephropathy, mesangial prliferation and crescent formation. Skin: palpable purpura in buttocks and lower extremities. Urticarial papules or plaques and subsequently evolved into purpura. Joints: self limited migratory arthralgias and arthritis This is IgA mediated hypersensitivity (leukocytoclastic) vasculitis commonly causes abdominalpain, joint pain, lower extremity palpable purpura and hematuria.

Small Cell Lung Carcinoma

smoking and centrlaly located. Neuroendocrine differentiation. Markers such as: neuron-specific enolase, chromogranin and synaptophysin. ON electron microscopy some of the cells are found to have secretory granules in the cytoplasm. Arise from the primitive cells of the basal layer of the bronchial epithelium.

Muscle tissue can be stained for

smooth muscle actin, caldesomon, or desmin

Trigeminal

somatic afferents are responsible for providing general sensation one the face, the motor branch of the trigeminal nerve innervates the muscle soy mastication and the tensor tympani.

High epinephrine levels can

someotimes cause hypokalemia via b2-receptors stimulation and resulting intracellular K+ shift.

Infectious mononucleosis

sore throat, malaise, lymphadenopathy, myalgias, spenomegaly and fever. Epstein Barr virus. Phyaryngeal mucosa and tonsilar crypts, virus goes to bloodstream and infects B lympochytes by binding to the CD21 cell surface receptor. Cytotoxic T lymphocytes CD8+ clonally expand in response to the EBV infected B lymphocytes in an effort ot destroy the virally infected cells. Atypical lymphocytes observed in the peripheral blood smears of pts with infectious mononucleosis reprent activated CD8 cytotoxic T lymphocytes. THese activated T Lymphocytes function to destroy virally infected B lymphoctyes.

Lateral cortospinal tract

spastic weakness

Rhizopus

species typically causes rhino-orbito-cerebral infection but can cause pulmonary disease, predominantly in immunocompromised pts. Histolgy seen here in a case of adominal mucormycosis typically shows road hypae with irregular ranching and rare septation.

Aspergillus fumigatus

sptate hyphae that branch at 45 degress. only a mold form. can colonize old lung cavities those formed by tb toform a fungal ball (aspergilloma). Symptoms include cough, dyspnea, and hemoptysis. Pts with asthma have an increased risk for developing an allergic reaction to A. fumigatus called allergic bronchopulmonary aspergillosis. cough dyspnea, wheezing, fever and migratory pulmonary infiltrates.

What bacteria causes parotitis

staph aureas, anaerobes increased amylase without pancreatitis.

Prolonged exposure to loud noises cause hearing loss due to damage to the

stereocilitated hair cells of the organ of Corti.

Epinephrine

stimulates B2-adrenergic receptors to increase skeletal muscle blood flow, glycogenolysis, and lipolysis.

Vit D

stored in adipose tissue, but vit D def can deelop over the course of several months.

Vit A def

stored int he liver in the perisinusoidal stellate Ito cells. These stores are often sifficient enough to last around 6 months.

Saddle pulmonary embolus

straddling the bifurcation of the main pumonary artery. THe pt's hx of prostate ca, somoking and age place him at high risk of developing venous thromoembolism. Vichow triad: Endothelial injury, venous stasis and hypercoagulable state due to ca.

seborrheic keratosis

stuck on small cells resembling basal cells, with variable pigmentation, hyperkeratosis, and keratin containing cysts.

B12 deficiency

subacute combined degeneration of the dorsal (posterior) and lateral spinal columns.

HIV dementia

subcortical dementia (attention.working memory problems/excccutive dysfunction, slow infomration processisng)- gray matter inflammatory activation of microglial cells HIV ifected monocytes cross the bbb to become perivascular macrophages. Activated macrophages and microglial cells (redisent macrophages of the CNS form microglial nodules around samll areas of necrosis and may fuse to form multinucleated giant cells. Neuronal damage form infalmmatory cytokines and toxic effecs from macrophages and microglial

Complications of Diphteria and vaccination:

submucosal edema and pseudomembrane aspiration can obstruct respiratory tract, causing suffocation. Systemically absorbed diphteria toxin has predilection of brain and heart tissue (mydocarditis/heart failure and neuologic toxicity). DPT vaccine, contains dipptheria toxoid, which stimulates production of neutralizing antibodies against the binding component (B subunit) of the diphtheria exotoxin. Antibody binding prevents the exotoxin from attaching to host cell membrane receptors, preventing the disease. Immunization with diphtheria toxid induces production of circulating IgG agains the exotoxin B subuni.

