Combined STEP ONE STUDY Part 1

what cytokine are seen in asthma

IL-4 IL-5

What cytokines for asthma

IL-4 (IgE) IL-5 (eosinophil) IL-10 (increase TH2)

Causes of Acute Pancreatitis: I GET SMASHED

Idiopathic(thought to be result of a hypertensive sphincter or microlithiasis) Gallstones(usually traveling down common bile duct and becoming trapped in the Ampulla ofVater) Ethanol(alcohol intake, usually extensive) Trauma(usually blunt abdominal trauma) Steroids(systemic corticosteroid use) Mumps(paramyxovirus) and other viruses (Epstein-Barr virus, Cytomegalovirus) Autoimmunedisease (polyarteritis nodosa, systemic lupus erythematosus) Scorpion sting (also snake bites) Hypercalcemia,hyperlipidemia, particularly hypertriglyceridemia and hyponatremia ERCP(post endoscopic retrograde cholangiopancreatography) Drugs(sulfonamides, azathioprine, NSAIDs, diuretic use {loop and thiazide},didanosine, DDP-4 inhibitor {-gliptin} use) and duodenal ulcers

Henoch-Schonlein Purpura

IgA-anti-IgA immune complexes -> palpable purpura on buttocks/legs, IgA GN, arthritis bloody stools bloody urine skin lesions

Rh antigen (what type of immunoglobulin)

IgG

Post strep glomerulonephritis (what type of immunoglobulin and what type of hypersensitivity?)

IgG immune complex type III hypersensitivity RXN

Post strep glomerulonephritis causes deposits of (???), (???), and (???) due to consumption. +ASO

IgG, IgM, and C3

what antibody does not cross placenta?

IgM

fail to express CD40 ligand. Based on this, the immunoglobulin isotype that predominates has which biological properties?

IgM --> complement activation

Kartagener's syndrome (defect)

Immotile cilia due to a dynein arm defect. Results in male and female infertility (sperm immotile), bronchiectasis, and recurrent sinusitis (bacteria and particles not pushed out); associated w/ situs inversus.

Kartagener's syndrome

Immotile cilia due to a dynein arm defect. Results in male and female infertility (sperm immotile), bronchiectasis, and recurrent sinusitis (bacteria and particles not pushed out); associated w/ situs inversus.(everything on opposite side)

IPEX syndrome

Immune Dysregulation, Polyendocrinopathy Enteropathy X Linked (thyroiditis, DM-1) Boys are affected...girls are cariers Frequent infections Mutation in FoxP3 gene that is expressed in thymus, spleen and lymph nodes

Aromatase deficiency

Inability to synthesize estrogens from androgens which occurs *early in embryonal life* . Since it is *autosomally recessive*, during pregnancy, there is *maternal virilization*(testosterone) due to the transfer of excess androgens into maternal circulation!!!! Increased serum testosterone and androstenedione. This causes: females: clitomegaly/ambiguous genitalia (but normal internal genitalia) at birth Primary amenorrhea, osteoporosis and tall stature (low estrogen delays fusion of epiphyses) !!! Males: nothing

HPV-related malignancy

Inactivation of tumor suppressor genes (HPV-16: E6 gene product inactivates TP53 gene; HPV-18: E7 gene product inactivates Rb gene)

Osgood-Schlatter disease (what part of tibia)

Incomplete separation or avulsion of the tibial tuberosity

thyroid during pregnancy

Increase in T3 BP (TBG) increase T4

Renal changes in pregnancy

Increased GFR from 50% increase in plasma volume and increased in glomerular filtration rate ---> lower Cr and BUN

• Mechanism of ETC Uncouplers

Increased permeability of mitochondrial membrane → reduced proton gradient and increased oxygen consumption → electron transfer without ATP synthesis.

Bohr effect

Increased serum carbon dioxide (increased H+ concentration, decreased pH) reduces affinity of hemoglobin for oxygen (right shift of the O2-Hb dissociation curve), which facilitates O2 loading in the lungs and unloading in peripheral tissues.

What do loop diuretics do? what metabolic changes?

Increased urinary excretion of sodium, potassium, and water metabolic alkalosis--> contraction

What is a combo pill that inhibits nephrilysin and blocks angiotensin II receptors causes what effects?

Increased urinary sodium excretion (valsartan/sacubitril) Nephrilysin increases ANP and BNP

Carbamazepine (mechanism, use, toxicity)

Increases Na channel inactivation; first-line for simple, complex, and tonic-clonic seizures and trigeminal neuralgia; adverse effects: agranulocytosis, aplastic anemia, P450 inducer, SIADH, liver toxicity

positive reinforcement

Increasing behaviors by presenting positive stimuli, such as food. A positive reinforcer is any stimulus that, when presented after a response, strengthens the response.

negative reinforcement

Increasing behaviors by stopping or reducing negative stimuli, such as shock. A negative reinforcer is any stimulus that, when removed after a response, strengthens the response. (Note: negative reinforcement is not punishment.)

