Uworld/ Rx Journal pt.2
how to tell difference between cobalamin deficiency and thiamine deficiency
cobalamin deficiency (B12) causes subacute combined degeneration of dorsal columns (diminished vibratory sensation and gait ataxia) and corticospinal tracts. The degen of the CSTs causes a positive, upgoing babinski sign. Thiamine deficiency has a LOSS of reflexes so no babinski sign.
transplant rejection: hyperacute vs acute vs chronic vs GVHD
hyperacute (minutes, ischemia, type 2 HSR) vs acute (weeks, vasculitis, type 4 HSR) vs chronic (months, arteriosclerosis, type 2 AND 4 HSR) vs GVHD (systemic sx: jaundice, rash, diarrhea)
defective lipoprotein lipase or Apo C II
hyperchylomicronemia (hgih chylomicrons, and TG's)
hyperosmolar hyperglycemic state
hyperglycemia induced dehydration and increased serum osmo. seen in elderly type 2 diabetics with limited ability to drink (osmotic diuresis as well). glucose in blood >600. no acidosis. ketone production inhibited by presence of insulin. tx: aggressive IV fluids, insulin therapy.
tertiary hyperparathyroidism
hyperparathyroidism from CKD that persists after kidney transplant. tx: parathyroidectomy
hepatic overproduction of VLDL
hypertriglyceridemia (increased VLDL, TG's)
SIADH and tx
hyponatremia, inability to dilute urine, urine osmolal>plasma osmolal and urine sodium conc >40 in the setting of hyponatremia and tx is water restriction
ABG's assoc with pulmonary embolism
hypoxemia, hypocapnia, and increased pH secondary to hyperventilation and assoc with respiratory alkalosis.
anxiety secondary to a general medical disorder
i.e. hyperthyroidism causing anxiety for instance. can also be hypercortisolism, or hypoglycemia, etc. if they have medical sx, think of this (i.e. weight loss, palpitations, diarrhea, etc)
normoblast
immature RBC
antimetabolite drugs
immunosuppressants; interferes with the normal metabolic processes within cells (usually by combining with enzymes). (ex: azathioprine (prodrug), mycophenolate mofetil, basiliximab, sirolimus, tacrolimus, cyclosporin, glucocorticoids)
hypoglycemia after prolonged fasting with inappropriately low ketone bodies suggests
impaired beta oxidation. Medium chain acyl-CoA dehydrogenase deficiency is teh most common genetic defect in beta oxidation.
dubin johnson
impaired excretion of conjugated bilirubin
underlying cause of cystic fibrosis
impaired protein trafficking
patient has trauma to the face, and gets double vision. fracture of the inferior orbit bone.
impairment of the ocular muscles causing diplopia. caused by damge to V2 or entrapment of the inferior rectus muscle
manic episode
impulsivity, poor judgement, disregard for risks. (bipolar disorder)
gastrin, somatostatin, omeprazole
in a steady state, intragastric acidity (low pH) stimulates D cells in the gastric antrum to release somatostatin, which binds to G cells in the gastric antrum and inhibits gastrin release.
excess ammonia (i.e. in cirrhosis) will deplete which compound
in pts with cirrhosis, they get hyperammonemia. the urea cycle plays an integral role in converting amino acid byproducts (i.e. ammonia) into urea. Ammonia is shuttled to the liver via alanine, whose amino group is transferred to alpha-ketoglutarate to form glutamate, a precursor for the urea cycle. Therefore, excess ammonia will deplete alpha ketoglutarate.
central line placement
in the internal jugular vein, lateral to the common carotid. vagus nerve is posterior.
substantia nigra is located
in the midbrain just deep to the corticobulbar tract in the cerebral peduncle.
where do the majority of carcinoid GI tumors form?
in the midgut-derived small bowel, which begins at the distal duodenum and ends at the mid transverse colon, which includes the ileocecal junction. Carcinoid tumors of the small intestine secrete serotonin, which is usually metabolized by the liver and does not cause sx. However, when they metastasize to the liver, the bioactive amines can no longer be metabolized and enter the systemic circulation, causing diarrhea, abdominal cramps, GI tract bleeding, malabsorption, flushing bronchospasm, and right-sided heart valvular disease. carcinoid tumors most commonly present in the small intestine and the lung.
histo of irreparable damage/ later stages of cell injury
in untreated acute bowel disease, later stages of cell injury are characterized by organelle membrane damage, cytoskeletal dysfunction and nuclear changes, including pyknosis.
CGD is
inability of leukocytes to kill intracellular microorganisms due to lack of superoxide radicals aka NADPH oxidase.
competitive inhibitors on lineweaver burk plot
increase in Km and maintenance of Vmax.
severe burns over 35% of body, over the next week, the body will
increase its metabolic rate to keep the pt warm (bc the skin would usually insulate but now it cant)
ACE BATs Right handed
increased [acid, pCO2, exercise, 2,3 Bpg, altitude, temperature] cause right shift (increased O2 unloading to tissues)
hemochromatosis
increased intestinal iron absorption bc defective HFE (iron sensing) gene. triad: cirrhosis, diabetes, skin pigmentation (bronze diabetes); tx: deferasirox, deferiprone
multiple myeloma
increased production of IgG ! (M spike is spike in Ig light chains on electrophoresis)
moa of rifampin
inhibits bacterial RNA synthesis by binding to the beta subunit of DNA dependent RNA polymerase and consequently blocking transcription. It is indicated for the treatment of tuberculosis and causes bodily fluids to turn orange or red.
moa of TMP SMX
inhibits dihydrofolate reductase (TMP) and interferes with dihydropteroate synthetase (SMX)
chloramphenicol moa
inhibits the 50S ribosomal subunit.
digoxin increases intracellular calcium how?
inhibtis Na/K ATPase which inhibits the Na/Ca antiporter which increase Ca in the cell and leads to positive inotropic effect on heart.
if a bacteriophage (virus) is made to contain bacterial DNA instead of its normal virus DNA, it will be able to
inject its DNA into bacteria, like normal, but it cant produce progeny bacteriophages anymore bc it doesnt have its viral genome.
thoracentesis to avoid the lungs
insert needle at costodipahragmatic recess bnetween the 8th and 10th ribs at the midaxillary line
female athlete triad
insufficient caloric intake, amenorrhea, osteoporosis
phosphofructokinase-2 (PFK-2)/ fructose 2,6 bisphosphatase complex is regulated by
insulin and glucagon.
growth hormone is a diabetogenic agent leading to increased
insulin resistance and elevated fasting plasma glucose levels.
two most important pathophysiologic mechanisms for the development of type 2 diabetes mellitus
insulin resistance and progressive beta cell failure
high baseline plasma insulin level in the setting of normoglycemia during fasting is a sign of
insulin resistance in the peripheral tissues. (prediabetes heading to type 2 diabetes - which happens when enough beta cells die to the point where they can't compensate for the insulin resistance)
intellecteualization vs rationalization
intellectualization: excessive thinking to avoid painful emotions. rationalization: attempt to cover up unacceptable feelings by using excuses or justifications (i.e. if terminal pt said his diag was for the best bc he had done everything in life he wanted to)
where is the AV node
interatrial septum near the tricuspid orifice
axillary nerve: cord levels
C5, C6
huntington trinucleotide repeat
CAG (caudate loses ACh and GABA)
tx for somatic symptom disorder
CBT and SSRI's
where does the bladder lymph drain to
internal iliac
cremaster muscle is formed from the
internal oblique muscle. the cremaster muscle is responsible for reflexively pulling the testes superiorly into the scrotum to maintain optimal temperature for spermatogenesis.
interossei vs lumbricals
interossei: abduction and adduction of fingers; lumbricals: flexion of the hand at the MCP joints.
L5-S1 herniated disc sx
intervertebral discs herniate posterolaterally, due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament along the midline of the vertebrae. S1 nerve radiculopathy is assoc with decreased sensation of the posterior leg and lateral foot, diminished ankle-jerk reflex (S1/S2) and weakness of plantar flexion, toe flexion and inversion.
H pylori cancer
intestinal gastric adenocarcinoma and MALT lymphoma
first thing that buffers excess acid in the body
intracellular proteins
thyroid hormone signaling occurs via
intracellular receptors
primary cause of a primarily conjugated hyperbilirubinemia
intrahepatic or extrahepatic biliary obstruction;
tx for x linked agammaglobulinemia
intravenous immunoglobulin
4 hour old infant presents with bulging head and stiff muscles and arms and legs jerking. diagnosis?
intraventricular hemorrhage; neonatal intraventricular hemorrhage is classically seen in premature and low-birthweight infants. The bleeding originates in the germinal matrix. Neonates may have altered level of consciousness, bulging fontanelles, hypotension, seizures or coma.
after 6 months, a diet consisting of breast milk only, or intro of cow's milk before 1 year of age, puts a child at risk of
iron deficiency anemia (cows milk is low in iron). after 6 mo, most infants' iron stores have been depleted and thus require complementary foods containing iron
Km and Vmax
is the substrate concentration at which half of the enzyme in the sample is saturated. Therefore if you have a reversible competitive inhibitor it will increase the Km bc it take more substrate to saturate half of the enzyme in the sample! (but the Vmax wont change bc the same Vmax can eventually be achieved with more substrate). noncompetitive inhibitors decrease Vmax and have no effect on Km.
influenza virus can cause a secondary bacterial pneumonia bc
it affects tracheobronchial epithelium leading to destruction of alveoli and loss of cilia.
why should metoclopramide NOT be used in pts with parkinson disease
it can cause or exacerbate parkinsonian symptoms due to its antagonistic effect on dopamine receptors
malaria can cause hypoglycemia because
it can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands
how does the IVC traverse the diaphragm
it passes through the central tendon of the diaphragm
xerosis
itchy, dry, cracked skin (asteatotic dermatitis, aka winter itch). tx: use moisturizers after bathing
torsades is more common in which class III antiarrhythmic
its more common in sotalol use (less common in amiodarone)
explain why anesthetics like propofol have a rapid onset of action and rapid recovery
its readily redistributed; highly lipid soluble drugs can cross membranes readily at physiologic pH and are preferentially distributed to organs with high blood flow, like the brain. They are also redistributed rapidly to other tissues. This explains the rapid onset and short duration of action, respectively, of propofol.
high specific gravity of urine means
its very concentrated
turners syndrome coarctation is where
juxtaductal coarctation of the aorta (opposite the ductus arteriosis)
densely immunostaining cells adjacent to the renal glomerulus are
juxtaglomerular cells that produce renin
schistosomiasis
katayama fever, HSM, eosinophilia! travel hx to middle east, africa, south america. unsanitary fresh water.
epidermal cells belong to which class of proliferative activity?
labile cells (cells that multiply constantly throughout life)
metformin ADR
lactic acidosis is a life threatening condition that may affect those on metformin. (MUDPILES), risk factors for metformin-assoc lactic acidosis: AKI, hypoxemia, sepsis, alcohol abuse, liver failure, radiologic contrast media admin, myocardial infarction and shock. lactic acidosis can set in when someone has surgery and metformin is stopped for extended period. sx of lactic acidosis: abdominal discomfort, decreased appetite, diarrhea, kussmaul respirations, muscle pain, fatigue.
pulmonary embolism blood gas outcomes
leads to hyperventilation which leads to respiratory alkalosis (acute pulmonary emb)
ductus arteriosus is which aortic arch derivative
left 6th aortic arch
the mitral stenosis from rheumatic heart disease usually causes what change to the cardiac structure (i.e. what is enlarged)?
left atrium
left circumflex artery is coming off the
left coronary artery
CO toxicity has what shift in the oxygen hemoglobin dissoc curve
left shift; CO has 250X higher affinity for Hb than O2, so it decreases the O2 carrying capacity of Hb and causes left shift.
the thoracic duct receives all lymphatic drainage from the abdominal viscera and the lymph from this duct is sampled by the
left supraclavicular lymph node. enlargement of this node (virchow's node) may signify an occult abdominal malignancy.
patent ductus arteriosis
left to right shunt. aorta and pulmonary artery stay connected, aorta sends blood to pulmonary artery as well. they get PAH after a while. (eisenmenger syndrome)
kala azar or black disease is the grey discoloration of the skin of the hands, feet, abdomen and face.
leishmania donovani
Weil disease
leptospirosis, which is caused by leptospira interrogans, presents with flu like sx, myalgia (classically of the calves), jaundice and conjunctival suffusion (pink eye w/o the puss). Weil disease is a more severe form of leptospirosis and presents with the additional sx of renal failure and hepatitis.
30 amino acid alpha helical segment that consists of repeated leucine residues at every seventh position
leucine zipper (i.e. transcription factor); binds major groove of DNA. modifies gene expression by turning transcription on or off.
leukemoid reaction: what is it and how to tell it apart from CML
leukemoid reaction is just an increase in white blood cell count because of an infection (not cancer). diff btw it and CML is that in leukemoid reaction, leukocytes alkaline phosphatase (LAP) is high and in CML the LAP is low.
v fib tx
lidocaine (bc it decreases the abs refractory period)
correlation coefficienct
linear relationship of two variables. tells how they correlate (i.e. as one increases the other increases or decreases). it does NOT prove causation!
humoral immunity (B cells) is important in controlling extracellular pathogens. Cell-mediated immunity is key in destroying intracellular organisms such as
listeria monocytogenes
measles, varicella, mumps and rubella vaccines are all
live attenuated vaccines; vs Salk vaccine is an inactivated, killed poliovirus vaccine (can be given to immunocompromised kids)
decrease in blood oncotic pressure can come from
liver failure, or nephrotic syndrome
glut 2
liver, pancreatic Beta cells, renal tubular cells and small intestinal epithelial cells.
I cells
loacted in the duodenum and secrete cholecystokinin, which digests fat and protein.
bupivicaine
long acting amide based anesthetic capable of causing cardiac arrhythmias and hypotension.
NONsegmented virus in sketchy
long ticket roll
RNA hybridization technique causes mRNA to bind to DNA targets but the DNA has loops. why does it have loops
loops in the DNA bc the mRNA already underwent RNA splicing in which introns were removed. the DNA still has introns so those are the loops that have no binding pair
prader willi syndrome is caused by
loss of function of a gene inherited from the father. (i.e. a mutation in the paternal gene and genetic imprinting through DNA methylation). the idsease is characterized by intellectual disability, short stature, hyperphagia, obesity, and hypogonadism.
salivary flow rates: low flow = ; high flow =
low flow = low sodium/Cl, high K/HCO3; high flow = high sodium/Cl, low K/HCO3
lower p value means
lower alpha (type 1) error and therefore lower likelihood that we report a diff when there is none. therefore if p value is lower, we can report significant results with more confidence.
if pt has prominent right uvular deviation, which cranial nerve is damaged?
lower motor neuron of left CN X. the vagus nerve mediates motor innervation of the palatal arches and uvula. An LMN lesion in CN X would cause the uvula to deviate to the side contralateral to the lesion. this is bc CN X innervates the levator veli palatini which ELEVATES the soft palate and if damaged it will droop.
tx for IBS
lubiprostone (stool softener for constipation) (lubes up the colon, so ya poop keeps flowin)
lipid soluble substances are transported via the _ system
lymphatic. the lymphatic system bypasses the liver initially and thus avoids the first pass effect (or first pass metabolism). Fat soluble vit A is then ultimately stored in Ito cells in the liver
aspergillus fumagatus
mold with septate hyphae that branhc at V shaped 45 degree angles. causes aspergillomas (fungus balls). Clinical features of invasive aspergillosis include fever, chills, hemoptysis, shortness of breath, headaches and chest pain. AND aspergillus can infect pre-existing lung cavities from things like sarcoidosis.
tx for refractory depression or atypical depression
monoamine oxidase inhibitors are an older class of antidepressants; ppl on these should avoid tyramine in foods and wine, (cheese and wine) bc excess catecholamines can cause HTN crisis
moa of abciximab
monoclonal antibody against glycoprotein receptor IIb/IIIa on activated platelets, which prevents aggregation of platelets.
schizoaffective disorder
mood episode with concurrent active phase sx of schizophrenia + 2 or more weeks of delusions or hallucinations in the absence of prominent mood sx
anemia of chronic disease
most common cause of anemia in pts with SLE, and presents with normo or microcuytic aneia, with decreased reticulocyte counts.
pleomorphic adenomas
most common parotid tumor and contain multiple cell types, typically epithelial cells in a chondromyxoid stroma.
transitional cell carcinoma
most common tumor of the urinary tract system, and painless gross hematuria is the most common symptom. histo: shows an increased number of epithelial cell layers with abnormal cell maturation from basal to superficial layers.
asthma gross appearance of their lungs
mucoid exudate forming a cast of the airways; bronchial smooth muscle hypertrophy, hyperplasia of bronchial submucosal glands and goblet cells and charcot leyden crystals.
chronic bronchitis
mucus secreting gland hypertrophy and hyperplasia. smoking is risk factor.
ghon complex
multinucleated giant cells and epitheloid cells, assoc with lymphnode involvement. means you have TB. ghon complex consists of caseating granulomas with multinucleated giant cells and epitheloid cells surrounding an area of central necrosis.
mushrooms moa
muscarine toxin in mushrooms is like ipratropium (M3 muscarinic antagonists). vasodilation is mediated by an increased release of nitric oxide by endothelial cells activated by M3 receptors.