Ace inhibitors

such as captopril and enalapril decrease blood pressure and cardiac hyptertrophy by inhibiting the conversion of angiotensin 1 to angiotensin 2. They are useful in htn, prevention of diabetic nephropathy, and in heart failure with systolic dysfunction. Their major side effects include cough and angioedema.

A fixed uppder airway obstruction

such as one caused by a arguer goiter, will lead to increased airflow resistance. This will favor slow deep breaths to minimize the work of breathing.

anti- HAV IgG positive

suggests that this pts is protected from acute HAV infection. Previous infection of vaccination

Paget's dz of the nipple.

superficial DCIS into the nipple skin withough crossing hte basement membrane .

Superficial peroneal nerve and the deep peroneal nerve

superficial peroneal nerve innervates the lateral leg and dorsum of the foot, except the skin between the great toe and second toes which is innervated by the deep peroneal nerve.

Dermatofibromas

superifical eign firous histiocytomas results form the eing proliferation of firolasts. Lower extermities solitary nodules.

Pyridoxine

supplementation when under going isoniasic, cofactor in transamination, deamination, decarboxylation and condensation rxns.

Occipital artery

supplies the posterior scalp and the sternocleidomastoid muscles.

THe inferior glut nerve

supplys motor function to the gluteus maximus muscle.

Pituitary adenoma

suprasellar and infundibular lesions block dopamine with inhibits prolacting in the anterior pituitary. -is the proliferation of lactotrophs int he anterior pituitary If a pt with glactorrhea has elevated serum prolactin, the god stander dx test is an MRI of the brain. First-line tx for prolactinomas is dopamine agonist (bromocriptine).

Communicating hydrocephalus

symmetrical enlargement of the ventriculi is characteristic of communicating hydrocephalus. Communicating hydrocephalus usually occurs secdary to dysfunction of obliteration of subarachnoid villi. This dysfunction is usually a sequelae of meningeal infection (Tuberculosis meningitis) or subarachnoid/intraventricular hemorrhage.

Insulin-like growth factor (somatomedin C)

syntheiszed predominanytly by growth hormone influences hepatocytes and seves to stimulate cell growth and multiplication.

Follicular lymphoma

t(14:18) translocation which moves the Bc-2 (B-cell lymphoma) protooncogene from chromosome 18 to 14, near the site of the immunoglobulin heavy chain enhancer element. Anti-apoptotic effect. Is a common indolent non-hodgkin lymphoma in adults. It is of B cell origin and presents with painless waxing and waning lymphadenopathy. Histol: a notable for a mixture of cleaved and non cleave follicular center cells in a nodular pattern. Clefted nuclei.

What kinds of RNA is a small, noncoding form of RNA that contains chemically modified bases (dihydrouridine, ribothymidine, pseudouridine).

tRNA. has a CCA sequence at it's 3' end that is used as a recognition sequence by proteins.Composed of 74-90 nucleotides. The 3' terminal hydroxyl groupd of the CCA tail serves as the aa binding site.

B12 Cobalamin def

takes several years to deplete. Megalobalstic anemia, degeneration of the dorsal and lateral spinal columns. Irreversible,.

Mallory-Weiss

tear in the gastic mucosa near the gastroesophageal junction. It typically results from repetitive forceful vomiting, which can also cause metabolic alkalosis. It can cause submuosal aterial or venous plexus bleeding. Verses: Boerhaave syndrome: Esophageal air/fluid leakage into the mediastinum and pleura.

Damage to the dorsal midbrain

tectum- usually result ins in vertical gaze palsy (inability to look up) due to its proximity to the superior colliculus, it may cause light0near dissociation. Pupils constrict with accommodation but not in response to light.

Granulomatous inflammation of media

temporal (giant cell) arteritis, the most common form of systemic vaculitis in adults.

Epidural hematoma

temporal bone fracture and MMA.

Bile salt malabsorptin typically occurs with conditions affecting the

terminal ileum (ileal resecrtion, crohns ileitis). Diarrhea as a result of excessive bile salt accumulation in the colon (cholerheic enteropathy).