Primary sclerosing cholangitis

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts that presents with obstructive jaundice Fibrous obliteration of bile ducte with depositon of onion skin-like pattern. strongly associated with ulcerative cholitis

1-week low-grade fever and joint pain. Has chronic headaches and takes ibuprofen several times. PE diffuse maculopapular rash. UA 2+ protein, 10-20 WBC and eosinophils. Renal biopsy would show what?

Inflammatory infiltrates in the interstitium

Fracture of orbital floor result from direct frontal trauma to orbit. (???) nerve runs along orbital floor in the groove of maxilla before exiting skull inferior to orbit. Damage means paresthesia of upper cheek, lip, and upper gingiva. Inferior rectus muscle can also be entrapped limiting vertical gaze.

Infraorbital

Rifaximin MOA

Inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase decrease intestinal production and absorption of ammonia

Prostacyclin (PGI2)

Inhibits platelet aggregation and prevents adhesion to uninjured endothelium; vasodilator

(???) Part of the limbic system. Involved in the perception of gustatory stimuli and integration of somatosensory stimuli.

Insular cortex

methylmalonyl CoA mutase

Involved in the oxidation of odd-numbered carbon fatty acids, producing succinyl-CoA for entry into the TCA; requires B12.

Sporotrichosis (Rose Gardener's Disease)

Is associated with activities that lead to puncture wounds from plant material. It can occur in groups of people working together. Can usually be cured by oral treatment with potassium iodide (KI) landscapping and have cigar shape

What does acute myocarditis look like histologically?

It can lead to sudden cardiac death, heart failure, or dilated cardiomyopathy

Cardiac Tamponade s/s

JVD, narrow pulse pressure, hypotension ( Becks Triad)

Eplerenone

K sparing diuretic like spironolactone, ACE inhibitor and lead to potassium retention which cause hyperkalemia especially in renal insufficient and those with increase potassium levels.

Epidermal Growth Factor receptor (EGFR) leads to downstream activation of (???) which stimulate cellular growth

KRAS

Where do you cauterize to stop nose bleeding?

Kesselbach's plexus

muscle transport: (???) is anterograde, (???) is retrograde aka (dying to get back home)

Kinesis is anterograde, dynein is retrograde aka (dying to get back home)

Syringomyelia

Knock out anterior white commissure from C8-T1 Cavitation of the spinal cord causing bilateral loss of pain and temperature

Groove sign associated with lymphogranuloma venereum

L1-3 chlamydia

abdominal aorta bifurcation

L4

Loading dose

LD = (Cp x Vd) / F

(???) stimulate the release of testosterone from Leydig cells of testes; (???) stimulates release of inhibin B from Sertoli cells in seminiferous tubules. Testosterone and inhibin B induce negative feedback on (??? and ???) production, respectively

LH FSH

Acute viral myocarditis

LV systolic dysfunction leading to heart failure and cardiogenic shock without pulsus paradoxus

treatment for hepatic encephalopathy?

Lactulose - converts ammonia to ammonium (ammonia trap) in the gut to further lower the serum ammonia Rifaximin - decrease the number of ammonia-producing bacteria in the colon --> can be added for pts. who do not respond to Lactulose

(???) are dendritic cells found in the skin and act as professional antigen presenting cells. These cells are derived from myeloid cell line and have (???) shaped intracytoplasmic granules known as Birkbeck granules

Langerhans cells racquet shaped intracytoplasmic granules

Wallenberg syndrome

Lateral medullary syndrome/ posterior inferior cerebellar artery(vertebral artery) syndrome: Dysfunction: vertigo/nystagmus ipsilateral cerebellar signs loss of pain/temp sensation to ipsilateral face and cantralateral body bulbar weakness ipsilateral horner syndrome

Innervation of abducen (CN VI)

Lateral rectus

Medial Lesions to the Cerebellum

Lesions involving midline structures [Vermal cortex, fastigial nuclei] and/or flocculonodular lobe → 1. Truncal ataxia [Wide-based cerebellar gait] 2. Nystagmus 3. Head tilting 4. Generally, midline lesions result in BILATERAL MOTOR DEFICITS affect AXIAL and PROXIMAL LIMB MUSCULATURE

talofibular ligament

Ligament inserting on the lateral malleolus and the posterior talus; most commmon injured ankle sprain

what virulence factor causes hypotension?

Lipopolysaccharide Lipopolysaccharide (LPS) causes the syndrome of septic shock by initiating the release of endogenous mediators such as tumor necrosis factor (TNF) and interleukin-1 (IL-1) from macrophages.

vinyl chloride or arsenic association + CD31 marker --> PECAM1 (platelet endothelial cell adhesion molecule) what cancer?

Liver angiosarcoma

(???) nerve causes winged scapula

Long thoracic nerve causes winged scapula

Microfilaments

Long, thin fibers that function in the movement and support of the cell

Enlarged coronary sinus

Look for factors that are causing the right atrium to overflow Note --> Pulmonary hypertension is most common cause

hypoosmotic volume contraction

Loss of Hypertonic Fluid = Addisons Disease, Aldosterone Dfcn. (Less Na retention) aka loops

damage to parietal lobe

Loss of imagery and visualisation, and spatial awareness; spatial neglect.