KRAS
mutations in KRAS lead to colon, lung and pancreatic cancer
cardiac hypertrophy is characterized by an increased rate of
myosin mRNA synthesis (not mitotic rate bc its hyperTROPHY not hyperplasia)
Orexin
narcolepsy can result from loss of the neuropeptides orexin-A and orexin-B, which are produced in the lateral hypothalamus; these peptides promote wakefulness. Common sx: excessive daytime sleepiness, cataplexy, hallucinations and sleep paralysis.
specific test for mycoplasma pneumoniae infection
nasopharyngeal swab PCR
pyoderma gangrenosum
nasty ulcers that are extraintestinal manifestations of inflammatory bowel disease (i.e. crohns, UC, IBD). Tx: treat the underlying IBD with corticosteroids.
acute hepatitis infection
nausea, vomiting, jaundice, and lab values indicating transaminitis. sero markers confirm diag of acute HBV (s, c, and e antigens). acute HBV most commonly resutls in spontaneous viral clearance without liver failure, although chronic HBV can sometimes develop if the initial infection occurs in a very young pt or the pt is immunosuppressed.
where is the omental foramen/ epiploic foramen of winslow
near the pyloric sphincter on the lesser curvature of the stomach. the omental foramen is partly formed by the hepatoduodenal ligament.
budd chiari syndrome
nearly complete obstruction of blood flow by an acute clot in the hepatic veins or in the IVC, causing centrilobular congestion and necrosis in the liver. It can occur as a result of any hypercoagulable state, including antiphospholipid antibody syndrome and polycythemia vera.
nephroblastoma vs neuroblastoma
nephro: wilms tumor, beckwith wideman syndrome (big tongue, hypoglycemia, big baby (macrosomia), hemi-hypertrophy), from renal mesenchymal tissue (blastema), in the kidney; NEUROblastoma: most common solid tumor in kids, in adrenal medulla, increased VIP secretion, opsomyoclonus (dancing eyes, dancing feet), from neural crest cells.
a genetic defect in aquaporin 2 water channels will cause
nephrogenic diabetes insipidus
ADR of lithium
nephrogenic diabetes insipidus, tremor, hypothyroidism, and ebstein anomaly in the fetus.
calcineurin inhibitors (tacrolimus, cyclosporine) are common immunosuppressive agents used to prevent transplant rejection. ADR is
nephrotoxicity can occur from drug induced arteriolar vasoconstriction, which results in hypertension and a rise in serum BUN and Cr. Long term use can result in obliterative vasculopathy.
most common adverse effect of vinchristine
neurotoxicity (peripheral sensory neuropathy)
incidence
new cases/ (people at risk). people at risk has to subtract out ppl that already have the disease0
firstline tx for UTI in pregnancy
nitrofurantoin; also penicillin or first gen cephalosporin (cephalexin),
how does the 'jugular venous pulse wave tracing' change in a pt with atrial fibrillation?
no 'a' wave bc the atria are not contracting fully or regularly.
SCID
no IL-2. no T cells no thymus
tx for gram positive filamentous rod that causes pneumonia
nocardia - tx: TMP/SMX (sulfa based antibiotic)
generalized lymphadenopathy, weight loss, night sweats
non-hodgkin lymphoma; majority of cases are malignancies of B cells. Exceptions: T cell lymphoblastic leukemia/ lymphoma, mycosis fungoides, and sezary syndrome (which are T cell derived).
down syndrome is due to _ of meiosis _
nondisjunction during anaphase of meiosis I
epinephrine & phenoxybenzamine given together do what
nonselective alpha and beta adrenergic receptor agonist. phenoxybenzamine is a nonselective alpha antagonist. When theyre given together, a net decrease in blood pressure occurs as a result of unopposed beta 2 agonism by epinephrine (bc epinephrine is a beta 2 agonist at small doses)
congenital deficiency of dopamine beta hydroxylase will impair synthesis of
norepinephrine and epinephrine and lead to impaired sympathetic adrenergic activity (i.e. orthostatic hypotension)
what is the sodium level in ppl on loop diuretics
normal bc ADH kicks in to normalize sodium
HCM and/or LVH can cause exertional angina despite having
normal coronary arteries (i.e. no atherosclerosis)
moa of topical tretinoin for acne
normalizes follicular keratinization; its a vit A analog that binds intranuclear receptors, which then acts as a transcription factor. In patients with acne, retinoids decrease sebum production and increase cellular turnover and the shedding of cells from the stratum corneum. This reduces hyperkeratinization, opens blocked pores and prevents formation of microcomedones.
p53
normally: blocks the G1->S transition (holds cells in G1 phase) (its a tumor suppressor gene)
ehrlichia chaffeensis
obligate intracellular gram negative species of rickettsiales bacteria. tick vector (lone star). dogs are vector. sx: fevers, headaches, malaise, myalgias. Macular, maculopapular, and/or petechial rash may occur on the trunk, legs, arms or face. Blood may also show berry-like cytoplasmic inclusions in macrophages or monocyte. tx: doxycycline
x linked recessive disorders
oblivious female will often give her boys her x-Linked disorders
sampling bias
occurs if factors unrelated to the aim of the study distinguish the subjects from the rest of the population so that the results of the study cannot be generalized.
retroperitoneal hematomas
often bc of trauma. can go unnoticed until its bled so much that it compresses nearby structures (i.e. aorta, IVC, duodenum, pancreas, adrenal glands, kidneys, ureters, colon and nearby nerves - L2-L4 nerve roots of the femoral nerve
chronic myelogenous leukemia
older person, weight loss, lots of leukocytes, monocytes, basophils, etc, splenomegaly (BCR ABL enzyme), (9,22)
pt with severe burns, which drug do you give them to prophylactically prevent stress ulcers
omeprazole, these are called curling ulcers and they are stress ulcers assoc w severe burns. the loss of plasma volume results in mucosal ischemia and necrosis.
HTLV-1 (human T cell lymphotrophic virus)
oncogenic virus that causes adult T lymphocute leukemia, and is also respinsle for HTLV-1 assoc myelopathy, characterized by myelin destruction within the spinal cord and brain. It manifests with a gradual, unremitting course that includes lower extremity weakness, back pain, urinary incontinence, and eventual spastic paraplegia.
live attenuated/ oral vs killed/ inactivated vaccine
oral vaccine = live attenuated. killed = it cannot revert to a virulent form
joint space narrowing in the knee
osteoarthritis
lytic bone changes and periosteal elevation
osteomyelitis (infection of bone)
RB mutations pts are at risk for what cancers later in life
osteosarcoma and retinoblastoma
hereditary retinoblastoma at increased risk for
osteosarcoma later in life (compared to sporadic acquisition of the two mutations) in hereditary you inhereit one mutation and acquire another
defect in acid maltase, that primarily affects the heart in a 5 month old. has cardiomegaly sx (breathlessness, peripheral edema, fatigue, palpable liver)
pompe disease (type 2 glycogen storage disease)
pontine hemorrhages cause pinpoint pupils, loss of horizontal gaze, guadriparesis, decerebrate posturing, and rapidly evolving coma that culminates in death within hours.
pontine hemorrhage is one of the things that causes horner syndrome.
anterior/ posterior dislocations of the knee joint: what structure is most at risk for damage
popliteal artery bc its fixed to the back of the knee.
which veins are backed up in the portal hypertension that causes esophageal varices?
portal vein is backed up into the left gastric vein into the esophageal veins/ azygos veins.
child <15 months old displays what qualities
positive babinski (upgoing great toe with fanning of the other toes) (shows until 12 mo), stranger anxiety (begins at 7 mo), mature 'pincer' grasp and ability to stand (begins at 10 mo)
if you see eosinophil casts and they have renal problems following recent medication exposure
possibly acute interstitial nephritis
if radial and axillary nerve stuff is damaged, its a lesion at the
posterior cord of the brachial plexus
most common etiology of bilateral fetal hydronephrosis in boys
posterior urethral valves; caused by an embryological defect that leads to a persistent obstructing urogenital membrane at the junction of the bladder and urethra. (i.e. a membrane remnant)
molluscum contagiosum
pox virus (small pox, cow pox, molluscum contagiosum); histo: eosinophilic cytoplasmic inclusions (molluscum bodies).
Whipple disease
presence of numerous foamy macrophages in the lamina propria of the small intestine on histo. H&E stain shows vacuolated macrophages, which contain partially digested Tropheryma whipplei bacteria. sx: unintentional weight loss, joint pain, diarrhea.
non-classic congenital adrenal hyperplasia
presents during adolescence when androgen levels increase. Sx: in females includes primary amenorrhea, hirsutism, clitoromegaly, and delayed development of secondary sexual characteristics. pts with non-classic CAH can have up to 50% of normal 21-hydroxylase activity. They present later in life with milder sx.
VHL disease
presents with hemangiomas in the retina, medulla and cerebellum. its assoc with a greatly increased incidence of bilateral renal cell carcinoma.
zollinger ellison syndrome
presents with multiple gastric and duodenal ulcers, diarrhea, and epigastric pain. It is caused by a pancreatic gastrinoma, a gastrin-secreting tumor that induces parietal cells itn eh stomach to secrete acid. Gastrin is normally produced in the G cells of the stomach.
bronchiectasis
presents with purulent cough, hemoptysis, sx of infection, and rales and rhonci on auscultation. Assoc with hx of cystic fibrosis, given the stasis of mucus in the lungs, which can serve as a breeding ground for pathogens.
if pt has urine osmolality that gets up to 300-500 with water deprivation, and they have excessive water intake with polyuria, its
primary polydipsia/ psychogenic polydipsia
radiation exposure is the most important risk factor for
primary thyroid malignancy (i.e. papillary thyroid carcinoma)
pt has brown urine and has hyperlipidemia
prob on a statin drug inducing rhabdomyolysis.
glucosuria, phosphaturia, amino aciduria
problem with reabsorption at the PCT, therefore its Fanconi syndrome which has led to type 2 RTA
the regenerative nodules (i.e. spherical ndoules within the confines of fibrous septae) see in liver cirrhosis are composed of
proliferating hepatocytes
prostacyclin endothelin
prostacyclin: vasodilator; endothelin: vasoconstrictor
warfarin induced skin necrosis is a risk in pts with
protein C or S deficiency (some ppl have hereditary protein C deficiency) protein C is decreased early on in warfarin admin which is the risk factor here
psoriasis on histo
psoriasis (gross) is silver scaling plaques on felxural areas with pinpoint bleeding with scraping of the plaques. Histo: increased stratum spinosum and decreased stratum granulosum.
CML
pts with CML have marked leukocytosis and a peripheral blood smear showing myeloid cells in various stages of development. DIC is often a prequel to blast crisis and is seen in all types of leukemia.
pt is post-meno, on hormone replacement therapy and feeling good. what are her thyroid hormone levels like
pts with increased estrogen (i.e. hormone therapy) have increased thyroxine binding globulin (TBG) levels. these increased TBG levels lead to an overall increase in total T4/T3 in the setting of normal TSH and normal free T3/T4. called euthyroid hyperthyroxinemia.
severe pancreatitis
pts with severe pancreatitis are at an increased risk for developing acute respiraotry distress syndrome (ARDS). ARDS is assoc with decreased PaO2/FiO2 ratio, bilateral infiltrates on chest x ray study and NO clear signs of cardiac dysfunction (normal pulmonary capillary wedge pressure).
cardiac conduction velocity
purkinje>atria>ventricles>bundle of His>AV node
supinator muscle is innervated by
radial nerve (deep branch of the radial nerve)
Raloxifene vs tamoxifen
raloxifene (relax): SERM, estrogen agonist at bone, (inhibits osteoclasts) and anatagonist at breast and uterus. Tamoxifen: SERM with antagonist at breast, and agonist at uterus and bone (higher risk for endometrial cancer)
acetyl CoA carboxylase
rate limiting enzyme for fatty acid synthesis (acetyl CoA to malonyl CoA)
in viruses, they mix genomic segments with other segmented viruses via
reassortment; i.e. this is responsible for major antigenic shifts resp for pandemics of influenza A
tx for renal cell carcinoma
recombinant IL-2 (aldesleukin) promotes the proliferation, differentiation and recruitment of lymphoid cells. It is used to treat RCC, and is thought to promote immune-mediated antitumor effects.
cohort study
relative risk
"risk of influenza in those who received the vaccine relative to those who received placebo" is an example of a q asking for _
relative risk (RR)
reliability and validity
reliability = precision (reproducibility). validity = accuracy (trueness of measurements)
smaller vessels have greater
resistance
methicillin resistant staph vs sensitive (tx)
resistant: vancomycin; sensitive: penicillin
idiopathic pulmonary fibrosis
restrictive lung disease that results in collagen deposits and hypoxia; "honeycombing appearance on imaging". prolonged hypoxia leads to increased EPO and hematocrit.
obesity is assoc with what type of lung change on pft's
restrictive pattern, due to reduced chest wall compliance.
case control:
retrospective look for risk factors in two groups.
erythema marginatum
rheumatic heart disease
HLA DR4
rheumatoid arthritis, DM type 1, addison disease (4 walls in 1 rheum)
right vs left recurrent laryngeal nerve loops around:
right: loops around right subclavian artery; left: loops around aortic arch distal to ductus arteriosis.
relative risk is
risk of affected/ risk of placebo
4 day fever of 104 degrees then they get a rash when fever goes away
roseola (ro-SIX-ola, 6th disease), rash that spares the face
bursitis vs tendonitis
rotator cuff tear: painful arc, drop arm sign, weakness in external rotation. bursitis: tenderness over the greater trochanter. Difficulty in abduction may occur (above 70-100 degrees).; Adhesive capsulitis = active and passive ROM are decreased similarly. ; if normal passive ROM = tendonitis
malignant plasma cells in multiple myeloma, have abundant
rough endoplasmic reticulum so they can make the excess immunoglobulin.
kid with rash and postauricular lymphadenopathy, and has no vaccinations
rubella virus (measles)
in pts with impaired renal or hepatic function, how do you alter the loading and maintenance doses of their drugs?
same loading dose, lower maintenance dose
stage 1 vs 2 of schilling test
schilling test tests levels of intrinsic factor. stage 1: pts given B12 without intrinsic factor - if pernicious anemia: they do not absorb the B12 bc they dont have IF. stage 2: given B12 WITH intrinsic factor, and they absorb it.
DIC on peripheral smear
schistocytes (helmet cells)
calcifications in the bladder wall
schistosomiasis (parasite)
uremic platelet dysfunction
seen in the setting of renal insufficiency, where unfiltered uremic toxins cause poor platelet function. The condition is characterized by an increased bleeding time in the setting of a normal platelet count and normal PT/aPTT.
most common testicular tumor
seminoma (germ cell tumor) (fried egg cells)
sensorineural hearing loss vs conductive hearing loss in old ppl
sensorineural hearing loss (loss of hair cells - this is the more common form in old age); vs conductive hearing loss (otosclerosis)
catalase positive organisms
serratia marcescens, burkholderia cepacia, aspergillus fumigatus
SCID
severe combined immunodeficiency disease; sx:hx of failure to thirve, and recurrent infections with viruses, fungi, protozoa and parasites in a kid. also low lymphocyte count and absence of a thymus. a deficiency of adenosine deaminase can lead to SCID.
during an acute pain episode in sickle cell crisis, what is the O2 Hb dissoc curve
shifts to the right bc deoxygenated HbS forms polymer that has less affinity for oxygen.
AAA repair puts what part of GI at risk for ischemia
sigmoid colon bc its supplied by IMA which is commonly affected by AAA's and therefore can be affected despite collateral circ.
