Uworld Incorrect Deck
compound nevi
benign proliferations of melanocytes that both the dermis and epidermis. lesions slightly raised papules with uniform pigmentation and symmetrical sharp borders.
Anti-Smith antibodies
Antibodies to spliceosomal snRNPs Highly specific for SLE
exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of adrenal cortex
CAH treatment
small, noncoding form of RNA that contains modified bases (eg, dihydrouridine, ribothymidine, pseudouridine)
CCA sequence at 3' end: recognition sequence by proteins amino acid binding site
coreceptor for viral surgace glycoprotein
CCR5 HIV attaches to host cells using the viral surface glycoprotein gp120. which binds CD4 and CCR5. causes conformational change in gp120 that exposes gp41. mediating viral fusion to the host cell
maraviroc
CCR5 inhibitors can be used in treatment of R5 virus not not X4 virus. because they bind to CXCR4 chemokine not CCR5.
precursor B-ALL immunophenotying
CD10, CD19 vs. precursor T-ALL show CD2, CD3, CD5, CD7, CD8
EBV envelope glycoprotein gp350 binds to
CD21 which is normally on the surface of CD19 positive cells.
increase in RAAS and SNS stimulation exacerbates symptoms of
CHF
loop diuretics work at the thick ascending loop of henle
CHF treatment first line includes: furosemide
linear esophageal lacerations in HIV patient
CMV enlarged cells with intranuclear inclusions
heterophile antibody negative mononucleosis like syndrome
CMV infection transfusion of leukocyte laden blood products.
heterophile antibody negative mononucleosis-like syndrome in immunocompetent patients
CMV infection!
infarction risk after occlusion of feeding artery
CNS myocardium kidney spleen liver (dual and collateral blood supply via hepatic artery and portal vein)
viral or bacterial upper URI commonly exacerbates
COPD vs. allergens exacerbate asthma
dobutamine shows mild improvement in cardiac contractility due to
Gs protein-adenylate cyclase activation
colonization of gastric antrum
H pylori
carcinogenic due to oncogenic proteins and the insertion of the genome into the host chromosome
HBV
odds ratio
OR=ad/bc
inactivated vaccine
Rabies
haemophilus influenzae
'blood loving' organism that requires X (hematin) and V (NAD+) factors for growth. this can be accomplished by growing H influenzae in the presence of Staphylococcus aureus and demonstrating the 'satellite phenomenon', whereby H influenzae grow only near the beta-hemolytic S aureus colonies that produce the needed X and V factors.
RANK-L
'receptor for activated nuclear facter kappa-B' important role in osteoclast differentiation. paget's disease of bone has increased numbers of abnormal osteoclasts, excessive bone turnover and disorganized bone remodeling.
maternal inheritance
'red ragged' muscle fibers are seen in mitochondrial diseases. muscle fibers have this appearance because abnormal mitochondria accumulate under the sarcolemma. Mitochondrial diseases show maternal inheritance.
ADHD
stimulant medications are first line. work by increasing availability of norepinephrine and dopamine in the prefrontal cortex.
glioblastoma
within the cerebral hemispheres and may cross midline. contain areas of necrosis and hemorrhage.
electron acceptor for succinate dehydrogenase
FAD riboflavin is precursor for FMN and FAD deficiency leads to: angular stomatitis, cheilitis, glossitis, seborrheic dermatitis, eye changes (keratitis, corneal neovascularization), and anemia.
Hartnup disease
Failed absorption of tryptophan in intestine/kidneys, that causes pellagra from niacin deficiency Tx: high protein diet, nicotinic diet niacin
regular insulin
DKA initially treated with IV regular insulin. when subcutaneous, starts working within 30 mins and peaks 2-4 hours, and lasts 5-8 hours.
pancreatic islet amyloid deposition is seen with
DM2 vs. DM1 shows pancreatic islet infiltration with leukocytes
primase
DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA. without this, DNA polymerase cannot initiate DNA synthesis.
delirium vs dementia
Delirium has: Acuteness, impaired consciousness, fluctuating course, reversible symptoms and global memory impairment. dementia has a gradual onset, is irreversible, and does not involve fluctuations in consciousness.
rate limiting enzyme of the pentose phosphate pathway
G6PD deficiency hemolytic anemia during times of oxidative stress: antimalarials/sulfonamide, infections fava beans
fever, pharyngitis, sandpaper like rash, circumoral pallor, and strawberry tongue
GAS produce pyrogenic exotoxins leading to scarlet fever predispose to ARF and glomerulonephritis
thiazolidinediones increase transcription of insulin responsive genes
GLUT 4 adiponectin
calcium-sensing receptors are
GPCRs that regulate secretion of PTH in response to circulating calcium levels. defective sensing receptors in familial hyocaciuric hypercalcemia
deficiency of beta-glucocerebrosidase deficiency hepatosplenomegaly pancytopenia bone pain crises avascular necrosis 'wrinkle tissue paper'
Gaucher disease
continuous administration leads to initial rise then inhibition of FSH and LH secretion leads to decreased testosterone production
GnRH agonist: leuprolide used: prostate cancer
cool, clammy skin, tachycardia= vasoconstriction due to SNS: epinephrine and norepinephrine
Gq alpha 1 receptor phospholipase C IP3 and DAG protein kinase C
protease inhibitors
HIV antiretroviral medications that inhibit cleavage of the polypeptide precursor into mature viral proteins. their side effects as a class include hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450.
Reactive arthritis
HLA-B27 assoicated arthropathy that occurs within several weeks following a geniturinary or enteric infection. chlamydia, campylobacter, salmonella, shigella, or yersinia. it presents with sterile arthritis due to deposition of immune complexes.
HPV and neonates
HPV is a small DNA virus with a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, including the true vocal cords, cervix, and anus. infants can acquire respiratory paillomatosis via passage through an HPV-infected birth canal.
infects sacral dorsal root ganglia can be reactivated to cause recurrent genital lesions
HSV2
decreased Hbg and haptoglobin increased lactate dehydrogenase and unconjugated bilirubin levels
HUS
are diagnostic of traumatic mechanism and indicate: microangiopathic hemolytic anemia or mechanical damage
HUS, TTP, DIC, Cx schistocytes
chancroid
Haemophilus ducreyi infection presents with deep, painful ulcers with ragged borders that are associated with a grey exudate and inguinal lymphadenopathy. diagnosis by gram stain and culture of organism from scraping of the ulcer base.
STEMI ECG
I & aVL=circumflex artery V1-V4=LAD
region of sarcomere that contains Z line and sections of thin filaments that do not overlap with thick myosin filaments
I band width of the I band lengthens during muscle relaxation and shortens during contraction
modified smooth muscle cells that release renin and reside in the afferent arteriole
JG cells hyperplasia with chronic stimulation (renal hypoperfusion)
proto oncogenes
KRAS stimulation of cellular proliferation
47,XXY
Klinefelter syndrome present with tall stature, small firm testes, azoopermia, and gynecomastia. mild intellectual disability is seen in some patients, and the severity generally increases with each additional X chromosome.
nerve roots for lower extremity reflexes
L2= hip extension L3= knee extension L4= platellar reflex L5=foot S1= achilles/ankle reflex
inhibin B
LH stimulates the release of testosterone from leydig cells of the testes; FSH stimulates the release of inhibin B from the sertoli cells in the seminiferous tubules. testosterone and inhibin B induce negative feedback on LH and FSH production, respectively.
follicle granulosa cells
LH stimulates the theca interna cells of the ovarian follicle to produce androgens. aromatose within the follicle's granulosa cells subsequently converts these androgens to estradiol under FSH stimulation. the theca externa cells serve as a connective tissue support strature for the follicle.
negative feedback for LH and FSH
LH: testosterone FSH: inhibin B from the sertoli
Leukocyte adhesion deficiency
Late seperation of umbilical cord, AR loss of CD18 necessary for integrin formation, recurrent infections without pus, recurrent skin and mucosal infections without purulence and persistent leukocytosis
decreases hepatic synthesis of triglycerides and VLDL and reduces clearance of HDL
Niacin decrease renal excretion of uric acid, causing gouty arthritis
hepatomegaly and cherry red macular spot in infancy
Niemann-Pick disease vs. Tay Sachs= no hepatomegaly
degradation of type II collagen and proteoglycans within articular cartilage
OA
most important virulence factor expressed by uropathogenic E coli
P fimbriae otherwise they cannot bind to uroepithelial cells and infect the bladder, ureters, and kidneys.
intermittent claudication that is better with rest sleep better when sitting or hanging leg off the bed foot ulcers MH: HTN, DM, smoking, high lipids thinning of the skin and hair loss
PAD
carrier protein-mediated process freely filters
PAH filters to bowmans space secretion of PAH can be saturated at high blood concentrations
elevated ovarian androgen levels (testosterone) stimulate development of small ovarian follicles and prevent the formation of a single dominant follicle.
PCOS associated with elevated insulin and insulin reisistance
majority of water reabsorption in the nephron occurs in the
PCT passively with the reabsorption of the solutes
continuous murmur at left infraclavicular region with maximal intensity at S2
PDA small is asymptomatic
triad of hemolytic anemia, hypercoagulability, and pancytopenia suggests
PNH due to acquired mutation in the PIGA gene that causes absence of GPI anchor and assoicated deficiency of CD55 and CD59 complement inhibitor proteins
Absence of CD55 and CD59 hemoglobinuria pancytopenia thrombosis at atypical sites
PNH uncontrolled complement mediated hemolysis chronic hemolysis leads to iron deposition= hemosiderosis
PAH clearance= (urine PAH x urine flow rate) / plasma [PAH]
RPF
selective estrogen receptor modulators exhibit estrogen antagonist and agonist properties in a tissue-specific manner.
Raloxifene--has estrogen agonist activity on bone, which decreases bone resorption and improves bone density. it as estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer, it also acts as an estrogen antagonist in the uterus, and does not increase the risk of endometrial cancer (vs. tamoxifen-which does).
agonist and protective on bone antagonist on breast and uterus and protective
Raloxifene=SERM
GTP binding, signal-transducing oncoprotein
Ras
retroperitoneal
SAD PUCKER suprarenal glands, aorta and IVC, duodenum, pancrease, ureters and bladder, colon, kidneys, esophagus, rectum
P450 inhibitors
SICKFACES.COM S=sodium valproate I=isoniazid C=cimetidine K=ketoconazole F=fluconazole A=alcohol C=chloramphenical E=erythromycin S=sulfonamides C=ciprofloxacin O=omeprazole M=metronidazole grapefruit juice, amioderone, quinidine
celecoxib
Selective COX-2 inhibitor: acts mainly on enzymes of cells involved in inflammation. Tox: GI toxicity, but less than that of aspirin
promote initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II
TATA and CAAT boxes 25 and 75 bases upstream of transcription start site
promoter region that binds transcription factors and RNA polymerase II during the initiation of transcription
TATA box
never treated with monotherapy due to fast emergence of mycobacterial antibiotic resistance from rapid, selective gene mutations.
TB isoniazid ...only monotherapy with PPD positive and CXR negative
internuclear ophthlmolplegia
a disorder of conjugate horizontal gaze in which the affected eye (ipsilateral to the lesion) is unable to adduct and the contralateral eye abducts with nystagmus. convergence and pupillary light reflex are preserved. typically due to damage to the medial longitudinal fasciculus on doral pons.
leuprolide
a gonadotropin-releasing hormone agonist that causes a transient increase in pituitary LH secretion, which leads to a rise in testosterone levels. continuous use suppresses LH release and leads to a decrease in testosterone production.
phencyclidine
a hallucinogen that causes dissociative symptoms, agitation, hallucinations, and violent behavior. Ataxia, nystagmus, and memory loss are other distinguishing symptoms of PCP abuse.
scabies
a human mite infection assoicated with a pruritic papular rash with excoriations and burrows. patients with impaired cell-mediated immunity (HIV) often develop a very high mite burden. treatment with topical permethrin and/or ivermectin is generally curative.
fidaxomicin
a macrocyclic antibiotic that inhibits RNA polymerase. it is bactericidal against C difficile.
gallstone ileus
a mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen. pneumobilia- air in the biliary tract is a common finding.
flutamide
a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors. it is used in combination with long-acting gonadotropin-releasing hormone agonists for the treatment of prostate cancer.
riboflavin
a precursor of the coenzymes FMN and FAD. FAD participates in the tricarboxylic acid cycle and electron transprot chain by acting as an electron acceptor for succinate dehydrogenase (complex II), which converts succinate into fumarate.
binds to portion of extracellular domain of HER2 and prevents activation of a transmembrane tyrosine kinase downregulates cellular proliferation and promotes apoptosis
Trastuzumab
DMD can also be use to nonsense mutations (usually frameshift) leading to premature stop codons
UAA UAG UGA
stop codons
UAA, UAG, UGA halt protein synthesis by binding a release factor; they do not add amino acids to the polypeptide chain.
key growth factors that promote angiogenesis in neoplastic and granulation tissue
VEGF and fibroblast growth factor
loss of epidermal melanocytes
Vitiligo
chronic granulomatous disease
X-linked disorder resulting from deficiency of NADPH oxidase, the enzyme responsible for formation of reactive oxygen species in phagosomes. Neutrophils affected by this disorder are unable to kill catalase-producing organisms, resulting in recurrent bacterial and fungal infections that frequently involve the lungs, skin, and lymph nodes.
fragile X syndrome
X-linked disorder, most common cause of inherited intellectual disability. pathogenesis involves an unstable expansion of trinucleotide repeats (CGG) in the fragile X mental retardation 1 gene. dysmorphic facial features: large jaw, protruding ears, long face and macroorchidism.
structure of immunoglobulin
Y-shaped site of attachment to phagocytic cells (Fc receptor) is the tail of the Y. site for attachment of complement is the neck of the Y. sites for attachment to antigens (fab) is the horns of the Y.
dobutamine
a beta adrenergic agonist with predominant activity on beta1 receptors and weak activity on beta2 and alpha1 receptors. this facilitates the interaction between actin and myosin, resulting in increased myocardial contractility.
physostigmine
a cholinesterase inhibitor with a tertiary ammonium structure that can reverse both the central and peripheral nervous system symptoms of anticholinergic toxicity. neostigmine, edrophonium, and pyridostigmine have a quaternary ammonium structure that limits central nervous system penetration.
Acute renal allograft rejection
a condition that develops in some kidney transplant patients in which the recipient's immune system attacks the cells of the transplanted organ, leading to loss of kidney function associated with diffuse lymphocytic infiltration of the renal vasculature, tubules, and interstitium
amlodipine
a dihydropyridine CCB that can cause headache, flushing, dizziness, and peripheral edema.
pigmented thickened plaques that arise in flexural regions such as back of neck or axillae
acanthosis nigricans usually due to insulin resistance or obesity if sudden and rapid spread: GI/ lung cancer!!
dihydrobiopterin reducatase deficiency
account for 2% of PKU. although phenylalanine levels can be corrected with dietary restriction, downstream deficiencies of dopamine, NE, Epinephrine, and serotonin lead to progressive neurologic deterioration.
unbalanced robertsonian translocation
account for a minority of down syndrome cases. karyotyping shows 46 chromosomes with a translocation between 2 acrocentric nonhomologous chromosomes [eg, 46,XX, t(14;21)] dysmorphic features of down syndrome include epicanthal folds, upslanting palpebral fissures, a protruding tongue and excessive skin at the nape of the neck.
increased intracellular solute concentration draws free water into the cell, causing cellular and mitochondrial swelling
accumulation of Na+ and Ca2+ due to: ion pump failure due to ATP deficiency during cardiac ischemia
placental aromatase deficiency
accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in female infants and maternal virilization. at puberty: impaired ovarian estrogen leads to: amenorrhea, osteoporosis, and tall stature
antigens taken by APC to langerhans cells and presented to CD4+ cells>>cells migrate to skin>inflammatory response within 24 hrs
accumulation of fluid in the intercellular spaces of epidermis: spongiosus acute allergic dermatitis
peripheral edema
accumulation of fluid in the interstitial spaces. due to elevated capillary hydrostatic pressure, decreased plasma oncotic pressure, sodium and water retention, and impaired lymphatic drainage. in chronic HF, increased lymphatic drainage initially offsets factors favoring edema. acute changes are more likely to produce edema.
proteasome inhibition for MM leads to
accumulation of toxic intracellular proteins and excess proapoptotic proteins >>increased apoptosis
isoniazid is metabolized by
acetylation. the presence of fast and slow acetylators within the same population results in a bimodal distribution of the speed of isoniazid metabolism. slow acetylators are at increased risk of adverse side effects.
decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relaxation at the lower esophageal sphincter
achalasia reduced numbers of inhibitory ganglion cells in the esophageal wall.
FGFR3
achondroplasia gain of function pint mutation on the fibroblast growth factor receptor 3 gene normally inhibits excessive cartilage proliferation, particularly in long bones always active= severely restricted condrocyte proliferation in growth plate cartilage and decreased endochondral ossification.
uric acid is soluble at physiologic pH but can precipitate in the
acidic environment of distal tubules and collecting ducts.
rifampin resistance
acquired by modification of the rifampin binding site on the bacterial DNA-dependent RNA polymerase. common side efffects include hepatotoxicity, blood dyscrasias, and harmless red-organe discoloration of body fluids.
diphtheria toxin and pseudomonal exotoxin A
act by ribosylating and inactivating elongation factor-2, inhibiting host cell protein synthesis and causing cell death.
binding site of actin and myosin filaments
actin=Z line darkest line myosin=M line line within lines
hypovolemia triggers a variety of compensatory mechanisms to improve tissue perfusion
activate RAAS= increased aldosterone and endothelin release, increase vasopressin release, and increased sympathetic tone.
interferon alpha and beta
are produced by most human cells in response to viral infections. the production of alpha and beta interferons helps suppress viral replication by halting protein synthesis and promoting apoptosis of infected cells, limiting the ability of viruses to spread through the tissues.
triptans
are serotonin 5HT1B/tHT1D agonists that block postsynaptic uptake of serotonin
umbilicated, flesh colored papules on the skin and mucous membranes
molluscum contagiosum caused by poxvirus eosinophilic cytoplasmic inclusions
elevated circulating paraproteins
monclonal immunogloulins multiple myeloma rouleaux formation normocytic anemia, hypercalcemia, bone pain, and renal insufficiency
CD14 is a surface marker of the
monocyte-macrophage cell linage. large epitheliod macrophages are always present in granulomas.
Kinesin
motor proteins in anterograde transport reactivation of latent HVS- from cell bodies in the sensory ganglia to the skin and oral mucosa
mucormycosis diagnosed with
mucosal biopsy broad ribbon-like nonseptate hyphae with right-angle branching
monclonal paraproteins= immunoglobulins>elevated normocytic anemia hypercalcemia bone pain renal insufficiency
multiple myeloma
buildup of pressure compresses optic nerves externally, impairs axoplasmic flow within optic nerves, causing bilateral optic disc edema
papilledema young women obese daily headaches transient visual disturbances pseudotumor cerebri: idiopathic intracranial hypertension
localized candidiasis is common in HIV patients where as systemic form is common in
neutropenic patients lymphocytes=local neutrophils= systemic
several significant side effects: flushing, hyperglycemia, and hepatotoxicity... and GOUT
niacin reduce uric acid excretion
binding acetylcholine leads to immediate: Na+, Ca2+ influx K+ outflux
nicotinic receptors
sphingomyelin accumulation, lipid-laden foam cell accumulation in liver and spleen, cherry-red macular spot
niemann-pick disease sphingomyelinase deficiency
headaches, cutaneous flushing, lightheadedness, hypotension after medication use
nitrates
replicate within host cell nucleus using host cell DNA and RNA polymerases
papillomaviruses usually: DNA viruses= replicate in nucleus (except poxvirus) RNA viruses: replicate in cytoplasm (except orthomyxoviruses)
polysaccharides must be degraded to monosaccharides by
pancreatic and brush border amylases before they can be absorbed. monosaccharides can be absorbed directly. D-xylose is a monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency, and can be used to differentiate between pancreatic versus mucosal causes of malabsorption.
cleavage of proinsulin in
pancreatic beta cell secretory granules= insulin and C-peptide stored in granules until they are secreted in equimolar amounts.
frequent source of retroperitoneal hematoma
pancreatic injury SAD PUCKER suprarenal glands aorta and IVC duodenum pancreas ureters and bladder colon kidneys esophagus rectum
most common GI disorder in CF patients
pancreatic insufficiency lead to thick, viscous secretions in the lumens of the pancreas, leading to obstruction, inflammation, and fibrosis. symptoms=steatorrhea, failure to thrive, and fat soluble vitamin deficiency.
severe hypertriglyceridemia
pancreatic lipases can cause toxic levels of free fattly acids to be released within the pancreatic tissue, leading to acute pancreatitis. Fibrates are the most effective agents for the treatment of hypertriglyceridemia.
autodigestion and acute pancreatitis
pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. premature cleavage of trypsinogen to trypsin within the pancreas leads to uncontrolled activation of these zymogens, causing pancreatic autodigestion and acute pancreatitis.
aplastic anemia causes
pancytopenia- as bone marrow is replaced by fat cells and marrow stroma absence of splenomegaly and increased reticulocyte count with normal appearing cells on peripheral smear bone marrow helpful in diagnosis
cerebral vasoconstriction
panic attacks are associated with hyperventilation and decreased pCO2. hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow.
pattern of pervasive distrust of others beginning in early childhood
paranoid personality disorder lack of sustained relationships no fixed delusions and other psychotic symptoms
smooth muscle contraction/relaxation
phenylephrine- alpha 1 agonist=constriction atropine- M3 agonist (inhibits muscarininc receptors on bronchial smooth muscle)= relaxation
cortisol increases the conversion of NE to epinephrine in the adrenal medulla by increasing the expression of
phenylethanolamine-N methyltransferase
phenylalanine hydroxylase deficiency or BH4 deficiency leading to defective metabolism of: phenylalanine tryptophan and deficient: serotonin, dopamine, NE
phenylketonuria
surfactant development
phosphatidylcholine (lecithin) increases after 30 weeks gestation sphingomyelin levels remain fairly constant during the third trimester. L/S ration =/> 2.0 means adequate production to avoid neonatal hyaline membrane disease.
phospholipids and pulmonary surfactant
phospholipids, including dipalmitoyl phosphatidylcholine, are major component of pulmonary surfactant. the amniotic fluit lecithin to sphingomyelin ratio is measured in order to assess fetal lung maturity. the fetal lungs are considered mature when they are producing adequate surfactant to yield an L/S ratio greater than 2
serine kinase
phosphorylation of serine and threonine residues leads to insulin resistance induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon
suspected child abuse
physician should attempt to conduct a full evaluation that includes seeking permission to interview the child alone. following a full evaluation, physicians should contact CPS immediately with any child abuse concerns.
enzyme responsible for conversion of propionly CoA to methylmalonyl CoA
propionyl CoA carboxylase deficiency>>propionic acidemia can't metabolize: valine isoleucine methionine threonine odd chain fatty acids
constitutional and urinary symptoms with prostate gland tenderness on digital rectal examination
prostatitis due to enteric organisms: E coli Enterococci
prostacylin
protaglandin 12- synthesized from prostaglandin H2 by prostacylcin synthase in vascular endothelial cells. once secreted, it inhibits platelet aggretion and causes vasodilation to oppose the functions of thromboxane A2 and help maintain vascular homeostasis.
glossopharyngeal nerve
results in loss of gag reflex, loss of sensation in upper pharynx, posterior tongue, tonsils, and middle ear cavity, and loss of taste sensation on the posterior third of the tongue.
decreased serum haptoglobin levels increased LDH and bilirubin
schistocytes (helmet cells) fragmented erythrocytes: mechanical trauma from microangiopathic hemolytic anemias or prothetic cardiac valves
gingival swelling/bleeding perifollicular hemorrhages and coiled hairs collagen synthesis impairment
scurvy vitamin C deficiency tea and toast diet
medulloblastoma
second most common brain neoplasm of childhood. first is pilocytic astrocytoma- which is also in cerebellum, often at the vermis, but contains rosenthal fibers and astrocytes. medulloblastoma consists of sheets of small, blue cells,. like other 'PNET' tumors, medulloblastomas are poorly differentiated and have a bad prognosis.
congenital pyloric stenosis
secondary to hypertrophy of the pyloric muscularis mucosae. physical exam shows visible peristalsis and the presence of an olive-sized mass in the distal stomach or pyloric region.
secretin and S cells
secretin is produced by S cells in the duodenal mucosa in response to stimulatioin by intraluminal acidity. secretin stimulates the release of bicarbonate-rich secretions from the exocrine pancreas, which is the major source of acid-neutralizing bicarbonate entering the duodenum.
increases level of thyroxine binding globulin
see with estrogen increase: pregnancy estrogen replacement this leads to increase in total thyroid hormone levels but negative feedback normalize free T4
red ragged muscle fibers
seen in mitochondrial disease due to abnormal mitochondria accumulate under the sarcolemma maternal inheritance
factor VII
shortest half-life failure of prothrombin time to correct with vitamin K indicates factor VII deficiency usually due to liver disease
language development by age 2
should have vocab of 50-200 words and use 2 word phrases. Parent's concerns about delayed milestones should be validated; they should be reassured that children often catch up but may need help. further evaluation and regular monitoring are required.
diagnostic findings for mesothelioma
stain positive for cytokeratins and calretinin can appear cuboidal or flattened celled or have spindle cells
immunohistochemistry of mesothelioma
stain positive for cytokeratins and many also stain postive for claretinin
immunohistochemistry of mesothelioma
stain positive for cytokeratins and many also stain postive for claretinin associated with asbestos exposure
auer rods
stain positively for myeloperoxidase found in AML M3 (acute promyelocytic leukemia)
hepatic abscess causes and route of spread
staph A: hematogenous enteric bacteria (E coli, klebsiella, and enterococci): ascending biliary tract, portal vein pyemia, or direct invasion from adjacent area entamoeba histolytic, echinococcal: most prevalent cause of liver abscess in developing coutnries
HMG-CoA reductase inhibitors
statins- can be hepatotoxic. check hepatic transaminases prior to therapy.
95% confidence interval does not include the null value
statistically significant
steroidogenesis: first step in mitochondria and the rest in smooth ER
steroid producing cells contain a well developed smooth ER
ankylosing spondylitis
stiffness and fusion of axial joints and inflammation at the site of insertion of tendons into bone (enthesitis). involvement of the thoracic spine and costovertebral and costosternal junctions can limit chest wall expansion, leading to hypoventilation.
high HCG
stimulate TSH receptors and can cause paraneoplastic hyperthyroidism.
NE
stimulates beta1 adrenoreceptors, increase cAMP concentration within cardiac myocytes and leads to increased contractility, conduction, and heart rate. peripheral vasoconstriction occurs via stimulation of alpha1 adrenoreceptors in vascular smooth muscle cells and activation of an IP3 signaling pathway.
UAA, UAG, and UGA
stop codons
releasing factors recognize
stop codons UAA UAG UGA and terminate protein synthesis
most commonly injured structure of the rotator cuff syndrome is the
tendon of the supraspinatus muscle. because the supraspinatus is an abductor of the humerus, injury to its tendon causes pain on abduction of the arm.
complete contralateral sensory loss
thalamic lesion (VPL and VPM) no somatosensory projections to the cortex via thalamocortical fibers.
CAAT
the TATA and CAAT boxes are promoters of transcription in eukaryotic cells are located approximately 25 and 75 bases upstream from the transcription start site, respectively. they promote initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II.
precursor of serotonin
tryptophan precursor to epi, NE, dopamine, melanin= tyrosine
precursor for serotonin
tryptophan serotonin syndrome- altered mental status, autonomic hyperactivity, and neuromuscular excitation (eg, hyperrelexia, clonus).
bilateral renal angiomyolipomas are associated with
tuberous sclerosis autosomal dominant condition. renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle, and fat.
hypocapnia is caused by
upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance. hypocapnia implies ongoing alveolar hyperventilation.
ornithine transport into mitochondria is necessary for proper function of the
urea cycle defects cause neurological damage due to the accumulation of ammonia protein restriction improves condition by reducing amino acid turnover
protein restriction improves this condition by reducing the amount of amino acid turnover
urea cyle defect ornithine transport into mitochondria to conduct urea cycle is impaired
gives rise to the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters
ureteric bud
intracranial hypertension (papilledema), skin changes, and hepatosplenomegaly
vitamin A overuse allopecia, hepatic injury (cirrhosis)
Niacin
vitamin B3 or nicotinic acid. many dehydrogenases use NAD+ and NADP+, which are formed from niacin. deficiency=pellagra and is classically associated with the 4 D's: dermatitis, dementia, diarrhea, and if untreated, death.
catalyzes rate-limiting step of heme synthesis with enzyme: aminolevulinate synthase
vitamin B6 deficiency can lead to siderblastic anemia
severe hypoglycemia
with loss of consciousness is typically treated with intramuscular glucagon in the nonmedical setting and with intravenous dextrose in the medical setting.
hypertrophic cardiomyopathy
worse with decreased LV volume caused by decreased preload and/or afterload. dihydropyridine CCB and nitroglycerin should be avoided.
chronic arteriovenous shunt
would increase cardiac output due to increased sympathetic stimulation to the heart, decreased total peripheral resistance, and increased venous return. it would also cause the venous return curve to shift to the right because the circulating blood volume is increased through renal retention of fluids and because venous pooling is reduced by the increased sympathetic tone.
G6PD inheritance pattern
x linked recessive
HER2
blockage with monoclonal antibody trastuzumab downregulates cellular proliferation and promotes apoptosis-by preventing activation of a transmembrane tyrosine kinase.
abciximab
blocker of glycoprotein IIb/IIIa receptor normally promotes platelet binding to fibrinogen. GP IIb/IIIa is either deficient or defective in patients with Glamnsmann thrombasthenia.
flow=r to the 4th power
blood flow directly proportional to the vessel radium to the fourth power. resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power.
accumulated homogenistic acid causing: pigment deposits in connective tissue
blue-black deposits become apparent in slcerae and ear cartilage. due to deficiency of homogentistic acid dioxygenase severe arthritis in adult life. called: alkaptonuria
conductive hearing loss
bone conduction will be greater than air conduction (abnormal Rinne test), and the weber test will lateralize to the affected ear. in sensorineural hearing loss, air conduction will be greater than bone conduction (normal Rinne test), and the weber test will lateralize to the unaffected ear.
hypochromic, microcytic anemia due to iron deficiency will increase
bone marrow erythropoiesis lots of immature RBCs into blood. contain bluish cytoplasm and reticular precipitates of residual ribosomal RNA.
proximal ureter receives its blood supply
from the renal artery whereas the distal ureter is supplied by the superior vesical artery. circulation to the middle portions of the ureter is variable and anastomotic.
lactic acidosis in septic shock
from tissue hypoxia impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. hepatic hypoperfusion also contributes to buildup of lactic acid as the the liver is the primary site of lactate clearance.
elastin has rubber like properties due to its high content of
cross-linking of nonpolar (hydrophobic) amino acids: lysine, proline
cells of the ovary are
cuboidal epithelium involved in surface repair of defects from ovulation endometriosis commonly affects the ovary and results in infertility.
vibrio vulnificus
curved, gram negative, free living bacterium that grows in marine environments. transmission primarily occurs due to the consumption of raw seafood (eg, oysters) or wound contamination. usually there is a mild cellulitis. but patients with liver disease or iron overload are at high risk for severe, fulminant infection (sepsis, necrotizing fascitis).
ecthyma gangrenosum
cutaneous necrotic disease with a strong association with pseudomonas aeruginosa bacteremia. perivascular invasion and release of tissue destructive exotoxins, causing vascular destruction and insufficient blood flow to patches of skin that become edematous and subsequently necrose. pseudomonas infections are common in patients who are neutropenic, are hospitalized, have burns, or have indwelling catheters.
methemoglobin contains ferric rather ferrous iron (Fe3+)
cyanide binds ferric iron more and is treatment for toxicity
cheyne stokes breathing
cyclic breathing of apnea followed by gradually increasing then decreasing tidal volumes until the next apneic period. usually in advanced CHF
eosinophils and mast cells: synthesize and release C4, D4, E4
cysteinyl-containing leukotriene asthma block them with: montelukast
activates caspases and indirectly brings about cell death
cytochrome C mitochondrial enzyme shrinks tumors
role in mRNA translation regulation and mRNA degradation
cytoplasmic P bodies
essential fructosuria
fructokinase definciency is a benign disorder. although affected patients are asymptomatic, their urine will test positive for a reducing sugar due to the presence of unmetabolized fructose.
alcohols
function by disorganizing the lipid structure in membranes, causing them to be leaky, and by denaturing cellular proteins. they are bactericidal, tuberculocidal, fungicidal, and virucidal, but do not destroy bacterial spores.
Neisseria gonorrhoeae
has high variability of its surface molecules-porins, opa proteins, polysaccharide, etc. this prevents the formation of protective immunity (even with infection and adequate antibiotics), and leads to susceptibility to repeat infection.
renal papillary necrosis
gross hematuria, acute flank pain, and passage of tissue fragments in urine. commonly seen in patients with sickle cell disease or trait, diabetes mellitus, analgesic nephropathy, or severe obstructive pyelonephritis.
ehlers danlos syndrome
group of rare hereditary disorders characterized by defective collagen synthesis. can be caused by procollagen peptidase dficiency, which results in impaired a cleavage of terminal propeptides in the extracellular space. patients of often have joint laxity, hyperextensible skin, and tissue fragility due to the formation of soluble collagen that does not properly crosslink.
cutaneous strawberry type capillary hemangiomas
grow in proportion to the growth of the child and then eventually regress. usually gone by age 7.
homeobox (HOX) genes
guide pattern of embryo development along the rostro-caudal, limb, and genital axes. HOXA13= hand-foot-genital syndrome distal limb defects: hypoplastic first digits and genitourinary malformations.
segmental demyelination of the peripheral nerves and an endoneural inflammatory infiltrate
guillain barre syndrome
lymphocytes with cytoplasmic projections
hairy cell leukemia indolent B cell neoplasm that infiltrates bone marrow and reticuloendothelial system. dry tap: due to fibrosis and bone marrow failure, leading to pancytopenia.
increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity
hallmarks of atypical subtype treatment resistant: use atypical features
halogenated inhaled anesthetics
halothane, enflurane, sevoflurane, desflurance metabolized by cyc P450 system by which they are converted to reactive intermediates that can cause heptaocellular damage (halothane hepatitis). patients present with acute hepatitis days after medication exposure, andliver biopsy may show centrilobular hepatic necrosis.
disorganized cartilage, fibrous, and adipose tissue in benign lung tumor
hamartomas asyptomatic 'coin lesion' in 50-60 years
single most important measure to reduce the risk of transmission of hospital acquired infections (MRSA)
hand hygiene
neutral amino acids in urine
hartnup disease mutation in neutral amino acid transporter treat: high protein diet daily niacin/NAD
carotid sinus reflex
has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus and medullary centers via the glossopharygeal nerve; the efferent limb carries parasympathetic impulses vis the vagus nerve.
methotrexate
folic acid antagonist used to treat ectopic pregnancy. it competitively inhibits the enzyme dihydrofolate reductase, which catalyzes the synthesis of tretrahydrofolate. DHF reductase inhibition causes the intermediate DHF to accumulate intracellularly.
isosorbide dinitrate
has low bioavailability due to extensive first-pass hepatic metabolism prior to release in systemic circulation. sublingual nitroglycerin is absorbed directly from oral mucosa into the venous circulation and has a higher bioavailability.
blocking histamine receptors with first generation antihistamines
have antimuscarinic, anti-alpha adrenergic, and anti-serotonergic properties. anticholinergic effects on the ocular ciliary muscles impair accommodation and cause blurring of vision for close objects.