Fracture of the neck of the fibula causes what nerve damage?

Loss of sensation of dorsum of the foot --> common peroneal nerve

G6PD deficiency

Low NADPH leads to hemolytic anemia (free radicals) with bite cells and heinz bodies Fava beans, sulfonamides, primiquine, dapsone X-linked recessive

supine hypotensive syndrome (in pregnancy)

Low blood pressure resulting from compression of the inferior vena cava by the weight of the pregnant uterus when the mother is supine. reduced venous return reduced preload decreased cardiac output hypotension

IgA deficiency

Low serum and mucosal IgA celiac disease

Lead toxicity symptoms

Low-level exposure causes long-term behavioral effects, impaired reading skills, aggression Increases absenteeism and dropout rates s-aminoleulinate dehydratase

Klumpke's paralysis

Lower brachial plexus (C8-T1) palsy that results from childbirth, creates a claw hand deformity with flexion of the wrist distal

Vinca alkaloids inhibit microtubule formation during (???) phase but cause neurotoxicity that manifest as peripheral neuropathy due to disruption of neuronal microtubules which are responsible for transporting organelles and other product between cell body and axon terminal

M

4-month joint pain, muscles aches and fatigue. Had a renal calculus 6 months ago and had cholecystectomy 1 year ago. Appears fatigue, depressed, there is mucosal pallor. No masses palpated in neck. Labs: erythrocyte count 3 million, K+ 4, Cl- 106, Ca2+ 13, phosphorous 2.7, alk phos 125. Technetium-99m scan shows 1.2 cm nodule in neck. Mutation?

MEN1

RET mutation associated with what disease?

MEN2B

Bosentan

MOA: Competitively inhibits endothilin-1 receptors thus decreasing pulmonary vascular resistance. (Endothelin vasoconstricts). Clinical Use: Pulmonary HTN Toxicity: Hepatotoxicity (Monitor LFTs)

First line for respiratory infection?

Macrolide

Bright yellow, yeast cluster and short curved septate hyphae aka (???)

Malassezia furfur (tinea versicolor) spaghetti and meatball

Ebstein anomaly

Malformed, enlarged tricuspid valve that is displaced downward. Atrialization of RV. Severe TR. Atrial right-to-left shunting results in cyanosis in the more severely affected patients.

(???) inhibits action of mitochondrial carnitine acyltransferase inhibiting beta-oxidation of newly formed fatty acids

Malonyl-CoA

Mara has been collecting rocks since she was 5

Maravaroc CCR5

Primary Myelofibrosis

Marrow distortion leads to the premature release of nucleated erythroid and early granulocyte progenitors= leukoerythroblastosis + basophilia *Teardrop-shaped RBC's (dacryocytes)* are cells damaged during the birthing process in the fibrotic marrow diffusely fibrotic marrow with cluster of megakaryocytes lead to extramedullary hematopoiesis

MEN II neoplasm of thyroid show sheets of granular cells embedded in hyaline stroma. with + calcitonin. What type of carcinoma?

Medullary

Distal convoluted tubule associated with what embryological orgin?

Metanephric mesenchyme

p-ANCA

Microscopic polyangiitis, Churg-Strauss syndrome, Ulcerative colitis

Hemolytic Uremic Syndrome: what lab will be elevated?

Microthrombi creating schistocytes in renal arteries Thrombocytopenia, renal failure Normal PT/PTT Often caused by EHEC 0157:H7in Kids, also caused by Shigella toxin >> 60S ribosome the decreased hemoglobin and haptoglobin will be due to destruction leading to increase in indirect bilirubin and lactate dehydrogenase COAG STUDIES WILL BE NORMAL

What are the 6 nephrotic syndromes?

Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy membranoproliferative glomerulonephritis Diabetic glomerulonephropathy Amyloidosis

• (???) DNA is most common non-nuclear DNA found in cells, it is small circular DNA that resemble bacterial chromosome and code for proteins, transfer RNA, and ribosomal RNA

Mitochondrial

Mid systolic click followed by late systolic crescendo murmur heard at apex?

Mitral regurg

Rh alloimmunization

Mom RH- Father RH+ 1st baby is RH+ Mom develops antibodies to RH+ Antibody screen (indirect Coombs test)/Rhogam At 28 wks/PP

Rituximab MOA

Monoclonal antibody against CD20, which is found on most B-cell neoplasms.

Von Willebrand Disease

Most common inherited bleeding disorder; defieincy or defect in von Willibrand factor which leads to instability of Factor VIII so prolonged Bleeding time and APTT; similar clinically to hemophilia A Tx: desmopressin due to induces release of von willlebrand from wibel bodies

Ornithine transcarbamylase deficiency (high levels of what)

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

Right-angle branching hyphae (what organism)

Mucomycosis/rhizopus species morphology

21-year-old woman with 10-days difficulty walking. Two years ago had loss of vision in left eye which improved. Neuro exam shows decreased visual acuity in left eye with pallor of optic disc. Has past-pointing on a finger-nose test. Broad-based gait. MRI shows brain lesions in white matter of cerebellum.Diagnosis? Pathogenesis?

