Combined STEP ONE STUDY Part 2

another name for inositol triphosphate

IP3

O antigen of LPS is used for what in gram negative organism

Id of different strains

function of lamellar bodies

In type II pneumocytes they secrete surfactant neonatal ARDS

IL-12

Induces differentiation of T cells into Th1 cells. Activates NK cells. macrophage --> IL-12 ---> Th1 ---> IFN-y

Bleomycin MOA

Induces free radical formation -> breaks in DNA strands

Left recurrent laryngeal nerve innervates what structures?

Innervates posterior cricoarytenoid Lateral cricoarytenoid oblique arytenoid transverse arytenoid thyroarytenoid

Intrinsic tyrosine kinase

Insulin, IGF-1, FGF, PDGF, EGF MAP Kinase pathway Think Growth factors

cell cycle regulatory proteins

Intracellular proteins that regulate, or prevent, a specific stage of the cell cycle (e.g., cyclin) P53 and Rb

Dubin-Johnson syndrome vs. gilbert syndrome

Isolated hyperbilirubinemia ↑ Unconjugated (indirect) bilirubin: Excess release Hemolytic anemia, Defective conjugation, Gilbert syndrome, Crigler-Najjar syndrome (1,2) ↑ Conjugated (direct) bilirubin: Defective excretion Dubin-Johnson syndrome, Rotor syndrome (3,4)

Hepatitis B pathogenesis

It is carried to the liver by the bloodstream. HBV uncoats and is transported into the nucleus. Transcription and translation occurs and HBV acquires its envelop and it exits the cell viral HBsAg are expressed with MHC class I leading to activation of CD8 and destroy infected hepatocytes.

treatment for strongyloides

Ivermectin or albendazole

EPO MOA

JAK/STAT

polycythemia vera EPO growth signals?

JAK2 --> cytoplasmic tyrosine kinase

patellar reflex

L3, L4 (kick the door)

Papillary carcinoma of the breast

LACK MYOEPITHELIAL CELLS

polycystic ovary syndrome increased (hormone)

LH

Hyporeflexia, hypotonia, atrophy, fasciculations

LMN damage

alpha and beta antagonists (2)

Labetalol Carvedilol

Birbeck granules

Langerhans cell histiocytosis

dead space vs. shunt

Large embolus obstructing pulmonary blood flow = Perfusion defect There is no capillary bed around smaller bronchi/bronchioles and they form the anatomical dead space. Since embolus also obstructs blood flow, the supplied alveoli which are ventilated, turn into dead space as no exchange of gases can occur through them. → Shunt = Ventilation defect

What X-linked recessive disorder is characterized by hyperuricemia, spastic cerebral palsy, mental retardation, and self-mutilation?

Lesch-Nyhan syndrome --> HGPRT deficiency aka hypoxanthine-guanine phosphoribosyltransferase

Sawtooth appearance at dermal epidermal junction?

Lichen planus 5 p's: pruritic, pink purple, polygonal papules and plaques

ovarian cancer and colorectal cancer with increase CA-125. What is the mechanism and cancer behind?

Lynch syndrome (MSH MLH) mutation in mismatch repair gene causing microsatellite instability

(???) cycle arrest is associated with vincristine and which the mitotic spindle which is what separates the chromosomes is not forming.

M cycle arrest is associated with vincristine and which the mitotic spindle which is what separates the chromosomes is not forming.

Papillary carcinoma of the thyroid

MC thyroid cancer, linked to radiation exposure, contains psammoma bodies "Orphan Annie" nuclei

3 disease that cause pheochromocytoma

MEN 2(A and B) von hippel-lindau disease neurofibromatosis type 1

peptide transporter (TAP) seen on what cell type

MHC class I

Extramammary Paget Disease Presents as? Key point?

Malignant epithelial cells in the epidermis of the vulva. Presents as erythematous, pruritic and ulcerated. MUST be distinguished from melanoma! 1.) Paget cells are PAS+, keratin+, and S100- 2.) Melanoma is PAS-, keratin-, and S100+

multiple osteolytic appearing lesion of the hip and pelvis, endocrine abnormality and cafe-au-lait spots. What is the diagnosis?

McCune-Albright syndrome

MDs don't LIe

Medial to inferior epigastric vessels = Direct hernia Lateral to inferior epigastric vessels = Indirect hernia

Thick glomerular basement membrane on H&E, due to immune complex deposition. , Immune complexes deposit SUBEPITHELIALLY. They have a granular immunofluorescence and a ________ appearance on EM. This is because epithelial cells lay down basement membrane when they get pushed off by immune complexes.

Membranous nephropathy

long slender microvilli and tonofilaments

Mesothelioma

comedonal inflammatory nodular eruption on the patients face chest and back. what can cause this in a 25 year old

Methyltestosterone

Acyclovir MOA

Monophosphorylated by HSV/VZV thymidine kinase. Guanosine analog. Triphosphate formed by cellular enzymes. Preferentially inhibits viral DNA polymerase by chain termination.

Ornithine transcarbamylase deficiency

Most common urea cycle disorder X-linked recessive (other urea cycle enzyme deficiencies are autosomal recessive) First few days of life, may present later Excess carbamoyl phosphate converted to orotic acid High orotic acid in blood and urine Low BUN Hyperammonemia symptoms No megaloblastic anemia (vs orotic aciduria)

Complete Androgen Insensitivity Syndrome (CAIS):

Mutated androgen receptor (AR) in 46 XY (male fetus) Y chromosome is present, so SRY gene will code for testis determining factor, and therefore Leydig and Sertoli cells are present. Leydig cells are producing testosterone, but lack of functioning AR means no male external/internal structures. External genitalia "defaults" to female. Sertoli cells produce Mullerian Inhibitory Hormone (MIH), which inhibits female internal structures. --> The absence of any internal genitalia means MIH is working, so choice D is wrong.

Mechanism of Acetaminophen toxicity?

N-acetyl-p-benzoquinoneiminie is a toxic metabolite that accumulates once glutathione is saturated metabolism to toxic metabolite by CYP enzymes

skin fagility with hyerextensible skin. What is the dx? what is the mechanism behind it?

N-terminal propeptide removal (cutting) ehlers-danlos syndrome (deficiency in procollagen peptidase)

INCREASE IN SUPEROXIDE ANIONS IS DUE TO INCREASE IN WHAT ENZYME (SOD, NADPH OXIDASE, MPO)

NADPH OXIDASE

what enzyme reduces oxygen to superoxide free radicals?

NADPH oxidase

Riboflavin deficiency (enzyme impaired)

NO one disease associated with it Tongue, skin, eyes, and digestive system may be affected succinate dehydrogenase

cause of chronic interstitial nephritis

NSAIDS

Acute interstitial nephritis

NSAIDs, penicillin, diuretics Fever and rash, eosinophils in urine Can progress to renal papilary necrois (also caused by sickle cell trait/DM) -rash, fever, recently started taking indomethacin with new renal failure, and wbc in urine

How does multiple myeloma cause hypercalcemia?

Neoplastic plasma cells activate RANK receptor on osteoclasts

(??? embryological???) cells migrate to form the aorticopulmonary septum and abnormalities associated include tetrology of fallot, transposition of the great arteries, and persistent truncus arteriosus. Fusion of the aorticopulmonary septum with the muscular ventricular septum is what forms the membranous septum, so patients with a persistent truncus arteriosus will have VSD as well.

Neural crest cells (ectoderm neural crest cells)

Best med to increase HDL

Niacin

Pemphigus vulgaris mouth

Nikolsky's sign (separation of epidermis caused by rubbing of the skin) desmoglein IgG and C3

if you had gastrectomy 8 months ago are you likely to have B12 deficiency?

No it takes 4-5 years

Does choriocarcinoma respond well to chemo?

No. It also spreads aggressively via hematogenous spread (germ cell tumor) but yes due to gestation of molar pregnancy

Filamentous gram (+) rod

Nocardia

stress induced cardiomyopathy pathology

Non ischemic cardiomyopathy caused by a sudden temporary dysfunction of the myocardium. Etiology is unclear, but possibly related to autonomic nervous system and excessive release of adrenalin ACUTE, will resolve in 2 months most commonly seen in *postmenopausal* women with a Hx of a recent and severe emotional or physical stress. Average age 58-75yrs Cause: Sudden temp dysfunction of myocardium Effect: Acute HF Effect: Lethal ventricular arrhythmia Effect: Possible ventricular rupture catecholamine surge causing reversible myopathy to heart

EML4-ALK fusion gene

Non-small cell lung cancer; fusion protein product that is a constitutively active tyrosine kinase, similar to BCR-ABL gene in CML.

Normal size of kidney

Normally, kidneys are about the size of a fist or 10 to 12 cm (about 5 inches

Metastatic carcinoma of liver

Occurs more often then primary liver cancer, tumors invade nearby organs and structures

1) little dude is from Congo 2) He's asymptomatic except for the skin nodules 3) the biggest key here was the presence of the microfilariae from the skin nodule what is the organism

Onchocerca volvulus --> black fly --> deposits larva in skin which mature into adults producing microfilariae causing scattered puritiic papules and potentially eye blindness.

Bcl-2

Oncogene Anti-apoptotic molecule, t(14;18) moves Bcl2 (18) to IgH locus Follicular and undifferentiated lymphomas bcl-2 think two L's for follicular and two L (but really 1's for 14,18

Morphine mechanism of action

Opioid agonist. Open K+ channels, close Ca2+ channels; decreases synaptic transmission thus decreasing release of Ach, NE, 5-HT, glutamate, substance P.

Foramen cecum of tongue WHICH GLAND DEVELOPS

Origin of the thyroglossal duct from which the thyroid gland develops

Hereditary Orotic Aciduria

Orotic Acid is excreted in the urine because UMP synthase is defective -pyrimidines cannot be synthesized, and therefore growth retardation occurs -oral administration of uridine bypasses the metabolic block and provides a source of pyrimidines

What drug resistance is due to overproduction of antibiotic target?

PABA/folic acid aka TMP-SMX

subacute infective endocarditis COMPLICATED BY EMBOLIC STROKE. FEW DAYS LATER WHAT IS THE MOST LIKELY COMPLICATION

PAPILLARY MUSCLE RUPTURE

where does aspirin act on

PDGG ↓

Factor XII deficiency - PT, PTT, BT, PC?

PT - unaffected PTT - prolonged BT - normal PC - normal AUTOSOMAL RECESSIVE -elevated aPTT but there is no bleeding No therapy needed !!!!!

A friction rub is associated with

Pericarditis

positive sense RNA virus that causes GI symptoms followed by meningitis?

Picornavirus enterovirus, coxackivirus, poli, hep A, rhino

Leukocidin Toxin

Pore-forming toxin - lyses white blood cells Leads to increased Interleukin (IL)-8 secretion and skin necrosis CA-MRSA (Not in HA-MRSA) European livestock

Heteroplasmy

Presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrial inherited disease

Pityriasis Rosea

Presents with a herald patch, Christmas-tree pattern.

Antimitochondrial antibodies (AMAs)

Primary biliary cirrhosis (female, cholestasis, portal hypertension)

treatment for heparin overdose

Protamine sulfate (positive charged molecule binds negatively charged heparin)

TAP proteins

Proteins that grab endogenous peptides and brings them to the ER to interact with MHC class I endoplasmic reticulum

renal artery stenosis causes what changes to opposit kidney

RAAS activation ---> ↑blood pressure ↑ renal perfusion --> hypertension and nephrosclerosis (wall thickening)

what genetic alteration in a protein that function to transduce signals from the cell membrane to the nucleus by activating other molecules. What is defective

RAS-->gain of function

Marfanoid habitus what gene mutation

RET gene ---> neural crest cells

Hand-foot-mouth disease, describe it and what it leads to

RNA Virus: Coxsackievirus herpangia, ulcerations, aseptic meningitis , myocarditis

newly transcribed nRNA undergoes (???) to form mature nRNA before leaving nucleus.

RNA splicing

Rifampin ihibits what?

RNA synthesis (dna dependent rna polyerase)

Paroxysmal nocturnal hemoglobinuria

Red urine in the morning, fragile RBCs PNH occurs at night due to mild respiratory acidosis (slower respiratory rate), which activates complement which destroys RBCs. The test is essentially doing the same thing, putting cells into an acidic environment -> dead RBCs

P bodies

Regulate mRNA translation in the cytoplasm

Ankle reflex

S1-S2 (buckle my shoe)

area between tricuspid valve and inferior vena cava in right atrium

SA node

Urine osmolality > serum osmolality

SIADH

what conidition is at highest risk of a infant living in a smoking household>

SIDS

pericarditis can be seen in what autoimmune disease

SLE

what antiarrhythmic prolong QT and lead to increased risk of torsades de pointes?

SOTALOL

Axillary nerve injury

Saturday night palsy, crutches, fracture of surgical neck of humerus, ANTERIOR DISLOCATION OF HUMERUS weakness of the abduction of shoulder (deltoid)

IgA protease Who secretes it?

Secreted by S. pneumoniae, H. influenzae, and Neisseria to prevent phagocytosis (SHIN)

Anaplastic carcinoma of thyroid

Seen in elderly Highly malignant Arises from longstanding follicular or papillary carcinoma Death within a few months

5-hydroxyindoleacetic acid (5-HIAA) seen in what disease

Serotonin's main metabolite, in the cerebrospinal fluid (CSF) seen in carcinoid tumor

Nitroprusside

Short acting; increase cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide)

Sirolimus

Similar to Tacrolimus, but inhibits *mTOR*-->decreased T cell proliferation INSULIN RESISTANCE

c-jun & c-fos used in what type of blotting

Southwestern blot; nuclear transcription factors that directly bind DNA via a leucine zipper motif

There are 4 structures to the 'side' (lateral) beginning with S

Spinocerebellar pathway: damage results in ipsilateral ataxia of the arm and leg Spinothalamic pathway: damage results in contralateral alteration of pain and temperature affecting the arm, leg and rarely the trunk Sensory nucleus of CN V: damage results in ipsilateral alteration of pain and temperature on the face in the distribution of CN V (this nucleus is a long vertical structure that extends in the lateral aspect of the pons down into the medulla) Sympathetic pathway: damage results in ipsilateral Horner's syndrome, that is partial ptosis and a small pupil (miosis)

Howell-Jolly bodies due to what?

Splenectomy (or nonfunctional spleen)

Colon watershed regions?

Splenic fleXure (SMA, IMA junction). Rectosigmoid.

Ovarian vein thrombosis

Stasis, hypercoagulability, endothelial damage

Best med to lower LDL

Statin

Type II error (β)

Stating that there is not an effect or difference when one exists (null hypothesis is not rejected when it is in fact false).

pharmacological stress testing

Stress test used when patient cannot complete a physical stress test and medication is given instead to stress & test the heart. Adenosine (Adenocard) & dobutamine (Dobutrex) is given. Pt. is monitored with 12 lead EKG & with frequent BP checks.

Magnesium ammonium phosphate stones

Struvite. The so called "infection stones" that comprise 20% of all renal calculi. Associated with proteus, klebsiella, and staph infections because they convert urea to ammonia. Typical to see "staghorn" stones that fill renal calyces.

Tender thyroid, high ESR, glanulomatous inflammation following flu-like illnes

Subacute Granulomatous (De Quervain) Thyroiditis

Drug-induced lupus

Sulfonamides Hydralazine Isoniazid Procainamide Phenytoin

pudendal nerve

Supplies sensation to external genitalia and perineum (external hemorrhoids, below dentate line)

IL-3

Supports growth and differentiation of bone marrow stem cells. Functions like GM-CSF

Alteplase mechanism of action

Synthetic form of tissue plasminogen activator (TPA); activates plasminogen, which forms plasmin; plasmin degrades fibrin mesh in clots

Acute Rheumatic Fever

Systemic complication of pharyngitis due to group A beta-hemolytic streptococci; affects children 2-3 weeks after an episode of streptococcal pharyngitis sterile vegetations mitral valve (regurgitation); pancarditis with Aschoff nodule (most common death complication)

carcinoma associated with celiac disease is (B or T) cell cacinoma

T cell

what produces IFN-y?

T lymphocytes

What cell type plays role in recognizing and killing HPV tumor cells?

T-lymphocytes

cancer that presents with large anterior mediastinal mass that compresses the great vessels causing superior vena cava syndrome is associated with what immature heatopoietic cell?

T-lymphocytes (T-ALL)

increase basal metabolic rate

T3 and T4 increased synthesis of Na/K atpase

first week of TB infection?

TB replication in unchecked fashion within phagosomes of macrophages

keloid have increased (???) activity in inflammation (cytokine)

TGF-B

muscle wasting cytokine?

TNF-a

septic shock is mediated by what cytokine?

TNF-a (activated by macrophages)

TNF-a drug = (??organism??)

TNF-a drug = Tb

relative risk

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed

DNA methylation

The addition of methyl groups to bases of DNA after DNA synthesis; may serve as a long-term control of gene expression. (slow it down)

dopamine beta hydroxylase deficiency

The entire body cannot produce epinephrine and norepinephrine --> impaired sympathetic adrenergic activity but normal parasympathetic and cholinergic sympathetic

Afterload

The force or resistance against which the heart pumps. (diastolic pressure) force against the muscle fiber must contract decrease in afterload would increase contraction velocity

Dysmetria

The inability to control the range of a movement and the force of muscular activity. cerebellum injury

odds ratio

The likelihood of a disease among individuals exposed to a risk factor compared to those who have not been exposed

relative risk

The risk of disease in the exposed group divided by the risk of disease in the non-exposed group.

grading vs staging ex. poorly cohesive cells with large nucleus and invasion to stromal with no adenopathy or mets seen.

The stage of a cancer describes the size of a tumour and how far it has spread from where it originated. The grade describes the appearance of the cancerous cells. Grade refers to the differentiation, whereas stage refers to the TNM decriptions This is high-grade because of the "poorly demarcated... cells growing in sheets" wit a high N:C ratio. Means it's got low differentiation. This is low-stage because there is NO METASTASIS. Even though there is invasion (and thus, a cancer), M for the TNM is most important.

Countertransference

Therapist has transference reaction to the patient ex: patient reminds therapist of his younger brother (instead of patient to physician)

Diphenoxylate, loperamide

These agents are used as antidiarrheal opioid agonist

What do eosinophils look like?

They have a nucleus similar to a neutrophil with chromatin that's not coarsely clumped and divided into 2 lobes or band-shaped. The cytoplasm is clear to pale blue with predominant pink to orange granules.

Acetazolamide MOA (urine ph level, urine potassium, serum calcium, PaCO2)

Thick ascending Tubule Carbonic anhydrase inhibitor Self limited NaHCO3 diuresis and decrease total body HCO3- stores increase urine pH increase urine potassium no change in calcium decrease PaCO2

steady state concentration

This plasma concentration is achieved when the Rate of Drug Elimination = Rate of Drug Administration. 4-5 half lives

Thyrotropin receptor autoantibodies

Thyrotropin-receptor antibody is an autoantibody to the thyroid cell receptor for thyroid-stimulating hormone. It can be demonstrated in 90% of patients with Graves' disease, and is the cause of the hyperthyroidism of that condition.

c-myc function

Transcriptional Activator (Burkitt's)

What is an unbalanced translocation?

Translocation accounts for 4% of all cases of Down syndrome. In translocation, part of chromosome 21 breaks off during cell division and attaches to another chromosome, typically chromosome 14. While the total number of chromosomes in the cells remain 46, the presence of an extra part of chromosome 21 causes the characteristics of Down syndrome.

eating polar bear meat, what is the diagnosis and test

Trichinella muscle biopsy (larvae bury themselves inside muscle tissue rather than remain in the intestine as in other roundworm infections, so stool sample tests don't often show evidence of the parasite)

Ebstein's anomaly

Tricuspid flaps fused to inside of right ventricle; creates constant opening between atrium & ventricle

low set ears small mandible and prominent occiput. clinching hands with second and fifth digits on top. heart defect. what chromosomal abnormality?

Trisomy 18 (Edwards syndrome) also has rocker bottom feet

Cystic hygroma (DOUGHY MASS ABOVE CLAVICLE THAT TRANILLUMINATES) is associated with

Turner syndrome Down syndrome (trisomy 21) Klinefelter syndrome (XXY) Trisomy 18, 13 CHROMOSOMAL ANEUPLOIDY

Crypt abscesses with neutrophils

Ulcerative colitis - *Pseudopolyps* (healing response); - loss of haustra --> *lead pipe* sign on imaging

idiosyncratic drug reaction

Unexpected, unusual response to a drug

treatment for DVT

Unfractionated heparin or LMWH ( ENOXAPARIN)----> then Warfarin for 3-6 months

Pleiotropy example

Untreated PKU manifests with light skin, intellectual disability, and musty body odor, sickle cell, marfans The ability of a single gene to have multiple effects.

Constipation in pregnancy

Usually occurs in the second and the third trimesters Results from an increase in progesterone production, decreased intestinal motility due to decreased colonic smooth muscle activity, displacement of the intestines, pressure of the uterus, and taking iron supplements

occlusion of LAD would expect ST elevation in what leads?

V1-V4

what leads show LAD MI?

V1-V4

what murmur has blowing holosystolic and is usually not detectable until age 4-10 days (pulmonary vascular resistance declines)

Ventricular septal defect

serpentine cords

Virulent strains of tubercle bacilli(TB) form microscopic "serpentine cords" in which acid-fast bacilli are arranged in parallel chains. Cord formation is correlated with virulence. A "cord factor" (trehalose-6,6'-dimycolate) has been extracted from virulent bacilli with petroleum ether. which prevent Macrophage mediated destruction

Whipple disease (Tropheryma whipplei)

Weight loss, diarrhea, arthritis, fever, adenopathy macrophages related

Western blot changed with no change in RNA or DNA. Means what changed?

Western blotting detects proteins. Since the number of proteins detected has increased, without any change in the mRNA (detected by Northern blot) or DNA (by PCR), there has been an increase in the translation

Adenosine deaminase

What enzyme of the purine salvage pathway is deficient in the following? • SCID

basal ganglia atrophy in a child (huntingtons in adult

Wilson's disease

What is the immunodeficiency? ■ A child has eczema, thrombocytopenia, and high levels of IgA.

Wiskott-Aldrich syndrome

Where is H. pylori found in greatest concentration?

Within the mucus layer overlying the gastric epithelium or adherent to its surface, and is NON INVASIVE to the mucosa (which means it secretes something) gastric ANTRUM

Bruton's agammaglobulinemia

XR condition where pre-B cells cannot differentiate into B cells so they cannon leave bone marrow. low B and normal T (<1% of CD19 or CD20+)

do you have increased tactile fremitus is pneumonia?

YES

Ichthyosis vulgaris

Young pt p/w dry and scaly skin. Dryness is worst in the winter despite frequent moisturizer application. due to defective keratinocyte desquamation ↑ thickness of stratum corneum; absent granular layer

you have (???) bone marrow if you take Zidovudine

ZERO (Z'S)

Focal nodular hyperplasia

a benign liver mass composed of a combination of hepatocytes and fibrous tissue that typically contains a central scar

seborrheic keratosis

a benign skin growth that has a waxy or "pasted on" look

lipoma

a benign, slow-growing fatty tumor located between the skin and the muscle layer

gumma

a characteristic soft, gummy lesion caused by bacteria that invade organs throughout the body; found in the tertiary stage of syphilis

Pseudofolliculitis barbae

a chronic inflammatory form of folliculitis known as "razor bumps" resembling folliculitis papules and pustules; generally accepted to be caused by ingrown hair

anisocoria

a condition in which the pupils are unequal in size

Ecthyma gangrenosum

a cutaneous necrotic disease associated with Pseudomonas bacteremia. These infections are common in patients who a neutropenic (chemotherapy, are hospitalized, have burns, or indwelling catheters.

diabetic retinopathy

a disease of the retina in diabetics characterized by capillary leakage, bleeding, and new vessel formation (neovascularization) leading to scarring and loss of vision -nonproliferation early cotton wool --> proliferation late neovascularization

Bronchiolitis obliterans (rejection)

a fibrotic process that occludes airways and causes permanent scarring of the lungs caused by CHRONIC rejection --> lymphocytic inflammation and fibrosis

Hepcidin

a hormone produced by the liver that regulates iron balance

hypotension is caused by blockage of (a-1, a-2, b-1, b-2)

a-1

united states mortality women

a. lung cancer b. breast

downs syndrome can be caused by what 3 abnormalities?

a. meiotic nondisjunction b. unbalanced translocation c. mosaicism (nondisjunction during mitosis)

superior sulcus tumor

a.k.a. Pancoast tumor (superior sulcus is a pleural groove made by the subclavian artery)

osteodystrophy can be seen in what chronic disease

abnormal development of bone chronic renal failure

prolyl hydroxylase inhibitor will cause impaired function of what during collagen synthesis

abnormal triple-helix formation of collagen molecules

hypertrophic cardiomyopathy (which increases or decreases) a. valsalva, abrupt standing, nitro b. sustained hand grip, squatting, passive leg raise

abrupt standing ---> increased murmur intensity squatting --> decreased murmur intensity

Abetalipoproteinemia

absence of apoliprotein B-48 adn B-100 Can't get fat in with chylomicrons and low VLDL and LDL (require B-100) an inherited inability to synthesize apolipoprotien B, thus lipids absorbed in the small intestine cannot be transported by chylomicrons and therefore it builds up in enterocytes.

What does p wave look like in A-fib?

absent (can be caused by alcohol consumption)

Hirschsprung disease

absent ganglion cells in submucosal/myenteric plexus rectosigmoid

high lower esophageal pressure

achalasia

girl with increased head circumference, mid-face hypoplasia, humoral and femoral shortening and shortened digit spaces. What is the diagnosis and mutation?

achondroplasia; point mutation on fibroblast growth factor receptor 3(FGFR3) causing gain of function

interferon gamma function

activates macrophages to induce granuloma formation (process of IGRA) testing

Apoptosis requires a. matrix metalloproteinases b. acid hydrolases c. caspases

activation of caspases

Erythromycin prokinetic effects on GI system?

activation of motilin receptor brown puddle: increases GI motility

increased insulin like growth factor with lack of GTPase activity would lead to increase in what activity?

adenylyl cyclase dealing with overactivation of the G alpha stimulatory subunit . If the GTPase aint working ( meaning it cant be inactivated ) , the effect would be an increase in the activity of adenyl cyclase

Cough reflex - Afferent - Efferent

afferent X efferent X

carotid sinus reflex afferent efferent

afferent: IX efferent: X

gastrin-mediated rebound acid hypersection occurs when

after being taken off ibuprofen and lansoprazole

persistence of (???) leads to umbilical hernia with minimal clear to straw colored discharge from umbilicus.

allantois remnant

Panacinar emphysema is associated with

alpha 1 antitrypsin deficiency

with DM-1 what failure will you get after 5 years of exogenous insulin release?

alpha cell failure --> decreased glucagon secretion

gastrointestinal hemorrhage causes what secondary messenger system to work?

alpha-1 --> IP3 (phosphatidylinositol) --> liberates calcium --> smooth muscle conctraction

Flutamide MOA

androgen receptor antagonist

IL-10

anti-inflammatory

Albendazole treats

antihelminithic agent treats cutanous larva migrans

side effect of levodopa/carbidopa

anxiety and agitation

"moldy grains" that cause a mutation in p53

aspergillus --> liver cancer

Monoclonal T cell receptor gene rearrangement

associated with malignancy

smooth muscle antibodies associated with what disease?

autoimmune hepatitis

how do you decrease parietal cell mass?

autoimmune response against parietal cells (elevated gastrin with no where to go) --> high gastric pH

what are some unmyelinated nerve fibers?

autonomic postganglionic nerve slow pain, heat sensation, and olfaction

allopurinol cannot be given with what drug

azathioprine

Binding of the 50S subunit a. ceftriaxone b. azithromycin c. moxifoxacin d. doxycycline

azithromycin (moxi is topoisomerase and doxy is 30s)

medications that increase methadone effect

azole cipro, clarithromycin cimetidine fluvoxamine (P450)

epinephrine + (???) will cause diastolic blood pressure to increase and heart rate to fall. a. alpha-1 agonist b. alpha-1 antagonist c. b-agonist d. b-antagonist

b-antagonist propranolol

vesicular hand lesion followed by tender regional lymphadenopathy proximar to lesion with pets. what is the organism

b. henselae ---> can lead to bacillary angiomatosis

injury to cerebellum cause (a or b) a. limb dysmetria b. truncal ataxia

b. truncal ataxia limb dysmetria is lesion affecting cerebellar hemispheres due to lateral descending motor system

fever chills, lungs coarse crackles bilaterally with palpable splenomegaly. What is dx?

babesiosis (lxodes tick)

Clostridium septicum

bacteremia in patients who have malignancies (such as breast or colon cancer)

anaerobic gram-variable rod

bacterial vaginosis (gardnerella vaginalis)

What is leukoplakia?

benign growth, white patches on surface membrane of mucosa. caused by tissue irritation, like with smoking, alcohol or vocal abuse. considered precancerous and must be monitored.