Platelet function analyzer PFA-100

test monitors the time needed for a pt to form a platelet based hemostatic plut in vitro Abnormal seen ing von willebrand dz, NSAIDS or thrombocytopenia.

Efflux resistance

tetracycle, macrolides, (that require entry into the cell to function).

Chemotherapeutic agents

that inhibit microtubles formation can be toxic to nerves, such as vincristine and paclitaxel.

The TH1 response involves

the activation of specific CD4+ T lymphocytes by antigen-presenting cells, follwed by an interferon-y and IL2 mediated activation of macrophages and cytotoxic T lymphocytes. This immune reaction causes "walling off" of the tuberculous foci with the creation of caseating granulomas, which consist of epithelioid cells, Langhans multinucleated giant cells, fibroblasts and collagen. Becaue of this immune response, the medial students PPD test will be positive.

Enolase catalyzes

the conversion of 2-phosphoglycerate to phosphoenolpyruvate in glycolysis

Bundle Branch conductivity dtermine

the duration of QRS complexes, which are widened when there is a bundle branch block.

Superior laryngeal nerve supplies the cricothryroid muscle and an internal branch provides sensation over the supraglottic area

the external branch of this nerve may be miligated during thyroid surgery due to its prooxiity to the superior thyroid artery.

Friedreich's ataxia

the fraxatxin gene, codes for mitochondrial protein important in respiratory function and iron homeostatis, is mutated. GAA repeats dirsupts tranctiption, not post-transcriptional processing.

adenomatous polys

the last step- malignant transformation of adenoma in ca requires mutation of tow gene: p53 and DCC.

A mature cystic teratoma

the most common benign germ cell tumor, is usually identified as a nonfunctional adnexal mass in an asymptomatic pt. Pathologic findings include keratinized epithelial tissue with sebaceous glands.

What part of meningococcal meningitis cause Waterhous Friderichsen syndrome

the outmembrane lipooloigosaccharide (LOS), ut it lacks the repeating O antigen of the LPS. acts as an endotoxin and is associtaed with many of the toxic effects of menngococcal disease. LOS causes speitis by TNFa- IL-1, IL-6 and IL - 8 (mostly due to LOS's interaction with Toll-like receptor 4). LOS has een implicated int he petechiase seen in meningoccomemia and the ilateral adrenal cortical hemorrhages in WFS.

During polypetide elongation,

the ribosome moves 3 nucleotides toward the 3' end of mRNA, advancing peptidyl tRNA from the A site to the Psite (translocation). Translocation is catalyzed by elongation factor 2 and requires GTP hydrolysis.

Suprapubic cystostomy

the trocar and cannula pierces at the aponeurosis of the abdominal wall muscles, along with the layers of the superficial fascia, transversals fascia, and extra peritoneal fat. However, the peritoneum is not entered, reducing the risk of peritonitis and hemoperitoneum.

Ventricular muscle refractory period does not limit the ventricular contraction rate during AF

the ventricular HR can approach 300 beats per minute in ventricular tachycardia.

Unprovoked syncope in a previously asymptomatic young person may result from a congenital QT prolongation syndrome.

there are two important congenital syndromes that cause QT prolongation: Jervell and Lange-Neilsen syndrome: AR with neurosensory deafness Romano-Ward syndrome: AR not deafness Both may predispose to torsades de points at young age, causing syncopal epodes and possible Studden death syndrome.

Budd-Chiari syndrome

there is occlusion of the hepatic vein, which drains blood from the liver and portal circulation into the systemic circulation. Liver bx shows centrilobular congestion and fibrosis.

In aplastic anemia

there is pancytopenia, and increased erythropoietin by the kidney (in response to anemia-induced hypoxia) would be expected, given his pt's normal renal function. Triad of low hemoglobin, thrombocytopenia and an absent hematopoietic cells in the bone marrow is consistent with aplastic anemia. increased erythropoeitin. Bruising = Thrmobocytopenia

Lab findings of inhaled anesthetic hepatotoxicity, such as halothane:

they cause acute viral hepatitis. elevated serum aminotransferase levels, prlonged prothrombin time, leukocytosis and eosinophilia. The prolonged prothromboin time is due to failure of hepatic synthetic function and def of factor 7 (which has the shortest half-life of all the procoagulant factors), usually normal albumin (low in chronic liver injury) bercaue of long half-life of albumin).