Multiple Sclerosis CD4+ T lymphocytes are activated by myelin basic protein

Lytic lesions in the back or skull

Multiple myeloma (cluster of mature plasma cells and plasmablasts)

(???) classically manifests with parotitis, low-grade fever, malaise, headache, and possibly swelling of other salivary glands or orchitis in post-pubertal males (rarely, oophoritis may also occur).

Mumps

McArdle's disease

Muscle phosphorylase deficiency Normal fasting serum glucose levels Muscular glycogen can't break down, so hypoglycemia with exercise until gluconeo can start Decreased glycogen use in muscle= lower lactate buildup

Lambert's sign

Muscle strength improves after muscle use.

Pyruvate dehydrogenase deficiency (what amino acid should you give?)

Must prevent the conversion of pyruvate to lactic acid since can't go to acetyl CoA (causes acidosis otherwise). Lysine and Leucine are exclusively ketogenic AA's and would not increase the blood lactate levels. when trying to avoid lactate, use lysine and leucine.

Xeroderma pigmentosum

Mutated single strand nucleotide excision repair gene, which prevents repair of thymidine dimers.; Dry skin w/ melanoma and other cancers ("children of the night").

Isoniazid resistance

Mutations leading to underexpression of KatG

Reversibly inhibits IMP dehydrogenase, causing inhibition of inosine monophasphate to guanosine monophasphate preventing purine synthesis of B and T cells. what is the drug?

Mycophenolate mofetil MOA

(???) does not have cell wall therefore cannot be acted upon by glycosyltransferase and must be treated with anti-ribosomal agents such as (???)

Mycoplasma tetracyclines and macrolides

(???) oxygen extraction exceeds that of any other tissue or organ. Therefore, (???) is most deoxygenate blood in body.

Myocardial heart venous blood into coronary sinus

what antidote works by rapid enzyme-dependent detoxification in the liver

N-acetyl-cysteine (NAPQI-->acetaminophen)

sleep spindles and K complexes (what do they look like and what sleep level)

N2

Staph promotes growth of HIB by supplementing which substance?

NAD+

G-6-P dehydrogenase is rate-limiting enzyme in pentose phosphate pathway and main source of (???). Necessary for reducing glutathione (protect RBC from oxidation) and biosynthesis of cholesterol, fatty acids, and steroids.

NADPH

Do not give (???) with sildenafil

NO

Negative predictive value

NPV = TN / (FN + TN) Probability that a person with a negative test result actually does not have the disease.

Indomethacin (baby function)

NSAID COX can close ductus arteriosus

Acute interstitial nephritis

NSAIDs, penicillin, diuretics Fever and rash, eosinophils in urine Can progress to renal pappilary necrosis (also caused by sickle cell trait/DM)

local anesthetics(lidocaine, benzocaine, cociane) block (????) channels leading to inhibition of signals

Na+ channels

Precontemplation stage

No intention to change the addiction behavior.

Fever night sweats and productive cough +immunosuppressed and shows filamentous, branching gram-positive rods

Nocardia which appears partial acid fastness and can lead to multiloculated brain abscesses and seizures. Partial acid fast due to mycolic acid in cell wall

incomplete penetrance

Not all individuals with a mutant genotype show the mutant phenotype

universal donor blood type

O

universal acceptor of plasma blood type?

O type blood

Late phase allergic reaction

Occurs 2-6 hours after allergen exposure, mediated by the influx of eosinophils, basophils, neutrophils, and mononuclear cells attracted via chemokines/cytokines (C4, C4, E4) released from mast cells during the immediate phase of the reaction. vasoconstriction bronchoconstriction (different from immediate that is bronchodilation) inflammation

Phenotypic mixing

Occurs w/ simultaneous infxn of a cell w/ 2 viruses. Genome of virus A can be partially or completely coated (forming pseudovirion) w/ surface protein of virus B. Type B protein coat determines the infectivity of the phenotypically mixed virus. However, the progeny from this infxn have a type A coat that is encoded by its type A genetic material.

Contraction atelectasis

Occurs when either local or generalized fibrotic changes in the lung or pleura hamper expansion and increase elastic recoil during expiration; irreversible

DNA synthesis occurs only 5 3 primes.(???) are short stretches of newly synthesized DNA that separated by RNA primers. They are formed by discontinuous synthesis of DNA on lagging strand.

Okazaki fragments

cn i

Olfactory (smell) does not go through thalamus

(???) causes blindness. (???) 'swims' across the eye but does not cause blindness. (micro)

Onchocercid Loa loa

reflexes mnemonic

One-two, buckle my shoe. Three-four, kick the door. Five-six, pick up sticks. Seven-eight, lay them straight. S1,2 ankle jerk; L3,4 knee jerk; C5,6 biceps and brachioradialis; C7,8 triceps.