Turner Syndrome is associated with what heart problems

bicuspid aortic valve

myasthenia gravis mechanism

binding of antibody to acetylcholine receptor vs. LES which autoantibodies are against presynaptic calcium channels and decreased ACh release

craniopharyngioma on imaging? visual defects?

bitemporal hemianopia (cant see on the outsides) Arise from squamous epithelial remnants of anterior lobe of pituitary gland (rathkes pouch). Commonly are symptomatic due to large size. Most common suprasellar mass in children. Large cystlike sellar/suprasellar mass with enhancing rim and some calcification.

Occupational exposure to rubber, plastics, aromatic amines-dyes, textile, leather is associated with what type of cancer?

bladder cancer

Embryonal rhabdomyosarcoma

bloody, grape-like vaginal mass in girls rhabdomyoblast: cytoplasmic cross striation desmin and myogenin

toxicity associated with cyclin-dependent kinase (CDK)?

bone marrow suppression

PE: right sided face and arm swelling and engorgement of subcutaneous veins on the same side of the neck. what is obstructed? a. axillary b. brachiocephalic c. superior vena cava d. subclavian

brachiocephalic (right sided brachiocephalic vein obstruction)

the parotid gland goes through what muscle

bucinator

Cryptococcus neoformans: a. budding yeast b. germ tubes c. spherules with endospore d. nonseptate hyphae

budding yeast

duodenal ulcers and surrounding anatomy (what artery affected)

bulb --> gastroduodenal artery

What is exophthalmos and can it be treated with beta blocker?

bulging eyes --> no must be treated with glucocorticoid due to immune mediation

Uniform, round, medium sized tumor cells with basophilic cytoplasm and a large proliferation fraction is indicative for which type of cancer

burkitt lymphoma (EBV virus, c-myc)

Medullary carcinoma of the thyroid

c cells calcitonin congo red MEN 2A and 2B

external beam radiation

can cause free radical formation

Angiosarcoma

cancer of a blood vessel or lymphatic vessel

Gastric adenocarcinoma

cancerous glandular tumor.

continued fever after receiving antibiotics with gram stain showing 4um, elliptical, purple, budding, organism. what is the cause?

candida albicans "when decolourizer is added, the crystal violet taken up by yeast cells is retained"

HIV associated esophagitis

candida is the most common cause, can also be caused by HSV-1 and CMV

otitis media with pleomorphic gram negative coccobacilli. what is the organism and virulence factor?

capsule of haemophilus influenza B (HIB)

what does central retinal artery occlusion look like

cherry red macula

fibrates inhibit what enzyme

cholesterol 7 a-hydroxylase

epigastric calcifications and history of alcohol use makes what diagnosis most likely

chronic alcoholic pancreatitis

colitis associated vs sporadic colorectal cancer

colitis: multifocal origin sporadic: singular, well differentiated, early APC gene muction

TP53

colon adenocarcinoma

Cholecystakinin (CCK)

contract gallbladder

unilateral orchiectomy results in what changed to labido and sperm count

decrease sperm count normal labido

foot drop

deep peroneal nerve

bladder effects due to muscarinic receptor activation

detrusor contraction

CFTR in sweat vs. bronchia differences

different tissue specific function fo cftr

isopropanol mechanism of action against oragnism

disruption of cell membrane

nonmeleficence

do no harm

Is renal failure more likely to cause metabolic acidosis or alkalosis? elevated anion gap or normal?

elevated anion gap -metabolic acidosis

Suppurative parotitis. how to diagnose it?

elevated serum amylase without pancreatitis

what type of virus is measles

enveloped ssRNA negative-stranded

allergies eosinophils vs mast cells

eosinophils: late reaction mast cells: immediate

neck mass + calcitonin. +increased arm span. what is most likely to develop?

episodic headache (pheochromocytoma due to increased blood pressure) MEN 2B

adverse effects of testosterone replacement

erythrocytosis venous thromboembolism

external vs internal oblique muscle aponeurosis, which one gets structures pulled through it and which one travels down with testes?

external: stays internal: goes through

turns blue when they cry, what heart problem?

fallot tetralogy

What excess vitamins should be avoided in pregnancy?

fat-soluble vitamins (vitamin A)

Hepatitis A transmission

fecal-oral route, people handling food don't wash their hands, eating seafood from contaminated water

cough wheezing and nausea with worm found in stool. what is the mechanism of contracting this organism?

feces-contaminated soil

sensation to anterior aspect of right thigh?

femoral nerve (lead to quadricep weakness, decreased patellar reflex )

Lateral pubic tubercle

femoral vein

Decreased 2,3-BPG looks like what specific type of hemoglobin (a,b,f)

fetal hemoglobin due to stronger attachement

Calf pseudohypertrophy pathophysiology

fibrofatty muscle replacement Muscular dystrophy (most commonly Duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)

Integrin interaction with what ECM? a. actin b. fibronectin c. keratin

fibronectin

purpose of ito cells (stellate cells)

fibrosis

radial traction of airways

fibrosis --> increased elastic recoil-->airway widening-->radial traction by pulling

common fibular nerve injury causes weakness on foot dorsiflexion (foot drop) and eversion with impaired sensation of lateral shin and dorsal foot. where is the injury? a. anterior compartment b. lateral compartment c. fibular neck

fibular neck lateral compartment would show superficial nerve injury without weakness to foot dorsiflexion

e. coli bacterial factor that cause UTI

fimbrial antigen

Hageman factor

first factor activated when a blood vessel or cell is injured; starts the cascading reaction of the clotting factors, activates the conversion of plasminogen to plasmin to dissolve clots, and activates the kinin system responsible for activation of the inflammatory response DIC related to gram (-)

viral meningitis with flaccid paralysis

flavivirus (west nile virus)

antiarrhythmic that causes increase in QRS but normal QT?

flecainide

area postrema location

floor of 4th ventricle (D)

What drug resistance is due to alteration of abx binding site on target protein?

fluoroquinolone

what deficiency causes diminished thymidine synthesis?

folic acid or B12 deficiency

blockage of voltage-gated calcium channels affects what step in neurotransmission?

fusion and release of vesicles

bilateral lens opacities with urine positive for reducing substances. not on any specific diet. What enzyme has deficient activity?

galactokinase

Jaundice, vomiting, hepatomegaly renal dysfunction, aminoaciduria, E. coli sepsis, cataract. hemolytic anemia. what is the enzyme deficiency?

galactose-1-phosphate uridyl transferase

what stimuli cause parietal cell hyperplasia?

gastrin

lactose malabsorption is an abnormality of what in enzyme

gene expression of lactase gene

epispadia is due to abnormal positions of the

genital tubercle

B-cells are found in the (????) of lymph nodes

germinal center

Germline mosaicism vs. somatic mosaicism

germline: genetic mutation identified in offspring but not the parents

preeclampsia= (???) + (???)

gestational hypertension + proteinuria (or end organ damage)

primary hyperaldosteronism results in hyperplasia of zona (????) in adrenal gland

glomerulosa

Gaucher disease

glucocerebrosidase (β-glucosidase) def. → ↑ glucocerebroside *aseptic necrosis of femur*, Gaucher cells (lipid-laden Mφ's, crumpled tissue paper), hepatosplenomegaly avascular necrosis and bone pain crises

t cell mediated destruction of pancreatic b cells is due to presence of what antibody

glutamic acid decarboxylase antibodies

renal metabolism of what amino acid is most important for maximizing acid excretion?

glutamine (ammonia buffer system)

excess ammonia leads to increase in what amino acid?

glutamine by astrocytes

5-aminolevulinic acid synthase in erythrocytes involves what two compounds

glycine and succinyl CoA

Crescent formation in glomeruli with linear IgG and C3 are characteristic of what disease?

goodpasture syndrome ---> due to antibodies directed at glomerular basement membrane

in Day 10-14 there is (???) tissue, 2 weeks to 2 months there's collagen deposition and scar formation

granulation

giant cell arteritis pathologic process

granulomatous inflammation of media due to T-cell mediated inflammatory process

scalloping edges histology for thyroid?

graves disease

where is strep gallolyticus (bovis) normally seen?

gut flora (look for colon cancer)

mechanism of quick recovery from volatile inhaled anesthesia?

halothane (eliminated by the lungs)

how do you reduce risk of spread of staph?

hand hygiene

HOXA13

hand-foot-genital syndrome

natural transformation

happens when bacteria take up DNA fragments spontaneously from their surroundings

germinal center and hurthle cells

hashimoto (also look for increased risk for b-cell lymphoma)

triad for HUS

hemolytic anemia thrombocytopenia acute kidney injury

brown pigment in lung parenchyma

heomsiderin-laden macrophages --> heart failure

Large hepatocytes filled with finely granular, homogenous, pale pink cytoplasm

hep B virus

reproducible pain with leg raise

herniated disc

Sheehan syndrome

high estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply. Peripartum hypotension (likely from blood loss) can cause ischemic necrosis of the pituitary leading to panhypopitutiarism. Patients commonly will develop failure of lactation due to deficiency in prolactin.

diverticulosis caused by

high fat food and red meat with no residue (fiber)

hepatic abscess/cysts 1. clinical presentation 2. dx --> organism

high fever, chills, elevated ast, and alt, and fluid filled cavity within lobe of liver. staph aureus can also be caused by e. coli klebsiella by biliary tract

what is the mechanism of recurrence of gonorrhoeae infection?

high variability of microbial antigenic structure (porins and Opa proteins)

Why do we give heparin in pregnancy

high water solubility (like unconjugated bilirubin) charged molecules dont like the cross placenta if its lipophilic it will love the baby

morphine pseudoallergy involves what cytokine

histamine

diarrhea with occasional trophozoites with phagocytosed red blood cells

histolytica

macrophages with intracellular small yeasts

histoplasma capsulatum

middle cerebral artery infarct causes what opthalmic disorder

homonymous hemianopsia

renin-angiotensin system

hormone pathway that *increases thirst and raises blood pressure* if blood volume falls (often due to *dehydration*), detected as decreased blood flow to the kidneys; aka *RAS* or renin-angiotensin-aldosterone system (*RAAS*)

ballotable flank mass week after pelvic surgery suggests?

hydronephrosis (ureteric obstruction

clinical features of primary hyperaldosteronism

hypertension hypokalemia alkalosis: muscle weakness and paresthesias low renin activity and elevated aldosterones

left atrium enlarged left ventricular myocardial mass increased left ventricular wall thickness increased what is the cause

hypertension --> hypertrophic cardiomyopathy

increase in preload or afterload that decreases intensity of murmur. dx?

hypertrophic cardiomyopathy

systolic murmur that intensifies on standing?

hypertrophic cardiomyopathy

hypovolemic shock leads to what changes

hyperventilation due to tissue hypoxia ---> lactic acidosis

Chvostek's sign (facial muscle contraction elicited by tapping on facial nerve anterior to ear) is a sign of what?

hypocalcemia ---> hypoparathyroidism

side effect for sulfonyurea (glyuride)

hypoglycemia

high altitude causes what change to vascular?

hypoxic pulmonary vasoconstriction increased cardiac output increased sympathetic activity aldosterone suppression

Imprinting of the genes

i.e. their methylation, occurs during maturation of germ cells

Glucagon effects on liver given due to hypoglycemia?

immediate glycogenolysis with delayed gluconeogenesis

PCP infection caused by

impaired cell-mediated immunity

Where is the SA node located?

in the right atrium near the opening of the superior vena cava

(increase or decrease) is expected with venous blood mean CO2 content with physical exercise

increase

hyperparathyroidism causes (increase/decrease) in alkaline phosphatase?

increase (osteoblast)

Effects of BNP and ANP

increase GFR decrease Na+ reabsorption decrease renin secretion

diabetic ketoacidosis causes k+ to increase or decrease

increase K+

hypovolemia leads to what changes in angiotensin II endothelin 1 vasopressin norepinephrine

increase in all that yes enothelin too due to ang-ii stimulating release aldosterone and endothelin

Latanoprost -- mechanism

increase outflow of aqueous humor

Myopia (nearsightedness)

increased anterior-posterior diameter

heart failure symptoms are cause by what?

increased sympathetic nervous system activity

glioblastoma multiforme histology

increased vascularity and pseudopalisading tumor cell around necrosis (vascular proliferation)

Cavernous carotid aneurysm

increasing headaches with cranial nerve defects including abducens nerve causing ipsilateral lateral rectus weakness (inward eye deviation and diplopia)

injections where will provide anesthesia to quadracepts tendon

inguinal ligament (femoral nerve)

Somatostatin mechanism of action

inhibit release of endogenous hormones that induce vasodilation thereby indirectly reducing portal blood flow. vasopressin also works

pirfenidone mechanism of action

inhibits TGF-B used for tx of pulmonary fibrosis

how does breast cancer travel to the spine

intercostal veins

yellow fever infects what zone of the liver

intermediate zone (zone II for ye-ll-ow fever)

lymph drainage above pectinate line

internal iliac lymph nodes

breakdown of dipeptides and tripeptides occur where?

intestinal mucosa

Is the spleen intraperitoneal or retroperitoneal?

intraperitoneal

what is the asthma treatment that uses M receptors by traveling through vagus nerve>

ipratropium

Inferior epigastric artery

is 1 of 2 branches of the external iliac artery (which eventually becomes the common femoral artery) that takes off immediately proximal to the inguinal ligament. It provides blood supply to the lower anterior wall as it runs superiorly and medially up the abdomen.

Pancreatic pseudocyst

it is caused by duct leakage, it is clinically suspected it pain persists > 2 weeks following a diagnosis of acute pancreatitis, surgery is reserved for those people who have stopped using alcohol

function of infraspinatus and teres minor

lateral (external) rotation of humerus

does gastric banding pass through greater omentum or less omentum?

lesser omentum

subdural space involves piercing what ligament?

ligamentum flavum The needle will pass through the supraspinous ligament, intraspinous ligament, and ligamentum flavum before entering the epidural space.

kidney disease in multiple myeloma is due to (???) nephropathy a. igm b.igg c. light chain d. heavy chain

light chain nephropathy

CMV esophagitis

linear ulcers with inclusion

myocardial cells with intracytoplasmic granules that are tinged yellowish brown. Did iron or lipid cause this?

lipid peroxidation (lipofuscin)

soft tissue malignancy with lipoblast and SCALLOPING OF EDGES OF FAT TISSUE

liposarcoma (not lipoma, it will look more normal)

postprandial short acting insulin

lispro aspart glulisine

spilled teacup sign

lunate dislocation

cell type most commonly involved with toxic shock syndrome?

macrophages and t-lymphocytes

antigenic shift

major change in influenza virus antigen due to gene reassortment

X4 strains of HIV that bind T lymphotropic with little to do with macrophages cannot be treated with what medication?

maraviroc

example of a chemokine receptor antagonist used in HIV treatment

maraviroc

A mutation in the fibrillin-1 gene causes:

marfan syndrome

Cromolyn

mast cell stabilizer

asymmetrical distribution-negatively skewed

mean<median<mode

what u-opioid receptor antagonist can alleviate constipation caused by opioids? (no opioid withdrawal though)

methylnaltrexone

diabetic Gastroparesis leading to extrapyramidal side effects is due to what medication?

metoclopramide

hookworm lead to what complication?

microcytic anemia Iron hanging - Can develop severe iron deficiency anemi

focal reversible neurologic symptoms presceding right focal headache. What is the diagnosis?

migraine with aura throbbing headache with photophobia and can last 4-72 hours

what is the most common mutation in cystic fibrosis?

misfolded protein (defect in protein structure) that results in protein being retained in RER and not transported to cell membrane

gastric cancer that has metastasized to the ovary. histology?

mucin-secreting signet cells

ganglion cyst due to ???

mucoid degeneration of periarticular tissue

Reduced saltatory conduction is seen in :

multiple sclerosis

acellular medium enriched with cholesterol to grow?

mycoplasma pneumoniae

Charcot-Marie-Tooth disease will show abnormal?

myelin sheaths

hypertrophic cardiomyopathy what would be seen on autopsy?

myocardial hypertrophy with patchy interstitial fibrosis myofiberdisarray

what do most people die from with DM

myocardial infarction

positive blood in urine with absent red blood cells is indicative of ???

myoglobinuria

polysaccharide protein conjugate vaccine

n. meningidis

Maternal Graves Disease with child born having stridor and respiration issues. what is cause?

neonatal graves disease: IgG antibodies can cross the placenta, leading to thyroid enlargement. This can also explain the stridor and issues with respiration in the newborn. Essentially, this is causing neonatal Graves disease.

Rapid progressive glomerulonephritis

nephritis syndrome seen in good pasture syndrome with glomerular creasenet

Melanocytes embryologic Origin

neural crest

neuroblastoma n's

neural crest cells normotensitve NSE + n-myc oncogene

most common tissue type in immature teratoma

neural ectoderm

Rosettes I always think ??? tumors

neuroendocrine tumor

what cell type helps prevent hematogenous spread of candida (t-cell, neutrophil)

neutrophil T-cell: cutaneously

centriacinar emphysema is associated with what cell type? a. neutrophils b. type II pneumocytes c. eosinophils

neutrophils

Does a leiomyoma progress to leiosarcoma

no (come up denovo)

do skeletal muscle depend on extracellular calcium influx?

no (that is why they are not effected by verapamil

NO causes what things not to change in the blood

no change in partial pressure of oxygen in the arterial blood

What changes to Vaptan (treatment for SIADH) have on sodium exreation

no changes

alternative splicing example:

no gene mutation but protein was shorter and lacked transmembrane domain Splicing of introns in a pre-mRNA that occurs in different ways, leading to different mRNAs that code for different proteins or protein isoforms. Increases the diversity of proteins.

Does ACH stimulate parietal cell hyperplasia?

no just parietal cell secretion

Sjogren's syndrome increased risk of what type of cancer

non-hodgkin lymphoma

Duchene Muscular Dystrophy (DMD) is a (???) mutation

nonsense (turned stop codon)

product produced at pigmented neuron in the posterior rostral pons at the lateral floor of the fourth ventricle?

norepinephrine (locus ceruleus)

impaired sertoli function: what changes to testosterone, inhibin, FSH, LH?

normal Testosterone ↓ inhibin ↑FSH normal LH

what joint disease is associated with myeloproliferative disorders?

normal gout

most common cause of gastroenteritis (viral)

norovirus

mitral valve stenosis

number 4

case fatality rate

number of fatal cases over total number of cases for that disease (fatal + alive)

cumulative incidence of disease

number of new case at specific period/ total population at risk at beginning of study

daytime sleepiness, morning headaches, does not feel refreshed upon waking. BMI high. Dz?

obstructive sleep apnea

main inducer of apoptosis

p53

what cells release intrinsic factor?

parietal cells

wallerian degeneration in CNS

persistent myelin debris

pigmented mucocutaneous macules (disease associated)

peutz-jeghers syndrome

bacteria virulence factor for diptheriae?

phage conversion permitting exotoxin production

metabolic states of chronic kidney disease (phosphate, parathyroid hormone, calcitriol) will they go up or down

phosphate up due to inability to excrete parathyroid up due to need to bring in more calcium calcitriol down due to kidney lack of 1-alpha-hydroxylase

rate limiting step of acyclovir

photophosphorylation by viral thymidine kinase to convert to active form

supplemental oxygen is given to COPD patient can lead to increased CO2 retention... this lead to hyoxic pulmonary vasocanstricion which increased (???)

physiologic dead space resulting in shunting and V/Q mismatch

difficulty breathing with oxygen desaturation with improvement when put in prone position. Small mandible and posteriorly displaced tongue with U shaped cleft palate. What is the disease?

pierre Robin sequence (a single developmental defect that causes a cascade of additional malformations) hypoplasia of mandibular prominence

bacterial factor for gonorrhoeae

pili

n. meningitidis initial and main virulence factor

pili that lead to attachment to nasopharyngeal cells Long Cotton Swab - Nasopharyngeal swab suggests that it is found in nasal cavities first and transmitted via respiratory secretions.

pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing, and rapidly evolving coma. due to hemorrhage of what structure of the brain

pons

NSAID-exacerbated respiratory disease

predisposing factor: asthma, polyps, rhino-sinusitis due to dysregulation in arachidonic acid due to cyclooxygenase inhibitor leading down path of 5-lipoxygenease

Factor XII activates

prekallikrein to kallikrein

neonatal complication of diabetes during pregnancy

premature fetal macrosomia congenital malformation respiratory distress transient hypoglycemia polycythemia

Viral Upper Respiratory Infection pathology

presence of viral receptor molecules on epithelial cells

Why is Primaquine used along with Chloroquine in the treatment of malaria?

prevent disease relapse and eradicate intrahepatic stage of vivax and ovale which are responsible for relapse

primary prevention

preventing a disease process from becoming established ex. health promotion -exercise, not smoking

Xanthelasma (soft, raised yellow plaques occurring on the skin at the inner corners of the eyes) associated with what disease?

primary biliary cholangitis ---> leak bile back in circulation

Impaired sperm motility associated with what disease

primary ciliary dyskinesia

statistical power

probability that the study will give a significant result if the research hypothesis is true 1-B

what is involved in informed consent? probable outcomes if surgery is not performed or risk of of agent that will be used during procedure

probable outcomes if surgery is not performed

cant taste what is the cause

probably an olfactory problem

Transformation

process in which one strain of bacteria is changed by a gene or genes from another strain of bacteria

Leydig cells

produce testosterone and other androgens

21-hydroxylase deficiency causes block of what reaction

progesterone ---> 11-deoxycorticosterone 17-OH progesterone ---> 11-deoxycorticsol

brain imaging of polyomavirus

progressive multifocal leukoencephalopathy (Bust of Julusis Ceasar on right hand side)

Romberg's sign tests for

proprioception Falling to one side when standing with feet together and eyes closed, indicating abnormal cerebellar function or inner ear dysfunction

gentamicin nephrotoxicity occurs where

proximal convoluted tubule

where in the tubule is phosphate lost?

proximal convoluted tubule Increased Phosphate loss --> Fanconi syndrome --> affects the PCT --> metabolic acidosis

tinea corporis

pruritic rash with raised scaly border and central clearing infects keratinized matter in stratum corneum

patient who develops prolonged muscle weakness after receiving succinylcholine is most likely due to???

pseudocholinesterase deficiency persistent depolarization of nicotinic acetylcholine receptor ---> DECREASED PLASMA HYDROLYSIS (supposed to be rapidly hydrolyzed by plasma pseudocholinesterase)

candida albicans esophagitis

pseudomembrane with yeast cells

WHITE/YELLOW PLAQUES ON COLON

pseudomembranous colitis

respiratory tract infection in cystic fibrosis pt

pseudomonas aeruginosa

right hip and knee flexed and limb externally rotated. what muscle is being tested

psoas major (stretching)

epidermal hyperplasia is associated with what skin lesion

psoriasis

what nerve allows for physical contact erection and it does not last long. this id due to what nerve?

pudendal nerve

thickening of the right ventricular free wall is due to what

pulmonary arterial hypertension

there is an absence of pulmonary edema with + heart murmur in what?

pulmonary hypertension

what is located in second intercostal space along the left sternal border?

pulmonary trunk

(???) are unique in that tissue hypoxia result in vasoconstrictive response to diverge blood away.

pulmonary vascular bed

midsystolic murmur heard at left upper sternal border and wide split S2. Dx?

pulmonic stenosis

HSV-1 esophagitis

punched out ulcers small vesicles with cowdry type A

what vitamin assist in amino acid transamination and decarboxylation reaction

pyridoxal phosphate (B6)

Pyruvate Pathways: what is the first enzyme is involved in replenishing glucose in episodes of starvation from pyruvate?

pyruvate ---> acetyl-Coa --> citric acid cycle---> energy pyruvate ---> oxaloacetate ---> gluconeogenesis ---> glucose

mononuclear infiltrate and eosinophilic round cytoplasmic inclusions in the neuron. what is the disease?

rabies

anterolateral displacement of proximal fragment vs anteromedial displacement of proximal fragment, which is radial nerve injury and which is median nerve injury

radial nerve-anterolateral median nerve-anteromedial

Erythema nodosum is characterized by ??? is a sign of what disease??

raised tender subcutaneous bilateral lesions on anterior surfaces of lower legs sarcoidosis

What is a complication of horseshoe kidney

random origins of multiple renal arteries to each kidney

what causes decreased amplitude of action potential

rapid inactivation of voltage gated sodium channel

adverse effect of trimethoprim-sulfamethoxazole

rash/nausea/vomiting/folate deficiency HYPERKALEMIA (blocks epithelial sodium channel in distal tubules and collecting duct) 25. Sweaty itchy red devil: sulfa allergy - fever, urticarial, rash 26. Broken G6PD-Free fruit: Hemolytic anemia in G6PD deficiency 27. Bites and seeds: Bite cells and Heinz bodies seen in RBC's 28. Red mask sloughing off: stevens-johnson syndrome 29. A mad scientist with 4 tubes of acid: type IV renal tubular acidosis 30. K shape: Type IV RTA leads to hyperkalemia 31. Kidney bag with little blue candies: interstitial nephritis 32. Flash Photo: photosensitivity 33. Yellow candy corn: kernicterus in the neonate (sulfonamides, when used in the last month of pregnancy, displace bilirubin in the neonate) 34. Displaced photos from the album: sulfonamides displace drugs from albumin (warfarin)

fick principle (cardiac output based on oxygen consumption)

rate of O2 consumption/arteriovenous O2 content difference=CO

CD21 receptor for what disease

receptor for EBV

carb was EXCEPTIONALLY low. That is generally???

renal tubular acidosis

COPD has increase in? a. expiratory reserve volume b. residual volume c. forced vital capacity

residual volume

most common outcome in HBV-infected adults

resolution (95%)

complication of amyotrophic lateral sclerosis (fasciculation and atrophy of muscle of upper extremities with gait ataxia). include most common cause of death?

respiratory failure

alveolar-arterial PO2 difference is caused by what disease

respiratory fibrosis

beta cells of pancreas location

secrete insulin

expansion of red pulp

seen in portal hypertension

Hox genes AND RETINOIC ACID HAVE IN COMMON

series of genes that controls the organs and tissues that develop in various parts of an embryo FUNCTION AS TRANSCRIPTION FACTORS

carcinoid tumor secrete?

serotonin

SRY gene

sex determining region of the Y chromosome if someone has it they have Y gene

fallopian tubes have what type of epithelia

simple columnar

must stop lamotrigine if patient has this condition

skin rash (could be steven-johnson)

Niemann-Pick disease

sphingomyelinase deficiency results in macrophages that have soap-bubble appearance.

carbolfuchsin, acid alcohol, methylene blue

stains used in acid fast stain

alpha value

statistical significance level probability of making type I error (false positive) decreased significance level will increase the confidence level

Desmosomes by function interconnect keratinocytes in the ???

stratum spinosum (keratinocyte to keratinocyte)

veins of internal hemorrhoids

superior rectal veins --> inferior mesenteric vein ---> splenci vein --> portal vein

puffy face and engorged neck veins

superior vena cava syndrome

Flu pathogenesis

surface glycoprotein ---> hemagglutinin allow for binding

inferior vena cava obstruction

symmetric bilateral lower extremity edema and development of venous collateral in abdominal wall

Mitotic cyclins

synthesized during G2; promote entry into, and progression through mitosis (M) phase

intense plasma cell-rich infiltrate with proliferative endarteritis describes what disease

syphilis

difficulty walking + loss of temperature sensation in hands. -biceps reflex. hand muscles are atrophic. +scoliosis. cause of symptoms?

syringomyelia

what occupies paracortical zone of lymph node

t cells

what will supply anastomotic blood supply to the testis?

testicular artery and artery of the ductus deferens (superior vesical artery)

Where is the amino acid bound to tRNA?

the 3' end (covalently)

Nutcracker syndrome

the engorgement of the L renal vein due to compression b/t the SMA & AO

meiotic nondisjunction

the event in which chromosomes do not segregate equally during meiosis

Babinski sign (plantar reflex) the sole of the foot is stimulated with a blunt instrument. In normal adults, the plantar reflex causes foot downward flexion. An upward response/extension is a Babinski response. An upward response would show what additional findings?

the increased briskness of deep tendon reflexes hyperreflexia, increased muscle tone, pyramidal weakness upper motor neuron lesion

standard error

the standard deviation of a sampling distribution (mean) larger sample size smaller standard error

bluish lesions on fingers (glomus tumor). what is their function?

thermoregulation

The blood-testes barrier is formed by

tight junctions between sertoli cells

in embryonic development cell differentiation is determined by ???

transcription factors (NOT GROWTH FACTORS) can induce cell dedifferentiation or pluripotency

primary ovarian insufficiency

transient or permanent loss of ovarian function leading to amenorrhea in women < 40 ~ 1% of women -increased FSH with decreased estrogen

Platelet endothelial cell adhesion molecule (PECAM-1) function

transmigration

superior mesenteric artery syndrome entraps what part of duodenum

transverse portion of duodenum

monoclonal antibody used in breast cancer and receptor binding?

trastuzumab ---> tyrosine kinase receptor

activation of mast cells

trauma c3a c5a crosslinking IgE

ARDS

trauma cuases injury to alveolar pneumoncytes and endothelium causing inflammatory cytokines and recruites neutrophils leading to increased pulmonary capillary permeability and diminished surfactant production resulint in hyaline membrane formation.

tertiary prevention

treating a disease to prevent progression/complications ex. disability limitation (blood sugar and blood pressure control in DM) and rehabilitation ( physical therapy after stroke)

Imiquimod

treatment of warts primary mediated through activation of toll-like receptor --> upregulates NF-kB

Osteoarthritis is the degradation of (???) and (???) within the articular cartilage.

type II collagen and prteoglycan

graves is what type of hypersensitivity

type II hypersensitivity

Lymph node spread in esophageal carcinoma

upper 1/3 -cervical nodes middle 1/3-mediastinal or tracheobronchial

Silver stain

used to visualize: fungi, Legionella

Hypoparathyroidism treatment

vit D+ca supplementation CALCITRIOL

what looks like a vitamin B12 deficiency?

vitamin E

vitiligo

white patches on the skin caused by the destruction of melanocytes

Monosodium urate crystals

yellow when parallel

is candida apart of normal oral flora?

yes (rarely cause invasive disease more likely an contaminat)

is testosterone normal in androgen use?

yes it can be so dont let it bamboozle you

is there M3 receptors on the lung

yes this is why you cant give bethanechol to asthmatic/induce asthma attack with methacholine

testicular tumor in a child?

yolk sac tumor (schiller-duval bodies-glomeruloid)

What is fetal hemoglobin?