Ornithine transcarbamylase deficiency
have discrete episodes of vomiting, tachypnea, and confusion/coma secondary to hyperammonemia. OTC deficiency is the most common disorder of the urea cycle and is characterized by hyperammonemia and elevated urinary orotic acid.
nitrate side effects
headaches and cutaneous flushing along with lightheadedness and hypotension due to systemic vasodilation.
thermal cycling PCR
heating for DNA strand denaturation, cooling for primer hybridization, and rewarming for primer extension and DNA synthesis
most common in children and affects metaphysis of long bones due to slower blood flow and capillary fenestrae
hematogenous osteomyelitis
route of metastasis to the skeleton
hematogenous seeding pelvis, prostate: via vertebral venous plexus
acute nausea
following administration of chemotherapy results from stimulation of the chemoreceptor trigger zone (CTZ), which lies in the area postrema of the dorsal medulla near the fourth ventricle.
bioavailability
fraction of administered drug that reaches the systemic circulation in a chemically unchanged form. non-IV route administration is always <1. F=9AUC oral x dose IV)/(AUC IV x dose oral)
long, narrow face, prominent chin and forehead, and large testes
fragile X syndrome developmental delay neuropsychiatric findings that overlap with: autism, ADHD
coronary sinus
freely communicates with right atrium. dilated when things increased right atrial pressure--pulmonary HTN.
Paraaminohippuric acid (PAH)
freely filtered from the blood in glomerular capillaries to the tubular fluid in bowman's space. it is also secreted from the blood into the tubular fluid by cells of proximal tubule by carrier protein-mediated process. the secretion of PAH can be saturated at high blood concentrations.
anatomic or functional vesicoureteral reflux
frequent bladder infections may weaken vesicoureteral junction and facilitate reflux
clear cell carcinoma
from renal proximal tubular cells. rounded or polygonal cells with abundant clear cytoplasm are seen on light microscopy. 'clear cells' are those with high glycogen or lipid content that dissolves during routine tissue preparation.
benign lymph node enlargement
in response to antigenic stimulation is asso. with a polyclonal proliferation of lymphocytes. a monoclonal lymphocytic proliferation is strong evidence of malignancy.
dermatitis herpetiformis associated with celiac disease
increased intraepithelial lymphocytes, loss of villus height, crypt hyperplasia, steatorrhea
colonic diverticula
increased intraluminal pressure case outpouching of the mucosa and submucosa through the muscularis- false diverticula
COPD flow volume loop
increased residual volume and TLC. both airway narrowing due to chronic bronchitis and decreased elasticity due to emphysematous destruction of interalveolar walls are responsible for the hyperinflation and airflow limitation.
small loop to the left
increased residual volume, TLC reduced EFR airway narrowing and decreased elasticity>>hyperinflation and airflow limitation
adverse effects of secondhand smoke exposure
increased risk of low birth weight asthma middle ear disease sudden infant death syn SIDS-due to impaired arousal and abnormal cardiovascular response to stimuli.
renal calculi
increased urinary calcium, oxalate, and uric acid promote salt crystallization increased urinary citrate and high fluid intake prevent calculi formation
fibrillin-1 (FBN1) gene mutation
marfan syndrome protein responsible for production and maintenance of elastic fibers. affects: CVS MSK eyes
defense mechanisms
mature defense mechanism involving a conscious choice not to dwell on a particular though or feeling. vs. repression with is not conscious.
ductus arteriosus derived from
6th aortic arch 4th= aortic arch 3rd= common carotid
pharyngeal pouches
1= middle ear and auditory tube 2=palatine tonsil crypts 3=thymus, inferior parathyroid glands 4=superior parathyroid glands, ultimobranchial body
drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
2-8 weeks after exposure phenytoin carbamazepine allopurinol sulfonamides minocycline vancomycin fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction.
dengue virus
4 serotypes secondary infection is much worse high grade fever headaches severe myalgias joint pains
unbalanced robertsonian translocations account for a minority of Down syndrome cases
46, XX, t(14;21) epicanthal folds, upslanting palpebral fissures, a protruding tongue, and excessive skin at the nape of the neck.
klinefelter syndrome
47,XXY presents with tall stature, gynecomastia, and small, firm testes. decreased testosterone secretion by fibrotic testes causes oligospermia and infertility.
finasteride
5-alpha reductase inhibitor that suppresses conversion of testosterone to dihydrotestosterone. used for treatment of BPH and androgenetic alopecia.
in patients with: chronic aortic stenosis & concentric left ventricular hypertrophy >> atrial contraction contributes greatly to LV filling
A fib means loss of this>> sudden decrease in LV preload and CO>> systemic hypotension
tricyclic antidepressants
Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. can cause confusion, constipation, and urinary retention.
PaO2<65
hypoxia
aromatase inhibitors
(anastrozole, letrozole, exemestane) decrease the synthesis of estrogen from androgens, suppressing estrogen levels and slowing progression of ER-positive tumors.
osler-weber-rendu syndrome
(hereditary hemorrhagic telangiectasia) is an autosomal dominant conditioin marked by the presence of telangiectasias in the skin as well as the mucous membranes of the lips, oronasopharynx, respiratory tract, gasterointestinal tract, and urinary tract. rupture of these telangiectasias may cause epistaxis, GI bleeding, or hematuria.
net excretion rate
(inulin clearance)(plasma concentration of substance)-(tubular reabsorption of substance)
maintenance dose equation
(steady state plasma concentration X clearance rate) divided by bioavailabillity. IV=1 for bioav. then multiple by hours and days.
loss of cardiomyocyte contractility occurs how long after onset of ischemia
60 seconds after 30 minutes, reversible contractile dysfunction, more leads to irreversible ischemic injury
attributable risk is calculated by
100 x [(RR-1)/RR]
lower angiotensin II levels, causing a reduction in systemic pressures and relative dilation of the efferent arteriole reduction in: GFR, FF
ACE inhibitors
ACE inhibitors and volume depletion
ACE inhibitors can cause significant first-dose hypotension in patients with volume depletion (eg, from diuretic use) or heart failure. to reduce the risk of first dose hypotension, ACE inhibitor therapy should be initiated at low dosages.
dehydration stimulates ADH secretion
ADH acts on the collecting ducts, increasing their permeability to water. thus, in the presence of ADH, the collecting ducts contain the most concentrated fluid in the nephron, while the thick ascending limb of the loop of Henle and distal convoluted tubule contain the most dilute fluid.
sertoli cells
AMH and regression of female internal organs leydig cells: stimulate wolffian ducts and make internal male organs. make testosterone which make external make organs
KRAS is a proto-oncogene vs. the tumor suppressors:
APC BRCA1 RB TP53
early-onset familial Alzheimer disease is associated with three gene mutations
APP (chromosome 21) presenilin 1 and presenilin 2 late onset familial Alzheimer disease is assoicated with apolipoprotein E4 genotype.
during the skeletal contraction cycle
ATP binding to myosin causes release of the myosin head from its binding site on the actin filament.
segmented viruses
BOAR: Bunyavirus Orthomyxovirus Arenavirus Reovirus (rotavirus) capable of genetic shifts through reassortment--involves exchange of entire genomic segments, a far more dramatic process than the point mutations responsible for genetic drift.
GABA-B receptor used to treat spasticity secondary to both brain and spinal cord disease
Baclofen can also use Tizanidine: alpha 2 agonist
liver P450 inducers
Barbs=phenobarbitol funny=phenytoin mom=modafinil refuses=rifampin greasy=griseofulvin carb=carbamazapine shakes=st. john's wort
gram negative coccobacillus
Bordetella pertussis
starry sky on histology
Burkitt's lymphoma very likely in HIV infection high mitotic index
disrupt actin cytoskeletal structure and intracellular signaling
C diff toxins: A and B cause: intestinal inflammation and fluid secretion
thick, viscous secretions in the lumens of pancreas, resulting in obstruction, inflammation, and subsequent fibrosis
CF pancreatic insufficiency
cytochrome p450 inducers
Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin decreased efficacy of warfarin. cimetidine, amiodarone, and trimethoprim-sulfamethoxazole inhibit warfarin metabolism, increasing the risk of bleeding.
disopyramide
Class IA antiarrhythmic depress phase 0 depolarization prolong repolarization increase action potential
disrupt cytoskeletal structure and intracellular signaling
Clostridium difficile A&B toxin A=intestinal inflam/fluid secretion B=cytotoxic
monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency
D-xylose used to differentiate between pancreatic vs. mucosal causes of malabsorption
HLA classes
I= HLAB27, expressed by all nucelated cless and present endogenous antigents to CD8 cells. II=DR,DP,DQ alleles are expressed by antigen presenting cells (macrophages, dendritic cells)and present predominantly foreign antigens to CD4 helper T cells. classI=IBD classII=RA, DM type I, and celiac.
presence of acute phase reactants increases the ESR
IL-1, IL6, TNF-alpha
produced by macrophages that induce chemotaxis and phagocytosis in neutrophils
IL-8 cause pus formation: protein rich fluid, dead leukocytes-mostly neutrophils
initial drug of choice for status epilepticus
IV benzodiazepines (lorazepam). work by enhancing the effect of GABA-A receptor, leading to increased chloride influx and suppression of action potential firing.
anti-Rh immune globulin
IgG anti-D antibodies that opsonize Rh+ fetal erythrocytes, promoting clearnace by maternal reticuloendothelial macrophages and preventing maternal Rh sensitization. it is routinely administered to Rh-negative women at 28 weeks gestation and immediately postpartum.
intracellular pathogens
Listeria monocytogenes Shigella flexneri Rickettsia species (multiple) E. coli strains Salmonella strains eliminated by cell-mediated response (T cells, macrophages, cytokines). impaired cell mediated immunity are at risk for invasive infections by these pathogens.
alcohol withdrawal
Long-acting benzodiazepines- diazepam or chlordiazepoxide in patients with advanced liver disease- use lorazepam, oxazepam, temazepam
breaks down monamine neurotransmitters (dopamine, NE, serotonin)
MAO inhibitors leads to buildup consume tyramine foods: aged cheeses, cured meats, draft beer cause tyramine-induced hypertensive crisis
each molecule consists of a heavy chain and a beta2-microglobulin
MCH class I
medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and marfanoid habitus
MEN2B episodic headache due to catecholamines from pheo
superantigens (toxic shock syndrome toxin) interact with
MHC molecules on APC and the variable region of T lymphocyte receptor cause nonspecific, widespread activation of T cell release IL2 from T cell TNF from macrophages
audible S3 gallop indicate severity of
MR increase atrial pressure leads to increase in ventricle volume/pressure
preferred diagnostic method for vertebral osteomyelitis
MRI of the spine should be suspected in patients with new/worsening back pain, fever, and recent endocarditis or bacteremia (staph A)
plaques contain foci of perivenular inflammatory infiltrates made up of autoreactive T lymphocytes and macrophages patchy demyelination
MS
DNA mismatch repair genes
MSH2, MLH1 HPPCC or lynch syndrome
anion gap metabolic acidosis
MUDPILES: Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates. DKA: treat with insulin, K+, saline
NNT
NNT=1/ARR
NO and arginine
NO is made from arginine by NO synthase. as a presursor, arginine supplementation may play an adjunct role in the treatment of conditions that improve with vasodilation, such as stable angina.
Thiazolidinediones
Pioglitazone Rosiglitazone reduce insulin resistance by altering gene transcription and protein synthesis through PPAR-gamma. takes several days to weeks after to take effect. can exacerbate HF, edema, weight gain
net filtration pressure
Pnet = (Pc - Pi) - (∏c -∏i)
oxidase positive non lactose fermenting gram negative rod
Pseudomonas A common: UTI in patients with catheters
Myastenia Gravis (MG)
Ptosis (inability to open upper eyelids), nasal smile abnormalities of the thymus
decreased CO
RAAS activation and increased sympathetic output raise arterial resistance (afterload) and exacerbate heart failure by making it more difficult for the failing hear to pump blood to the tissues.
direct contributors to sarcoidotic granuloma formation
Th1, IL-2, interferon-gamma
caused by gram positive actinomycete
Trophyeryma whippelii whipple disease rare systemic illness that involves small intestine, joints, and central nervous system. classic histologic findings include small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS positive, diastase- reisistant granules.
nitroprusside
a short acting venous and arterial vasodilator that decreases both preload and afterload. since these changes are balanced, stroke volume is maintained.
Mitochondrial vacuolization
a sign of irreversible cell injury- involved mitochondria have been permanently damaged.
pyrimidine dimers that are formed in DNA as a result of UV light is repaired by
a specific endonuclease complex that nicks the damaged strand on both sides of the dimer, excise the damaged segment, and DNA is replaced by DNA polymerase.
human multidrug resistance (MDR1) gene codes for P-glycoprotein
a transmembrance ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds. this protein reduce the influx of drugs into the cytosol and can increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.
kawasaki disease
a vasculitis of medium-sized arteries that presents with persistent fever for more than 5 days, bilateral conjuctivitis, cervical lymphadenopathy, and mucocutaneous involvement. coronary artery aneurysms are serious complication
extrinsic vs intrinsic pathway factors
aPTT: intrinsic XII XI IX VIII PT: extrinsic VII
gonadal artery arises from the
abdominal aorta
disulfiram like effects
abdominal cramps, nausea, headache metronidazole when combined with alcohol can cause due to acetaldehyde accumulation.
specificity
ability to correctly identify individuals without the disease. it should be high in confirmatory test to decrease false positives.
penicillins, cephalosporins, and vancomycin
able to disrupt the peptidoglycan cell wall of gram positive and gram negative organisms. the peptidoglycan cell wall of these organisms gives them the ability to survive osmotic stress; this ability is lost after treatment with these antibiotic agents.
systemic mastocytosis
abnormal proliferation of mast cells and increased histamine release. histamine causes hypersecretion of gastric acid by parietal cells in the stomach as well as a variety of other symptoms (eg, hypotension, flushing, pruritus)
upper motor neuron damage
above the anterior horn of lower medulla. leads to spastic paralysis, hyperreflexia, and an upgoing plantar reflex (Babinski sign) due to loss of descending inhibition over lower motor neurons in the anterior horn. lower motor neuron lesions cause flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy, and fasciculations.
drug induced lupus erythematosus
abrupt fever, arthralgias, pleuritis, with positive anti-histone antibodies. linked to drugs metabolized by N-acetylation in the liver (procainamide, hydralazine, isoniazid). genetically predisposed individuals who are slow acetylators are at greater risk for developing DILE.
development of atherosclerotic plaque (atheroma)
activated macrophages, platelets, and endothelial cells release growth factors (eg, platelet-derived growth factor) that stimulate recruitment of smooth muscle cells from the arterial wall media and their subsequent proliferation in the intima.
cytochrome C
activates caspases in mitochondria and indirectly brings about cell death through intrinsic pathway apoptosis.
Rb tumor suppressor gene
active (hypophosphorylated): prevent cells from going pas the G1/S checkpoint. inactive (hyperphosphorylated): allows damaged cell to enter mitosis.
cefuroxime
acts against cell wall synthesis leads to organism destruction by placement in hypotonic solution
fas receptor
acts to initiate the extrinsic pathway of apoptosis. mutations involving the Fas recceptor of fas ligand can prevent apoptosis of autoreactive lymphocytes, thereby increasing the risk of autoimmune disorders such as SLE.
increased neutrophil count and decreased lymphocyte, monocyte, basophil, and eosinophil counts
acute effects of corticosteroids increase in neutrophils due to: demargination of neutrophils previously attached to the vessel wall.
urine darken with exposure to sunlight NO skin sensitivity deficiency of porphobilinogen deaminase
acute intermittent porphoryia
accumulation of ALA and PBG
acute intermittent porphyria inherited PBG demainase deficiency combined with ALA synthase induction treat: glucose/hemin inhibit ALA synthase activity
HUS
acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia labs: decreased hemoglobin and platelet count increased bleeding time, lactate dehydrogenase, bilirubin, BUN, and creatinine.
acute/subacute (2-4wks): migratory arthritis pancarditis sydenham chorea
acute rheumatic fever
acute stress disorder v. PTSD
acute: 3 or more days but less than 1 month PTSD: more than 1 month
worse prognosis with PSGN
adult onset poor prognosis and higer risk of chronic hypertension and renal insufficiency
total oxygen content of blood
affected by: hemoglobin concentration, oxygen saturation of hemoglobin (SaO2), and the partial pressure of oxygen dissolved in blood (PaO2). Anemia is characterized by decreased hemoglobin concentration (oxygen content) in the setting of normal SaO2 and PaO2.
unilateral renal stenosis
affected kidney is protected from high bp by the narrowing of the renal artery and may suffer ischemic damage, leading to glomeruli crowding. vs. other kidney is well perfused and shows changes of hypertensive nephropathy (eg, hyaline or hyperplastic arteriolosclerosis).
hematogenous osteomyelitis
affects children commonly usually at the metaphysis of long bones due to slower blood flow and capillary fenestrae could progress to suppurative osteomyelitis
light reflex pathway
afferent limb is the optic nerve, and efferent limb is the parasympathetic fibers of the oculomotor nerve. when an optic nerve is damaged, light in that eye will cause neither pupil to constrict (the nerve can't sense the light). however, light in the contralateral eye will cause both pupils to constrict (because motor pathways are intact).
Protein kinase C
after a ligand binds to a G protein-coupled receptor that activates phospholipase C, membrane phospholipids are broken down into DAG and IP3. protein kinase C is activated by DAG and calcium
acute pancreatitis
after gallstones, alcohol abuse is the second most common cause of acute pancreatitis. macrocytosis and AST:ALT >2 are indirect indicators of chronic alcohol consumption. alcohol related macrocytosis can occur independently of folate deficiency.
maximal velocity of skeletal muscle contraction increases as
afterload decreases =force against which muscle fiber has to contract highest contraction velocity=afterload is zero
increased collagen deposition accum. of cytoplasmic pigment sigmoid vent. septum
age related myocardial changes
baclofen
agonist at GABA-B receptor effective as monotherapy for the treamtment of spasticity secondary to both brain and spinal cord disease (MS). tizanidine also used
rises a bit trachea medium sized bronchi and then decreases all the way down to alveoli
airway resistance
nitrogen transfer
alanine is the major amino acid responsible for transferring nitrogen to the liver for disposal. during catabolism of proteins, amino groups are transferred to alpha-ketoglutarate to form glutamate. glutamate is then processed in the liver to form urea, the primary disposal form of nitrogen in humans. free ammonia is also excreted into the urine by the kidney for regulation of acid-base status.
dissolve lipid bilayer membranes and denature proteins of influenza virus, fungus, enveloped viruses
alcohol based disinfectants
lung abscesses
alcoholics are more likely than the general population to develop pulmonary infectioins and abscesses involving combinations of anaerobic oral flora (bacteroides, prevotella, fusobacterium, and peptostreptococcus) and aerobic bacteria. clindamycin covers most of these organisms and is thus the antibiotic of choice for treating lung abscesses.
hereditary fructose intolerance
aldolase B deficiency accumulation of toxic metabolite fructose-1-phosphate result in hypoglycemia and vomiting with fructose or sucross avoid: fructose sucrose
polyol pathway
aldose reductase converts glucose into sorbitol, which is slowly metabolized into fructose by sorbitol dehydrogenase. chronic hyperglycemia overwhelms this pathway, causing intracellular sorbitol accumulation and increased osmotic/oxidative stress. this accelerates cataract development in patients with diabetes and contributes to the pathogenesis of diabetic retinopathy, neuropathy, and nephropathy.
can't metabolize tyrosine to fumarate to send to TCA cycle and has urine turn dark after standing
alkaptonuria increase: homogentisic acid due to deficiency: homogentisic acid dioxygenase
3' to 5' exonuclease activity (proofreading)
all 3 prokaryotic DNA polymerases can remove mismatched nucleotides via their 3' to 5' exonuclease activity. only DNA polymerase I has 5' to 3' exonuclease activity, which is used to remove the RNA primer synthesized by RNA primase.
organisms that lack peptidoglycan walls
all organisms of mycoplasma genus resistant to penicillins, cephalosporins, carbapenems, and vancomycin need to be treated with antiribosomal agents (eg, tetracyclines, macrolides)
different mutations at same genetic locus cause similar phenotypes
allelic heterogeneity more than one type of mutation is possible in a given gene, different mutations can cause protein alterations or loss of function, resulting in disease.
desmopressin effects on vWF
alleviate bleeding through endothelial release of vWF.
E coli K1 capsular antigen
allows bacteria to survive in the bloodstream and establish meningeal infection. lipopolysaccharide: bacteriemia and septic shock verotoxin (shiga-like): gastroenteritis, bloody heat stable/labile: watery gastroenteritis p fimbriae: UTI
sodium/calcium exchange pump
along with sarcoplasmic reticulum calcium-ATPase pump mediate calcium efflux from cardiac cells prior to relaxation
alpha 2 receptors and insulin
alpha 2 inhibit insulin secretion, beta 2 stimulate secreation alpha 2 is predominant--sympathetic stimulation leads to overall inhibition of insulin secretion.
BPH meds
alpha adrenergic antagonists: terazosin, tamsulosin---smooth muscle relaxants that work on the dynamic component bladder outlet obstruction. work within days to weeks but no not significantly affect prostate volume. 5-alpha reductase inhibors: finasteride, dutasteride---inhibit the conversion of testosterone to dihydrotestosterone and address the fixed component of bladder outlet obstruction. they reduce prostate volume but can take up to 6-12 months to achieve maximal effect.
reddish-pink globules on PAS stain: interalveolar septa destruction elevated LFTs dyspnea smoking: early onset basilar lung predominant
alpha-1-antitrypsin deficiency
complications of Fabry disease
alpha-galactosidase A deficiency early: neuropathic pain and angiokeratomas later: renal=nephropathy cardia=LV hypertrophy CNS=TIA, stroke
fabry disease
alpha-galactosidase A deficiency causes accumulation of the sphingolipid globotriasylceramide. the earliest manifestations of Fabry disease are neuropathic pain and angiokeratomas. glomerular (proteinuria, renal failure), cardiac (left ventricular hypertrophy), and cerebrovascular (TIA, stroke) complications in adulthood.
lower vermis and the flocculonodular lobe
also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear.
hemoglobin levels are affected by
alterations in RBC survivial increased turnover RBCs cause false> HbA1c== low
internal ribosome entry
alternative method used by apoptotic cells whereby a distinct nucleotide sequence allows translater to being in the middle of the mRNA, while cell may be going apoptosis
spleen a mesodermal orgin
although it is supplied by the splenic artery (a branch of the major foregut vessel, the celiac trunk, it is not of foregut derivative.
abdominal pain, vomiting, and severe, cholera-like diarrhea with positive urine alpha-amanitin
amatoxin poisoning duet o poisonous mushroom ingestion bind DNA-dependent RNA polymerase type II and halt mRNA synthesis. ....affect organs with rapid cell turnover: GI, proximal CRT
vancomycin resistance
amino acid change from D-ala to D-lac
catabolism of proteins
amino groups transferred to alpha-ketoglutarate to form glutamate
antibiotic modifying enzymes add chemical groups: acetyl, adenyl, phosphate to a target drug and lead to
aminoglycoside resistance gentamicin
class III antiarrhythmic drugs
amioderone, sotalol, dofetilide block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential--prolonging repolarization and total action potential duration. sodium, calcium, potassium
hypoxia, hypotensive shock, and DIC after prolonged delivery in mom
amniotic fluid embolism fetal squamous cells are seen in pulmonary vasculature
amniotic fluid embolism
amniotic fluid entering the maternal circulation. hypoxia, hypotensive shock, and DIC. fetal squamous cells are seen in pulmonary vasculature during histologic evaluation.
antifungals that bind ergosterol
amphotericin B and nystatin azoles: inhibit synthesis of ergosterol caspofungin: blocks cell wall flucytosine: DNA and RNA synthesis griseofulvin: mitosis
hypospadias
an abnormal opening of the urethra proximal to the glans penis along the ventral shaft of the penis. incomplete fusion of urogenital folds.
theophylline
an adensoine receptor antagonist and indirect adrenergic agent with a narrow therapeutic index. it is predomonantly metabolized by the hepatic cytochrome oxidases. inhibition of these enzymes by concurrent illness (eg, infection with fever) or ingestion of certain drugs or substances (ciprofloxacin) can raise serum theophylline concentrations and cause toxicity (eg, seizures, cardiac arrhythmias).
ipratropium
an anticholinergic agent and derivative of atropine, treats obstructive lung disease by blocking aceytlcholine at muscarinic receptors, which prevents bronchoconstriction and reduces mucus secretion from the tracheobronchial submucosal glands.
pernicious anemia
an autoimmune disease characterized by CD4+ cell-mediated destruction of parietal cells. as parietal cells aredestroyed, their ability to secrete hydrochloric acid decreased, resulting in an elevated intraluminal pH that leads to upregulation of gastrin secretion. patients also develop vitamin B12 deficiency as a result of decreased intrinsic factor secretion.
acute intermittent porphyria
an autosomal dominant condition caused by porphobilinogen deaminase deficiency. most patients remain asymptomatic, but a minority present with acute attacks characterized by abdominal pain and vomiting, peripheral neuropathy, neuropsychological symptoms, and reddish-brown urine. treatment consists of intravenous glucose or heme preparations, which downregulate ALA synthase activity.
friedreich ataxia
an autosomal recessive condition that presents during childhood/adolescence with progressive gait ataxia (due to degeneration of the posterior columns and dorsal root ganglia). other features-hypertrophic cardiomyopathy (most common cause of death), skeletal abnormalities (eg, kyphoscoliosis, pes cavus), and diabetes mellitus.
Tay-Sachs disease
an autosomal recessive disorder caused by beta-hexosaminidase A deficiency, which results in GM2 ganglioside accumulation. key clinical features include preogressive neurodegeneration and a cherry-red macular spot. in contrast to patients with Niemann-Pick disease, those with Tay Sachs disease have NO hepatosplenomegaly.
alkaptonuria
an autosomal recessive disorder in which the lack of homogentisic acid dioxygenase blocks the metabolism of tyrosine, leading to an accumulation of homogentistic acid. features: black urine when exposed to air, a blue-black pigmentation on the face, and ochronotic arthropathy.
postpartum hemorrhage
an obstetrical emergency. bilateral ligation of the internal iliac artery can decrease uterine blood flow and control postpartum hemorrhage that is unresponsive to medical management.
pretibial myxedema
and Graves ophthalmopathy are specific features of Graves disease. caused by autoimmune response directed against the TSH receptor that results in accumulation of glycosaminoglycans within the affected tissues.
sodium/clacium exchange pump
and sarcoplasmic reticulum calcium ATPase pump are the main sources of calcium efflux from cardiac cells prior to relaxation
interscalene nerve block
anesthesai for shoulder and upper arm procedures. causes ipsilateral diaphragmatic paralysis due to anesthetizing the roots of the phrenic nerve (C3-C5) should be avoided in patients with chronic lung disease or with contralateral phrenic nerve dysfunction.
composed of blood vessels, smooth muscle, and fat
angiomyolipoma benign tumor if bilateral in kidneys associated with tuberous sclerosis
occlusion of proximal LAD
anteroseptal transmural ischemia, with ST elevations in leads V1-V4. occlusion of the LCX- transmural ischemia of the lateral wall of the left ventricle, with ST elevations mainly in V5 and V6, and possibly also in I and aVL.
routinely administered to Rh-negative women at 28 weeks
anti-Rh immune globulins- IgG anti-D antibodies
main protection against refection with influenza virus
anti-hemagglutinin antibodies neutralize the virus and primarily block binding to host cells
fever, dry skin and mucous membranes, flushing, blurred vision, and altered mental status
anticholinergic intoxication jimson weed (datura stramonium)
dimercaprol
antidote for arsenic poisoning pain, vomiting, diarrhea, hypotension, and garlic odor on breath causes: insecticides and contaminated water
SLE
antiphospholipid antibodies causing aPTT prolongation and false-positive RPR/VDRL at risk for arterial thromboembolism and unexplained, recurrent pregnancy loss
anxiety due to a medical condition
anxiety due to a general medical condition is diagnosed when symptoms are the physiological consequences of an underlying medical condition
teniae coli
are 3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix. if the appendix cannot be identified by palpation during an appendectomy, it can be located by following the teniae coli to their origin at the cecal base.
calcium-sensing receptors
are G protein-coupled receptors that regulate the secretion of parathyroid hormone in response to changes in circulating calcium levels. familial hypocalciuric hypercalcemia is a benign autosomal dominant disorder caused by defective calcium-sensing receptors in the parathyroid gland and kidneys.
most common cause of death in patients with tricyclic antidepressant overdose
are cardiac arrhythmias and refractory hypotension. inhibition of fast sodium channels in cardiac myocytes (and the His-purkinje system) is thought to be the major underlying cellular event.
both myasthenia and lambert eaton syndrome
are caused by poor signal transmission at the neuromuscular junction. lambert eaton syndrome is associated with underlying malignancy. antibodies to voltage gated presynaptic calcium channels are found in these patients.
mitochondrial diseases
are characterized by exclusively-maternal inheritance. variable severity of these diseases is explained by random distribution of normal and mutated mitochondria between daughter cells during mitosis; as a result, some cells may have completely healthy mitochondria, while other cells contain mitochondria affected by genetic mutation (heteroplasmy). 1. leber hereditary optic neuropathy 2. myoclonic epilepsy with ragged red fibers 3. mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes
are ch
are cholinesterase inhibitors that are widely used as pesticides in agriculture. they inhibit the breakdown of acetylcholine, leading to a state of cholinergic excess. symptoms of organophosphate poisoning include salivation, lacrimation, diaphoresis, bradycardia, and bronchospasm.
selective estrogen receptor modulators (tamoxifen, raloxifene)
are competitive inhibitors of estrogen binding to estrogen receptors. they can have agonist or antagonist effects depending on the specific tissue. Tamoxifen has an estrogenic effect on the uterus and can cause endometrial hyperplasia and cancer.
zinc-finger motifs
are composed of chains of amino acids bound together around a zinc atom via linkages with cysteine and histidine residues. they recognize specific DNA sequences and are used by many transcription factors to bind DNA and alter activity of target genes. intracellular receptors that bind steroids, thyroid hormone, and fat-soluble vitamins act directly as transcription factors and contain zinc-finger binding domains.
neonates born to mothers with poorly controlled diabetes during pregnancy
are exposed to high maternal glucose levels in utero, resulting in excessive fetal insulin production and islet hyperplasia. fetal hyperinsulinemia persists for several days following birth and predisposes the infant to transient hypoglycemia.
VIPomas
are pancreatic islet cell tumors that hypersecrete vasoactive intestinal peptide (VIP), which increases intestinal chloride loss into the stool and causes excess losses of the accompanying water, sodium, and potassium. VIP also inhibits gastric secretion. Somatostatin inhibits the secretion of VIP and is used to treat the symptoms of VIPoma.
monamine oxidase inhibitors
are particularly useful in patients with treatment-resistant major depressive disorder with atypical features. increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of the atypical subtype.
amatoxins found in poisonus mushrooms
are potent inhibitors of RNA polymerase II (halting mRNA synthesis).
cardiac amyloidosis
areas of myocardium infiltrated by an amorphous and acellular pink material.
arginase deficiency
arginase produces urea and ornithine from arginine spastic diplegia, growth delay, and abnormal movements treat: arginine-free, low protein diet
temporomandibular disorder
arises from problems involving the TMJ, muscles of mastication, and the nerves that supply the jaw. because mandibular division of the trigeminal nerve supplies the middle ear and the muscles of mastication, TMD can present with both otologic symptoms and jaw pain.
aromatase deficiency
aromatase converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues. placental aromatase defficiency causes accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in female infants and maternal virilization.
anesthetics with high tissue solubility are characterized by large
arteriovenous concentration gradients and slower onsets of action
glucose, bicarbonate, and amino acids decrease
as fluid runs along proximal tubule vs. PAH, creatinine, inulin, and urea: increase as fluid runs along proximal tubule
EBV
associated with Burkitt lymphoma and nasopharyngeal carcinoma.
aflatoxin
associated with G:C to T:A conversion, leading to increase risk of developing hepatocellular carcinoma.
helocobacter pylori antral gastritis
associated with formation of duodenal ulcers due to increased gastric acid production. this acidity caused by unchecked gastrin production due to the destruction of somatostatin-secreting cells in the gastric antrum. H pylori also releases cytotoxins that inhibit duodenal production of bicarbonate.
sudden onset back pain, hematuria, and oliguria
associated with high anion gap metabolic acidosis and osmolar gap anion gap=sodium-(Cl+bicarb) normal is 10-14 MUDPILES
cardiac myocyte action potential
associated with increased membrane permeability to sodium, and calcium and decreased permeability to potassium. going up with sodium, plateau with calcium, and down with potassium.
VSD
associated with low-pitched holosystolic murmur at the left sternal border. accentuates during maneuvers that increase afterload (handgrip maneuver). a small VSD is asymptomatic and produces a louder murmur due to higher interventricular pressure gradient.
cutaneous small vessel vasculitis
associated with medication- penicillins, cephalosporins presents with palpable purpura in the lower extremities. histo--marked perivascular inflammation of small blood vessels with fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei (leukocytoclastic vasculitis).
second generation antipsychotics
associated with metabolic adverse effects- weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes. within the class, olanzipines and clozapines carry the greatest risk. clozipine needs monitoring for agranulocytosis.
polycystic ovary syndrome
associated with oligomenorrhea, hirsutism, and polycystic ovaries. disruption in intraovarian steroidogenesis causes anovulatory cycles and results in chronic estrogen stimulation with decreased progesterone secretion, placing PCOS patients at risk for endometrial hyperplasia/carcinoma.
mutations in VHL gene on chromosome 3p
associated with sporadic and hereditary renal cell carcinomas
intermittent respiratory symptoms in a patient with a ormal CXR, sputum eosinophils, and reduced FEV1 suggest
asthma common triggers: exercise, cold air, respiratory infection, and exposure to inhaled allergens (eg, dust mites, cockroaches, pet dander, mold, pollen)
frequent causes of pulsus paradoxus in absence of pericardial disease
asthma and COPD treat with beta adrenergic agonists (Gs GPCR)...produce relaxation of bronchial smooth muscle
excess of Th2 cell activity relative to Th1 cell activity may underlie the pathogenesis of asthma.
asthma sensitization phase, inhaled antigens stimulate Th2 cells to secrete IL4 and IL13, which promote B-lymphocyte class switching for IgE synthesis, leading to mast cell priming. Th2 cells also secrete IL-5 which activates eosinophils.
glial scar formed by
astrocytic processes
oval yeasts with thick walls and broad-based budding
blastomyces dermatitidis
hypertrophic cardiomyopathy
asymmetric ventricular septal hypertrophy and varable dynamic left ventricular outflow tract obstruction. maneuvers that increase preload or afterload will decrease murmur intensity. sudden standing, valsalva, or nitroglycerin
sillicosis
asymptomatic but can present with dyspnea on exertion and productive cough. silicosis is distinguished by calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrounded by fibrous tissue.
tRNA has CCA sequence
at 3' end that us used a recognition sequence by proteins
saddle pulmonary embolism
at bifuration of the main pulmonary arter. venous thromboembolism arises due to virchow triad: endothelial injury, venous stasis, and hypercoagulable state. malignancy causes a hypercoagulable state and is strong risk factor for venous thromboembolism.
norepinephrine synthesis in the brain
at locus ceruleus- a paired brainstem nucleus in posterior rostral pons near the lateral floor of the fourth ventricle. it projects to virtually all parts of the central nervous system and helps control mood, arousal (reticular activating system), sleep-wake states, cognition, and autonomic function.
kidney glucose filtration
at normal plasma concentrations of glucose, the renal tubules reabsorb the entire filtered load of glucose as this is below the maximum tubular reabsorption ability (transport maximum of glucose [TmG]). at higher plasma concentrations, glucose is excreted when the filtered amount exceeds the TmG.
asbestos exposure
at risk for asbestosis, pleural disease, and malignancies such as bronchogenic carcinoma and mesothelioma. bronchogenic carcinoma is the most common malignancy in this population, followed by mesothelioma.
invasive vascular procedures can be complicated by
atheroembolic disease involve kidneys, GI tract, CNS, and the skin how needle shaped cholesterol clefts within the atheromatous embolus.
chronic mesenteric ischemia
athersclerosis of the mesenteric arteries, resulting in diminished blood flow to the intestine after meals. causes postprandial epigastric pain (intestinal angina due to increased demand for blood/oxygen) with associated food aversion/weight loss.
chronic aortic stenosis and A. Fib.
atrial contraction contributes to left ventricular filling. loss of atrial contraction due to A. Fib can reduce left ventricular preload and CO sufficiently to cause systemic hypotension. decreased forward filling of the left ventricle can also result in backup of blood in left atrium and pulmonary veins, leading to acute pulmonary edema.
excess risk in the exposed population that can be attributed to the risk factor
attributable risk percent ARP=100 x [(RR-1)/RR]
goodpasture syndrome caused by
autoantibodies against alpha 3 chain of type IV collagen in glomerular and alveolar basement membranes (anti-GBM antibodies). patients typically present with rapidly progressive glomerulonephritis (nephritic syndrome) and alveolar hemorrhage (shortness of breath, hemoptysis).
pemphigus vulgaris
autoimmune bullous disease characterized by autoantibodies directed against desmosomal proteins (eg, desmoglein==whole circles) painful flaccid bullae and erosioins (ulcer like) affected the skin and mucosal membranes. the bullae spread laterally with pressure and new blisters may form with gentle rubbing. vs. bullous pemphigoid usually tense and full of liquid inside. separates from dermis. mucosal involvement is less common and Nikolsky sign is negative.
myasthenia gravis
autoimmune disease that causes a decrease in the number of functional acetylcholine receptors within the neuromuscular junction. this reduces the number of postsynaptic cation channels that can open in response to acetylcholine, which reduces the amplitude of motor end plate potential and prevents muscle fiber depolarization.