RSV
single stranded, non-segmented, negative sense enveloped RNA virus (most common cause of bronchiolitis in children <1 year of age)
which is NOT assoc with a pancoast tumor
small cell carcinoma
lambert eaton myasthenic syndrome is assoc with which lung cancer
small cell lung cancer
squamous cell carcinoma: major risk factor
smoking
lipid and membrane biosynthesis happen where
smooth endoplasmic reticulum
beta blockers decrease which ions
sodium and calcium (reducing the slop opf phase 4 and 0) decreases cAMP first. this is how they slow arrthythmias (AV nodal conduction is slowed)
as the rate of salivation increases, less
sodium is reabsorbed and less potassium is secreted. In this condition, salivary sodium will be increased while potassium will be decreased relative to normal salivary electrolyte levels. Normally: ductal cells reabsorb sodium and chloride and secrete potassium and bicarbonate. the final composition of saliva is normally hypotonic to plasma.
anticonvulsant meds like valproic acid can cause which birth defect
spina bifida occulta
most likely type of bone fracture in child abuse
spiral fracture; (caused by a twisting rotational force to the bone)
outcome of a ganglion cyst
spontaneous regression
pancoast tumors are most often
squamous cell carcinomas
renal amyloidosis
stains with congo red and demonstrates apple green birefringence under polarized light
bed bugs can cause infection with
staph aureus
strep pyogenes vs staph aureus on histo
staph aureus: cocci in clusters; pyogenes: cocci in chains
signaling cascade that leads to smooth muscle contraction
starts with influx of Ca from extracellular fluid, followed by binding of Ca to calmodulin (CaM) which forms a complex that then activates (phosphorylates) MLCK (myosin light chain kinase). MLCK phosphorylates the myosin light chains, which triggers the formation of the cross bridge and subsequent contraction.
erythema multiforme
stevens johnson syndrome
weibel palade bodies
store von willebrand factor and P-selectin (cell adhesion molecule) (involved with platelet stuff)
which layer of the epidermis does a benign nevus come from?
stratum basalis; nevus cells are derived from melanocytes, which are respinsible for producing melanin. They are distributed variably between the columnar cells of the stratum basalis.
migratory serpiginous perianal rash
strongyloides stercoralis. check stool for larvae
serpiginous rash, chronic cough, eosinophilia, pt is from southeast asia
strongyloidiasis is a parasitic infection that presents with chronic rash, cough and eosinophilia. Infection can be confirmed via microscopic examination of stool for rhabditiform larvae or via a serum ELISA test.
mutated gene that has same number of amino acids as that of the wild type gene.
substitution of one amino acid for another (i.e. a point mutation resulting in amino acid substitution aka a missense mutation).
tx for child with PSGN
supportive care only bc it will resolve on its own
pain with overhead motion of arms, and pain is worst with internal rotation of the shoulder. what muscle
supraspinatus (empty can test)
fever, maculopapular rash, and peripheral eosinophilia and acute onset of renal failure
sx of acute interstitial nephritis (following a recent medication exposure)
sx of and tx for beta blocker overdose
sx: cardiogenic shock, i.e. pale and cool extremities, bradycardia, hypotension. tx: glucagon
coccidiodes immitis
sx: dyspnea, cough, fever, unintentional weight loss, night sweats, and joint pain. Infection is seen in immunocompromised pts or the elderly and is in southwestern US. histo: sphere that is larger than a red blood cell and filled with endospores.
sweating is (symp/ parasymp)
sympathetic (but uses ACh aka muscarinic receptors)
androgen binding protein
synthesized by Sertoli (FSH) cells of the seminiferous epithelium and secreted into the seminiferous tubule lumen. ABP maintains the hgih local concentration of testerosterone necessary for normal sperm production and maturation. (i.e. without ABP you would have normal circulating testosterone levels but low testosterone in the seminiferous tubules)
patients with complement deficiencies (i.e. C1q, C4 and C2) are more likely to have
systemic lupus erythematosis bc they cant remove immune complexes.
fatigue, weight loss, migratory joint pains, female, joint inflammation, normocytic anemia, increased Cr, UA: blood and protein, spherocytes on periph smear
systemic lupus erythematosus with assoc normocytic anemia and glomerulonephritis
polyarteritis nodosa
systemic necrotizing vasculitis of small to medium sized arteries that spares the vasculature of the lungs. Transmural inflammation of the arteries with fibrinoid necrosis is seen on histo.
which portosystemic anastomoses are affected by portal hypertension
systemic vein: portal vein: consequence/sx --- esophageal veins:left gastric vein: esophageal varices; middle&inferior rectal veins:superior rectal vein: hemorrhoids; veins of the posterior abdominal wall: veins draining secondarily retroperitoneal structures: retroperitoneal bleed; superficial epigastric vein: paraumbilical veins: caput medusa
post-splenectomy: what type of RBCs will you see
target cells and howell jolly bodies bc of the loss of splenic macrophages
G CSF (filgrastim)
targets CD34+ cells (stem cells) to induce them to become granulocytes.
prosencephalon->telenceph and dienceph mesencephalon-> rhombencephalon->metencephalon and myelencephalon
telenceph: cerebrum and lateral ventricles (telemetry w your cerebrum); dienceph: thalamus and 3rd ventricle; (DieT) mesenceph: midbrain; metenceph: pons, cerebellum, upper 4th ventricle; (meet me at the pond, bella) myelenceph: medulla
jaw pain with granulomatous inflammation and multinucleated giant cells =
temporal arteritis. tx = prednisone
tension pneumothorax vs obstructive lesion of the mainstem bronchus
tension pneumo: trachea deviates AWAY from the pneumothorax; obstructive lesion: trachea deviates TOWARD obstructed side
DHR (dihydrorhodamine test)
test for chronic granulomatous disease (in CGD, it makes less green flouresence)
nitroblue tetrazolium test
test for chronic granulomatous disease (its negative in CGD).
a rapid increase in the secretion of what substance causes acne vulgaris in teens?
testosterone/ androgens
cyanosis that worsens with feeding, crying or exercise (infant).
tetralogy of Fallot. in older children, they squat to improve pulmonary blood flow
HR from RR interval
the R-R interval is seconds/beat. The inverse is beats per second and can be multiplied by 60 to get beats/min aka HR.
Receiver operating characteristic curves can be produced by plotting the sensitivity (true positive rate) against 1 - specificity (false positive rate). the area under the ROC curve represents
the accuracy of the test
the hepatoduodenal ligament contains
the common bile duct, the hepatic artery, and the hepatic portal vein. neoplasia in this area may disrupt the hepatobiliary system, resulting in jaundice.
st john's wort
the compounds in St johns wort inhibit neurotransmitter reuptake, which is amplified when taken in conjunction with an SSRI.
Hartnup disease
the defective transporter is expressed in both the urinary and GI tracts and results in loss of the neutral amino acids (i.e. tryptophan). Niacin deficiency, or pellagra, can develop as a result of reduced absorption of tryptophan, a precursor for niacin synthesis in the liver.
what is the continuation structure of the umbilical vein in the fetus' liver
the ductus venosus (dumps into the IVC)
globus sensation
the feeling of a lump in the throat without acompanying physical, endoscopic or radiologic findings of esopahgeal obstruction
umbilical vein and arteries are named in relation to
the fetus. I.e. the vein is supplying oxygenated blood TO the fetus and the arteries are delivering waste/ deoxygenated blood AWAY from the fetus.
the median nerve doe which lumbricals
the first and second lumbricals
phenylketonuria (PKU)
the genetic mutation that causes PKU results in the dysfunction of the enzyme phenylalanine hydroxylase and a subsequent increase in phenylketones. Tx: decrease phenylalanine in diet and increase tyrosine and thus prevent intellectual disability.
in a bimodal distribution
the mean is equal to the median and there are two modes
never event
the medical errors that should never happen. For an event to be classified this way, it should be serious, largely preventable and of concern to both the public and healthcare providers for public accountability (i.e. a sponge in the body cavity after a surgery)
which layer surrounding nerves in the PNS is the major permeability barrier between the blood and the nerve?
the perineurium
the increase in parathyroid hormone production in chronic kidney disease (secondary hyperparathyroidism) is caused by
the reduction in phosphate excretion.
if right hemidiaphragm is above left on an inspiratory chest x ray
the right phrenic nerve is damaged
Km is defined as
the substrate concentration at which half of the active sites are filled (i.e. Vmax/2)
pancoast tumor
the sympathetic nerve fibers of the inferior cervical or stellate ganglion may be compressed by pancoast tumors, leading to horner syndrome (unilateral ptosis, miosis, and anhidrosis). Pancoast tumors may cause hoarseness. In addition, a right sided pancoast tumor may cause SVC syndrome.
macrocytic anemia: folate deficiency: moa of tetrahydrofolate
the tetrahydrofolate form of folate functions as an intermediate in the "transfer of 1-carbon units", which is important for purine synthesis.
if the gallstones are radiopaque (i.e. white/ you can see them) on x ray film
they are pigmented gallstones, which are composed of unconjugated bilirubin. (cholesterol stones are radiolucent)
if pt is IV drug user and has negative PPD but has hemoptysis, fatigue, weight loss, and dry skin...
they might have HIV as well as TB and the HIV is preventing them from having a positive TB test, even though they have TB.
macrolides moa
they work by binding the 23S rRNA of the prokaryotic 50S ribosome, effectively blocking the translocation step of protein synthesis and are indicated as first line tx for M. pneumoniae. Methylation of the 23S rRNA in resistant bacteria diminishes the binding of macrolides.
maple syrup urine disease can be caused by what besides a deficiency in alpha ketoacid dehydrogenase (the enzyme that breaks down isoleucine, leucine and valine)
thiamine deficiency (B1RANCES) bc B1 is cofactor for that enzyme
systemic sclerosis: two types: diffuse cutaneous systemic sclerosis (extensive skin sclerosis) and limited cutaneous systemic sclerosis which presents with
thickening of the skin and hands and face leading to CREST syndrome. 60% of CREST syndrome pts have pulmonary arterial hypertension which is causes by hyperplasia of intimal smooth muscle layer of pulmonary arteries and subsequent increased pulmonary vascular resistance.
pt has fever jaundice and upper right quadrant pain
this is charcot triad and is therefore (ascending) cholangitis (infection of biliary tree usually due to obstruction that leads to stasis/ bacterial overgrowth).
cystathionine synthase deficiency
this is the enzyme that converts homocysteine to cystathionine to cysteine. it is a cause of homocysteinuria (kyphosis, intellectual disability, marfanoid, lens sublux down and in)
absence of thymic shadow in child, no tonsils, low T and B cell count, recurrent diarrhea and failure to thrive
this type of severe combined immunodeficiency (SCID) is characterized by lack of T and B lymphocytes and low Ig levels resulting from deficiency in adenosine deaminase.
abnormal grieving sx
thoughts of being better off dead (i.e. suicidal thoughts)
unstable angina is mediated by
thromboxane A2 (platelet aggregation -> incomplete occlusion -> ischemia ->pain in chest)
COX-1 synthesizes
thromboxane A2(TXA-2) from arachidonic acid. Therefore, aspirin and other COX-1 inhibitors reduce CV risk of platelet aggregation and clots via inhibiting this.
aspirin toxicity includes
tinnitus
drugs known to cause disulfiram like reactions when taken with alcohol
tolbutamide (long acting first gen sulfonylurea), metronidazole, griseofulvin, chloramphenicol, chlorpropamide, and some cephalosporins
submandibular lymphadenopathy, has squamous cell carcinoma in it. Where is the primary site of the cancer
tongue; bc most head and neck SCC's are from tobacco/ alc and they start in the mouth somewhere.
if kid has yellow skin but his eyes are nonicteric (and everything else is normal too) its
too much carotene in diet (i.e. its in carrots and it is a orange/ red pigment)
bacitracin
topical antibiotic that is highly effective against gram positive bacteria; it works by inhibiting bacterial wall synthesis. It is most commonly administered topically, rather than systemically, because of its harsh nephrotoxic effects.
quinidine (antiarrhythmic) ADR
torsades de pointes
tx for tourette syndrome and for intractable tourette's
tourette syndrome is cahracterized by rapid, recurrent, involuntary motor and vocal tics that persist for at least 1 year. tx: psychoeducation, behavioral therapy. for intractable tics: atypical (SGA) antipsychotics (risperidone) or high potency antipsychotics (Hal Tries to Fly High), or alpha 2 agonists, or tetrabenazine
outdoors; raised erythematous spots and streaks in the affected areas.
toxicodendron species exposure (poison ivy), causing a type IV HSR.
C diff is diag via
toxin assay
cellular differentiation is determined by the
transcription factors within an individual cell. All nucleated cells in humans possess the entire genome, but tissue specific transcription factors allow only for the expression of genes that are relevant for a particular cell type. Transcription factors can also induce cellular DE-DIFFERENTATION, causing terminally differentiated cells to revert to less specialized forms.
amaurosis fugax
transient loss of vision in one or both eyes, which can last from seconds to hours. It has been assoc with several etiologies but is due to underlying ischemia affecting the eye.
spermatocele
transilluminates. benign, cyst due to dilated epididymal duct or rete testis.
egg on a string heart
transposition of the great vessels
mast cell degran (histamine release) can be triggered by foreign antigens and
trauma
patau syndrome
trisomy 13; holoprosencephaly, cleft lip/ palate, microphthalmia (small eyes), cutis aplasia, inte dis, polydactyly, congenital heart disease, and rocker bottom feet. The first trimester screen combines the blood tests for PAPP-A and hCG, an ultrasound exam and screens for trisomy 13, trisomy 18 (edwards syndrome) and trisomy 21 (down syndrome).
edwards syndrome
trisomy 18, flexed fingers w overriding digits, narrow cranium with prominant occiput, and congenital heart anomalies (i.e. VSD)
whipple disease
tropheryma whipplei. sx: weight loss, diarrhea and arthralgias. intestinal biopsy reveals PAS staining macrophages in the lamina propria.
what do you find in stool samples of pts who have giardia lamblia
trophozoites.
developmental delay and multiple benign tumors in brain, eyes, skin and other organs
tuberous sclerosis
why is there hyponatremia in DKA
two reasons: serum sodium is decreased bc of the osmotic activity of glucose (serum sodium drops 1.6 for every 100 mg rise in blood glucose); and bc of the hyperglycemia induced osmotic diuresis which results in sodium and free water losses.
EDTA (ethylenediaminetetraacetic acid)
tx for lead poisoning
MG is a _ HSR
type 2 HSR
autoimmune hemolytic anemia is a
type 2 HSR (IgG to RBCs). spherocytosis, increased reticulocyte count, and a positive direct antiglobulin (coombs) test are suggestive of AIHA in pts with SLE
the type of ehlers danlos (stretchable skin) that causes ruptured berry aneurysms leading to subarachnoid hemorrhage
type III collagen gene mutation (vascular type of ehlers danlos syndrome)
poison ivy is which type of HSR
type IV HSR (CD4 T cells)
availability heuristic
type of cognitive bias where people rely upon immediate examples that come to their mind. In medicine, physicians can wrongfully apply this to pts if they do not properly asses each one
which amino acid can be synthesized by the body (and therefore is not essential) but can BECOME essential in a certain disease
tyrosine is made from phenylalanine normally. in PKU they dont have phenylalanine hydroxylase and cant make tyrosine (sx: int dis, seizures, musty body odor)
tyrosine kinase vs jak stat moa
tyrosine kinase: ligand binding causes formation of receptor dimers; jak stat: ligand binding causes translocation to nucleus
levodopa can cause autoimmune hemolytic anemia leading to an increase in
unconjugated (indirect) bilirubin
cancers in the upper two-thirds of the esophagus are most likely _ whereas cancers in the lower third are most likely _ evolved from _. antibodies against _ can be used to detect the latter
upper 2/3rds is squamous cell carcinoma and lower third is adenocarcinoma evolved from barrett esophagus. antibodies against cytokeratin can be used as an immunohistochemical stain to detect adenocarcinoma of the esophagus.
old person with urinary incontinence gait disturbance and dementia.
wet wacky and wobbly. normal pressure hydrocephalus. if severe, tx is ventriculoperitoneal shunt
most common moa of acute mesenteric ischemia for old ppl
when an artery (like SMA or IMA) is blocked by embolic events (i.e. arterial sided thrombus occluding vessels), acute mesenteric ischemia occurs. This presents with severe abdominal pain taht is out of proportion to physical findings. Atrial fibrillation and atherosclerotic disease are predisposing factors. Vs. Chronic mesenteric ischemia is due to atherosclerosis producing angina when ppl eat.
fishbone diagram
when sentinal events occur, such as mistakes that lead to the death of a pt, a root cause analysis is confucted in order to identify the mistake and prevent it from occurring again in the future. A fishbone diagram, which visualizes contributors to a never event, is a useful tool to help guide the root cause analysis.