Concentric hypertroph

thickening

obturator nerve

thigh adduction and medial thigh sensory loss.

A-delta fibers

thin, myelinated nerve fibers, temp and pain. Sharp pain and withdraw reflex arc from noxious stimuli.

Babesia microti

tick bite and causes babesiosis, endemic i the NE USA and causes flulike symptoms, hepatosplenomegaly, and anemia, and often affects asplenic pts.

Hibernating myocardium refers

to the presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization.

Methadone is

to treat opioid abuse. It is a potent, long acting opioid agoinst with good bioavailability and cna be given in once-daily oral dosing. Its prolonged effect suppress withdrwal symptoms and craving. SE is QT prlongation and respiratoty depression with lethality in overose. Buprenorphine is also used, it is a partial agoinist used along with naloxone (opiod antagoinist), buprenorphine is less lekely to caues respiratory depression or martality in overdose compared to methadone. non-opioid: clonidine.

Somatostainoma

too much somatostatin present with abdominal pain, gallbladder stones, constipation, hyperglycemia and steatorrhea. These manifestations result from somatostaitin-induced inhibition of insulin, glucagon, gastrin, secretin and cholecstokinin secretion and inhibition of gastrointestinal motility.

Burkitt lymphomas demonstrate a

translocation between the c-Myc oncogene on the long arm and the chromosome 8 and the Ig heavy chain region on chromosome 14 (t(8:14)). The product of c-Myc is a nuclear phosphoprotein that functions as a transcription activator controlling cell proliferation, differentiation and apoptosis. HEAVY 14

Crohn's dz: What explains strictures and fistulas:

transmural granulomas explains the two most common complications of chron's disease:Strictures and fistulas.

anti-HER2 monoclonal antibody

trastuzumab

Chlamydia

treat with azithromycin or doxycycline.

Reactive arthritis

triad of HLA-B27 related inflammatory arthritis, uveiti/conjunctivitis and urethritis following Chlamydia trachomatis infection.

Wet mount with leukocytes and pear-shaped organisms

trichomonas vaginitis

A salvage metabolic pathway can restore metabolic function would inhibit what antibiotic?

trimethoprim and sulfamethoxazole.

Cerbellar vermis lesions

truncal and gait ataxia due to impaired modulation of the medial-descending motor systms. Involvement of the lower vermis and the flocculonodular lob also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear complex.

uric acid cystals

tumor lysis syndrome occurs when tumors with a high cell turnover are treated with chemotherapy. The lysis of tumor cells causes intracellular ions, such as potassium and phosphrous, and uric acid (metabolite of tumor nucleic acid) to be released into the serum. Uric acid is soluable at physiologic pH, but it can precipitate in the normally acidic envrionment of the distal tubules and collecting ducts. The prevention of tumor lysis syndrome includes urine alkalinization and hydration as high urine flow and high pH along the nephron prevent crystallization and precipitation of uric acid.

BRCA

tumor suppressor gene

Meningiomas

tumors of leptomeninges, which is lining of brain. Hence, meningiomas can occur in any lined part of the brain including sellar and suprasellar regions. Meningiomas are usually homogeneous appearance on MRI and can be seen "sticking to leptomeninges".

P53 gene inactivation

two hit- tumor suppressor. Li-Fraumeni syndrome is an AD ca syndrome caused by an inherited mutation in the p53.

Flaccid bladder

typically occurs in the setter of lower motor neuron lesions (cauda equina syndrome). will have large residual volume of urine after attempted emptying and will typiclaly experience urinary incontinence at the end of the day (pressure from a full bladder becomes greater than urinary sphincter pressure)

H. Pylori

ulcers can happen in the duodenum, hight concentrations of H. pylori are not typically found in the upper and lower duodenal regions, as H. pylori can only colonize areas of gastric metaplasia.

Posteriormedial humeral nerve damage

ulnar

Prinzmetal's angina

uncommon condition of episodie angina that may occur at rest, independent of physical activity, HR and BLood pressure. The spasm may occur at the sites of atherosclerosis and results in transient transmural ischemia with ST segment elevations on ECG. Responds promply to vasodilators, NO and Ca channel blockers.