MS
autoimmune disorder of the central nervous system characterized by recurrent episodes of demyelination, leading to reduced saltatory conduction. internuclear ophthalmoplegia and optic neuritis are common manifestations.
angioedema
autosomal dominant or acquired via ACE inhibitor treatment. in hereditary angioedema, low C1 esterase inhibitor activity leads to in increase in bradykinin activity. ACE inhibitors should be NOT be used in these patients.
huntington disease
autosomal dominant trait it manifests with progressive dementia and choreiform movements. loss of neurons in the caudate nucleus and putamen is characteristic. behavioral: aggressiveness, apathy, or depression
wilson disease
autosomal recessive excessive copper deposition into tissues (eg, liver, basal ganglia, cornea). it typically presents in young adults with liver disease, neuropsychiatric symptoms (eg, gait disturbance, dysarthria, depression, personality changes), and Kayser-Fleischer rings on slit lamp examination.
alkaptonuria
autosomal recessive disorder caused by deficiency of homogentisic acid dioxygenase, an enzyme inovolved in tyrosine metabolism. excess homogentisic acid causes diffuse blue-black deposits in connective tissues. adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of the spine and large joints.
familial dysbetalipoproteinemia
autosomal recessive disorder characterized by elevated cholesterol and triglyceride levels. caused by defects in ApoE3 and ApoE4, leading to decreased clearance of chylomicrons and VLDL remnants. patients can develop eruptive and palmar xanthomas and premature aterosclerosis.
chediak-higashi
autosomal recessive disorder of neutrophil phagosome lysosome fusion that results in neurologic abnormalities, partial albinism and an immunodeficiency caused by defective neutraphil function.
niemann-pick disease
autosomal recessive disorder that is common in the Ashkenazi jewish population. characterized by shingomyelinase deficiency and sphingomyelin accumulation, which causes hepatosplenomegaly and neurologic regression in infancy.
Gaucher disease
autosomal recessive lysosomal storage disorder that is characterized by beta-glucocerebrosidase deficiency and presents with pancytopenia and hepatosplenomegaly. glucocerebroside accumulation leads to distended macrophages with 'wrinkled tissue paper' appearance.
colle's fracture complication
avascular necrosis
beers criteria
avoid in geriatric patients: anticholinergics (first gen. antihistamines) alpha blockers TCA antidepressants benzodiazepines antipsychotics most antiarrhythmics skeletal muscle relaxants
schwannomas
biphasic pattern of cellularity (antoni A & B) and S-100 positivity arise from peripheral nerves, nerve roots, and cranial nerves.
polycistronic
bacterial mRNA can be polycistronic, meaning that one mRNA codes for several proteins. example--bacterial lac operon. the transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of regulatory elements.
insulin uses
basal, long acting: glargine, detemir basal intermediate: NPH postprandial, short acting: regular: best for IV use with DKA lispro, aspart, glulisine: best for postmeal hyperglycemia
alpha 1 receptors
basoconstriction
unilateral facial paralysis, decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior two-thirds of the tongue idiopathic paresis of the facial nerve (CNVII)
bells' palsy
leukemoid reaction
benign leukocytosis (>50,000/mm3) that occurs in response to an underlying condition such as severe infection/hemorrhage, malignancy (eg, leukemia), or acute hemolysis. leukocyte alkaline phosphatase levels are normal or increased. peripheral smear can show increased bands, early mature neutrophil precursors (eg, myelocytes), and granules (eg, Dohle bodies) in the neutrophils.
strawberry hemangiomas (capillary hemangiomas)
benign vascular tumors of childhood. appear during the first weeks of life, initially grow rapidly, and typically regress by 5-8 years old. are composed of capillaries separated by connective tissue.
somatic symptom disorder
best managed with regularly scheduled medical visits that are not contingent on having active symptoms. unnecessary diagnostic testing and specialist referrals should be avoided.
isoproterenol
beta 1 and 2 receptor agonist that causes increased myocardial contractility and decreased systemic vascular resistance.
prevents interaction of epi and NE with beta 1&2 receptors
beta blockers block beta2>>bronchoconstriction
drugs that have been shown to improve long-term survival in patients with heart failure due to left ventricular systolic dysfunction include
beta blockers, ACE inhibitors, angiotensin II receptor blockers, and aldosterone antagonists.
stress axis and opioid system
beta endorphin and ACTH derived from POMC
streptococcus pyogenes
beta hemolytic, bacitracin susceptible, and pyrrolidonyl arylamidase positive
defective transcription, processing, and translation of beta globin mRNA
beta thalassemia
landmark for lumbar puncture
between highest points of iliac crests L3/L4 or L4/L5
secretory phase of menstrual cycle
between ovulation and menses progesterone secretion from corpus luteum: glands coil and secrete glycogen-rich mucus endometrial stroma becomes edematous and have tortuous spiral arteries that extend from the deep layers to uterine lumen.
intracardiac fistula
between the aortic root and right ventricle will most likely demonstrate a left-to-right cardiac shunt as blood continuously flows from the aortic root (high pressure) to the right ventricle (low pressure).
PD-1 receptor and ligand
biding of programmed death receptor (PD-1) downregulates the immune response against tumor cells by inhibiting cytotoxic T cells. many cancers evade immune system by increasing expression of PD-1. Monoclonal antibodies blocking PD-1 help prevent T cell inhibition and promote apoptosis of tumor cells.
inhibit enterohepatic circulation of bile acids and lead to increase in hepatic production of triglycerides
bile acid binding resins
thiazolidinediones (pioglitazone)
bind to peroxisome proliferator-activated receptor-gamma (PPAR-gamma), an intracellular nuclear receptor that acts as a transcriptional regulator of many genes involved in glucose and lipid metabolism. improve insulin sensitivity by increasing expression of adiponectin.
opiate analgesics reduce pain by
binding to mu receptors and inhibiting synaptic activity in the central nervous system. activation of presynaptic mu receptors on primary afferent neuron leads to closure of voltage-gated calcium channels and reduced excitatory neurotransmitter release. binding to mu receptors on the post synaptic mu receptors on the postsynaptic membrane causes opening of potassium channels, efflux, and membrane hyperpolarization.
protein A in peptidoglycan cell wall of Staph. Aureus
binds to Fc portion of IgG leading to impaired complement activation, opsonization, and phagocytosis.
protamine sulfate
binds to heparin, causing chemical inactivation. vitamin K and fresh frozen plasma can be used to reverse warfarin effects.
raw egg whites have avidin with bind to
biotin and lead to deficiency affects carboxylation reactions
ingestion of lots of egg whites, also: poor diet congenital metabolic disorder
biotin deficiency cofactor for carboxylase enzymes: pyruvate to oxaloacetate
dihydrobiopterin reductase deficiency is a cofactor for
both phenylalanine hydroxylase and tyrosine hydroxylase downstream deficiencies of dopamine, NE, epinephrine, and serotonin can lead to progressive neurologic deterioration.
highest tubular osmolarity in the nephron
bottom of the loop of henle ...at end of descending
17alpha-hydroxylase deficiency
boys are phenotypically female at birth but girls develop normal genitalia. patients exhibit hypogonadism, hypertension, and hypokalemia.
low C1 esterase inhibitor activity leads to increases in
bradykinin activity ...and angioedema avoid ACE inhibitors
middle meningeal artery
branch of maxillary artery, which enters the skull at the foramen spinosum and courses intracranially deep to the pterion (where the frontal, parietal, temporal, and sphenoid bones meet). skull fractures at this site may cause laceration of this vessel, leading to an epidural hematoma.
maple syrup urine disease
branched chain alpha ketoacid dehydrogenase requires several coenzymes: thiamine, lipoate, coenzyme A, FAD, NAD (mnemonic: tender loving care for nancy). some patients with maple syrup urine disease improve with high dose thiamine treatment, but most require lifelong restriction of leucine, isoleucine, and valine.
DDX for psychotic disorders
brief psychotic disorder: less than 1 mo schizophreniform: 1-6 mos schizophrenia: more than 6 mos schizoaffective: mood symptoms and psychosis-not at same time delusional disorder: more than 1 mo, 1 or more delusions, no other symptoms
broad spectrum vs narrow spectrum anticonvulsants
broad= lamotrigine, levetiracetam, topiramate, valproic acid used for most seizure types narrow=carbamzapine, gabapentin, phenobarital, phenytoin used for focal onset seizures (can also be used for focal that has progressed to general)
beta adrenergic agonists control acute asthma and COPD exacerbations by causing
bronchial smooth muscle relaxation via increased intracellular cAMP
methacholine
bronchoprovocation that is administered to diagnose asthma. shows hyperresponsivity to the stimulus, leading to FEV1 reductions at lower doses than in those without asthma.
uniform, round, medium-sized tumor cells with basophilic cytoplasm and aproliferation fraction (di-67 fraction) approaching 100%
burkitts lymphoma associated with EBV
cross linking of multiple membrane-bound IgE antibodies
by a multivalent antigen results in aggregation of the FceRI receptors, causing degranulation and the release of preformed mediators (histamine and tryptase) that initiate an allergic response.
lac operon regulated
by two mechanisms: negatively by binding of the repressor protein to the operator locus and positively by the cAMP-CAP upstream from the promoter region. constitutive expression of the structural genes of the lac operon occurs with mutations that impair the binding of the repressor protein (lac I) to its regulatory sequence in the operator region.
small, red, cutaneous papules common in aging adults
cherry hemangiomas
monphosphorylation of acyclovir
by viral thymidine kinase is the first and rate limiting step in conversion of acyclovir to its active triphosphate form. acyclovir and related drugs (famciclovir, valaciclovir) are more effective agains herpes simplex virus and VZV than CMV and EBV.
tube traverses through the serratus anterior muscle, intercostal muscles, and parietal pleura
chest tube for drainage of pleural effusion midaxillary line at 4/5th intercostal space
calcium dependent adhesion molecules that bind epithelial cells together within tissues
cadherins form adherens junctions and desmosomes remove calcium from extracellular fluid= dissociation and loss of cell-cell adhesion
accumulation effect
can be applied to disease pathogenesis and exposure to risk modifiers. cumulative exposure to risk factor or risk reducer must sometimes occur for prolonged periods before a clinically significant effect is detected.
pyridoxine (B6) deficiency
can be caused with isoniazid--which is structurally similar. this antibiotic increases urinary excretion of pyridoxine causing a deficiency and competes for B6 binding sites leading to defective synthesis of neurotransmitters like GABA. isoniazid induced neuropathy can be prevented with B6 supplementation.
arteriovenous 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 from the arterial system to the venous system, bypassing the arterioles. high volume AV shunts can eventually result in high-output cardiac failure.
isoniazid
can be directly heptotoxic causing acute, mild hepatic dysfunction and frank hepatitis- fever, anorexia, and nausea, sometimes progressing to hepatic failure
glomerular filtration rate
can be estimated by the inulin or creatinine clearance,while the renal plasmaflow is calculated using the para-aminohippuricacid clearance. the filtration fraction (FF=GFR/RPF) is the fraction of the RPF that is filtered across the glomerular capillaries into Bowman's space. it is usually equal to 20% in healthy individuals. C(creatnine or PAH)=amount in urine TIMES flow rate DIVIDED by amount in serum
supplementation with thymidine
can bypass DHF reductase and reduce erythroid cell apoptosis due to folate deficiency
obesity, central obesity
can cause a pattern of extrinsic restrictive pulmonary function tests. the most common indicator of obesity-related disease is a reduction in expiratory reserve volume and functional residual capacity, but forced expiratory volume in 1 second, forced vital capacity, and total lung capacity are also decreased.
crohn disease with ileal resection
can cause bile acid malabsorption, which may lead to impaired absorption of fat-soluble vitamins (A,D,E,K). vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (hemarthrosis) after minor trauma, and prolonged bleeding after surgery.
opiod analgesics
can cause contraction of smooth muscles in the sphincter of Oddi, leading to increased pressures in the common bile duct and the gall bladder. patients who develop biliary colic due to this, must discontinue mu opioid analgesics and pain control with alternative agents suchs as NSAIDs.
Neiserria meningitidis
can cause sepsis and circulatory collapse in previously healthy young individuals. lipooligosaccharide, a virulence factor in pathogens outer membrane, is the major underlying cause of disease severity
first generation antihistamines
can cause significant side effects due to blockade of cholinergic, alpha adrenergic, and serotonergic pathways. they should be avoided in older patients with cognitive or functional impairments.
RBC loose mitochondria
can do first and final 3 steps of heme synthesis
antidepressant monotherapy
can induce mania in susceptible patients, especially those with unrecognized bipolar disorder.
supplemental oxygen administration in COPD
can lead to increased CO2 retention (oxygen-induced hypercapnia), resulting in confusion and depressed consciousness. the major cause of reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli.
vitamin E deficiency
can occur in individuals with fat malabsorption. deficiency of fat soluble vitamin is associated with increased susceptibility of the neuronal and erythrocyte membranes to oxidative stress. clinical manifestations include ataxia, impaired proprioception and vibratory sensation, and hemolytic anemia.
ventilation perfusion
lowest at the base and highest at the apex
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 toxicity can be achieved by 3 different strategies: direct binding of cyanide ions (hydroxyocobalamin), induction of methemoglobinemia (sodium nitrite), and use of detoxyfying sulfur donors (sodium thiosulfate).
postpartum hemorrage
can result from abnormal placentation. prior uterine surgery can impair decidualization, resulting in myometrial invasion by villous tissue and a placenta that is abnormally adherent to the myometrium (placenta accreta).
tertiary syphilis
can result in aortic aneurysm. the the aneurysm compresses adjacent structures and dilates the aortic valve ring, a murmur and mediastinal widening might be present. pathogenesis begins with vasa vasorum endarteritis and obliteration, resulting in inflammation, ischemia, and weakening of the aortic adventitia. fluorescent treponemal antibody absorption testing is specific for syphilis.
vitamin A overuse
can result in intracranial hypertensioin, skin changes, papilledema, skin changes and hepatosplenomegaly. toxicity occur after ingestion of a single high dose: nausea, vomiting, vertigo, and blurred vision.
vascular catheters, skin & soft tissue infections
candida pesudohyphae with blastoconida
inhibit fungal cell wall
capsofungin
drop in pulse amplitude during inspiration >10mmhg
cardiac tamponade
beta 1 adrenergic receptors found in
cardiac tissue and renal tissue but not vascular smooth muscle
prevent beta-oxidation of FA into acetyl CoA
carnitine deficiency impaired ketone body production by liver during fasting periods
most highly oxygenated blood in the fetus is
carried by the umbilical vein, which empties directly into the IFC via the ductus venosus. the umbilical arteries orginate from the fetal internal iliac arteries and carry deoxygenated blood back to the placenta via the umbilical cord.
odds ratio
case-control study is used to compare the exposure status of people with the disease to the exposure status of people without the disease. main measure of association is the odds ratio.
ethylene glycol ingestion
cause acute tubular necrosis with vacuolar degeneration and ballooning of the proximal tubular cells. findings- altered mentation, renal failure, high anion gap metabolic acidosis, increased osmolar gap, and calcium oxalate crystals in the urine.
mutations resulting in 2,3-BPG binding pocket's positive charge
cause hemoglobin A to resemble fetal hemoglobin, which binds oxygen with a higher affinity due to its inability to interact with 2,3-BPG.
genetic reassortment
cause influenza epidemics and pandemics. code for hemagglutinin or neuraminidase proteins (major antigenic shifts). this process can occur between human and animal strains of influenza A virus in avian or swine hosts.
repetitive pronation/supination of forearm (screwing things)
cause injury to radial nerve at passage through the supinator canal also due to: trauma, subluxation of the radius. cause: weakness during finger and thumb extension without wrist drop or sensory deficits
orthostatic hypotension
cause lightheadedness and syncope. decrease in systolic >20 mm Hg or diastolic >10 mm Hg blood pressure on standing from the supine position. medications alpha-adrenergic antagonists, diuretics, volume depletion, and autonomic dysfunction are common causes of orthostatic hypotension.
prolonged seizure, crush injuries, or drugs (statins)
cause myocyte injury rhabdomyolysis>>myoglobinuria>>renal failure
enterococcus
cause of UTIs. gram positive cocci in pairs and chains and when grown on blood agar, they do not consume hemolysis (gamma hemolytic)
anabolic steroid misuse
cause of acne, especially in competitive athletes. androgens stimulate follicular epidermal hyperproliferation and excessive sebum production.
thiazide and loop diuretics
cause significant volume depletion, activating the RAAS system, leading to hypokalemia and metabolic alkalosis. thiazide diuretics are more likely to cause hyponatremia and hypercalcemia; loop diuretics cause hypocalcemia.
facet joint osteophytes and hypertrophy of ligamentum flavum
cause: posture dependent lower extremity pain, numbness/paresthesia, and weakness
genomic imprinting
caused by DNA methylation, an epigenetic process in which genes can be silenced by attaching methyl groups to cytosine residues in the DNA molecule.
infectious mononucleosis
caused by EBV positive heterophile antibody fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, atypical lymphocytosis increased incidence of Burkitt lymphoma and nasopharyngeal carcinoma
spontaneous deep intracerebral hemorrhage
caused by HTN vasculopathy involving pentrating branches of major cerebral arteries. usual locations--basal ganglia, cerebellar nuceli, thalamus, and pons. basal ganglia are supplied by lenticulostriate arteries, branches of MCA.
hypercalcemia in sarcoidosis
caused by PTH-independent formation of 1,25-dihydroxyvitamin D by activated macrophages. leads to increased intestinal absorption of calcium.
factor V leiden mutation
causes factor Va resistance to inactivation by activated protein C, may account for approximately 20% of cases of atypical venous thrombosis.
communicating hydroceles and indirect inguinal hernias
caused by an incomplete obliteration of the processus vaginalis. the connection between scrotum and abdominal cavity can allow for fluid leakage (hydrocele) or the passage of abdominal contents (indirect inguinal hernia)
Myasthenia gravis
caused by circulating antibodies directed against acetylcholine receptors of the neuromuscular junction. autoantibody binding leads to receptor degradation, producing fluctuating weakness that worsens over the course of the day and most commonly affects the extraocular muscles (eg, ptosis, diplopia). most patients also have thymic abnormalities (eg, thymoma).
neuropathy due to DM
caused by diabetic microangiopathy which leads to nerve ischemia. another pathogenetic factor is the accumulation of sorbitol, which leads to osmotic nerve injury. the symmetric peripheral neuropathy is common. also due to non-enzymatic glycosylation of proteins-leading to increased thickness, hyalinization, and narrowing of the walls of the arteries. ischemic nerve damage.
congenital QT syndrome
caused by genetic mutations in potassium channel protein that contribute to outward rectifying potassium current. decrease in the outward potassium current leads to prolongation of action potential duration and QT interval. this predisposes to development of life-threatening ventricular arrhythmias (torsades de pointes) that can cause palpitations, syncope, seizures, or sudden cardiac death
deep intraparenchymal hemorrhage
caused by hypertensive vasculopathy of small penetrating branches of the cerebral arteries (charcot bouchard aneurysm rupture) vs. saccular aneurysms- cause subarachnoid hemorrhage
hartnup disease
caused by impaired transport of neutral amino acids in the small intestine and proximal tubule of the kidney. symptoms include pellagra-like skin eruptions and cerebellar ataxia, due to niacin deficiency. the diagnosis can be confirmed through detection of excessive amounts of neutral amino acids in the urine.
hepatic encephalopathy
caused by increased levels of ammonia and other neurotoxins in the circulation that lead to increased inhibitory neurotransmission and impaired excitatory neurotransmitter release. hepatic encephalopathy is frequently precipitated by a stressor (eg, gasterintestinal bleeding, infection) that increases blood ammonia levels. 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.
fragile X
caused by increased number of CGG trinucleotide repeats on the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. this leads to hypermethylation and inactivation of FMR1.
ARDS
caused by injury of pulmonary epithelium and/or endothelium, and occurs most often due to sepsis or pneumonia. cytokines recruit neutrophils to the lung tissue, cause capillary damage and leakage of protein rich fluid into the alveoli.
epistaxis
caused by irritation of the highly vascular mucosa at the anterior nasal septum. the anterior nasal septum contains the kiesselback plexus. the anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region.
hereditary hemochromatosis
caused by missense mutation in HFE gene, resulting in excessive intestinal iron absorption and organ damage (cirrhosis, DM, cardiomyopathy, arthropathy) due to iron accumulation within parenchymal tissues.
erythema infectiosum (5th disease)
caused by parvovirus B19 nonspecific prodrome: malaise, fever, congestion. followed by 'slapped cheek' facial rash and lacy, reticular body rash. parvovirus is highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow.
traumatic aortic rupture
caused by rapid deceleration that occurs in 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.
achalasia
caused by reduced numbers of inhibitory ganglion cells in the esophageal wall. esophageal manometry in achalsia shows decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relation at the lower esophageal sphincter.
gram negative sepsis
caused by release of LPS from bacterial cells during division or by bacteriolysis; LPS is not actively secreted by bacteria. lipid A is the toxic component of LPS; it causes activation of macrophages leading to widespread release of IL1 and TNF alpha which cause the signs and symptoms of septic shock: fever, hypotension, diarrhea, oliguria, vascular compromise, and DIC.
acute allergic contact dermatitis
caused by type IV hypersensitivity reaction to antigen on skin surface. erythematous, papulovesicular, weeping lesions spongiosis- accum. of edema fluid in the intercellular spaces of epidermis. with chronic exposure, lesions become less edematous, with thickening of the stratum spinosum and stratum corneum.
abusive head trauma
caused by vigorous shaking of an infant and results in--subdural hemorrhage (due to tearing of bridging veins) and retinal hemorrhages. red flags= injuries inconsistent with history or developmental age.
retinopathy of prematurity
caused oxygen therapy due to retinal particularization
MI
causes a sharp decrease in cardiac output due to loss of function of a zone of myocardium. on cardiac function curve, myocardial infarction would decrease both the slope and the maximal height of the line.
thiamine deficiency
causes beriberi and wernicke korsakoff syndrome dry berberi is characterized by symmetrical peripheral neuropathy; wet beriberi includes the addition of high output congestive heart failure.
defect in HGPRT leading to purine salvage pathway failure
causes degradation of hypoxanthine and guanine to uric acid Lesch-Nyhan syndrome must increase: de novo purine synthesis ...replace lost bases: increase in PRPP
methemoglobinemia
causes dusky discoloration of the skin (similar to cyanosis), and because methemoglobin is unable to carry oxygen, a state of functional anemia is induced. however, the blood partial pressure of oxygen will be unchanged as it is a measure of oxygen dissolved in plasma and is unrelated to hemoglobin functon.
primary and secondary TB
causes formation of Ghon foci in the lower lungs. secondary (reactivation) TB occurs in patients with prior TB infection that never cleared completely. reactivation occurs often in immunosuppressed patients and is characterized by apical cavitary lesions and hemoptysis.
androgenetic alopecia
causes hair loss primarily at the anterior scalp and vertex. it shows polygenic inheritance, with dihydrotestosterone (DHT) being the primary pathogenic factor. 5-alpha-reductase inhibitors decrease the conversion of testosterone to DHT and are effective for treating the condition.
prolonged exposure to loud noises
causes hearing loss due to damage to the stereociliated hair cells of the organ of Corti.
G6PD deficiency
causes hemolytic anemia and jaundice secondary to increased oxidative stress due to the lack of NADPH. glutathione reductase deficiency has a similar clinical consequence as its absence results in an inability to utilize NADPH to reduce glutathione.
Hep B
causes heptaocellular cytoplasm to fill with Hep B surface antigen. these inclusions are highly specific for hep B infection and have a finely granular, pale eosinophilic, ground glass appearance.
impaired beta-oxidation of fatty acids
causes hypoglycemia after prolonged fasting and insufficient levels of ketone bodies. acyl-CoA dehydrogenase catalyzes the first step in the beta-oxidation pathway and is the most commonly deficient enzyme. adults start ketone use after 1-2 days. children use as early as 8-10 hours.
aortic regurge
causes increase in total stroke volume and abrupt distension and rapid falloff of the peripheral arterial pulses, resulting in a wide pulse pressure. leads to bounding peripheral pulses and head bobbing with each heartbeat.
C1 inhibitor deficiency
causes increased cleavage of C2 and C4 and results in inappropriate activation of the complement cascade. C1NH also blocks kallikrenin-induced conversion of kininogen to bradykinin, a potent vasodilator associated with angioedema.
maternal hyperglycemia
causes increased transplacental glucose delivery to the infant, fetal hyperglycemia, and ultimately beta cell hyperplasia. resulting hyperinsulinemia caused by islet cell hyperplesia is associated with fetal macrosomnia and hypoglycemia after delivery.
giardia lamblia
causes injury to the duodenal and jejunal mucosa by adhering to the intestinal brush border and releasing molecules that induce a mucosal inflammatory response. secretory IgA, which impairs adherence, is the major component of adaptive immunity against G lamblia infection. conditions causing IgA deficiency predispose patients to chronic giardiasis.
oculomotor nerve compression by aneurysm
causes mydriasis, diplopia, ptosis, and 'down and 'out deviation of the ipsilateral eye
hypoventilation
causes of respiratory acidosis--heroin overdose
portal vein thrombosis
causes portal hypertension, splenomegaly, and varicosities at portocaval anastomoses. does not cause histologic changes to the hepatic parenchyma. ascites is uncommon as the obstruction is presinusoidal.
long-term use of supraphysiologic doses of glucocorticoids
causes suppression of the hypothalamic-pituitary-adrenal axis, which in turn leads to bilateral adrenocortical atrophy involving the zona fasciculata and reticularies. sudden cessation of the exogenous corticosteroids can precipitate adrenal crisis.
polymyositis
causes symmetric proximal muscle weakness. muscle biopsy reveals inflammation, necrosis, and regeneration of muscle fibers. over-expression of major histocompatibility complex class I proteins on the sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte damage.
trauma/sustained pressure to the neck of the fibula can injure the common peroneal nerve
causing weakness on foot dorsiflexion and eversion and impaired sensation over the lateral shin and dorsal foot, and between the first and second toes.
selective COX 2 inhibitor use with patients who have gastric peptic ulcer disease
celecoxib
Il-1 and TNF-alpha induce COX2 during inflammation---inhibited by
celecoxib if patient has history of peptic ulcer disease
give off branches to pancreas and stomach: pancreatic short gastric left gastroepiploic
celiac artery (splenic)
duodenal biopsy is confirmatory for
celiac sprue vs. ileum biopsy for crohns
IL6 and giant cell arteritis
cell mediated immunity is the primary mechanism underlying GCA. production of cytokines, IL6 in particular, is an important driver of this process and closely correlates with the severity of symptoms.
erythema multiforme
cell mediated inflammatory disorder of the skin characterized by erythematous papules that evolve into target lesions. it is most commonly associated with herpes simplex virus.
inhibition of transpeptidase with cephalosporin ceftriaxone leads to
cell wall instability and bacteriolysis. 5 such protein binding sites produced by strep pneumo
initial treatment for pseudomonas aeruginosa
cephlasporins- cefepime and ceftazidime
in tumor cells, ATP powered eflux pump protein actively removes
chemotherapeutic agents. P glycoprotein encoded by multidrug resistance (MDR1) reduce this: verapamil, diltiazem, ketoconazole
Friedreich ataxia
cerebellar ataxia (spinocerebellar tract degeneration) and loss of position/vibration sensation (dorsal column/dorsal root ganglia degeneration), kyphoscoliosis, and hypertrophic cardiomyopathy. foot abnormalities and diabetes mellitus are also common.
most common cause of spontaneous lobar hemorrhage, particularly in elderly
cerebral amyloid angiopathy occipital and parietal lobes
midline spisiotomy
certical incision from the posterior vaginal opening to the perineal body. transects the vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa.
early syphillis
chancre often have false-negative initial serologic testing. direct visualization of the organism (Treponema pallidum) by dark-field microscopy or fluorescent antibody testing is the gold standard for diagnosis but is not widely available.
bacterial mechanism of resistance to cephalosporins
change in structure of penicillin-binding proteins that prevent cephalosporin binding
viral mutations
changes in host range are most commonly caused by mutations in the viral encoded surface glycoprotein that mediates virion attachment to target host cell plasmalemma receptors. mutations in viral encoded capsid proteins, RNA polymerases, endonucleases, or proteases could nonspecifically affect viral replication in the standard host cell but would be less likely to significantly alter the range of host cell types that an enveloped RNA virus could successfully infect.
Axonal reaction
changes in the body of a neuron after the axon has been severed. this process reflects an increased protein synthesis that facilitates axon repair. enlarged, rounded cells with peripherally located nuclei and dispersed finely granular Nissl substance are seen. wallerian degeneration occurs in the segment of axon that has lost connection with the cell body.
symmetrical enlargement of the ventriculi
characteristic of communicating hydrocephalus. communicating hydrocephalus usually occurs secondary to dysfunction or obliteration of subarachnoid villi. this dysfunction is usually a sequelae of meningeal infection (including tuberculosis meningitis) or subarachnoid/interventricular hemorrhage.
pancreatic islet amyloid deposition
characteristic of type 2 diabetes mellitus. a strong linkage with HLA class II gene makeup, pancreatic islet infiltration with leukocytes (insulitis), and antibiotics against islet antigens are frequently seen in type 1 diabetes.
cirrhosis
characterized by diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous-lined parenchymal nodules. chronic viral hepatitis (hep C and B), alcohol, hemochromatosis, and nonalcoholic fatty liver disease are the most common causes of cirrhosis in the US.
acute respiratory distress syndrome (ARDS)
characterized by hypoxia and bilateral pulmonary infiltrates and is assoicated with pneumonia, sepsis, trauma, and pancreatitis. the associated pulmonary edema is noncardiogenic in nature, so the pulmonary capillary wedge pressure will be within the normal range (6-12 mm Hg).
sarcoidosis
characterized by noncaseating granulomas due to dysregulated cell-mediated immunity. activated antigen-presenting cells produce IL-12 which stimulates the differentiation of Th1-type CD4+ cells. Th1 cells produce IL-2 and interferon-gamma, which stimulate Th1 cell proliferation and macrophage activation, respectively.
synovitis
characterized by pain, erythema, swelling, and reduced range of motion in a joint. acute synovitis may represent serious pathology (septic arthritis), especially if accompanied by fever or leukocytosis; it should be evaluated urgently with synovial fluid analysis.
pituitary apoplexy
characterized by severe headaches, bitemporal hemianopsia (compression of the optic chiasm), and ophthalmoplegia (compression of the oculomotor nerve). it usually occurs in a preexisting pituitary adenoma. it is a medical emergency that requires urgent treatment with glucocorticoids to prevent acute adrenal crisis and circulatory collapse.
polymyositis
characterized by symmetric proximal muscle weakness. it is associated with antinuclear and anti-jo-1 autoantibodies. biopsy shows an endomysial mononuclear inflammatory infiltrate and patchy muscle fiber necrosis. polymyositis is similar to dermatomyositis but lacks the characteristic skin findings.
MEN 2B
charaterized by medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and marfanoid habitus. hyperparathyroidism is not a feature.
hypertensive vasculopathy of small penetrating branches of the cerebral arteries
charcot bouchard aneurysm rupture vs. saccular aneurysm=cause subarahnoid hemorrhage
IL8
chemikine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils. other significant chemotatic agents include n-formylated peptides, leukotriene B4, 5HETE (leukotriene precursor), and complement component C5a.
located in the area postrema of the dorsal medulla near the fourth ventricle
chemoreceptor trigger zone cause acute nausea due to chemo treatment
lymphogranuloma venereum
chlamydia trachomatis serotypes L1-L3 initial painless ulcers with later progression to painful inguinal lymphadenopathy 'buboes' and ulceration (vs. T pallidum=no buboes). chlamydial inclusion bodies are seen in host cell cytoplasm.
squamous cell debris that form a mass behind tympanic membrane
cholesteatoma
collections of squamous cell debris
cholesteatomas primary- negative pressure cause retractions secondary-infection, trauma, or surgery
inhibits enterohepatic circulation of bile acids leads to hypertriglyceridemia
cholestyramine
bile acid binding resins
cholestyramine colestipol colesevelam can increase triglyceride levels
anaplastic cytotrophoblasts and syncytiotrophoblasts without villi
choriocarcinoma dyspnea/hemoptysis due to pulmonary metastasis from hematogenous spread
axillary lymph node dissection is a risk factor for development of
chronic lymphadema involving the ipsilateral arm. chronic lymphedema predisposes to the development of angiosarcoma (stewart-treves syndrome).
atherosclerosis of mesenteric arteries
chronic mesenteric ischemia causes postprandial epigastric pain (intestinal angina) with food aversion/weight loss. similar to angina pectoris. increased demand for oxygen.
takayasu arteritis
chronic, large-artery vasculitis that primarily involves the aorta and its branches. it presents with constitutional (eg, fever, weight loss) and arterio-occlusive (eg, claudication, blood pressure discrepancies, pulse deficits) findings in patients age <40. histopathology shows-granulomatous inflammation of vascular media.
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 of dermatitis.
PAD symptomatic management inhibits platelet aggregation direct arterial vasodilator
cilostazol
antiarrhythmic that prolongs QRS duration with little effect on QT interval
class 1C agents flecainide block fast sodium channels responsible for ventricular depolarization (phase 0)
HLA class I vs class II
class I: B27 present on all nucleated cells and present to CD8 class II: DR, DP, DQ APC on macrophages, dendritic cells and present to CD4
autosomal recessive disorder severe disorder present within days of birth: jaundice, vomiting, and hepatomegaly
classic galactosemia
GALT deficiency galactose-1-phosphate accumulation E Coli sepsis
classic galactosemia liver toxicity and renal impairment due to galactose-1-phosphate accumulation
proinsulin
cleaved in pancreatic beta cells in secretory granules yeilds insulin and C peptide stored in granules until they are secreted in equimolar amounts.
PCOS patient desires pregnancy treated with
clomiphene estrogen receptor modulator that decreases negative feedback inhibition on they hypothalamus by circulating estrogen, thereby increasing gonadotropin production. anti-androgen meds for hhirsutism and acne not fertility.
PCWP
closely reflects LA and LVEDP. mitral stenosis leads to an increase in the LA pressure that is reflected as elevated PCWP during pulmonary artery catheterization. left ventricular filling may be normal, resulting in an increased pressure gradient between the LA and LV diastole.
PDA
clubbing and cyanosis without pressure or pulse discrepancy. complicated by eisenmenger syndrome severe coarctation of the aorta can cause lower extremity cyanosis. right to left shunting in patients with large septal defects and tetralogy of fallot results in whole body cyanosis
cavernous hemangiomas
clusters of dilated, thin-walled capillaries with little or no intervening nervous tissue. increased risk of seizures and may develop progressive neurologic deficits. these have tendency to bleed, further contributing to neurologic symptoms. appears as irregular hyperdense/bright mass on head CT.