WAGR syndrome
wilms tumor, aniridia, genital anomalies, retardation
wiskott aldrich syndrome
x linked recessive, recurrent pyogenic infections, thrombocytopenia, purpura, and eczema. (WATER: WA: thrombocytopenia, eczema, recurrent infections)
becker muscular dystrophy
x-linked recessive disorder, presents with muscular weakness between the ages of 5-15 years. Although most pts with duchenne muscular dystrophy die before the age of 30, the majority of pts with becker muscular dystrophy die btw the ages of 40 and 50, typically from heart failure or respiratory failure.
defect in correcting pyrimidine dimers
xeroderma pigmentosum
does sublingual nitroglycerin affect heart rate?
yes, the decrease in left ventricular volume causes a reflexive increase in heart rate (but still decreases O2 demand of heart)
at 8 weeks gestation, the fetus is still separate from the
yolk sac (it becomes the gut)
zafirlukast vs zileuton
zafirlukast: leukotriene receptor blocker (maintenance therapy for chronic asthma) (LTD4 receptor antagonist); zileuton: tx of chronic asthma, inihibits the 5 lipoxygenase pathway and blocks conversion of arachidonic acid to leukotrienes. (inhibits leukotriene production)
the test to screen for celiac disease
celiacs is an autoimmune disease caused by autoantibodues directed agiasnt gliadin, an epitope found in gluten. An IgA transglutaminase antibody assay is recommended as part of initial diagnostic work up. Endoscopic biopsy of the duodenal mucosa confirms the diagnosis.
transformation
cell takes up DNA from donor cell.
VEGF inihibitors (bevacizumab) can treat
wet macular degen, colon/lung/breast cancers
what is another way to express odds ratio besides (a/c)/(b/d) ?
(AxD)/(BxC)
antigenic shift vs drift
(Doktor drift): changes based on random mutation in HA or NA genes; (Night S_ift): reassortment of viral genome segments such as when segments of human flu A virus reassrot with swine flu A virus. Sudden shift is more deadly than gradual drift.
tx for prostate cancer
(for late stage): leuprolide and flutamide
IPEX
(immunodysregulation polyendocrinopathy enteropathy X-linked); mutation of FOXP3 gene which is a regulator for the Regulator T cell lineage. It leads to the dysfunction of regulatory T cells and the subsequent autoimmunity.
ToRCHeS infections
(toxo, rubella, CMV, HIV, Herpes, Syphilis)
moa of dantrolene
(tx for neuroleptic malignant syndrome) inhibits calcium release from the sarcoplasmic reticulum of skeletal muscle (i.e. inhibits the RyR/ ryanodine receptors)
BMI calculation
(weight in kg)/ (height in meters squared). (may need to multiply that answer by 10,000) 18.5 - 24.9 is normal
equation for filtration fraction
FF = GFR/RPF; RPF = RBF x (1 - Hct) therefore FF = GFR/ [RBF x (1 - Hct)]
mid face hypoplasia, shortening of limbs, head circumference in the 90th percentile, hands have space between the 3rd and 4th digits
FGFR3 gene mutation (achondroplasia)
obstructive lung disease PFT
FRC, RV and TLC are increased in obstructive (decreased in restrictive)
most common cause of hereditary aplastic anemia. inherited bone marrow failure syndrome in which cells are at increased susc to chromosomal breakage due to defects in DNA repair. It is characterized by pancytopenia, predisposition to malignancy and physical abnormalities including short stature, microcephaly, developmental delay and cafe au lait skin lesions.
Fanconi anemia
risk of exposure to aflatoxin is greater where? causing increased incidence of what
africa and asia (bc its assoc with grains and peanuts) and it carries aspergillus fumigatus infection
postpartum endometritis
C section is most important risk factor for this due to intro of mcirobial organisms into incised uterus. sx: fever, leukocytosis, uterine tenderness, and foul-smelling vaginal discharge (from bacterial vaginosis, etc)
AIDS infections: <200 CD4 <150 <100 <50
<200 CD4: p jiroveci (TMP SMX) <150: histoplasmosis (itraconazole) <100: toxoplasma (TMP SMX) <50: MAC (azithromycin)
major depressive disorder
>2 weeks
MDD with peripartum onset
>2 weeks of blues. tx with SSRI or CBT
x intercept of lineweaver burk plots is
-1/Km (bigger Km means the x intercept moves closer to zero)
chlorpropamide and tolbutamide
-amide = maid outfit on swan in sketchy. first generation sulfonylureas that can cause a disulfiram-like reaction when taken with ethanol. Patients typically present with vomiting, flushing and tachycardia.
pt has retinal hemorrhages and cotton wool spots and has low CD4 cell count
.cytomegalovirus retinitis. tx with ganciclovir, or foscarnet
homocystinuria results in intellectual disability, marfanoid habitus, and lens subluxation. Untreated homocysteinuria increases patient's risk for thromboembolic events in the third decade of life. the three types of homocystinuria are:
1. cystathionine synthase deficiency (this enzyme uses vitamin B6 as a cofactor), 2. decreased affinity of cystathionine synthase for pyridoxal phosphate and 3. methionine synthase deficiency (uses B12 as a cofactor)
intracerebral neoplasms can raise the intra-cranial pressure through two major mechanisms
1. disruption of the blood brain barrier and 2. obstruction of normal CSF flow. ; disruption of the BBB leads to vasogenic edema which causes the increased ICP.
NNH
1/AR; AR = [a/(a+b)]-[c/(c+d)] AR = attributable risk (difference in risk between exposed and unexposed groups)
accessory spleen
10% of ppl have another small spleen. after splenectomy, these ppl will still be able to process RBC's, etc
hypertension in CAH suggests
11 beta hydroxylase def or 17 alpha hydroxylase def
phase I vs II drug trials
1: tested in disease free volunteers for ADRs. 2: in pts with the disease
1/2 meat LOAF
1st and 2nd lumbricals, median nerve innervates them and the opponens pollicis, abductor pollicis brevis, and the flexor pollicis brevis
which congenital adrenal hyperplasia is similar to the effects of hypovolemic shock on renin?
21 hydroxylase deficiency
syncopal episodes are included in which CAH
21 hydroxylase deficiency bc they get hypotension due to lack of GC's and MC's. 11 beta hydroxylase def is hypertension (due to increased MC's)
alcohol withdrawal sx by time
3-36 hours: tremors, diaphoresis; 6-48 hours: withdrawal seizures; 12-48 hours: alcoholic hallucinosis; 48-96 hours: delirium tremens
DNA polymerase synthesizes DNA strands in a
5' to 3' direction, therefore new nucleotides are added only to the 3' hydroxyl end of the elongating strand (and it reads the template in a 3' to 5' direction)
DNA pol III
5' to 3' synthesis of complementary DNA (requires an RNA primer to initiate synthesis)
kid has stranger anxiety, able to roll over, hold a sitting position unassisted, pass toys from hand to hand and babble. how old?
6 months old (parents start observing (infant 0-12 mo); child rearing working (toddler, 12-36 mo); dont Forget, they're still Learning (preschool, 3-5 yr old)
drugs that reduce mortality in HF (i.e. prevent remodeling)
ACEI's, beta blockers, ARBs, aldosterone antag, hydralazine,
familial hypercholesterolemia
AD, defect in LDL receptor, high LDL, accel atherosclerosis
hypertriglyceridemia
AD, overprod of VLDL, increased TG's, pancreatitis
peutz-jeghers syndrome
AD, pigmented mucocutaneous macules and hamartomatous polyps in the GI tract. progressive growth can lead to malignant transformation.
peutz jeghers syndrome
AD, pigmented mucocutaneous macules and multiple hamartomatous polyps in the GI tract. hyperpigmented mouth, lips, hands and genitalia.
AML vs ALL on histo
AML: granules in cytoplasm, old person; ALL: kid, no granules in cytoplasm
hyperchylomicronemia
AR, defect in lipoprotein lipase or ApoC2, increased TG's, pancreatitis
dysbetalipoproteinemia
AR, defective ApoE, increased chylomicrons, premature atherosclerosis
strict vegan diet for years is at risk for
B12 deficiency
pt has tongue with glazed appearance (i.e. glossitis), megaloblastic anemia, and paresthesias. They are without a weird travel history or a restrictive diet so that means its prob _ caused by _
B12 deficiency caused by pernicious anemia
scleroderma
african american women, atrophy of smooth muscle of lower two thirds of the esophagus and incompetent lower esoph sphincter leading to reflux.
decreased LAP
CML
what type of liver dysfunction do azoles cause
CYP450 inhibition
how does isoniazid interact the cyp system
CYP450 inhibitor
aortic stenosis increases the
afterload on the heart
most significant risk factor for osteoarthritis
age; osteoarthritis is a chronic condition characterized by the progressive erosion of articular cartilage and is most common with advancing age.
fibrinolysis in DIC increases
D-dimer
which DNA polymerase removes the RNA primers and synthesizes new DNA in their place
DNA polymerase I
where do DNA vs RNA viruses replicate in relation to the cell architecture
DNA viruses (except for poxvirus) replicate in the nucleus. RNA viruses (except for orthomyxovirus and retrovirus) replicate in the cytoplasm.
how to diag small bowel obstruction on radiography
air-fluid levels
ARP and class I antiarrhythmic drugs
Different class I drugs can affect the absolute refractory period (ARP). A class IA drug will prolong the ARP because it increases the action potential (AP) duration. A class IB drug will decrease the AP and therefore decrease the ARP. A class IC drug will not change the ARP. Regardless of ARP action, all class I drugs decrease the slope of phase 0.
what substance can potentiate the effects of benzodiazapines
alcohol (leads to respiratory depression)
most common cause of UTI in young sexually active females
E Coli
cold agglutinin IgM mediated hemolytic anemia is caused by antibodies directed to RBCs and often follows infection with
EBV (epstein barr virus), mycoplasma pneumoniae, leukemia or HIV. pts present with anemia, painful gray or purple discoloration of the fingers exacerbated by cold exposure.
most appropriate method of diagnosing HIV infection
ELISA, followed by western blot
Eccrine vs Apocrine glands
Eccrine glands: secrete a watery solution and are stim by direct sympathetic innervation. these are thermoregulatory and used in marathon runners, for example. (most numerous on palms and soles). Apocrine glands: secrete oily, viscous fluid and are stimulated by catecholamines. these are in axillae, areolae, genitals, and anus.
renal tubular defects
F is first, the rest are in alphabetical order: fanconi syndrome (PCT: bicarb, phosphate, etc); Bartter syndrome (thick ascend loop: Na/K/Cl transport); Gitelman syndrome (DCT: Mg, K, Ca); Liddle syndrome (K, aldosterone, Na); Syndrome of apparent mineralocorticoid excess (K, aldosterone)
herniations
Examples: C7 nerve impingement = C6/C7 disc herniation; L5 nerve impingement = L4/L5 disc herniation; everything below T1: herniation hits the descending nerve (the one that traverses the intervertebral space) vs. above T1: herniation hits the nerve exiting that intervertebral level
turcot syndrome
FAP or Lynch syndrome PLUS malignant CNS tumor (i.e. medulloblastoma, glioma). (turcot = turban)
moa of G-CSF
G-CSF is a glycoprotein growth factor that stimulates immature neutrophils to differentiate in the bone marrow by binding a cytoplasmic receptor.
5-FU can cause _ if admin'd orally
GI ulceration if admin'd orally. therefore admin is rec to be IV
nonpolar hydrophobic amino acids
GLAMP TVIP
Ras
GTPase proto-oncogene. (active when bound to GTP).
glucagon acts via what receptors
Gs (GPCRs on hepatocytes)
histamine - alertness
H1 receptors are also located centrally, where they play a role in alertness and emesis
rash on kid that starts on trunk and spreads to face
HHV 6 (roseola)
PAIR
HLA B27: Psoriasis, Ankylosing spondylitis, irritable bowel syndrome, Reiter's syndrome
adenocarcinoma caused by microsatellite instability (mismatch repair defect)
HNPCC; hereditary nonpolyposis colorectal cancer. ppl get colorectal cancer and other cancers like endometrial, ovarian, urinary tract, small intestinal , stomach and biliary cancer.
fetal hemoglobin has what shift in the oxygen hemoglobin dissoc curve
HbF has higher affinity for O2 so its shifted left.
skeletal abnormalities, coarse facial features, corneal clouding and psychomotor retardation
I-cell disease. This is a defect in the ability of the golgi apparatus to send proteins to lysosomes via mannose 6 phosphate phosphorylation and consequently proteins are innapropriately sent to the extracellular space.
IBS vs IBD
IBD: (disease) includes Crohns and UC. IBS: does not cause inflammation/ damage to the bowel like IBD, sx include diarrhea AND constipation.
recurrent mycobacterial (acid fast pneumonia) infections in young child
IL-12 deficiency (bc assoc with macrophages)
ITP vs TTP
ITP: secondary to autoimmune, low platelets; TTP: schistocytes, high LDH, ADAMTS13
tx for direct hyperbilirubinemia from gall stones in common bile duct causing charcot triad (fever, jaundice) is
IV fluids and antibiotics
hepatic veins drain contents of the liver into the
IVC (ergo, IGF and somatomedins are secreted into circulation via the hepatic veins into the IVC)
IVC pressure in portal hypertension
IVC pressure is normal
tx for HBV
IVIG (IgG antibodies to help fight Hep B infection)
which virulence factor contributes to the ability of strep pneumo to colonize the lower lungs
IgA protease is the main colonizing factor of strep pneumo. strep pneumo's main virulence factor is its polysaccharide capsule.
multiple myeloma is assoc with overprodution of which immunoglobulin
IgG (its a monoclonal plasma cell cancer)
most common cause of death immediately after an MI is
an arrhythmia that leads to cardiac arrest (can occur anytime from right after MI to a few days later).
normal CSF and nonenhancing lesions on brain MRI (and CD4 less than 200)
JC virus
JC virus vs CMV
JC virus: PML rapid, multiple nonenhancing white matter T2 weighted hyperintensities. PCR is diag. CMV: enhancing PERIVENTRICULAR white matter lesions in cortical and subependymal regions. histo: giant cells with eosinophilic inclusions in cytoplasm and nucleus.
kaposi's sarcoma vs UC
Kaposi's sarcoma: endoscopy shows hemorrhagic nodules in the GI, and bleeding. UC: bloody stools, endoscopy shows erythematous, adematous, friable, and granular mucosa that begins at the anal verge an entends proximally. neutrophils accumulate in the crypt lumina
equation for loading dose
Ld = (Vd x Cpss)/bioavailability
pigmented nodules on the iris
Lisch nodules in neurofibromatosis type 1 (also has neurofibromas and cafe au lait spots)
glucocorticoids (i.e. cortisol) fxn on glucose
MAKE MORE glucose! (stimulates gluconeogenesis) (also causes body to release FFAs from adipose tissue, breakdown protein/ amino acids from muscle, and breakdown glycogen aka glycogenolysis) cortisol is active in times of STRESS to provide the body with energy
CO =
MAP/TPR or (rate of oxygen consumption)/(arterial oxygen - venous oxygen)
osteomyelitis from staph aureus from IV drug abuse is best evaluated with what type of imaging
MRI
if pO2 gets higher when going from SVC to right atrium there is probably
an atrial septal defect which is causing the right atrium and pulmonic artery to have higher pO2 than normal.
maple syrup urine disease: what sx?
MSUD is due to a defect in alpha ketoacid dehydrogenase, which causes an inability to degrade branched chain amino acids. If isoleucine, leucine, and valine are not eliminated for the diet, infants sustain severe brain damage and eventually die. Infants with this disorder have a characteristic sweet odor to their urine. Dystonia (uncontrolled movement) is another characteristic feature of MSUD.
tx for acetaminophen toxicity
N-acetylcysteine (acetaminophen toxicity sx: anorexia, nausea, vomiting, malaise, can cause hepatic failure)
what is the primary reducing equivalent used in the synthesis of steroids
NADPH, supplies reducing equivalents, generated by glucose 6 phosphate dehydrogenase in the oxidative portion of the pentose phosphate pathway.
firstline tx for acute low back pain
NSAIDs or acetaminophen; prolonged bed rest is assoc with longer duration of pain.
where do thiazides act
Na-Cl channel of the early DCT
sacroiliitis is assoc with what
PAIR (all of the seronegative spondyloarthropathies) i.e. HLA B27 positive ppl
HLA B27
PAIR (psoriatic arthritis, ankylosing spondylitis, IBD, Reactive arthritis
in areas of higher prevalence, the PPV is _ and the NPV is _
PPV is higher and the NPV is lower; increasing the prevalance will increase the likelihood that a positive test is positive and that a negative test may be a mistake.
tamoxifen
estrogen antagonist in the breast, making it effective adjuvant therapy against breast cancer; however it functions as an estrogen agonist in the uterus, increasing the risk of endometrial cancer.