Bells palsy

unilateral facial paralysis, may experience decreased tearing, hyperacusis, and or loss of taste sensation one the anterior two thirds of the tongue. Cranial nerve 7- 1) Motor output tot he facial muscles 2) parasympathetic innervation to the lacrimal, submandiubular and sublingual salivary glands 3) Special afferent fibers for taste from the anterior 2-3rds of the tong 4. somatic afferents from the pinna and external auditory canal.

Spastic bladder

upper motor neuron lesion (bladder hypertonia)

Dimple is found instead of an anal opening

upper part of the anal canal is formed from the hindgut. The lower part of the anal canal is derived from the invagination of the surface ectoderm. The junction between these canals is closed during embryonic life by an anal membrane that is located at the level of the pectinate line. Absence of anal opening is most often associated with unrorectal urovesical or urovaginal fistula. Imperforate anus is most commonly associated with genitourinary tract malformations. malformation include renal agenesis, hypospadiase, episapdias, and bladder extrophy.

Tubular obstruction with urate crystals

urate nephropathy is due to tubular obstruction from urate crystal deposition is usually seen in individuals with acute hyperuricemia (tumor lysis syndrome). The classic presentation is acute renal failure during chemotherapy for a malignancy.o

Pt with urinary infection and then fever, hemodynamic instability, tachypnea, and pulmonary symptoms

urosepsis is likely complicate dby acute respiratory distress syndrome (ARDS). During sepsis, cytokines such as TNF, IL-1, and IL-8 begin to circulate in response to the infection, causing activtion the pulmonary epithelium. This results in ncreased recruitment and extravasation of the neutrophils intot he lung tissues, provoking an inflammatory response that leads to capillary damage and the leakage of protein and fluid into the alveolar space.

Cidofovir

used for CMV retinitis, is associated with nephrotoxicity manifesting as proteinuria or elevated creatinine.

Phenobarbital

used for generalized tonic clonic

Anti-interleukin therapy

used for immunosupression in organ transplant pts and in condition such as graft versus host dz

Cause of sudden cardiac death

usually caused when a coronary artery disease causing an acute myocardial infartion due to thrombitc occlusion of th right coronary artery. The cross-sectional image shows a large atheromatous plaque causing significant stenosis with superimpoesed thrombosis lead to complete lumen occulsion of the RCA. Sudden cardiac death refers to abrupt cessation of organized cardiac activity with hemodynamic collapse, causing an inability to maintain adequate tissue perfusion. SCD typically occurs due to mailgnant ventricular arrhythmias and it is related to coronary heart dz in 70% of pts. Ventricular fibrillation is the most frequent mechansim of SCD in the first 48 hours after actue MI and is related to electrical instability due to lack of perfusion in the ischemic myocardium.

Mitochondrial swelling

usually occurs during cell injury and would not be expected to render the cell cytoplasm completely clear on routine hematoxylin and eosin stain.

Respiratory acidosis respiratory alkalosis

usually occurs in pts with chronic obstructive pulmonary disease or CNS depression (narcotic overdose). Respiratory alkalosis: occurs with hyperventilation (panic attacks, PE)

Epidural hematomas

usually result from rupture of the mingle meningeal artery in the setting of head trauma (skull, fracture at the pterion)

DES (diethylstilbestrol)

vaginal adenosis- replacemnet of vaginal squamous epithelium with glandular columnar epithelium.

Mullerian aplasia

vaginal agenesis or Mayer-Roitansy-Kuster-Hauser syndrome. Aplasia is defined as defective develoment or congenital absence of an organ or tissue, and pts with MRKH have variable uterine development and no upper vag (short vagina). As the uterus is hypoplastic or absent, the pt cannot menstruate. But do have normal ovaries and develope regular secondary sexual characteristics. pts with mullerian defects should undergo renal ultrasound, as renal agenesis is common. versus angdrogen insensitivity syndrome: males who apprea female, have little axillary or pubic hair due to androgen resistance. cryptochid testes, no uterus no ovaris.

far posterior

vagus nerve posterior area of the tongue root, both gustatory and general sensory stimuli.

vascular vs immunologic endocarditis

vascular: -Systemic emboli (cerebral, pulm, splenic) -Mycotic aneurysm -Janeway (nontender lesions on palms and soles) Immunologic: -Osler nodes: painful (fingertips and toes) -Roth spots (edmatous and hemorrhagic lesions of the retina

Main MOA of Nitrates

venodilation which decrease preload with decreases ESV which lead to less oxygen consumption of the heart.

what is most common with left anterior descending artery occlusion

ventricular septal rupture and cardiac free wall rupture can occur as mechanical complications of actue MI and lead to cardiogenic shock and sudden death. These complications typically occur 3-7 days after the initial MI episode.