SRY gene on Y chromosome
codes for testes-determining factor: differentiates the primitive gonads into testes. Sertoli cells produce anti-Mullerian hormone, which causes regression of the Mullerian ducts and suppresses female internal reproductive organ development. Leydig cells produce testosterone: differentiating wolffian ducts into internal male reproductive organs. Dihydrotestosterone is required for differentiation of the external male genitalia.
Biotin (Vitamin B7)
cofactor for all 4 carboxylase enzymes: pyruvate carboxylase, acetyl-CoA carboxylase, propionyl-CoA carboxylase, and 3-methylcrotonyl-CoA-carboxylase.
destruction of alveoli and adjoining capillary beds leading to decreased DLCO
early onset emphysema due to alpha-1-antitrypsin deficiency
ascorbic acid (vitamin C)
cofactor in hydroxylation of proline and lysine residues and is important in the synthesis of collagen. deficiency (scurvy) is characterized by microvascular bleeding, gingivitis, and impaired wound healing.
tetrahydrobiopterin BH4
cofactor used by hydroxylase enzymes in synthesis of tyrosine, dopamine, and serotonin. Phenylketonuria-result from BH4 deficiency intellectual disability, neurotransmitter deficiency (serotonin) hyperphenylalanemia treatment with low phenylalanine diet and BH4 supplementation.
Down syndrome
cognitive impairment, facail dysmorphism, and cardiac defects. 95% due to extra chromosome 21 due to nondisjunction. unbalanced robertsonian translocations or mosaicism are less common causes.
phenotypic mixing
coinfection of host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the unchanged parental genome of the other strain. no change in underlying viral genomes and so the next generation of virions revert to their original, unmixed phenotypes.
inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization
colchicine side effects: nausea and diarrhea
uric acid precipitates in low pH in the nephron at
collecting ducts (tumor lysis syndrome)
cholesteatoma
collection of skin cells and cholesterol in a sac within the middle ear
postoperative hypoparathyroidism
common after thyroidectomy. surgical removal of or damage to the parathyroid glands results in a drop in parathyroid hormone levels, resulting in decreased calcium and phosphate resorption from bone and decreased calcium reabsorption by the kidneys.
folic acid deficiency anemia
common among alcoholism. megaloblastic anemia that can develop within weeks. peripheral blood smear shows macrocytosis, ovalocytosis, and neutrophils with hypersegmented nuclei.
hemosiderosis (iron overload)
common and serious complication of chronic hemolytic anemia and frequent blood transfusions. hemosiderin accumulation is the cardinal histologic finding. chelation therapy is indicated to reduce parenchymal iron deposition.
hemolytic uremic syndrome
common cause of acute renal failure in children. characterized by triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. most cases develop following a diarrheal illness caused by shiga toxin-producing organisms (E. coli and shigella).
bacterial antibiotic efflux pumps
common cause of drug/multidrug reisistance actively transport antibiotics out of the bacteria into the external environment using ATP, Na+ grandient, or proton electrochemical gradients for energy
Campylobacter jejuni
common cause of gastroenteritis and is typically acquired from contaminated food (eg, undercooked poultry) or domesticated animals (eg, household dogs). manifestations usually include fever, cramping abdominal pain, and watery diarrhea that may be bloody. stool studies typically show blood and leukocytes. associated with guillain-barre syndrome.
diabetic autonomic neuropathy
common in type 1 diabetics and can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. postvoid residual testing with ultrasound or catheterization can confirm inadequate bladder emptying.
injury at the neck of the fibular can cause injury to
common peroneal nerve weakness on foot dorsiflexion and eversion and impaired sensation over the lateral shin and dorsal foot, and between the first and second toes.
aminoglycoside resistance
commonly due to antibiotic modifying enzymes. these add chemical groups (acetyl, adenyl, phosphate) to the antibiotic, which diminishes its ability to bind to the 16S ribosomal RNA within the 30S ribosomal subunit.
DIC in pregnancy
commonly due to release of tissue factor (thromboplastin) from an injured placenta into maternal circulation. DIC presents with bleeding from incision sites, IV lines, and mucosal surfaces due to rapid consumption of clotting factors and platelets.
COPD exacerbation
commonly due to viral infection: rhinovirus, influenza virus or less commonly due to bacterial infections: H influenzae, moraxella catarrhalis, and strep pneumo
acute bacterial parotitis
commonly in elderly postoperative patients who are intubated and dehydrated. S aureus is the most common. diagnosis can be confirmed by imaging and elevated serum amylase level with a normal serum lipase level and no evidence of pancreatitis.
spinal stenosis
commonly in the lumbar region and presents with posture-dependent lower extremity pain, numbness/paresthesia, and weakness. the most common cause is degenerative arthritis of the spine, which results in narrowing of the spinal canal due to the intervertebral disc herniation, ligmamentum flavum hypertrophy, and osteophyte formation affecting the facet joints.
acoustic schwannomas
commonly located in cerebellopontine angle and arise from cranial nerve VIII. patients have ipsilateral sensorineural hearing loss/tinnitus and vertigo VIII, loss of facial sensation V and facial paresis VII. bilateral acoustic neuromas are associated with NF2.
dilation of the left ventricular cavity
commonly occurs in response to systolic dysfunction (ischemic heart disease, dilated cardiomyopathy) or certain types of valvular disease (aortic regurge, mitral regurge). chronic volume overload causes progressive eccentric hypertrophy that eventually leads to reduced ventricular contractility and decompensated heart failure.
heparin
commonly used for prevention of deep venous thrombosis in nonambulatory patients or those undergoing elective surgery, especially hip and knee surgery. heparin increases the effect of the naturally occurring anticoagulant antithrombin III.
coronary sinus
communicates freely with the right atrium and will become dilated secondary to any factor that causes increased right atrial pressure. the most common cause is pulmonary hypertension, leading to elevated right heart pressures.
incomplete obliteration of the processus vaginalis can lead to
communicating hydroceles and indirect inguinal hernias open space allows fluid/abdominal contents to come down into scrotum
analysis of variance
compares the difference between the means of 2 or more groups. t-test is used to compare the difference between the means of 2 groups. results from a t-test and ANOVA test will be equivalent when comparing the difference between the means of 2 groups.
neck of the antibody is site of attachment for
complement tail= phagocytic cells ears=antigens
empty ovum is fertilized by a haploid sperm
complete mole 23X>>duplication= 46, XX
brown pigment stones
composed of calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract. Beta-glucuronidase released by the injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. the liver fluke clonorchis sinensis has a high prevalence in East Asian countries and is a common cause of pigment stones.
complete hydatidiform mole
composed of cystic edematous hydropic villi as a result of trophoblast proliferation. serial measurements of beta-hCG should be performed following evacuation of a hydatidiform mole. persistently elevated or rising levels may signify the development of an invasive mole or choriocarcinoma.
elevated cholesterol
concentrations increase the likelihood of cholesterol precipitation and gallstone formation. high levels of bile salts and phosphatidylcholine increase cholesterol solubility and decrease the risk of gallstones.
fluid concentrations along proximal tubule
concentrations of PAH, creatinine, inulin, and urea increase as fluid runs along the proximal tubule, while the concentrations of bicarbonate, glucose, and amino acids decrease.
hearing loss
conductive: bone conduction greater than air conduction sensorineural: air conduction greater than bone
carcinoid tumors
confined to intestine do not cause carcinoid syndrome as their secretory products are metabolized by the liver before entering the systemic circulation. vs. intestinal carcinoid that metastasize to the liver and extraintestinal (eg, bronchial) carcinoids release vasoactive substances that avoid first-pass metabolism, resulting in carcinoid syndrome (eg, flushing, diarrhea, bronchospasm).
decrease in outward K+ current leads to prolongation of AP duration and QT interval
congenital QT syndrome can cause: ventricular arrhythmia, torsades de pointes, death!
bronchopulmonary sequestration
congenital malformation characterized by extra, nonfunctional lung tissue without communication to the tracheobronchial tree. recurrent pneumonia in the same site.
prion protein accumulation
considered a cause of prion diseases microscopic findings: vacuoles in the gray matter (spongiform encephalopathy) with no inflammatory changes. creutzfeldt-jakob disease
rabies vaccines
consist of various rhabdovirus strains grown tissue cell culture and then inactivated.
crescent formation
consists of glomerular parietal cells, lymphocytes, and macrophages along with abundant fibrin deposition. crescents eventually become fibrotic, disrupting glomerular function and causing irreversible renal injury.
reye syndrome
consists of hepatic failure and encephalopathy. the characteristic histological finding is microvesicular steatosis of hepatocytes without inflammation and cerebral edema.
wiskott-aldrich syndrome
consists of the triad: eczema, thrombocytopenia and combined B and T lymphocyte deficiency. onset of disease is early in life with thrombocytopenia present at birth and eczema and repeated infections, particularly by encapsulated organisms, following at 6 to 12 months of age.
side effects of opioids that do not subside with tolerance
constipation and miosis
mutation in janus kinase (JAK2), a cytoplasmic tyrosine kinase
constitutive tyrosine kinase activity, and consequently, in the cytokine-independent activation of signal transducers and activators of transcription (STAT) proteins (JAK-STAT signaling pathway).
translocation causes BCR gene on chromosome 22 to fuse with ABL gene on chromosome 9
constitutively active tyrosine kinase accelerate cell division and increase genetic instability.
integral membrane proteins
contain transmembrane domains composed of alpha helices with hydrophobic amino acid residues (alanine, valin, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine). these transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane.
marijuana
contains tetrahydrocannabinol, which stimulates cannabinoid receptors to produce a mild euphoria with inappropriate laughter, increased appetite, slowed reaction time/motor speed, and cognitive impairment. Tachycardia and conjunctival injection (red eyes) are the 2 most immediate physical symptoms of marijuana use.
PDA
continuous murmur with maximal intensity at S2. small PDA is often asymptomatic and usually detected incidentally during routine cardiac auscultation. common in premature and cyanotic congenital disease.
DM2 and elevated FFA
contribute to insulin resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis.
pyruvate dehydrogenase
converts pyruvate to acetyl-CoA, which is subsequently metabolized by oxidative phosphorylation. however, if inadequate oxygen is present in the tissues, pyruvate is converted to lactate by lactate dehydrogenase, leading to lactic acidosis.
hexokinase
converts some of the dietary fructose load to fructose-6-phosphate, which can then enter glycolysis; this pathway is not significant in normal individuals. useful in patients with essential fructosuria caused by fructokinase deficiency.
primary virulence factor of M tuberculosis and prevents macrophages from being bactericidal due to inhibition of phagolysosome acidification>>>caseating granulomas
cord factor: long, serpentine cords surface glycolipid on the cell wall
costosternal syndrome
costochondritis due to repetitive activity causes pain that is reproducible with palpation and worse with movement/position changes
repetitive activity leading to pain that is reproducible with palpation and worse with movement/position changes
costosternal syndrome (costochondritis)
phrenic nerve roots
course through he interscalene sheath. can be involved during shoulder surgery involving anesthesia to the brachial plexus
third part of the duodenum
courses horizontally across the abdominal aorta and inferior vena cava at the level of the third lumbar vertebra. the superior mesenteric vessels lie anterior to the duodenum at this location.
noncaseating granulomas in IBD is a hallmark of
crohn disease
attacks are due to accumulation of aminolevulinate (ALA) and porphobilinogen (PBG)
due to PBG deaminase deficiency Acute intermittent porphyria treat: glucose or hemin
muscarinic and nicotinic effects
d=diarrhea/diaphoresis u=urination m=miosis b=bronchospasm, bronchorrhea, bradycardia e=emesis l=lacrimation s=salivation nicotinic effects: muscle weakness, paralysis & fasciculations Atropine reverses muscarinic effects but not nicotinic. pralidoxime is a cholinesterase-reactivating agent that allows for degradation of excess acetylcholine and treats both muscarinic and nicotinic effects of organophosphates.
DM
daily foot inspection recommended
gerstmann syndrome
damage to the angular gyrus of the dominant parietal lobe. agraphia (inability to write), acalculia (inability to carry out mathmatical calculations), finger agnosia (inability to identify individual fingers on the hand), and left-right disorientation.
depolarization of bacterial cellular membrane and inhibition of DNA, RNA, and protein synthesis
daptomycin treat MRSA
urterine curettage of ectopic
decidualized endometrium only dilated, coiled endometrial glands and vascualarized edematous stroma.
beta blockers
decrease AV nodal conduction, leading to increased AV nodal refractory period. this correlates to PR interval prolongation on an ECG.
P-450 enhancers and warfarin
decrease efficacy of warfarin vs. inhibitors of P-450 increase risk of bleeding
thioamides (methimazole, propylthiouricil)
decrease formation of thyroid hormones via inhibition of thyroid peroxidase, the enzyme responsible for both iodine organification and coupling of iodotyrosines. propylthiouracil also decreases the peripheral conversion of T4 and T3.
normal morphological changes in the aging heart
decrease in left ventricular chamber apex-to-base dimension development of a sigmoid-shaped ventricular septum myocardial atrophy with increased collagen deposition accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes.
increase in amount of enzyme available in particular system will cause increase in Vmax but not Km
decrease in y-intercept and no change in x-intercept on lineweaver-burke plot
management of drug induced parkinsonism
decrease or discontinue offending medication anticholinergics--benztropine, trihexyphenidyl
CML
decreased alkaline phosphatase level vs. normal or elevated in leukemoid reaction demonstrate t(9;22) or BCR-ABL fusion gene or mRNA.
hyperventilation induced hypocapnia
decreased cerebral blood flow and cerebral hypoperfusion blurred vision, dizziness, lightheadedness
alzheimer disease
decreased levels of acetylcholine in the nucleus basalis of meynert and the hippocampus, caused by diminished activity of choline acetyltransferase.
postoperative urinary retention
decreased micturition reflex activity, decreased contractility of the bladder detrusor, and/or increased vesicle sphincter tone. treated with muscarinic agonist (bethanechol) or an alpha1 blocking drug.
pulmonary hypertension
develops in patients with systemic sclerosis as a result of damage to the pulmonary arterioles. it manifests with an accentuated pulmonary component of the second heart sound and signs of right-sided failure due to cor pulmonale.
right ventricular infarction
decreases RV stroke volume, which leads to diminished LV filling nad cardiac output despite preserved LV systolic function, resulting in hypotension and shock. because left-sided filing pressures are reduced, PCWP also decreases as it reflects left atrial pressure. patients have elevated central venous pressure due to impaired forward flow and backup of blood into the systemic venous system.
protective for ovarian cancer
decreasing frequency of ovulation OCP multiparity breastfeeding risk: BRCA mutation nulliparity infertility
terminally differentiated cell reverts to less specialized form
dedifferentiation can be induced by transcription factors
midshaft fractures of the humerus risk injury to
deep brachial artery and radial nerve which run together along the posterior aspect of the humerus.
uridine deficiency
defect in uridine 5' monophosphate synthase cause orotic aciduria mental retardation, megaloblastic anemia, and large amounts of urinary orotic acid.
Dubin-Johnson syndrome
defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinemia and jaundice. liver appears black due to impaired excretion of epinephrine metabolites, which histologically appear as dense pigments within lysosomes.
hyperimmunoglobulin M syndrome
defective immunoglobulin class switching due to defect in CD40 ligand-CD40 interaction. absence of CD40 ligand is the most common cause and is an X-linked recessive pattern. clinical features include recurrent sinopulmonary, gastrointestinal, and opportunistic infections.
recurrent infection with neisseria species
deficiency of the complement factors that form the MAC complex
classic salt wasting 21 hydroxylase deficiency
deficient cortisol and aldosterone synthesis adrenal androgen overproduction male-normal genitalia with vomiting, hypotension, hyponatremia, and hyperkalemia. females-ambiguous genitalia.
stress urinary incontinence
defined as an involuntary urine loss with increased intraabdominal pressure. pelvic floor strengthening (kegel exercises) targets the levator ani to improve support around the urethra and bladder.
single sarcomere
defined as the distance between two Z lines. Thin (actin) filaments in the I band are bound to structural proteins at the Z line, whereas thick (myosin) filaments in the A band are bound to structural proteins at the M line.
NAD and NADP are cofactors for many
dehydrogenase and reductase enzymes niacin (B3) is a precursor for NAD and NADP
cryptococcus neoformans
demonstrates round or oval budding yeast.
ductus arteriosus
derived from sixth embryonic aortic arch. a patent ductus arteriosus causes left-to-right shunting of blood that can be heard as a continuous murmur over the left infraclavicular region. indomethacin (aPGE2 inhibitor) can be used to close a PDA in premature infants, but surgical ligation is often necessary in older patients.
strong association with malignancy: lung colorectal ovarian
dermatomyositis
developmental field defect
describes multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells. holoprosencephaly is a developmental field defect characterized by a spectrum of fetal anomalies due to incomplete division of the forebrain (prosencephalon).
hep B immunized people
develop anti-HBs antibody. those who recover have anti HBs and anti HBc. chronic infection have HBs antigens for more than six months.
alpha 1-antitrypsin deficiency
develop early onset lower lobe predominant emphysema due to excessive alveolar elastin degradation. rubber like properties of elastin are due to high content of nonpolar amino acids and extensive cross-linking between elastin monomers facilitated by lysyl oxidase
hepatic schizonts
develop in the liver over 8-30 days continue treatment for 4 weeks after return with: mefloquine
severe mitral regurgitation
develop left sided volume overload with an S3 gallop due to the large volume of regurgitant flow reentering the ventricle during mid-diastole. absence of S3 gallop excludes severe chronic MR.
HZV (shingles)
develops due to reactivation of varicella zoster virus in the dorsal root ganglia (sensory neurons). it presents with a painful vesicular rash in a dermatomal distribution. intranuclear inclusions in keratinocytes and multinucleated giant cells are seen on light microscopy.
pulmonary actinomycosis
develops most commonly following aspiration and can be confused with lung abscess, malignancy, or tuberculosis. microscopic findings include vaguely filamentous, branching, gram positive bacteria and sulfur granules.
ptosis, 'down and out' gaze, and normal light and accommodation reflexes MH: DM
diabetic mononeuropathy involves cranial nerve III ischemia
wet mount
diagnose trichomonas vaginitis
chronic pancreatitis
diarrhea, weight loss, and epigastric calcifications in patient with chronic alcoholism manifest as exocrine insufficiency and malabsorption.
sequence of amino acids in growing polypeptide
dictated by interaction of mRNA codon with the tRNA that is mischarged with the incorrect amino acid (and not corrected by aminoacyl-tRNA synthetase proofreading) will incorporate the wrong amino acid into the growing polypeptide chain.
decreases AV nodal conduction by increasing parasympathetic vagal tone
digoxin lowers heart rate
changes in color vision and GI: anorexia, nausea, vomiting could indicate
digoxin toxicity ventricular arrhythmias are most serious complication
nonspecific GI/neuro: anorexia, nausea, vomiting fatigue, confusion, weakness changes in color vision
digoxin toxicity ventricular arrhythmias!!
Blastomyces dermatitidis
dimorphic fungus infection through inhalation of aerosolized fungus from the environment. flu like illness in immunocompetent. round or oval yeasts with thick walls and broad based budding.
histoplasma capsulatum
dimorphic fungus that is small, ovoid yeast at tissue temps. it replicates within macrophages and spreads through the lymphatic and reticuloendothelial system. immunocompetent patients usually have an asymptomatic pulmonary infection, but those who are immuncompromised can develop disseminated disease to the liver, spleen, and bone marrow.
primary treatment for diphtheria is
diphtheria antitoxin (passive immunization) this inactivates circulating toxin antibiotics should be administered to reduce continued production of toxin.
IgG against the exotoxin B subunit
diphtheria toxoid
avoidant personality
disorder is a maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, and fear of embarrassment and rejection.
depersonalization/derealization disorder
dissociative disorder involving recurrent episodes of feeling detached from one's body and/or feelings of unreality.
short grastric veins
drain blood from the gastric fundus into the splenic vein. pancreatic inflam. can cause a blood clot within the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varices only in the fundus.
superficial inguinal lymph nodes
drains most of cutaneous lymph from the umbilicus down, including the anus below the dentate line. glans penis and posterior calf, drain to the deep inguinal nodes.
half life (t1/2)
drug is almost completely eliminated after 5 half life intervals. 0=0% 1=50% 2=75% 3=87.5% 4=93.75% t(1/2)=(0.7 X Vd)/CL
nonnucleoside reverse transcriptase inhibitors
drugs that bind to sites on the reverse transcriptase, preventing RNA- and DNA-dependent DNA polymerase activities needed to carry out the viral DNA synthesis; prevents the transfer of information that allows the virus to replicate and survive nevirapine and efavirenz
ductal carcinoma in situ
ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane. is the precursor to invasive ductal carcinoma, the most common type of breast cancer.
ion pump failure
due to ATP deficiency during cardiac ischemia causes intracellular accumulation of Na+ and Ca2+. the increased intracellular solute concentration draws free water into the cell, causing the cellular and mitochondrial swelling that is observed histologically.
anti-nausea meds
due to GI results=5-HT3 receptor antagonists vestibular=antihistamines and anticholinergics migraine=dopamine antagonist
mucopurulent cervicitis
due to N gonorrhoeae and Chlamydia trachomatis can lead to PID>>scarring>>ectopic and infertility
low levels of drug that is metabolized by P450
due to P450 inducer concurrent use: decreases the concentration of the drug in plasma and its effectiveness. is with inhibitor of P450= increases plasma concentration and could lead to toxicity
cystic fibrosis
due to a 3 base pair deletion in CF transmembrane conductance regulator (CFTR) gene at amino acid position 508. mutation impairs post translational processing, insulting in shunting of CFTR toward the proteasome, with complete absence of protein on the cell surface. elevated chloride concentrations are found in most patients with CF.
acute intermittent porphyria
due to accumulation of aminolevulinate and porphobilinogen, due to PBG deaminase deficiency combined with ALA synthase induction---due to medications, alcohol sue, or low-calorie diet. management with glucose or hemin inhibits ALA synthase activity.
wernicke encephalopathy
due to admin of glucose to thiamine-deficient patients (eg, alcoholics), causes acute confusion, ophthalmoplegia, and ataxia due to increased thiamine demand. pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase require thiamine as a cofactor.
HBV and HCV increase risk of HCC
due to chronic hepatic inflammation and cell turnover. HBV is also carcinogenic due to the production of oncogenic proteins and the insertion of the HBV genome into the host chromosome.
DHF polyglutamate accumulation
due to competitive inhibition of DHF with methotrexate toxicity treated with: leucovorine
thoracic outlet syndrome
due to compression of 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.
tibial nerve injury at level of popliteal fossa
due to deep penetrating trauma or knee surgery. typically weakness on foot plantarflexion, foot inversion, and toe flexion, with sensory loss over the sole.
presbyopia
due to denaturatio of structural proteins within the lens, leading to loss of lens elasticity. decreased synthesis and increased breakdown of collagen and elastin contribute to the development of skin wrinkles.
patella fractures
due to direct impact to anterior aspect of knee. acutely swollen knee, focal patella tenderness, inability to extend the knee against gravity, and a palpable gap in the extensor mechanism.
photoaging
due to excess UV light epidermal atrophy with flattening of rete ridges. decreased collagen fibril production and increased degradation of collagen and elastin in the dermis.
staph SSS in infants and children
due to exotoxin-mediated inflammatory response widespread epidermal sloughing with gently pressure.
pulmonary HTN and left sided HF
due to filling pressures transmitting backward to the pulmonary veins resulting in pulmonary venous congestion. leads to arterial remodeling (medial hypertrophy and intimal thickening with fibrosis can occur) but not to the extent that occurs in pulmonary arterial HTN
paroxysmal nocturnal hemoglobinuria
due to gene defect that leads to uncontrolled complement-mediated hemolysis (CD55, CD59) classic triad includes hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at atypical sites. chronic hemolysis can cause iron deposition in the kidney (hemosiderosis).
rubber like properties of elastin
due to high content of nonpolar amino acids and lots of cross-linking between elastin monomers facilitated by lysyl oxidase. excess degradation of elastin present in alpha-1 antitrypsin deficiency
malabsorption syndrome
due to impaired intestinal digestion and absorptioin. fats are the most affected macronutrient and so testing for stool fat with sudan III stain is best screening for malabsorptive disorders.
squamous metaplasia of the epithelial lining of pancreatic exocrine ducts
due to insufficiency leading to ADEK vitmain deficiency Avitamenosis A: squamouts metaplasia
lymph drainage testis vs scrotum
due to intra abdominal origin, lymphatic drainage of the testis is the para aortic lymph nodes. in contrast, lymph drainage from the scrotum goes into the superficial inguinal lymph nodes.
atrial fibrillation
due to irregular, chaotic electrical activity within the atria and presents with absent P waves, irregularly irregular R-R intervals, and narrow QRS complexes. atrioventricular node refractory period regulates the number of atrial impulses that reach the ventricle and determines the ventricular contraction rate in conditions where the atria undergo rapid depolarization.
autoimmune insulitis with progressive beta cell loss
due to islet leukocytic infiltration are common causes of type 1 DM vs. type 2 DM insulin resistance accompanied by relative insulin deficiency are main causes.
hypertensive arteriolar sclerosis
due to lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall>>> risk of thrombotic vessel occlusion lacunar infarct: deep brain structures
multiple myeloma effects on kidney
due to low PTH, decrease renal Ca reabsorption (hypercalciuria), decrease 1,25-dihydroxyvitamin D synthesis does not effect PTH related protein
contraction of smooth muscles in the sphincter of oddi
due to mu opioid use lead to spasm and increase in common bile duct pressures develop biliary colic, severe pain and cramping in RUQ discontinue meds and start something else: NSAID diclofenac ketorolac
short gastric arteries
due to poor anastomoses, gastric tissue supplied by short gastric arteries is vulnerable to ischemic injury following splenic artery blockage.
green discoloration of pus/sputum
due to presence of myeloperoxidase, a blue-green heme-based enzyme that is released from neutrophil azurophilic granules and forms hypochlorous acid.
testicular torsion
due to twisting of the testis around the spermatic cord (containing the gonadal artery), which can eventually lead to ischemia. the gonadal artery arises from the abdominal aorta.
fatty streaks
early lesions of atherosclerosis and can be seen as early as the second decade of life. appear as a collection of lipid-laden macrophages (foam cells) in the intima that can eventually progress to atherosclerotic plaques.
chronic granulomatous disease
due to x-linked mutation affecting NADPH oxidase. leads to inability to form the oxidative burst to kill organisms in their phagolysosomes. CGD can be diagnosed by absence of the normal blue and fluorescent green pigment produced by the nitroblue tetrazolium test and dihydrorhodamine flow cytometry test, respectively.
confirmatory test for celiac disease
duodenal biopsy shows villus flattening and intraepithelial lymphocyte infiltration. elevated IgA against translutaminase
Squatting in Tetralogy of Fallot
during a Tet spell increases systemic vascular resistance and decreases right to left shunting, thereby increasing pulmonary blood flow and improving oxygenation status. more blood will go through pulmonary artery than through VSD.
radial nerve injury
during its passage through the supinator canal may occur due to repetitive pronation/supination of the forearm, direct trauma, or subluxation of the radius. patients typically have weakness during finger and thumb extension (finger drop) without wrist drop or sensory deficits.
left ventricular blood flow occurs during diastole
during ventricular systole, the coronary vessels supplying the left ventricle are compressed by the surrounding muscle. systolic reduction in coronary blood flow is greatest in the subendocardial region, making this portion of the left ventricle most prone to ischemia and infarction.
hyertrophic cardiomyopathy
dynamic left ventricular outflow tract obstruction due to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum.
Acute extrapyramidal symptoms
dystonic reactions, akathisia, parkinsonism due to D2 blockade in the nigrostriatal pathway. first generation high potency antipsychotics (haloperidol, fluphenazine) strongly block D2 receptors and are the most likely antipsychotics to cause extrapyramidal symptoms.
hallmark of cell injury and death in the setting of normal calcium levels. result of endothelial and fibroblast death secondary to chronic hemodynamic stress or atherosclerotic inflammation
dystrophic calcification elderly= aortic sclerosis stiffing/outlfow obstruction= calcific aortic stensis
provides stabilizing interaction between sarcolemma and intracellular contraction apparatus
dystrophin
CD8+ cells recognize foreign antigens
each MHC class I molecule consists of a heavy chain and a beta2-microglobulin.
SNS regulates visceral function via 2 neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons
eccrine sweat glands and the adrenal medullae are exceptions to this rule as they are both innervated by cholinergic neurons. the parasympathetic system uses both preganglionic and postganglionic cholinergic neurons.
3 primary germ layers
ectoderm, mesoderm, and endoderm. the ectoderm gives rise to the surface ectoderm, neural tube, and neural crest. anterior pituitary from surface ectoderm. posterior pituitary from neural tube.
bacillus anthracis
edema factor is an adenylate cyclase that increases intracellular cAMP, leading to neutrophil and macrophage dysfunction and tissue edema. similar to bordatella pertussis.
nitrates are oxidizing agents
effective in treating cyanide poisoning due to their ability to induce methemoglobinemia--which contains ferric (fe3+) rather than ferrous iron (fe2+). cyanide binds to ferric iron more avidly than to mitochondrial cytochrome enzymes, diminishing cyanides toxic effect.
thiazide diuretics
effectively increase calcium reabsorption from the nephron. they are indicated in patients with nephrolithiasis secondary to hypercalciuria and contraindicated in hypercalcemia.
pharmacokinetics
efficacy- measure of maximum pharmacodynamic effect achievable with a drug. potency-refers to the dose of drug that is required to produce a given effect. drugs that bind their receptors with a higher affinity or are better able to gain access to their target tissues will have greater potency (lower ED50).
acute hepatic failure due to halothane use
elevated ALT and AST prolonged prothrombin time normal albumin levels due to long half life vs. chronic liver failure hepatosplenomegaly, palmar erythema, etc.
alpha fetoprotein
elevated in hepatitis, hepatocellular carcinoma sudden rise in AFP can be a sign of chronic liver disease harboring HCC
pretreatment with propranolol then epinephrine administration
eliminates the beta effects (vasodilation and tachycardia) leaving only alpha effect of vasoconstriction
adjustment disorder
emotional and behavioral symptoms occurring wihtin 3 months of an identifiable stressor. patient has significant distress and impairment but does not meet full criteria for another mental disorder.
klebsiella pneumonia
encapsulated, lactose-fermenting, gram-negative bacillus that appears mucoid in culture. it causes pneumonia in individuals with impaired host defenses, especially patients with alcoholism. klebsiella pneumonia- characterized by tissue necrosis and early abscess formation with production of thick, mucoid, blood thinged sputum (currant jelly sputum).
beta-endorphin
endogenous opiod peptide that is derived from proopiomelanocortin (POMC). polypeptide precursor that goes through enzymatic cleavage and modification to produce not only beta-endorphins but also ACTH and MSH. beta endorphin and ACTH derived from same precursor suggests close physiological relationship between the stress axis ad the opioid system.
fusion inhibitors
enfuvirtide bind the HIV transmembrane glycoprotein gp41 and prevent it form approximating the viral and host cellular membranes, which prevents HIV penetration into new host cells.
gram positive cocci in pairs and chains that are gamma hemolytic
enterococcus PRP positive can grow in bile and in 6.5% sodium chloride cause UTI, bacteremia/endocarditis, wound infection, or intraabdominal or pelvic infection in nosocomial setting.
most common cause of viral meningitis
enteroviruses of picornaviridae family
extensive glycosylation in the RER and golgi and then cleaved into
envelope proteins: gp120 gp41
congenital deficiency of propionyl CoA carboxylase
enzyme responsible for the conversion o propionyl CoA to methylmalonyl CoA leads to development of propionic acidemia. presents with lethargy, poor feeding, vomiting, and hypotonia 1-2 weeks after birth. valine, isoleucine, methionine, threonine, and odd chain fatty acid metabolism makes propionyl CoA.
Carcinoid syndrome
episodic flushing, secretory diarrhea, and wheezing. lead to pathognomonic plaque like deposits of fibrous tissue on the right-sided endocardium, causing tricuspid regurgitation and right-sided heart failure. elevated 24-hour urinary 5-hydroxyindoleacetic acid can confirm the diagnosis.
Prinzmetal angina
episodic, transient attacks of coronary vasospasm (at rest and at night), produce temporary ST elevations. triggers are cigarette smoking, cocaine/amphetamines, and dihydroergotamine/triptans. treatment is tobacco/smoking cessation and vasodilator therapy (nitrates, CCB)
granulomas
epithelioid macrophages that fused together to form multinucleated cells surrounded by band of lymphocytes involve chronic Th1 and macrophage activation
highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow
erythema infectiosum= parvovirus B19
peau d'orange
erythematous, itchy breast rash with skin texture changes analogous to an orange peel. key dermatologic presentation of inflammatory breast cancer and is caused by cancerous cells obstructing lymphatic drainage due to spread to the dermal lymphatic spaces.
absolute vs. relative erythrocytosis
erythrocytosis: hematocrit >52% check RBC mass: normal=plasma volume contraction as the cause of polycythemia= relative increase RBC mass=absolute
descending throacic aorta lies posterior to the
esophagus and the left atrium allows clear visualization with transesophageal echo, to detect dissection or aneurysm
ulcers that increase risk for malignancy
esphagus, stomach, and colon duodenal ulcers are not
blunt trauma to globe (eye) can cause orbital blowout fractures that may cause herniation into
ethmoid or maxillary sinuses
pulsus parodoxus
exaggerated drop (>10 mm Hg) in systolic blood pressure during inspiration. commonly seen in patients with cardiac tamponade but can also occur in severe asthma, COPD, hypovolemic shock, and constrictive pericarditis.
polyhydramnios
excessive accumulation of amniotic fluid presents with increased abdominal circumference out of proportion to gestational age. usually due to decreased fetal swallowing or increased fetal urination. fetal anomalies associated with impaired swallowing include gastrointestinal obstruction (eg, duodenal, esophageal, or intestinal atresia) and anencephaly.
separation anxiety disorder
excessive and distressing anxiety, more than month for kids and more than one and a half month for adults, due to separation from attachment figures. children have physical symptoms and nightmares.
contractures
excessive matrix metalloproteinase activity and myofibroblast accumulation in the wound margins during healing produce deformities of the wound and surrounding tissues, most often on the palms, soles, anterior thorax, or at serious burn sites.
hypoglycemia, in DM patient, can be precipitated by
exercise in patients with insulin-treated diabetes. uptake of glucose by skeletal muscle is mediated by the glucose transporter type 4, which is translocated to the cell membrane in response to insulin and muscle contraction.
uncal herniation
expanding space occupying lesions within the temporal love can cause elevated intracranial pressure with transtentorial herniation of the uncus. uncal herniation often compresses the ipsilateral third cranial nerve as it exits the midbrain, resulting in oculomotor nerve palsy with a fixed dilated pupil (due to preganglionic parasympathetic fiber damage).
hepatic angiosarcoma
exposure to carcinogens: arsenic, thorotrast, and polyvinyl chloride. tumor cells express CD 31- an endothelial cell marker.
phenylethanolamine-N-methyltransferase
expression increase due to cortisol increasing the conversion of NE and Epi in the adrenal medulla.
gallstones and pregnancy
extrogen-induced cholesterol hypersecretion due to upregulation of hmg-coA reductase activity and progesterone-induced gallbladder hypomotility are responsible for the increased incidence of cholelithiasis in women who are pregnant or using oral contraceptives.
fetal alcohol syndrome
facial dysmorphisms: short palpebral fissures, indistinct philtrum, thin vermillion border, poor growth, and neurobehavioral problems.
bells palsy
facial nerve exits stylomastoid foramen and courses through stubstance of parotid gland, where it divides into its 5 branches. parotid gland tumors compress this nerve, causing ipsilateral facial droop.