α₂,γ₂

treatment of sarcoidosis

(1) majority = spontaneous remission in 2 years (2) corticosteroids (3) TNFa inhibitors (4) hydroxychloroquine if skin involvement is present

Normocytic anemia causes

(MCV 80-100) - chronic dz - bone marrow failure - hemolysis -hereditary spherocytosis

Mucoepidermoid carcinoma

*MC malignant tumor* arises from duct causes pain CNVII palsy painful mass has mucinous and squamous components

gastric carcinoma: diffuse type

- *signet ring cells* that infiltrate the gastric wall - desmoplasia - thickening of the stomach wall (*linitis plastica*) - NOT associated with H pylori, intestinal metaplasia or nitrosamines - *krukenberg tumor: b/l ovaries* SPREAD VIA LYMPH TO LEFT SUPRACLAVICULAR NODE

Statin mechanism of action

- Inhibits the enzyme HMG-CoA reductase, which is used by the liver to produce cholesterol - Lowers the rate of cholesterol production - Also activates LDL receptors to pull LDL out of blood stream and into the liver - Peak or maximal therapeutic effect occurs at 2 weeks**

Follicular carcinoma of the thyroid

- More common in females, and patients age 40-60. RAS mutations often seen! FNA unfortunately cannot distinguish between follicular adenoma and carcinoma. Need to see capsule (carcinoma goes beyond the capsule!!!!!), so need to see gross specimin, or examine capsule under microscope to ensure no extension beyond capsule. - Propensity for hematogenous (blood) spread, (!!!) thus can present with distant metastasis (liver, bone, lungs). - Generally good prognosis.

Hepatitis E virus

- inflammation of liver - transmitted through fecal and oral routs -waterborne disease - self limit followed by recovery with mortality rates btw .5-4% (EXCEPT IN PREGNANT WOMEN WHICH IS HELLA HIGH) -SINGLE STRANDED RNA VIRUS UNENVELOPED

ischemic optic neuropathy due to what condition

- irreversible optic nerve damage due to loss of blood flow to the nerve & can lead to permanent visual loss - c/o loss of central field and/or altitudinal visual field defect giant cell arteritis

agglutination in HCG mean (+ or -) pregnancy test

- pregnancy test absence of agglutination is positive because all the all the HCG is bound to antibodies and the latex coated HCG cannot bind meaning it cannot stick together

Bacteroides treatment

--Metronidazole --Ampicillin/sulbactam --Piperacillin/taxobactam --Carbapenems --Chloramphenicol

Are there T tubules in smooth muscle?

--No --Caveoli are sarcoplasmic reticulum

candida antigen injection test causes what cell type immune reaction? (its two)

-CD4+ -macrophages

Tacrolimus MOA and SIDE EFFECTS

-Calcineurin inhibitor; binds FK506 binding protein (FKBP). -Blocks T-cell activation by preventing IL-2 transcription ITS GONNA MESS UP THOSE KIDNEYS DUDE (JUST LIKE CYCLOSPORIN).

Impairment in glycogenolysis:

-Muscle phosphorylase deficiency -weakness and fatigue w/ exercise -No rise in blood lactate levels after exercise

1 Treatment for both BPH and HTN

-zosin

Behcet syndrome (3)

1) Recurrent aphthous ulcer 2) genital ulcers 2)uveitis - Due to immune complex vasculitis involving small vessels - seen after viral infection

Branches of the pudendal nerve

1. Inferior rectal nerve 2. Perineal nerve 3. dorsal nerve of penis 4. dorsal nerve of clitoris

steps of translation

1. Initiation 2. Elongation 3. Termination

treatment for polyneuropathy? (3)

1. SNRI 2. tricyclic 3. gabapentinoids

OCP mechanism of action

1. block ovulation by suppressing FSH, LH, *LH surge* 2. create hostile cervical mucus 3. Prevent blastocyst implantation in endometrium 4. Decrease tubal transport, sperm capacitation

Digoxin side effects

1. bradycardia 2. anorexia 3. nausea and vomiting 4. fatigue 5. dysrhythmias 6. diaphroesis

Functions of the facial nerve (4)

1. motor output to facial muscles 2. parasympathetic innervatio to lacrimal submandibular and sublingual salivary glands 3. special afferent fibers for tast from the anterior 2/3 of the tongue 4. somatic afferent from the pinna and external auditory canal

X-linked recessive disease =1/100,000 males Prevalence of heterozygous females?

1/50,000 If the disease frequency in males is 1/100,000 then the disease allele frequency in the population q = 1/100,000. Because p + q = 1, you can approximate that p = 1. Since you have derived p and q, you can now calculate the frequency of a carrier for females - females have two copies of X chromosomes so for them it's the usual carrier frequency 2pq: 2 * 1 * 1/100,000 = 1/50,000

AML genes

15, 17

Block testosterone synthesis via inhibition of (21,17,11)

17

Sibling HLA match

25%

how do you treat chemotherapy induced vomiting?

5-HT3 receptor antagonist (ondansetron)

treatment for traveler's vomiting? mechanism?

5-HT3 receptors like ondansetron

Depletion of ATP in critical cellular areas of the hear with accumulation of toxin result in loss of contrctility within about (???time) of total myocardial ischemia

60 seconds

atypical lymphocytes are CD(??)+ T- cells that are activated to eliminate EBV infected B- lymphocytes.

8

Burkitt's lymphoma

8:14 translocation; associated with EBV

right anterior cerebral artery

A 45-year-old patient with left lower limb weakness and some executive dysfunctions but with no aphasia is referred for an SLP evaluation. The patient's MRI (see below) shows an infarct on the medial surface of the frontal and partly parietal lobe. Which of the cerebral arteries is involved in this case?

Atonic bladder

A condition in which the urinary bladder becomes flaccid and overfills, allowing urine to dribble through the sphincters.

mammary duct ectasia

A condition in which there is dilation of the lactiferous duct, caused by stagnation of cellular debris. Occurs in women who have lactated. Signs of duct ectasia can include nipple retraction, inversion, pain, and sometimes a bloody discharge. GREEEN BROWN NIPPLE DISCHARGE

hyperopia

A condition in which visual images come to a focus behind the retina of the eye and vision is better for distant than for near objects -- called also farsightedness.

7-dehydrocholesterol

A precursor cholesterol compound in the skin that when irradiated by sunlight produces cholecalciferol (D3).

Concentration-dependent killing

A property of some antibiotics, especially aminoglycosides, whereby achieving high plasma drug concentrations, even if briefly, results in the most effective bacterial kill (compare time-dependent killing).

Conjugation

A temporary union of two organisms for the purpose of DNA transfer.

flexor digitorum profundus

A: flexes distal interphalangeal joints; wrist flexion. O: Coronoid process; anteromedial surface of ulna. I: distal phalanges of fingers 2-5.

diabetic nephropathy and htn treatment

ACE inhibitor

anti-hypertensive that causes potter sequence

ACE-I/ARB

diagnosing the cause of cushing syndrome

ACTH suppressed or elevated? if elevated is it relieved by dexamethasone?

Alkaptonuria

AR homagentistic acid dioxygenase deficiency ---> increase homogentisate DECREASED METHYLACETOACETATE Arthritis and urine turns black when exposed to air, dark skin

Myeloperoxidase deficiency

AR; respiratory burst present; no bleach produced recurrent candida infections

Dyskeratosis

Abnormal, premature keratinization within cells below the stratum granulosum

Rh incompatibility causes a delayed hemolytic transfusion reaction, this reaction was immediate so it is indicative more of the ABO blood group incompatibility... explain ABO hemolysis?

According to pathoma: Intravascular hemolysis will lead to hemoglobin binding to haptoglobin. This complex will travel to the kidneys and be excreted. This will lead to red-colored urine and hemosiderin (Note: This can also lead to acute tubular necrosis) Extravascular hemolysis is when macrophages break down the RBC. Then the Haeme is converted to biliverdin then bilirubin and conjugated in liver, and then excreted ABO: IgM -> Complement -> Intravascular Rh: IgG -> Splenic Macrophage -> Extravascular

lateral pterygoid

Action: grinding movement, depresses and protracts mandible and moves it from side to side.

reddish-brown urine with restless and irribtable outburst and abdominal pain. What part of heme production in defective in patient?

Acute intermittent porphyria --> inhibition on porphobilinogen(PBG) to hydroxymethybilane lead to build up of PBG and aminolevulinic acid

adduction of thigh

Adductors action?

treatment for enterobiasis

Albendazole or Pyrantel Pamoate (pregnant women). Treat all household contacts.

transamination reaction

Amino acids undergo a reaction in which they lose an amino group to form an a-keto acid.

Histology in Type II DM

Amyloid deposition in the islets

Smooth Endoplasmic Reticulum

An endomembrane system where lipids(hormones) are synthesized, calcium levels are regulated, and toxic substances are broken down.

operator locus

An operator is a genetic sequence which allows proteins responsible for transcription to attach to the DNA sequence. The gene, or genes, which get transcribed when the operator is bound are known as the operon. ... The function of the operator within genetics is to regulate the production of a certain portion of the DNA.

Pure red cell aplasia

Anemia with low reticulocytes Thymoma (lymphocytic leukemia and parvovirus B19)

Buy AT 30, CCELL at 50

Antibiotic Site of action 30S Aminoglycosides Tetracyclines 50S Chloramphenicol Clindamycin Erythromycin (Macrolides) Lincomycin Linezolid

Paraneoplastic cerebellar degeneration

Antibodies against antigens in purkinje cells Small cell lung cancer (anti-Hu); Gynecologic and breast cancers (anti - yo); Hodgkin Lymphoma (Anti-Tr)

Metoclopramide is not used in what subset of patients

Antiemetic not used in parkinson patients (can make them worse)

Uhthoff's phenomenon

Appearance of signs and symptoms of M.S. after a hot bath or exercise. MS pt whose symptoms worsen with increase in body temperature

When is LH most abundant in the menstrual cycle?

At ovulation (day 14-ish)

Anti-smooth muscle antibodies

Autoimmune hepatitis (portal and periportal lymh

Immune Thrombocytopenic Purpura (ITP)

Autoimmune platelet destruction is a common cause of thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding, and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) . occurs around only having thrombocytopenia

Histology of bullous pemphigoid

B for basement membrane

Diphyllobothrium latum can cause what complication?

B12 deficiency Must B12 to buy fireworks: Fish tapeworm causes diarrhea and associated w/ B12 deficiency leading to megoblastic anemia, Cobalamin = B12

treatment for ascites

Bed rest, low-sodium diet, diuretics (furosemide and spironolactone) ascites: splanchnic vasodilation ---> decrease vascular resistance --> activation of RAAS --> vasoconstriction with sodium and water retention --> spirolactone can induce natriuersis

Warthin tumor

Benign cystic tumor with abundant lymphocytes and germinal centers (lymph node-like stroma); 2nd most common tumor of the salivary gland

urinary 5-HIAA

Best initial test for carcinoid syndrome

Hypocalcemia S/S

C.A.T.S. C - Convulsions A- Arrhythmias T - Tetany (involuntary contraction of muscles) S - Spasms and stridor

left shoulder pain, hiccups, and dyspnea. compression of what nerve in lungs?

C3-C5 (shoulder is referred pain)

C3a vs C5a

C3A: inflammatory anaphylatoxin trigger histamine release recruits and activates eosinophil and basophil NOT NEUTROPHILS C5A: recruits and activates neutrophil, basophil,monocyte, and eosinophil

what substance acts in the most similar manner to IgG antibodies to facilitate phagocytosis? (most important opsonins) a. C3b b. C5a c. IgM

C3b

ambiguous genitalia and hypertension

CAH (11-OHase deficiency), 5%

AV BLOCK IN SETTING OF NEW MEDICATION USE WITH A-FIB IS DUE TO WHAT MEDICATION

CALCIUM CHANNEL BLOCKER THERAPY WITH DILTIAZEM OR VERAPAMIL

Side effects of benzodiazepines

CNS depression (Sedation, light-headedness, ataxia, decreased cognitive function) Anterograde amnesia (difficulty recalling events after dosing) Acute toxicity Withdrawal symptoms

differential diagnosis of vaginitis

COMBANK wants you to know pH... 1) Bacterial vaginosis > 4.5 Tx: oral metronidazole 2) Trichomonas > 4.5 Tx: Oral metronidazole for both sexual partners 3) Vaginal Candida 4-4.5 Tx: oral fluconazole for tx 2nd line = intravaginal Nystatin (NOT ORAL)

increased functional residual capacity is a sign of what disease

COPD

Capsaicin MOA

Causes release of substance P from nerves depleting substance P over time

Anti-endomysial (anti-tissue transglutaminase). Histological findings?

Celiac disease, villous atrophy

Organ of Corti

Center part of the cochlea, containing hair cells, canals, and membranes

Patau syndrome (trisomy 13)

Characterized by severe intellectual disability, a small head, sloping forehead, small eyes, cleft lip and palate, extra fingers and toes, and other disabilities; results from the presence of three copies of chromosome 13. holoprosencephaly due to meiotic nondisjunction

Lichen sclerosis

Characterized by thinning of the epidermis and fibrosis (sclerosis) of the dermis; presents as a white patch (leukoplakia) with parchment-like vulvar skin

Negative nitroblue tetrazolium test

Chronic Granulomatous disease - phagocytic NADPH oxidase deficiency - normally phagocytes take up stain and turn it blue by reducing it Increased susceptibility to catalase producing organisms: - Nocardia - Pseudomonas - Listeria - Aspergillus - Candida - E. coli - Staphylococcus (aureus; epidermidis; saprophyticus) - Serratia marscecens - Burkholderia cepacia Would also see abnormal dihydrorhodamine (flow cytometry) test

Spherules packed with endospores

Coccidioides

Thin walled cavity in right middle lobe and skin rash after traveling to mexico?

Coccidoides immitis (san juaquin valley)

Paget disease of bone (osteitis deformans)

Common idiopathic alteration of bone exhibiting abnormal resorption and deposition, resulting in distorted and weakened bones

Paget disease of bone (osteitis deformans)

Common idiopathic alteration of bone exhibiting abnormal resorption and deposition, resulting in distorted and weakened bones complication: cranial lesions can lead to hearing loss and high output heart failure, osteosarcoma look for the sunburst pattern

migratory thrombophlebitis

Commonly associated with pancreatic adenocarcinoma Intermittent superficial vein thrombosis in arms, legs, and chest wall think cancer

Sertoli-Leydig cell tumor

Composed of Sertoli cells that form tubules and Leydig cells (between tubules) with characteristic Reinke crystals hirsutism virilization reinke crystals tubules and leydig cells between tubes

Dandy-Walker malformation

Congenital failure of cerebellar vermis to develop

leucine zipper

Contains regularly spaced leucine residues Function is to hold two recognition helices in the correct orientation

Q fever causative agent

Coxiella burnetii (thrombocytopenia)

fatigue poor appetits and dull pain in back. recently treated for perianal fistula is now showing large eccymosis. What is the disease and why is he bleeding so much?

Crohn disease ---> bile acid malabsorption --> fat malabsorption ---> deficiency in fat-soluble vitamins --> vitamin K deficiency

Cobblestone appearance

Crohn's

Homocystinuria

Cystathione synthase deficiency Lens subluxation, *thrombosis*, marfanoid, intellectual disabiliity Tx: pyridoxine

Wilson disease treatment and mechanism

D-penicillamine (copper chelator)

adenosis-exposed to what drug?

DES (prevent pregnancy complications)

Heat stroke can lead to what dz?

DIC

Mallory bodies

Damaged INTERMEDIATE FILAMENTS within a hepatocyte; seen in alcoholic hepatitis

Rheumatoid Arthritis Treatment

Disrupt destruction of joints by immune system Steroidal and nonsteroidal anti-inflammatory drugs decrease pain and inflammation Immune suppressants slow autoimmune reaction Some agents target tumor necrosis factor to block action of inflammatory chemicals Can replace joint with prosthesis

Beneficence

Doing good or causing good to be done; kindly action

cancer detach from surrounding cells via

E-cadherins

astrocytoma most likely express what?

EGFR (GFAP also)

Mechanism of Ciprofloxacin resistance

Efflux pumps

crampy abdominal pain 1-2 days before menses with minimal relief with OCP. Ultrasound finding of pelvic pass with enlargement of ovary adherent to pelvic wall containing dark brown fluid?

Endometriosis

"Chocolate cyst" of ovary

Endometriosis (frequently involves both ovaries), normal uterus size (as opposed to adenomyosis which would have symmetrically enlarged uterus)

Spongiosis

Epidermal accumulation of edematous fluid in intercellular spaces type IV hypersensitivity

atopic dermatitis

Excess inflammation; dry skin, redness, and itching from allergies and irritants. related to certain foods INTENSE PRURITUS KEY SIGN

filtration fraction

FF = GFR/RPF

Hyperestrinism

Feature of Liver Failure (HE); associated with palmar erythema and spider angiomas gynecomastia testicular atrophy think of angiomata increasing with hyperestrogenic states like pregnanct

septic abortion

Fever, abdominal pain and tenderness; foul-smelling vaginal discharge; bleeding from scant to heavy; treated with termination of pregnancy, antibiotic therapy and monitoring for septic shock caused by staph aureus

Best med to lower triglycerides

Fibrates

simple cuboidal epithelium location

Function: secretion and absorption Location: Kidney tubules; ducts and secretory portions of small glands, ovary surface.

Aspergillus

Fungi

seizure in 5 month old with hepatomegaly and low glucose level. fructose results in lactic acidosis without increase blood glucose level. what enzyme is deficient?

G-6-P (VON GEIRKE)

Hemolysis induced by trimethoprim-sulfamethoxazole

G6PD deficiency (erythrocyte enzyme deficiency)

most specific receptor for huntington's

GABA (caudate nucleus)

sickle cell genetic mutation (GAG-->???) resulting in glutamic acid to (???) substitution

GAG --> GTG valine

main amino acid found in collagen?

GLYCINE

trigeminal neuralgia can occur at what distribution? (V1, V2, or V3)

GOTCHA ALL OF THE ABOVE!!! so make sure you know which one

Cough syncope

Generally occurs in overweight patients with COPD. Increased intrathoracic pressure during coughing decreases venous return to the heart, thus decreasing CO and cerebral perfusion. (basically the same as Valsalva)

base excision repair

Glycosylase AP site AP-endonuclease Lyase DNA polymerase-b DNA ligase Occurs throughout cell cycle Repair spontaneous/toxic deamination

In AML (acute myeloid leukemia) is that precursor cells "get stuck" on their way to becoming (mature) granulocytes. Giving (???)"pushes" them toward a more differentiated state and, because they divide as they mature, the cells become vulnerable to drugs that disrupt cell division (replication): (???) can stimulate proliferation of leukemic blasts and sensitize these cells to the cytotoxic effects of S-phase-specific drug

Granulocyte-macrophage colony-stimulating factor (GM-CSF)

Takayasu arteritis

Granulomatous (giant cell) inflammation of media and adventitia of large elastic arteries. IAsian women. Female-to-male ratio of 10:1. Most often affects thoracic aorta and its proximal branches and pulmonary arteries. LEADING TO WEAK LEFT RADIAL PULSE AND DORSALIS PEDIS PULSE IN BOTH LEGS

Grehlin vs leptin

Grehlin- hormone from stomach that stimulates hunger Leptin- hormone released by adipose tissue to reduce hunger (and insulin) grehlin will increase if caloric restriction is implemented

problem with was receptor can cause pseudohypoparathyroidism?

Gs

glucagon acts on what receptor type causing downstream activation?

Gs protein (NOT Gq... stupid)

anogenital warts should be tested for what other disease

HIV

hairy cell leukoplakia (what organism is associated)

HIV with coinfection of EBV lateral border of tongue no malignant potential

HIV symptoms with no detectable plasma HIV-1 RNA. what is dx?

HIV-2

bronze diabetes

Hemochromatosis

Polyarteritis nodosa

Hep B +, affects multiple medium-sized arteries EXCEPT PULMONARY Transmural inflammation

Polyarteritis nodosa associated with what disease?

Hep B +, affects multiple medium-sized arteries EXCEPT PULMONARY Transmural inflammation

Heparin induced thrombocytopenia

Heparin causes a decrease in platelet count because of the formation of a complex with platelet factor 4, IgG antibodies against platelet-heparin complex that the spleen proceeds to destroy (antiplatelet antibody)

Aflatoxin - associated cancer?

Hepatocellular carcinoma (aspirgillosis)

Osler-Weber-Rendu syndrome

Hereditary hemorrhagic telangiectasia *Telangiectasias* AV malformations (bleeding) Aneurysms (bleeding

Reed-Sternberg cells (owl eyes) associated with what cancer

Hodgkin's lymphoma

antidiuretic hormone (ADH)

Hormone produced by the neurosecretory cells in the hypothalamus that stimulates water reabsorption from kidney tubule cells into the blood and vasoconstriction of arterioles.

anticholinergic toxicity (eating jimson weeed)

Hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat, full as a flask, fast as a fiddle

CD40L deficiency

HyperIgM syndrome B cell cannot undergo class switching therefore leaving them as IgM with little to no IgG, IgA, and IgE

idiopathic aplastic anemia vs parvovirus

IAA: acquired disorder, pancytopenia, bone marrow hypocellularity parvo: RBC aplastic crisis but only to RBC (mostly in immunocompromised)

right coronary artery leads?

II, III, aVF

cytokines associated with ulcerative colitis

IL-1, IL-6, TNF-a, and IF-g due to it being proinflammatory

Bordetella pertussis virulence factors

- Receptors that recognize and bind to ciliated respiratory epithelial cells - Toxins that destroy and dislodge ciliated cells thats why you have such a long cough

sublimation (defense mechanism)

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: physical abuse by step father as a child --> fierce competitor of rugby dont confuse with displacement where: physical abuse by step father as a child --> takes it out on his own kids

apocrine metaplasia of the breast

- NO increased risk of progression to dysplasia. (metaplastic exception)

Procalcitonin (PCT)

- Normally made in thyroid and converted to calcitonin which causes ↓ blood Ca++ - In bacterial infection elevated levels (greater than 2.0 ng/mL) marker of high risk of sepsis and fall in response to viral infections its an acute phase reactant

jugular venous tracing

"A" would not appear in a-fib

Rapid Urease Test

"CLO test" biopsy sample placed on reaction strip/agar gel containing urea, buffer, and pH indicator urease for H. pylori results in change of color in pH indicator results within 3 hours used in pts not taking PPIs, antibiotics, or bismuth due to ENZYMATIC PRODUCTION OF AMMONIA

Infliximab

"Inflicts pain on TNFalpha" Really very similar to Etanercept, but this actually binds TNFalpha itself --> anti-inflammation Uses = autoimmune diseases (RA, IBD, etc)

brachial plexus branches

"My Aunt Raped My Uncle": From lateral to medial: Musculocutaneous Axillary Radial Median Ulnar

cranial nerve and vessel pathway of V1, V2, V3 (mnemonic)

"Standing room only" for the pathways of V1, V2, and V3 V1: Superior orbital fissure V2: Foramen rotundum V3: Foramen ovale

hamartoma of the lung include what types of cells

"popcorn calcification" islands of mature hyaline cartilage, fat, smooth muscle, and respiratory epithelium

pancreatic pseudocyst

"sterile abscess" collection of pancreatic enzymes that accumulate in the available space in the abdomen (usually in or near the pancreas)

TRALI (transfusion related acute lung injury)

#1 cause of fatality related to transfusion onset w/n 6hrs of plasma containing products signs/symptoms: *severe respiratory distress* bilateral pulmonary infiltrates --occurs due to donor antibodies vs. reciptient leukocytes (more specifically, neutrophils),, they release cytokines which dilate capillaries making them permeable so they cant move 02 or co2 and are less compliant treat with o2 or vent in severe cases

half life equation

(0.7 x Vd) / CL volume of distribution of 10L 7L/h t1/2=(.7x10L)/7L/h=1hour 75% excretion at? 2 hours

high anion gap

(Na-[Cl+bicarb])

bones of the wrist

(a)scaphoid, (b)lunate, (c)triquetrum, (d)pisiform, (e)trapezium, (f)trapezoid, (g)capitate, (h)hamate

Peripartum cardiomyopathy: EJECTION FRACTION COMPLIANCE

1. Antibodies made against myocardium in pregnant women 2. LV dysfunction reversible, short term 3. If LV dysfunction does not improve - undergo cardiac trasnplatnation 4. Medical therapy : ACEi, ARB, BB, spironolctone, diurteics, digoxin 4. Repeat pregnancy in woman wiht periaprtum cardiomypatohy wil provoke enormous antibody production agaisnt myocardium EJECTION FRACTION DECREASED COMPLIANCE INCREASED

liver receives blood from two sources

1. Hepatic artery (oxygenated blood) arises from celiac trunk 2. Hepatic portal vein (deoxygenated blood with newly absorbed nutrients, drugs, and possible microbes and toxins from the GI tract)

nucleotide excision repair of UV damaged DNA

1. UV exposure creates thymine dimers 2. recognition of deformed helix by endonuclease complex 3. sing strand cleavage on both sides of segment 4. damaged DNA discarded 5. DNA polymerase synthesises and replaces segments 6. DNA ligase seals remaining gap

cellular swelling mechanism

1. decreased ATP needed for cell function 2. Na+/K+ ATPase and Ca2+ ATPases failure to work 3. increase Na+/Ca2+ intracellularly with K+extracellular 4. Free water is attracted into the cell 5. cellular and mitochondrial swelling

Dofetilide MOA

- similar effects to amidarone but no iodine - postassium channel blocker -Class III antiarrhythmic

Tertiary syphilis

-gummas (chronic granulomas) -aortitis (vasa vasorum destruction) -neurosyphilis (tabes dorsalis) -Argyll Robertson pupil (small pupils that accomodate but do not constrict/react [according to wikipedia, known as prostitutes pupils b/c they accomodate, but don't react - not sure what that means) -Signs: Broad-based axilla Positive Romberg Charcot joints Stroke w/o HTN

what virus family does varicella zoster belong to and what puts someone at an increased risk for shingles?

-herpes virus -stress, HIV

Heteroplasmy

-heteroplasmy, a mitochondrial genetic disease, which is known to show varying degrees of expressivity owing to heterogeneity in genetic mutations in mitochondria. -if you see a muscle problem and it comes from the mom think this

risk factor for gastric adenocarcinoma

-high salt diet --> salt directly damage gastric epithelium -Nitroso-containing compounds -autoimmune chronic atrophic gastritis -obesity

carbon laden macrophages

-lungs -macrophages have ingested carbon pigment (cleaning up area)

what are the two hallmark for chronic inflammation?

-lymphocytic infiltrate -collagen deposition

Clear cell adenocarcinoma of the vagina

-malignant proliferation of glands with clear cytoplasm -rare comp of DES-assoc vaginal adenosis -discoveyr of this and other comp led to cessation of DES usage

prognosis for esophageal cancer

-neoplasms detected mostly in advanced stages.... -one of the lowest possibilities of cure -5 year survival rate = 10% -median of 10months -metastasizes rapidly

Retinoid mechanism of action

-normalize epidermal differentiation -reduce hyperkeratinization to open block pores

What two malaria species require primaquine to kill dormant hypnozoite?

-p. vivax -p. ovale

what is the cause for atrophy of left calf after being in cast?

-polyubiquitination (Proteins targeted for destruction are covalently tagged with the ubiquitin protein)

what two sections of the nephron most susceptible to hypoxic conditions?

-proximal convoluted tubule -medullary section of thick ascending loop of henle

splenic artery gives off what branches?

-short gastric artery (poor anastomoses) -left gastroepiploic artery

glossopharyngeal nerve functions

-somatic motor: stylopharyngeus muscle -parasympathetic: inferior salivatory nucleus -sensory: tympanic membrane, posterior third of tongue and tonsils -taste posterior third tongue -gag reflex

complication of subarachnoid hemorrhage

1 day: rebleeding 3 days: vasospasm - Vasospasm is detected by CT angiography and can be prevented by nimodipine

Number needed to treat

1/absolute risk reduction (ARR) 1/[Event Rate (control) - Event Rate (treatment)] Ex: 100 people alive after chem given to 500 & 45 still alive after new treatment of 100 1/[(400/500-55/100)=4 patients needed to treat to save 1 additional live

Number needed to harm

1/attributable risk increase (ARI) 1/[Event Rate (treatment) - Event Rate (placebo)]

nocturnal LH surge

12 year old boy going through puberity

acute promyelocytic leukemia chromosomal abnormalities

15,17

What part of the duodenum is intraperitoneal?