EKG: QT prolongation, ST depression, U waves, T wave inversions, peaked T waves
QT prolongation: hypocalcemia, ST depression: ischemic changes, U waves: hypokalemia, T wave inversions: (ischemia or recent MI), peaked T waves: hyperkalemia
histiocytosis X
RESPIRATORY SX, lytic bone lesions, HSM, lymphadenopathy
alteration in a gene that functions to transduce signals from the cell membrane to the nucleus by activating other molecules. predisposes ppl to malignancy
Ras is a GTP-binding, signal transducing oncoprotein. (part of the MAP kinase system). promotes mitogenesis.
Ras-MAPK pathway
Ras proteins are G proteins linked to receptor tyrosine kinases in the cell memb. Ras is an important G protein for intracellular transmission of signals from growth hormone. It has intrinsic GTPase activity which converts GTP to GDP, inactivating the protein's function. Mutations, such as KRAS, result in constitutive activation of Ras proteins and unrestricted growth. This is assoc with pancreatic cancer, among others. (KRAS is a GTPase)
which type of RNA is the most abundant in the body
Ribosomal RNA makes up a central part of the ribosome. As a result, rRNA is also the most abundant form of RNA in the human body, constituting about 80% of all RNA.
cord levels of pelvic splanchnics AND external anal sphincter
S2-S4 (pudendal nerve is anal sphincter, pelvic splanchnics is erections)
standard error of the mean and z score for 95% CI
SD/sqrt(sample size); 1.96 CI = mean +/- 1.96(SD/sqrt(sample size))
enterocytes contain which glucose transporter
SGLT-2 (sodium glucose cotransporter)
first line tx for social anxiety disorder
SSRI
pt with major depressive disorder presents with restlessness, tremors and excessive sweating. What drug was the pt put on?
SSRI's are first line for MDD. ADR is serotonin syndrome which is mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity.
kid with fever, sore throat and tonsillar exudates
STREP THROAT (streptococcal pharyngitis) - firstline tx is penicillin (beta lactam that blocks cell wall synthesis by inhibiting the PBP's cross linking)
treatment of non-typhoid salmonella mediated gastroenteritis with antibiotics in the absnece of bacteremia can
both prolong the symptomatic course of the disease and increase the risk of relapse. However, in S. typhi, antibiotics (flouroquinolones or ceftriaxone) are indicated.
fatty acid metabolism
Sytrate = Synthesis; CARnitine = CARnage of fatty acids (breakdown)
birbeck granules, found in langerhans cells which are a type of antigen presenting cell found only in the skin, activate which type of cell
T cell (CD4 helper T cell)
referred pain spinal cord segment for early appendicitis (when there is generalized peri-umbilicle pain)
T10 nerve distribution. belly butTEN. this is the point of referred pain in early appendicitis. (dermatome for umbilicus)
TE fistula
TE fistula with esopahgeal atresia manifests with choking, coughing, and an air bubble in the stomach on x ray. (air goes in when the infant breathes)
pt has acute renal failure, hypocalcemia, hyperphosphatemia, and metabolic acidosis. Pt also has cancer. what is the tx for these sx?
This is tumor lysis syndrome. Allopurinol, a xanthine oxidase inhibitor, often used to treat gout, can be used to prevent buildup of uric acid. this happens bc when ppl are treated for cancer, their tumor cells die at rapid pace and release purines and phosphate into bloodstream. purines form excess uric acid.
toxoplasmosis Gondii
ToRCHeS infections (toxo, rubella, CMV, HIV, Herpes, Syphilis) are those transmitted to a fetus transplacentally or during delivery. Congential toxo is caused by transplacental transmission of the parasite. Its thru mom touching cat feces or eating undercooked meat. neonate sx: chorioretinitis, hydrocephalus, and intracranial calcifications.
an increase in the amount of enzyme available in a system will do what to Vmax and Km
Vmax will increase and Km will stay the same
type 1 vs type 2 diabetes
Type 1: Absolute insulin deficiency (beta) cells in pancreas are destroyed. Autoimmune. Minimal or absent endogenous insulin. Thin. Issue with insulin production. Type 2 Diabetes: Issue with insulin attaching to receptors. obese ppl. normal insulin levels. Insulin resistance with an insulin secretory deficit
crohns vs UC. abscesses
UC has abscesses in colonic crypts but crohn's can have perianal abscesses (and fistulas). Crohns also have aphthous ulcers of the mouth and is most common in the terminal ileum. also UC has bloody diarrhea more often.
most common cause of URI
URI/common cold most common cause is: rhinovirus
horseshoe kidney (turner's) can lead to increased risk for
UTI's
split S1 sound: what is the first component
closure of the mitral valve
physiologic dead space
VD = VT x [(PaCO2 - PeCO2) / PaCO2] (peco2 is expired air CO2 pressure)
VACTERL
Vertebral anomalies Anal imperforate Cardiac anomalies TE fistula (E is in this also) Renal Limb defects
wiskott aldrich syndrome
WATER: wiskott aldrich, thrombocytopenia, eczema, recurrent infections
wolff parkinson white syndrome affect on ventricular filling
WPW is aberrant accessory pathway leading to decreased ventricular filling during diastole (bc the ventricle contracts earlier than it should bc the accessory pathway thru the bundle of kent - making it fill less during diastole)
SMA type 1
Werdnig-hoffman disease; autosomal recessive; destruction of the anterior horn cells. manifests with diffuse muscle strophy, hypotonia, fasciculations and decreased deep tendon reflexes. (in babies)
subclavian steal syndrome
When a narrowing or blockage occurs in the subclavian artery proximal to the vertebral artery, vascular demand from the ipsilateral upper extremity can cause blood to flow in a retrograde fashion. The blood flows down the vertebral artery to the distal subclavian artery; this is called the subclavian steal syndrome.
lesch nyhan syndrome
X linked recessive disorder caused by a deficiency in HGPRT, an enzyme in the purine salvage pathway. It results in accumulation of uric acid and is assoc with self-mutilation behaviors, intellectual disability, gout, and movement disorders (muscular hypotonia)
both hemophilia and duchenne muscular dystrophy are
X linked recessive disorders
which stain is used to diagnose TB
Ziehl - Neelson (aka Acid fast) stain
EPO is
a cytokine produced by interstitial oxygen sensing cells of the renal cortex.
irritable bowel syndrome
a diagnosis of exclusion (i.e. no abnormalities such as fecal occult blood, weight loss, abnormal endoscopy or colonoscopy) but pt has vague abdominal complaints (diarrhea, constipation). no pathologic changes are visible on a biopsy specimen. tx: lifetyle mod and dietary changes
MALT lymphoma is
a low grade clonal proliferation of extranodal B lymphocytes (a type of non-hodgkin lymphoma)
standard error
a measure of variability around the mean. the larger the sample size, the smaller the SE.
intussusception occurs when
a proximal segment of bowel telescopes into a distal segment, causing intermittent, colicky pain in young children who are otherwise healthy. A characteristic finding is "currant jelly" stool, which is composed of blood and mucous. If left untreated, venous and lymphatic congestion results in intestinal edema and can cause ischemia, perforation and peritonitis.
pts who have been restrained for a long period are at risk for
a pulmonary embolism (i.e. dyspnea and chest pain) due to venous stasis and thromboembolic disease that follows. tx: intravenous heparin)
locked in syndrome can be caused by
a stroke of the basilar artery (since its on top of the pons then the lesion would be at the pons, impeding horizontal eye movement as well bc abducens nucleus is at pons)
moa of toxic shock syndrome
a toxin that nonspecifically cross-links MHC II with T cell receptors
milrinone
he's one in a million (digoxin sketch); increases cardiac contractility (flexed bicep donkey); causes arteriolor dilation in heart failure, decreases cAMP breakdown; phosphodiesterase inhibitor
tx for third degree heart block (i.e. independent, regular P and QRS waves)
ablation of the AV node
"difference in risk attributable to the intervention as compared with a control" is asking for _
absolute risk reduction (ARR)
accidental vs intentional child injuries by parent
accidental: irregular margins and are asymmetric; intentional: regular margins and are symmetric
resident tells you to get informed consent from pt, what do you do
accompany the resident while the resident obtains signed consent
achalasia vs nutcracker esophagus
achalasia: esophageal motility disorder is the absence of esophageal peristalsis in the distal esophagus and incomplete relaxation of a hypertensive lower esophageal sphincter. Achalasia is caused by the degeneration of inhibitory ganglion cells in the mysenteric (auerbach) plexus. nutcracker: overactivity of esoph smooth muscle in respose to excitatory stimuli and typically presents with dysphagia or reflux sx. barium swallow demonstrates normal peristalsis without esophageal dilation but manometry shows high pressures in the distal esophagus.
compensatory neurohormonal mechanisms of CHF include
activation of RAAS, increased sympathetic output by the CNS, increased secretion of antidiuretic hormone. They do this bc CHF is the inability of the heart to maintain adequate cardiac output.
ethambutol ADR
active TB tx is RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol). Ethambutol toxicity can manifest with reduced visual acuity and red green color blindness, which are sx of optic neuritis.
contraindications to thrombolytic therapy
active bleeding, hx of intracranial bleeding, recent surgery, known bleeding diatheses (unusual susceptibility to hypocoagulability), or severe hypertension.
equalization of end-diastolic aortic and left ventricular pressures is characteristic of
acute aortic regurgitation bc the rise in left ventricular end-diastolic volume occurs too rapidly for left ventricular compensation to occur.
pulmonary edema as a result of heart failure on histo
acute build up of intra-alveolar transudative fluid and the presence of hemosiderin-laden macrophages, representing chronic fluid congestion within the lungs.
jaundice, elevated LFTs, diarrhea and the pt is on an antibiotic
acute cholestatic hepatitis secondary to macrolide toxicity
neurosyphilis
affects dorsal columns and the dorsal nerve roots. Pts present with decreased vibration and proprioception, sensory ataxia, pupillary abnormalities, neurogenic bladder disturbance, and shooting pains.
Km is INVERSE
affinity for substrate is LOW in HIGH Km and vice versa.
alcoholic hallucinosis vs delirium tremens
alcoholic hallucinosis: visual, auditory, tactile hallucinations 12-24 hours after consumption of the last alcoholic beverage. tx: benzos. differentiated from delirium tremens by the timing and severity. Delirium tremens: between 48-96 hours after the last alc drink and lasts 1-5 days. also get tachy, HTN, fever, agitation, lethargy, and diaphoresis. tx: benzos,
dark urine and dark connective tissue
alkaptonuria (def of homogentisic acid oxidase)
defic of homogentisate oxidase
alkaptonuria, leads to build up of homogentisic acid which causes blue black cartilage and skin, darkening of urine on exposure to air and osteoarthropathy
procarbazine
alkylating anti cancer drug, risk for hypertensive crisis bc tyramine bc inhibits MAO
tx for acute promyelocutic leukemia is _ and the moa of it is _
all-trans retinoic acid (ATRA), moa is to promote differentiation of immature cells
autogenic vs allogenic vs syngenic grafts
allo: most common, same species; syngenic: identical twin; auto: self-graft (no need for immunosuppresion)
ADR of etoposide
alopecia
(after) QISSes, (you get a) QIQ (out of) SIQ Super Qinky Sex
alpha1,2, beta1,2, M1-3, D1,2, H1,2, V1,2
moa for resistance to vancomycin (in enterococcus or any bacteria)
alteration in terminal amino acid (D ALA D ALA) of microorganism's cell wall component to D ALA D LAC
MRSA resistance moa
altered PBPs. although the main mech of resistance to beta lactam antibiotics is production of beta lactamase, MRSA has altered PBP2 (penicillin binding protein)
postoperative lung problem thats common
alveolar collapse/ atelectasis (pulmonary lucency on the side of the collapse)
pt takes a med for parkinsons and gets livedo reticularis (purple, lace-like discoloration of skin) and ataxia. whats the drug
amantadine
ventricular fibrillation tx
amiodarone
which CCB is best for woman about to get pregnant that has essential HTN
amlodipine has longer half life than nifedipine
entamoeba histolytica causes
amoebic colitis; which manifests with dysentery (bloody, mucus-containing diarrhea), abdominal pain, and weight loss. Its confirmed by detection of the organism or its antigen. It is common in tropical countries with poor sanitation.
tx for enterococcus (E. feacalis - nosocomial UTI)
ampicillin is used as first line for infections caused by susceptible strains of enterococcus including complicated UTIs, bacteremia, and endocarditis
what is the mech behind breast cancer
amplification (i..e overexpression) of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common
complete molar pregnancy is
an abnormal proliferation of cytotrophoblasts and syncytiotrophoblasts without fetal tissue. due to paternal imprinting, staining with p57 is negative. (a complete mole is distinguished from a partial mole by negative staining for p57). cytotrophoblasts and syncytiotrophoblasts are just placental precursor cells. the complete mole is derived entirely from the sperm.
clozapine is
an antipsychotic (second generation)
lac operon
an inducible set of genes that allows bacteria to use lactose as an energy source when glucose is not available. when glucose is present, the lac operon should not be active because cAMP levels are low. When cAMP is low, it does not bind to CAP (catabolite activator protein - which facilitates binding of RNA polymerase to the promoter) and thus transcription of genes involved in lactose metabolism is not activated. (summary: when glucose is low, cAMP creates CAP which activates lac operon to use lactose)
ITP (immune thrombocytopenic purpura) classically arises after
an upper respiratory tract infection
phase of meiosis that nondisjunction occurs at in down syndrome
anaphase I
normocytic anemia is either nonhemolytic or hemolytic in nature based on reticulocytes. in pts with SLE, anemia is usually secondary to
anemia of chronic disease (nonhemolytic) or autoimmune hemolytic anemia (AIHA)
low serum iron level, low total iron binding capacity (TIBC), and elevated ferritin level =
anemia of chronic disease. Tx is EPO
premenopausal nontender adnexal mass on left shows fluid filled cyst. This is due to
anovulation (i.e. when follicle doesnt rupture). its benign. simple adnexal cyst
what structure is at risk in a dissection surgery of the lower esophagus where it comes out of the right crus of the diaphragm
ant and post trunks of the vagus nerve
all 4 types of transfusion reactions are mediated by
antibodies (this includes ABO incompatibility reaction)
ADRs of tricyclic antidepressants
anticholinergic, antihistaminic, and alpha andrenergic antagonist effects. also affects cardiac conduction.
tx for tourette syndrome
antipsychotic (dopamine antagonist)
long term immunosuppressant therapy drug that is used after organ transplantation
azathioprine
tx of choice for chlamydia
azithromycin
most commonly injured site in traumatic aortic rupture
aortic isthmus (just distal to the left subclavian artery, right before the start of the desc aorta). This is bc the ligamentum arteriosum tethers the isthmus to the pulmonary trunk, rendering this locaiton relatively immobile and vulnerable to tearing during rapid deceleration.
transposition of the great vessels (right to left shunt)
aorticopulmonary septum fails to spiral during development, and the systemic and pulmonary circulations are completely separate, preventing proper oxygenation of systemic blood.