Mucormycosis
facial pain, headache, and black eschar in the nasal cavity in a patient with diabetic ketoacidosis. histologic exam is necessary for diagnosis. fungi show broad nonseptate hyphae with right angle branching. treatment consists of surgical debridement and antifungal therapy.
gap junctioins
facilitate communications and coordination between cells and play an important role in labor contractions. connexins are proteins that assemble into gap junctions and their density increases in the uterus before delivery in response to rising estrogen levels.
meckel diverticulum
failed obliteration of viteline duct spontaneous but painless lower GI bleeding. 99mTc-pertechnetate localizes ectopic gastric mucosa, and its increased uptake is diagnostic.
pancrease divisum
failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. pancreatic ductal system remain separate, with the accessory duct draining the majority of the pancrease.
scaphoid bone
fall onto an outstretched hand. tenderness in the anatomical snuff box. the scaphoid bone is vulnerable to avascular necrosis due to its tenuous blood supply.
in absence of advance directive and designated health care proxy
family member should be contacted to act as surrogate decision maker followed by person who cares about and knows the patients wishes. in EM, treat without consent.
'park at venture avenue'
fastest to slowest conduction velocity: purkinje system atrial muscle ventricle muscle AV node need time for complete filling after atrial contraction
golgi tendon system
feedback system that monitors and maintains muscle force. GTOs are exquisitely sensitive to increases in muscle tension but are relatively insensitive to passive stretch. muscle spindle system is a feedback system that monitors and maintains muscle length.
paget's disease is associated with development of osteosarcoma
femur, tibia, humerus, or other bones destruction of normal trabecular bone, mixed areas of radiodense/radiolucent , perosteal new bone formation
fibrate medications
fenofibrate, gemfibrozil inhibit cholesterol 7alpha-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 gallstones.
selective peripheral dopamine 1 receptor agonist arterial dilation, increase renal perfusion, and natriuresis
fenoldopam hypertensive emergency when patients has renal insufficiency
ductus venosus
feta blood umb. vein into liver diverted to IVC via ductus venosus
umbilical vein to liver, bypass hepatic circulation, then to IVC
fetal circulation
loss of 2,3 BPG binding packets positive charge cause hemoglobin A to resemble
fetal hemoglobin binds O2 with higher affinity due to its inability to interact with 2,3 BPG
lecithin and sphingomyelin
fetal lung lecithin production increases sharply after 30 weeks gestation, and phosphatidylglyercol prodcution increases at 36 weeks gestation. amniotic fluid sphingomyelin (S) level should remain approximately constant during the third trimester. an L/S ratio more than or equal to 2.0 indicates adequate surfactant production to avoid neonatal hyaline membrane disease.
septic aboration
fever, abdominal pain, uterine tenderness, and/or foul-smelling discharge after pregnancy termination. Staph. aureus and E. coli common due to seeding of the uterine cavity during instrumentation.
anticholinergic toxicity
fever, cutaneous flushing; dry oral mucosa; dilated, poorly reactive pupils; and confusion. tricyclic antidepressants, particularly amitriptyline, have strong anticholinergic adverse effects.
later stages of aortic stenosis
fibroblasts differentiate into osteoblast-like cells and deposit bone matrix, leading to progressive valvular calcification and stenosis.
knee anatomy
fibula is on the outer side when looking anterior tibia is larger and on the inside/middle when looking at anteriorly
treatment for C difficile infection other than oral vancomycin
fidaxomicin inhibits the sigma subunit of RNA polymerase bacteriocidal minimal systemic absorption
the amount that is filtered in glomerulus divided by the amount of plasma flow
filtration fraction
NSAIDs
first line for treatment of acute gouty arthritis. inhibit cyclooxygenase and decrease prostaglandin synthesis and exert a broad anti-inflammatory effect that includes inhibition of neutrophils. allupurinol should NOT be used as it can exacerbate acute arthritis.
synthesis of steroid hormones
first step is the conversion of cholesterol to pregnnenolone in the mitochondria. the remainder of steroidogenesis occurs in the smooth endoplasmic reticulum. steroid-producing cells contain a well-developed smooth endoplasmic reticulum.
syringomyelia
fixed segmental loss of upper extremity pain and temperature sensations, upper extremity lower motor neuron signs, and/or lower extremity upper motor neurons signs in the setting of scoliosis suggests syringomyelia. damage to the ventral white commissure and anterior horns.
nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors
flutamide used in combination with long-acting gonadotropin releasing hormone agonists in treating prostate cancer
involves both hemispheres at onset and treated with narrow spectrum antiepileptics
focal seizures -simple and complex narrow Rx: carb, gaba, phenobarb, pheny.
mefloquine chemoprophylaxis
for malaria must be continued 4 weeks after return from an endemic region to ensure the elimination of hepatic schizonts (which develop in the liver over 8-30 days). P ovale and P vivax have a dormant hepatic phase (hypnozoite) that may reactivate several months after return from an endemic region (if not treated with primaquine).
minors can consent
for medical treatment in certain circumstances, including legal emancipation (eg, parent, married), emergency care, and specific conditions (eg, sexually transmitted infection, pregnancy, substance abuse).
gluacoma
form of optic neuropathy characterized by increased intraocular pressure associated with increased production or decreased outflow of aqueous humor. topical prostaglandins (lantanoprost) increase outflow of aqueous via the uveoscleral pathway and are the preferred treatment for open-angle glaucoma.
left atrium
forms the majority of the posterior surface of the heart and resides adjacent to the esophagus. enlargement of the left atrium can compress the esophagus and cause dysphagia.
HbA1c
forms within circulating red blood cells as hemoglobin A is exposed to glucose, and HbA1c levels are useful indicator of average glycemic control over the erythrocyte life-span. HbA1c levels are affected by alterations in red blood cell survival; conditions that increase red blood cell turnover (eg, hemolytic anemia) can cause falsely low HbA1c levels.
hormone sensitive lipase
found in adipose tissue. breaks down stored triglycerides into FFA and glycerol. during starvation, this enzyme provides substrates for hepatic gluconeogenesis and ketone body formation.
brown adipose tissue
found in newborns and in hibernating mammals. brown cells contain several intracytoplasmic fat droplets and many more mitochondria than white adipose cells. they function to produce heat by uncoupling oxidative phosphorylation with the protein thermogenin.
treatment for GBS is
intrapartum penicillin or ampicillin prevents neonatal GBS sepsis, pneumonia, and meningitis
glucokinase
functions as a glucose sensor i pancreatic beta cells by controlling the rate of glucose entry into the glycolytic pathway. insulin release by pancreatic cells is stimulated by increased ATP production. mutations in the glucokinase gene are a cause of maturity-onset diabetes of the young.
binds HIV transmembrane glycoprotein gp41 and prevent it from approximating the viral and host cellular membranes, which prevents HIV penetration into new host cells
fusion inhibitors (enfuvirtide)
bind HIV transmembrane glycoprotein gp41 and prevent it from approximating the viral and host cellular membranes, preventing HIV penetration into new host cells
fusion inhibitors -enfuvirtide
vision problems in adolescent
galactokinase deficiency galactitol accumulation leads to cataracts
biliary sludge
gallbladder functions to actively absorb water from bile. galssbladder hypomotility causes the bile to become concentrated, promotoing precipitation and accumulation of particulate material. this forms a viscous biliary sludge that can cause transient bile duct obstruction (biliary colic) and promote cholesterol gallstone formation.
large gallstone through a cholecystenteric fistula into the small bowel causes
gallstone ileus travels down until lodged in ilium gas in the gallbladder and biliary tree due to the ileus
common causes of pancreatitis
gallstones and chronic alcoholism are 80% of cases. other causes- inherited or acquired hypertriglyceridemia can cause acute pancreatitis if the serum level of triglycerides exceeds 1000 mg/dl.
zollinger ellison syndrome
gastrinoma in small intestine/pancreas with peptic ulcers, heartburn, and diarrhea. patients have elevated gastrin levels that rise with exogenous secretin admin. secretin inhibits release of gastrin from normal gastric G cells.
involve both hemisphere and Rx with broad spectrum antiepileptics
generalized seizures -tonic-clonic -myoclonic (juvenile myoclonic) -absence
wobble
genetic code is 'degenerate' because more than 1 codon can code for a particular amino acid. wobble hypothesis--first 2 nucleotide positions on the mRNA codon require traditional base pairing, whereas the third 'wobble' nucleotide position may undergo less stringent base pairing.
high content of nonpolar amino acids and extensive cross-linking between elastin monomers
give elastin rubber-like properties. facilitated by lysyl oxidase
femoral nerve block to anesthetize skin and muscles of anterior thigh, femur, and knee
given at inguinal crease
pauci immune progressive glomerulonephritis
glomerular crescent formation without immunoglobulin or complement deposits.
bluish neoplasm underneath the nail bed
glomus tumor or subungual melanoma
Gs
glucagon TSH PTH activates adenylate cyclase, ATP to cAMP, then protein kinase A, phosphorylates serine/threonine residues, leading to activation/deactivation
GPCR
glucagon, TSH PTH Gq stimulate protein kinase A
Guacher disease histo
glucocerebroside accumulation leads to distended macrophages with a 'wrinkled tissue paper' appearance. vs. ALL: blast cells
most abundant amino acid in collagen
glycine triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each alpha chain, in which glycine occupies every third amino acid position.
sequence of single base DNA defects by base excision repair
glycosylases remove defective base empty sugar phosphate site is cleaved an removed by endonuclease and lyase DNA polymerase replaces missing nucleotide and ligase seals the final remaining nick
gout and PPRP
gout occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines.
haploid genome and a peptidoglycan cell wall sandwiched between an outer membrane and an inner plasma membrane
gram negative bacterium have no nuclear membrane
10-14 days post MI
granulation tissue and neovascularization
myoglobuinuria
heme pigment (from myoglobin after degradation in the kidney) is toxic to tubular cells and can cause acute tubular necrosis. positive blood on urine dipstick in the absence of red blood cells on microscopic urinalysis suggests myoglobinuria.
hepatomegaly, DM secondary to pancreatic islet destruction, arthropathy, pituitary hormone deficiencies, hyperpigmentation, and cardiomypathy
hemochromatosis
golden cytoplasmic granules in macrophages taht turn blue with prussian blue staining
hemosiderin laden macrophages due to extravasation of RBCs and alveolar hemorrhage which is then phagocytosed by macrophages and the iron from hemoglobin is converted to hemosiderin
finely granular, pale eosinophilic, ground-glass appearance
hep B infection can cause HCC
PAN is commonly associated with
hepatitis B
hypoxemia with respiratory alkalosis
high altitude exposure over a course of a few days chronic respiratory alkalosis sets in, with corresponding decrease in serum bicarbonate level reflecting renal compensation.
prolactinoma
high levels of circulating prolactin supress GnRH secretion from the hypothalamus, leading to reduced secretion of LH and subsequent hypogonadism, anovulation, and amenorrhea. the resulting estrogen deficiency can cause osteoporosis with an increased risk for fragility fractures, and lead to vaginal dryness and atrophy.
factors that trap the drug in the plasma compartment resulting in low Vd (3-5 L)
high molecular weight high plasma protein binding high charge hydrophilicity
low volume of distribution: 3-5 L
high molecular weight high plasma protein binding hydrophilicity high charge
colorectal carcinoma secondary to IBD, especially ulcerative colitis
higher risk young age of onset more aggressive higher grade evolves from flat lesions multifocal should monitor regularly with biopsies.
inhaled anesthetic, such as halothane, can be associated with a
highly lethal fulminant hepatitis same as acute viral hepatitis elevated aminotransferases levels due to hepatocellular injury prolonged prothrombin time due to failure of hepatic synthetic function.
trazedone
highly sedating antidepressant commonly used to treat insomnia. priapism is a rare but serious adverse effect of trazedone.
screening for rare, life threatening disease
highly sensitive test should always be considered over a highly specific test when screening for life-threatening diseases, where identification of every person with the disease is important.
inflammatory mediators released in after mast cell and basophil degranulation
histamine and tryptase tryptase is relatively specific to mast cells and can be used as marker for mast cell activation
dimorphic fungus, ovoid yeast at tissue temp. replicates within macrophages
histoplasmosis disseminate to liver, spleen, and bone marrow in immunocompromised patients
unilateral visual pathway lesion beyond optic chiasm can cause
homonymous hemianopsia infarction of MCA, PCA, or anterior choroidal arteries
breaks down stored triglycerides into free fatty acids and glycerol
hormone sensitive lipase found in adipose tissue (vs. lipoprotein lipase found in endothelial cells) provides substrate for hepatic gluconeogenesis and ketone body formation during times of starvation
phthirus pubis
human pubic louse sexually transmit via skin-skin contact intense pruritus louse and nits can be visualized on exam. treat with topical permethrin.
intense lymphocytic infiltrate, often with germinal centers
hurthle cells: large oxyphilic cells filled with granular cytoplasm chronic lymphocytic (hashimoto) thyroiditis: common cause of hypothyroid
heavy menses after adolescents pelvic heaviness infertility
leiomyomas common, benign, uterine muscle tumor
proteins destined for the rough endoplasmic reticulum possess
hydrophobic, N-terminal peptide signal sequences deletions of these: cause inappropriate accumulation in the cytosol
occurs in the rough endoplasmic reticulum and requires vitamin C as a cofactor
hydroxylation of proline and lysine residues in collagen---helps it attain its maximum tensile strength. impaired collagen synthesis due to vitamin C deficiency can lead to: fragile vessels gingival bleeding ecchymosis petechia
organ rejection
hyperacute: mins-hrs antibodies to graft acute: less than 6 mos humoral/lymphocytic of naive immune cells chronic: mos-yrs low grade immune response refractory to immunosuppressants
thrombotic occlusion of the microvasculature with skin necrosis after warfarin
hypercoagulability exaggerated by preexisting protein C deficiency
glucagonoma
hyperglycemia (often as newly diagnosed DM) and necrolytic migratory erythema (blistering erythematous plaques with central clearing on the groin, face, and extremities. diagnose with elevated glucagon levels.
loss of free water with retention of electrolytes
hyperosmotic volume contraction diabetes insipidus or decreased fluid intake/excessive sweating
increase in activity of enzymes responsible for DNA synthesis=cells went from G1 to S phase
hyperphosphorylated RB=inactive >> cells allowed to transition unchecked from G1 phase to S phase in the cell cycle
single most important risk factor for the development of intimal tears leading to aortic dissection
hypertension HTN, smoking, DM, and hypercholesterolemia are all major risk factors of atheroscherosis, which predisposes more to aortic aneurysm formation.
PRPP synthetase is responsible for de novo synthesis of purine and pyrimidine nucleotides and can lead to
hyperuricemia and gout
Primary hyperaldosteronism
hypokalemia, hypertension muscle weakness and paresthesias
dandy walker malformation
hypoplasia/absence of cerebellar vermis, cystic dilation of fourth ventricle, posterior fossa enlargement. progressive skull enlargement.
weight gain bradycardia brittle nails myalgias and proximal weakness
hypothyroid myopathy
chronic lymphocytic (hashimoto) thyroiditis
hypothyroidism intense lymphocytic infiltrate, with germinal centers residual follicles may be surrounded by Hurthle cells
ABG and PE
hypoxemia due to ventilation/perfusion mismatch and respiratory alkalosis (hypocapnia) due to hyperventilation.
lung injury results in focal loss of type 1 penumocytes and hyperplasia of type 2 pneumocytes
idiopathic pulmonary fibrosis
multiple sclerosis
immune-mediated disorder of the CNS characterized by focal demyelination. histologically, plaques contain foci of perivenular inflammatory infiltrates made up primarily of autoreactive T lymphocytes and macrophages.. patchy demyelination occurs followed by astrocyte hyperplasia (glial scarring).
PSGN
immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 in the mesangium and basement membranes
most important opsonins (coating proteins) are
immunoglobulin G and complement C3b directly enhance phagocytosis
carnitine deficiency
impair FA transport from cytoplasm into mitochondria, preventing beta oxidation of FA into acetyl CoA. leads to cardiac and skeletal myocyte injury and impaired ketone body production by liver during fasting periods--due to lack of ATP from citric acid cycle
internalized silica particles
impair macrophage function by disrupting phagocytosis and promoting apoptosis. this increases the risk of mycobacteria infection (particularly M tuberculosis). multiple rounded nodules located in upper lobes with hilar lymph node calcifications.
crohn disease is associated with oxalate kidney stones
impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption. intestinal lipids then bind calcium ions, and the resulting soap complex is excreted. free oxalate (normally bound by calcium to form an unabsorbable complex) is absorbed and forms urinary calculi (enteric oxaluria).
thrombotic thrombocytopenic purpura
impaired function of the von villebrand factor-cleaving protease ADAMTS13 results in uncleaved vWF multimers that are significantly more prothrombotic and cause diffuse microvascular thrombosis, microangiopathic hemolytic anemia, and thrombocytopenia.
cystic fibrosis
impairment of CFTR reduces Cl secretion and increased Na absorption by the respiratory epithelia, resulting in dehydrated mucus. when saline is applied to nasal mucosa, the increased Na absorption in patients with CF causes a more negative nasal transepithelial potential difference, which can be used to diagnose CF.
acute arsenic poisoning
impairs cellular respiration and presents with abdominal pain, vomiting, diarrhea, hypotension, and a garlic oder on the breath. insecticides and contaminated water are common sources of arsenic. Dimercaprol is the chelating agent of choice.
chronic thiamine (B1) deficiency
impairs glucose utilization in the central nervous system. this occurs due to decreased activity of the enzymes that use thiamine as a cofactor: pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase. thiamine deficiency can be diagnosed if baseline erythrocyte transketolase activity is low but increases after addition of thiamine pyrophosphate.
ectopic pregnancy
implantation outside of the uterus. usterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but no embryonic or trophoblastic tissue (eg, no villi)
snRNPs
important component of spliceosome, a molecule which removes introns from pre-mRNA during processing within the nulceus. spinal muscular atrophy is a disorder caused by mutations in the SMN1 gene, resulting in impaired assembly of snRNPs in lower motor neurons. infants often have flaccid paralysis due to degeneration of anterior horn cells in the spinal cord.
permissive effect of cortisol
improve response increase vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.
glycoprotein
in cell walls of actinomycete Tropheryma whippelii colors magenta with PAS and is diastase resistant, making this stain an excellent choice in evaluating for whipple disease.
stem cell have very long telomere and are present
in continuously replaced cells: basal cell layers of epidermis. bone marrow add TTAGGG repeats at 3' end of chromosome
2,3-BPG produced from 1,3-BPG by bisphophoglycerate mutase bypass ATP generating step of glycolysis
in erythrocytes 2,3-BPG decrease Hbg affinity for O2 occur in low O2 states
zero order kinetics
in first order kinetics, a constant fraction of drug is metabolized per unit time, so that amount metabolized changes based on the serum concentration. in zero-order kinetics, a constant amount of drug is metabolized per unit of time, independent of serum levels.
beta 1 receptors
in heart and renal juxtaglomerular cells but not in vascular smooth muscle.
hypocretin 1 &2 deficiency (orexin A&B)
in lateral hypothalamus that function to promote wakefullness and inhibit REM sleep related phenomena undetectable levels in hypocretin 1 in cerebrospinal fluid
oxidative metabolism of glucose
in pancreatic beta cells generates ATP. ATP-induced closure of the ATP sensitive potassium channel leads to membrane depolarization and subsequent insulin release.
gallstone formation
in patients with crohn disease--terminal ileum (most common site of involvement) are prone to developing gallstones. decreased bile acid absorption by the inflamed terminal ileum promotes cholesterol supersaturation of the bile, resulting in gallstone formation.
small vessel occulsion due to lipohyalinosis and microatheroma
in penetrating vessels supplying the deep brain structures lacunar infarctions
increase estrogen activity
in pregnancy or postmenopausal estrogen replacement therapy, increases level of thyroxine-binding globulin. leads to increase in total thyroid hormone levels, but feedback control maintains normal levels of free (biologically active) thyroid hormone.
hyperplastic arteriolosclerosis
in renal arterioles can result from and perpetuate malignant hypertension. diastolic pressures >120-130 mmHg pathological lesion is an onion like concentric thickening of arteriolar walls in the renal vasculature and elsewhere.
changes in membrane potential occur
in response to changes in neuronal membrane permeability to various cellular ions. the more permeable the membrane becomes for a cellular ion, the more that ion's equilibrium potential contributes to the total membrane potential.
intestinal microbiome
in the absence of intestinal microbial flora, C. Diff. can overgrow and produce exterotoxin (toxin A) and cytotoxin (toxin B). clinical disease resulting from C diff. overgrowth can range from transient diarrhea to severe pseudomembranous colitis.
attributable risk percent
in the exposed represents the excess risk in the exposed population that can be attributed to the risk factor. it can be easily derived from the relative risk using the formula: ARP(exposed)=100 X [(RR-1)/RR]
lenticular accumulation of galactitol
in the lenses of patients with galactosemia can cause osmotic damage and development of cataracts. cataracts may be the only manifestation of galactokinase deficiency.
haldane effect
in the lungs, the binding oxygen to hemoglobin drives the release of proton and CO2 from hemoglobin. in peripheral tissues, high concentratioins of CO2 and H+ facilitate oxygen unleading from hemoglobin (Bohr effect).
ovarian vein thrombosis
in the puerperium. symptoms include fever and localized abdominal or flank pain. most thrombosis is right sided and can extend to the IVC; left ovarian vein thrombosis can extend to the left renal vein.
branched chain ketoaciduria
inability to degrade branched chain alpha-amino acids: leucine, isoleucine, and valine defect in branched chain alpha keto acid dehydrogenase complex---requires thiamine as cofactor
hyperphosphorylated Rb is
inactive cells allowed to transition unchecked from the G1 phase to the S phase in the cell cycle
common cause of unilateral fetal hydronephrosis
inadequate canalization of ureteropelvic junction vesicoureteral refux= common cause of nonobstructive fetal hydronephrosis
common side effects of ACE-inhibitors
include decreased GFR, hyperkalemia, and cough. angioedema is a rare, but life-threatening side effect.
milrinone and inamrinone
increase cAMP leading to increased contractility also vasodilation limits use in hypotensive patients
exercising muscles
increase in CO splanchnic vasoconstriction modest increase in mean blood pressure as vasodilation within active skeletal muscles significantly decreases the total systemic vascular resistance.
sulfonylureas
increase insulin secretion by pancreatic beta cells independent of blood glucose concentration. long-acting sulfonylureas (glyburide, glimepiride) have a high incidence of hypoglycemia, especially in the elderly.
arteriovenous shunt
increase preload and CO
elevated TRH due to hypothyroidism can
increase prolactin secretion and lead to hyperprolactinemia lactotroph cells express TRH receptors
alpha adrenergic agonists
increase systolic and diastolic blood pressure by stimulating alpha1-adrenoreceptors in the vascular walls, causing vasoconstriction. increase venous tone and elevated bp, cause reflexive increase in vagal tone resulting in decrease HR and slowed AV node conduction.
during exercise, blood shows
increase: mean venous CO2 content ...muscle making more CO2 arterial O2 and CO2 content remain constant
IL-2
increased activity of T cells and natural killer cells anti-cancer effect
risk factors for acne
increased androgen levels obstruction of pilosebaceous glands by oil based hair products mechanical irritation of skin follicles sports triggers acne due to the use of tight fitting clothing and protective gear.
peripheral venous capacitance
increased by nitrates due to venodilation reduce preload and LVEDV and pressure
work of breathing
increased elastic resistance: pulmonary fibrosis fast, shallow breaths increased airflow resistance: asthma, COPD slow deep breaths
lipoprotein production in minimal change disease
increased in the liver (ie, hyperlipidemia) due to low oncotic pressure. hyperalbuminnuria.
selective vasoconstriction of the efferent arteriole
increases hydrostatic pressure in the glomerular capillaries, and therefore increases the glomerular filtration rate. as efferent arteriolar constriction continues to increase, the glomerular filtration rate begins to decrease due to flow-mediated rise in oncotic pressure in the glomerular capillaries. filtration fraction always increases with increasing efferent arteriole constriction.
gastrointestinal hormones produced by gut mucosa that stimulate pancreatic insulin secretion in response to sugar-containing meals
incretins two hormones with incretin: glucagon-like peptide (GLP) gastric inhibitory peptide these are independent of blood glucose levels and occur prior to blood glucose elevation
gastrin levels rise in response to exogenous secretin
indicate neoplasm (secretin should inhibit gastrin from normal gastric G cells) zollinger ellision syndrome
extramedullary hematopoiesis
indicated by presence of erythroid precursors in organs such as the liver and spleen. characterized by erythropoietin-stimulated, hyperplastic marrow cell invasion of extramedullary organs. most frequently caused by severe chronic hemolytic anemias, such as beta-thalassemia.
cholinmimetics
indicated for non-obstructive urinary retention, paralytic ileus, and glaucoma side effects: nausea, vomiting, abdominal cramps, diarrhea, dyspnea and increased secretions (sweating, lacrimation and salivation)
failure of prothrombin time correction with vitamin K
indicates factor VII deficiency which is often due to underlying liver disease . factors II, VII, IX, and X are vitamin K dependent coagulation factors synthesized in the liver.
increased blood oxygen saturation between 2 right-sided vessels or chambers
indicates the presence of a left to right shunt. if the abnormal oxygen increase occurs between the right atrium and the right ventricle, a VSD is likely present. small VSDs produce a holosystolic murmur that is loudest over the lower left sternal border.
inferior epigastric vessels help guide indirect and direct inguinal hernias
indirect=lateral and continue into the scrotum direct=medial ...do not protrude into the scrotum
myoglobin
individual hemoglobin molecule are structurally analogous to myoglobin. if separated, the monomeric subunits will demonstrate a hyperbolic oxygen-dissociation curve similar to that of myoglobin.
hairy cell leukemia
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. 'dry tap' with bone marrow aspiration. lymphocytes with cytoplasmic projections.
respiratory papillomatosis
infants can acquire via passage through an HPV infected birth canal. HPV is a small DNA virus with a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, including the true vocal cords, cervix, and anus.
enterohemorrhagic E. Coli O157:H7
infection is a common cause of bloody diarrhea and can lead to hemolytic uremic syndrome. it is associated with consumption of undercooked ground beef and elaborates a Shiga-like toxin capable of inhibiting protein synthesis in colonic mucosal cells and renal endothelial cells. this particular strain of E coli is unable to ferment sorbitol and does not produce a glucuronidase.
primary amebic encephalitis
infection with Naegleria fowleri free living, motile protozoan that lives in warm water. acute fever, headache, confusion, and neck stiffness. diagnosis confirmed when motile trophozoites are seen on cerebrospinal fluid wet mount.
mycobacterium avium complex
infections are a common opportunistic infection in patients with advanced AIDS. it often spreads through the reticuloendothelial system and causes nonspecific symptoms- fever, fatigue, weight loss, diarrhea, lymphadenopathy, and hepatosplenomegaly. prophylaxis with azithromycin can prevent MAC infection and is recommended for patients with AIDS who have CD4 counts less than 50.
1 of 2 branches of the external iliac artery and takes off immediately proximal to the inguinal ligament
inferior epigastric artery supply: lower anterior abdominal wall
isthmus of the horseshoe kidney lies anterior to the aorta and posterior to the
inferior mesenteric artery IMA limits ascent o the horseshoe kidney
crohn disease
inflammatory bowel disease characterized by patchy inflammation that can occur throughout the entire gastrointestinal tract. gross path shows skip lesions, cobblestoning of the mucosa, bowel wall thickening, and creeping fat. vs. ulcerative colitis contiguous inflammation that extends from the rectum. ulcerations are shallow and involve only mucosa and submucosa; pseudopolyps are seen.
TNF-alpha cytokine produced by macrophages must target with autoimmune condition
infliximab: monoclonal antibody to TNF-alpha etanercept: recombinant TNF receptor fusion protein
secondary bacterial pneumonia
influenza infection alters the respiratory epithelium and can increase the risk of secondary bacterial pneumonia. the leading pathogens are Strep. pneumoniae, Staph. aureus, and haemophilus influenza. elderly are affected most commonly but S aureus can affect young healthy patients.
beta blockers
inhibit renin release by blocking beta-1 receptor mediated regulation of RAAS system--results in decreased ATI/II, aldosterone
bile acid-binding resins
inhibit the enterohepatic circulation of bile acids. this leads to diversion of hepatic cholesterol to synthesis of new bile acids, increased uptake of cholesterol from the circulation, and reduced blood LDL levels. however bile acid binding resins increase hepatic production of triglycerides and can cause hypertriglyceridemia.
common side effect of Atropine
intraocular pressure may precipitate acute closed angle glaucoma
prolactin inhibition and secretion
inhibited by hypothalamic dopaminergic pathways but secretion is stimulated by thyrotropin releasing hormone. in patients with hypothyroidism, the increased production of TRH by the hypothalamus can lead to hyperprolactinemia
BB decrease bp by
inhibiting renin release by JGC through antagonism of beta-1 receptors on these cells decrease RAAS also leads to decreased renal sodium and water retention
normally filtered at glomerulus and completely rebasorbed by the proximal convoluted tubule
inhibition of Na+ couple carrier mediated transport of glucose by proximal tubule would cause: glucose clearance to approach value of GFR typically estimated by clearance of inulin
selegiline
inhibitor of MAO type B and can prevent MPTP induced damage of dopaminergic neurons used to delay progression of parkinson disease. neurologist use combinations of selegiline, anticholinergics, and amantadine until they no longer provide control of symptoms. only then is levodopa/carbidopa introduced.
Bcl-2 normally
inhibits apoptosis and promotes survival of tumor cells oncogene
ethanol
inhibits gluconeogenesis and can cause hypoglycemia once hepatic glycogen stores are depleted.
tuberoinfundibular pathway
inhibits prolactin secretion. disruption by tuberoinfundibular pathway D2 receptor blocking antipsychotics may cause hyperprolactinemia with galactorrhea and amenorrhea. other pathways: mesolimbic and mesocortical pathways for congition and behavior regulation. nigrostriatal pathway for regulating coordination of voluntary movements.
mechanism of action of colchicine
inhibits tubulin polymerization into microtubules side effects: nausea, abdominal pain, and diarrhea.
ganciclovir
inhibits viral synthesis by blocking CMV DNA polymerase. it also blocks host DNA polymerase to a lesser degree, which leads to hematologic side effects-- neutropenia, anemia, and thrombocytopenia.
Trendelenberg sign/gait
injections given at superomedial part of the buttock risk injury to the superior gluteal nerve. this leads to trendelenberg sign. injections at the superomedial, inferomedial, and inferolateral regions of the buttock risk injury to the sciatic nerve. the superolateral quadrant of the buttock is a relatively safe site for intragluteal injections, although the anterolateral gluteal region is preferred.
preventable adverse event
injury to a patient due to failure to follow evidence-based best practice guidelines.
foot droop and eversion with toe extension dysfunction
injury to common peroneal nerve usually at neck of fibular by compression or fracture loss of sensory to dorsum of foot
musculocutaneous nerve
innervates the major forearm flexors (eg, biceps brachii, brachialis) and coracobrachilalis (flexes and adducts the arm) and provides sensory innervation to the lateral forearm. it is derived from the upper trunk of the brachial plexus (C5-7) and can be injured by trauma or strenuous upper extremity exercise.
crohn disease
insidious onset of abdominal pain, diarrhea, and weight loss and fever. prone to fistulas/abscesses as lesion affect the entire thickness of the bowel wall. perianal disease (eg, skin tags, fissures) also common.
pleiotropy
instances where multiple phenotypic manifestations result from a single genetic mutation. most syndromic genetic illnesses exhibit pleiotropy.
fluid in the pleural space
insulate sound vibrations that originate in the airways. decreased tactile fremitus and decreased intensity of breath sounds. high density of pleural fluid compared to normal lung tissue also causes dullness to percussion.
superantigens (TSS)
interact with major histocompatibility complex molecutles on antigen-presenting cells and the variable region of the T lymphocyte receptor to cause nonspecific, widespread activation of T cells. the results in the release of IL2 from the T cells and IL1 tumor necrosis factor from macrophages. --leading to TSS.
selective COX2 inhibitor for gout treatment
interleukin 1 and TNF alpha activation celecoxib minimal effect on COX1 and so minimal gastroduodenal toxicity
ureters lie anterior to
internal iliac artery posterior to gondal vessels
during initial phase of ARDS
intersitial and intraalveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes.
downregulation of gastric acid secretion
intestinal influences- ileum and colon release peptide YY which binds to ECLs counteracting cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine release from ECLs.
integration of double stranded HIV DNA
into the host cell's chromosomes is necessary to induce viral gene expression and prevent degradation of the viral genome. Raltegravir is an integrase inhibitor that disrupts HIV genome integration, preventing synthesis of viral mRNA.
HZV histology
intranuclear inclusions in keratinocytes and multinucleated giant cells
after a total gastroectomy
intrinsic factor is a glycoprotein that is normally secreted by parietal cells in the stomach and is necessary for the absorption of vitamin B12 in the ileum. patients who have undergone a total gastrectomy require lifelong vitamine B12 due to inability to produce IF. pepsin and HCI is not required due to pancreatic and intestinal proteases.
markers for renal function
inulin and mannitol ...no tubular reabsorption or secretion (goes right through) glucose, sodium, urea ...net tubular reabsorption PAH & creatinine ....net tubular secretion
kidney filtration
inulin=GFR and so if glucose is blocked at PCT and cannot be reabsorbed then it's clearance is approximately that of insulin.
kaposi's sarcoma
involve skin and GI tract and is common in HIV patients not on antiretroviral therapy. reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or polyploid masses. biopsy show spindle cells, neovascularization, and extravasated RBCs.
diabetic mononeuropathy
involves CN III caused by central ischemia, which affects the somatic nerve fibers but spares peripheral parasympathetic fibers. symptoms include ptosis, a 'down and out' gaze, and normal light and accommodation reflexes.
adhesion of cells to the extracellular matrix
involves integrin-mediated binding to fibronectin, collagen, and laminin. differential expression of integrin subtypes affects adhesion properties of individual cells, and has been found to correlate with malignant behavior in a number of tumors.
factitious disorder
involves the conscious and deceptive feigning or self-production of physical or psychological symptoms to obtain attention and medical care from health care personnel. there is an absence of obvious rewards. vs. malingering which is for personal gain-financial, benefits, time off from work, etc.
renal plasma flow
is RPF=PAH clearance=(urine[PAH] x urine flow) / plasma [PAH] RBF=(PAH clearance)/(1-hematocrit)
dietary fructose
is Phosphorylated in the Liver to Fructose 1 Phosphate and Rapidly Metabolized, because it Doesn't Pass through PFK 1, which is a Regulatory Enzyme of Glycolysis.
Oppositional defiant disorder
is a behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures. it does not involve the more severe violations of the basic rights of others seen in conduct disorder.
chemokine receptor CCR5
is a coreceptor that enables the HIV virus to enter cells. Blockade of CCR5 by chemokine receptor antagonists prevents viral entry into host cells.
legionella pneumophila
is a facultative intracellular gram-negative bacillus that can cause a systemic infection. symptoms frequently include high fever, cough, confusion, and diarrhea. most common laboratory abnormality seen with legionella pneumonia is hyponatremia, and sputum Gram stain often shows many neutrophils but few or no organisms.
poison ivy dermatitis
is a form of allergic contact dermatitis, which is a type IV hypersenstivity reaction mediated primarily by T lymphocytes. it manifests as intensely pruritic erythematous papules, vesicles, or bullae that often form linear patterns.
kartagener syndrome
is a form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. occurs due to mutations that impair the structure or function of cilia. cystic fibrosis also causes chronic respiratory infections, but it is not associated with situs inversus.
Buspirone
is a nonbenzodiazepine anxiolytic used to treat generalized anxiety disorder. it has a slow onset of action, lacks muscle relaxtant or anticonvulsant properties, and carries no risk of dependence.