1st part

renal potassium excretion of high dietary K+ load

35% left at end of proximal 5-10% left in loop 5-100+% collecting duct

Complete Androgen Insensitivity Syndrome

46, XY a hormonal condition that results in babies who are genetically male but possess completely normal-appearing female external genitals and internal testicles

Complete hydatidiform mole

46,XX fertilization of empty oocyte by sperm + duplication or by 2 sperm, no fetal tissue, ↑ risk of invasive mole & choriocarcinoma, "snowstorm" ultrasound, hyperemesis, ↑↑↑ hCG 1 sperm makes all the dna

Enzyme deficiency that causes hypospadias and small phallus with testes in inguinal area with XY and normal testosterone

5a-reductase testosterone --x--> DHT (development of external genitalia, prostate, male hair growth)

peripheral artery disease

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. ex: cramping lower extremity pain that is worse at night and better with sitting upright.

Erythroplakia

A clinical term used to describe an oral mucosal lesion that appears as a smooth red patch or granular red and velvety patch. more likely to be malignant

vertebral subluxation

A complication of chronic rheumatoid arthritis that affects CERVICAL SPINE at the ATLANTOAXIAL joint causing a misaligned vertebra. This can lead to spinal cord compression and areflexic paralysis.

androgen insensitivity syndrome

A condition caused by a congenital lack of functioning androgen receptors; in a person with XY sex chromosomes, causes the development of a female with testes but no internal sex organs

promoter region

A regulatory region a short distance upstream from the 5' end of a transcription start site that acts as the binding site for RNA polymerase. A region of DNA to which RNA polymerase binds in order to initiate transcription.

Lactated Ringer's Solution

A sterile crystalloid isotonic IV solution of specified amounts of calcium chloride, potassium chloride, sodium chloride, and sodium lactate in water. normal saline

regression anaylsis

A technique for determining the best mathematical expression describing the functional relationship between one response and one or more independent variables.

Paired t-test

A test designed to determine the statistical difference between two groups' means where the participants in each group are either the same or matched pairs.

Case-control study

A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls

What medication prolongs QT interval without much increase IN TORSADES INCIDENCE

AMIODARONE

Sarcoidosis (giant multinucleated cells) is associated with what cytokines?

APC: IL-12 ----> TH-1: IL-2, IFN-y

What substance binds and regulates ion channels that secrete insulin?

ATP glucose acts indirectly while ATP is real reason

3rd degree block Complete absence of conduction between atria and ventricles. P marches into the QRS complex. what paces the ventricles?

AV node

Explain azathioprine vs mofetil mechanism

AZ CANNOT BE GIVEN WITH ALLOPURINOL

HLA-B*5701

Abacavir

Adductor muscles and gracilis are innervated by the (???) nerve External oblique is innervated by the (????) nerve obturator internus is innervated by the (???) nerve (L5-S2) Piriformis is innervated by the (???) nerve (L5-S3)

Adductor muscles and gracilis are innervated by the obturator nerve External oblique is innervated by the iliohypogastric nerve obturator internus is innervated by the obturator internus nerve (L5-S2) Piriformis is innervated by the sciatic nerve (L5-S3)

vasogenic edema

An accumulation of fluid in the cerebrum that is typically caused by an increase in capillary endothelial cell permeability with a disruption in the blood-brain barrier normally caused by malignancy

Root Cause Analysis

An analytical technique used to determine the basic underlying reason that causes a variance or a defect or a risk. A root cause may underlie more than one variance or defect or risk. --> interviewing everyone

Anion gap equation

AG = Na - (Cl + HCO3)

What is the biggest factor that osteoarthritis?

AGE others are obesity, female sex, and joint loading.

Neurokinin 1 receptor antagonist (uses)

Aprepitant is the first NK1 antagonist available; blocks the effects of substance P on NK1 receptors. Used to prevent acute and delayed chemotherapy-related nausea and vomiting caused by highly emetogenic antineoplastic agents

transmembrane ligand-gated ion channels

Are a group of transmembrane ion channels which allow Na, K, Ca or Cl to pass through the membrane. These ion channels are usually closed and are opened by an agonist for very brief time.

Autoimmune adrenalitis

Autoimmune destruction of steroid-producing cells; most common cause of primary adrenal insufficiency (60-70% of cases)

innervation of deltoid

Axillary nerve (C5, C6)

C.H.A.L.K the things that cause vasodilation in skeletal muscle

C - Co2, H - H+, A- adenosine, L - lactate K- K+

Candida histology

Can be in any of the following forms: budding yeast aka blastoconidia (NOT BROAD BASED like Blastomycosis and no capsule like cryptococcus), germ tubes, pseudohyphae, true hyphae Can form at 37C

communicating hydrocephalus

Can occur post-meningits from scarring of the arachnoid granulations. hydrocephalus caused by a problem with the normal uptake of CSF through the arachnoid granulations; whole CSF system would have increased pressure

Prader-Willi Syndrome

Caused by a lack of genetic material in the 15 pair of chromosomes. inherited from the father. The leading genetic cause of obesity. degree of mental retardation. excessive eating and life-threatening obesity. BOTH CHROMOSOMES 15 ARE FROM MOTHER

5-alpha reductase inhibitors

Block conversion of testosterone to dihydrotestosterone. Slow growth of hyperplastic or cancerous prostate by blocking conversion to dihydrotestosterone which binds with higher affinity to androgen receptor.

Methimazole MOA

Blocks thyroid peroxidase inhibiting organification and coupling of iodotyrosine

Broca's area and impairment

Controls language expression - an area of the frontal lobe, usually in the left hemisphere, that directs the muscle movements involved in speech. Impairment causes: agrammatic speech

What is the cause of achalasia?

Degeneration of inhibitory neurons in myenteric plexus(inhibitory ganglion cells in esophagus wall) inhibiting the inhibitor Associated with Chaga's Disease. Occurs in 1/100,000

Crypts of Lieberkuhn function

Glands located at the base of the intestinal villus regeneration of mucosal epithelium

something stuck in ones throat with no changes in upper GI and and normal barrow swallow?

Globus sensation

presence of (???) hep b indicated increase risk of vertical transmission of the virus.

HBeAG

if experiencing hep B sypmtoms would you show serum HBsAg or anti-HBsAg IgG

HBsAg

Trastuzumab mechanism of action of cardiotoxicity

HER2 plays role in minimizaing oxidative stress on cardiomyocytes and preserving cardiomyocyte function... toxicity manifest as a decrease in myocardial contractility without cardiomyocyte desrtuction or myocardial fibrosis reversible

ankylosing spondylitis is associated with whate type of HLA (class 1 or class II) serotype?

HLA class I (HLA-B27)

head and neck mucosal squamous cell carcinoma caused by?

HPV

Nitroglycerin effects on heart rate and end-diastolic left ventricular volume?

HR: up EDLVV: decrease relax smooth muscle in venules and decreased venous return which will lower ventricular volume and pressure which which reduces oxygen demand. The drop in blood pressure causes reflex tachycardia

most common cause of fatal sporadic encephalitis

HSV-1 edema and hemorrhagic necrosis of temporal lobe

Onion Skinning arteries related to what disease?

HTN

Which cytokines are produced exclusively by lymphocytes?

IL-2

IgE Cytokine

IL-4

IgA cytokine

IL-5

Giant cell arteritis associated inflammatory infiltrate cytokine?

IL-6

what cytokine form pus

IL-8

what drug used for ventricular arrhythmia with largest affect on ischemic ventricular myopcardial fibers and minimal effect on normal ventricular myocardium

Ib class lidocaine and amiodarone

Hydroxyurea (sickle cell)

Increases HbF levels. Given with > 3 crisis a year, symptomatic anemia, and life threatening complications.

treatment of prolactinoma

Dopamine agonists to suppress prolactin production Surgery for larger lesions

acute dystonia caused by antagonism of what receptor?

Dopaminergic D2

Complete atrioventricular septal defect associated with what disease?

Down syndrome: COMPLETELY patient b/w atria, b/w ventricles, b/w atria and ventricles. Findings: increased pulmonary markings and cardiomegaly due to biventricular volume overload

Di George Syndrome

Due to failure of 3rd and 4th pharyngeal pouches to develop; no thymus, parathyroid, and cardiac problems; also can have cleft palate (22q11) CATCH-22 cardiac(TOF) abnormal facies thymic hypoplasia (T-cell) craniofacial and cleft palate hypocalcemia--> hypoparathyroidism cardiac include truncus arteriosus

posterior longitudinal ligament

Connects all the posterior surfaces of the vertebral bodies

Mutation of chromosome 9p21

Dysplastic nevus syndrome; family history of melanoma

folic acid vs. leucovorin administration in realm of methotrexate?

Leucovorin, folinic acid, is a modified version of THF and enter folate metabolism where THF is, after the point where methotrexate takes its effect. I have a pharm. card that says "toxic effects on normal cells may be reduced by administration of folinic acid (a.k.a. leucovorin or citrovorum factor), which is **preferentially taken up by normal cells versus tumor cells**."

Lichen Simplex Chronicus

Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching., hyperplasia of the vulvar squamous epithelium

Gleason grade

Level of anaplasia in prostate biopsy

Accumulation effect

Long term exposure to RF or risk reducer may affect significance of effect

Maintenance dose equation

MD = (Cp x CL x tau) / F MD = [Steady state] * Cl

IL-8

Major chemotactic factor for neutrophils

Treacher Collins Syndrome

Mandibular hypoplasia, down-slanted palpebral fissures, colobomas, malformed ears, and zygomatic hypoplasia are commonly seen in what pharyngeal arch 1 abnormality?

Metaplasia

Mature cell type is replaced by a different mature cell type

Fibromuscular dysplasia

Most commonly affects renal artery and carotid artery

There are 4 structures always in the 'midline' beginning with M

Motor pathway (or corticospinal tract): damage results in contralateral weakness of the arm and leg Medial Lemniscus: damage results in contralateral loss of vibration and proprioception in the arm and leg Medial longitudinal fasciculus: damage results in ipsilateral inter-nuclear ophthalmoplegia (failure of adduction of the ipsilateral eye towards the nose and nystagmus in the opposite eye as it looks laterally) Motor nucleus and nerve: damage results in ipsilateral loss of the cranial nerve that is affected (III, IV, VI or XII)

Intermittent difficulty chewing and double vision with mild ptosis of right eye in 31 year old is caused by? and what does this lead to?

Myasthenia gravis --> thymic hyperplasia

(???) initiates the respiratory burst (FA2020 p109) which is vital for appropriate intracellular killing of phagocytosed organisms.

NADPH oxidase

decreased respiratory burst with increased staph. what is deficiency

NADPH oxidase

patient already had a stent placed, was symptom-free for a few months, and now has angina with exertion. Angina with exertion is describing "Stable angina", the angina is due to "demand ischemia"... neointima formation or a thrombosis?

NEOINTIMA The most common cause of stable angina is atherosclerosis/atherosclerotic plaque build up and a very common adverse effect of stents is neointima formation/ forming a new plaque on the stent.... a thrombosis would cause angina at both rest and with exercise, due to "supply ischemia", and it would be more acute, not progressive like the question stem describes

can you fix memory loss and confabulation seen in thyamine deficiency?

NO

do most kidney stones have hypercalcemia?

NO NORMOCALCEMIA HYPERCALIURIA

do you give direct thrombin inhibitors dabigatran or factor Xa inhibitors to pregnant women

NO (ENOXAPARIN IS NOT XA INHIBITOR)

Does carbon monoxide poisoning change the PaO2?

NO (no change in in amount oxygen dissolved in plasma)

Does atenolol change vascular smooth muscle CAMP?

NO its a B1 blocker not a non-selective b blocker only changes cardiomyocyte cAMP, Juxtaglomerular cell cAMP

muscarinic agonist promote synthesis of what compound?

NO leading to vascular dilation

in the case of irreversible CNS damage would you see fibroblast migration?

NO, only occurs at peripheral tissue of the body

Kussmaul sign? seen in what conditions

No fall in the JVP on inspiration - Ordinarily the JVP falls with inspiration due to reduced pressure in the expanding thoracic cavity and the increased volume afforded to right ventricular expansion during diastole. Kussmaul's sign suggests *impaired filling of the right ventricle* due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium. This impaired filling causes the increased blood flow to back up into the venous system, causing the jugular vein distension (JVD) and is seen clinically in the external jugular veins becoming more readily visible. Constrictive pericarditis, restrictive cardiomyopathy

Tubocurarine

Nondepolarizing neuromuscular blocking agent prototype: competitive nicotinic blocker. Releases histamine and may cause hypotension. Analogues: pancuronium, atracurium, vecuronium, and other "−curiums" and "−curoniums." Antidote: cholinesterase inhibitor, eg, neostigmine

tropheryma whippelii

Obligate Intracellular Parasites that Infect and live within Macrophages, forming "Foamy" Macrophages -> Stain brown Causative agent of Whipple Disease Treatment: 2 Weeks of Penicillin/Streptomycine + 1 Year of Oral Trimethoprim-Sulfamethaxazole

how do you rehydrate a patient with cholerea?

Oral rehydration therapy commonly consists of sugar/electrolyte water because of the ability to utilize the sodium glucose symporter. Where sodium goes, water follows, so by hydrating with this mixture it allows for an osmotic "pull" of water into the intestines.

Blue sclera. Disease/Dx? mechanism?

Osteogenesis imperfecta (type I collagen defect) defect in procollagen synthesis (triple helix formation)

low bone mineral density in a 20 year old who works out and eats healthy and has mild scoliosis. Ophthalmologic shows thin sclerae with visibility of underlying choroid layers. +osteoporosis. what protein is messed up?

Osteogenesis imperfecta --> COL1A1 which encode type 1 collagen

Mixed lysis and sclerosis with focal periosteal elevation and reactive new bone formation?

Osteosarcoma

Atherosclerosis affects (???) 1/3 of renal artery and occurs in older people while Fibromuscular dysplasia affects (????) 2/3 of renal artery is in younger females

PROXIMAL 1/3 of renal artery Fibromuscular dysplasia affects DISTAL 2/3 of renal artery

Cardiac tissue conduction velocity

Park AT VENtura AVenue Purkinje system Atrial muscle Ventricle muscle AV node

non-enveloped single stranded DNA virus

Parvovirus B19 aplastic anemia, sickle cell

Axonal reaction

Pathologic changes that occur in the axon and cell body of a neuron PROXIMAL to an axonal lesion. The process is characterized by central chromatolysis which features flattening and displacement of the nucleus, loss of Nissl bodies, and cellular edema. Central chromatolysis primarily occurs in lower motor neurons

What is capitation?

Paying the physician/hospital one lump sum per time period for each patient covered (regardless of whether or not patient was actually seen during that time period) fixed predetermined fee per patient to cover all medical services

Entacapone (tolcapone) mechanism of action?

Peirpheral COMT inhibitor. Decreases dopamine metabolism. Parkinson

Pemphigus vulgaris vs bullous pemphigoid

Pemphigus vulgaris: desmosomes, separation of epidermis with touching, makes uclers - mouth, body Bullous pemphigoid: hemidesmosomes, between keratinocytes, does not separate from skin with touching - makes bullae

difference between diarrhea by vibrio parahaemolyticus and clostridium perfringens?

Perfringens usually a delayed response vs a few hours after ingestion

example of genomic imprinting

Prader-Willi (father inherited) and Angelman (mother inherited) syndromes (both caused by missing regions of chromosome 15)

Treatment of Schistosomiasis

Praziquantel

Necrotizing enterocolitis

Pre-term infants have lower immune function, bacteria proliferate in bowel and cause ischemia and air in the bowel. Dx: thin curvilinear lines of lucency

otitis externa caused by

Pseudomonas aeruginosa (gram negative, rod, oxidase positive, motile)

HIV-2

Related to viruses that infect monkeys and sooty mangabeys Not often encountered outside of Africa Less pathogenic than HIV-1

HMG-CoA Reductase Inhibitors MOA

Inhibit conversion of HMG-CoA to Mevalonate, a cholesterol precursor increases synthesis of LDL receptors!!!

Fomepizole(mechanism, use, competitive or noncompetitive)

Inhibits alcohol dehydrogenase; used as an antidote to methanol or ethylene glycol poisoning. competitive (increase Km with no change in Vmax)

Stress hyperglycemia pathophysiology

Insulin resistance associated with critical illness, caused by increased catecholamines/glucocorticoids. Often found in patients recovering from serious burns/trauma. increased production cortisol, glucagon, and catecholamines → increase glycogenolysis and gluconeogenesis (stimulating release fo lgucose from liver into blood)

great saphenous vein location

Just inferolateral to the pubic tubercle

what is an example of activating mutation?

KRAS

Ovarian venous drainage

Left ovarian vein drains into the left renal vein Right ovarian vein drains into the IVC

17 year old develops difficulty seeing at night that has worsened. on exam optic disc pallor, and attenuation of retinal vessels, with area of dark discoloration. What is the diagnosis?

Retinitis pigmentosa

Kid had a viral URI then took aspirin. what is the dx and mechanism?

Rey syndrome, a hepatic encephalopathy. There is increased ammonia production because of the liver damage, leading to hyperammonemia. This gets to the brain, is converted to glutamine (an osmolyte). This causes the brain swelling.

Abortive treatment for migraines?

Step up approach: For moderate migraines - use NSAIDs, anti-emetics, analgesics For severe migraines - use triptans, ergot alkaloids

Jaw jerk reflex afferent, efferent?

V3 (sensory - muscle spindle from masseter) V3 (motor - masseter)

raised granular lesion with abundant capillaries and fibroblast. what is responsible for changes?

VEGF induced tissue proliferation

palpable right ventricular lift seen in what disease

VSD with left to right shunting

Mast cell delayed response

produces leukotrienes that allow for maintenance of the inflammatory response

N. meningitidis virulence factor that vaccine works against?

production of a polysaccharide capsule (attached to toxioid)

Osteoblastic Metastatic Carcinoma due to what cause

prostate adenocarcinoma

skeletal muscle mets from prostate cancer travel through what (lymph or vein and which one)

prostatic venous plexus

lesion biopsy with hyperkeratosis, parakeratosis, dilated capillaries in dermal papillae with neutrophils. what is the diagnosis

psoriasis

complication of psoriasis

psoriatic arthritis (deforming joint disease), nail changes, inflammatory disorder of the eye polyarthritis resembling AR that affects distal interphalangeal joints

Fatty streaks seen in :

pts of all ages. As early as 1, and commonly in 10 and up.

stool continence caused by failure of relaxation of what muscle?

puborectalis

anal fissure innervation

pudendal nerve

inferior thyroid artery is in close proximity to what nerve?

recurrent laryngeal nerve (vocal cord paralysis)

Erythroplasia of Queyrat

red velvety plaques on penus; involves the glans; similar to bowen's disease

cavernous hemangioma

reddish-blue, irregularly shaped, solid and spongy mass of blood vessels abnormally dilated blood vessels with recurrent hemorrhage. tend to bleed

Surfactant function besides surface tension

regeneration tissue

what lymph nodes drain upper portion of vagina

regional iliac lymph nodes

Retinoblastoma function

regulates G1 --> S checkpoint active (hypophosphorylated) state or inactive (hyperphosphorylated) states

HOX genes

regulation gene transcription

Triptan mechanism of action

release vasoactive neuropeptides including substance P and calcitonin gene-related peptide and also include 5-HT agonist

systemic lupus have autoantibodies directed against snRNPS which removal of ????

removal of introns from RNA transcripts

blood supply from proximal ureter is supplied by what artery?

renal artery distal urethral ischemia common in transplant causing ischemia to superior vesical artery

what is a common renal complication of sickle cell disease?

renal papillary necrosis due to ischemia in sickle cell trait or diseasesickling is promoted in the renal medulladue to low oxygen tension, low pH, and high osmolality (pulling water out of red blood cell and increasing concentration of hemoglobin S)increased blood viscosity leads to infarcts and causes papillary infarcts

is digoxin liver or renally cleared and what does that mean for old people?

renally cleared with GFR going down with age

17 alpha hydroxylase deficiency (increase or decrease) renin, ACTH, and LH

renin down ACTH up LH up they overproduce aldosterone while under produce cortisol and sex hormones

Complication of pneumothorax

reoccurrence of pneumothorax, re-explansion pulmonary edema, tension, bronchoplerual fistula tension RESPIRATORY ACIDOSIS

superior gluteal nerve injury

results in weakness and paralysis of the gluteus minimus and medius. This causes the pelvis to tilt downward toward the contralateral side (positive Trendelenburg sign) when standing on the affected leg. When walking the patient leans toward the affected side.

stimulus increases the activity of several enzymes including dihydrofolate reductase and DNA polymerase. What causes these activation?

retinoblastoma protein phosphorylation

Bicuspid Aortic Valve Disease

retrograde flow from aorta into the left ventricle through abnormal aortic cusps, aortic valve should be tricuspid, usually mild aortic valve disease, occurs in about 2% of males and 1% of females

Is the pancreas intraperitoneal or retroperitoneal?

retroperitoneal (except tail)

low grade dysplasia is different from cervical malignancy because of?

reversibility of changes

commissural fusion of leaflet edge and narrowing of mitral valve orifice with diastolic murmur is indicative of what?

rheumatic fever

auto-reactive immunoglobulin M antibodies are associated with what disease?

rheumatoid arthritis

synovial neovascularization is a sign of what disease?

rheumatoid arthritis

Basophilic stippling of RBCS is due to what structure remaining

ribosomal RNA

P450 inducer? a. rifampin b. metronidazole c. fluconazole d. oral contraceptives

rifampin

drug that causes red-orange body fluids and mechanism of action

rifampin -inhibition of bacterial DNA-dependent RNA polyerase

where is intimal tear in aortic dissection non involving ascending aorta?

right after left subclavian artery

sick sinus syndrome results for degeneration of what cell? a. interatrial septum b. interventricular septum c. right atrial wall

right atrial wall --> degeneration of SA node

When does estrogen peak?

right before ovulation (day 12-ish)

anisocoria with increase in dim lighting

right oculosympathetic pathway increases in dim light sympathetic defect increases in bright light parasympathetic defect

what artery is affected by emboli that causes right eye vision loss?

right ophthalmic artery (if there was an embolus in any of the other arteries, there would be more severe symptoms outside of the vision loss)

what is located in fourth intercostal space along the left sternal border?

right ventricle

3 day of fever chills, myalgia and severe headache. after camping trip to mountains.Erythematous maculopapular rash on distal forearms. what mechanism of drug used

rocky mountain spotted fever (rickettsia rickettsii) tx is doxycycline which inhibits protein synthesis by binding 30s subunit

Yersinia pestis spread through what organism

rodent to fleas

when determining a problem in hospital system what anaylsis should happen

root cause analysis --> interviewing all members to see what happened

what virus undergo similar mechanism to influenza antigenic shift (reassortment)?

rotavirus (segmented nature of genome)

multiple myeloma is associated with what RBC

rouleaux formation

What structures are found in inguinal canal?

round ligament, genital branch of the genitofemoral nerve, and the ilioinguinal nerve

sacubitril/valsartan

sacubitril=does not allow for breakdown of ANP/BNP valsartan=inhibit aldosterone while causing increase in ANG-II

hydrogen sulfide producer

salmonella

allelic herogeneity

same genetic locus cause similar phenotypes ex: pt with missense pt with nonsense pt with promoter site mutation but all have similar manifestation of disease. Duchene vs becker MD

hypertrophic cardiomyopathy show mutation in protein belonging to what structure?

sarcomere

glycogen degradation within skeletal muscle contraction occurs due to release of ??? which causes activation of phosphorylase kinase

sarcoplasmic calcium

osteogenesis imperfecta leads to a decrease in (???) formation

scar tissue

type of tumor with a neural crest cell derivative

schwannoma

posterior hip dislocation affects what nerve

sciatic nerve

fusion of the sclerotomes

sclerotome. : the ventral and mesial portion of a somite that proliferates mesenchyme which migrates about the notochord to form the axial skeleton and ribs. cause of spina bifida

gingivitis associated with what vitamin deficiency

scurvy ---> ascorbic acid

Fibroblast Migration and Proliferation

second step of CT-driven repair; driven by platelet derived growth factor (PDGF), FGF-2, and transforming growth factor beta (TGF-B)

creatinine clearance is slightly higher than actual gfr why?

secreted slightly by the proximal tubule

Carcinoid tumor

secretes serotonin, can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation) slow-growing cancer that can arise in several places throughout your body. Carcinoid tumors, which are one subset of tumors called neuroendocrine tumors, usually begin in the digestive tract (stomach, appendix, small intestine, colon, rectum) or in the lungs

lung abscess with peptostreptococcus and fusobacterium is due to what disorder?

seizure disorder, alcoholism, drug abuse, stroke or dementia (aspiration pneumonia)

Rolling is mediated by

selectins (E/P)

anaphylactic reaction after receiving blood product with history of celiac disease and pneumonia multiple times. what is the dx?

selective IgA deficiency

dihydropyridine calcium channel blockers mechanism of action (smooth muscle or myocardium)

selective for smooth muscle fo the peripheral vasculature with minimal effect on ventricular contractility or heart rate --> leads to increased stroke volume and cardiac output

Congenital Rubella : The triad of ( Gregs Triad )

sensorineural deafness cataracts cardiac defects - - blueberry muffin rash -Infection in mother - air droplets ( Sx of polyarthritis)

Congenital CMV :

sensorineural hearing loss chorioretinitis blueberry muffin rash periventricular calcifications -Infection in mother will present with nonspecific symptoms of lymphadenopathy , malaise e.t.c

if air louder and weber positive

sensorineural hearing loss (lateralized to unaffected ear)

knee pain with synovial fluid with numerous polymorphonuclear leukocytes?

septic arthritis

WBC in joint of 28 year old. what do you think

septic arthritis caused by gonococcus

Hox genes

series of genes that controls the organs and tissues that develop in various parts of an embryo. code for transcription factors that alter expressivity

BRCA1 mutation have an increased risk for what cancer specifically in ovary?

serous carcinoma

Neoplastic Colonic Polyps

serrated adenomatous (villous > tubular)

patient has difficulty raising right arm above her head and has prominence of right scapular angle when pushing against wall. What muscle and nerve are affected?

serratus anterior (rotates scapula up) that is innervated by long thoracic nerve

what cell dysfunction causes decreased testosterone in seminiferous tubules?

sertoli cells

ovarian neoplasm with hirsutism. What type of neoplasm?

sertoli-leydig tumor

SGLT2 inhibitors workup prior to starting

serum creatinine

what lab test should you order when starting metformin?

serum creatinine level

WPW syndrome

short PR interval, delta waves and wide QRS atrioventricular conduction bypassing AV node

Skeletal muscle I band (lengthen/shorten) during contraction and (lengthen/shorten) during relaxation

shorten lengthen it is the actin filament only

ECG with bradycardia and dropped P wave. what syndrome?

sick sinus syndrome

multiple oxalate crystal

sign of ethylene glycol poisoning

Phosphodiesterase Inhibitors effect what portion of penis?

sildenafil effects corpora cavernosa (increase cGMP)

formation of intrapulmonary free radicals leading to progressive lung injury and interstitial collagen deposition. characterized by birefringent silica particles within dense whorled collagenous nodules surrounded by dust-laden macrophages

silica

Mefloquine MOA

similar action to chloroquines, but effective against many chloroquine-resistant strains cannot clear liver schizonts

periductal lymphocytic infiltration of labial glands

sjograns syndrome

changes in creatinine caused by what two factors in normal adult

skeletal muscle mass and dietary intake (high meat increases)

women with heterozygous x-linked disorder with disease is most likely caused by

skewed x inactivation

Erythema multiforme

skin disorder resulting from a generalized allergic reaction to an illness, infection, or medication cause target lesion and associated with infections like HSV

Erythema multiforme is caused by?

skin disorder resulting from a generalized allergic reaction to an illness, infection, or medication cytotoxic t-cell mediated epithelial injury: pmn phagocytize bacterial --> DNA fragments transferred to keratinocytes ---> cytotoxic T cells attack and initiate inflammatory cascade

Physician fatigue

sleep deprivation

Sliding Hiatal hernia vs Paraesophageal hiatal hernias

sliding: due to laxity of phrenoesophageal membrane allowing GE junction to slide upward paraesophageal: defect or hole in phrenoesophageal membrane allowing gastric fundus to migrate

why does drug metabolism vary person to person?

slow/fast acetylators

weakness that improves with repeated use is associated with what cancer?

small cell carcinoma ---> lambert eaton syndrome

Neural Cell Adhesion Molecules can be stained in what cancer

small cell carcinoma of lung (enolase, chromogranin, and synaptophysin)

risk factor of renal cell carcinoma

smoking

Centriacinar emphysema is most commonly due to:

smoking -- consider that the proximal portion of the airway would be exposed to the highest concentration of toxin

most beneficial for reducing MI risk

smoking cessation

mechanism of action of first line treatment of asthma attack?