Diphenoxylate MOA

Opiate anti-diarrheal: binds to mu receptor in GIT and slow motility AE: bloating and sedation

Median nerve injury

Opponents splint (thumb spica), C-bar (hand in C position)

CN II

Optic - vision

aldosterone escape

Over a couple days of hyperAldo, sodium levels will return to normal due to kidney adaptations.

Fetal blood flow

Oxygenated blood from the placenta is carried in the umbilical vein back to the fetal circulation via the hepatic circulatory system. About one third of this blood flows to the lower trunk and extremities. The rest flows though the ductus venosus, which bypasses the liver's circulation and flows to the inferior vena cava. The better oxygenated blood then returns and enters the right atrium. About half of this blood is shunted from the right atrium into the left atrium through the foramen ovale. The left arterial blood flows to the left ventricle and then to the ascending aorta, where it continues to the brain, brachiocephalic trunk, and descending aorta. Venous blood from the superior vena cava then goes through the right atrium in the right ventricle and then into the main pulmonary artery.

(???) has relapse caused by hypnozoites that need to be treated with primaquine but also chloroquine for the normal treatment

P. Vivax

Causes of eosinophilia 7-PACCMAN

PACCMAN: - *Parasites* - *Asthma* - *Churg-Strauss syndrome* - *Chronic adrenal insufficiency* - *Myeloproliferative disorders* - *Allergic processes* - *Neoplasia (eg, Hodgkin lymphoma)*

Change in (???) that prevent cephalosporin binding is one mechanism of bacterial resistance to cephalosporin.

PBP (change in protein structure)

Alpha-1-antitrypsin deficiency

Panacinar emphysema Intrahepatic accumulation of AAT molecules leading to cirrhosis PAS stain + leading to interalveolar septa destruction

Testes lymph drainage is through where?

Para-aortic

cant look up where the lesion

Paralysis of conjugate verticle gaze due to lesion in superior colliculi (e.g., pinealoma) Parinaud syndrome

Where is intrinsic factor produced? if you had gastrectomy what would you need to treat with?

Parietal cells in the body of the stomach B12 supplementation due to inability to produce IF

Baum's loop

Part of visual pathway In Parietal lobe Damage--> quadrantic anopia (Pie in the floor)

what are Kimmelstiel Wilson Nodules?

Pathognomonic for Diabetic Renal probs - Dense sclerosis

developmental field defect

Pattern of anomalies caused by disturbance of a region of the embryo that develops in a contiguous physical space

Adenocarcinoma of the lung

Peripheral More common in Women Most common in nonsmokers and overall Bronchioalveolar subtype = lepidic, with hazy infiltrates similar to pneumonia

Where is erythropoietin made?

Peritubular INTERSTITIAL cells of kidney

Scabies treatment

Permethrin (or oral ivermectin)

Zellweger syndrome

Peroxisomal disease; can't metabolize very long chain FA (VLCFAs) or branched-chain FAs (e.g. phytanic acid, via alpha-oxidation). Can't form myelin in CNS. Hypotonia, seizures, hepatomegaly, MR, early death.

pacemaker Action Potential

Phase 0-upstroke of calcium Phase 3- repolarization (Ca inactivated, K efflux) Phase 4- slow depolarization (spontaneous depolarization due to increased inward Na conductance, known as the pacemaker ("funny") current. The funny current controls the rate of spontaneous activity of sinoatrial myocytes and hence the cardiac rate.

(??)diet recommend for PKU (phenylalanine hydroxylase deficiency)

Phenylalanine-free

Gingival hypertrophy side effects

Phenytoin, Verapamil, cyclosporine (immunosuppressant for transplants) PDGF

(???) is component of pulmonary surfactant and (???) is common membrane phospholipid. Usually equal in pregnancy until 3rd trimester when (???) concentrations increase sharply while (???) remain unchanged.

Phosphatidylcholine (lecithin) sphingomyelin lecithin concentrations increase sharply while sphingomyelin remain unchanged.

(???) is also component of surfactant that raises after 36 weeks

Phosphatidylglycerol

Gout, what enzyme

Phosphoribosyl pyrophosphate synthetase responsible for purine and pyrimidine but if inhibited will lead toward feed-forward activation of purine synthesis resulting in hyperuricemia and increased risk of gout. Gout can be treated with NSAID due to inhibition of neutrophils or colchicine (impair neutrophil migration)

first year of life

Pincer grasp stand with help crawling

(???) is common and related to bilateral temporal visual fields leading to increase prolactin causing decreased libido

Pituitary adenoma

DIC in obstetrics

Placental Damage leads to release of tissue factor from the placenta to the maternal circulation. this will activate intravascular coagulation and the circulating microthrombi leads to organ ischemia and increased d-Dimer (fibrinolysis). Platelet consumption is increased pt and aptt ultimately leading to bleeding.

gap junctions (what is the gene that encodes?)

Points that provide cytoplasmic channels from one cell to another with special membrane proteins. Also called communicating junctions. connexin-43 and oxytocin and estrogen

Precision vs. Accuracy

Precision: - immunity to variation (hits the same spot every time) Accuracy: immunity to systematic error or bias - dart hits center

Heteroplasmy

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

Cholestyramine mechanism of action?