Buprenorphine
is a partial opioid receptor agonist that binds with high affinity but has low intrinsic activity. in patients on long-term opioid therapy, buprenorphine can displace the other opioids and precipitate withdrawal.
adenoma to carcinoma sequence
is a series of gene mutations that leads to the development of colon andeocarcinoma. TP53 tumor suppressor gene mutation is part of the final step in the sequence and leads to malignant transformation of preexisting large adenomatous polyps. mutation of the APC tumor suppressor to KRAS protooncogene then to TP53 mutation
alpha 1 antitrypsin
is a serine protease inhibitor that regulates the activity of elastase in the lung. inherited deficiency of AAT leads to alveolar destruction and panacinar emphysema. accumulation of improperly folded AAT proteins in hepatocytes can lead to liver dysfunction and cirrhosis in some patients.
NF1
is a single, gene autosomal dominant disorder. it occurs due to mutation on the NF1 gene located on chromosome 17. Cafe-au-lait spots, multiple neurofibromas, and lisch nodules are the most common symptoms.
telomerase
is an RNA-dependent DNA polymerase that synthesizes telomeric DNA sequences that can replace the lost chromosomal ends of the telomeres. cancer cells typically contain increased telomerase activity to allow for continued proliferation.
acute acalculous cholecystitis
is an acute inflammation of the gallbladder in the absence of gallstones. it typically occurs in critically ill patients (eg, those with sepsis, severe burns, trauma, immunosuppression) due to gallbladder stasis and ischemia. clinical findings may be subtle and include fever, right upper quadrant pain, and leukocytosis.
Folic acid (B9)
is an essential cofactor in nucleic acid synthesis, and a deficiency of either folate or vitamin B12 results in megaloblastic anemia.
abetalipoproteinemia
is an inherited inability to synthesize apolipoprotein B, an important component of chylomicrons and very low-density lipoprotein. lipids absorbed by the small intestine cannot be transported into the blood and accumulate in the intestinal epithelium, resulting in enterocytes with clear or foamy cytoplasm.
zollinger-ellison syndrome
is caused by gastrin-secreting tumors (gastrinomas) involving the small intestine or pancreas. patients typically have peptic ulcers (often beyond the duodenal bulb), abdominal pain/acid reflux, and diarrhea. the condition is frequently associated with multiple endocrine neoplasia type 1.
imperforate hymen
is caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina. adolescent patients typically present with primary amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and uterus (hematocolpos).
burkitt lymphoma
is characterized by aggressive rapid growth and a 'starry sky' microscopic appearance. translocation of the c-Myc oncogene on the long arm of chromosome 8 with the Ig heavy region on chromosome 14 produces a nuclear phosphoprotein (c-Myc) that functions as a transcription activator.
liquefactive necrosis
is characterized by complete digestion and removal of necrotic tissue with formation of cystic cavity. hypoxic CNS injury is often followed by liquefactive necrosis. abscess formation due to bacterial or fungal infection also like this.
autism spectrum disorder
is characterized by impaired social communication/interactions and restricted, repetitive interests or behaviors. it can occur with or without language and intellectual impairment.
schizotypal personality disorder
is characterized by long-standing pattern of eccentric behavior, odd beliefs, perceptual distortions, and social anxiety despite familiarity.
obesessive-complusive disorder
is characterized by persistent, intrusive thoughts leading to repetitive, ritualistic behaviors. serotonergic antidepressants (SSRI) are treatment of choice.
transforming growth factor beta
is critical for fibroblast migration, proliferation, and connective tissue synthesis. increased TGF-beta activity is responsible for the hypertrophic, keloid scarring and fibrosis of the lung, liver, and kidney that occur with chronic inflammation.
mosaicism
is defined as the presence of multiple, genetically different cell lines within the body. it can results from several processes, including chromosomal nondisjunction or a mutation during the first stages of embryonic development. somatic mosaicism results in a mixture of normal and mutated somatic cells, often leading to a milder form of the disease.
prognosis of colorectal adenocarcinoma
is directly related to the stage of tumor (not to the grade!). extend of tumor expansion is characterized by stage of tumor. the degree of tumor differentiation (from well-differentiated to anaplastic) is referred to as the grade. tumor stage is the most important criteria for determining prognosis.
primary cause of morbidity in acute rheumatic fever
is heart failure from severe pancarditis. mitral stenosis develops years or decades after the original illness. joint involvement is usually transient.
perfusion and ventilation in the lung
is highest in the base of the lung and lowest in the apex; however, the variability in perfusion is greater than that in ventilation. this causes the ventilation/perfusion ratio to follow the opposite gradient. it is lowest in the base and highest in the apex.
selection of control subjects in case-control studies
is intended to provide an accurate estimation of exposure frequency among the nondiseased general population. cases and controls should be selected based on disease status, not exposure status.
work of breathing
is minimized in patients with increased elastic resistance (e.g. pulmonary fibrosis) when their respiratory rate is high and tidal volume is low (fast, shallow breaths). in contrast, patients with diseases that increase airflow resistance (e.g. asthma, COPD) breathe at a lower rate/higher tidal volume (slow, deep breaths) in order to minimize the work of breathing.
lung abscess
is most often due to aspiration of anaerobic oral bacteria such as Peptostreptococcus, prevotella, Bacteroides, and Fusobacterium species. risk factors for lung abscess include conditions that increase aspiration risk: alcoholism, drug abuse, seizure disorders, previous stroke, and dementia. CXR=air fluid level symptoms: indolent and include fever, night sweats, weight loss, and a cough producing foul-smelling sputum.
vitamin K
is necessary for the carboxylation and functionality of coagulation factors II,VII,IX, and X. newborns who do not receive prophylactic supplementation are at risk for bleeding complications. patients with cystic fibrosis are also at risk for vitamin K deficiency due to poor absorption of fat-soluble vitamins.
DVT in patient <50yrs, inherited disease?
is no change after activated protein C>>>factor V leiden factor Va resistant to inactivation by activated protein C
digital clubbing
is often associated with prolonged hypoxia. it can be found in patients with large-cell lung cancer, tuberculosis, cystic fibrosis, and suppurative lung diseases such as empyema, bronchiectasis, and chronic lung abscesses.
dietary fructose
is phosphorylated in the liver to F1P and is rapidly metabolized because it bypasses PFK-1, the major rate-limiting enzyme of glycolysis. other sugars (eg, glucose, galactose, mannose) enter glycolysis prior to PFK-1 and as a result are metabolized more slowly.
marfan syndrome
lens dislocation and aortic root dilatioin. arachnodactyly, scoliosis, and mitral valve prolapse.
protein kinase A
is responsible for the intracellular effects of the G protein-mediated adenylate cyclase second messenger system. Hormone receptors that use this system include the TSH, glucagon, and PTH receptors.
proximal ureter receives its blood supply from the renal artery whereas the distal ureter
is supplied by the superior vesical artery supply to the middle is variable and anastomatic.
cytomegalovirus retinitis
is the most common cause of disease in patients with untreated AIDS who have CD4<50/mm3. diagnosis is made by funduscopy, which typically reveals yellow-white, fluffy retinal lesions near the retinal vessels with associated hemorrhage. treatment with ganciclovir is required to prevent blindness.
echinococcus granulosus
is the most common cause of hydatid cysts. spilling of cyst contents can cause anaphylactic shock. surgical manipulation should be performed with caution.
cerebral amyloid angiopathy
is the most common cause of spontaneous lobar hemorrhage, particularly in the elderly. the most common sites of hemorrhage include the occipital and parietal lobes. amyloid angiopathy is a consequence of beta-amyloid deposition in the walls of small to medium sized cerebral arteries, resulting in vessel wall weakening and predisposition.
trochlear nerve palsy
is typically traumatic or idiopathic and presents with vertical diplopia that worsens when the affected eye looks down and toward the nose (eg, walking downstairs, up-close reading). patients may compensate by trucking the chin and tilting the head away from the affected eye.
riboflavin vitamin B2)
is used in dehydrogenase reactions involving FMN and FAD.
absorbed copper
is used to form ceruloplasmin, which accounts for 90-95% of circulating copper. senescent ceruloplasmin and the unabsorbed copper are secreted into bile and excreted in stool, which is the primary route for copper elimination.
mucosal hemorrhage and patchy areas of necrosis
ischemic colitis two mechanisms: hypoperfusion due to low CO occlusion due to atheroma, thrombosis, embolism weak lower extremity pulses=extensive athersclerosis
inadequate blood supply to the brain caused by arterial thrombosis or embolism leads to
ischemic stroke. first microscopic changes are 12-24 hours after injury and show intense eosinophilic staining of the neuronal cytoplasm. 24-72 hours-neutrophils 3-7 days-macrophage/microglia 1-2 weeks- reactive gliosis more than 2 weeks-glial scar
increased myocardial contratility and SVR with
isoproterenol beta 1 and 2 receptor agonist
occurs in lymphoid follicles located in the lymph node cortex where they form germinal centers
isotype switching requires CD40 receptor on B cell and CD40 ligand on T cells IgG= main serum immunoglobulin of the secondary response
fasting state energy use
ketone bodies produced in liver used by mitochondria of peripheral tissues brain preferentiall uses glucose, but will utilize ketones for most of its energy needs during prolonged starvation erythrocytes lack mitochondria and are unable to use ketones
horseshoe kidney
kidneys are fused at the poles. isthmus of the horseshoe kidney usually lies anterior to the aorta and posterior to the inferior mesenteric artery. during fetal development, the IMA limits the ascent of the horseshoe kidney.
ATP powered motor protein that facilitates anterograde transport of neurotransmitter containing secretory vesicles down axons to synaptic terminals.
kinesin
ELISA
known antigen fixed to surface and patient serum added add anti-human immunoglobulin antibodies coupled to peroxidase chromogen substrate added and modified by linked enzyme detectable color change
sound more audible at end expiration> decrease in lung volume brings heart closure to the chest wall
left ventricular gallops S3 and S4
mycoplasma genus
lack peptidoglycan cell walls and are resistant to agents that target cell wall such as penicillins, cephalosporins carbapenems, and vancomycin. need to be treated with antiribosomal agents (eg, tetracyclines, macrolides).
Hep C and proofreading
lacks proofreading 3' to 5' exonuclease activity in its RNA polymerase. its envelop glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation
progressive proximal muscle weakness with reduced/absent reflexes predominantly involving lower extremities usually associated with malignancy
lambert-eaton myasthenic syndrome small cell lung cancer
latissimus dorsi
large thoracolumbar muscle that originates from the iliac crest and lumbar fascia to the spinous processes of T7-12 and lower ribs, and inserts at the bicipital groove of the humerus. is innervated by the thoracodorsal nerve. primary functions include extension, adduction, and medial rotation of the humerus.
nitrates predominantly affect
large veins SM relaxation lead to venodilation leads to decrease in preload and decrease in demand
abscess formation
largely driven by neutrophil recruitment and activation leading to the release of cytotoxic granules that kill bacteria but also cause liquefying necrosis of surrounding tissue. lung abscess=several days of fever, cough with copious sputum and CXR of cavitation with air fluid level.
tabes dorsalis
late form of neurosyphillis causes progressive degeneration of the dorsal column and dorsal roots of the spinal cord. manifestations include loss of proprioception and vibratory sensation, severe lancinating pains, and sensory ataxia (wide based gait, positive Romberg sign). many patients have Argyll Robertson pupils.
directly inhibits ferrochelatase and sigma-aminolvulinic acid (ALA) dehydratase
lead
coarse erythrocyte basophilic stippling and microcytic hypochromic anemia
lead poisoning young children ingesting pain chips and industrial workers inhaling particulate lead are at risk.
cortisol increases expression of pehnylethanolamine-N-methytransverase (PNMT)
leading to increased conversion of NE to epinephrine in the adrenal medulla
alpha galactosidase A deficiency
leads to accumulation of sphingolipid globotriaosylceramide in the vascular smooth muscle, glomerular/distal tubule cells, cardiac myocytes, and dorsal root and autonomic ganglia. early manifest as neuropathic pain and angiokeratomas. then proteinuria, renal failure, left ventricular hypertrophy, TIA, stroke in adulthood.
chronic opioid use
leads to development of tolerance to analgesic effects and most side effects, with the exception of constipation and miosis. to prevent bowel complications, it is recommended that patients be treated prophylactically with adequate fluid intake and daily laxatives.
increased osteroclast activity in multiple myeloma
leads to elevated serum calcium and reduced parathyroid hormone production. this decreases renal calcium reabsorption, causing hypercalciuria. hypercalcemia and light chain cast nephropathy cause progressive renal failure, leading to reduced 1,25-dihydroxyvitamin D synthesis.
increased number of CGG trinucleotide repeats on fragile X mental retardation 1 (FMR1) gene on long arm of X chromosome
leads to hypermethylation and inactivation of FMR1 Fragile X syndrome
carotid sinus massage
leads to increase in parasympathetic tone causing inhibition of sinoatrial node activity, slowing of conduction through the AV node, and prolongation of AV node refractory period. useful in vagal maneuver for termination of paroxysmal supraventricular tachycardia.
small intestinal bacterial overgrowth post gastric bypass
leads to malabsorption of most vitamins: B12, A, D, E but increased production of folic acid and vitamin K ....leading to nausea, bloating, abdominal discomfort, and malabsorption.
mitral valve regurgitation
leads to markedly elevated left atrial pressure during atrial diastole, leading to the characteristic early and large V wave on left atrial pressure tracing.
leftward shift (decreased P50) of oxygen dissociation curve
leads to reduced ability to release oxygen within peripheral tissues--causing renal hypoxia, increased erythropoietin synthesis, and compensatory erythrocytosis.
leprosy skin test
lepromatous-macrophages remain inactivated due to inability of TH1 cells to recognize M leprae antigens. see high acid fast bacilli within macrophages and often a TH2 cytokine profile IL 4,5,10. tuberculoid- activated macrophages. see TH1 cytokine profile IL 2, 12, IFN-gamma.
Femoral nerve lesion causes:
lesions due to trauma, nerve compression, stretch injury or ischemia can cause weakness of the quadriceps muscle, loss of patellar reflex, and loss of sensation over the anterior and medial thigh and medial leg.
dietary restriction of branched-chain amino acids
leucine, isoleucine, valine treatment for maple syrup urine disease
peripheral smear: increased bands, early mature neutrophil precursors, granules (basophilic oval inclusions) in neutrophils
leukemoid reaction
URI then purpua
leukocytoclastic vasculitis perivascular inflammation of small blood vessels with fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei
stimulates neutrophil migration to sites of inflammation
leukotriene B4 others: C5a and IL-8
GnRH analog
leuprolide continuous transient increase in pituitary LH/testosterone levels then suppression and decrease
prostatic plexus
lies within the fascia of the prostate and innervates the corpus cavernosa of the penis, which facilitates penile erection. as a result, prostatectomy or injury to the prostatic plexus can cause erectile dysfunction.
neuroleptic malignant syndrome
life threatening adverse reaction ot antipsychotic medications characterized by diffuse muscle regidity, hyperthermia, autonomic instability, and altered sensorium. meds should be stopped and supportive care provided, and dantrolene can be used to reduce muscle rigidity.
paranoid personality disorder
lifelong pattern of pervasive suspicion and distrust. they do not have fixed delusions and other psychotic symptoms.
nicotinic receptors
ligand gated ion channels that open after binding acetylcholine cause immediate influx of: sodium calcium and outflux: potassium
hyperestrinism in liver cirrhosis
likely arises due to increases in androstenedione production, androgen aromatization, and sex hormone-binding globulin concentration (preferentially binds testosterone). impaired estrogen metabolism by the liver may also be a contributing factor. a decreased free testosterone/estrogen ratio leads to gynecomastia, testicular atrophy, decreased body hair, and spider angiomata---estrogen's effects on arteriolar dilation.
isthmus of aorta (right after branches)
likely to rupture due to trauma rapid deceleration isthmus: tethered by ligamentum arteriosum and is more fixed and immobile compared to descending aorta.
yellowish eyelid papule or plaque containing lipid-laden macrophages is
likely xanthelasma. occurs in association with primary or secondary hyperlipidemia. cholestatic conditions such as primary biliary cirrhosis are a potential cause of hypercholesterolemia leading to xanthelasma.
degree of overlap between healthy and diseased population curves
limits the maximum combined sensitivity and specificity of a quantitative diagnostic test. the degree to which sensitivity or specificity is affected depends on the chosen cutoff value.
increased acitvity of cyclooxgenase 2
linked to some forms of colon adenocarcinoma regular aspirin use is suggested to decrease adenomatous polyp formation.
ovarian cancer pathogenesis
linked to the frequency of trauma and repair at the ovarian surface. OCP, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation.
septic shock due to release of endotoxin in blood stream: found in outer membrane of gram negative bacteris: LPS
lipid A is the toxic component of LPS
normal PaO2 and SaO2 and low O2 content
lower hemoglobin concentration due to chronic blood loss: menstruation
Vitamin E
lipid soluble vitamin deficiency mimic friedreich ataxia ataxia (degeneration of spinocerebellar tracts), loss of position and vibration sense (degeneration of the dorsal columns, and loss of tendon relfexes (due to peripheral nerve degeneration.
lacunar infarcts caused by
lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall (arteriolar sclerosis) normal head CT and in the deep brain structures
N meningitidis sepsis and circulatory collapse due to virulence factor
lipooligosaccharide
daptomycin
lipopeptide antibiotic with activity limited to gram positive organisms, including MRSA causes depolarization of bacterial cellular membrane and inhibition of DNA, RNA, and protein synthesis.. assoicated with increased creatine phosphokinase levels and an increased incidence of myopathy.
postprandial short acting insulin
lispro aspart glulisine
hypothyroidism and nephrogenic diabetes insipidus are most common adverse effects of long term
lithium therapy serum TSH and renal function (BUN and creatinine) should be monitored routinely.
lowest risk for infarction
liver dual blood supply by hepatic artery and portal vein
disseminated candida infection
local defense against candida is performed by T cells vs. systemic infection is prevented by neutrophils. due to this, localized candidiasis is common in patients with HIV but neutropenic individuals are more likely to have the systemic form of the disease.
NE extravasation and resulting vasoconstriction can lead to necrosis and can be prevented by
local injection of alpha 1 blocking drug i.e. phentolamine
cortisol receptors
located within the cytoplasm and translocate to the nucleus after binding to their substrate. in the nucleus, the cortisol-receptor complex binds to hormone-responsive DNA elements, altering gene transcription to enhance hepatic glucose production and limit peripheral glucose utilization. cortisol and growth hormone contribute to glucose homeostasis during prolonged fasting.
newer generation antihistamines
loratidine cetirizine good for elderly
born with one germline defect in RB1 and then additional somatic mutation
loss of heterozygosity hereditary retinoblastoma risk: bilateral and multifocal retinoblastoma osteosarcoma sporadic: 2 spontaneous somatic mutations in single retinal cell= unilateral tumor.
turner syndrom (45,X)
loss of paternal chromosome X in neonates, causes lymphedema and cystic hygromas. short stature, primary amenorrhea, and aortic anomalies
fibular neck fracture can sever the common peroneal nerve
loss of sensation over the dorsum of the foot
resting membrane potential
low concentration of sodium and chloride in the cell and high concentration of potassium in they cytoplasm.
S3
low frequency sound occurring during early diastole after S2. left ventricular gallops (S3 and S4) are best heard with bell of the stethoscope over the cardiac apex while the patient is in the left lateral decubitus position at the end of expiration.
reguritant flow into LA in acute mitral regurge>> increased LA pressure and increased LVEDV (preload)>>
low resistant pathway also decreased LV afterload and a resultant increase in EF.... but overall decrease in FORWARD stroke volume
dopamine
low-dose dopamine infusion stimulates D1 receptors in the renal and mesenteric vasculator, resulting in vasodilation and increased blood flow to these sites. increasing doses of dapamine stimulates beta1 and alpha1 receptors, resulting in increased cardiac output and elevated systemic vascular resistance. at higher end of the dose range, the increase in afterload can result in decreased cardiac output.
dopamine low vs. high dose
low=D1: renal and mesenteric vessels> vasodilation and increase blood flow high=beta/alpha1: increase CO and increase SVR
direct arteriolar vasodilators
lower blood pressure but trigger reflex sympathetic activation and stimulate the renin-angiotensin-aldosterone axis. this results in tachycardia and edema. to counteract such compensatory effects, these agents are often given in combination with sympatholytics and diuretics.
V/Q gradient in lung with patient standing
lowest at the base and highest at the apex due to variability in perfusion greater than ventilation (even though both are highest at the base of the lung and lowest at the apex)
several days of fever, cough productive of copius sputum (foul smelling), and CXR= cavitation with air fluid level
lung abscess activated neutrophils release cytotoxic granules (lysosomes) containing myeloperoxidase and other digestive enzymes that destroy extracellular bacteria
between 1950-2000, rising rates of tobacco use resulted in an increase in
lung cancer incidence and mortality
reverse transcription polymerase chain reaction used to detect and quantify levels of
mRNA in a sample (messenger RNA transcript containing BCR and ABL exons)
suffix of biological agent indicates what type of med it is
mab= monclonal antibody cept=receptor molecule nib=kinase inhibitor
hydrocephalus in infants
macrocephaly and poor feeding enlarged ventricles untreated leads to spasticity due to stretching of the periventricular pyramidal tracts, developmental delays, and seizures.
6-mercaptopurine
mainly degraded in the liver by xanthine oxidase. allopurinol (XP inhibitor), can increase the concentration of 6-MP significantly. both 6-MP and 6-thioguaninee are prodrugs that require activation by hypoxanthine-guanine phosphoribosyl transferase.
vitamin A
maintains differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjuctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts. avitaminosis A can cause squamous metaplasia of such epithelia to a keratinizing epithelium. CF leads to ADEK vitamin deficiency
steady state plasma [ ] times clearance divided by bioavailability
maintenance dose bio fraction= 1 if IV
Anti-hemagglutinin antibodies
major adaptive immune mechanism that prevents reinfection with the influenza virus.
ventral pancreatic bud is a precursor to
major pancreatic duct dorsal pancreatic bud: majority of pancreatic tissue
alpha-1-antitrypsin (AAT)
major serum inhibitor of extracellular elastase typically develop early-onset panacinar emphysema due to unchecked elastase activity. exposure to smoke dramatically accelerates the development of emphysema in patients with AAT deficiency and should be avoided.
multiple origins of replication
make eukaryotic DNA replication quick and effective despite the large size and complexity of the genome compared to that of prokaryotic organisms.
choriocarcinoma
malignant form of gestational trphoblastic disease composed of anaplastic cytotrophoblasts and syncytiotrophoblasts without villi. it often presents as dyspnea/hemoptysis due to pulmonary metastasis from hematogenous spread.
older children with absence seizures
may also develop generalized tonic-clonic or myoclonic seizures. although ethosuximide is effective against isolated absence seizures, it does not suppress tonic-clonic seizures. valproate is used for both types of seizures.
enhancers and silences
may be located upstream, downstream, or within a transcribed gene; these gene sequences function to increase and decrease the rate of transcription, respectively. promoter regions are typically located 25 or 75 bases upstream from their associated genes and function to initiate transcription.
paraneoplastic syndrome of hypercoagulability
may be seen in some patients with cancer, especially adenocarcinomas of the pancreas, colon, or lung. superficial venous thromboses may therefore appear in one site and then resolve, only to recur in another site==Trousseau syndrome (migratory superficial thrombophlebitis), an indication of visceral cancer.
medically intractiabl esymptoms of parkinson disease
may benefit from high-frequency deep brain stimulation of the globus pallidus internus or subthalamic nucleus as it promotes thalamo-cortical disinhibition with improved mobility.
odds ratio
measure of strength of an asso. between an exposure and outcome. odds that an outcome occurred in the presence of a particular exposure compared with the odds that the outcome occurred in the absence of that exposure. OR=ad/bc
korotkoff sounds
measures pulsus paradoxus inflate bp cuff above systolic pressure and gradually deflate. first audible during expiration and the pressure at which they are heard through all phases of respiration quantifies pulsus paradoxus.
rupture of the left ventricular free wall
mechanical complication of anterior wall myocardial infarction that usually occurs within the first 5-14 days after MI. rupture leads to hemopericardium and cardiac tamponade, causing profound hypotension and shock with rapid progression to pulseless electrical activity and death.
increased intestinal iron absorption decreased hepcidin
mechanisms to increase iron due to: mutation of HFE protein cause enterocytes and hepatocytes to sense falsely low iron levels.
ACE inhibitors effect on kidneys?
mediates vasoconstriction of efferent renal arterioles. leading to a reduction in renal perfusion, GFR, and renal filtration fraction. for patients with bilateral renal artery stenosis, use of ACE inhibitors should be closely monitored as they can participate acute renal failure.
trigger IgE independent mast cell degranulation: diffuse itching and pain, bronchospasm, and localized swelling (urticaria)
meds: opioids radiocontrast agents antibiotics: vancomycin
acute tubular necrosis predominantly affects the renal
medulla terminal proximal tubules and thick ascending limb of the loop of henle- they are in medulla
multiple endocrine neoplasia type 2B
medullary thyroid cancer, pheochromocytoma, marfanoid habitus, and oral and intestinal mucosal neuromas.
urethral injury
membranous segment of urethra in male, below prostate, is the weakest point. injury associated with pelvic fractures. the anterior urethra is most commonly damaged in saddle injuries. inability to void with a full bladder sensation, a high-riding boggy prostate, and blood at the urethral meatus are suggestive of urethral injury, particularly in the presence of a pelvic fracture. if urethral injury is suspected, placement of a foley catheter is contraindicated.
most common presentation of Cryptococcus neoformans infection
meningoencephalitis pulmonary cryptococcus N. usually: asymptomatic cough, scant sputum, dyspnea, pleuritis chest pain
tricyclic antidepressant overdose
mental status changes, sezures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings. sodium bicarbonate is used to treat associated cardiac toxicity and works by increasing serum pH and extracellular sodium (alleviating fast sodium channel blockade).
Confidence interval
meta analysis groups results of several trials to increase statistical power and provide an overall pooled effect estimate. if confidence interval doesn't include the null value, then the result is statistically significant.
gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of henle, and distal convoluted tubules.
metanephric mesoderm
schistocytes suggest
microangiopathic hemolytic anemia HUS, TTP, DIC, or mechanical damage. coagulation studies are normal in HUS-TTP but abnormal in DIC.
thrombotic thrombocytopenic purpura
microangiopathic hemolytic anemia and thrombocytopenia are essential to diagnosis neurologic symptoms are not present in 1/3 of patients
predominant cell in the necrotic area 3-7 days after onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris.
microglia
flial scar
microglia move to area of ischemic infarct approximately 3-5 days after the onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris. a cystic space replaces the necrosis, and astrocytes form a glial scar along the periphery.
HIV assiciated dementia
microglial nodules- groups of activated microglia/macrophages around small areas of necrosis- and multinucleated giant cells
kinesin
microtubule-asso., ATP powered motor protein that facilitates the anterograde transport of neurotransmitter containing secretory vesicles down axons to synaptic terminals.
damage to the brainstem at/below the level of the red nucleus
midbrain tegmentum, pons results in decererate (extensor) posturing. vs. damage to neural structures above the red nucleus- cerebral hemispheres, internal capsule. typically results in decorticate (flexor) posturing.
midgut volulus, intestinal obstruction, fibrous bands connecting retroperitoneum in RLQ to the right colon/cecum
midgut malrotation (i.e. around SMA)
intestinal malrotation
midgut undergoes incomplete embryological counterclockwise rotation. it can present as intestinal obstruction (due to compression by the adhesive bands) and midgut volvulus (intestinal ischemia due to twisting around the blood vessels).
termination of first trimester pregnancy
mifepristone is a progesterone antagonist (progesterone is necessary for implantation and maintenance of pregnancy), that is used with misoprostol- a prostaglandin E1 agonist. methotrexate is a folic acid antagonist and can also be used in termination of pregnancy.
PDE3 inhibitor leading to cAMP increase and venous dilation
milrinone
selective phosphodiesterase (PDE)-3 enzyme inhibitor
milrinone and inamrinone lead to cAMP increase increase contractility and also systemic vasodilation don't use in hypotensive patient
sickle cell disease
missense mutation that causes valine to replace glutamic acid at position 6 in the hemoglobin beta globin chain RNA contains the pyrimidine base uracil, whereas DNA contains the base thymidine.
MAO
mitochondrial enzyme that breaks down monoamine neurotransmitters (eg, dopamine, norepinephrine, serotonin). Tyramine-induced hypertensive crisis can occur in patients taking MAO inhibitors who consume foods containing high amounts of tyramine (eg, aged cheeses, cured meats, draft beer).
native valve infective endocarditis predisposing condition
mitral valve prolapse with regurgitation RHD remains a frequent IE in developing nations
elevated left atrial pressure during systole (seen on pressure waves)
mitral valve regurge mitral stenosis: elevated pressure throughout
Cytomegalovirus (CMV)
monospot test is positive in most cases of epstein barr virus-associated mononelosis. in immunocompetent patients with a heterophile antibody-negative mononucleosis-like syndrome, the most likely diagnosis is CMV
chronic renal allograft rejection
months to years after transplant. worsening hypertension and slowly rise in serum creatnine. mediated by chronic, indirect immune response against donor alloantigens and results in obliterative intimal thickening, tubular atrophy, and interstitial fibrosis.
major depressive disorder psychotic
more than or equal to two weeks of depressed mood, impaired concentration, decreased appetite/weight loss, sleep disturbance, and suicidal ideation. psychotic symptoms: delusions of causing evil, auditory hallucinations
NSAID-associated chronic renal injury
morphologically characterized by chronic interstitial nephritis and papillary necrosis.
glycine
most abundant amino acid in collagen. triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each alpha chain, in which glycine occupies every third amino acid position.
cytochrome P450 oxidase (microsomal monooxygenase) system
most chemical carcinogens enter the body in an inactive state (ie, as procarcinogens). these pro-carcinogens are converted into active metabolites by the cytochrome P450 oxidase system. individual susceptibility to chemical carcinogens depends on the activity of these P450 enzymes, which is genetically determined.
classic galactosemia
most common and severe galactosemic disorder and presents within days of birth with jaundice, vomiting, and hepatomegaly. autosomal recessive
cavernous hemangioma
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 biopsy of a suspected hemangioma is not advisable, as the procedure has been known to cause fatal hemorrhage and is of low diagnostic yield.
enterovirus
most common cause of aseptic meningitis.
inadequate canalization of ureteropelvic junction
most common cause of unilateral fetal hydronephrosis due to high compliance.
accessory nipples
most common congenital breast anomaly resulting from failed regression of mammary ridge in utero. they are usually asymptomatic but can become tender along with breast tissue during times of hormonal fluctuation.
congenital CMV
most common eye related complication is chorioretinitis.
down syndrome
most common genetic cause of intellectual disability. short neck, low set ears, epicanthnic folds, and slanted palpebral fissures. karyotype with 47 chromosomes with 3 copies of chromosome 21.
von willebrand disease
most common inherited bleeding disorder. has autosomal dominant pattern of inheritance and variable penetrance. absence of von willebrand factor leads to impaired platelet function (prolonged bleeding time) and coagulation pathway abnormalities due to decreased factor VIII activity (prolonged partial thromboplastin time).
deltaF508
most common mutation of CF transmembrane regulator protein in patients with cyctic fibrosis. this mutation leads to protein misfolding and failure of glycosylation, followed by proteasome-mediated degradation and significantly decreased number of transmembrane CFTR.
epithelial ovarian cancer
most common ovarian malignancy. histologic findings include anaplasia of epithelial cells with invasion into the stroma, along with multiple papillary formations with cellular atypia. epithelial ovarian tumors produce CA-125, which can be used as serum marker for this condition.
germinomas
most common pineal gland tumor and present with obstructive hydrocephalus and dorsal midbrain (parinaud) syndrome. germinomas in the suprasellar region cause endocrinopathies due to pituitary/hypothalamic dysfuntion.
fibrinous pericarditis
most common type of pericarditis and is characterized by pericardial inflammation with a serous, fibrin-containing exudate in the pericardial space. pleuritic chest pain and a triphasic friction rub are frequently seen. common causes include viral infection, myocardial infarction, uremia, and rheumatologic disease (SLE, RA).
aplastic anemia
most commonly due to a toxic effect or autoimmune response causing apoptosis of pluripotent stem cells (pancytopenia). bone marrow biopsy reveals hypocellularity with an abundance of fat cells. fanconi anemia-inherited cause of AA that presents with short stature and absent thumbs and has increased risk of malignancy.
asthma and COPD exacerbation
most frequent causes of pulsus paradoxus in the absence of significant pericardial disease. beta-adrenergic agonists control acute asthma and COPD exacerbations bu causing bronchial smooth muscle relaxation via increased intracellular cAMP
renal disease caused by light chain cast nephropathy
multiple myeloma free light chains form obstructive casts in the renal tubules. osteolytic lesions, hypercalcemia, anemia, or acute kidney injury. monoclonal paraproteins are not detected by urine dipstick (which detects only albumin) but both spot and 24 hour protein concentrations will be elevated. intact immunoglobulins, IgA, IgG, IgM, are too large to pass through the glomerulus.
brachial plexus C5-C7 derived nerve
musculocutaneous motor: forearm flexors sensory: lateral forearm
vitamin K: gamma carboxylation of coagulation factors: II, VII, IX, X
must for newborns especially CF patients due to low absorption of fat-soluble vitamins (K)
hypothyroid myopathy
myalgias, proximal muscle weakness, elevated creatine kinase levels, and delayed relaxation of deep tendon reflexes. diagnosis can be confirmed with an elevated TSH level. other common causes of myopathy with elevated CK levels are inflammatory myopathies, muscular dystrophies, and HMG-CoA reducatase inhibitors.
DNA-binding proteins include transcription factors
myc, CREB steroid receptors (cortisol, aldosterone, progesterone) thyroid hormone receptor fat soluble vitamin receptors (vitamin D, retinoic acid) DNA transcription and replication proteins.