smooth muscle relaxation (decreased smooth muscle tone)

in cystic fibrosis what will be stuck in the cells?

sodium

what polypeptide decreases portal venous pressure

somatostatin

diarrhea with comma-shaped, oxidase-positive, gram-negative rod is caused by what microbe and will cause what to be seen on stool microscopy? (leukocytes?erythrocytes?only mucus?)

some mucus and no erythrocytes or leukocytes (can also been seen in e.coli)

liver cirrhosis causes increased pressure in what structure?

spleen via the splenic vein

In ITP what is responsible for phagocytosing platelets?

spleenic macrophages

fungal dermatologic infection

sporotrichosis (spreads along lymphatics with granulomas)

most important prognostic derminant of colorectal cancer?

spread to muscularis propria ---> regional lymph nodes ---> distant sites

Wernicke's encephalopathy

What encephalopathy causes ocular palsies, confusion, and gait abnormalities related to a lesion in the mammillary bodies and/or the dorsomedial nuclei of the thalamus? B1 before glucose-mamillary bodies

postprandial epigastric pain, weight loss, and FOOD AVERSION with ischemic heart diesase =

stable angina ---> chronic mesenteric ischemia

contemplation stage

stage of change in which people are considering changing behavior in the next 6 months know they have a problem but dont want to fix it now

Sudan III stain

stains unabsorbed fat. for malabsorption Dx specific nutrient deficiencies good for testing malabsorption of any etiology

mayo based dressings and vomiting following, what is the organism involved and how can it be prevented?

staph ---> keeping food refrigerated while storing

purulent cellulitis with fluctuant nodules is most likely what organism

staph aureus

Stenosis vs Regurgitation, which is caused by rheumatic fever and which is caused by infective endocarditis

stenosis - rheumatic fever regurg- infective endocarditis

what structure causes noise-induced hearing loss

stereo ciliated hair cells on organ of corti

vegetations by bacteria are caused on what type of pathogenesis ?

sterile fibrin-platelet nidus

DNA binding domains

steroid hormones

pathogenesis of Grave's ophthalmopathy

stimulation of orbital fibroblast by TRAb which SECRETE ECESS AMOUNTS OF GLYCOSAMINOGLYCANS (hyaluronic acid)

strawberry capillary hemangioma life cycle

strawberry birthmark in infants vascular tumor grow rapidly during first few weeks, then regress

strawberry hemangioma vs Cherry hemangioma

strawberry: congenital collection of dilated blood vessels causing a red birthmark that fades a few months after birth (pic) Cherry: Benign capillary hemangioma of the elderly (see picture) . -Does not regress. -⬆ frequency with age.

gram-positive cocci with hemolysis and coag cat negative and pyrrolidonyl arylamidase test is positive

strep pyogenes

dark urine and facial puffiness after pustular skin lesion that broke down and formed thick scab over lower extremities. Pyrrolidonyl arylamidase (PYR) test positive. what is the organism

strep pyogenes cause by impetigo

Sodium channel blocker Class 1C with strong Na channel blockage and its contraindicated in (???)

structural and ischemic heart disease

onset following viral illness leading to painful thyroid enlargement and a transient hyperthroid sxs. what is the dx? WHAT WOULD BE SEEN PATHOLOGICALLY?

subacute granulomatous thyroiditis INFLAMMATORY INFILTRATE WITH MACROPHAGES AND GIANT CELLS check c-reactive protein or ESR

Post-strep glomerulonephritis characteristic biopsy feature

subepithelial hump

irregular uterine enlargement with pelvic pressure resulting in constipation. Arise from what disease

subserosal leiomyomas

what bacterial product used to treat idopathic torticollis?

subterminal spore formation from botulism --> skeletal weakness

hemiballismus lesion

subthalamic nucleus

what part of the brain would provide benefit in parkinson patient at being inhibited?

subthalamic nucleus

what step of kreb cycle provides GTP?

succinyl-CoA ---> succinate can be used in phosphoenolpyruvate carboxykinase

neuromuscular blocking agent that starts to show potassium level at 9.5 meq/l. what is the agent used?

succinylcholine: adverse effects include malignant hyperthermia, severe hyperkalemia, bradycardia

hepatitis A clinical presentation

sudden onset fever, N/V, tenderness of the liver, jaundice, AST elevation <3 weeks, fever anorexia, dark colored urine (increased conjugated bilirubin levels)

persistent hypoglycemia due to what antidiabetic

sulfonylurea (glyburide)

how do you treat cyanide toxicity (caused by accidental increased nitroprusside)

sulfur donor induction methemoglobinemia (sodium nitrate) binding cyanide (hydroxocobalamin)

lymph drainage below pectinate line

superficial inguinal nodes

sensory over lateral leg and dorsolateral foot

superficial peroneal nerve

collateral circulation from inferior mesenteric artery

superior mesenteric artery

neutralization of reactive oxygen species is accomplished by what enzyme?

superoxide dismutase also glutathione peroxidase and catalase

circumflex artery

supplies the left atrium and the posterior walls of the left ventricle

Codocytes also known as target cells are red blood cells that have the appearance of a shooting target with a bullseye. ... These cells are characterized by a disproportional increase in the ratio of (???) to (???).

surface membrane area to volume

episiotomy

surgical incision of the perineum to enlarge the vagina and so facilitate delivery during childbirth must cut perineal body

extraembryonic mesoderm

surrounds amniotic cavity and yolk sac

where are the ovarian artery, vein, lymph, and nerve contained in?

suspensory ligament of the ovary

decreased levels of complement C3 and C4 are associated with what autoimmune condition?

systemic lupus positive ANA, positive anti-DS DNA, anti-smith, low complement, high immune complexes

glomerulonephritis with diffuse thickening of glomerular capillary walls with wire-loop structures. dx?

systemic lupus erythematosus

thickened valve leaflet with small vegetations on both valvular surface and arterioles. dx?

systemic lupus erythematosus

myocardial infarction leads to increase in a. cardiac contractility b. systemic vascular resistance c. pulmonary artery systolic pressure -can be more than one choice-

systemic vascular resistance pulmonary artery systolic presssure (decrease cardiac contractility)

Follicular lymphoma

t 14;18 causing BCL-2 over-expression- prevents apoptosis (remember through the prevention of cytochrome c release from mitochondria)

Follicular lymphoma

t 14;18 causing BCL-2 overexpression- prevents apoptosis (remember through the prevention of cytochrome c release from mitochondria)

Follicular lymphoma genetics

t(14;18)-translocation of heavy-chain Ig (14) and bcl-2 (18)

Is di-george a immunoglobulin problem or T-cell problem?

t-cell problem aka no thymus

chronic muscle weakness leading to difficulty walking and removing objects from overhead bin. endomysial mononuclear infiltrate and patchy muscle fiber necrosis. what is the autoantibody directed against?

tRNA synthetase (polymyositis) anti-jo-I antibodies

Endometrial polyps can arise as a side effect of what drug?

tamoxifen

Tamoxifen vs Raloxifene

tamoxifen: *bad for endometrium (+)*, good for bone (+), breast (-) because of increase risk of endometrial hyperplasia/cancer would not be suitable to treat osteoporosis raloxifene: good for bone (+), breast (-), endometrium (-) both: inc risk VTE

Prosencephalon

telencephalon and diencephalon cerebral hemispheres and lateral ventricles thalamus and 3rd ventricle

HSV encephalitis. What lobe classically?

temporal fever headache seizure and AMS tx: acylovir

treatment for HIV that produces loss of brush border and basement membrane denudation. what causes nephrotoxicity?

tenofovir-induced nephrotoxicity TMP-SMX would not produce focal damage of proximal tubule

intrascrotal nodule difficult to distinguish from testes. Non-tender and does not change with positioning, without tranlumination. cancer or varicocele?

testicular cancer

treatment for orchitis induced by mumps?

testosterone (seminiferous tubule atrophy)

masseter muscle spasm which can also be elicited when the posterior pharynx is touched with a depressor. What organism is the cause?

tetani -->toxin mediated neuronal blockade that inactivates inhibitory interneurons

Mesencephalon

the midbrain; a region of the brain that surrounds the cerebral aqueduct; includes the tectum and the tegmentum

Adenocarcinoma of the lung

the most common cancer of the general population, especially in women who are non-smokers. It is located periphery with tumor cells forming gland-like structures.

cellular swelling

the most common degenerative change, is caused by the shift of extracellular water into the cells due to decreased ATP

carotid sinus reflex

the stimulation of baroreceptors in the arteries leading to the brain that helps regulate blood pressure in the brain afferent is glossopharyngeal nerve ---> efferent is vagus nerve

parietal cells histology

they are eosinophilic on histo and they are located more superficially compared to chief cells (super basophilic, labeled as C).

gout causing drugs

thiazide cyclosporin tacrolimus

tiny mass in testicle with large malignancy else where

think choriocarcinoma spread early af

bleeding gums, normal coag studies.

think vitamin C

if you see a rash that is STREAKED

thnk allergic contact dermatitis

Patient with excessive sweating and heat intolerance can be corrected by cutting what ganglion>

thoracic sympathetic trunk

Left supraclavicular node provides lymph drainage for what?

thorax and abdomen

impaired cleavage of vWf is a sign of what condition?

thrombotic thrombocytopenic purpura (will have normal pt ptt

what 3 functions is controlled by the median nerve to the thumb?

thumb abduction thumb flexion thumb opposition

what is the active product of the thyroid gland that is needed for normal development of fetus?

thyroxine (T4) is the active hormone produced that would affect development.

what nerve innervates plantar aspect of foot, which also innervates foot plantar flexion, inversion, and toe flexion?

tibial nerve

microsporum causes what disease

tinea capitis, tinea corporis

mechanism of quick recovery from IV anesthesia?

tissue redistribution of drug

Metalloproteinases function in cancer

tissue remodeling tumor invade bsement membrane via enhanced secretion of proteolytic enzymes like mealloproteinase

fever and rash with tender lymphadenopathy bilateral behind ears. what organism?

togavirus rubella

thyroid gland is derived from

tongue (foramen cecum)

X-linked recessive

What pattern of genetic transmission affects only M and has no M-to-M transmission, and mother is usually an unaffected carrier?

corticospinal tract

What tract is responsible for voluntary refined movements of distal extremities?

orchiectomy changes to prostate gland

With removal of this stimulus, the cells will undergo apoptosis (scattered shrunken cells are apoptotic bodies). Necrosis of the blood vessel walls is not likely because the blood vessels are not affected by the loss of the androgens, rather the actual prostatic cells are. Widespread necrosis is also not likely as this is not the mechanism of death after testosterone removal (death will occur by apoptosis rather than necrosis) and widespread necrosis is more characteristic of infarct or something that causes massive sudden tissue death.

infant with recurrent infections due to intracellular messaging abnormaility that codes for tyrosine kinase. What chromosome is responsible?

X chromosome due to bruton agammaglobulinemia

Lesch-Nyhan syndrome: genetics?

X-linked recessive. HGPRT gene: "H e's G ot P urine R ecovery T rouble" purine must be increased from another site ---> de novo purine synthesis increased phosphoribosyl pyrophosphate (PRPP) amidotransferase activity

p57 negative

complete mole

hepatocellular carcinoma histology

abundant eosinophilic cytoplasma

child with large full anterior fontanelle and retinal hemorrhages are suspectful of what type of injury?

abusive head trauma

mortality benefit of chronic heart fialure

ace inhibitors arb beta-blocker mineralocorticoid receptor antagonist (spironolactone)

increased complement, +hereditary angio edema. what drug should be avoided?

ace inhibitors -april

acute pulmonary edema

acellular pink material with engorged capillaries

is omeprazole a passive or active transport inhibitor?

active transport inhibitor (ion channels are mostly passive)

is glycogen phosphorylase active in phosphorylated or dephosphorylated form?

active with phosphorylase

is glycogen synthase active in its phosphorylated or dephosphorlyated form?

active without phosphate

gallbladder complication due to critically ill patient?

acute acalculous cholecystitis

sudden onset muscle spasms after receiving antipsychotic. What is the treatment?

acute dystonia baenztropine or diphenhydramine

pain to right testicle with swelling and tenderness to posterior superior portion. +leukocytes but no bacteria. what is the disease and cause?

acute epididymitis chlamydia or gonorrhea in older men it is due to gram-negative colonic flora

What is a leukemoid reaction?

acute inflammatory response to infection: ↑ WBC count with ↑ neutrophils and neutrophil precursors such as band cells (left shift); ↑ leukocyte alkaline phosphatase

Blast cells with Auer rods

acute myelogenous leukemia

fever, fatigability, and sore throat with Auer rods?

acute promyelocyctic leukemia (15;17)

what can be prevented by treating strep?

acute rheumatic fever (post-streptococcal glomerulonephritis)

brown muddy cast

acute tubular necrosis

vomiting and lethary in a 2 year old after not eating for a few days with low BSG and low ketones. Which of the following enzymes is deficient?

acyl-CoA dehydrogenase due to MCAD deficiency MCAD deficiency: hypoketotic, hypoglycemic, seizures, sudden death

B3 Niacin deficiency = Pellegra = diarrhea, dermatitis, dementia death. = Niacin combines with ???? to become NAD+

adenine

Cholangiocarcinoma histology

adenocarcinoma with cuboidal or columnar cells with prominent nucleoli arranged in glandular structures +mucin production. + desmoplasmic response

what medication acts on funny channels?

adenosine

periventricular leukomalacia or necrosis of white matter adjacent to ventricles of the brain due to systemic hypotension or ischemia has resulted in spasticity of muscles. what CNS drug would be given to down regulate this?

agonist of GABA (benzo or baclofen) or glycine

bowel obstruction with hard mass containing cholesterol blocking ileocecal valve. what else would you see?

air in biliary tree ---> gallstone ileus (gastric acid through fistula)

Globus sensation

aka globus hystericus/pharyngis, feeling of having a lump in one's throat without radiographic evidence

bone marrow increase heme production through what?

ala

g-protein coupled hydrophobic amino acids. what is a amino acid that works

alanine valine leucine isoleucine phenylalanine

what process is inhibited by increasing levels of fructose-2,6-bisphosphate?

alanine ---> glucose (inhibit gluconeogenesis)

diabetic nephropathy measured using urinary concentration of what substance

albumin

ataxia and alcoholic, diagnosis?

alcoholic cerebellar degeneration

what test is performed for gallstone obstruction

alkaline phosphatase

What is the name for the common idiopathic alteration of bone exhibiting abnormal resorption and deposition, resulting in distortion and weakening of the affected bones? (enlarged vertebral bodies with cortical thickening) serum testing?

alkaline phosphatase ---> paget disease of the bone

Thiazide diuretics causes metabolic (???)

alkalosis

Urine turns black on standing, degenerative arthritis of the spine, hip, knee. what pathway is deficient?

alkaptonuria tyrosine to fumarate

Lithium causes __?__. A. Tremor B. Hair loss C. Weight gain D. Memory loss E. All the above

all of them above (hypothyroidism) also nephrogenic DI

Fanconi syndrome changes in amino acids, glucose, phosphate, HCO3-? increased or decreased reabsorption?

all will be decreased reabsorption leading to metabolic acidosis

mitral stenosis (early) causes what changes diastolic pressure, afterload, contractility?

all would be normal until later in disease

Cretinism

condition of congenital hypothyroidism in children that results in a lack of mental development and dwarfed physical stature; the thyroid gland is either congenitally absent or imperfectly developed enlarged tongue due to maternal hypothyroidism thyroid agenesis, dyshormonogenetic goiter (thyroid peroxidase)

weber and rinne test with lateralization to right ear and bone louder than air

conductive hearing loss to right ear

mother from poor country has child. 2 months after birth. difficult to rouse. small stool. large anterior fontanelle, large tongue, and reducible umbilical hernia, floppy baby. what is the diagnosis?

congenital hypothyroidism

Amyloid staining

congo red and apple-green birefringence

Dermatomyositis

connective tissue disease involving destruction of the muscle tissue

ductus venosus

connects the umbilical vein to the inferior vena cava, bypassing the liver

Nocturnal back pain, unrelieved by rest

consider metastatic malignancy to the spine from cancer of the prostate, breast, lung, thyroid, and kidney. Loss of normal lordosis, muscle spasms, and limited anterior and lateral flexion.

First order elimination kinetics is a constant (???) of drug per unit time

constant fraction of drug whereas zero order is constant amount In two hours, 2.5 mg of 12.5 mg is metabolized, which is a fraction of 2.5/12.5 = 0.2 or 20% Thus, in another two hours, another 20% will be metabolized since this is first-order elimination 20% of 10 is 2 and 10-2 = 8

gram positive rod with tumbling motility most likely contracted from what source?

contaminated food

Wernicke's area and impairment?

controls language reception - a brain area involved in language comprehension and expression; usually in the left temporal lobe impairment causes: impaired comprehension word salad

aldose reductase (associated with diabetes)

converts glucose into sorbitol, which is further metabolized into fructose by sorbitol dehydrogenase .This pathway is most active in seminal vesicles (testes main source of energy is fructose). The lens also has significant levels of sorbitol dehydrogenase that become overwhelmed in setting of hyperglycemia which can lead to cataracts (a complication of diabetes) Other tissues like the retina, schwann cells, and renal papilla have less sorbitol dehydrogenase activity

evaporation of sweat

cools the body to reduce the temperature

mutation in what gene can cause ALS?

copper-zinc superoxide dismutase

Copper deposits in what part of the eye from Wilson's disease

cornea (NOT IRIS)

tumor marker for hepatocellular carcinoma?

alpha-fetoprotein

fetal ultrasound shows ascites, bilateral pleural effusion and small percardial effusion, this is due to what blood disorder? and will show what on maternal smear?

alpha-thalessemia and will show microcytes alpha-thalessemia major --> barts --> extreme affinity to oxygen and does not release it in the tissue causing hydrops fetalis Parents will have microcytic cells due to alpha-thalassemia minor

acute respiratory distress syndrome (ARDS)

alveolar hyaline membranes ARDS is a complication of pancreatitis

antibiotic that causes ototoxicity and mechanism of antibiotic?

aminoglycoside process by mRNA genetic code reading

treatment for acute intermittent porphyria involves down regulation of what enzyme?

aminolevulinate (ALA) synthase AIP involves accumulation of ALA and porphobilinogen

inspiratory crackles with ulnar deviation on broth wrist and patchy area of interstitial infiltration throughout lungs can be caused by what drugs?

amiodrarone, bleomycin, methotrexate RA, SLE, systemic sclerosis, silica, fungi, idopathic pulmonary fibrosis can also cause

htn treatment that can cause edema?

amlodipine

Kluver-Bucy syndrome: characterized by emotional changes, such as reduction of fear and anxiety, inappropriate sexual activity and oral fixation after bilateral (???part of brain??) damage

amygdala

What is an example of a fistula?

an abnormal passage from an internal rogan to the body surface or between two internal organs bowel contents drain to surface of the skin

celiac disease

an inherited autoimmune disorder producing atrophy of intestinal villi CD8 T cells inflilatrate and release a large amount of inflammatory cells Lead to dermatitis herpetiformis: pruritic rash of elbows and knees caused by IgA antibody cross reactivity

Abetalipoproteinemia

an inherited inability to synthesize apolipoprotien B, thus lipids absorbed in the small intestine cannot be transported by chylomicrons and therefore it builds up in enterocytes.

Necrotizing pneumonia and lung abscess what organism

anaerobic (extremely common) -> S. aureus, Klebsiella, streptococcus pyogenes

ecological study

analyzing population-level data to evaluate exposure and outcome should not be used to draw conclusions regarding individuals within population

thyroid cancer associated with tp53 mutation

anaplastic carcinoma

anemia with a minimal reticulocyte response. characteristic of what type of anemia?

anemia of chronic disease

biopsy of Kaposi's lesion

angiogenic proliferation and spindle cells

Chronic lymphedema is a risk factor for the development of what?

angiosarcoma

Stewart-Treves syndrome

angiosarcoma in long standing chronic lymphedema which has often resulted from radical mastectomy

ARB function

angiotensin II receptor blocker renin ↑ --> ang-I ↑ ---> ang-II ↑ ---> aldosterone low

Niacin mechanism (lipids)

antagonize VLDL cholesterol secretion inhibits lipolysis ( hormone sensitive lipase ) and hepatic VLDL synthesis /secretion . Side effects : Facial flushing , secondary to prostaglandin release . Pre treat with NSAIDS- Also causes Hyperglycemia and Hyperuricemia , as such avoid in Gouty patients and Diabetics

2 year history of abdominal discomfort, greasy stool, and weight loss. Multiple macrophages loaded with PAS-positive granule in lamina propria. Treatment?

antibiotics (tropheryma whippelii)

small cell lung cancer causes muscle weakness through what mechanim?

antibodies against voltage-gated calcium channels ---> lambert-eaton syndrome calci-yum ice cream with the lamb eating it (pixorize)

how do you prevent diptheriae from systemically spreading?

antibody administration to bind bacterial product

Preventative treatment for migraines

anticonvulsants (topiramate/valproate) bblocker antidepressant

treatment for vestibular nausea?

antihistaomines and anticholinergics

renal vein thrombosis is associated with nephrotic syndrome due to loss of what?

antithrombin III s/s: flank pain hematuria and elevated lactate dehydrogenase, left-sided varicoceles

where can shingles be?

anywhere (dont forget about the knee) it can even happen in younger kids if they have previous infection

decreased diastolic blood pressure and increased left ventricular end diastolic pressure are a sign of of what valve problem?

aortic regurgitation (common complication of prosthetic valve sealing)

bicuspid valve complications

aortic stenosis usually around age >65

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 kindneys (mildly increased serum calcium with low urinary calcium and mildly to normal increased PTH)

Neurophysins function

are carrier proteins for oxytocin and vasopressin (ADH). They are carried from the paraventricular and supraoptic nuclei of the hypothalamus to the axon terminals in the posterior pituitary. A point mutation in neurophysins could be the reason for hereditary diabetes insipidus (No ADH)

dyspnea on exertion with interstitial pattern of involvement on chest x ray with prominent in lower zones with pleural plaques. fusiform rods on histology

asbestosis

what part of the nephron is water impermeable

ascending limb of loop of henre

intermittent respiratory symptoms in setting of normal cxray with sputum eosinophils and reduced FEV1 is highly suggestive of what

asthma (triggers are inhaled allergens-animal dander, dust mites, pollen respiratory irritants-cigarette smoke, perfumes medications- aspirin NSAID)

temporal lobe epilepsy with atrophy of the hippocampal neurons. what is dx

astrocyte proliferation

what cell type forms glial scar?

astrocytes

what cell type produces gliosis?

astrocytes

is Hep C often symptomatic or asymptomatic?

asymptomatic

ataxia, nest of capillaries, and recurrent pulmonary infections. Disease and mechanism?

ataxia telangiectasia --> DNA break repair (ATM gene) (will also see IgA deficiency)

chloroquine-resistant malaria treatment

atovaquone-proguanil or artemisinins

The saw tooth pattern is indicative of which rhythm?

atrial flutter

which do you give first atropine or pralidoxime for organophosphate poisioning?

atropine

acute angle glaucoma side effect of what drug

atropine (given in bradycardia MI)

suspensory ligament of ovary

attaches ovary to lateral pelvic wall watch out for ureter when performing oophorectomy

patient develops sustained tonic-clonic convulsion without regaining consciousness. what is the mechanism of action of the drug that would be used during this seizure?

benzodiazepine (they rapid af) ---> enhanced post synaptic chloride influx

dyspnea and ill-defined nodular or irregular opacities on x ray. noncaseating epithelioid granuloma

berylliosis

nonpurulent cellulitis with no fluctuant nodule is most likely what organism

beta-hemolytic streptococi

What drug resistance is due to bacterial enzymes that destroy abx?

beta-lactamases

A young patient with a family history of sudden death collapses and dies while exercising. what is the mutation?

beta-myosin heavy chain or myosin-binding protein C

misleadingly low hemoglobin A1c level

beta-thalassemia minor

target cells

beta-thaleassemia minor

median nerve runs between what muscles in forearm?

between flexor digitorum superficialis and profundus

secretin stimulates

bicarbonate secretion by pancreatic ductal cells (secretin produced in duodenal S-cells due to increased H+ concentrations)

upper neuron disorders such as Multiple sclerosis causes what type of urologic disorder?

bladder hypertonia --> spastic bladder --> due to loss of inhibitory control from upper motor neuron

mold with hyphae and yeast at body temperature?

blastomyces dermatidis (dimorphic)

mechanism of action for treatment of absence seizure in 8 year old?

block thalamic t-type ca2+ channels (ethosuximide)

What intercellular adhesion between epithelial cells can be disrupted?

cadherins

neuroprotective after subarachnoid hemorrhage

calcium channel blocker (nimodipine)

myositis ossificans

calcium deposits that result from repeated trauma

Myocyte relaxation

calcium efflux from cytoplasm via Na/Ca2+ exchange pump into sarcoplasmic reticulum

Long-chain acyl-coA dehydrogenase

can be defeiicnet and infant would present with lethargy and hypoglycema and lack of ketones (can't make em)

G-6-PD leads to deficiency in what product in the pentose phosphate pathway

cannot synthesis 6-phosphogluconate

what is the payment structure underlying health maintenance organization?

capitation

SIADH due to what drug

carbamazepine

pulsus paradoxus, jugular venous distention, and tachycardia. what is diagnosis?

cardiac tamponade

where is the primary site for sensing PaO2 and hypoxemia and reduce peripheral chemoreceptor stimulation and reduce respiratory rate?

carotid and aortic bodies

most time efficient experimental design

case-control

Subacute sclerosing panencephalitis

caused by a variant of the measles virus. This occurs in children and young adults who had measles before age 2, after a 6- to 10-year asymptomatic period. It causes progressive dementia, seizures, and paralysis, leading to death. Initially may have focal lesions in gray matter and subcortical white matter. Later, periventricular white matter lesions may enhance. Late stages usually are profound cortical atrophy.

hypothalamic supression

caused by weight loss strenuous exercise chronic illness eating disorder

cryptorchidism must be corrected due to increased risk of?

causing decreased spermatogenesis and infertility(infertility if corrected before age 2). Also increases risk for testicular cancer.

what medication selectivity bind IL-1 inducible enzyme that is highly expressed on inflammatory cells used in treatment of gout?

celecoxib (COX-II)

How does anaphylaxis occur?

cell surface-bound antibody bridging by antigen as antigen molecules enter the blood stream they interact with IgE's that are bound to mast cells and basophils --> this creates a cascade of rxns --> a signal is transmitted through the IgE's in the cell membrane, and activates a series of enzymes --> this leads to an influx of Ca++ into the membrane and a diffusion of granules rise to the surface of the cell membrane --> this is degranulation --> which leads to histamine release into the Extracellular space

Sertoli cells

cells found within the seminiferous tubules that provide metabolic support for the spermatids produce anti-mullerian hormone allow internal structure change from female to male

hemodynamic changes due to pulmonary embolism (central venous pressure, cardiac output, systemic vascular resistance)

central venous pressure ↑ systemic vascular resistance ↑ cardiac output down

What connects the 3rd and 4th ventricles?

cerebral aqueduct

pancoast tumor impinge what nerve?

cervical ganglion

what part of the spine is most often involved in RA ?

cervical spine

X-linked agammaglobulinemia leads to what specific type of infection?

characterized by low or absent circulating CD19+ and CD20+ B cells and pan-hypogammaglobulinemia. Patient would be a boy with pyogenic bacterial infections and Giardia possibly due to lack of IgA and opsonizing antibodies. primary lymphoid follicles and germinal centers will not form in the lymph nodes due to no B ccells. Defect in the BTK gene (a tyrosine kinase gene)

when taking furosemide what lab test must be checked?

check blood electrolyte level

bullous pemphigoid antigen

check for bullous pemphigoid - chear fluid filled bilster that are tense over trunk

joint pain following high fever and rash during a trip to Puerto Rico. lymphopenia. What is the cause?

chickungunya fever (viral infection transmitted by mosquito bite)

what hormone causes release of bile?

cholecystokinin

unstable angina, femoral stent, blue discoloration of toes, high creatinine. what is causing the creatinine problem?

cholesterol clefts in arterial lumen

needle shaped clefts

cholesterol emboli

pathogenesis of cholesterol gallstones cause (cholesterol/bile acid/phosphatidylcholine) to increase or decrease?

cholesterol increase bile acid decrease phosphatidylcholine decrease

3 medications used to treat alzheimers?

cholinesterase inhibitors (donepezil) antioxidants (vitamin E) NMDA antagonist (memantine)

Drug that can cause constriction of pupil?

cholinomimetic agent which activates muscarinic receptors aka pilocarpine physostigmine will not work on de-innervated eye

cells responsible for achondroplasia

chondrocytes (long bone problem)

what hormone binds to INTRACELLULAR receptors to maintain blood sugar

cortisol

headache, sob, fatigue, myalgia, that works on dairy farm and also has increase AST, ALT, and lower lobe consolidation. What organism you thinking?

coxiella (Q fever)

Rapidly progressive glomerulonephritis characteristic biopsy feature

crescents (severe immunologic injury-immune complex deposition)

granuloma in bowels. what dx?

crohns disease

explain mechanism between crohns disease and gallstones

crohns disease causes irritation in terminal ileum causing gallstones not to be absorbed due to excretion of bile salts

what is one potential cause of fistula?

crohns disease due to transmural inflammation (can also lead to abscesses and strictures)

stem cells in small intestine

crypt celles

empty scrotal half, no testis upon palpation. Testes that have never descended. True undescended testes have a histologic change by 6 years. what is the diagnosis?

cryptorchidism

Leukocytoclastic vasculitis

cutaneous small vessel vasculitis that arises due to drug (penicllin, cephalosporin, sulf, phenytoin, and allopurinol) or pathogen exposure (Hep B or C) non-blanching palpable purpura (inflammed small blood vessels with fibinoid necrosis +neutrophils)

what cytokines involved in acture inflammation

cute inflammation + Vasodilation of vasculature and increased endothelial permeability. IL1, IL6, and TNFa are all involved in acute inflammation.