Prevents intestinal reabsorption of bile acids; liver must consume cholesterol to synthesize lost bile.

Field cancerization

Process whereby exposure to carcinogens creates a field of molecularly altered cells that have an increased potential to malignantly transform cells within a field that are primed to develop cancer because of widespread exposure to mutagens

Acute megakaryoblastic leukemia (downs relationship and MPO)

Proliferation of megakaryoblasts that usually lack MPO (Don't need MPA though because they don't do oxygen-dependent killing) Leukemia of Down Syndrome <5y

Osteoblastic bone Mets caused by what cancer?

Prostate cancer

after giving analgesic patient is unable to be weaned off ventilator. what is the problem?

Pseudocholinesterase deficiency --> genetic polymorphism

Papulopustular rash that is most noticeable on trunk and extremities with oxidase positive gram negative rod that produce pigment, where would you contract this?

Pseudomonas aeruginosa; hot tub folliculitis

(???) block is performed by injecting anesthetic intravaginally medial to ischial spin through sacrospinous ligament and provides anesthesia to most of perineum.

Pudendal nerve

multiple myeloma

Punched out lesion

• The Starling equation represents net flow of fluid across a semipermeable (capillary) membrane. (?equation?)

Qf = K [(Pc+πif) - (Pif+πc)] where Qf = net fluid flow, K = capillary fluid permeability constant, Pc = capillary pressure, Pif = interstitial pressure, πc = capillary oncotic pressure, and πif = interstitial oncotic pressure. Positive Qf = net filtration.

viral squamous cell carcinoma of throat results in decreased activity of that gene?

RB-associated protein

urinalysis of ureterolithiasis

RBC in urine due to disruption of ureteral epithelium

Hereditary Spherocytosis

RBC membrane defect in cytoskeleton tethering proteins: spectrin/band 3.1/ankyrin, Hemolytic anemia, jauncide, and splenomegaly often after URIs

Hereditary spherocytosis

RBC membrane defect in tethering proteins: spectrin/band 3.1/ankyrin, Hemolytic anemia, jauncide, and splenomegaly often after URIs pigmented gallstones are complication of hemolytic anemia

Renal plasma flow equation

RPF=RBF (1-hematocrit) FF=GFR/RPF

Relative risk reduction

RRR = 1 - RR

A Negri body is a pathognomonic sign of what disease?

Rabies

Fracture of left humerus. Muscle strength is 2/5 with extension of elbow and 1/5 with extension of wrist and fingers. Patient most likely sustained a fracture at (which location in humerus)?

Radial groove (radial N. is the extensors of arm, wrist and fingers)

Scleroderma S/S

Ranges from diffuse thickening of skin to organ involvement. Calcinosis: painful deposits of calcium in skin. Raynauds: abnormal blood flow in response to cold/stress *most common* nursing action: keep room warm/free of drafts. Esophageal dysfunction: dysphagia due to internal scarring. Sclerodactyly: tight skin around fingers and toes. Telangiectasia: red spots/lines on hands, forearms, palms, face, lips. *Renal disease is cause of death: dialysis, transplants*

Crescent formation in glomeruli with no immunoglobulin or complement deposition. associated with what antibody?

Rapidly Progressing Glomerulonephritis --> ANCA(vasculitides-granulomatous polyangiitis, microscopic polyangiitis)

Liver infarcts (common or rare?)

Rare due to dual blood supply of portal system and hepatic artery with exception of transplanted liver

HMG-CoA reductase

Rate limiting enzyme in cholesterol biosynthesis Inhibition leads to increase in 3-Hydroxy-3-methylglutaryl-CoA --> mevalonic acid

PFK-1

Rate-limiting enzyme in glycolysis, inhibited by ATP and citrate, activated by AMP.

Lecithin/sphingomyelin (L/S) ratio

Ratio of two components of amniotic fluid, used for predicting fetal lung maturity; normal L/S ratio in amniotic fluid is 2:1 or greater when the fetal lungs are mature.

Paroxysmal nocturnal hemoglobinuria (glycoprotein deficiency?)

Red urine in the morning, fragile RBCs CD55 and CD59 deficiency

Paroxysmal nocturnal hemoglobinuria

Red urine in the morning, fragile RBCs, due to absent GPI leading to decreased DAF(CD55) test by sucrose and acidify urine, most recent testing is lack of CD55

How does this intracellular shift happen?

Release of catecholamine like norepinephrine and epinephrine which activate beta-2 receptor leading to increase activity of Na-K ATPase pump which will transport potassium into the cell.

RB

Retinoblastoma, osteosarcoma

antiretroviral resistance suspected. HIV genotype analysis confirms that the virus has resistance mutations, which of the following most likely mutated?

Reverse transcriptase and protease - The two targets of HAART therapy, therefore if therapy stopped working, must be these two target proteins of virus mutated)

confusion and vomiting in 6 year old after being given "something" for fever OTC which helps. This leads to coma and death. What is the problem and liver specimen show?