TB cord factor
mycobacterium tuberculosis intracellular pathogen: this blocks phagolysosome acidification and leads to formation of caseating granulomas
genomes or organisms
mycoplasma: single, circular DNa fungi: diploid DNA viruses: haploid DNA
subacute combined degeneration
myelopathy associated with vitamin B12 deficiency. degeneration of both the ascending (dorsal columns) and descending (corticospinal tract) pathways. loss of position and vibration sensation, ataxia, and spastic paresis are common manifestations.
polycythemia vera
myeloproliferative disorder characterized by uncontrolled erythrocyte production. virtually all patients with polycythemia ver have a mutation in JAK2, a non-receptor (cytoplasmic) tyrosine kinase associated with the erythropoietin receptor.
common primary cardiac tumor>>most arise in the left atrium peduncluated mass- scattered cells within a mucopolysaccharide stroma
myxoma
primary cardiac neoplasm
myxomas arise in left atrium. cause mitral valve obstruction of mitral valve leading to diastolic murmur and decreased CO dyspnea, syncope, fever, weight loss scattered cells within a mucopolysaccharide stroma and abnormal blood vessels with hemorrhaging.
treat opioid intoication/overdose
naloxone pure opioid receptor antagonist greatest affinity to mu receptors
undetectable levels of hypocretin-1
narcolepsy hypocretin-1 and 2: produced in hypothalamus promote wakefulness inhibit REM sleep-related phenomena
vitamin C
necessary for hydroxylation of proline and lysine residues in pro-collagen. vitamin C deficiency (scurvy) often in malnuourished individuals and leads to capillary bleeding, poor would healing, and periodontal disease. in children, bony deformities and subperiosteal hemorrhages are also characteristic.
probability of not having a disease given a negative test result
negative predictive value NPV=#true negatives/total number of negative tests
membranous glomerulopathy
nephrotic syndrome in adults solid malignancy, viral hepatitis, and SLE 'spike and dome' appearance
pharmocologic nitrates
nitroglycerin, isosorbide mononitrate, isosorbide dinitrite are metabolized by NO and S-nitrothiols in vascular smooth muscle cells, leading to an increase in cyclic guanosine monophosphate (cGMP) that stimulates vasodilation. large veins are predominantly affected, leading to increased venous capacitance and reduced venous return (preload), which decreases left ventricular wall stress and myocardial oxygen demand to relieve anginal symptoms.
decrease preload and afterload with SV maintained
nitroprusside short acting venous and arterial vasodilator.
undifferentiated (anaplastic) tumors
no resemblance to the tissue of origin composed of pleomorphic cells with large, hyperchromatic nuclei that grow in disorganized fashion. also contain numerous, abnormal mitoses and giant tumor cells.
digoxin toxicity
nonspecific GI and visual symptoms--nausea, vomiting, confusion, weakness. elevated potassium is another sign due to inhibition of Na-K-ATPase pumps.
digoxin toxicity
nonspecific GI--anorexia, nausea, vomiting, neurologic--fatigue, confusion, weakness changes in color vision are a more specific but rare finding. life threatening ventricular arrhythmias are the most serous complication.
janeway lesions
nontender, macular, and erythematous lesions typically located on the palms and soles of patients with acute infective endocarditis and are the result of septic embolization from valvular vegetations. can also develop osler nodes and splinter hemorrhages.
diagnostic tests for syphilis
nontreponemal: antibody to cardiolipin-cholesterol-lecithin antigen (RPR, VDRL) treponemal: antibody to treponemal antigens (FTA-ABS, TP-EIA)
part of normal flora in upper respiratory tract are common cause of acute otitis media, sinusitis, and bronchitis do not form a polysaccharide capsule
nontypeable strains of Haemophilus influenzae
normal circulating testosterone levels low concentration of testosterone in seminiferous tubules
normal HPG axis and leydig cells dysfunction sertoli cells: not making adequate androgen binding protein
adenoma to carcinoma sequence
normal colon APC inactivation hyperproliferative epithelium KRAS activation adenoma p53 inactivation carcinoma
Viridans streptococci
normal inhabitants of the oral cavity and are a cause of transient bacteremia after dental procedures in healthy and diseased individuals. in patients with pre-existing valvular lesions, viridans strep can adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis. vs. staph aureus which can infect intact valves.
measures of central tendency
normal-mean, median, and mode are all at the center. negatively skewed-the 'hill is sliding to the left' and the mode is at top, median after that and mean after that. positively skewed-'hill is sliding to the right'
intravascular catheters associated with
nosocomial bloodstream infections allow skin bugs: staph A and staph epi to enter bloodstream
adrenal insufficiency
not able to increase glucocorticoid production in response to acute stress. adrenal crisis characterized by severe hypotension, abdominal pain, vomiting, weakness, and fever. aggressive fluid resuscitation, treatment requires immediate glucocorticoid supplementation.
highest risk factor for HPV infection
not using consistent barrier contraceptives for STI prevention carcinogenic strains are: 16, 18, and 31
preschool age children's ideas on death are
not yet developed; think it is temporary or reversible and that people's grief is their fault. finality of death understood around age 7.
site of ribosomal subunit maturation and assembly
nucelolus ..a round, basophilic body within the nucleus RNA polymerase I ...functions in nucleolus to transcribe the 45S pre-rRNA gene= codes for ribosomal RNA components
cumulative incidence
number of new cases of a disease over a specific period divided by total population at risk at the beginning of the study
number needed to treat
number of patients that need to be treated with a medication to avoid an additional negative outcome. NNT is calculated by dividing 1 by the absolute risk reduction (the difference between the control and experimental group event rates). lower NNT values present more beneficial treatments.
vitamin B12 deficiency
obtained through diet from animal sources, which places strict vegans at risk for dietary deficiency. this deficiency takes years to develop due to the large hepatic B12 reserve--4-5 years presents with megaloblastic anemia and potentially irreversible neurologic deficits--paresthesias, weakness, ataxic gait
malaria
p ovale and p vivax: have dormant hepatic phase and can reactivate several months after return. treat: primaquine p falciparum does not have dormant phase
paraneoplastic syndromes
occur due to production of hormone like substances from tumor cells. can also be immune reaction against tumor cells that cross react with normal cells. neurologic paraneoplastic syndromes are autoimmune.
apoptosis
occur through intrinsic (mitochondria-mediated) pathway or the extrinsic (receptor-initiated) pathway. both converge in the activation of caspases. caspases are proteolytic enzymes that cleave cellular proteins.
features of malignant cause of back pain
occurrence at night not relieved with rest/analgesics advanced age systemic symptoms
abacavir hypersensitivity reaction
occurs in 2-8% of patients and is strongly associated with the HLA-B*57:01
dystrophic calcification
occurs in damaged or necrotic tissue in the setting of normal calcium levels; metastatic calcification occurs in normal tissue in the setting of hypercalcemia.
staphylococcal scalded skin syndrome
occurs in infants and children due to the production of the exotoxin exfoliatin by staphylococcus species. causes widespread epidermal sloughing, especailly with gentle pressure (nikolsky's sign).
DNA replication
occurs in the 5' to 3' direction on both strands. in contrast to the continuous synthesis of the leading strand, lagging strand synthesis occurs discontinuously and is composed of short stretches of RNA primer plus newly synthesized DNA segments (Okazaki framents). as a result, lagging strand synthesis requires the repetitive action of DNA primase and DNA ligase.
menopause
occurs on average at age 51 and is diagnosable retrospectively after 12 months of amenorrhea. an elevated serum FSH level confirms the diagnosis. patient can have hypoestrogenic symptoms: hot flashes and vaginal dryness.
kozak consensus sequence
occurs on eukaryotic mRNA and is defined by; (gcc)gccRccAUGG, in which R is either adenine or guanine. this sequence helps initiate translation at the methionine start codon (AUG)
urinary acid excretion
occurs primarily in the form of NH4+ and titratable acids (H2PO4-). in metabolic acidosis, urinary pH decreases due to increased excretion of free H+, NH4+, and H2PO4-. bicarbonate is completely reabsorbed from the tubular fluid in acidotic states.
mycobacterial antibiotic resistance
occurs when active TB is treated with drug monotherapy. results in rapid, selective gene mutations. isoniazid monotherapy may be used for patients who have a positive PPD and a negative chest x-ray.
superior mesenteric artery syndrome
occurs when the transverse portion of the duodenum is entrapped between the SMA and aorta, causing symptoms of partial, intestinal obstruction. occurs when aortomesenteric angle critically decreases, secondary to diminished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis.
tumor lysis syndrome
occurs when tumors with a high cell turnover are treated with chemotherapy. they lysis of tumor cells causes intracellular ions, potassium and phosphorous, and uric acid to be released into serum. uric acid is soluble at physiologic pH, but it can precipitate in the normally acidic environment of distal tubules and collecting ducts. prevention=urine alkalization with hydration and/or allopurinol.
posttranslational cleavage of protective and signaling sequences within/outside the cell or origin
occurs with proteins that are destined for secretion from the cell. removal of nonfunctional polypeptide sequences once the protein has reached its target site--by specific endoproteases.
significant renal hypoperfusion leads to hyperplasia
of JG cells in afferent arteriole of nephron due to JG increasing renin secretion to combat hypoperfusion
phosphorylation of serine and threonine residues
of insulin receptor and insulin receptor substrate by serine kinase leads to insulin resistance. this type of phosphorylation can be induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon.
moderately elevated alkaline phosphatase
of unclear etiology should be followed up with a gamma-glutamyl transpeptidase. help distinguish is hepatic or bone origin (is elevated then liver).
small PDA
often asymptomatic and found incidentally at left sternal border
biotin acts as a CO2 carrier
on the surface of carboxylase enzymes and is an essential cofactor for numerous reactions, including the conversion of pyruvate to oxaloacetate and fatty acid metabolism. excess ingestion of avidin, found in egg whites, has been associated with biotin deficiency. this condition presents with mental status changes, myalgias, anorexia, macular dermatitis, and lactic acidosis.
acute effects of corticosteroids
on the white blood cell count include an increased neutrophil count and decreased lymphocyte, monocyte, basophil, and eosinophil counts. the increase in the neutrophil count results from 'demargination' of neutrophils previously attached to the vessel wall. can also cause corticosteroid-induced psychosis.
reticulocyte count increases dramatically
once vitamin B12 is administered hemoglobin and erythrocyte count levels rise more gradually and take up to 8 weeks to normalize
permissiveness
one hormone allows another to exert its maximal effect. cortisol exerts this effec on many hormones to help improve the response to a variety of stressors. ----cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.
vascular smooth muscle cells
only cells in within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matrix components. progressive enlargement of the plaque results in remodeling of the extracellular matrix and VSMC death, promoting development of vulnerable plaques with an increased propensity for rupture.
env gene- gp 160
only one that is glycosylated. subsequently cleaved in the golgi apparatur to form the envelope glycoproteins gp120 and gp41. responsible for immune evasion and host cell binding.
phase 2: plateau of AP in cardiomyocytes
open of L-type Ca++ channels close some K+ channels
pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness for 6 or more months
oppositional defiant disorder defies authority figures and refuses to follow rules easily annoyed, angered, resentful, or vindictive blames others for own mistakes deliberately annoys others
fetopathy due to ACE inhibitors
or angiotensin II receptor blockers- angiotensin II is necessary for normal renal development. use of these antihypertensive drugs during pregnancy can result in fetal anuria, oligohydramnios, pulmonary hypoplasia, limb contractures, and calvarium defects.
postoperative hypoparathyroidism treatment
oral calcium and vitamin D
psoas muscle
originates at the anterior surface of the transverse processes and lateral surface of the vertebral bodies at T12-L5. acts primarily to flex the thigh at the hip and lateral rotation and abduction of the thigh. intraabdominal or distal infections can spread to this. abdominal pain, fever, and weight loss.
prevents release of newly formed viral particles
oseltamavir inhibits neuraminidases that usually cleave and release
telangiectasias of skin and mucous membranes: lips, oronasopharynx, respiratory tract, GI tract, urinary tract
osler-weber-rendu syndrome= hereditary hemorrhagic telangiectasia autosomal dominant rupture of telangiectasias: epistaxis GI bleed hematuria
impaired synthesis of type 1 collagen by osteoblasts
osteogenesis imperfecta type 1 collagen: predominant in osteoid
defective synthesis of type 1 collagen by osteoblasts
osteogenesis imperfecta findings: fractures after minimal trauma, blue sclerae, and small, malformed teeth. transmitted by autosomal dominant inheritance.
imaging of bone metastases
osteolytic or osteoblastic bony pain in an older man with osteoblastic lesions on imaging is suspicious for prostate cancer.
low bone mass fragility fractures normal Ca and PTH
osteoporosis
vitamin D deficiency due to poor diet, inadequate sunlight, or GI malabsorption can lead to
ostomalacia decreased mineralization of osteoid
atypical lymphocytes in EBV infection
overserved in peripheral blood smears of patients with EBV represent activated CD8+ cytotoxic T-lymphocytes. these activated T-lymphocytes function ot destroy virally-infected B-lymphocytes.
parent's authority to make medical decisions for their children can be challenged in cases in which
parents a child is at significant risk for harm. physicians are justified in obtaining a court injunction to proceed with life saving medical treatment of the child.
nontypeable strains of H flue
part of normal upper respiratory tract flora cause otitis media, sinusitis, and bronchitis do not form polysaccharide capsule, immunity not conferred by vaccination
aplastic crisis in sickle cell anemia and other chronic hemolytic disorders
parvovirus B19 nonenveloped single stranded DNA virus
inflammation is characterized by
passage of circulating inflammatory leukocytes into the inflamed tissue. the steps involved include margination (increased vascular leakage leading to hemconcentration and decreased wall shear stress--contact of neutrophils with endothelial lining), rolling (roll on endothelium via loose binding of sialyated carbohydrate groups), activation (sample chemokines secreted by inflamed tissue activating integrins by inducing signaling cascade leading to conformational change in integrins necessary for binding), tight adhesion and crawling (tightly attached to endothelium via CD18 beta 2 integrins to ICAM-1), and transmigration (migrate out of vasculature and adhering to PECAM1).
mouse like ordor and cellulitis 24 hours after dog/cat bite
pasteurella multocida
warfarin induced skin necrosis
patients on warfarin develop transient hypercoagulable state due to the short half life of protein C. this is further exaggerated by preexisting protein C deficiency and can result in thrombotic occlusion of the microvasculature with skin necrosis.
nitrate free period
patients taking daily maintenance nitrates need to have a nitrate-free period every day to avoid tolerance to the drug. may be due to decreased vascular sensitivity to nitrates and an increased sensitivity to endogenous vasoconstricting agents.
reactivation of JC virus
patients with advanced AIDS cause progressive leukoencephalopathy confusion, ataxia, and motor deficits. multifocal areas of white matter demyelination with no mass effect or enhancement
antisocial personality disorder
pattern of violating the rights of others, engaging in unlawful behaviors (eg, physical aggression, illegal occupations), and lacking remorse for transgressions. individuals must be 18 or older and have history of conduct disorder prior to age 15.
maternal serum quadruple screen
performed to assess risk of congenital defects in fetuses. accurate dating is important for determining whether levels of alpha-fetoprotein and other analytes are abnormal for gestational age. patients with a history of irregular menses are at risk for inaccurate pregnancy dating.
fatigue, peripheral neuropathy, and atrophic glossitis MH: autoimmune thyroiditis megaloblastic anemia
pernicious anemia due to autoimmune destruction of gastric mucosa leading to atrophic gastritis causing profound hypochlorhydria and compensatory increase in gastrin levels.
tertiary ammonium structure that reverses both central and peripheral system symptoms of anticholinergic toxicity
physostigmine neostigmine, edrophonium, and pyridostigmine have a quaternary ammonium structure that limits central nervous system penetration. ...only reverse peripheral symptoms.
complications of hereditary spherocytosis include
pigmented gallstones and aplastic crises from parvovirus B19 infection abnormalities in spectrin and ankyrin cytoskeleton proteins increased osmotic fragility on acidified glycerol lysis testing confirms diagnosis. hemolytic anemia, jaundice (increase indirect bilirubin), and splenomegaly.
direct muscarinic agonist cause pupillary constriction in the denervated eye
pilocarpine
antibiotic to treat gram negative enteric rods and against bacteroides fragilis
piperacillin-tazobactam
piriformis syndrome
piriformis passes through the greater sciatic foramen and is involved with external hip rotation. muscle injury or hypertrophy can compress the sciatic nerve in the foramen, causing piriformis syndrome.
sever headaches, bitemporal hemanopsia, ophthalmoplegia preexisting pituitary adenoma
pituitary apoplexy emergency! treat: glucocorticoids prevent acute adrenal crisis and circulatory collapse
dysphagia, esophageal web formation, and iron deficiency anemia
plummer vinsion syndrome findings- koilonychia (spoon shaped nails) and a shiny red tongue. treat with iron supplementation for symptom improvement.
throat issues and spoon shaped nails
plummer vinson syndrome also has iron deficiency anemia
CMV
pneumonia and cytoplasmic inclusion bodies histologically points to opportunistic infection with cytomegalovirus, an enveloped virus that contains a double stranded DNA genome.
proteins necessary for lactose metabolism by E. Coli are
polycistronic unique to bacterial mRNA transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of regulatory elements
polyenes, azoles, echinocandins, and pyrimidines
polyene antifungals (eg, amphotericin B, nystatin) act by binding ergosterol in the fungal cell membrane.
anencepahly causes
polyhydramnios due to impaired swallowing
glucose to sorbitol to fructose
polyol pathway use: aldose reductase sorbitol dehydrogenase
POMC
polypeptide precursor that goes through enzymatic cleavage and modification to produce: beta endorphins ACTH MSH relationship between stress and opioid response
polymicrobrial infection after C-section fever, lower abdominal pain, and malodorous vaginal discharge
postpartum endometritis urterine infection portal of entry: cervix/vagina
bladder dysfunction in diabetic patient includes elevated
postvoid residual volume inability to sense a full bladder and incomplete emptying. ultrasound and catheterization can confirm inadequate bladder emptying.
pharmocodynamics
potency: dose for 1/2Vmax efficacy: Vmax
microdeletions involving the paternal chromosome 15q11-13 region maternal uniparental disomy
prader-willi syndrome loss of paternal chromosome neonatal hypotonia, extreme hyperphagia and progressive obesity, hypogonadism, and small hands and feet.
behavioral change stages
precontemplation (denial of problem), contemplation (acceptance of problem and thinking about change but done nothing), preparation (planning to make change in near future), action (putting active changes into place), and maintenance (maintaining change over the long term).
most adverse drug reactions are
predictable due to known pharmacologic properties of the drug- gastritis due to NSAID use. unpredictable reactions are less common and are due to genetic differences, immune interactions, or other mechanisms.
cystic medial degeneration
predisposes to the development of aortic dissections and aortic aneurysms. frequently seen in Marfan syndrome.
blastoconida
presence of central vascular catheter and receipt of parenteral nutrition are risk facters for candidemia. displays pseudohyphae with blastoconidia.
mitochondrial myopathy
presence of lactic acidosis and ragged skeletal muscle fibers histologically. variable clinical expressions in affected family can occur due to heteroplasmy, coexistence of distinct versions of mitochondrial genomes in an individual cell.
hemosiderin-laden macrophages
present in pulmonary alveoli indicates chronic elevation of pulmonary capillary hydrostatic pressures, most commonly as a result of left-sided heart failure.
pituitary tumors
present with headaches, hemianopsia, and hypopituitarism; the most common hormonally active (functional) adenomas are prolactin-secreting adenomas (prolactinomas). which can cause galactorrhea and amenorrhea in women. in men, they often present with hypogonadism. prolactin suppresses GnRH.
idiopathic intracranial hypertension
presents in young obese women with daily headache (worse during valsalva), bilaterally symmetric papilledema, and transient visual disturbances. increased intracranial pressure compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema.
HSV2
presents with fever and painful vesicular genital rash. infects sacral dorsal root ganglia and can be recurrent
HSV6 roseola
presents with fever for 3-5 days followed by a truncal rash. it is also the most common cause of febrile seizures.
renal infarction
presents with flank pain, hematuria, elevated lactate deydrogenase, and a wedge-shaped kidney lesion on CT scan. the most common cause of renal infarction is systemic thromboembolism, often due to thrombus formation during atrial fibrillation. the brain and kidneys are more likely than other organs to suffer embolic infarctions because they are perfused at higher rate.
maple syrup urine disease
presents with irritability, dystonia, poor feeding, and a 'maple syrup/burnt sugar' scent to the patient's urine within the first few days of life. dietary restriction of branched-chain amino acids (leucine, isoleucine, valine) is the treatment.
aortic coarctation in child/young adult
presents with lower-extremity claudication (pain and cramping with exercise), blood pressure discrepancy between the upper and lower extremities, and delayed or diminished femoral pulses. turner syndrome (45,XO) is associated with coarctation of aorta in up to 10% of cases.
acute promyelocytic leukemia
presents with persistent infection and coagulopathy causing hemorrhagic signs and symptoms. bone marrow biopsy classically reveals promyelocytes with intracytoplasmic Auer rods. APL is associated with a t(15;17) chromosomal translocation that causes fusion of the retinoic acid receptor alpha gene and promyelocyte leukemia gene.
nutcracker effect
pressure in the left renal vein may become elevated due to compression where the vein crosses the aorta beneath the SMA. causes hematuria and flank pain. pressure can also be elevated int he left gonadal vein, leading to formation of a varicocele.
class 4 antiarrhythmics (verapamil, diltiazem)
prevent recurrent nodal arrhythmias (PSVT). work by blocking calcium channels in slow-response cardiac tissues, slowing phase 4 (spontaneous depolarization) and phase 0 (upstroke). reduce impulse conduction velocity in the SA and AV nodes.
allopurinol and rasburicase
prevent tumor lysis syndrome and gout
posterior cruciate ligament
prevents posterior displacement of the tibia relative to the femur when the knee is flexed. it attaches to the posterior part of the intercondylar area of the tibia and the anterior part of the lateral surface of the medial epicondyle of the femur. vs. ACL which attaches to the later femoral condyl.
nitrates
primarily venodilators and increase peripheral venous capacitance, thereby reducing cardiac preload and left ventricular en-diastolic volume and pressure. nitrates also have a modest effect on arteriolar dilation and cause a decrease in systemic vascular resistance and cardiac afterload.
popliteal artery
primary concern for both anterior and posterior dislocations of the knee joint rigidly fixed proximal and distal to knee joint by adductor magnus and soleus muscles
HFE protein mutations leading to decreased hepcidin and DMT1 expression by enterocytes leading to iron overload
primary hemochromatosis increased risk for liver cirrhosis and hepatocelllular carcinoma
klinefelter syndrom (47,XXY)
primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH,LD) levels. elevated estradiol results in gynecomastia.
isotype switching
primary immune response to a new antigen initially results in plasma cells that only produce IgM. isotype switching later occurs in the germinal centers of lymph nodes and requires interaction of the CD40 receptor on B-cells with the CD40 ligand expressed by activated T-cells. IgG is the main serum immunoglobulin of the secondary response.
Ghon complex of TB
primary infection: lower lobe of lung secondary: apical lobe
osteoporosis
primary- not caused by a medical disorder but by caucasian ethnicity, female sex, advanced age, positive smoking history, prior glucocorticoid use normal calcium, phosphorus, and parathyroid hormone levels
gluconeogenesis
principal source of blood glucose after 12-18 hours of fasting. gluconeogenesis uses many glycolytic enzymes, but hexokinase, PFK, and pyruvate kinase need to be bypassed as they are unidirectional. the initial steps of gluconeogenesis involve the conversion of pyruvate to oxaloacetate and oxaloacetate to phosphoenolpyruvate by pyruvate carboxylase and phosphoenolpyruvate carboxykinase, respectively.
locus ceruleus= paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle
principle site for norepinephrine synthesis in the brain controls: mood, arousal, sleep wake, cognition, autonomic function
1-beta
probability of rejecting a null hypothesis when it is truly false. it is typically set at 80% and depends on sample size and difference between outcomes.
dystrophic intramural deposition of calcium salts in the setting of chronic inflammation
procelain gallbladder increased rise adenocarcinoma of the gallbladder manifestation of chronic cholecystitis and often found in association with multiple gallstones.
alternative splicing
process by which a single gene can code for various unique proteins by selectively including or excluding different DNA coding regions (exons) into mature mRNA.
Ehlers-Danlos syndrome
procollagen peptidase deficiency impaired cleavage of terminal propeptides in the extracellular space. joint laxity, hyperextensible skin, and tissue fragility due to formation of soluble collagen that does not properly crosslink.
toxigenic strains of corynebacterium diptheriae
produce diphtheria toxin, which irreversibly inhibits host protein synthesis due to ADP-ribosylation of elongation factor-2. local effects include pseudomembranous pharyngitis; systemic effects include potentially life-threatening myocarditis and neuritis. immunization with diphtheria toxoid generates protective circulating IgG against the exotoxin B subunit.
infarcts involving anterior portion of medial pons
produce dysarthria and contralateral hemiparesis/lower faial palsy due to disruption of the ipsilateral corticospinal and corticobulbar tracts. the trigeminal nerve arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid pons.
IgAprotease
produced by N. meningitiditis, N gonorrheoease, strep pneumoniae, and H. influenza. this enzymes cleaves secretory IgA at its hinge region, rendering it ineffective. secretory IgA exists on mucosal surfaces and in secretions and acts to bind and inhibit the action of pili as well as other cell surface antigens that normally mediate mucosal adherence and subsequent penetration.
IL-4
produced by TH2 T-helper cells stimulates antibody isotype switching, particularly to IgE
gycerol
produced by degradation of triglycerides in adipose tissue can be used by glycerol kinase in the liver and kidney to synthesize glucose during gluconeogenesis.
interferons alpha and beta
produced by human cells in response to viral infections. halts viral protein synthesis and promotes apoptosis of infected cells. limits the spread of the virus through the tissues.
beta hCG
produced by the syncytiotrophoblast after implantaiton, whcih generally occurs 6-7 days after fertilization at the earliest. beta HCG is typically detectable in the serum 8 days after fertilizaiton and 14 days in the urine.
DMD
progressive proximal muscle weakness in young boys due to increased muscle fiber degeneration. it is caused by frameshift mutations or nonsense mutations in the dystrophin gene that leads to the formation of a truncated, defective protein. nonsense mutations introduce premature stop codons--UAA, UAG, UGA
exudative phase>leakage of protein-rich fluid into alveolar space>proliferative phase>fibrotic phase
proliferative phase=1-2weeks later ARDS
qualitative platelet disorder
prolonged bleeding time due to uremic toxins impairing platelet aggregation and adhesion. normal PT and aPTT usually in renal dysfunction leading to uremia. dialysis removes the toxins and partially reverses the abnormality.
toxic shock syndrome
prolonged use of tampons or wound packing- allow staph A to replicate locally and release pyrogenic toxic superantigens into the blood. superantigens bind to MHC II complex of antigen presenting cells without processing and nonspecifically activate T cells. leads to release of cytokines-IL1,2 and TNF alpha and beta, interferon gamma causes hypotension, high fever, organ failure, diffuse, erythematous rash.
anterolateral left ventricle infarction
prolonged, burning substernal pain and ST segment elevation in leads I and V3-V6. common consequences-left ventricular failure, cardiogenic acute pulmonary edema, pulmonary venous hypertension (congestion), and transudate of plasma into the lung interstitium and alveoli.
dystonia
prolonged, repetitive muscle contractions due to basal ganglia cervical (torticollis), blepharospasm, writer's cramp vs. myoclonus: sudden, brief, sometimes sever (shock like) muscle contraction
frontotemporal dementia
pronounced atrophy of prefrontal cortex with later degeneration of anterior temporal cortex. it manifests initially with changes in personality, social behavior, and language that progress over time to a more global dementia with obvious neurocognitive deficits.
3' to 5' exonuclease activity
proofreading all 3 prokaryotic DNA polymerases can do only DNA I have 5' to 3' exonuclease activity- used to remove RNA primer synthesized by RNA primase
steps for central venous catheter infections prevention
proper hand hygiene, full barrier precautions during insertion, chlorhexidine skin disinfection, avoidance of femoral insertion site, removal of the catheter when it is no longer needed.
MAC infections are common in AIDS patients: fever fatigue weight loss diarrhea lymphadenopathy
prophylaxis= azithromycin
CFTR
protein is a transmembrane ATP-gated chloride channel. defects in CFTR result in thick, plugging mucous and elevated sodium and chloride levels in sweat.
insulin>> tyrosine kinase/phosphatidylinositol-3-kinase stimulation promotes glycogen synthesis by activating
protein phosphatase dephosphorylates (activates) glycogen synthase
ubiquitin
protein that undergoes ATP dependent attachment to other proteins, labeling them for degradation. these modified proteins enter the proteasome and are degraded into small peptides. impairment of the ubiquitin-proteasome system can contribute to development of neurodegenerative disorders, like parkinson's and alzheimers
conjugate vaccines
provide higher, longer lasting antibody titers relative to pneumo polysaccharide vaccines. stronly immunogenic in infancy due to both B and T cell recruitment. the pneumo polysac. vaccine is poorly immunogenic in infants due to relatively immature humoral antibody response.
iliohypogastric nerve
provides sensation to the suprapubic and gluteal regions and motor function to the anterolateral abdominal wall muscles. abdominal surgery (eg, appendectomy) can damage the nerve and cause decreased sensation and/or burning pain at the suprapubic region.
lymphatic drainage of the rectum
proximal to the anal dentate line occurs via the inferior mesenteric and internal iliac lymph nodes. areas distal to the dentate line drain primarily into the inguinal nodes.
dermatitis herpetiformis
pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces. associated with celiac disease- intraepithelial intestinal lymphocytic infiltrate
hypocalcemia and hyperphosphatemia despite elevated PTH levels
pseudohypoparathyroidism end-organ resistance to parathyroid hormone .....defect in downstream signaling. albright hereditary osteodystrophy: ....pseudohypoparathyroidism, short stature, short metacarpal/metatarsal bones
common cause of urinary tract infections in patients with indwelling bladder catheters
pseudomonas aeruginosa--oxidase positive, non lactose fermenting organism.
common complications of psoriasis
psoriatic arthritis, nail pitting, and uveitis
schizoaffective disorder
psychosis must occur in the absence of major mood episodes but mood episodes must be present for a majority of lifelong illness. vs. bipolar and major depression with psychotic features, psychotic symptoms occur exclusively during mood episodes.
pO2 in the left atrium and ventricle is lower than that in the
pulmonary capillaries due to mixing of oxygenated blood from the pulmonary veins with deoxygenated blood from the bronchial circulation and the thebesian veins. only some of the bronchial veins return to right heart most of it goes to left heart through pulmonary veins.
elevated left-sided diastolic filling pressures transmitting backward to the
pulmonary veins secondary pulmonary hypertension
vibrio cholerae and entertoxigenic E coli cause a
purely toxin mediated watery diarrhea. toxins modify electrolyte handling but don't cause cell death; therefore, no erythrocytes or leukocytes are typically noted on stool microscopy.
class IA antiarrhythics
quinidine, procainamide, and disopyramide are sodium channel blocking agents that depress phase 0 depolarization. they also prolong repolarization due to moderate potassium channel, blocking activity, increasing action potential duration in cardiac myocytes.
annular ligament impingement
radial head subluxation (nursemaid's elbow) results from sudden traction on the outstretched and pronated arm of a child. affected children are usually in little distress unless attempts are made to move the elbow. the annular ligament is torn and displaced in this injury.
disrupt double stranded HIV DNA to integrate into the host cell's chromosomes
raltegravir integrase inhibitor if can't integrate then can't transcribe viral genome by host cellular machinery and is eventually degraded by nucleases
exogenous T3 supplementation
rapidly suppresses TSH levels by increasing negative feedback, which in turn decreases T4 secretion from the thyroid gland. rT3 also decreases because less T4 is available for conversion (T3 cannot be converted into rT3)
reid index
ratio of the thickness of submucosal bronchial glands to the thickness of the bronchial wall between the epithelial basement membrane and the bronchial cartilage. higher values correlate with increased duration and severity of chronic bronchitis.
jarisch-herxheimer
reaction is an acute inflammatory reaction that occurs within hours of treatment for spirochetal (eg, syphilis) infections. the rapid lysis of spirochetes releases inflammatory bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias.
sacroiliitis associated with
reactive arthritis HLA-B27 genitourinary or enteric infection
recall bias vs. detection bias
recall is due to inaccurate recall of past exposure and occurs with retrospective studies such as case control studies. those with adverse effects are more likely to recall risk factors than those who have not experienced an adverse event. detection bias refers to the risk factor itself leading to extensive diagnostic investigation and increase probability that a disease is identified.
natural killer cells
recognize and kill cells with decreased MHC class I antigen cell surface expression, such as virus-infected cells and tumor cells. they are large lymphocytes that contain perforins and granzymes in cytoplasmic granules. NK cells kill target cells by inducing apoptosis.
strep penumo vaccine
recommended for young patients and the elderly polysac. vaccine is unconjugated vaccine that induce T cell independent humoral immune response.
familial chylomicronemia syndrome
recurrent episodes of acute pancreatitis. eruptive skin xanthomas--hypertriglyceridemia. tendon xanthoma and xanthelasmas--hypercholesterolemia.
innervate all intrinsic muscles of the larynx except: cricothyroid
recurrent laryngeal
panic disorder
recurrent, unexpected panic attacks and should be considered in young, healthy adults who come to the ED with unexplained chest pain. benzodiazepines can provide rapid relief.
kehr sign
referred pain to the C3-C5 shoulder region due to phrenic nerve sensory fibers around the diaphragm becoming irritated. due to ruptured spleen, peritonitis, hemoperitoneum
wallerian degeneration
refers to the process of axonal degeneration and breakdown of myelin sheath that occurs distal to a site of injury. axonal degeneration does not occur in the central nervous system due to the persistence of myelin debris, secretion of neuronal inhibitory factors, and development of dense glial scarring.
elevated systemic blood pressure causes
reflexive increase in vagal tone, result in decreased heart rate and slowed atrioventricular node conduction
site of water reabsorption in kidney
regardless of the patient's hydration status, the majority of water reabsorption in the nephron occurs in PCT passively with reabsorption of solutes.
RNA splicing creates loops of unbound DNA
regions of the gene that code for introns remove them via splicing to form mature mRNA
suprachiasmatic nucleus
regulates cicadian rythm. processes light information received from the retina and relays it to other hypothalamic nuclei and the pineal gland to modulate body temperature and the production of hormones such as cortisol and melatonin. melatonin supplementation is recommended for the treatment of insomnia associated with jet lag.
mitral regurge vs. stenosis
regurge: holosystolic murmur best over the cardiac apex with radiation to the axilla. stenosis: holosystolic murmur has opening snap at beginning of diastole with a low pitched, mid-diastolic rumbling murmur at the cardiac apex.
primaquine added to chloroquine to eradicate intrahepatic stages of malaria and prevent
relapses
neurocysticercosis
relatively common cause of seizures in patients from central and south america. imaging- cystic brain lesion
ATP binding to myosin causes
release of the myosin head from its binding site on the actin filament
during antigen processing in macrophages, invariant chain is
removed from MHC-invariant complex and replaced by external protein. MHC-peptide (alpha chain, beta chain, and external protein) is expressed at the cell surface.
sporadic and hereditary
renal cell carcinomas are asso. with VHL mutations on chromosome 3p.
hypoxia of which organ stimulates hematocrit
renal cortical cells sense hypoxia and respond by synthesizing and releasing erythropoietin. erythropoietin stimulates the production of erythrocytes in the bone marrow.
renal ammoniagenesis
renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in the urine and bicarbonate that is absorbed into the blood. this is responsible for the vast majority of renal acid excretion in chronic acidotic states.
beta blockers inhibit
renin from justaglomerular cells through antagonism of beta-1 receptors on these cells. inhibition of renin release prevvents activation of renin-angiotensin aldosterone pathway which results in decreased vasoconstriction and decreased renal sodium.
meglitinides
repaglinide nateglinide can reduce postprandial glucose excursions.
sickle cells disease and spleen
repeated splenic infarctions ultimately result in splenic atrophy and fibrosis--typically complete by childhood/adolescence. after autosplenectomy, predisposed to infections with encapsulated bacterial organisms. develop megaloblastic anemia due to increased folic acid requirements-due to increased RBC turnover.
atheroclerosis initiated by
repetitive endothelial cell injury leads to chronic inflammatory state in the underlying intima of large elastic arteries as well as in large and medium sized muscular arteries.
chronically elevated FFA levels contribute to insulin
resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis DM type 2 and acanthosis nigracans
inhibit DNA-dependent RNA polymerase, thereby preventing transcription and leading to deficiency of proteins necessary for mycobacterial survival.
resistance to: rifampin rifabutin
KRAS activating gene mutations
resistant to treatment with anti-EGFR drugs cetuximab panitumumab
superimposed respiratory acidosis
respiratory failure if PaCO2=[1.5*HCO3]+8+_2
HIV pol gene mutation
responsible for acquired reisitance to reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors. --usually due to inconsistent use of meds. mutations of the env gene enable escape from host-neutralizing antibodies.
lysogenic bacteriophages
responsible for converting nonpathogenic Corynebacterium into toxigenic Corynebacterium. Toxigenic strains elaborate the diphtheria exotoxin, which causes pseudomembranous pharyngitis and potentially life-threatening systemic effects (eg, myocarditis, neuritis).
niacin (B3) deficiency
result in pellagra: dermatitis diarrhea dementia niacin can be synthesized from tryptophan
occlusion of the right coronary artery
result in transmural ischemia of the inferior wall of the left ventricle, producing ST elevation in leads II,III, and aVF as well as sinus node dysfunction.
hirschsprung disease
result of migration of neural crest cells, which are precursors of ganglion cells of intestinal wall plexi. since neural crest cells migrate caudally, the rectum is always affected in hirschsprung disease.
hereditary spherocytosis
results from red cell cytoskeleton abnormalities, most commonly spectrin and ankyrin. hemolytic anemia, jaundice, and splenomegaly are classic manifestations. spherocytes are seen on peripheral blood smear.
increased bone marrow erythropoiesis
results in an accelerated release of immature red blood cells (reticulocytes) into the bloodstream. reticulocytes contain bluish cytoplasm and reticular precipitates of residual ribosomal RNA.
deficiency of galactose-1 phosphate uridyl transferase
results in classic galactosemia. vomiting, lethargy, jaundice, and E. Coli sepsis. cessation of breastfeeding and switching to soy-milk-based formula is recommended.