APGAR
appearance (pink/blue), pulse (100), grimace (cry), activity, respiration
greater bioavailability means the drug has greater
area under the curve (i.e. overall greater drug exposure)
exemestane
aromatase converts testosterone to estradiol and androstenedione to estrone. exemestane forms an irreversible bond with aromatase, thereby inhibiting its activity, and is commonly used to treat hormone-responsive breast cancer in postmenopausal women.
tuberous sclerosis
ash leaf spots, shagreen patches, hamartomas in CNS, angiofibromas, mitral valve regurg, rhabdomyoma in heart, auto dom, mental retardation, renal angiomyolipoma, seizures. higher chance of autism.
aspirin overdose sx
aspirin overdose causes tinnitus, a combined metabolic acidosis and respiratory alkalosis will also develop.
samter's triad
aspirin sensitive asthma (triad of nasal polyps, asthma, and aspirin sensitivity)
dermatitis herpetiformis
assoc w celiac sprue and its a skin disorder with clustered vesicles often in a symmetric pattern.
peripheral artery disease and arterial atherosclerosis
atherosclerotic plaques are characterized by eccentric intimal thickening, with a fibrous cap, smooth muscle proliferation, local inflammatory infiltrate and a lipid filled core. Sx of peripheral artery atherosclerosis include exertional leg pain, dermal atrophy and arterial ulcers.
second line tx for pneumocystis jirovecii
atovaquone, primaquine-clindmycin, trimethoprim-dapsone, or pentamidine
ADRs of PPI's like omeprazole
atrophic gastritis secondary to hypergastrinemia, B12 deficiency, weakened bones, and increased risk of C difficile infection and pneumonia.
pt has diarrhea, weakness and watery eyes. works on a farm. tx is:
atropine bc they have organophosphate poisoning (DUMBBELSS sx). atropine is tx of choice (pralidoxime is adjunct therapy)
bullous pemphigoid location
autoantibodies bind lamina lucida, hemidesmosomes of basal keratinocytes at the epidermal-dermal junction
VHL disease is (genetics)
autosomal dominant
von willebrand disease (genetic inheritance pattern)
autosomal dominant
tuberous sclerosis
autosomal dominant disease; presents with a clinical syndrome including seizures, benign hamartomas, subependymal brain tubers, intellectual disability, renal angiomyolipomas, cardiac rhabdomyomas, astrocytomas, pulmonary lymphangioleiomyomatosis, and cutaneous manifestations (i.e. hypopigmented ash leaf spot, shagreen patch, and facial angiofibromas)
jervell and lange-nielsen syndrome
autosomal recessive condition caused by mutated voltage gated potassium channels. individuals commonly present with sensorineural deafness, a fam hx of sudden death, and a prolonged QT interval on ECG (>420 ms)
fanconi anemia
autosomal recessive disorder in which cells have increased susceptibility to chromosomal breakage when exposed to DNA cross-linking agents. Fanconi anemia is clinically characterized by progressive bone marrow failure (pancytopenia) and multiple congenital anomalies, including radial hypoplasia and thumb deformity. tx: bone marrow transplant [if pt has pancytopenia + skeletal abnormalities think fanconi anemia)
pyruvate kinase deficiency
autosomal recessive glycolytic disorder cahracterized by decreased ATP production in glycolysis resulting in a rigid RBC membrane. Changes to the RBC membrane manifest as extravascular hemolysis. Burr cells (echinocytes) are seen on periph smear.
bernard soulier disease
autosomal recessive inherited deficiency of the platelet membrane protein complex GP1b. Bernard soulier disease results in increased bleeding time without affecting PT or PTT. Giant platelets are a characteristic finding on a peripheral smear.
after completing a course of rituximab, what is a pt at risk for
bacterial infections (i.e. bacterial pneumonia) bc deficiency of B cells
tetanus moa
bacterial toxin mediated neuronal blockade (i.e. blocking inhibitory interneurons that would normally release GABA and glycine)
trimethoprim sulfamethoxazole treats MRSA as well. Its moa is
bactericidal agent that blocks nucleotide synthesis
transduction
bacteriophage
histo shows peripheral palisading nuclei and islands of tumor cells.
basal cell carcinoma (gross: pearly borders and fine telangiectasias)
base excision repair defect vs nucleotide excision repair defect
base excision repair: repairs DNA damage involving deamination, depurination and alkylation by ROS, radiation and alkylating agents. defect leads to leukemia and RCC.; nucleotide excision repair: xeroderma pigmentosum
why do ppl with longstanding diabetes get periods of prolonged hypoglycemia after injecting insulin?
bc destruction of pancreatic islets that contain beta cells (insulin secretion) and alpha cells (glucagon secretion)
venous drainage below pectinate
below pectinate is caval bc you have to enter the cave to get into the butt! (above is portal)
thoracic duct drains
below the diaphragm and LEFT thorax and upper limb into junction of left subclavian and internal jugular veins (rupture of thoracic duct can cause chylothorax). Most of the lymph in the body is drained via the thoracic duct. However, the lymph in the right chest, back, arm and neck and head are drained via the right lymphatic duct.
below dentate line and above it: what is the lymph drainage of cancer
below: superficial inguinal; above: superior rectal (then iliac)
tx for theophylline overdose
beta 1 antagonist (metoprolol)
which drug can mask the sx of hypoglycemia
beta blockers decrease HR, contractility and conduction thru the AV node. they can mask sx of hypoglycemia (diaphoresis and tachycardia) by decreasing heart rate.
how do propranolol and verapamil (non-DHPs) affect the pacemaker action potential (the funny current)
beta blockers increase the refractory period (phase 4) by slowing conduction. non-DHPs will effect phase 0 (bc thats the Ca dependent phase)
MS tx
beta interferon
Rhogam is given in order to
bind and remove the RhD antigens in pregnant moms so that they dont form an immune response (i.e. antibodies to RhD) against the antigen in the fetus' blood. given at 28 weeks and at delivery.
where does furosemide act?
binds and blocks the Na - K - 2Cl cotransport system in teh thick ascending limb of the loop of Henle
haptoglobin
binds free hemoglobin
schistosoma haematobium is assoc with which type of cancer?
bladder cancer (i.e. squamous cell carcinoma of the bladder) via long term irritation from the eggs of the trematode (schistosoma). histo: keratin pearls from the SCC
meckel diverticulum location in the GI
blind pouch coming out of ileum. (derived from vitelline duct)
Aminocaproic acid
blocks the conversion of plasminogen to plasmin and is used to reverse bleeding assoc with tPA. (put cap on paint bottle in sketchy)
yellow fever
body aches, high fever, dark vomit. histo: councilman bodies (eosinophilic globules indicative of hepatocytes)
bordatella pertussis and vibrio cholerae have same moa bc
bordatella pertussis disables Gi whereas vibrio cholerae activates Gs which both lead to increased levels of cAMP
borderline personality disorder vs histrionic
borderline: suicidal, efforts to avoid abandonment, impulsive; histrionic: excessive emotionality, attention seeking, sexually provacative behavior
ranitidine vs cimetidine
both are H2 blockers (-tidine = tye dye shirt kids); but ranitidine has less anti-androgenic effects (i.e. doesnt cause gynecomastia and impotence like cimetidine does). Both are used to treat peptic ulcers.
cyclothymic vs dysthymic
both for 2 years or more. cyclothymic: has hypomania (i.e. similar to manic but functional) AND mild depression. Dysthymic: no hypomania, just has mild depression
LTC4, D4 and E4 cause
bronchoconstriction (all except B4 lacrosse girls holding tightly to lacrosse sticks)
aspergillus on histo
broom-like structure on silver staining. TB pts are prone to aspergillomas in lung cavities
person who has CML and is being treated with chemotherapeutic drugs who has pulmonary symptoms. what drug is causing this ADR
busulfan
frameshift is due to insertion or deletion thats not evenly divisible
by 3, thereby disrupting the reading frame
granulomatosis with polyangiitis
c-ANCA, necrotizing granulomas (bull skull on sketchy path in sand trap), in lungs, assoc with necrotizing glomerulonephritis.
medullary thyroid cancer secretes
calcitonin (bc it originates from parafollicular cells (C cells))
NMDA (n methyl d aspartate) channel mediates flow of what ion?
calcium
calcium oxalate stones vs uric acid stones (radio-opaque vs lucent)
calcium oxalate = radiopaque; uric acid stones = radiolucent
fluoroquinolones should not be taken with
calcium, iron or magnesium as these will decrease absorption of the antibiotic
obstructive lesions of the mainstem bronchus
can cause atelectasis (collapse of the lung tissue) distal to the obstruction. This would be shown with complete opacification of lung on chest x ray with tracheal deviation toward the opacification.
where does cancer below the pectinate (dentate) line drain? (lymphnode)
cancer below the pectinate line (i.e. squamous cell carcinoma of the anus) drains to the superficial inguinal node.
myelin speeds the transmission of electrical impulses aka action potentials by insulating the axon and reducing axonal membrane _
capacitance (the ability of a system to store an electrical charge)
acetazolamide
carbonic anhydrase inhibitor that decreases secretion of H+ and increases secretion of HCO3-
episodic diarrhea, flushing, shortness of breath, chest tightness
carcinoid tumors in the bowel, (in the presence of liver metastasis). (malignant carcinoid syndrome), 90% of carcinoid tumors originate from the distal ileum or appendix (eembryological midgut). intestinal carcinoid tumors are often asymptomatic until metastasis to the liver occurs. this is bc the liver inactivates bioactive products secreted into the portal circulation.
which is more responsive to hypotension: carotid sinus baroreceptor or aortic arch baroreceptor
carotid sinus baroreceptor
adenomyosis
caused by the infiltration of endometrial (glandular) cells into the uterine myometrium. Women with adenomyosis present with menorrhagia, dysmenorrhea, and a diffusely enlarged, soft "boggy" uterus on exam.
naegleria fowleri
causes CNS amoebiasis; (brain eating amoeba); fresh water bodies like lakes and ponds. 3 forms: cyst, trophozoite (ameboid), and a biflagellate. Infection is via olfactory cell axons through the cribriform plate to the brain. causes meningitis like symptoms.
arteriovenous fistulas cause what to happen to the left ventricular pressure volume relationship and the heart
causes a rightward expansion and downward contraction of a pressure volume curve. it would cause an increase in preload and decrease in afterload, which causes an increase in cardiac output but would eventually cause high-output heart failure.
why does tumor lysis syndrome cause arrhythmias?
causes excess potassium and low calcium
acute adrenal insufficiency does what to glucose
causes hypoglycemia
busulfan toxicity
causes pulmonary fibrosis, hyperpigmentation, and myelosuppresion
midshaft humerus fracture damages radial nerve at spiral groove. what action is affected
causes wrist drop (i.e. can't do wrist extension). Elbow extension is intact bc the nerve fibers innervating the triceps leave the nerve before it enters the radial groove.
timeline of histo for post-MI
early coagulative necrosis appears 4 hours after an acute MI, with neutrophilic infiltration following at about 24 hours. Neutrophils are eventually replaced with macrophages >3 days after an MI, and contracted granulation tissue is evident within 1 week.
acetaminophen overdose causes what type of liver damage
centrilobular necrosis
cerebro- vs spino- vs vestibulo-cerebellum
cerebro: (aka neocerebellum) includes lateral hemispheres of cerebellum that fxn in motor planning and complex coordination. lesions here have dysdiadokokinesia and intention tremor. theyre laterally located and affect lateral limbs; Spino: (aka vermis) truncal ataxia (drunken sailor, wide based gait, nystagmus), vermis is centrally located and affects central body, degen assoc w alcohol use; Vestibulo-cerebellum: flocculonodular lobe, balance, maintaining posture, and eye movements. lesions: eyes cant follow/track objects.
cerebrum vs cerebellar lesion
cerebrum lesion = paralysis; cerebellar lesion = ataxia
trichomonas is not assoc with
cervical motion tenderness
if question is prerenal azotemia (i.e. heart failure, etc) and they give you BUN and Cr separate (values) you
check BUN/Cr ratio to see which is greater than or equal to 20
muscle weakness, cramps, myalgias and fatigue in a pt whose on loop diuretics
check electrolyte levels, bc this is hypokalemia. replenish to avoid respiratory depression and ventricular arrhythmias.
C5a is a
chemotactic factor for PMNs (neutrophils)
chlorpromazine, chlordiazepoxide, chlorpropamide
chlorpromazine: FGA (antipsychotic); chlordiazepoxide: benzo; chlorpropamide: (maid) sulfonylurea (first gen) for T2DM
what causes the pain after meals in pts with gallstones? (i.e. what substance is secreted that causes this pain)
cholecystokinin (bc it causes the gallbladder to contract and if these people have a stone obstructing the cystic duct, this causes pain). CCK is secreted bc of fatty acids, and amino acids.
Autosomal dominant polycystic kidney disease is what chromosome
chromosome 16
anti-HBc IgG can be present in
chronic Hep B infection and recovered pt who had prior infection with Hep B. if chronic infection, pt has HBsAg. pt who recovered has anti-HBs
negative dihydrorhodamine test
chronic granulomatous disease
Monday Disease
chronic industrial exposure to nitroglycerin can lead to nonatherosclerotic-related cardiac ischemia when exposure is abruptly stopped. Also known as monday disease, pts can experience reflex tachycardia, hypotension, flushing, and headaches.
smudge cells
chronic lymphocytic leukemia
alternative to firstline agents for uncomplicated UTI
ciprofloxacin
which substrate inhibits the rate limiting step of glycolysis
citrate inhibits phosphofructokinase, the enzyme that acts at the rate limiting step of carb metabolism in glycolysis
which enzyme inhibits the rate limiting enzyme of glycolysis and activates the rate limiting enzyme of fatty acid synthesis?
citrate is a key intermediate in the TCA cyle that inhibits phosphofructokinase. It also activated acetyl-CoA carboxylase, thus driving fatty acid synthesis.
tx for WPW
class 1A antiarrhthmics
galactose 1 phosphate uridyltransferase def
classic galactosemia
galactose 1 phosphate uridyltransferase deficiency
classic galactosemia. FTT, jaundice, hepatomegaly, int dis
the deltoid is attached to the inferior side of the
clavicle (at the distal end).
when a specific ion channel opens, the membrane potential will become
closer to that ion's equilibrium potential. sodium potassium pump is 3 sodium OUT and 2 potassium IN. this creates the concentration gradient thats used to generate action potentials. so if you have decreased sodium outside the cell, it messes up that concentration gradient.
on palpation of the injured area, a crackling sound is heard
clostridium perfringens (an obligate anaerobic rod that produces a phospholipase toxin, lecithinase (phospholipase/ alpha toxin) - this toxin causes cellulitis which leads to myonecrosis which causes the crepitus and hemolysis.
myelomeningocele caused by what developmental defective process
closure of the caudal neuropore
the most likely source for liver metastases is
colon (i.e. GI tumors)
pt with LOF of a protein that helps detect and correct base pair errors in microsatellites, short DNA sequences composed of repetitive stretches of nucleotides. this pt will develop what
colorectal carcinoma bc this is lynch syndrome. i.e. microsatellite instability occurs as a result of defective DNA mismatch repair and is the basis for lynch sydnrome (HNPCC).
leiomyomas
common, benign, uterine smooth muscle tumors that can result in endometrial venous dilation, which in turn can lead to heavy menstrual bleeding. Submucosal/ intracavitary fibroids are particularly assoc with anemia. Distortion of the intrauterine cavity can result in reproductive difficulties.
productive cough, chest pain, fever, malaise and lobar consolidation =
community acquired pneumonia; tx: macrolides bc its probably strep pneumo (most common)
blind vaginal pouch
complete androgen insensitivity syndrome (X linked, 46 XY, dude looks like a lady, no axillary/pubic hair) or mullerian agenesis (46XX, absent mullerian system, normal tanner stages)
spindle apparatus
complex structure that is essential for mitosis and meiosis. It involves microtubule polymerization at opposing centrosomes and microtubule capture by kinetochores located on each chromosome's centromere.
intrinsic factor moa
complexes with free vitmain B12 in the small intestine and then binds to receptors on the wall of the terminal ileum.
carcinoid tumors
composed of polygonal, eosinophilic cells that stain positive for neuropeptides such as chromogranin and synaptophysin. They typically arise in the GI tract or bronchus and can be assoc with dramatically elevated levels of vasoactive compounds, particularly serotonin, leading to carcinoid syndrome (episodic flushing and diarrhea).
unmyelinated nerve fibers
conduct action potentials more slowly. Among primary sensory (afferent) fibers, those resp for slow pain, heat sensation and olfaction are unmyeinated. Efferent neurons are all myelinated except the postganglionic autonomic neurons.
conjugation vs transformation vs transduction vs DNAse
conjugation: direct cell to cell interaction causing DNA passing. protected from extracellular environement bc of the conjugation pilus. transformation: when bacteria take up naked DNA from their environment (i.e from lysed cells) and incorp it into their genome. transduction: bacteriophage-mediated transfer of genetic info from one bacteria to another via the bacteriophage. DNAse: degrades DNA in the culture medium released by lysed bacteria, preventing transformation
kaposi sarcoma
consists of malignant proliferations of spindle cells and endothelial cells and can appear on the skin and in the lungs and GI tract. It is an AIDS-defining condition and is associated with human herpesvirus 8 infection. the lesions can appear in any organ, most commonly the lungs, GI tract, and biliary tree. 50% of pts have GI involvement which presents as mucosal bleeding leading to hematochezia, hematemasis and/or melena (black stools)
coagulase enables
conversion of fibrinogen to fibrin (formation of fibrin clots in cases of staph aureus leads to abscess formation).
kayser fleischer rings are deposits of copper in what part of the eye
cornea (descemet's membrane).
what does cortisol do to glucose
cortisol makes fat and muscle cells resistant to the action of insulin, and enhances the production of glucose by the liver.