Extramedullary hematopoiesis caused by what condition?

cx by severe chronic hemolytic anemias (b thalassemia)

long arms, anterior protrusion of sternum with sagittal sinus thrombosis and INFERIOR/DOWNWARD dislocated lens in right eye. what is deficiency?

cystathionine beta synthase gene mutation homocystinuria

Medication given to asthmatic in order to help with sxs (target of action)

cysteinyl-containing leukotrienes (anti-leukotriens aka montelukast)

absent vas deferens

cystic fibrosis

CFTR channel is (???) gated

cystic fibrosis transmembrane conductance regulator ATP gated

what is a classic histological finding in aortic dissection?

cystic medial degeneration

Defect in the transporter for cystine, ornithine, lysine and arginine (COLA) is associated with what syndrome and what clinical findings?

cystinuria --> cystine kidney stones

what mitochondrial substance regulates cell apoptosis

cytochrome C

de novo synthesis of pyrimidines occurs where

cytosol

alveolar ventilation vs minute ventilation discrepancy due to what

dead space volume

Vitamin K deficiency causes

dec. activity of epoxide reductase (dec. vitamin K function) --> inc. PT, hemorrhagic diathesis IMPAIRED GAMMA CARBOXYLATION

is colon retroperitoneal or intraperitoneal

decending and ascending are retro

Secondary mitral regurgitation is due to what

decompensated heart failure leading to holosystolic murmur that can improved with improvement of heart failure

Does ANP increase or decrease Blood pressure?

decrease

Does ANP increase or decrease in massive hemorrhage?

decrease

beta blockers (increase or decrease) renin secretion

decrease

does total body sodium content increase or decrease with SGLT2 inhibitors?

decrease

nitrates cause what changes to left ventricular diastolic pressure?

decrease

pituitary adenoma that secrete prolactin (increase/decrease) GnRH secretion.

decrease

Laboratory results are notable for glucose of 440, potassium of 5.8, pH of 7.14 and HCO3 of 17. After administrating IV fluids and insulin, which of the following would you expect?

decrease in serum K+ diabetic ketoacidosis: hyperkalemia acidosis results in ICF/ECF exchange of H+ for K+ depletion of total body potassium due to cellular shift and losses through urine

is forced vital capacity increased, or normal in obstructive lung disease?

decreased (FEV1 and FVC both decrease but overall more decrease in FEV1)

changes due to anabolic steroid abuse (FSH, LH, estrdiol, spermatogensis)

decreased FSH, LH, spermatogenesis increased estradiol

Heterozygous medium chain fatty acid dehydrogenase deficiency will show what symptoms and what activity of MCAD

decreased activity of MCAD but remain phenotypically normal due to wild type

oral contraceptives in polycystic ovary syndrome

decreased androgen production by suppressing LH secretion

chest pain that is persistent and prolonged that is worse with movement or changes in position that often follows repetitive activity. what is the dx?

chostocondritis

pheochromocytoma derived from (???) cells

chromaffin cells --> neural crest

carcinoid tumor of gut stain positive for what

chromogranin

Fluoroquinolones resistance

chromosome-encoded mutation in DNA gyrase plasmid-mediated resistance efflux pumps Unwinding braid: inhibit bacterial DNA gyrase (Topoisomerase)

CYP450 inducers

chronic alcoholic Mona Steals Phen-Phen and Never Refuses Greasy Carbs chronic alcoholism modafinil St. John's Wort phenytoin phenobarbital nevirapine rifampin griseofulvin carbamazepine

thyroid with mononucular infiltrate consisting of lymphocytes and plasma cells with germinal centers is a sign for what?

chronic autoimmune (hashimoto) throiditis

Fibromyalgia

chronic condition with widespread aching and pain in the muscles and fibrous soft tissue with no clinical findings

common complications of varicose veins

chronic edema, statsis dermatitis, skin ulcerations, poor wound healing, and infection

causes of black gallstones

chronic hemolysis increased enterohepatic cycling of bilirubin (Crohn's disease)

primary ciliary dyskinesia symptoms

chronic sinusitis (abnormal airway enlargement) situs inversus infertility (kartagener syndrome)

AAA leads to

chronic transmural inflammation and extracellular matrix degradation within walls

hemosiderin deposits are a sign of what?

chronic venous insufficiency

what is the most important respiratory component that is responsible for removing irritants in terminal bronchioles

ciliated cells

pathophysiology of febrile seizure?

circulating cytokines hyperthermia-induced diffuse neuronal dysfunction

What chemotherapy drug causes hearing loss

cisplatin

(???) normally binds to ionized calcium in urine preventing the formation of insoluble calcium-oxalate complexes

citrate

antiarrhythmic that causes increase in QT but normal QRS?

class III antiarrhythmic drug -dofetilide

concentric left ventricular hypertrophy causes what changes to LV compliance, ang-II signalling, and myosin heavy chain expression?

decreased compliance increase ang-II signaling increased cardiac myosin heavy chain expression

what is a reason why fluoroquinolone would not work in sensitive organism?

decreased drug bioavailability (chelation drug interaction with calcium, iron, aluminum, magnesium)

hemodynamic changes of NO?

decreased in left ventricular end-diastolic volume

QT prolongation

decreased outward K+ current during repolarization phase of the cardiac action potentials results in QT prolongation, which can increase risk of Torsades and sudden death.

A shift from depolarization of +40 to +10 would be explained by what ion decreasing concentration (inside/outside) the cell

decreased sodium concentration outside the cell

Aspirin and Platelet Aggregation

decreases adherence of platelets inhibits platelet aggregation and produces a mild bleeding defect by inhibiting cyclooxygenase, a platelet enzyme that is required for TXA2 synthesis

weakness in legs with decreased muscle bulk and reflex diminished with normal pain/temp/position. Shows sign of lower motor neuron lesion. what is once potential cause of these symptoms?

degeneration of motoneuron of the lumbar cord

friedreich ataxia will show what neuropathological findings?

degeneration of spinocerebellar tract

under hypoxic conditions intracellular accumulation of NADH inhibits pyruvate (???)

dehydrogenase. resulting in increase pyruvate that is shunted to lactate by lactate dehydrogenase

what cell is primarily involved in pathogenesis of psoriasis

dendritic cells

secondary prevention

detecting disease process before it causes symptoms ex. individual case finding (cervical cancer), community screening (blood pressure drive)

urge incontinence is due to (???) causing sudden and frequent urge to urinate and empty the bladder.

detrusor overactivity (contraction)

patient with difficulty swallowing dyspnea and leg and arm weakness. exam showed atrophy of right lower and left upper extremities. what would chest exam show?

diaphragmatic atrophy

Clostridium perfringens symptoms (besides gas gangrene-crepitus and swelling to leg)

diarrhea, severe abdominal pain

Water deprivation test with desmopressin (explain graph findings before and after desmopressin)

differentiate between psychogenic polydipsia and DI

S1 lesion

difficult or impossible to walk on tiptoes

Congenital Toxoplasmosis : The triad of

diffuse intracranial calcifications Chorioretinitis hydrocephalus ( may or may not have Blueberry muffin rash) Infection in mother - either from cat faeces or undercooked meat (more common)

Orbital Hypertelorism, submucous cleft palate, and bifid uvula. what is dx

digeorge (velocardiofacial syndrome)

what drug is associated with disturbed color perception (color vision alterations)

digoxin

Phenylketonuria: hyperphenylalaninemia and elevated prolactin what enzyme is deficient?

dihydrobiopterin reductase

if someone is lacking ability to traffic vesicles into golgi complex what structure will be dilated?

dilated rough endoplasmic reticulum

giving ACE Inhibitors will cause renal failure in patients due to what mechanism

dilation of efferent arteriole increased creatinine

tyrosine kinase

dimerizes of 2 identical receptor subgroups causing conformational change

Apixaban mechanism

direct factor Xa inhibitor --> conversion of prothrombin to thrombin will not affect x to xa conversion -->

Pseudoallergic drug reactions

directly stimulating mast cell degranulation and nonimmunologic non-igE mediated effect opioids

loonies love lunate

dislocated wrist think lunate

Integrase Inhibitors MOA

disrupts the ability of double stranded HIV DNA to integrate into host cell's chromosomes. in the absense of integration the viral genome cannot be transcribed and prevent syntehsis of viral mRNA

joint pain with scattered painless vesiculopustular lesions on upper extremities associated with that type of infection

disseminated gonococcal infection

what medication can lead to increased BUN/creatinine ratio?

diuretic therapy --> prerenal azotemia due to hypovolemic status

bradyarrhythmia and atrioventricular block can be caused by what medication? a. amlodipine b. donepezil c. diphenhydramine

donepezil ---> parasympathetic over activation

nausea associated with migraines

dopamine antagonist

Hepatitis B Replication Cycle

double stranded DNA +RNA template partially double-stranded DNA progeny

drug induced immune mediated hemolytic anemia

drug coats erythrocytes --> IgG binding --> splenic destruction of RBC ---> immune complex triggered --> complement destruction of RBC seen in ceftriaxone

fluctuating mobility seen in parkinson patients is due to what problem with drugs?

drug response unpredictable (on-off phenomenon due to nigrostriatal neurodegeneration)

severe infection after starting antithyroid drugs. what is cause?

drug-induced agranulocytosis ---> discontinue drug

sixth aortic arch adult derivative

ductus arteriosus (proximal pulmonary arteries)

vertical gaze palsy

due to damage to dorsal midbrain (pineal gland) (Ex: parinaud's) because the riMLF which controls vertical eye movements travels to the pretectal area near the CN III nucleus and cross over to the contralateral side via the posterior commissure

Intraventricular hemorrhage of premature infant

due to fragility of germinal matrix

depletion of somatostatin producing antral cells in gastric antrum leads to what ulcer (duodenal or gastric)

duodenal h. pylori directly increase H+ secretion in upper part that leads to decreased somatostatin in antral cells and duodenal ulcer distal

what should be biopsied in celiac disease

duodenal biopsy

difference between alive attenuated polio virus and killed virus?

duodenal luminal IgA

GI tract where ulcers pose smallest risk of development of cancer?

duodenum

where is celiac disease mostly at?

duodenum

Zenker diverticulum presentation

dysphagia, obstruction, halitosis cricopharyngeal motor dysfunction (diminished relaxation of cricopharyngeus muscles during swallowing causing herniation overtime forming zenker diverticulum)

what other medication is in the same class as nevirapine

efavirenz

Pelvic nerve in bladder

elvic parasympathetic nerves, which arise at the sacral level of the spinal cord, excite the bladder, and relax the urethra; lumbar sympathetic nerves, which inhibit the bladder body and excite the bladder base and urethra; and pudendal nerves.

Partial mole

embyro present, 69XXY, rare transformation into choriocarcinoma 2 sperm 1 egg

Arboviruses are most common cause of ????

encephalitis outbreaks in united states

AFP elevated in what type of cancer

endodermal sinus tumor (glomeruloid type structure)

e. coli can cause septic shock via what factor?

endotoxin via LPS --> lipid A --> organ failure

pulmonary embolism leads to what changes to right ventricle

enlargement due to back up of blood

watery diarrhea that turns bloody after travel. what is the organism?

entamoeba histolytica key word: erythrophagocytosis (trophozoites with engulfed RBCs)

loose stools turned bloody after spending week in egypt. with fever. no bacteria on culture. +trophozoites. what is dx and produce what additional findings?

entamoeba histolytica ---> liver abscess Liver shape dig site and hole in right side of liver - Right lobe is most common involved site of amoebic liver abscess

ELISA

enzyme-linked immunosorbent assay, 1. virus antigen attached to well 2. patient serum added and own antibodies added 3. serum washed and secondary antibody fluid added 4. anti-human immunoglobin antibody with enzyme added 5. washed and detecting fluid added 6. color changing substrate added

sex hormones promote closure of what plate?

epiphyseal plate closure

decreased hemoglobin with decreased reticulocytes?

erythrocyte enzyme deficiency glucose-6-phosphate dehydrogenase deficiency

how to test for giant cell arteritis

erythrocyte sedimentation rate and c reactive protein

what cell does not produce ATP due to lack of mitochondria

erythrocytes

what tissue cannot utilize ketone bodies?

erythrocytes

spider angioma due to increase what hormone

estrogen

Foam stability index

evaluates surfactant functionality by shaking ethanol and amniotic fluid. high value contains a ring of stable foam

syncopal episode with skin appearing darkly tanned. hyperglycemic. abnormal diastolic relaxation of left ventricle. what is underlying cause?

excessive accumulation of iron in tissue hereditary hemochromatosis

decreased TSH, elevated free thyroxine (T4), and undetectable thyroglobulin levels. are a sign of what?

exogenous thyroid supplementation (thyroglobulin) --> diffuse atrophy

Is staphylococcal scalded skin syndrome caused by exotoxin-mediated skin damage or endotoxin-mediated inflammatory response?

exotoxin-mediated skin damage

spinal cord tumors cause

extension of neoplastic cells into epidural space --> vertebral metasis

if you have increased direct bilirubin what is the problem

extrahepatic obstruction of bile ducts

in SLE is autoimmune hemolytic anemia extravascular or intravascular?

extravascular --->IgG autoantibodies bind erythrocytes and identified on splenic macrophages --> extravascular hemolysis

increased sensitivity to sound is caused by what nerve?

facial nerve (VII) palsy

component of clinical syndrome of gram-positive cocci in chains causing impetigo?

facial puffiness and dark urine (post strep glomerulonephritis)

T-cell deficiency (low CD3+ but normal CD20+) most associated with?

failed pharyngeal pouch developement --> di-george syndrome

Eruptive xanthomas

familial chylomicronemia (lipoprotein lipase)

Fas ligand mutation

fas ligand: molecule expressed on cytotoxic T cells and NK cells that binds to the fas molecule on a target cell and induces it do undergo apoptosis mutation: no T cell apoptosis in negative selection in thymic medulla = incr circulation of self-reacting lymphocyte = autoimmune lymphoproliferative syndrome

Saponification

fat binding with calcium

SOB, confusion following motorcycle accident with multiple fractures. lungs are clear. and rash is present on chest. what is causing sxs?

fat microglobules in pulmonary arterioles fat embolism syndrome

how to test for pancreatic digestiv enzymes in stool

fecal elastase

typhoid fever clinical manifestions

fecal oral route

autopsy of child showing pleural effusion with secondary pulmonary hypoplasia and ascites represents

fetal hydrops (common in parvoB19)

what drug activated PPAR alpha (lipid related)

fibrates

fibroadenoma vs fibrocystic change

fibroadenoma-hard solid mass with clear border that is mobile fibrocystic changes-solitary mobile cyst or muscle that is tender and related to menstrual cycle

how to treat methotrexate toxicity

folinic acid (leucovorin)

thyroid cancer associated with ras mutation

follicular

what is a potential complication to taking too much thyroxine?

follicular atrophy

IgA nephropathy

following upper respiratory infection with mesangial immune deposit

L5 lesion

foot drop and difficulty with toe extention and difficulty with heel walk

Metyrapone stimulation test

for adrenal insufficiency diagnosis metyrapone blocks last step of cortisol synthesis (11-deoxycortisol-->cortisol) normal: dec cortisol, compensatory inc ACTH +: ACTH remains dec after test

2 medications given after TIA stroke?

for prevention of secondary stroke: -antiplatelet agent (aspirin, clopidogrel) -statin -lifestyle modification

The CSF exits the 4th ventricle through which opening?

foramina of luschka or midline foramen of Magendie

is pancreas a foregut, midgut, or hindgut derivative

foregut

granuloma after laceration injury is due to what

foreign body

Bowen disease (Bowen precancerous dermatosis)

form of intraepidermal carcinoma (squamous cell) characterized by red-brown scaly or crusted lesions that resemble a patch of psoriasis or dermatitis

pyrimidine dimers

form when DNA is exposed to UV light

what is the underlying mechanism of damage due to Iron or Copper overload?

free radical

Bronchopulmonary dysplasia (BPD) is a form of chronic lung disease that affects newborns (mostly premature) and infants. it is due to what mechanism

free radicals by giving oxygen metaplasia to dysplasia

schistosomiasis contact via what organism

freshwater snails

most likely organism if sputum shows gram neg and gram pos organism with cavitation

from normal oral flora (look for poor dental hygeine)

what is an inhibitor of fructose 1,6 bisphosphatase

fructose-2,6-bisphosphate

mechanism of treatment for CMV retinitis

ganciclovir by inhibiting DNA chain elongation

weight loss, poor appetite, pale conjunctivae and shiny tongue with hyperpimented plaques on skin in axillae and neck with microcytic anemia?

gastric adenocarcinoma acanthosis nigrican --> insulin resistance or malignancy of GI tract

gastrin-secreting tumors

gastrin-secreting tumor (zollinger-ellison sydrome)

The candida skin test used to assess what function?

gauges the activity of the cell-mediated immune response (T-lymphocytes) from macrophages, CD4+, CD8+ and NK cells.

chronic alcoholic pancreatitis, alcohol induced secretion of protein rich fluid precipitates in pancreatic duct--> forms ductal plugs that calcify and cause diarrhea this is a sign of what?

generalized malabsorption

Li-Fraumeni syndrome mechanism

germline mutation of one p53 gene. ---> impaired apoptosis

Li-Fraumeni syndrome

germline mutation of one p53 gene. AD. that leads to waiting for the second hit hypothesis to happen. "inactivation mutation affecting 1 allele"

what substance from GI is increased in prader willi

ghrelin

what substance causes a difference in glucose levels due to oral vs. IV?

glucagon-like peptide-1

what is sucrose

glucose + fructose

Diabetic cataract formation (name 3 steps and enzymes)

glucose --> sorbitol ---> fructose (sorbet is made from fruit) aldose reductase sorbitol dehydrogenase

standard tissue fixation dissolves

glycogen and lipids

muscle weakness after exercising. What glycogen deficiency should you immediately think?

glycogen phosphorylase scissors on table-inability to cut down glycogen

Diabetic nephropathy

glycosylationo of endothelial proteins and inflammation leading to increased production of growth factors, collagen, fibronectin this leads to mesangial expansion, basement thickening and glomerular sclerosis. With first clinical sign being albuminuria

what is the only glycosylated HIV polyprotein? and its function

gp160 --> env gene --> immune evasion, host cell binding, proper protein folding

graft versus host disease (look for skin involvement) is associated with what cell type?

graft (T cells) are attacking the recipient (cells).

depletion of donor CD3+ T cells it performed to reduce what risk during donor transplant?

graft vs. host disease

psoas lesion will have refered pain to what region

groin pain

what hormone can cause paraneoplastic hyperthyroidism

hCG (choriocarcinoma and germ cell tumors)

skin lesion on sun-exposed areas and cerebellar ataxia +increased amino acids in urine. what deficiency is this caused by?

hartnup disease (niacin deficiency) -can't absorb tryptophan due to defect transporter -tryptophan is supposed to make niacin (which it cant) -amino acid in urine because it cant be absorbed in GI or kidneys

Pediculus humanus capitis

head lice

adverse effects of nitrate therapy?

headache, flushing, hypotension, reflex tachycardia

Probenecid MOA when used with penicillin?

helps inhibit renal tubular secretion fo penicillin while also increased uric acid excretion

loss of function mutation affecting telomerase reverse transcriptase gene will affect

hematopoietic stem cell

cell adhesion to basement membranes is caused by what?

hemidesmosomes

strange tan , knee pain, fatigue, mild hepatomegaly and atrophic testes with BSG of 252. No ketones or protein in urine?

hemochromatosis causing high dermal hemosiderin deposition with HFE mutation. AR disease.

Why does hepatitis D need hepatitis B to infect cells

hep B provides coating for hepatitis D to penetrate hepatocytes

altered mental status following GI bleed. with abdominal distention and gynecomastia. There is a flickering motion of the hands. what is the cause?

hepatic encephalopathy--> increased nitrogen delivery to gut which is converted to ammonia and absorbed --> increased ammonia increases inhibitory neurotransmission and impairs excitatory neurotransmitter release. must give lactulose (traps ammonia in gut)

decreased free fatty acid oxidation is charactistic of what disease?

hepatic steatosis (fatty liver) excess NADH dont need to break down fat

enveloped virus with partially double-stranded circular DNA

hepatitis B

Hemochromatosis is associated with what cancer?

hepatocellular carinoma

What cells do hepatitis B act on?

hepatocytes

retinitis pigmentosa

hereditary, progressive disease marked by night blindness with atrophy and retinal pigment changes

what enzyme allows fructose to be metabolized in fructokinase deficiency?

hexokinase

complication of high-altitude illness

high altitude pulmonary edema

causes of hypoxia with normal A-a gradient

high altitude--> reduced PiO2 CNS depression morbid obesity --> hypoventilation

HIV history with current petechiae skin rash. what is the organism involved

human herpes virus type 8 kaposi sarcoma

AIDS dementia is associated with what type of hydrocephalus?

hydrocephalus ex-vacuo

What symptoms of graves disease be treated with beta blockers?

hypertension, palpitations, tachycardia, sweating, heat intolerance, tremor, and hyperreflexia

uniformly thickened left ventricle (not just localized to septum)

hypertensive heart disease

tapping of the facial nerve leads to contraction of facial muscles hyper or hypocalcemia?

hypocalcemia

during recovery stage of acute tubular necrosis what is a complication?

hypokalemia, hypomag, hypophosphorous, hypocalcemia (high volume of diuresis due to increased urine output)

increased ADH leads to (hyper/hypo) natremia

hyponatremia leads to hyponatremia primarily by increased volume and subsequent inhibition of the RAAS (renin-angiotensin-aldosterone system) which causes loss of sodium.

extracellular osmoles> intracellular so it will pull the h20 out.... then the high osmotic pull of the sugar overwhelming the SGL2 transporter in the kidney will pull the h20 out of the body dehydrating the extracellular compartment

hyponatremia dilutional hyponatremiaglucose acts as an osmotic agent and draws water from ICF to ECF

high altitude (acid-base distrubance) -pH, renal H+ secretion, renal HCO3 reabsorption

hypoxemia --> hyperventilation--> excessive exiration of CO2 --> respiratory alkalosis ---> increase blood pH --> kidnesy decrease HCO3 reabsorption and H+ secretion to compensate

Minimal change disease triggered by?

idiopathic NSAIDS (drugs) malignancy t-cell dysfunction results in production of glomerular permeability factor which damages podocytes and decreases anionic charge of basement membrane allowing for selective loss of albumin

Cyclosporine causes gout by what mechanism

impaired renal excretion of uric acid

Diabetic autonomic neuropathy effect on the bladder.

inability to sense full bladder and incomplete emptying

mutation in pol gene of HIV caused by

inconsistent use of antiretroviral therapy

IV normal saline will (???) hydrostatic pressure in vasculature.

increase

nitrates cause what changes to peripheral venous capacitance?

increase

Fibrates MOA

increase LPL activity, decrease VLDL production via PPAR-y --> increase TG clearance so can cause CHOLESTEROL STONES!

GNAS1-inactivating mutation Gs of parathyroid --> labs

increase pth decrease Ca

lab findings (-increase/decrease-parathyroid hormone, calcium, phosphorus, 25-vita D, 1,25-vita D) in chronic renal failure

increase pth decrease calcium increase phosphorus (kidney cant excrete phosphorus) normal 25-vita d decrease 1,25-vita d

cardiogenic shock: central venous pressure, pulmonary capillary wedge pressure, coronary perfusion pressure?

increase pulmonary cap wedge pressure increased central venous pressure decreased coronary perfusion pressure LV not moving ---> ↑pulmonary pressure --> back up in right side of heart --> ↑central veous pressure LV not working ---> aorta not getting any blood ---> decreased cardiac output --->hypotension ---> decreased coronary perfusion pressure

cigarrette changes on mucus secretion, airway cilia, and macrophages (up or down)

increase secretions decrease cilia decrease macrophages decreased activity of airway cilia as there is soot overlying them and cant function properly tobacco has silica Cigarette smoke impairs both the phagocytic and respiratory burst function of neutrophils! Macrophages-->activated by cigarette smoke extract to release inflammatory mediators COPD--> alveolar macrophages and neutrophils are defective in their antimicrobial functions.

furosemide increases/decreases (serum bicarb, serum chloride, urine sodium, urine potassium)

increase serum bicarb decrease serum chloride increase urine sodium increase urine potassium

renal artery stenosis results in hyperplasia of what cell type due to hypoperfusion

increase smooth muscle cells from juxtaglomerular in afferent glomerular arterioles

Is residual volume decreased, increased, or normal in obstructive lung disease?

increased

total T4 (or T3) = free + TBG-bound pregnancy → TBG increase → TBG-bound T4 increase → free decrease → less negative feedback → more TSH → restore free T4 levels

increased T4 with normal TSH increased levels of TBG lead to lowered free T4 concentrations, which results in elevated TSH secretion by the pituitary and, consequently, enhanced production and secretion of thyroid hormones. The net effect of elevated TBG synthesis is to force a new equilibrium between free and bound thyroid hormones and thus a significant increase in total T4 and T3 levels. The increased demand for thyroid hormones is reached by about 20 weeks of gestation and persists until term.

during maintenance stage (1-3 weeks) of acute tubular necrosis what is a complication?

increased creatinine/BUN, increased potassium, metabolic acidosis

Hyperthyroidism increased sympathetic nervous system through

increased expression of B receptors

DIC (fibrinolysis, thrmobin production, plasmin generation)

increased fibrinolysis increased thrombin production increase plasmin generation

DKA causes what electrolyte abnormailities (glucose/potassium/sodium)

increased glucose decreased sodium decreased potassium due to osmotic diuresis and GI loss

excess vitamin D supplementation leads to what changes in body?

increased intestinal absorption of calcium and phosphorus low level-bone mineralization high level vita D- bone resorption

Mallory-Weiss syndrome due to

increased intraabdominal gastric pressure due to vomiting or other abd straining

what is the compensatory response for heart failure decreasing amount of edema?

increased lymphatic drainage

Pulmonary embolism changes in pH, PaCO2, PaO2?

increased pH decreased PaO2 decreased PaCO2

Corticosteroids are used in asthmatics to help decrease inflammatory effect but also cause what effect which is beneficial

increased responsiveness of beta-2 receptors

symptoms of hemolytic anemia

increased reticulocytes spherocytes nucleated erythrocytes

study's power increases with (???) size.

increased sample size

hyperparathyroidism causes (increase/decrease) in urinary cAMP?

increases through adenyl cyclase

Sodium Bicarbonate mechanism of action for treatment of salicylic acid overdose

increasing excretion of drug in the urine

how do you prevent working on the wrong arm?

independent verification

variable expressivity

individuals with the same genotype have related phenotypes that vary in intensity Example: Marfans

prostatectomy causes what nerve damage?

inferior hypogastric plexus (erectile dysfunction)

what artery does horse shoe kidney get stuck on

inferior mesenteric artery

veins of external hemorrhoids

inferior rectal vein --> internal pudendal vein --> internal iliac vein --> common iliac vein ---> IVC

ST elevation in leads II, III, aVF. Occlusion of what coronary artery

inferior wall MI --> right coronary artery

looks like acute mastitis but antibiotics did no help. what is the diagnosis

inflammatory carcinoma

external rotation of arm (SItS muscle?)

infraspinatus (C) teres minor (D)

Ovarian Torsion ovary twist around what ligament (also causing infarction)

infundibulopelvic ligament (suspensory ligament of the ovary)

what lymph nodes drain lower portion of vagina

inguinal lymph nodes

osteogenesis imperfecta

inherited condition when bone formation is incomplete, leading to fragile, easily broken bones due to improperly synthesized type 1 collagen

Indomethacin MOA

inhibit COX. dddduuuuuhhh

Probenecid MOA

inhibits reabsorption of uric acid in proximal tubule Preventing punk from grabbing yarn: probenecid decreases renal tubular reabsorption of uric acid 32. Accumulating yarn and needles: probenecid may increase the risk of forming renal stones due to increased uric acid excretion. 33. "Drugs" tattoo: probenecid can inhibit the excretion of many drugs 34. Cid's purple pencil: probenecid prevents excretion of penicillin 35. Uricosyurics are only for under excretors and only for chronic gout. 36. Rotten sulfas eggs: probenecid is a sulfa drug