Reye syndrome microvesicular steatosis

Effect modification

Reyes and aspirin use but children being common variable

Left ventricular hypertrophy with ischemia of inferior surface of heart what is the artery supplying it?

Right coronary artery

pneumocystis pneumonia Risk factor

Risk factors: immunosuppression (especially if CD4 count < 200/μL) Tx: High-dose TMP-SMX (treatment and prophylaxis)

Temporal arteritis

Risk of ipsilateral blindness due to occlusion of ophthalmic artery; polymyalgia rheumatica (neck, shoulder, and pelvic girdle pain and morning stiffness)

most common cause of osteomyelitis (soft-tissue swelling and periosteal reaction over lower femor)

S. aureus

standard error of the mean (smaller or larger with smaller sample size)

SEM = standard error of the mean = An estimate of how much variability exists between the sample mean and population mean. Increases as the sample # (n) decreases. So sample n decreased-> increased SEM and made CI larger!

Subarachnoid hemorrhage can lead to ??? (drinking a lot of water)

SIADH

Hypoosmotic volume expansion

SIADH compulsive water drinkers cirohsis right heart failure

Mannitol side effects (lungs)

SIDE EFFECTS: * Fluid & electrolyte imbalance. * Pulmonary edema from rapid shift of fluids. * N/V * Tachycardia from rapid fluid loss. * Acidosis. ADVERSE EFFECTS: * Disorientation * Confusion * Headache * Convulsions

Anti-dsDNA antibodies what disease?

SLE

CO=(???)

SVxpulse

Fungal diagnosis

Saboraud dextrose agar, KOH mount, silver stain, India ink mount, serology, urine antigen, Woods lamp.

Sickle cell and osteomyelitis micro?

Salmonella

(???) that are phagocytosed by macrophages and induce massive inflammatory response by cytokine... macular rash on truck, non-lactose gram negative fever chills Abd discomfort

Salmonella gram-neg that are phagocytosed by macrophages

Ehrlichia

Same tick vector as lyme dz - Elevated LFT's, thrombocytopenia and leukopenia Dx: peripheral smear looking for "morulae" Tx: doxycycline

Eggs of what parasite cause bladder cancer? (spine where or no)

Schistosoma haematobium, has spine!

Eggs of what parasite cause fibrosis of portal vein? (spine where or no)

Schistosoma mansoni, has spine!

Grave's ophthalmopathy (MOA and treatment)

Secondary to autoimmune lymphocytic infiltration of the EOM resulting in fibroblast proliferation, hyaluronic acid deposition, edema, fibrosis treatment is glucocorticosteroids

(???) is type III hypersensitivity by nonhuman protein that sxs include vasculitis, fever, rash, arthralgia and low C3 and C4 levels.

Serum sickness

Sirolimus

Similar to Tacrolimus, but inhibits *mTOR*-->decreased T cell proliferation blocking IL-2 signal transduction preventing proliferation

piriform recess

Site of aspirated lodged fishbone

Sturge-Weber syndrome

Skin and meningeal angiomatous lesions. Port-wine nevus: skin angioma in ophthalmic division of trigeminal nerve. Pial angiomas may result in chronic ischemia, gliosis, and gyral cortical calcifications. Enlargement of deep and subependymal veins may mimic arteriovenous malformations.

(???) is important component of spliceosome. Spinal muscular atrophy is a disorder caused by mutation in SMN1 gene resulting in impaired assembly of (???) of lower motor neurons. Flaccid paralysis due to degeneration of anterior horn cell of spinal cord

Small nuclear ribonucleoprotein snRNP

Sponification

Soap created from fat- sebum to soap

neurologic regression with inability to sit, poor head control, and loss of social smile. Enlarged liver and spleen. + cherry red macula. what is accumulating in this patient?

Sphingomyelin increases deficiency in sphingomyelinase

Microtubules (what drug)

Spiral strands of protein molecules that form a tubelike structure Taxol

HER1

Squamous cell lung cancer

• What are side effects for hyper cholesterol drugs? Statin cause (???)

Statin cause muscle toxicity and hepatotoxity

(???) are the primary cells involved in hepatic fibrosis. In response to hepatic injury (???) cells are activated and transform into myofibroblast and are capable of proliferating, chemotaxis, and producing large quantity of collagen.

Stellate (Ito) cells

S4 heart sound

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

Infectious Endocarditis are caused by what organisms?

Strep viridans staph aureus strep.bovis

most common meningitis in adults

Streptococcus pneumoniae

Ejection fraction determined by (???)... stroke volume equals (???)

Stroke volume/End diastolic volume... stroke volume equals EDV-ESV

Thunderclap headache

Subarachnoid hemorrhage maybe caused by berry aneurysm (blood layering the cerebral sulci)

Pituitary apoplexy

Sudden massive hemorrhage and degeneration of the pituitary gland associated with a pituitary tumor. Common symptoms include severe headache, visual problems, and loss of consciousness

(??? or ??? or ???) with warfarin will displace warfarin and increase INR

Sulfa or phenytoin or ASA

Internal hemorrhoids are supplied by what set of veins?