Vertigo

vestibular dysfunction tends to be of sudden onset, interfere with walking, and cause nausea and vomiting. Typical causes of vestibulopathy include meniere's disease, perilymphatic fistulas, benign positional verigo, labyrinthitis and acoustic neuroma (not vagus).

How does strptococcus phneumonia bacteria acquire the ability to produce capsules

via transformation. The capsule is the major virulence factor for S. pneumoniae, strains without the capsule are not pathogenic.

Parietal lobes and interpret

visual, auditory, and motor signals received from the other brain area. Parietal lobe damage results in difficulties with spatial and visual perceptions. Dominant lesions (commonly left-sided) result in Gerstmann syndome with right-left confusion and difficulty with writing and mathematics. Non-dominant parital lobe lesions can result in hemi-neglect, constructional apraxia (Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw object) and denial of the problem.

Where is pyridoxine absorpted

vit B6 in the jejunum and ileum by passive diffusion.

Riboflavin

water soluble B2

Femoral nerve

weakness on hip flexion and knee extension due to involvement of the iliopsoas and quadriceps muscles, respectively. Femoral nerve -> Saphenous nerve

Contact precautions with: Neisseria, influenzia, bordeteela pertussis, mycoplasma pneumoniae, RSV?

wear simple facemasks, droplet precaution, gloves and gowns are not required.

Symptoms of hypothyroid?

weight loss, polyuria, papitations, heat intolerance, excessive sweating.

Hyperplastic polyps

well-differentiated mucosal cells that form glands and crypts.

An axonal reaction occurs

when a neuron's axon is severed. This reaction entails swelling of the cell bedy, movement of the nucleus to the periphery and dispersion of Nissl substance.

Linkage disequilibrium

when a pair of alleles are inherited together int he same gamete (haplotype) more or less often than would be expected given random chance. It is important to understand that this can occur even if the genes are on different chromosomes.

What triggers antigen-specific IgE antibodies attached to high affinity receptors on the surface of mast cells and basophils to release vasoactive substance

when multivalent antigen comes in contact with the cell, multpiple IgE antibodies become cross-linked, resulting in aggregation of the FceRI receptors on the mast cell surface. This clumping of receptors leads to the activation of non-receptor tyrosine kinases, triggering an intracellular cascade that ultimately results in mast cell and basophil degranulation.

Non-communicating hydrocephalus

when normal flow of CSF from the ventriculi to the subarachnoid space is disrupted. Ventriculi above the obstruction are enlarged, while those below the obstruction are normal. Congenital anomalies, such as aqueductal stenosis, Arnold-Chiari or Dandy-Walker malfromations, cause non-communicating hydrocephalus.

Mast cells

when stimulated (due to antigeninduced cross-linking of IgE on their cell membrane), release histamine, prostaglandins, leukotrienes and other inflammatory mediators, they are active in allergic rxns and anaphylaxis.

Symptoms of aortic regurg increase when?

when volume increases, including papitations or atypical chest pain. Signs and symptoms of left heart failure can also occur which may explain this pt's exertional dyspnea and fatigue.

Fat-globule occlusion of pulmonary vasculature is an early histologic manifestation of fat embolism syndrome,

which is not associated with MI but multiple factures of one bones, plevis or ribs.

ASD

wide splitting S2

Anaphylaxis

widespread mast cell and basophil degranulation and the release of preformed inflammatory mediators, including histamine and tryptase

Asthma

will have a decrease FEV1 and decreased in peak expiratory flow rate on spirometry. Methacholine is a muscarinic cholinergic agonist that causes bronchoconstriction and increased airway secretions, a decrease of FEV1 after a methacholiine challenge indicates bronchial asthma. Intermittent respiratory symptomes in pts with a normal CXR occasional sputum eosinophils, and reduced FEV1 suggests a dx of asthma. Aspirin and other NSAIDS that inhbiti cyclooxygenase 1 can precipitate asthma attack by a mechanism involving leukotrienes overproduction in the airways. Acetamnopen is a weak inhibitor of cyclooxygenase and is not known to precipitate asthma.