Major hormones that shift K+ intracellularly are (???) & (???) agonists

insulin & beta-2-adrenergic agonists

F-2,6-BPase PFK-2 (insulin increases which activity/glycogen increases)

insulin increases fructose-2,6-bisphosphate promoting PFK-1 and formation of fructose-1,6-bisphosphate

elevated free fatty acids lead to what disease

insulin resistance by impairing insulin dependent glucose uptake and increasing hepatic gluconeogenesis ---> type 2 diabetes mellitus

hypoglycemia in DM patient can be triggered by?

intense physical exercise/physical acitivity

Reactive arthritis

classically presents in a triad of nongonococcal urethritis, conjunctivitis, and arthritis. It is an HLA-B27 associated arthropathy that occurs within several weeks following a geniturinary or enteric infection. It is one of the seronegative arthropathies and can cause sacroiliitis in 20% of patients. Often also forms a rash on the palms and soles called keratoerma blennorhagicum.

bacterial vaginosis treatment (other than metronidazole)

clindamycin

CD18 deficiency

clinical: immunodeficiency: LADI (leukocyte adhesion deficiency), margination (leukocyte unable to travel to site of infect) => necrotic infects, Tx = BMT, gene therapy

what happens to vocal cords while swallowing, laryngeal irritation and while coughing (open or closed)?

closed to swallow closed to irritation open while coughing

Tinea pedis treatment

clotrimazole (topical antifungal) or terbinafine (allylamine).

sigmoid colon lymph drainage

colic --> inferior mesenteric anal canal has different lymphatic drainage that is worth noting (FA2020 p366) - above the pectinate line and lower rectum drains to the internal iliac lymph nodes and below the pectinate line drains to the superficial inguinal lymph nodes.

what extracellular matrix component increases tensile strength of incision?

collagen

low specific gravity following fluid restriction test + bipolar. shows impairment of nephron at what level?

collecting duct (lithium induced nephrogenic diabetes insipidus)

What drug resistance is due to reduced cell wall permeability to abx?

common but can be countered by drugs that impair cell wall synthesis aka beta-lactams

TB dissemination can occur through (complement production or interferon signaling)

interferon signaling complement is neisseria

where would you ligate if there was bleeding after vaginal deliverly but wanted to preserve fertility?

internal iliac

Internal ribosome entry

internal ribosome entry site attract eukaryotic ribosomes to mRNA and allow translation to begin in the middle of the mRNA sequence. usually located in the 5' untranslated region.

what connect lateral ventricle to 3rd ventricle?

interventricular foramina of monroe

what is a way to treat hepatitis encephalopathy

intestinal content acidifcication

Left Supraclavicular Node (Virchow node)....common site of metastasis for?

intraabdominal malignancy

cavernous hemangiomas involve subarachnoid hemorrhage or intracerebral hemorrhage

intracerebral hemorrhage

compensatory increase in (????) helps decrease degree of aortic regurg symptoms

compensatory increase in stroke volume

ethanol works as a (???) inhibitor

competitive

The most common cause of bloody nipple discharge.

intraductal papilloma (may have normal imaging b/c so small in size)

Is the spleen retroperitoneal or intraperitoneal?

intraperitoneal

double stranded breaks in DNA

irradiation with x-rays

Mitochondrial vacuolization is a sign of

irreversible injury

shrunken nuclei in brain and eosinophilic cytoplasm lacking nissl bodies is a sign of what?

irreversible ischemic injury

Fabry disease

is an inherited deficiency of alpha-glactosidase A that causes accumulation of the globoside ceramide trihexoside in tissues. The earliest manifestations are skin rash, pain in lower extremities .Without enzyme replacement, patients typically develop progressive renal failure.

external branch of superior laryngeal nerve

is at risk for injury during thyroidectomy due to its proximity to the superior thyroid artery and vein. This nerve innervates the cricothyroid muscle, which tenses the vocal cords (loss may lead to hoarsness)

Effect modification

is present when the effect of the mian exposure on the outcome is modified by the presence of another variable. Effect modification is not a bias but is confused with confounding often.

a confidence interval that includes the null value of 1 in terms of relative risk means it (is/not) statistically significant

it is not statistically significant

Osteoarthropathy is any disease involving what?

joints and bones (alkaptonuria)

Where is renin released from?

juxtaglomerular cells

Psoriasis pathophysiology

keratin hyperplasia due to T-cell activation and cytokine release tx: topical corticosteroid and vitamin D analog (inhibit T cell and keratinocyte proliferation)

where is another place gluconeogenesis happens?

kidney

what organ increases hematocrit?

kidney (EPO)

cholesterol rich microemboli going in the circulation would end up where?

kidney ---> acute kidney injury

Eosinophil function

kill parasitic worms (helminths infection); complex role in allergy and asthma

heosiderosis is associated with what type of granule formation

kupffer cells with heomsiderin

Alport syndrome characteristic biopsy feature

lamellated appearance of GBM

cancer adheres to membrane via what expression

laminin

testicular cancer in >60 year old male. think?

large B-cell lymphoma

molluscom contagiosum

large eosinophilic cytoplsmic inclusion

Pathogenesis of crescent formation in rapidly progressive glomerulonephritis

large qualities of fibrin deposit leading to disrupting glomerular function

Hydrocephalus ex vacuo

large spaces develop inside cortex due to loss of cortical tissue - 'cortical atrophy'; seen in dementia; NOT really hydrocephalus

homogenization of dermal collagen bundles are a sign of what

late-stage dermatitis (due to TGF-b)

what muscle internally rotates the arm and is innervated by thoracodorsal nerve?

latissumus dorsi

Basophilic stippling (what does it look like and indicative of what poisioning)

lead poisoning

LDL receptor deficiency

lead to subcutaneous nodules, tendon xanthomas

Senile amyloidosis in heart

leads to restrictive cardiomyopathy myocardium infiltrated by amorphous and acellular pink material

Leads I, aVL, V5, and V6 view the _____ surface of the left ventricle.

left

extrinsic compression of mid-esophagus

left atrium

ST elvation in leads I and aVL will show occlusion to what artery of the heart?

left circumflex artery

LAD (left anterior descending) comes off (???artery) - LAD is blocked in anterior infarctions

left coronary

Right sided weakness, slurred speech with HTN crisis. hemorrhaging seen on CT. what artery is affected?

lenticulostriate arteries

developmental delay with involuntary movement and tendency to aggressively bite lips and fingers. elevated uric acid level. what disease?

lesch-nyhan syndrome

is hepatoduodenal ligament part of the greater or lesser omentum

lesser omentum

basophilic oval inclusions in mature neutrophils is a sign of what?

leukemoid reaction caused by infection

anti-GBM disease characteristic biopsy feature

linear staining IgG

where does malaria hide?

liver

breast cancer that lacks e-cadherin

lobular carcinoma in situ

ewing sarcoma normally found in what part of bone

long bone diaphysis

osteomyelitis is found it what part of the bone

long bone metaphysis

hypnozoites

long-surviving modified liver schizonts of P. vivax and P. ovale that are the source of relapsing infections in these species

loss of (???) leads to stem cell loss of endometrium that occurs in D/C leads to scarring

loss of basalis

lytic lesion of distal femoral metaphysis that is diagnosted as osteosarcoma and has past history or retinoblastoma. What is mechanism of cause of contition?

loss of heterozygosity

cause of achalasia (organism)

loss of inhibitory neurons in the myenteric (Auerbach) plexus trypanosoma cruzi or idiopathic

idiopathic pulmonary fibrosis involves loss of what structure and hyperplasia of what

loss of type I pneumocytes with hyperplasia of type II that do no differentiate into type I

anemia of chronic disease (circulating iron levels, bone marrow iron)

low circulating iron high bone marrow iron hepcidin

Sickling of red blood cells can be produced in those with sickle-cell anemia by ________.

low oxygen levels -->oxygen unloading incrased acidity low blood volume

acid-base disturbance associated with diarrhea (pH, PaCO2, Serum bicarbonate)

low pH low bicarb low PaCO2 substantial bicarb lost through stool

abdominal discomfort + watery diarrhea followed by dry cough headache fever (104) and bilateral lower lobe interstitial infiltrates. what is the additional finding in patient (increased eosinophil, low serum sodium, or cold agglutinins)

low serum sodium (legionella)

Dopamine receptor binding (Low/high dose)

low-dose: D1>B1>a1 high dose: A1>B1>D1

Lymph node spread in adenocarcinoma of esophagus

lower 1/3-celiac and gastric nodes

Where is the Bartholin gland located?

lower vestibule adjacent to vaginal canal

what structure is not involved in polyarteritis nodosa?

lungs

an inflammatory response, histamine increases vascular permeability, and blood will move from the capillaries into the interstitial space. To maintain fluid balance and prevent edema, the (???) system will respond with increased (???) flow back into blood vessels to offset the increased fluid flow into the interstitial space.

lymphatic

breast tissue with indurated skin with a dimpled texture and several enlarged hard lymph nodes. what is the cause

lymphatic obstruction

inherited (???) storage disorder (autosomal recessive); defect in N-acetylglucosaminyl-1-phosphotransferase leading to excretion of acid hydrolases into medium.

lysosomal

lung abscess key contributor to lesion?

lysosomal content release by neutrophil

liquefactive necrosis mechanism involves release of what enzymes

lysosomal enzymes

POMPE DISEASE IS CAUSED BY A DEFICIENCY IN ACID A-GLUCOSIDASE IN WHAT STRUCURE?

lysosomes

triggered statin rhabdomyolysis (what chemotherapy agent, antibiotic, heart medication)

macrolide-clarithromycin cyclosporine non-dihydropyridine calcium channel blocker

fatty streaks associated with atherosclerosis involve what cells?

macrophages

histoplasma involves what cell type

macrophages

in anemia of chronic disease iron is sequestred where?

macrophages (increased hepcidin)

elastase derived from what cells

macrophages and neutrophils

alpha 1 antitrypsin is release by what cells

macrophages and neutrophils (can degrade eachother but not their own)

chloride shift in RBC between O2 and CO2 is due to what enzyme

maintains the ionic balance between the red blood cells and the plasma. carbonic anhydrase

MRI of knee

make sure you know if its the posterior or anterior view

Does phototherapy conjugate bilirubin or does it make UCB water soluble?

makes UCB water soluble

liver neoplasm with multiple tumors and no underlying hepatic disease is primary or a malignancy? mechanism?

malignancy through portal cenous system

Glucagonoma

malignant alpha-islet cell tumor -> hyperglycemia and rash Necrolytic migratory erythema

Pleomorphic adenoma

mc *parotid gland tumor* - Usually parotid benign but recurs-*painless and mobile*- cartilage and epithelium reoccurs often due to irregular border if facial nerve damage ---> more likely going to be carcinoma

heterotopic gastric mucosa

meckel diverticulum (painless lower GI bleeding) mucosa can ulcerate and cause brisk but painless lower GI bleeding

anterior cerebral arteries that arise from circle of willis provide blood to what structures?

medial hemispheres ---> occlusion leads to contralateral motor and sensory loss of lower extremity, behavioral changes, and urinary incontinence

unable to look inward during side gazing (impaire adduction. with convergence preserved. where is the lesion?

medial longitudinal fasciculus: impaired adduction of ipsilateral eye convergence preserved

opposition of thumb-what nerve?

median nerve

Lunate fractures are associated with

median nerve injury (aka thumb abduction flexion and opposition)

what nephron segment responds to vasopressin by increasing absorption of a specific solute that is important for generation of high medullary concentration gradient?

medullary segment of the collecting duct

MEN 2B

medullary thyroid cancer, pheochromocytoma, Marfanoid neuromucco- gangliomas

fibroma with pleural effusion and ascites are called what

meig syndrome

nephrotic syndrome associated with SLE

membranous nephropathy IgG and C3 deposit in GBM

morphine toxicity due to what mechanism?

metabolized into active metabolites that accumulate... Morphine is primarily metabolized by the liver via glucuronidation to form 2 major metabolites. These metabolites, morphine-3-glucoronide and morphine-6-glucoronide, then undergo renal elimination via excretion in the urine.

MI is associated with plaque stability not size. inflammatory macrophages may reduce stability by secreting (????) which degrade extracellular matrix protein (collagen)

metalloproteinases

stage of meiosis immediately prior to fertilization?

metaphase of meiosis II

Rhombencephalon

metencephalon and myelencephalon pons, cerebellum, upper 4th ventricle, medulla and lower 4th ventricle

schistocytes suggest

microangiopathic heolytic anemia (HUS, TTP, DIC) or mechanical damage

what cells are responsible for uptake of shigella?

microfold (m) cells M cannon

peripheral sensory loss due to what chemotherapy agent?

microtubules for axonal transport

skull fracture at pterion (meeting spot of all the bones) would lacerate what artery from what artery prior?

middle meningeal artery that comes from maxillary artery

Maturing erythrocytes lose their ability to synthesize heme when they lose their

mitochondria

ragged red fibers associated with what disease

mitochondrial myopathies

mid to late diastolic murmur

mitral stenosis

a slight decrease in partial pressure of O2 leaving the alveolar capillary blood is due to what?

mixture of deoxygenated blood

Calcium disodium versenate mechanism of action? treats (abdominal pain, constipation, and altered mental status) in this disorder

mobilizes lead and is renally excreted lead toxicity

asymmetrical distribution-positively skewed

mode<median<mean

Atypical (Reactive) Lymphocytes

mono-EBV-releated to nasopharyngeal carcinoma

basiliximab, daclizumab

monoclonal antibody to IL-2 receptor

histology of cavernous hemangioma

most common benign liver tumor

post partum hemorrhage most common cause cause if lack response to uterotonic agents and removal of placenta

most common cause is uterine atony placenta accreta

Von Gierke's Disease

most common glycogen storage disease defect in glucose 6 phosphatase leads to periods of very low blood sugar between meals needs continuous feeding to maintain blood sugar levels glucose 6 phosphate builds up in the cell and cannot be broken down into glucose - so the liver enlarges and is damaged over time

seminoma

most common type of testicular tumor, composed of immature germ cells; highly treatable with early detection bHCG large cell with clear cytoplasm homogenous mass with no hemoragic or necrosis

cavernous sinus is associated with what organism

mucormycosis

polyneuropathy

multiple areas of nerve damage on the motor tracts and proprioception is a senory component, so instead of saying they feel burning, they cant tell where their limbs are in 3D space. If they said burning you wouldn't have to know all the other 4 possible answer choices to get to this one

CNS-targeted immunomodulators like ocrelizumab are used for treatment of what disease?

multiple sclerosis

optic neuritis (eye pain worsened with movement/ swelling/decreased vision)

multiple sclerosis (demyelinating plaques)

levator ani muscle

muscle composing the pelvic floor; supports pelvic viscera

Ischemic colitis causes what findings on colonoscopy?

muscosal hemorrhage and patchy necrosis this will lead to bowel wall thickening and edematous and transmural infarction develops

Biopsy in Hirschprung Disease

must include the submucosa of the narrow part, because usually submucosa and myenteric plexus are absent in this disease.

Streptomycin resistance

mutation in 30S ribosomal protein

Rifampin resistance

mutation in RNA polymerase

Erythema multiforme + low grade fever + headache + fatigue +cough +wheezing in 12 year old

mycoplasma pneumoniae

ATP causes what changes to sarcomere?

myosin head detachment from actin filament

weakness, inability to loosen grip after opening door knob, gait disturbances with cataract frontal baldness and gonadal atrophy is associated with what condition?

myotonic dystrophy ( inability to loosensi ones grip after handshake)

recurrent staph infection and chronic granulomatous disease is a sign of what enzyme deficiency? a. NADPH oxidase b. myeloperoxidase

nadph oxidase nitroblue tetrazolium + absent green pigment on dihydrorhodamine

myopia refers to:

nearsightedness --> age related changes just like wrinkles

3 week old with abdominal distension vomiting and blood streaked stools. Xray shows thin curvilinear area of lucency that parallel the bowel wall lumen. what is th dx?

necrotizing enterocolitis

Propionibacterium acnes

need anaerobic lipid-rich environment

The probability that a person with a negative test result is truly disease free refers to what value? "Doc what are the chances I truely dont have thyroid cancer?"

negative predictive value

diabetes insipidus ( serum osmolality, urine osmolality, serum ADH, serum sodium)

nephrogenic: high serum osmolality low urine osmolality high serum ADH High serum sodium

Focal segmental glomerulosclerosis

nephrotic but foci of sclerosis and hyalinosis

tingling in bilateral hands in first 3 fingers with no problems in legs is normally caused by what mechanism?

nerve compression within an anatomic compartment (carpal tunnel)

RET mutation leads to what seen on histology

nest of polygonal cells with congo red-positive deposits

degeneration of what CNS structure leads to rigid movement, shuffling gait, and resting tremor?

neuronal degeneration

oliguria, high serum creatinine and intranasal ulcer that has not healed. What cell type is most likely associatd with antibodies? what is this disease

neutrophils, granulomatous with polyangiitis (wegener) C-ANCA

cGMP

nitrates PDE inhibitors if used together can cause severe hypotension

myocardial autoregulation is accomplished by what two endogenous factors?

nitric oxide adenosine

can you use alpha-adrenergic agonist in angle-closure glaucoma?

no

is renal tubular acidosis an elevated anion gap?

no

do lesion on the medial foot drain to popliteal areas?

no only lateral lesion

does flumazenil have same effect on barbiturates as it does benzos?

no so it will still be active causing increase in Cl-conductance

do tamoxifen and raloxifene cause decrease bone mineral density?

no they cause increase in bone mineral density throuhg partial estrogen receoptor agonist

would you see PCP pneumonia in isolated B cells?

no! its T cell

is rupture of the chordae tendineae a risk factor for infectious endocarditis?

no, its a complication

Patiromer MOA

nonabsorbable cation exchange resin that binds colonic potassium in exchange for calcium sodium zirconium cyclosilicate

Sevelamer mechanism

nonabsorbable phosphate binder that prevent phosphate absorption from GI tract used for hyperphosphatemia

nondepolarizing block vs. depolarizing block examples?

nondepolarizing block (vecuronium) competitive inhibition of receptors leading to progressive reduction in each 4 response depolarizing blockers (succinylcholine) prevent repolarization and show equal reduction at all 4 twitch during phase I then lead to phase II due to desensitization and inactivation

decreased left ventricular cavity size and sigmoid-shaped ventricular septum. increased collagen in the wall. some myocardial cells also have brownish perinuclear cytoplasmic inclusions. What are the most consistent? a. dilated cardiomyopathy b. hypertrophic cardiomyopathy c. normal aging

normal aging lipofuscin pigment (indigestible byproduct of subcellular membrane lipid oxidation)

minimal change disease

normal glomeruli but diffuse effacement of podocyte under electron microscopy

most common risk factor for endometrial hyperplasia and postmenopausal bleeding

obesity ---> peripheral aromatization of androgens to estrogens in adipose tissue ---> unopposed estrogen exposure early menarch late menopause

obesity effects on lean and adipose mass

obesity causes disproportionate increase in adipose mass leading to distribution of the drug is limited to the extracellular fluid compartment

Synovial pannus formation

occur due to rheumatoid arthritis look for swan neck deformities synovial hperplasia and inflammatory infiltrates

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.

treatment for HIV diarrhea

octreotide

multiple sclerosis is a demyelinating disorder chararcterized by autoantibody attacks on what cell type?

oligodendrocytes

medication with increased risk of osteoporosis and hip fracture

omeprazole

meckel diverticulum histology

on right lots of glands under normal mucosa most common pathological lead point to intussucption

permissiveness-example

one hormone cannot exert its full effects without another hormone being present norepi + cortisol (no affect on its own but helps other catecholamines)

Ascites (heart failure) what changes to oncotic pressure, hydrostatic pressure, and permeability

only changes hydrostatic pressure due to body thinking low blood pressure so goes back to bring in more water and more hydrostatic pressure

miosis (pin point pupil) decreased bowel signs and hypotension

opioids

difference between oral nitro and sublingual

oral results in extensive first pass metabolism sublingual has high bioavailability

hyperammonemia is seen in all urea cycle disorders except arginase deficiency. (???) directly inhibit urea cycle => hyperammonemia

organic acids

what drug is used for weight loss but has significant GI side effects?

orlistat

high ammonium high urinary orotic acid excretion. What enzyme is deficient?

ornithine transcarbamylase deficiency

what is RNA virus that replicates in nucleus (besides HIV)

orthomyxovirus (influenza)

polyethylene glycol moa

osmotic laxative look like lactase deficiency due to water being excreted due to increasing lactose in colon

example of paracrine signaling

osteoblasts to osteoclasts

bone biopsy with haphazardly oriented segments of lamellar bone with prominent cement lines. elevated alkaline phosphatase in eldery patient. what cell type is involved?

osteoclast

Trabecular thinning with fewer interconnections associated with what disease

osteoporosis

What do gram negative bacteria have?

outer membrane

CA-125

ovarian cancer

Brenner tumor

ovarian tumor resembling bladder transitional epith p296

decreased function of what organ can cause easy vertebral fracture?

ovary

decrease in (???) causes nasal squamous cell carcinoma

p53 (tumor suppressor gene-decrease suppressor)

lesion that is keratin +, s100 -. extramammary or melanoma?

paget-extramammary

painful vs painless hematemesis

painful-mallory weiss painless-esophageal varices

superior mesenteric artery supplies

pancreas, small intestine, and most of colon

admitted to hospital for after benign drinking for abdominal pain. 4 weeks later comes in with cystic lesion to abdominal wall. what is the lesion and what is it lined with?

pancreatic pseudocyst ---> fibrous and granulation tissue

acute promyelocyctic leukemia and treatment

pancytopenia and DIC(disseminated intravascular coagulation) Tx: all-trans retinoic acid

What is a virus that replicates in the nucleus of the host?

papillomaviridae (generally all DNA replicate in nucleus and RNA in cytoplasm)

Medullary carcinoma of the thyroid

parafollicular cells; calcitonin; amyloid (calcitonin conversion)

what type of cell release hydrogen ions in stomach

parietal cells

Chiari malformation

part of cerbellum herniates down through foramen magnum

child has facial rash and mother came in with swelling and pain to hand wrist and knee joints. what is diagnosis?

parvovirus

mouse-like odor gram - coccobacilli seen after dog bite. organism?

pasteurella multocida

child born with cleft lip and palate. round punched-out lesion with overlying thin membrane on head. what is condition responsible?

patau syndrome (trisomy 13)

Kimmelstiel-Wilson lesion

pathognomonic for diabetic nephropathy

Cystic fibrosis not identified on panel. What should you think of next

patient has another mutation that was not included in previous analysis

population susceptible to development of vibrio cholerae?

patient taking proton pump inhibitor (acid sensitive)

autoantibodies to desmoglein are seen in ???

pemphigus vulgaris

penicillin plus gentamicin

penicillin allow gentimycin

Septic pulmonary emboli characteristically result in

peripheral nodular or wedge-shaped pulmonary opacities, many of which cavitate and will be associated with positive blood cultures

clearing particles that lodge distal to terminal bronchioles is dependent on what type of clearance?

phagocytosis by alveolar macrophages

spread of Neisseria meningitidis

pharynx ---> blood --> choroid plexus ---> meninges

What drug is given prior to surgery for adrenal mass removal due to episodic tachycardia and diaphoresis? and what the diagnosis?

phenoxybenzamine (pheochromocytoma) --> alpha antagonist that block vasoconstriction

Cortisol induces the synthesis of gluconeogenic enzymes in liver such as? (3)

phenylethanolamine N-methyltransferase (norepi --> epi) help bring up glucose level

hypertensive crisis +MAOI. what is treatment

phetolamine

nausea, vomiting, headache, ataxia, visual complaint. nightly headaches. cystic tumor in cerebellum. neoplasm comprised of spindle cells and hair like glial processes with micro cysts. rosenthal fibers and eosinophilic bodies. what is diagnosis?

pilocytic astrocytoma

is acne found in eccrine sweat glands or pilosebaceous follicles

pilosebaceous follicles

Upward gaze palsy, absent pupillary light reflex, impaired convergence

pinealoma

Auspitz sign

pinpoint bleeding after a scale is removed

what oral antidiabetic induced differentiation of preadipocytes into adipocytes and increases glut-4 expression on adipocyte cell membrane?

pioglitazone

Idiopathic pulmonary fibrosis treatment

pirfenidone treatment that inhibit PDGF, TGF-B, VEGF)

adduction of flexed thigh and internal rotation of extended thigh is accomplished mainly through what muscle?

piriformis muscle

tubuloglomerular feedback mechanism

The mechanism for renal autoregulation in which the macula densa senses increased load and cause constriction of the nearby afferent arteriole, increasing resistance to maintain constant blood flow. a drop in arterial will cause increased filtration fraction through the efferent arteriolar constriction

what workup would you do for bloody stool in ulcerative colitis?

plain abdominal xray

EPO is measure by

plasma hemoglobin

metastatic melanoma of the lungs

pleomorphic cells with pigment (melanin granules)

Decreased tactile fremitus (saying 99) and dullness to percussion

pleural effusion acts as insulator to airway

Ferruginous bodies sign of what disease?

pleuropulmonary asbestosis

increased tactile fremitus

pneumonia

arteries with area of amorphous eosin-staining arterial wall necrosis with interanl elastic lamina disruption. what is dx?

polyarteritis nodosa

postpartum endometritis

polymicrobial UTERINE infection that is common after cesarean delievery

intra-abdominal abscess secondary to appendicitis mostly caused by what organism

polymicrobial with normal colonic bacteria leading

key characteristic of cryptococcus neoformans?

polysaccharide capsule

hemorrhage to what structure causes rigid extension of upper and lower extremities

pons

Transitional cell carcinoma

The most common histology of bladder cancer. CIGARETTE SMOKING

chronic kidney disease showing eosinophilic hyaline material in intima and media is caused by what two things?

poorly controlled HTN (no malignant) diabetes mellitus

Posterior displacement of a tibial relative to femur would injury what structures?

popliteal artery and vein and tibial nerve

contralateral hemianopia with macular sparing + contralateral paresthesia and numbness involve what artery?

posterior cerebral artery

hoarseness and dilation of aortic arch. what is an additional finding?

posterior cricoarytenoid muscle dysfunction

posteromedial papillary muscle rupture associated with

posterior descending artery blockage

where does aspiration go when lay on back? (hint not bottom right lobe like when standing up)

posterior segment of right upper lobe

acute ischemia results in depletion of ATP stores. What will increased in the extracellular space at that time?

potassium (sodium goes into cell K leaks out of cell and causes depolarization that cannot be fixed) cytoplasmic Ca accumulation is the hallmark of ischemia

actinic keratosis associated with what type of cancer

precancerous skin condition of horny tissue formation that results from excessive exposure to sunlight squamous cell carcinoma

actinic keratosis vs seborrheic keratosis

precancerous skin condition of horny tissue formation that results from excessive exposure to sunlight (picture) A noncancerous skin condition that appears as a waxy brown, black, or tan growth. "stuck on". velvety or greasy

TdT+ CD19 and CD10+ (what type of ALL)

precursor B-ALL

what can cause a false negative H. pylori treatment?

use of omeprazole

PCR primers

used to amplify small fragments of DNA that are complementary to region of DNA flanking the segment of interest

usual symptom of leiomyoma

usually asymptomatic

what nerve structure runs near esophageal hiatus?

vagal trunk

prolactinoma causes what changes to the vaginal canal

vaginal dryness

innervation to hypopharynx and ear?

vagus nerve

chronically elvated intraluminal pressure of lower extremities can lead to dilation of veins and incompetence of (??)

valves

left sided renal cell carcinoma is associated with what condition in the scrotum

varicocele

painless scrotal mass that disappears when laying flat and has no light shine through?

varicocele --> nutcracker effect

allergy testing involves what cytokine?

various procedures used to identify specific allergens in an individual by exposing the person to a very small quantity of the allergen histamine

sickle cells causes what changes to spleen if not removed

vascular occlusion

what medications should be avoided in patient with hypertrophic cardiomyopathy?

vasodilators=dihydropyridine calcium channel blockers/nitro/ace inhibitors diuretics

ion defect causes decreased outward potassium flow and prolongs action potential what is a potential cause of death?

ventricular tachycardia (torsades de pointe)

what can lead to hypertension in child with kidney problems

vesicoureteral reflux

s/p vasectomy can still have what process occur?

viable sperm

tubulin is the target for what chemotherapy agent?

vincristine

temporal lobe edema + headache + confusion + seizures + fever. what is the diagnosis and what would CSF analysis show?

viral encephalitis glucose normal increased protein lymphocytes predominant

is the periportal zone affected first by ischemia or viral hepatitis?

viral hepatitis pericentral vein (ischemia)

gram-positive cocci that synthesiz dextrans from sucrose

viridans streptococci

20 month old with rash fever cough congestion and conjunctivitis. rash started on face. what deficiency will complication disease?

vitamin A deficiency --> measles

What vitamin deficiency leads to hemolytic anemia, posterior and spinocerebellar tract demyelination (look like b12 but not)

vitamin E deficiency (look like friedreich ataxia)

persistence of (???) leads to painless GI bleeding + diverticulum in child.

vitelline or omphalomesenteric duct

malignant hyperthermia: mutations in receptors (especially ryanodine receptor type 1) predispose to (???) causing an accumulation of intracellular calcium in skeletal muscle that leads to its overactivation and hypermetabolism

volatile anesthetic agents(-furane, NO) or succinylcholine

creatinine can rise due to what other causes besides renal issues

volume depletion

S3 gallops are associated with ___

volume overload implying decreased ejection fraction

Chromosome 3 disorders

von Hippel-Lindau disease, renal cell carcinoma

Mechanical heart valves require what long term treatment and mechanism of action?

warfarin --> vitamin K epoxide reductase inhibitor

hemorrhagic necrosis of adrenal gland due to DIC with neisseria meningitdis

waterhouse-friderichsen syndrome

L2-L4 lesion

weakness hip flexion/adduction knee extension

fever, headache, confusion, tremors, seizures, and motor deficits. +meningeal irritation. with lymphocytic and no bacteria seen. What is the disease and how is it spread?

west nile virus --> elimination of vector arthropod breeding grounds

At what time during the cycle are the endometrial sampling coiled glands filled with carb rich mucus, edematous stroma, and tortuous spiral arteries?

when progesterone is high

Dating Error

where the expectancy Date was miscalculated, might be the most Important Reason for Increase in Alpha Fetoprotein

Bordetella pertussis (sketchy)

whooping cough Streamers to represent pili - Respiratory droplets are very infective using Pilus called filamentous hemagglutinin 2. Bow tie - Pertussis Toxin - Ribosylates Gi disabling it 3. GI uniform - Toxic inhibits GI, Disabled Gi (G inhibitor Protein) 4. Military Camp - Leads to a rise in cAMP 5. Popcorn, overabundance of white kernels - ADP Disables Chemokine receptors for lymphocytes leading to an overabundance of white blood cells in the blood stream, lymphocytosis 6. EF Shield - Adenylate cyclase toxin acts like the anthracis toxin edema factor, increases cAMP, Edema Factor, Most Virulent 7. Tractor on the middle road cutting the grass- Tracheal toxin damages ciliated cells in the epithelium, tractor cuts long cilia grass

Right Bundle Branch Block cardiac exam findings

widened splitting of S2 due to splitting of closure of aortic and pulmonic valves

17 year old boy with mood changes. poor appetite. tremor in both hands and broad based gait. +ceruloplasmin. what is disorder?

wilson disease

EPO side effects

worsening hypertension thromboembolism accelerated tumor growth heart failure

portal vein ct

would be just within the right lobe of the liver adn anterior to the vena cava.

male offspring of unaffected parents

x link recessive inheritance

A mutation in the Dystrophin gene causes:

x-linked familial dilated cardiomyopathy duchenne and becker muscular dystrophy

Pyrimidine bases think what disease

xeroderma pigmentosum

GUT 4 transport does it translocate the protein with the glucose?

yes

are there t-tubules in cardiac muscle?

yes

doe hep B use reverse transcription to synthesize?

yes

is insulin secreted by pancreatic beta cells 24 hours a day?

yes

is isoniazid directly hepatotoxic

yes

is nitrate increase tolerance?

yes

would you get b-hcg in women with IUD who would like to be started on isotretinoin?

yes

lightning-related complications

you die from arrhythmia

microcephaly with arthrogryposis, seizures, hypertonia, and ocular abnormalities with brain thinning.

zika virus

ulcers found BEYOND the duodenal bulb suggest what?

zollinger-ellison syndrome

P-glycoprotein

—found in the liver, kidney, placenta, intestine, and brain capillaries(BBB)—can transport a variety of drugs out of cells.