X-inactivation (lyonization)
results in conversion of inactivated X chromosome into compact heterochromatin (barr body). heterochromotin is condensed chromatin composed of heavily methylated DNA in tight association with deacetylated histones. it has a low level of transcriptional activity. vs. euchromatin, which is loosely arranged and exhibits a high level of transcriptional activity.
high altitude
results in hypoxemia with respiratory alkalosis. over a course of a few days, chronic respiratory alkalosis sets in, with a corresponding decrease in the serum bicarbonate level reflecting renal compensation.
vitamin K deficiency
results in impaired clotting factor carboxylation. newborsn are at risk for vitamin K deficiency due to poor transplacental transfer of vitamin K and low content in breast milk. all newborns should receive vitamin K prophylaxis to prevent bleeding complications.
HF
results in stimulation of sympathetic nervous system and the RAAS systems to maintain effective intravascular volume. inactive angiotensin I is converted to active angiotensin II by endothelial-bound angiotensin-converting enzyme in the small vessels of the lungs.
communicating hydrocele
results when serous fluid accumulates within the tunica vaginalis in the setting of a patent processus vaginalis. presents as a painless swelling that transilluminates on examination.
cannulation above the inguinal ligament for cardiac cath, increase the risk of
retroperitoneal hemorrahge. injury to the femoral artery is less likely to cause intraperitoneal bleeding due to the external iliac artery coursing underneath the peritoneum. pelvic trauma with fracture or Gyn procedure will have intraperitoneal bleeding.
inactive form of thyroid hormone that is generated almost entirely from the peripheral conversion of T4
reverse T3
cor pulmonale
right ventricle hypertrophy suspect in young patient with: fatigue, progressive dyspnea, atypical chest pain, or unexplained syncope.
pressures in heart
right-sided pressures in the heart are lower than left sided pressures due to lower resistance in the pulmonary vasculature. right--1-6mm Hg pulmonary artery--6-12 mmHg due to high resistance to flow in the pulmonary circulation.
hypercalcicuria
risk factor for calcium kidney stones in adults increased GI absorption, increased bone resorption, or decreased renal tubular calcium reabsorption. most people remain normcalcemic due to regualtion of plasma calcium levels by vitamin D and PTH.
ligament that projects from uterus through inguinal canal into the labia majora
round ligament of the uterus
postauricular and occipital lymphadenopathy
rubella caused by togavirus rash begin on face and spread to trunk
infraorbital nerve
run along orbital floor in groove in maxilla before exiting the skull just inferior to the orbit damage: paresthesia of upper cheek, upper lip, and upper gingiva
infraorbital nerve
runs along the orbital floor in a groove in the maxilla before exiting the skull just inferior to the orbit. damage can result in paresthesia of the upper cheek, upper lip, and upper gingiva. in addition, the inferior rectus muscle can also become entrapped, limiting vertical gaze.
subarachnoid hemorrhage
rupture of saccular (berry) aneurysm or AVM. severe vasospasm 4-12 days after the initial insult is the major cause of morbidity and mortality in patients recovering from SAH. Nimodipine, a selective calcium channel blocker, is often prescribed to prevent this vasospasm.
decrease standard error by increasing
sample size proper technique= lowers selection bias
highly contagious disease that presents with an intensely pruritic rash (worse at night)
scabies in flexor surfaces of wrist, lateral surfaces of the fingers, and the finger webs. excoriations with small, crusted, red papules scattered around the affected areas. diagnosis is confirmed by skin scrapings from excoriated lesions that show mites, oval, and feces under light microscopy.
PID leads to:
scarring of the fallopian tubes, leading to ectopic pregnancy and infertility
DIC on peripheral smear shows
schistocytes
thromboangiitis obliterans (buerger disease)
segmental, inflammatory vasculitis that affects the small and medium sized arteries and veins of the distal extremities with inflammatory, intraluminal thrombi and sparing of the vessel wall. it is usually seen in young, heavy smokers, and can present with digital ischemia and ulceration, extremity claudication, Raynaud phenonmenon, and superficial thrombophlebitis.
PAN
segmental, tranmural, necrotizing inflammation of medium- to small-sized arteries. renal artery often prominent. kidneys, heart, liver, and GI tract are most commonly effected--leading to ischemia, infarction, or hemorrhage. cutaneous- palpable purpura. lungs are rarely involved.
fenoldopam
selective peripherl dopamine 1 agonist given IV for hypertensive crisis. lowers blood pressure in patients with renal insufficiency. causes arteriolar dilation, increases renal perfusion, and promotes diuresis and natriuresis.
undescended testes
seminiferous tubules atrophy if uncorrected due to higher body temperatures, resulting in decreased fertility and increased risk for malignancy. Orchiopexy (surgical placement of the testes in the scrotal sac) can minimize damage and decrease risk for testicular cancer.
heterophile antibody test (monospot test)
sensitive and highly specific for EBV infection. EBV commonly infects B cells, stimulating them to proliferate continuously. it is an oncogenic virus that promotes polyclonal B cell proliferation and heterophile antibody production.
children experience physical symptoms and nightmares when separated from attachment figures
separation anxiety disorder
fever, abdominal pain, uterine tenderness, and/or foul smelling discharge after pregnancy termination
septic abortion seeding of the uterine cavity during instrumentation: staphylococcus aureus and E. coli
joint pain leukocyte count >100,000/mm3
septic arthritis Rx= antibiotics
proinflammatory cytokines induce insulin resistance through activation of
serine kinases> serine phosphorylation on beta subunits of IR and IRS-1> inhibits tyrosine phosphorylation of IRS-1 by IR>>hinder down stream actions of insulin catecholamines, glucocorticoids, and glucagon=same effect with: phosphorylation of threonine
alpha-1 antitrypsin (AAT)
serum protein that, through the inhibition of neutrophil elastase, reduces tissue damage caused by inflammation. histologically: AAT deficiency can demonstrate reddish-pink globules on periodic acid-schiff stain; these globules represent unsecreted, polymerized AAT in the periportal hepatocytes.
fever, pruritic skin rash, and arthralgias 7-14 days after exposure to an antigen
serum sickness type III hypersensitivity vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration usually due to: chimeric monoclonal antibodies, nonhuman immunoglobulins
earliest beta-hCG can be detected in serum and urine
serum: 8 days urine: 14 days
Thiamine (vitamin B1)
serves as a coenzyme for a number of important dehydrogenase enzymes, including transketolase, alpha ketoglutarate dehydrogenase, and pyruvate dehydrogenase.
ablation of thoracic sympathetic trunk can be used to treat
severe axillary hyperhidrosis sweating mediated by cholinergic postganglionic fibers of the sympathetic nervous system.
necrotizing fasciitis
severe infection of subcutaneous tissue and deep fascia==surgical EM! infection polymicrobial or Strep pyogenes--PYR positive, beta hemolytic, gram positive cocci that grows in chains.
increase in effective stroke volume/EF on pressure volume loop
shift in isovolumic relaxation line to the left- indicating less residual blood volume in the ventricle at the end of systole.
invades GI mucosa by gaining access to microfold cells in ileal peyer patches through endocytosis
shigella
splenic infarctions result in splenic atrophy and fibrosis
sickle cell disease autosplenectomy infection with encapsulated bugs increased RBC turnover leads to increase need for folic acid: prone to folic acid deficiency and megaloblastic anemia.
high baseline plasma insulin level in setting of normoglycemia
sign of insulin resistance in peripheral tissues
west nile virus
single strand flavivirus transmitted by mosquitos, most commonly in the summer. most infections are asymptomatic or may present with a flu like illness, often with a maculopapular or morbilliform rash. neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; patients may have parkinsonian features.
zika virus
single stranded RNA virus infects fetal neural progenitor cells, causing severe congenital malformations (eg, microcephaly, arthrogryposis), cerebral cortical thinning, and possible fetal demise.
unmyelinated nerve fibers
slower conduction primary sensory/afferent: slow pain heat sensation olfaction efferent: postganglionic autonomic neurons
cardiac action potential conduction speed
slowest in the atrioventricular node and fastest in the Purkinje system. conduction speed of the atrial muscle is faster than that of the ventricular muscle. (park at venture avenue)
tumors stain for neuroendocrine markers: neural cell adhesion molecules (NCAM)=CD56 enolase chromogranin synaptophysin
small cell carcinomas
eosinophilic granulomatosis with polyangiitis (churg-strauss)
small to medium vessel vasculitis characterized by late-onset asthma, rhinosinusitis, and eosinophilia. mononeuritis multiplex due to involvement of the epineural vessels of peripheral nerves is common.
cherry hemangiomas
small, red, cutaneous papules common in aging adults. they do NOT regress spontaneously (vs. superficial hemangiomas that appear in first weeks of life and then regress) and they typically increase in number with age. light microscopy of these lesions shows proliferation of capillaries and post capillary venules in the papillary dermis.
emphysema
smoking or alpha 1 antitrypsin deficiency decreased forced expiratory volume in 1 second/forced vital capacity ratio, increased total lung capacity, and decreased diffusing capacity--due to destruction of alveoli and adjoining capillary beds.
esophageal squamous cell carcinoma risk factors include
smoking, excessive alcohol consumption, and intake of foods containing N-nitroso compounds. characterized by: polyhedral/ovoid epithelial cells with eosinophilic cytoplasm, keratin nests within or between cells.
important component of the spliceosome removes introns from pre-mRNA
snRNPs
serves as a sulfur donor to promote hepatic rhodanese-mediated conversion of cyanide to thiocyanate, which is excreted in the urine
sodium thiosulfate treatment of cyanide toxicity also with: hydroxycobalamin sodium nitrite
esophageal squamous cell carcinoma
solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders. areas of keratinization and the presence of intercellular bridges are characteristic. typically present with progressive solid and eventually liquid dysphagia and weight loss.
atypical pneumonia
sore throat persistent cough CXR= patchy infiltrate usually due to mycoplasma or chlamydia no cell wall treatment with bacterial protein synthesis inhibitor: macrolide or tetracycline
detect DNA-binding proteins such as transcription factors, nucleases, and histones
southwestern blot vs. northern: RNA southern: DNA western: protein
niemann-pick disease
sphingomyelinase deficiency causes accumulation of the lipid sphingomyelin. clinical features include hepatospenomagaly, neurologic regression, and a cherry-red macular spot in infancy.
cerebellar ataxia
spinocerebellar tract degeneration and loss of position/vibration sensation, hyphoscoliosis, and hypertrophic cardiomyopathy. friedreich ataxia
colonic watershed areas
splenic flexure and rectosigmoid junction lie between regions of perfusion of major arteries. susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency.
normal commensal GI organism unless there is a break in mucosa>>invasion and subsequent hematogenous dissemination to healthy muscle tissue, resulting in
spontaneous gas gangrene other risk factors: IBD immunosuppression
clostridium speticum
spore forming, exotoxin-producing, gram-positive organism that is the most common cause of spontaneous gas gangrene (eg, rapid-onset pain, hemorrhagic bullae, tissue crepitus). underlying colonic malignancy is the greatest risk factor for infection. part of normal GI tract--breakdowns in the gastrointestinal mucosa can lead to invasion.
actinic keratoses increase risk for
squamous cell carcinoma
Turner syndrome
streak ovaries, amenorrhea, and infertility are implications. patients usually have short stature, webbed neck, shield chest, and low posterior hairline. bicuspid aortic valve is the most common cardiac comorbidity.
stress incontinence and kegl exercises
stress urinary incontinence is defined as involuntary urine loss with increased intraabdominal pressure. pelvic floor strengthening targets the levator ani to improve support around the urethra and bladder.
incontinence
stress- leakage with cough, lift, sneeze--decreased urethral sphincter tone, urethral hypermobility urge-sudden, overwhelming urge to urinate--detrusor hyperactivity overflow-incomplete emptying and persistent involuntary dribbling--impaired detrusor contractility bladder outlet obstruction
crohns disease complications:
strictures due to muscularis mucosae hypertrophy leading to obstruction of bowel. fistulas abscesses can have skip lesions from mouth to anus.
small cell carcinoma
strongly associated with smoking and is usually centrally located. arises from primitive cells of the basal layer of the bronchial epithelium. immunohistochemical stains positive for neuroendocrine markers: neuron specific enolase, chromogranin, synaptophysin. light microscopy: round or oval cells with scant cytoplasm and large hyperchromatic nuclei.
autoimmune paraneoplastic syndrome affecting cerebellar purkinje fibers leading to degeneration
subacute cerebellar degneration due to: small cell lung Cx breast, ovarian, uterine Cx
myelopathy associated with B12 deficiency
subacute combined degeneration degeneration of dorsal columns and corticospinal tracts. loss of: position, vibration, sensation, ataxia, and spastic paresis
thoracentesis should be above the 8th rib in the midclavicular line, 10th rib along the midaxillary line, and 12th rib along the posterior scapular or paravertebral line to avoid risk to
subcostal neurovascular bundle (run along rim of ribs) damage to abdominal structures is possible
channel unacceptible thoughts or impulses into socially acceptable behavior
sublimation vs. reaction formation: unacceptable feelings are transformed into their opposites (towards that same object)
hirschsprung disease
submucosal (Meissner) and myenteric (auerbach) autonomic plexi are absent in the affected segment of the bowel. the submucosa of the narrowed areas is the most superficial layer where the absence of ganglion cells can be seen. barium enema shows narrowing in the rectosigmoid area. proximal to the obstruction, the bowel is dilated and filled with feces.
nephrotic syndrome is a hypercoagulable state
sudden-onset abdominal or flank pain, hematuria, and left-sided varicoceles suggest renal vein thrombosis, a well-known complication of nephrotic syndrome. loss of anticoagulant factors, especially antithrombin III, is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome.
rash begins at face and spreads to trunk and extremities
suggestive of rubeola and rubella. the additional finding of postauricular lymphadenopathy indicates that rubella is the most likely etiology.
studies have linked increased activity of COX2 to some forms of colon adenoarcinoma
suggests: aspirin use decreases adenomatous polyp formation
clavulanic acid
sulbactam and tazobactam are beta lactamase inhibitors. concurrent administration of calvulanate with amoxicillin expands amoxicillin's spectrum of activity to include strains of beta-lactamase synthesizing bacteria that are resistant to amoxicillin alone.
catalyzes conversion of 7-dehydrocholesterol to cholecalciferol (vitamin D3) in the skin
sunlight
lower extremity lymph drainage
superficial lymphatic system divided into medial and lateral tracks. medial track-runs up to superficial inguinal lymph nodes, bypassing the popliteal nodes.--lesions on medial foot cause inginal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas.
pityriasis versicolor (tinea versicolor)
superficial skin infection caused by Malassezia species. causes erythematous, hyper/hypo pigmented macules and patches. Malassezia forms spores and hyphae, producing the 'spagehetti and meatballs' appearance on KOH prep light microscopy.
great saphenous vein
superficial vein of the leg that originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up to the medial aspect of the leg and thigh. it drains into the femoral vein within the region of the femoral triangle, a few centimeters inferolateral to the pubic tubercle--good place to get graft.
superficial and deep inguinal rings are physiologic openings in the
superficial: external abdominal oblique aponeurosis deep: transversalis fascia orchiopexy: go through superficial
collateral flow to areas supplied by inferior mesenteric artery
superior mesenteric artery. these arteries have a pair of anastomoses: marginal artery of drummond, which is the principle anastomosis, and the inconsistently present arc of riolan
posteromedial papillary msucle
supplied by posterior descending artery vs. anteromedial papillary muscle supplied by LAD
omeprazole and other proton pump inhibitors
suppress the activity of the gastric parietal cell H/K ATPase leading to an increase in the pH of the gastric lumen.
hyperprolactinemia
suppresses secretion of GnRH, which leads to reduced estrogen in women. low estrogen levels are a risk factor for accelerated bone loss.
craniopharyngiomas
supracellar tumors found in children and composed of calcified cysts containing cholesterol crystals. they arise from remnanats of Rathke's pouch, an embryonic precursor of the anterior pituitary.
SADPUCKER
suprarenal glands Aorta and IVC duodenum pancreas ureters & bladder colon kidneys esophagus rectum
rotator cuff muscles
supraspinatus- abduction infraspinaturs-external rotation teres minor-adduction and external rotation subscapularis-adduction and internal rotation
CD14
surface marker of the monocyte-macrophage cell lineage. the caseating granulomas of TB almost always contain large epitheloid macrophages with pale pink granular cytoplasm and surface CD14 at the periphery.
portal triad (pringle maneuver)
surgical technique used to distinguish the source of RUQ bleeding if hepatic bleeding persists after occlusion of the portal triad, the IVC or hepatic veins are likely to be injured.
multiple myeloma patients synthesize large amounts of monoclonal immunoglobulins or immunoglobulin fragments that are
susceptivle to proteasome inhibition due to large amount of proteins that they manufacture. results in accumulation of toxic intracellular and proapoptotic proteins increases cellular apoptosis.
multiple myeloma
suspected in elderly patients with any combination of hypercalcemia, normocytic anemia, bone pain, elevated gamma gap, or renal failure. renal failure is commonly caused by light chain cast nephropathy; large, waxy, eosinophilic casts composed of Bence Jones proteins are seen in the tubular lumen.
vertebral osteomyelitis
suspected with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially S. Aureus). it should also be suspected if there are new neurologic findings and fever with or without back pain. MRI of the spine is preferred for diagnosis.
contains the ovarian artery, vein, lymphatics, and nerves
suspensory ligament of the ovary ligate to prevent surgery
fatigue weakness headache irritability glossal pain dry mouth atrophy of tongue papillae alopecia pagophagia
symptoms of iron deficiency anemia
pseudogout
synovial fluid analysis showing rhomboid-shaped calcium pyrophosphate crystals. crystals are positively birefringent under polarized light. knee joint is involved in >50% of cases.
sarcoidosis
systemic inflammatory disorder characterized by noncaseating granulomas in a variety of tissues. most patients develop liver involvement, which typically manifests as asymptomatic hepatomegaly with mild liver function test abnormalities. liver biopsy frequently demonstrates scattered noncaseating granulomas. also have erythema nodosum and arthralgias.
statistical comparisons
t-test: means of 2 groups analysis of variance: means of 2 or more chi square: compare 2 categorical variables (vs. quantitative)
on jugular venous pressure tracings,
the first peak is the a wave which is generated by atrial contraction. this is absent in patients with atrial fibrillation.
at high altitude
the low partial pressure of inspired oxygen leads to hypoxemia with consequent hyperventilation and respiratory alkalosis. the hypoxemia and alkalemia can cause symptoms of altitude of sickness (egg, headache, fatigue, lightheadedness). the kidneys respond by creating a compensatory metabolic acidosis and by increasing erythropoietin secretion.
all hormone-containing contraceptives prevent pregnancy through the actions for progestins.
the main mechanism of contraceptive with systemically active progestins (eg, combined hormonal oral contraceptives) is inhibiting ovulation by decreasing FSH and LH synthesis in the anterior pituitary, by suppressing GnRH--inhibiting ovulation.
clear cell carcinoma
the most common subtype of renal cell carcinoma and is composed of large, rounded, or polygonal cells with clear cytoplasm. These tumors are often detected incidentally at an advanced stage; the lung is the most common site for metastasis, followed by osteolytic bone and liver.
several months to years after ischemic brain infarction
the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by astrocytic processes=glial scar.
ribosomal subunit maturation and assembly
the nucleolus is the site of ribosomal subunit maturation and assembly. RNA polymerase I functioins exclusively within the nucleolus to transcribe the 45S pre-rENA gene, which codes for most of the ribosomal RNA components (18S, 5.8S, and 28S rRNAs).
arteriovenous concentration gradient reflects
the overall tissue solubility of an anesthetic. anesthetics with high tissue solubility are characterized by large arteriovenous concentration gradients and slower onsets of action.
lacunar infarctions
the result of vessel occlusion (eg, due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures. uncontrolled hypertension and diabetes mellitus are major risk factors for this condition.
supplied by branch of celiac trunk
the spleen prone to rupture with blunt trauma derived from mesoderm (same as kidneys)
blunt trauma to the globe can cause orbital blowout fractures
these fractures most commonly involve the media or inferior orbital walls due to the thin bone bordering the ethmoid and maxillary sinuses.
hamartomas are the most common benign lung tumors.
they present as asymptomatic peripherally located 'coin lesion' in patients 50-60 years old. these tumors are composed of disorganized cartilage, fibrous and adipose tissue.
peroxisome proliferator acitvated by
thiazolidinediones decrease insulin resistance
descending thoracic aorta lies posterior to the esophagus and the left atrium
this position permits clear visualization of the descending aorta by transesophageal echocardiography, allowing from the detection of abnormalities such as dissection or aneurysm.
hydroxylation of proline and lysine residues in collagen helps it attain its maximum tensile strength.
this process occurs in the rough endoplasmic reticulum and requires vitamin C as a cofactor. impaired collagen synthesis resulting from vitamin C deficiency (scurvy) can lead to fragile vessels, predisposing to gingival bleeding, ecchymosis, and petechia.
impaired function of vWF-cleaving protease: ADAMTS13
thrombotic thrombocytopenic purpura uncleaved vWF=more thrombotic>>diffuse microvascular thrombosis, microangiopathic hemolytic anemia, and thrombocytopenia
bypasses dTMP and reduce erythroid cell apoptosis due to defect DNA synthesis
thymidine supplementation due to folate deficiency
catalyzes oxidation of iodide to iodine, iodination of thyroglobulin tyrosine residues, and the iodotyrosine coupleing reaction to form T3 & T4
thyroid peroxidase
common cause of primary hypoparathyroidism and hypocalcemia
thyroid surgery muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability.
pseudomonas aeruginosa in burn patient treated with
ticarcillin, piperacillin ceftazidime, cefepime ciprofloxacin, levofloxacin imipenem, meropenem
psoriasis
tipical vitamin D analogs (calcipotrient, calcitriol, and tacalcitol) bind to the vitamin D receptor and inhibit keratinocyte proliferation and stimulate keratinocyte differentiation.
duodenal ulcers due to increased gastric acid production due
to H pylor destruction of somatostatin-secreting cells in the gastric antrum. h pylor in gastric body= gastric ulcers
base pairs that are shorter indicate base pair deletions due
to deletion/addition of number of bases that are not divisible by 3 in the coding region of a gene. cause a frameshift mutation
pulmonary diastolic pressure is slightly higher than right ventricle diastolic pressure due
to resistance to flow in the pulmonary circulation
top of foot going up the leg on the inside>> lateral leg going up the back of the leg>>
to uperolateral and superomedial nodes to deep inguinal and popliteal nodes
first line treatment for localized psoriasis
topical corticosteroids and vitamin D analogs
loss of cardiomyocyte contractility occurs within 60 seconds after
total ischemia (ATP depletion) <30 mins=reversible >30mins=irreversible
inactivates EF-2 via ribosylation and inhibit host cell protein synthesis
toxin produced by: C. diphtheriae pseudomonas A.
neonatal complications of diabetes during pregnancy
transient hypoglycemia macrosomia NARDS malformations prematurity polycythemia
beta thalassemia initiated by
translation of beta globin mRNA mutation leading to deficiency of beta globin chains required for normal hemoglobin synthesis
physostigmine
treat anticholinergic toxicity
muscarinic overstimulation
treat with antimuscarinic agent such as glycopyrrolate, hyoscyamine, or propantheline.
cholinesterase inhibitors may cause adverse effects related to muscarinic overstimulation
treat with antimuscarinic agent: glycopyrrolate hyoscyamine propantheline DUMBELLS: diarrhea urination miosis bronchospasm emesis lacrimination salivation
aspiration of aerobic and anaerobic flora leading to lung abscess in alcoholic patient
treat with clindamycin
permethrin
treatment for phthirus pubis: pubic louse blocks parasitic sodium ion conduction in nerve cell membrane channels and results in louse paralysis and death
congenital hyperplasia
treatment involves low doses of exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex.
hypoglycemia
tremor, diaphoresis, or confusion low blood glucose with symptom resolution with correction of blood glucose. elevated insulin and low C-peptide level= exogenous insulin injection elevated C-peptide suggest an insulin secretagogue or insulin-secreting tumor.
mental status changes, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic effects
tricyclic antidepressant overdose blockage of cardiac fast sodium channels and inhibition of muscarininc acetylcholine, histamine, and alpha-1 adrenergic receptors treat with: sodium bicarbonate
Mycobacterium tuberculosis
triggers CD4 lymphocytes to release interferon gamma leading to macrophage activation and differentiation into epithelial histiocytes. these along with langhans giant cells form granulomas. .
dihydrofolate reductase inhibitors
trimethoprim, methotrexate, and pyrimethamine trimethoprim restricts bacterial growth through this process, and works particularly well in conjunction with sulfonamide, which inhibits an earlier step in the bacterial folic acid pathway.
serotonin 5-HT1B/5-HT1D agonists inhibit vasoactive peptides> promote vasoconstriction/pain pathway blockage
triptans (sumatriptan)
pheochromocytoma
tumor arising from the chromaffin cells of the adrenal medulla characterized by excess production of catecholamines. causes episodic HTN, diaphoresis, and palpitations. microscopic examination shows electron dense membrane bound secretory granules, and immunohistochemistry is positive for synaptophysin, chromogranin, and neuron-specific enolase.
glomangioma
tumor of modified SM cells of glomus body involved in thermoregulation. shunting blood to/away from skin surface.
familial retinoblastoma
two Rb genes must be mutated increased risk for osteosarcomas
serum sickness
type III hypersensitivity reaction to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes. presents with fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels. histologic findings-small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration. can be caused by: chimeric monoclonal antibodies or nonhuman immunoglobulins, and nonprotein drugs (penicillin, cefaclor, and trimethoprim-sulfamethoxazole)
absence seizures
type of generalized epilepsy characterized by brief staring spells with momentary loss of awareness followed by an abrupt return to full consciousness. a classic 3-Hz spike wave is seen on electroencephalogram; the treatment is ethosuximide.
HPV
types 16 and 18 are associated with anal and cervical squamous cell carcinoma. HIV infection increases the prevalence of HPV infection and the risk of anal carcinoma, this risk is further augmented in men who have sex with men.
resting membrane potential
typically about -70 mV high potassium efflux and some sodium influx are responsible for the value of the resting potential.
valvular aortic stenosis
typically an ejection or midsystolic murmur of crescendo-decrescendo configuration with maximum intensity over the right second interspace and radiation to the neck and carotid arteries. most common cause of aortic stenosis in elderly patients (age>70) is degenerative calcification of the aortic valve leaflets.
pulmonary infarcts
typically hemorrhagic (red) and wedge-shaped in the periphery of the lung. IVDU are at increased risk of tricuspid valve endocarditis, which can cause multiple septic pulmonary infarcts due to emobolization of tricuspid valve vegetation fragments.
congenital torticollis
typically noted by 2 to 4 weeks of age, after which the child prefers to hold the head tilted to one side. it is most commonly the result of malposition of the head in utero or birth trauma. most cases resolve with conservative therapy and stretching exercises.
transamination reactions
typically occur between an amino acid and an alpha-keto acid. the amino group from the amino acid is transferred to the alpha-keto acid, and the alpha-keto in turn becomes an amino acid. pyridoxal phosphate (active vitamin B6) serves as a cofactor in amino acid transamination and decarboxylation reactions.
invasive breast carcinoma
typically presents as an irregularly shaped adherent breast mass, most commonly in the upper outer quadrant. malignant infiltration of suspensory ligaments of the breast causes dimpling of the overlying skin. is spread through lactiferous sinuses, it may cause nipple discharge and superficial nipple changes.
cardiac tamponade
typically presents with hypotension with pulsus paradoxus, elevated JVD, and muffled heart sounds (Beck's triad). pulsus paradoxus refers to an abnormal exaggereated decrease in systolic blood pressure >10 mm Hg on inspiration, and is a common finding in patients with pericardial effusion with cardiac tamponade.
common peroneal (fibular) nerve injury
typically results from trauma to the leg near the head of the fibula. signs include 'foot drop' and a characteristic 'steppage gait'.
acute decompensated heart failure CXR
typically shows prominent pulmonary vessels, patchy, bilateral airspace opacification; and blunting of the costophrenic angles due to pleural effusions.
protein that undergoes ATP-dependent attachment to other proteins, labeling them for degradation
ubiquitin impaired: alzheimers parkinsons etc.
restless leg syndrome
uncomfortable sensation in the legs accompanied by an urge to move them. worse at rest and when falling asleep. Dopamine agonists are preferred for treatment (pramipexole, ropinirole)
transference
unconscious shifting of emotions associated with a significant person from one's past to a person in the present. project--misattributing one's own unacceptable feelings to another person.
Hepatitis E virus
unenveloped and single stranded RNA virus spread though the fecal oral route. high mortality rate observed in infected pregnant women.
schizoaffective disorder vs. schizophrenia
unlike schizoaffective disorder, schizophrenia does not include prominent mood symptoms that meet criteria for manic and/or depressive episodes. psychotic episodes are experienced without mood episodes.
renal derivatives from embryology
ureteric bud ultimately gives rise to the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters. metanephric mesoderm (blastema) gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of Henle, and distal convoluted tubules.
photosenstivity (vesicel and blister formation on sun exposed areas) due to enzyme deficiency in
uroporphyrinogen decarboxylase causes porphyria cutanea tarda
Sublingual nitroglycerin
used for rapid symptom relief in patients with stable angina. vendilation with a decrease in LVEDV and wall stress, resulting in decreased myocardial oxygen demand and relief of angina symptoms.
colchicine
used for treatment of acute gouty arthritis in patients who cannot take NSAID drugs. it inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization--disrupting chemotaxis, phagocytosis, and degranulation. significant side effects of colchicine include nausea and diarrhea.
digoxin
used for ventricular rate control in A. Fib. decreases AV nodal conduction by increased parasympathetic vagal tone. also used in heart failure due to its positive inotropic effect. these effects are accomplished via inhibition of the sodium-potassium ATPase pump.
base excision repair
used to correct single-base DNA defects induced spontaneously or by exogenous chemicals. glycosylases remove defect base, corresponding empty sugar-phosphate site is cleaved and removed by action of endonuclease and lyase. DNA polymerase then replaces the missing nucleotide, and ligase seals the final remaining nick.
southwestern blotting
used to detect DNA-binding proteins such as transcription factors, nucleases, and histones.
thayer-martin medium
used to isolate pathogenic Neisseria species. it is a chocolate sheep blood agar that contains vancomycin to inhibit the growth of gram-positive organisms; colistin and trimethoprim to inhibit gram-negative bacteria (other than pathogenic neisseria); and nystatin to inhibit yeasts.
erythropoiesis-stimulating agents
used to treat anemia of chronic kidney disease. increased risk of thromboembolic events due to increased blood viscosity. may also develop hypertension- maybe due to activation of erythropoietin receptors on vascular endothelial and smooth muscle cells.
glycerol kinase
uses glycerol from degradation of triglycerides in adipose tissue in liver and kidneys synthesizes glucose during gluconeogenesis
fick principle can be applied to calculate cardiac output
using the rate of oxygen consumption divided by the arteriovenous oxygen content difference.
selective IgA deficiency
usually asymptomatic recurrent sinopulmonary, gastrointestinal infections, autoimmune disease, anaphylaxis during transfusions.
congenital hypothyroidism
usually asymptomatic at birth. after maternal T4 wanes (two-ish months) infant develops constipation, lethargy, hypotonia, macroglossia, an umbililcal hernia, and a large anterior fontanelle.
skeletal system metastases
usually hematogenously. cancers of pelvis, including prostate, spread to lumbosacral spine via the vertebral venous plexus, which communicates with prostatic venous plexus.
nuclear factor kappa B
usually in the cytoplasm in inactive form= IkB lipopolysaccharide can initiate signal cascade that results of IkB and translocation of free NF-kB to the nucleus.
protective carrier protein for circulating factor VIII
vWF function as promoter of platelet adhesion at sites of vascular injury by binding platelet glycoproteins to subendothelial collagen on injured blood vessel walls.
difference in phenotype observed in those with same genetic mutation
variable expressivity dependent on multiple interacting genetic and environmental factors
dilations of the spermatic vein pampiniform plexus enlarge with standing and regress with lying down
varicoceles some asymptomatic others experience: aching pain that is relieved with recumbency, testicular arophy, or reduced fertility
phenylephrine
vasoconstriction, SVR increase, afterload increase, and decrease CO
lymphatic drainage proximal to the anal dentate line occurs
via inferior mesenteric and internal iliac lymph nodes distal: inguinal nodes
insulin resistance
visceral obesity measured by wait circumference or wait-to-hip ratio is an important predictor of insulin resistance.
breast milk content is insufficient in
vitamin D and K K is given parenterally to all newborns at birth to prevent hemorrhagic disease of the newborn. exclusively breastfed infants require vitamin D supplementation due to lack of sunlight exposure and to prevent rickets.
vitamin deficiency mimic friedreich ataxia
vitamin E deficiency antioxidative properties ataxia, loss of position and vibration sense, and loss of deep tendon reflexes
enteric bacteria produce
vitamin K and folate inhibit proliferation of surrounding pathogenic bacteria, and digest unabsorbed dietary sugars and convert them to fatty acids. small intestinal bacterial overgrowth: deficiency: B12, A, D, E, iron
renal blood flow
volume of blood that flows through the kidney per unit time and can be calculated by dividing the renal plasma flow by (1-hematocrit). plasma flow=PAH clearance times urine flow rate.
VIP persists with fasting, achlorhydria, and hypokalemia
vs. gastrinoma ZES: ulcer!, diarrhea, abdominal pain/acid reflux
PT/INR used to monitor
warfarin vs. aPTT used for monitoring unfractionated heparin
adenocarcinoma in situ
well differentiated, dysplastic columnar cells that line the alveolar septa without vascular or stromal invasion. tendency to undergo spread and can progress to invasive disease if not resected.
lead time bias
when new test diagnoses condition earlier than conventional studies, causing apparent increase in survival time despite no improvement in overall mortality.
lactic acidosis in septic shock results from tissue hypoxia
which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis
chronic inflammation is associated with increased circulating pro-inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis factor -alpha)
which stimulates the liver to release acute-phase reactants (eg, C-reactive protein, fibrinogen). the presence of acute-phase reactants increases the erythrocyte sedimentation rate, a nonspecific marker for inflammation.
sensory ataxia
wide based gait, positive romberg sign. evident in tabes dorasalis along with loss of proprioception and vibratory sensation, severe lancinating pains
probability of child of parents from 2 populations with different mutant allele carrier frequencies
will inherit an autosomal recessive disease is 25% multiplied by the carrier frequencies.
widening of pressure volume loop
with a shift in the isovolumic relaxation line to the left (indicating less residual blood volume in the ventricle at end-systole). an increase in effective stroke volume or ejection fraction is depicted on the left ventricular pressure-volume relationship.
fragile X syndrome
x-linked disorder that presents with a long, narrow face, a prominent chin and forehead, and large testes. patients have developmental delay and neuropsychiatric findings that overlap with anxiety disorders, autism, and ADHD.
lesch-nyhan syndrome
x-linked recessive disorder caused by deect in hypoxanthine-guanine phosphoribosyltransferase (HGPRT). this results in failure of the purine salvage pathway, leading to increased degradation of hypoxanthine and guanine to uric acid. de novo purine synthesis must increase to replace the lost bases, necessitating an increase in phosphoribosyl pyrophosphate (PRPP) amidotransferase activity.
DMD
x-linked recessive myopathy that manifests with proximal muscle weakness and enlargement of the calf muscles in boys ages 2-5. deletions affecting the dystrophin gene. this gene stabilized sarcolemma and the intracellular contraction apparatus, and disruption of the protein results in membrane damage and myonecrosis.
allopurinal and azathioprine
xanthine oxidase catalyze 1 of 2 major inactivating pathways. allopurinal competitively inhibits XO, resulting in increased conversion of azathioprine to its active metabolite.
metalloproteinases
zinc containing enzymes that degrade the extracellular matrix participate in normal tissue remodeling and in tumor invasion through the basement membrane and connective tissue.