Copper accumulation in

wilson dz, cirrhosis and neurologic complications.

Rugal thicking

with acid hyper secretion is Zollinger-Ellison syndrome. Rugal hypertrophy with parietal cell atrophy and decreased acid secretion occurs with Menetrier disease (cquired, premalignant disease of the stomach characterized by massive gastric folds, excessive mucous production with resultant protein loss, and little or no acid production. The disorder is associated with excessive secretion of transforming growth factor alpha (TGF-α).[1]).

Diffuse inflammatory infiltrates

with neutrophilic micro abscesses in the crypt lumina would be expectd in its with uc, which present with intermittent bloody diarrhea and abdominal pain.

Atrial fibrillation

with rapid venticular response. absent P waves, irregularly irregular R-R intervals and a narrow QRS complexes. Rapid, irregular, low amplitude fibrillatory waves are also frequently seen and represent chaotic continuous atrial depolarization. Average ventricular rate of AF usually ranges from 90 -170 eats per minute. ecaue atral exciation is chaotic, the venticular rate is irrgular with no set intervals etween contractions.

Calcineurin inhibitor nephrotoxicity

with resultant impairment of renal refunction is the most significant adverse effect of cyclosporine. Cytochrome P450 3A (CYP3A) is responsible for cyclosporinemetabolism in the small intestine and liver.

Lipid accumulaton

within muscle fibers is seen in lipid myopathies such as carnitine palmitoyltransferase def.

Regional airway resistance

within the first 10 generations of bronchi contribute to most of the total airway resistance of the lower respiratory tract. Resistance is maximal in the 2nd to 5th generation airways, including the segmental bronchi. In contrast, airways <2 mm in diameter (bronchioles) contribute <20% of the tool airway frictional resistance. Resistent increases in the medium sized bronhi, because of hight turbulent airflow.

Ribavirin

works against chronic hep c and respiratory synchytial virus. It is a nucleoside antimetabolite drug that interferes with duplication of viral genetic matieral. Phosphorylated intracellularly by adenosine kinase to ribavirin. Where it is incorporated into RNA, and can pain with uracil or cytosine. and cause hypermutation during RNA dependent RNA replication. Ribavirin enhances Th1-cell mediated immunity while inhibiting Th2 cytokine production, thus modulating a more effect immune response.

Colchicine

works primarily by inhibiting microtubular polymerization. It binds to the tubulin protein that helps form microtubules, preventing their aggregation. This in turn disrupts cytoskeletal-dependent fuctions such as chemotaxis, phagocytosis, and degranulation. It reduces the formation of leukotriene B4. It does not have any effect on the metabolism or urinary excretion of uric acid. Important adverse effects of colchicine are nausea, abdominal pain, and diarrhea. Don't use in elderly pts or those with severe renal dysfunction.

Presence of numerous neurotics in the alveolar fluid

would be consistent wit an exudate, which occurs int he setting of an acute bacterial or aspiration pneumonia.

Inflitratio of the intestinal lamina propria with atypical lympchytes

would be expected in its with MALT (Mucosa-associated lymphoid tissue) lymphomas associated with chronic H. Pyloir infection of the stomach..

Lower extremity hypoflexia

would result from damage to the lower motor neurons, which can occur in poliomyelitis or spinal muscular atrophy.

Leydig cell hyperplasia

would result in masculinization due to excessive prodution of testosterone, androstenedione and dehydroepiandrosterone, however there will not have an increase in serum adrenal hormone 17-hydroxyprogesterone.

Skin rhytides

wrinkles, directly cause by reduced elasticity and subdermal fat. This dermal and epidermal thinning, flattening of the dermoepidermal junction, a decreased number of fibroblasts, and redued syntheis of increaed breakdown of collagen and elastin.

in Schizophenia

you have too much dopamine. If you experiment bad SE such as Tardive dyskinesia, the switch to a a second generation antipsychoti preferable clozaine.