myocarditis damages the cardiac myocytes, leading to signs of ventricular dysfunction, elevated cardiac enzyme levels, inflammatory infiltration, and myocardial necrosis. Although there are many causes of inflammation of the myocardium, one of the most common viral infections assoc with myocarditis is
coxsackievirus B
dilated cardiomyopathy causes systolic dysfunction of the heart, and results in CHF with sx that include an S3 heart sound and dyspnea. infectious agents leading to this are
coxsackievirus B and trypanosoma cruzii
how does crohns disease cause acute cholecystitis
crohns affects the terminal ileum, which decreases bile acid reabsorption and leads to increased formation of cholesterol stones due to decreased lipid emulsification. Gallstones can obstruct the gallbladder, causing acute cholecystitis, which presents with upper right quadrant pain.
if no time frame given in a stem, the study design is prob
cross sectional
physostigmine
crosses the blood brain barrier to treat anticholinergic toxicity in the CNS.
where are GI stem cells located
crypts of lieberkuhn
the proliferative phase of the menstrual cycle is controlled by
cyclin dependent kinases
B cells can present antigens to CD4 helper T cells which then release
cytokines to activate the B cell, causing it to become a plasma cell and release IgG (isotype switch) antibodies that recognize this antigen, marking those cells for degradation
heme synthesis occurs in both the
cytoplasm and the mitochondria. Mitochondria are involved in the first and final three steps of the pathway. However, the defective enzyme in PCT (porphyria cutanea tarda), uroporphyrinogen decarboxylase, is present in the cytoplasm.
preproinsulin is in the
cytosol (goes to RER where it becomes proinsulin)
what to do to reduce incidence of catheter related bloodstream infections
daily chlorhexidine bathing
which activity most recommended in diabetics (if blood glucose levels are already under control)
daily foot inspection
erb's palsy
damage to C5-C6; affects deltoid, supraspinatus, infraspinatus, and biceps brachii.
median episiotomy is at risk for _ if the incision is torn further
damage to external anal sphincter muscles
premature atherosclerosis and xanthomas (lipid deposits) in the skin and tendons
decreased LDL receptors due to familial hypercholesterolemia (most common inherited lipid disorder)
baby has coughing and choing and its worse during feedings, and it turns blue. there is gastric distension with tympanic sounds on PE. X ray shows gas in stomach.
esophageal atresia with distal tracheoesophageal fistula
female professional runner has focal midline tenderness over the lower thoracic spine after falling in shower.
decreased hypothalamic GnRH secretion due to chronic energy deficits from exercise or restricted caloric intake that suppresses the hypothalamic secretion of GnRH leading to early onset osteoporosis
alkaptonuria
def of homogentisic acid oxidase. results in deposition of homogentisic acid in cartilage (i.e. eyes and ears), kidneys, heart valves. homogentisic acid oxidase is in the tyrosine and phenylalanine pathway. have to limit dietary intake of these substances. (vs phenylketonuria where tyrosine becomes an essential amino acid due to lack of BH4 - tetrahydrobiopterin)
acute intermittent porphyria
def of porphobilinogen deaminase; sx: intermittent epidodes of abdominal pain with neuro manifestations following exposure to an offending med. urine during attacks will darken when exposed to sunlight. Skin photosensitivity is characteristically absent.
albinism gene
defective tyrosinase (cant make melanin)
von gierke disease
defic of glucose 6 phosphatase so all the glucose gets trapped inside cells and they get hypoglycemia.
which two enzymes are impaired in lead poisoning
delta-aminolevulinic acid dehydratase and ferrochelatase are disrupted. results in anemia, abdominal pain, encephalopathy, and peripheral neuropathy. Burton lines can be a sign of lead poisoning (blue lines along the gums).
delusional disorder vs schizotypal personality disorder
delusional disorder: persistant, false beliefs > 1 month without the presence of other psych sx. Functioning is intact apart from the impact of the delusion. Delusional pts are NORMAL besides their delusion (schizo is obviously weird all the time) Schizotypal: eccentric behavior and odd thoughts and perceptions. different than delusional disorder by the absence of clear delusions (i.e. persistant, false, fixed beliefs) (delusional ppl don't have the interpersonal awkwardness)
delusional disorder vs paranoid personality disorder
delusional: 1 month of fixed, false beliefs on ONE TOPIC. theyre otherwise normal Paranoid disorder: pervasive distrust of others (i.e. lots of topics).
the spider angiomas, palmar erythema, gynecomastia, testicular atrophy, Dupuytren's contractures and decreased body hair in alcoholics is from excess
estrogen
a hemangioma is
densely packed capillaries
4 D's of niacin deficiency
dermatitis, diarrhea, dementia, and death (excessive
in staphylococcal scalded skin syndrome, what structures in the skin are disrupted to cause the blisters?
desmosomes; the epidermis separates at the stratum granulosum as a result of binding of epidermolytic toxins A and B to desmoglein 1 (desmosomes) in this layer. results in positive nikolsky sign
drug to suppress the cough reflex
dextromethorphan
autoimmune hemolytic anemia
diagnosed by means of a positive direct coombs test result, which shows antibodies to the patient's red blood cells. It is assoc with elevated lactate dehydrogenase and indirect bilirubin levels and low haptoglobin levels.
S3 heart sound
diastolic (filling) heart sound caused by vibrations of the ventricular wall as it reaches its elastic limit during rapid filling in states of volume overload and/or ventricular enlargement. Maneuvers that increase preload, such as abrupt squatting, passive leg raising, and volume expansion, will accentuate the S3 heart sound.
which drug to give asthmatic that has arrhythmia? (i.e. cant give them a beta blocker)
diltiazem (non-dihydropyridine CCB) bc it has negative dromotropy
if eye is denervated in experiment, which drug would cause pupillary constriction
direct muscarinic cholinergic agonist (i.e. pilocarpine).
tx for HIT
direct thrombin inhibitor (argatroban, bivalrudin)
cromolyn sodium
directly binds to mast cells, etherby preventing their degranulation and release of histamine and leukotrienes. This treats the inflammation and bronchoconstriction of the airways that is characteristic of mild persistant asthma. Omalizumab (monoclonal antibody to IgE) is reserved for severe persistant asthma.
langerhans cell histiocytosis
disorder characterized by monoclonal proliferation of cells derived from myeloid progenitor cells which resemble the langerhans cells found in the dermis and mucosa. LCH often presents with nonspecific symptoms, inclduing fever, rash and bone swelling. On EM: birbeck granules may be seen within the cytoplasm of the aberrant cells. normal fxn of langerhans cells: phagocytosis of cell debris and pathogens
concussion sx are due to
disruption of axonal function
hepatic encephalopathy can be precipitated in severe liver disease pts with the use of
diuretics (i.e. hydrochlorothiazide) bc they cause hypokalemia, metbaolic alkalosis, azotemia, and hypovolemia.
abnormalities in color perception and visual acuity, fatigue, and cardiac depression are potential toxic effects of digoxin. They can be precipitated by hypokalemia, which may be caused by the use of certain _
diuretics (like furosemide)
hirschsprung disease aka congenital megacolon is assoc with
downs syndrome
negative dromotropy
dromotropy is the conduction speed at AV node
if pt develops parkinson-like sx after a long time of being on a certain drug for a chronic condition
drug induced parkinsonism from typical or atypical antipsychotics to treat schizoaffective disorder (or something like it). DIP can also be caused by GI prokinetics, CCBs, and antiepileptic drugs.
defective Apo E
dysbetalipoproteinemia (elevated chylomicrons and VLDL)
paget disease of the breast
eczematous lesions of the nipple or areola and characteristic large, halo-like cells on histo. Full-thickness biopsy that includes lactiferous ducts should always be done due to high suspicion of underlying ductal carcinoma.
a decrease in blood oncotic pressure (as in liver failure or nephrotic syndrome), an increase in capillary hydrostatic pressure (as in congenital heart failure), or a lymphatic obstruction can lead to
edema; Starling eqn: Net fluid flow = Kf [(Pc - Pi ) - ς (πc - πi)]. A positive net fluid flow indicates that fluid will move out of the capillary, and a negative net fluid flow indicates that fluid will move into the capillary.
what is elevated in molar pregnancy (hydatidiform mole) besides beta HCG
elevated beta HCG levels give rise to sx of hyperthyroidism bc of a shared alpha subunit. this type of pregnancy classically presents with triad of hyperemesis, vaginal bleeding, and hyperthyroidism.
pt has elevated gastrin and kidney stones, what else do they have
elevated prolactin bc this is MEN1 and they have pituitary problems, of which the most common is prolactinoma
pseudohypoparathyroidism
end organ resistance to parathyroid hormone due to defects in the PTH receptor and downstream signaling pathways. Pts have hypocalcemia and hyperphosphatemia despite elevated PTH levels. Albright hereditary osteodystrophy is a form of pseudohypoparathyroidism further assoc with short stature and short metacarpal and metatarsal bones. inherited from mom
treatment for hepatitis B
entecavir (or tenofovir) and interferon alpha
picornaviruses are
enteroviruses (and the most common cause of viral (aseptic) meningitis)
virus dies when heated, what outer structure does it have
envelope
histo of atopic dermatitis
epidermal thickening and hypertrophy along with lichenified plaques
sickle cell trait is most commonly assoc with which complication
episodic hematuria
periventricular intracranial calcifications on CT vs diffusely scattered intracranial calcifications
periventricular: CMV; diffusely scattered: toxoplasmosis gondii
internal ribosome entry site feature of mRNA
eukaryotic translation is initiated when the small ribosomal subunit binds the 5' cap of mRNA (facillitated by initiation factors) and scans for the AUG start codon within the Kozak consensus sequence. Internal ribosome entry is an alternative method used by apoptotic cells whereby a distinct nucelotide sequence (usually in the 5' untranslated region) allows translation to begin in the middle of mRNA. this happens during programmed cell death (apoptosis), the activation of caspases results in eIF degradation leading to interruption of translation. bc of this, the proteins needed for apoptosis are translated using this alternative method of internal ribosome entry.
right vs left renal vein
everything nearby on the left comes off the left renal vein (i.e. adrenal blood supply - left suprarenal vein, left gonadal vein). everything on right drains directly to the IVC.
palindromic sequence of DNA
example: TGTACA (bc the matching strand will be the same)
expel normal inspiration = _ , expel maximal inspiration = _
expel normal inspiration = inspriaotry capacity TV + IRV , expel maximal inspiration = vital capacity TV + IRV + ERV
action of gluteus maximus
extends and laterally rotates the thigh and aids in standing from a sitting position. pts with damage to the inferior gluteal nerve will also have difficulty ascending stairs and jumping
integral membrane proteins are anchored within the membrane via
extensive hydrophobic interactions between the amino acid side chains of the protein and the membrane's phospholipid tails
indirect coombs
external RBCs in maternal serum with external anti-IgG (direct would be fetal RBCs in anti-IgG serum)
intravenous injection puts fluid in what space (intra vs extra cellular fluid)
extra CELLular fluid.
angiokeratomas (black papules), acroparesthesia (intermittent periph paresthesias) and heat intol
fabry disease (accum of ceramide trihexoside) def of galactosidase A
middle cerebral artery provides blood flow to the motor and sensory cortex of the
face and the upper limbs
factor 8 vs vWF deficiency presentation
factor 8 (hemophilia A) deficiency: X linked, most common inherited coagulopathy, easy bruising, hemarthrosis and bleeding caused by oral injury. tx is factor 8 infusion. normal bleeding time ; vWF deficiency: increased bleeding time, ristocetin test shows no platelet aggregation,
defective proline hydroxylation leads to
failure of triple helix formation and stabilization by pro-alpha chains during collagen synthesis.
defective Apo B 100
familial hypercholesterolemia (high LDL, cholesterol), defective LDL receptors
aunt and cousin with breast cancer
family hx of breast cancer may have BRCA
ehlers danlos syndrome
faulty collagen synthesis; hypermobile joints is most common type. vascular type is mutation in type 3 collagen
polyarteritis nodosa
fibrinoid necrosis on histo, strong assoc w Hep B, segmental transmural necrotizing inflammation
common estrogen sensitive benign breast tumor in yoiung women. solitary, nontender, firm, well-demarcated, spherical, and mobile nodule corresponding to an encapsulated proliferation of stromal and ductal elements
fibroadenoma
on step, bleeding girls have _ and bleeding boys have _ (i..e increased bleeding time)
girls: vWF deficiency; boys: hemophilia
what drug is used as prevention/ prophylaxis for surgical site infections (i.e. before doing the surgery)
first and second gen cephalosporins (i.e. cefazolin) bc of their excellent activity against gram positive bacteria which are the most likely cause of surgical infections.
tolbutamide
first gen sulfonylurea for T2DM. disulfiram like reaction when taken w alcohol, (maid outfit on swan)
tx for hyperthyroidism
first give them beta blocker, then give them methimazole or propylthiouracil
thiosulfate
first line tx for cyanide poisoning
tx for SIADH
first line: conivaptan, tolvaptan. Second choice: demeclocycline
flu vs URI
flu: fever, muscle aches, dry cough; URI/ common cold (i.e. rhinovirus): rhinorrhea, headache, sneezing, sore throat, postnasal drip (mucus in back of nose)
addison disease tx
fludrocortisone (electrolyte imblance i.e. MC replacement) and dexamethasone (GC replacement)
collapsing glomerulopathy is a variant of
focal segmental glomerulosclerosis characteristic of HIV-assoc nephropathy
how to differentiate folate vs B12 deficiency
folate has NO neurologic sx
what are the arteries, respectively, that provide collateral circ in the hand (radial/ulnar) and the foot (dorsal/plantar)
foot: arcuate artery; hand: arteries of deep and superficial palmar arch
ADRs of interferon alpha
for young patients with chronic hepatitis B infection without cirrhosis, entecavir, tenofovir or pegylated interferon (IFN) may be used to tx. for pts who want to avoid long term treatment, interferon may be used. However, pts should know ADRs are cytopenia, neuropsychiatric sx, autoimmune disorders and ischemic sx.
excretion of what substance increases in acute tubular necrosis
fractional excretion of sodium increases from 1% to greater than 2% in ATN
what is the genetic mutation/ cause of duchenne muscular dystrophy
frameshift mutation (deletion in the dystrophin/ DMD gene).
Duchenne muscular dystrophy (genetics of it)
frameshift mutation caused by a deletion (i.e. frameshift deletions). X linked.
skin lesion with black base, transmitted by a tick, fever, fatigue
francisella tularensis (carried by rabbits or dermacenter tick, leads to ulceroglandular tularemia)
lactose is hydrolyzed to
galactose and glucose
sympathics will synapse at
ganglion. so preganglionic (second order) before synapsing at the stellate or cervical ganglion for instance (when they are outside of the T1-S2 range). When inside of that its prob postganglionic (third order) nerves getting compressed.
weight loss, early satiety, and abdominal pain
gastric adenocarcinoma (periumbilical nodule) (also a virchow node)
which hormone is increased in pernicious anemia
gastrin; pernicious anemia is due to autoimmune destruction of gastric mucosa. Prod of gastric acid is diminished leading to rise in gastrin release.
gaucher disease
gauche such a bro (crying); most common lysosomal storage disease. beta glucocerebrosidase deficiency and glucocerebroside accumulation. Clinical sx: splenomegaly leading to pancytopenia due to rapid splenic destruction of blood cells and skeletal destruction, which can lead to severe bone pain and avascular necrosis
SGLT1
glucose and galactose transporter that enables glucose and galactose absorption across the apical membrane of enterocytes. SGLT1 achieves glucose and galactose absorption by coupling to the sodium gradient, created by the basolateral sodium-potassium pump. Since SGLT1 is not involved in fructose absorption, inhibiting its function would not affect fructose.
protein modification happens in which organelle
golgi apparatus (through addition of oligosaccharides to proteins and lipids, tagging them for delivery to vesicles and lysosomes)
which two conditions both affect type IV collagen
goodpasture (IgG against alpha 3 type 4 collagen) and alports (hereditary connective tissue disease caused by inheritance of a defective form of type IV collagen.
in addition to bergers and PSGN, _ can present after an infection of the pulmonary system.
goodpasture syndrome (usually a virus) (hematuria and hemoptysis)
goodpasture syndrome causes what type of lung disorder
goodpasture syndrome has antibodies against the alpha 3 chain of type 4 collagen. pulm fxn tests show a RESTRICTIVE lung disease pattern with a decrease in FEV1 and FVC and a normal FEV1:FVC
whats a granulocyte; what is myelosupression?
granulocyte: neutrophil, basophil or eosinophil; myelosupression: granulocytes, platelets and RBCs mature in the bone marrow so these are suppressed (i.e. cyclophosphamide does this)
granulosa cell: vs theca
granulosa cel: FSH; theca: LH (in the follicle of the ovary)
group B strep vs group A strep
group B strep is agalactiae; group A strep is strep pyogenes
most common causes of meningitis in an infant/ newborns
group B streptococci, E. coli, and listeria.