Prader-Willi Syndrome mechanism (3)

-defect in paternal chromosome 15 ---> imprinting -maternal uniparental disomy -methylation defect

what has a 5->3 exonuclease activity

DNA polymerase I

what protein removes RNA primer and replaces it with DNA

DNA polymerase I

Osteoporosis treatment that can cause esophageal erosions?

-dronate (alendronate) pill-induced esophagitis = bisphosphonates, tetracyclines, NSAIDs, iron, potassium chloride

what enzyme removes short fragments of RNA that are base paired to DNA?

DNA polymerase I (only DNA polymerase with 5' to 3- exonuclease activity

what is the herpes virus?

DNA virus, double stranded, enveloped

what are some class II proteins expressed by antigen-presenting cells

DR DP DQ -RA, DM-1, celiac disease

clinical manifestation of factor V leiden

DVT cerebral vein thrombosis recurrent pregnancy loss

NMS treatment

Dantrolene D2 agonists (e.g., bromocriptine). For NMS, think FEVER: Fever Encephalopathy Vitals unstable Elevated enzymes Rigidity of muscles

major risk factors for esophageal adenocarcinoma

(look like barrett esophagus) chronic GERD OBESITY smoking Nitro and foods containing nitroso compounds

CEA (carcinoembryonic antigen) used for following what aspect of patient care?

(most widely used tumor marker): Used in management of gi tumors (colon cancer), adenocarcinomas of the colon, pancreas, lover and lung

osteoporosis affects what parts of bone?

(spongy and ) trabecular bone mass loss or compact bone loss

Medusa head, gram-positive rods. what organism?

Bacillus anthracis

Neurofibromatosis type 1 (what cell type associated)

- HYPER pigmentated café au lait spots - OPTIC Gliomas - Cutaneous neurofibromas - Bone dysplasia Schwann cells

Acute salicylate intoxication

-Occurs from a single ingested dose -Metabolic acidosis occur -Signs and symptoms are more pronounced and occur more quickly.

clinical features of endometriosis

-Pain can coincide with menstrual period (as implanted endometrium undergoes changes) -Implants lead to adhesions and other forms of scarrimg INFERTILITY

exocrine pancreas secretions

-Potassium -Sodium -Bicarbonate -Magnesium -Calcium -Chloride levels of bicarb and chloride vary in flow rate (bicarb high with flow and chloride low due to exchanger)

Charcot-Bouchard microaneurysm

* Symptoms: *Affects small vessels of deep brain structures (e.g. basal ganglia, thalamus, internal capsule). May rupture and result in intracerebral hemorrhage.* Lab Values: *Hemorrhage evident as intraparenchyal hyperdensity on CT.* Pathophysiology: *Associated with chronic hypertension.* Treatment: *

Pseudohypoparathyroidism

* Symptoms: *Hypocalcemia, shortened 4th/5th digits, short stature.* Lab Values: ** Pathophysiology: *Albright's hereditary osteodystrophy. Autosomal dominant. Characterized by renal unresponsiveness to PTH.* Treatment: *

Cerebral amyloid angiopathy

* Symptoms: *Recurrent rhemorrahgic strokes in elderly person. Typically lobar and more benign than hypertensive hemorrhages.* Lab Values: ** Pathophysiology: ** Treatment: *

effects of prolonged glucocorticoid therapy

* increased gluconeogenesis and glycogenesis in liver

male breast cancer

-Rare -subareolar mass under nipple in older males = may produce nipple discharge -usu invasive ductal carcinoma** -a/w BRCA2 mutation and Klinefelter syndrome

Tertalogy of Fallot

*P*ulomanry (infundib) Stenosis *R*ight Ventricular Hypertrophy *O*verriding Aorta *V*SD *E*levated epo, hemacrit from cyanosis

Lichen Planus Histology

*Sawtooth pattern of lymphocytes* at the dermal-epidermal junction.

Nitrate MOA

*Veno*dilation by increase NO in SM results in increased cGMP and SM relaxation, myosin light chain dephosphorylation Dilates veins >>arteries Thus reduced preload to reduce cardiac work, some reflex tachycardia

Germinal matrix hemorrhage

*occurs in PREMATURE INFANTS *SUBEPENDYMAL MATRIX HEMORRHAGES during 25th week blood in lateral ventricles germinal matrix: subventricular zone

in gluconeogensis its basically reverse glycolysis except what 3 steps and what steps are replaced?

*pyruvate kinase * PFK-1 *hexokinase *pyruvate carboxylase, malate dehydrogenase, and PEPCK * Fructose-1,6-phosphatase *glucose-6-phosphatase

a drop in PaCO2 due to HYPERVENTILATION causes (vasodilation or vasoconstriction)

*vasoconstriction* resulting in reduction in cerebral blood volume -> decerased ICP lower PaCO2 is one of the measures employed to reduce ICP in mechanically ventilated pts with cerebral edema

Metoclopramide mechanism

- D2 receptor antagonist (note: d2 is inhibitory, antag is inhibitory) - increases resting tone, contracitility, LES tone, motility - does not influence colon transport time Tickler blocking the D-rings: metoclopramide antagonizes D2 receptors in the area postrema (treats chemotherapy induced vomiting)

Lactate Dehydrogenase Deficiency

- GSD XI - Paradoxically low serum LDH - Exercise intolerance & cramps +/- skin lesions - Confirmation by genetics available -muscles cannot regenerate NAD+

Signet ring cells

- Gastric adenocarcinoma diffuse involvement of the stomach wall and leather bottle stomache

metabolized by CYP450 and changes composition of fungal cell membrane?

-azole

Congenital Torticollis etiology

-cause unknown -may be associated with malpositioning in utero (e.g., breech) and birth trauma

Supratherapeutic INR

-change in dietary vitamin K intake -disruption of intestinal flora -alteration of cytochrome p450 activity

Chronic endometritis characterized by plasma cells

-chronic inflamm of endometrium -char by plasma cells** (b/c lymphocytes are norm present in endometrium) -common causes = retained products of conception, chronic PID (chlamydia), IUD, and TB -presents with abn uterine bleeding, pelvic pain, and **infertility**

DNA laddering

-A sensitive indicator of apoptosis; during karyorrhexis, endonucleases cleave at internucleosomal regions, yielding fragments in multiples of 180 bp. Radiation therapy causes apoptosis of tumors and surrounding tissue via free radical formation and dsDNA breakage. -Rapidly dividing cells (e.g., skin, GI mucosa) are very susceptible to radiation therapy-induced apoptosis. BCL2 can use this and evade apoptosis

Metformin mechanism

-Exact mechanism unknown. -Decrease gluconeogenesis, increase glycolysis, increase peripheral glucose uptake (increase insulin sensitivity).

Leuprolide (mechanism, use, toxicity)

-Mechanism: GnRH analog with agonist properties when used in pulsatile fashion; antagonist properties when used in continuous fashion (downregulates GnRH receptor in pituitary causing decreased FSH/LH). -Use: infertility (pulsatile), prostate cancer (continuous use following androgen receptor blockade with flutamide), uterine fibroids (continuous), precocious puberty (continuous). -Toxicity: antiandrogen, nausea, vomiting.

Liddle syndrome

-Mimics hyperaldosteronism -AD -Decreased degradation of Na channels in collecting tubules -Presnts as HTN, hypokalemia, metabolic alkalosis in young -Low aldo and low renin -Tx: K sparing diuretics (amiloride or triamterene) to block Na channels; not spironolactone

Obtaining a Sexual History

1. do not make assumption about preferred gender of sexual partners 2. use gender-neutral terms, allows sexual minority youth to feel comfortable with you 3. ask open ended questions

Glucagon mechanism of action (used in aspect of hypoglycemia)

1. elevates blood glucose level by converting stored liver glycogen into glucose 2. Increases heart rate and myocardial contractility and improves AV conduction in a manner similar to that produced by catecholamines

Acute diverticulitis

1. fever, leukocytosis, left lower quadrant pain with a palpable tender mass 2 CT diagnosis, no contrast studies or endoscopy in acute phase

Bacillus anthracis virulence factors

1. plasmid-encoded toxins: - 3 Toxin combined: protective antigen, edema factor, and lethal factor. - Results in massive edema - (Combined these can activate signal machinery inside the cell (such as activation of adenylate cyclase) which results in massive edema (accumulation of fluid) and eventually cell death.) 2. Unique capsule : - Made of poly-D-glutamic acid, rather than polysaccharide.(acid-protein capsule is unusual) - Difficult to phagocytosis as the human body also produces and possesses D-glutamic acid - As such it is difficult to produce AB for this bacterial capsule

Burkitt lymphoma translocation (patient comes in with left sided jaw tumor. what oncogene is overexpressed)

8; 14 c-myc and Ig Heavy chain = increased c-myc = transcription activator

HIV associated dementia

= subcortical dementia attention/working memory problems executive dysfunction, slow information processing microglial nodules and multinucleated giant cells

lamins

A group of intermediate filament proteins that form a fibrous network, the nuclear lamina, on the inner surface of the nuclear envelope.

Duchenne muscular dystrophy mode of inheritance?

A human genetic disease caused by a X-linked recessive allele; characterized by progressive weakening and a loss of muscle tissue. (walking up from hands)

Tay-Sachs disease

A human genetic disease caused by a recessive allele that leads to the accumulation of lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth. hexosaminidase A deficiency

Hypothalamus

A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.

pleural plaques on CXR associated with what exposure

Asbestos exposure (insulation)

2 examples of DNA repaire genes

BCRA1 BCRA2

Acute mastitis organism?

Bacterial infection of the breast, usually due to Staphylococcus aureus

Bacillary angiomatosis

Bartonella henselae; vascular infection in AIDS

what hormone binds to EXTRACELLULAR receptors to maintain blood sugar (2)

CATECHOLAMINES (EPI, NOR) AND GLUCAGON

mono symptoms with an agglutination test that fails to agglutinate horse erythrocytes. (CMV or EBV)

CMV

TB infection involve CD(???) and macrophages

CD4

cell type found in sarcoidosis

CD4 lymphocytes

few weeks into TB infection?

CD4 lymphocytes release IFN-y

Capsaicin MOA

Capsaicin cream treats neuropathic pain by depleting substance P in the localized area. Since there was partial relief after administration of capsaicin, substance P is most likely mediating this patient's pain.

endobronchial mass with no focal parenchynmal opacities or lymphadenopathy. It shoes unifirom polgonal cells containing eosinophilic cytoplasm and granular nuclear chromatin. +chromogranin and synaptophysin. What is the tumor and what will secrete?

Carcinoid tumor: produces vasoactive peptides release serotonin leading to flushing and diarrhea

opsonins

Coating proteins that promote phagocytosis: IgG and C3b

enzyme responsible for replication of adenovirus (DNA/RNA dependent DNA/RNA polymerase)

DNA dependent DNA polymerase

Transduction in bacteria

DNA is transferred from a donor cell to a recipient via a bacteriophage

beta-thalassemia minor mutation

DNA mutation affecting the transcription, processing, and translation of b-globin mRNA

Is fibrinogen increased or decreased in DIC?

Decreased (more fibrinogen is being converted to fibrin)

indole positive

E. coli

increasing partial pressure of oxygen at hemoglobin saturation will cause what compasatory mechanism?

EPO synthesis ---> erythrocytosis

JAK-STAT pathway

EPO, growth hormone, prolactin

improperply folded CFTR gets trapped in what structure

ER

Enfuvirtide

En FU virtide is a ... FU sion inhibitor. Binds gp41 and inhibits fusion and entry of the virus.

Hyperosmolar non-ketotic coma

Extreme hyperglycemia in elderly patients Increased urination Dehydration Decreased blood volume Increased blood osmolarity (Gets thicker) Coma and/or increased blood clotting

Ezetimibe vs colesevelam

Ezetimibe: decreases intestinal absorption of new cholesterol colesevelam: bile acid sequestrant or binds bile acid and decreases reabosprtion

MOST COMMON TUMOR IN A PREMENOPAUSAL FEMALE

FIBROADENOMA

Marfan's is caused by defect in what molecule?

Fibrillin (holds together tropoelastin)

Ivermectin treats

For river blindness (Onchocerca volvulus) and strongyloides

nevus simplex

Flat, pink area on the nape of the neck, on the mid-forehead, or over the eyelids resulting from dilation of the capillaries; also called stork bites, salmon patches, or telangiectatic nevi.

mecA gene

Found in S. aureus and S. pneumoniae This encodes for PBP2a which is a modified transpeptidase --> significantly reduces the binding affinity for Beta-lactam Abx --> antibiotic resistance

Strongyloides stercoralis life cycle

Free-living cycle in soil Larvae penetrate unbroken skin --> enter bloodstream, enter alveolar spaces via lung capillaries --> migrate up respiratory tract, ingested --> adults mature in small intestine --> eggs are excreted OR larvae penetrate bloodstream and autoinfect host Larvae resemble those of hookworm (necator americanus, ancylostoma) rhabditiform larvae in stool

right groin pain and difficulty bearing weight in right lower extremity in 18 year old with osteopenia and cortical collapse... what enzyme is deficient? what is the diagnosis?

Gaucher disease --> b-glucocerebrosidase deficiency

gag reflex

Glossopharyngeal (IX) sensory, Motor (X)

Heberden and Bouchard nodes

Heberden: DIP Bouchard: PIP

INCREASED SERUM PARAPROTEIN

IMMUNOGLOBULINS

giardia involved Ig(???) production

IgA

IgA nephropathy characteristic biopsy feature

IgA in mesangium

painless hematuria following upper respiratory tract infection should make you think of what type of nephropathy

IgA nephropathy ( distinguish this from post strep glomerulonephritis by time and organism involved. If only related to strep then youll see IgG and C3 but if its to multiple infections think IgA)

HLA haplotypes that do not bind the viral antigens are unable to present the antigen to T cells impairing isotype switching and preventing (???) formation

IgG antibody

Cold Agglutination

IgM complement-fixing antibodies, agglutinate RBCs at temperatures below 37 C --> usually autoimmune and occur in pts. w/ atypical pneumonia

Intellecualization

Immature is the use of reasoning and excessive thinking about conflicted feelings and impulses as a way to avoid experiencing them and to defend against experiencing the accompanying anxiety. looking up everything about a disease instead of emotionally dealing with it

Acute Lymphocytic Leukemia (ALL)

Immature lymphocytes (lymphoblasts) predominate. This form is seen most often in children and adolescents; onset is sudden t(12;21)

Bowenoid papulosis

In Situ Carcinoma that presents as multiple reddish papules Does NOT progress to Invasive Carcinoma

Uncal herniation

Medially displaced medial temporal lobe over free margin of tentorium. Focal effacement of ambient cistern and lateral suprasellar cistern. Rarely compresses contralateral cerebral peduncle (Kernohan's notch) against tentorial margin. can cause compression of oculomotor nerve

first line immediate treatment for rheumatoid arthritis

NSAID then corticosteriods

Urine anion gap equation

Na + K - Cl

Anion gap equation

Na - (Cl + HCO3)

reversible cell injury due to swelling. decreased function of what enzyme

Na K ATP ase reversible cell injury because of swelling. If the Na/K ATPase is not working, Na is not leaving. Na follows water, so water is getting stuck in the cell, leading to swelling.

Oseltamivir mechanism of action

Neuraminidase inhibitor by blocking viral release

Tight adhesion/crawling

Neutrophils are attached to the endothelium via binding of CD18 beta to Integrins (Mac-1, LFA-1)!!!! These bind to ICAM-1 !!!

best way to establish closteridum infection

PCR for bacterial gene encoding a toxin

Which artery gives rise to the posterior descending artery determines the "dominance" of the heart

PDA from the RCA(right coronary) is right dominant [right dominant is most common], PDA from the left circumflex is left dominan

sildenafil action

PDE-5 inhibitor resulting in increased intercavernosal cGMP, smooth muscle relaxation, vasodilation, and erection (FILs the Penis) corposum cavernosum

Misoprostol MOA

PGE1 analog. Increase production and secretion of gastric mucus barrier. Decrease in acid production. do not give during pregnancy due to spontaneous abortion Missed swing: misoprostol (PGE1) 10. Gastric protective equipment: misoprostol promotes protective mucus secretion by gastric mucosa 11. Missed swing hitting fire extinguisher: misoprostol can prevent NSAID-induced peptic ulcer 12. Opening uterus bag: misoprostol can facilitate labor or terminate pregnancy same as dinoprostol

Misoprostol

PGE1 derivative: orally active prostaglandin used to prevent peptic ulcers in patients taking NSAIDs for arthritis. Tox: diarrhea

Lateral Medullary (Wallenberg) Syndrome

PICA infarct → NVNV, ipsilateral Horner's, loss of pain/temp to ipsilateral face & contralateral body,CN X loss (dysphagia, hoarseness, ↓ gag reflex)

phosphatidylinositol 2nd messenger system

PLP-C cleaves PIP2 into DAG + IP3 1) IP3 goes to ER and causes release of calcium 2) DAG recruits protein kinase C to the cell surface 3) Calcium binds protein kinase C and activates it 4) Phosphorylation cascade is activated!

H. pylori treatment

PPI + 2 of the following antibiotics --Clarithromycin --Metronidazole --Amoxicillin One week treatment: 90% cure rate Two weeks of PPI + 1 antibiotic (typically clarithromycin): 10-20% lower cure rate MHD notes: --Tetracycline can be 1 of the 2 antibiotics --Bismuth salts, doxycycline, and metronidazole for 14 days is cheap and effective

African Americans have highest risk for melanoma on what part of skin?

Palms

TdT+, CD1+, CD2+, CD5+ (what type of ALL)

Precursor T-ALL

patient centered care

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs.

CYP 450 inhibitors

SICKFACES.COM -Sodium Valproate -Isoniazid -Cimetidine -Ketoconzaole -Fluconazole -Acute Alcohol Abuse -Chloramphenicol -Erythromycin (macrocodes) -Sulfonamides -Ciprofloxacin -Omeprazole -Metronidazole

Inducer of CYP450 (NAME?) and would (increase or decrease) effects of warfarin?

ST. JOHN WORT Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin decrease effects (increased metabolism)

Synaptobrevin

Synaptic vesicle protein containing one transmembrane segment that is essential for transmitter release. Botulitum

what cytokine cause fibrosis

TGF-B

what cell and what cytokine mediate fibrosis of liver?

TGF-b from stellate cell

precursor of the compensatory pathway that makes NAD+?

Tryptophan (gotta make niacin)

Mycobacterium tuberculosis spondylitis

Tuberculous spondylitis, also known as Pott disease, refers to vertebral body osteomyelitis and intervertebral diskitis from tuberculosis (TB). The spine is the most frequent location of musculoskeletal tuberculosis, and commonly related symptoms are back pain and lower limb weakness/paraplegia

BRCA1 and BRCA2

Tumor Suppressor (2 hit) Breast and ovarian cancer DNA repair protein

Fat embolism syndrome

Unlike emboli that arise from thrombi (blood clots), fat emboli are small and multiple, and thus have widespread effects. Fat embolism syndrome (FES) is distinct from the presence of fat emboli. Symptoms usually occur 1-3 days after a traumatic injury and are predominantly pulmonary (shortness of breath, hypoxemia), neurological (agitation, delirium, or coma), dermatological (petechial rash), and haematological (anaemia, low platelets). The syndrome manifests more frequently in closed fractures of the pelvis or long bones. The petechial rash, which usually resolves in 5-7 days, is said to be pathognomonic for the syndrome, but only occurs in 20-50% of cases. Fat emboli occur in almost 90% of all patients with severe injuries to bones, although only 10% of these are symptomatic. The risk of fat embolism syndrome is thought to be reduced by early immobilization of fractures and especially by early operative correction. There is also some evidence that steroid prophylaxis of high-risk patients reduces the incidence. The mortality rate of fat-embolism syndrome is approximately 10-20%.[1] Fat emboli can be either traumatic (resulting from fracture of long bones, accidents, or trauma to soft tissue) or non-traumatic (resulting from burns or fatty liver).[ Clinical fat embolism syndrome presents with tachycardia, tachypnea, elevated temperature, hypoxemia, hypocapnia, thrombocytopenia, and occasionally mild neurological symptoms. tx-The most effective prophylactic measure is to reduce long bone fractures as soon as possible after the injury. Maintenance of intravascular volume is important because shock can exacerbate the lung injury caused by FES. Albumin has been recommended for volume resuscitation in addition to balanced electrolyte solution, because it not only restores blood volume but also binds fatty acids, and may decrease the extent of lung injury.[6]

Deficiency in Vitamins A, D, E, K, and Riboflavin would cause what conditions respectively?

Vit A deficiency can be caused by Cystic fibrosis leading to pancreatic insufficency, fat malabsorption and deficiency of vitamins ADEK, but Vit A deficiency could cause squamous metaplasia to a keratinizng epithelia since Vit A maintains orderly differentiation of specialized epithelia eg mucus secreting columnar epithelia Vit D deficiency could produce rickets in children and osteomalacia in adults. Vit E deficiency could cause infertility and decrease in some serum phospholipids. Usually caused by fat malabsorption (e.g. gastric bypass, abetalipoproteinemia) Acanthocytosis: red blood cells with spiny projections. Neurological abnormalities: Posterior column and spinocerebellar tract demyelination often presents with progressive ataxia, retinitis pigmentosa, Hemolytic anemia and muscle weakness also seen Vit K deficiency could cause coagulopathy (bleeding diathesis) secondary to inadequate vitamin K dependent clotting factors Riboflavin Deficiency: Cheilosis-inflammation of lips; glossitis and stomatitis, Corneal vascularization

Pancreatic ducts are lined with squamous epithelium with areas of keratinization. This finding of squamous metaplasia in the pancreatic duct is due to what deficiency?

Vitamin A deficiency. Recurrent sinopulmonary infections + exocrine gland fibrotic atrophy in young caucasian is suggestive of Cystic fibrosis. Severe CF may cause total obstruction followed by complete fibrotic atrophy resuilting in pancreatic insufficiency which causes a deficiency of fat soluble vitamins. Vitamin A levels and its metabolite retinoic acid are needed to maintain differentiation of specialized eptihelia like mucus secreting columnar so if when a deficiency exists it can turn to squamous metaplasia

Crohn's disease- what is the most helpful spot to biopsy?

a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon

Chronic myelogenous leukemia

a form of leukemia characterized by the accumulation of abnormal, mature granulocytes (granulocytes are a type of white blood cell)

sudden cardiac death

a nontraumatic, unexpected death from sudden cardiac arrest, most often due to arrhythmia or hypertrophic cardiomyopathy in a child; in most instances, victims have underlying heart disease

what is a health care proxy?

a person chosen by another person to make medical decisions if the second person becomes unable to do so overrule surrogate decision makers

carotid sinus massage

a procedure that involves rubbing the large part of the arterial wall at the point where the common carotid artery divides into its two main branches increased afferent firing form carotid sinus --> increased vagal parasympathetic tone --> slows conduction through the AV node and prolongs AV node refractory period --> terminate reentrant tachycardia

Presenilin

a protein produced by a faulty gene that causes B-amyloid precursor protein to be converted to the abnormal short form; may be a cause of Alzheimer's disease

What is osteomalacia?

a rare condition of the adult bone associated with vitamin D deficiency from minimal sun exposure, resulting in decalcification and softening of bone.

toxic shock syndrome (TSS)

a severe illness characterized by high fever, rash, vomiting, diarrhea, and myalgia, followed by hypotension and, in severe cases, shock and death; usually affects menstruating women using tampons; caused by Staphylococcus aureus and Streptococcus pyogenes

HLA-DR

a type of MHC Type II protein, expressed on the surface of antigen presenting cells as a receptor for CD4+ cells to recognize

what lab studies are most useful in determining the cause of metabolic alkalosis

urinary chloride

anaplastic tumors

undifferentiated tumors: dont' resemble tissue of origin. composed of pleomorphic cells w/ large, hyperchromatic nuclei , disorganized growth. Numerous abnl mitosis and giant tumor cells.

what anticoagulant is most effective in inactivating thrombin?

unfractionated heparin

insufficient vitamin D --> inadequate calcium --> rickets which is characterized by excessive (???) matrix

unmineralized osteoid matrix and epiphyseal cartilage s/s: frontal bossing, craniotabes, rachitic rosary, and bowed legs

ace inhibitor induced renal failure will show what changes to urinalysis

unremarkable (just due to artery dilation)

what area mediate the direct and consensual pupillary light reflex?

upper midbrain

corticospinal tract upper or lower motor neuron

upper motor neuron --> spastic paralysis hyperrelexia and plantar reflex

tardive dyskinesia mechanism

upregulation of dopamine receptors

hysterectomy associated with what stucture?

ureter

what structure passes inferior to ovary?

ureter "bridge over water"

sensitivity is true (???) and specificity is true (???)

true positives true negatives

hypospadias is due to failure of (????) to close

urethral folds

prolonged seizure can lead to rhabdomyolysis. why would cause kidney injury?

tubular injury due to released myoglobin

powerhouse of the kidney (uses a lot of Oxygen)

tubular reaborption

what histologic finding confirms the diagnosis of follicular thyroid carcinoma? (vs. follicular adenoma)

tumor capsular invasion

teratoma in males

tumor composed of mature fetal tissue derived from two or three embryonic layers; - MALIGNANT in males, even though benign in females

Maturity Onset Diabetes of the Young (MODY)

type II is an autosomal dominant disorder involving mutations in the glucokinase gene -patients have nonprogressive hyperglycemia that is usually asymptomatic at diagnosis and is usually managed with diet alone

alcohol induced cardiomyopathy

type of dilated cardiomyopathy

cell-mediated immunity

type of immunity produced by T cells that attack infected or abnormal body cells acute rejection

Albinism is caused by the absence of

tyrosinase

peptide fragments that are coupled to MHC class 1 molecules are broken down by what enzyme?

ubiquitin ligase

toxic megacolon is associated with what disease?

ulcerative colitis

Aminosalicylic acid derivative used for

ulverative colitis

sparse transverse tubules cause what problems

uncoordinated contraction of myofibrils within affected muscle fibers