peyer patches
gut lymphoid tissue, located primarily in the ileum. M cells in the peyer patches take up antigens from the intestines and present them to B cells, which then secrete IgA antibodies.
fragile X syndrome
happens in boys; CGG (Chin protruding, Giant Gonads) trinucleotide repeat, autism, int dis
cisplatin ADR
hearing loss
tx for hemolytic disease of the newborn vs tx for mom that's pregnant with baby with diff ABO blood type
hemolytic disease of newborn: (baby is born with high bilirubin, etc): tx is exchange transfusion with matched Rh-negative blood; if baby still in utero: give mom Rho (D) immune globulin IV (RhoGAM)
hep B vs C: outcomes
hep B: complete resolution; hep C: lifelong persistent infection
warfarin vs heparin: why does heparin not cross placental barrier
heparin is water soluble and warfarin is lipid soluble, therefore heparin does not cross placental barrier
prolonged oral contraceptive use can lead to
hepatic adenomas, which are benign and often regress after cessation of contraception use
hepatitis E is similar to hepatitis _ in its classification
hepatitis A; nonenveloped, single stranded RNA virus
hepadnavirus
hepatitis B virus is the only DNA hepatitis virus and therefore its called a hepadnavirus
hepatocellular carcinoma can be caused by
hepatitis B, hepatitis C, chronic alcoholism, and fatty liver disease. Pts with risk factors for these who present with RUQ pain and weight loss should raise suspicion for HCC.
brisk, painless rectal bleeding in a child (2 year old). caused by
heterotopic mucosa (i.e. meckel diverticulum from an incompletely obliterated omphalomesenteric duct (vitelline duct)). contains heterotopic gastric tissue that can ulcerate and cause brisk but painless lower GI bleeding.
in a newborn who fails to pass meconium within the first 24 hours of life,
hirschsprung disease is in the ddx. its also known as congenital megacolon, and is secondary to failure of neural crest cells to migrate to the distal colon.
clear corneas, coarse facial features, aggressive behavior, pearly skin lesions
hunter syndrome (def of iduronate 2 sulfatase).
the two histo features of hashimoto's in the thyroid
hurthle cells (eosinophilic metaplastic cells that line follicles) and lymphoid aggregates with germinal centers (it replaces thyroid parenchyma w lymphoid cells in this disease)
vitamin D
increases Ca and PO4 absorption from the intestines
tissue ischemia does what to electrolyte levels
increases extracellular potassium due to reduced fxn of the Na K ATPase and subsequent leakage of K+ from affected cells. ischemia also reduces extracellular Na Ca and HCO3. Cytoplasmic Ca accumulation is a hallmark of ischemic injury.
secretin
increases pancreatic bicarb secretion, decreases gastric acid secretion, and increases bile secretion. neutralizes gastric acid in duodenum allowing pancreatic enzymes to function
Il-12 is critical to the cell-mediated immune response. if pt is deficient in IL-12 you should give them _
individuals lacking IL-12 or its receptor are unable to mediate Th1 helper cell immune responses. For this reason, they cannot activate macrophages via interferon gamma to kill phagocytosed organisms and are suceptible to recurrent mycobacterial infections. Administration of interferon gamma bypasses the need for IL-12 and is helpful for these patients.
what is the cause of aspiration pneumonia in epileptics/ people prone to reduced consciousness?
individuals with reduced consciousness have an impaired cough reflex with incomplete glottic closure that predisposes to the development of aspiration pneumonia. Other risk factors for aspiration pneumonia include dysphagia, NG/ET tubes, upper GI tract disorders and prolonged vomiting.
treatment for acute lymphocytic leukemia is divided into 3 phases:
induction, consolidation and maintenance. induction: vinchristine, L-asparaginase and prednisone.
a posterior hip dislocation can injure the
inferior gluteal nerve which innervates the gluteus maximus.
vascular supply of the parathyroid glands
inferior thyroid arteries supplied by the thyrocervical trunk supplied by the subclavian artery
endometriosis (dysparenunia, chocolate cysts) leads to
infertility
anti-TNF alpha drugs
infliximab (monoclonal antibody to TNF alpha) and etanercept (a recombinant TNF receptor fusion protein)
teres minor vs infraspinatus: which is more commonly injured
infraspinatus. SItS muscles (supraspinatus, Infraspinatus, teres minor, and subscap)
moa of TCA's
inhibit NE and serotonin reuptake from the synaptic cleft.
azoles moa
inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol
antibody target of Hib vaccine
polyribosylribitol phosphate that comprises the type B capsule.
C diptheriae and strep pyogenes both acquire their virulence from
lysogenic conversion which is done via a bacteriophage that infects the bacteria and injects its genome.
firstline tx for mycoplasma pneumoniae
macrolides
if pt gets strep pyogenes and is allergic to penicillin, what drug to tx?
macrolides (azithro or clinda)
why do pts with sarcoidosis get hypercalcemia and hypercalciuria?
macrophage-mediated conversion of vitamin D to its active form.
goodpasture more common in
males (6:1)
multiple myeloma
malignancy in which malignant plasma cells secrete excessive quantities of immunoglobulin. resulting in renal failure, hypercalcemia, lytic bone lesions, and blood component deficiencies.
sudden appearance or rapid spread of acanthosis nigricans means
malignancy within the GI tract or lungs.
sublimation
mature; chanelling unacceptable desires into acceptable behavior
cells pile into small mounds in petri dish
means they are malignant bc normal cells only grow in single layer due to contact inhibition
pts with hodgkin lymphoma who have relapsed from ABVD treatment or cannot tolerate the ABVD regimen can be treated with the MOPP regimen:
mechlorethamine, oncovin (vinchristine), procarbazine, and prednisone.
tardive dyskinesia moa
med induced movement disorder due to prolonged exposure to dopamine-blocking agents which causes upregulation and supersensitivity of dopamine receptors.
femoral fractures causing osteonecrosis: which blood vessel
medial femoral circumflex artery
in a positively skewed distribution the mean is greater than the
median
1/2 meat LOAF
median nerve innervates these. OAF is oppenens pollicis, ABductor pollicis and flexor pollicis brevis. ADductor pollicis is innervated by the deep branch of the ulnar nerve
histo: increased levels of calcitonin in pt with cancer of neck
medullary thyroid carcinoma assoc with MEN2A and 2B (RET mutations)
firstline tx for UC
mesalamine or sulfasalazine (anti-inflammatory drugs)
severe lactic acidosis can occur due to surgical stress in patients who are diabetic and taking
metformin (you'll see an anion gap)
mecA positivity
methicillin resistant (MRSA) i.e. tx with vancomycin
thrombotic thrombocytopenic purpura
microangiopathic hemolytic anemia, thrombotic purpura, fever, renal failure, neurologic abnormalities (AMS).
absence of complement or immunoglobulin deposits on IF is seen with
minimal change disease (i.e. besides effacement, it looks normal)
blood transfusion reactions: within minutes, 1 hour, 1-6 hours, and within 6 hours
minutes: Type 1 HSR; 1 hour & 1-6 hours: type 2 HSR; within 6 hours: donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells.
adverse effect of phenoxybenzamine (long acting irreversible alpha antagonist)
miosis (pupillary constriction) - hard to see at night.
medication to prevent peptic ulcer disease that also is contraindicated in pregnancy
misoprostol (prostaglandin analog used in the prevention and treatment of NSAID-induced peptic ulcer disease (PUD). It also causes uterine contractions and therefore should not be used for the tx of PUD during pregnancy)
increase in left atrial pressure during systole
mitral regurgitation is assoc with holosystolic murmur that is heard at the cardiac apex.
acetyl CoA is an allosteric activator of a biotin dependent enzyme that catalyzes an irreversible step in gluconeogenesis. What is the product of this reaction in gluconeogenesis
oxaloacetate (i.e. pyruvate decarboxylase is the first irreversible enzyme in gluconeogenesis, and converts pyruvate to oxaloacetate)
shorter acting benzodiazepines
oxazepam, triazolam, and midazolam. these have a HIGH risk of causing dependency
pacinian corpuscles, meissner corpuscles, merkel discs, ruffini corpuscles and free nerve endings
pacinian corpuscles: vibration/pressure, meissner corpuscles: fine touch/position sense, merkel discs: pressure/deep touch, ruffini corpuscles: pressure/joint angle change and free nerve endings: A Delta plane is fast but a taxC is slow (Adelta fibers and C fibers) they both sense pain and temperature
the LATERAL spinothalamic tract controls
pain and temperature. LST is located LATERALLY
follicular lymphoma
painless lymphadenopathy, diffuse, bcl-2, non-hodkin lymphoma, t (14;18)
the vagus nerve innervates which muscle of the tongue
palatoglossus
electrolyte exchange of exocrine glands: pancreas vs salivary
pancreas: has HCO3 out and Cl in; salivary: low flow = high potassium excr, low sodium/ chloride excr...high flow = high sodium & bicarb excr, low potassium & chloride excr. ; ileal secretions: alkaline, high flow = bicarb and potassium
gallstones causing pancreatitis due to
pancreatic autolysis due to trypsin. trypsin is released by the pancreas and is first enzyme in the protein digestive enzyme cascade in the GI. inappropriate conversion of trypsinogen to trypsin causes autolysis and necrosis in pancreatitis
weight loss, painless jaundice and migratory thrombophlebitis are signs of
pancreatic cancer (trousseau syndrome)
orphan annie eye nuclei
papillary thyroid carcinoma
histo: grainy laminated calcifications in pt with nodule in anterior neck.
papillary thyroid carcinoma typically presents as a nodule in the anterior neck and may cause hoarseness bc of local compression. assoc with radiation exposure. has Psammoma bodies (grainy laminated calcifications), orphan annie eye nuclei, and nuclear grooves.
the upper optic radiations pass thru the
parietal lobe (the lower pass thru the temporal lobe)
fast to slow: cardiac tissue conduction velocity
park at ventura avenue; purkinje (fastest), atrial, ventricular, AV node (slowest)
slap cheek rash
parvovirus B19
acute interstitial nephritis: drugs that cause it
pee, pain free, penicillins, PPI's, rifamPin (diuretics, NSAIDs, penicillins/ cephalosporins, PPI's, rifampin) AIN can progress to hematuria by becoming renal papillary necrosis
hartnup disease
pellagra, caused by niacin (vit B3) deficiency, can be a result of insufficient dietary intake or a hereditary metabolic disease that leads to reduced renal tubular reabosrption of tryptophan (hartnup disease) the classic triad of pellagra is diarrhea, dermatitis, and dementia (the 3 D's of B3)
diffuse esophageal spasm (DES)
periodic uncoordinated, non-peristaltic contraction of the esophagus that leads to episodic substernal chest pain accompanied by dysphagia. It may mimic other etiologies of chest pain but can be differentiated by normal EKG and normal upper endoscopy findings. barium swallow would show a "corkscrew pattern".
intellectual disability, seizures, musty body odor
phenylketonuria
drugs with zero order elimination
phenytoin, ethanol and high dose aspirin
cardiolipin
phospholipid found in the inner mitochondrial membrane that is targetted in various immunologic conditions. Anticardiolipin antibodies are detected in syphilis, and their presence is considered a nonspecific marker of treponemal infection.
main bacterial factor resp for establishing infection in pts with N. gonorrhea
pili (they use it to establish infection)
lewy bodies
pink staining inclusions that are aggregates of the protein alpha synuclein seen in parkinson disease and lewy body dementia.
tx for pseudomonas
piperacillin/tazobactam, aztreonam, or a fluoroquinolone
which plasmodium species is the only one that has cerebral involvement
plasmodium falciparum
thromboxane A2 causes
platelet aggregation and vasoconstriction
enlarged spleen from portal hypertension backup from a cirrhotic liver will sequester increasing numbers of
platelets within the spleen, causing a low platelet count
pleiotropy vs allelic heterogeneity
pleiotropy: when a one mutation causes several phenotypic effects in the same person (i.e. marfans). allelic heterogeneity: different mutations in the same genetic locus cause similar phenotypes.
esophageal webs, iron deficiency anemia, atrophic glossitis
plummer vinson syndrome tx: iron supp and esophageal dialtion
pneumonia in an immunocompromised pt (AIDS) with dyspnea, fevers, weight loss and fatigue and CD4 of 110.
pneumocystis jirovecii. tx: TMP SMX; TMP SMX can also be used to prevent another infection in the future
polymyositis vs. dermatomyositis (both have anti jo)
poly: CD8 T cells, endomysial; dermato: CD4 T cells, gottron papules, perimysial, rash
primary myeloproliferative disorders
polycythemia vera: rbcs increased, wbcs increased, platelets increased; essential thrombocythemia: platelets increased, jak2 mutation; myelofibrosis: rbcs decreased, jak2 mutation, dry tap, dacrocytes; CML: decreased rbcs increased wbcs, increased platelets, philadelph chromo;
polygonal eosinophilic cells vs sheets of small blue cells
polygonal eosinophilic cells: carcinoid tumor; sheets of small blue cells: small cell lung cancer
morning stiffness in the shoulders and hips is a sx of
polymyalgia rheumatica, (assoc with giant cell arteritis) tx: prednisone
rhabdomyolysis UA
urine dipstick shows blood but UA shows absence of RBCs on microscopy.
what is implied or required under Good Samaritan laws
use of standard of care
schilling test
used to identify patients who have vitamin B12 deficiency because of a lack of instrinsic factor.
quinine
used to treat malaria caused by infection with plasmodium falciparum and can precipitate development of cardiac arrhythmias, such as torsades de pointes, a life threatening ventricular arrhythmia
shingles in what age
usually adults >50 y/o, but can happen in any age that has already had infection with the primary varicella zoster infection (chicken pox) (especially if it happened in first year of life).
variable expressivity vs mosaicism
v. expressivity: distinct genotype has varying phenotypic expressions. marfans can do this. mosaicism: multiple sets of genetic info found in Dad or Mom. Results in affected offspring without parent being affected.
recurrent laryngeal nerves branch off of
vagus nerves
painless masses in the scrotum that do NOT transilluminate
varicocele (enlarges w standing, regresses w laying down), testicular cancer (does not change in size with position).
angiogenesis is driven by two factors:
vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). VEGF increases endothelial cell proliferation and leads to new capillary formation. FGF also leads to endothelial cell proliferation, but unlike VEGF, it is involved in additional processes such as hematopoiesis and wound healing.
which cells are directly responsible for the synthesis of the fibrous cap overlying the arterial atherosclerotic lesions
vascular smooth muscle cells are responsible for the secretion of matrix proteins, which ultimately form the fibrous cap of mature atheromas.
what will happen to vasopressin levels in nephrogenic diabetes insipidus
vasopressin levels are increased due to vasopressin resistance in the renal collecting ducts.
vinca alkaloids vs taxanes
vinca alkaloids: inhibit microtubule assembly. Taxanes: inhibit microtubule disassembly.
pediatric pt with tetany (intermittent muscular spasms), hypocalcemia, cardiac anomalies, recurrent viral/fungal infections
viral infections = T cell deficiency. that with hypocalcemia, means digeorge syndrome. which means that the pt will have underdeveloped paracortex in the lymph node secondary to thymic hypoplasia/ aplasia and consequent T lymphocyte deficiency.
which vitamin is stored in hepatic stellate cells in the space of Disse (in their cytoplasm)
vitamin A
eggs overingestion
vitamin A toxicity
cephalosporins long term use (and other broad spectrum antibiotics) can cause
vitamin K deficiency
vomiting leads to loss of _ and _ resulting in decreased ECF which activates the RAAS system. this causes what electrolyte exchanges to occur in the kidney
vomiting leads to loss of volume and protons. leads to increased Na absorption in exchange for K and H+ at the PCT. this contraction alkalosis is secondary to volume depletion and worsens the metabolic alkalosis that was already there from vomiting.
pheochromocytoma, hemangioblastomas, and renal cell carcinoma is
von hippel lindau syndrome
after thyroidectomy, pts must be treated with levothyroxine to prevent the sx of hypothyroidism which include
weight gain, cold intolerance, and fatigue. (i..e decreased lipolysis, and decreased gluconeogenesis - bc thyroid hormone stimulates gluconeogenesis)
alcoholic cerebellar degeneration vs wernicke korsakoff
wernicke korsakoff: confabulation, thiamine deficiency, mamillary bodies, horizontal nystagmus, ataxia. ; alcoholic cerebellar degeneration: long term alcohol use, cerebellar vermis degen, gait ataxia, truncal instability, rhythmic tremor of hands