Superior rectal vein which subsequently drains to inferior mesenteric vein. And would perform band ligation

Erb-Duchenne palsy

Superior trunk brachial plexus injury ("waiter's tip") arm adducted and medially rotated proximal effects

Sore throat 3 months ago and irregular jerking movement involving face, arms, and legs?

Sydenham chorea due to acute rheumatic fever side effect is valvular heart disease

burned hands firing pots 3 months ago. He has no pain during or after burn. PE shows mild atrophy of arms and hands, absence of deep tendon reflexes in upper extremities, and decreased pain and temperature sensations in C4 to T1 dermatomes. Touch is preserved. Dx?

Syringomyelia

Poiseuille Law - Key concepts

Systemic vascular resistance is proportional to blood viscosity, which is primarily determined by hematocrit. -Systemic vascular resistance is proportional to blood vessel length. -Systemic vascular resistance is inversely proportional to vessel radius to the 4th power.

granuloma formation is product of chronic (???) and (???) activation.

T-lymphocyte(TH1) and macrophages which produce IL-2 and interferon-gamma

Sternal angle vertebral level

T4

bifurcation of trachea

T4

"Silicosis increases the risk of what pulmonary infection?"

TB

tumor necrosis factor-alpha inhibitor (atanercept). what test should be performed before beginning?

TB test

Idiopathic pulmonary fibrosis cytokine associated?

TGF-B

Chrohns disease involves what cytokine?

TNF alpha

Autoimmune conditions drug used?

TNF related

Adalimumab can lead to development of antidrug antidbodies. Ab normally binds to (???)

TNF-alpha

what cytokines are related to rheumatoid arthritis?

TNF-alpha and IL-1 due to activation of CD4+ T cells

Eisenmenger syndrome

TOF pulmonary vascular resistance increase with eventual right-to-left shunt aka worst problems

Calcineurin inhibitors

Tacrolimus Cyclosporine

Introjection

Taking in and "swallowing" the values and standards of others

HTLV(human t cell leukemia virus)

Tax gene required for proliferation. Cells have clover-leaf nuclei & C-type particles.

hexoaminidase A deficiency

Tay-Sachs

• The five cofactors of the pyruvate dehydrogenase complex

Tender (Thiamine) Loving (lipoic acid) Care (CoA) For (FAD) Nancy (NAD+).

C5-C9 deficiencies causes what type of infection

Terminal complement deficiency increases susceptibility to recurrent Neisseria bacteremia.

Turning blue and better with squatting with harsh systolic murmur

Tertalogy of Fallot (neural crest cell) which causes ventricular septal defect, overriding aorta of ventricles, right ventricular outflow tract obstruction (pulmonary stenosis), right ventricular hypertrophy and murmur is caused by deviation of infundibular septum

Edrophonium (Tensilon) test

Test used to differentiate between myansthenia and cholinergic overdose of medication (cholinergic crisis) A worsening symptoms after edrophonium administration by indicate cholinergic crisis Implementation: atrophine sulfate and oxygen should immediately be available whenever edrophonium chloride is used

Man in a Barrel Syndrome-sxs and cause?

The "man-in-the-barrel syndrome" (MBS) is character- ized by bilateral upper extremity paresis with intact motor function in the lower extremities. The patient is unable to move his arm to any stimulus, appearing as if the upper limbs are confined within a barrel2. infarct due to hypoperfusion of watershed zones

Tanner stage 4

The areola and nipple form a secondary mound over the breast

androgenic insensitivity syndrome

The developmental disorder of genetic males in which a mutation to the androgen receptor gene renders the androgen receptors defective and causes the development of a female body oligospermia/gynocomastia increase LH increase testosterone

what is the length constant

The distance at which an originating action potential decreases to 37% its original amplitude. Myelin increases the length constant.

Hexokinase

The enzymes that catalyzes the phosphorylation of glucose to form glucose-6-phosphate in the first step of glycolysis. This is one of the ain regulatory steps of this pathway. Hexokinase is feedback-inhibited by glucose-6-P.

intestinal crypt cells

The fourth most radiosensitive cells in the body highly proliferative cells damaged in ionizing radiation like stem cells

action stage of change

The individual has replaced the addiction behavior with new, healthier

Preparation stage

The individual is ready to take action in the foreseeable future.

Factor V Leiden mutation

The most common inherited cause of hypercoagulability. Decreased PTT time

Minimum Alveolar Concentration (MAC)

The percent concentration of an agent required to prevent a response to surgical stimulation in 50% of patients A measure of the potency of the agent

• Zero order kinetics

The rate of metabolism and/or elimination remains constant and is independent of the concentration of a drug (e.g., metabolism of alcohol - only a constant amount can be eliminated in a given time, permitting a reliable estimate of the amount of alcohol consumed through blood alcohol testing).

DNA binding domain

The site on a DNA-binding protein that directly interacts with specific DNA sequences. include thyroid hormone, transcription factors, steroid receptors (progesterone), fat soluble vitamins and dna transcription and replication proteins

MPO deficiency

These people will respond to NBT dye test. But they cannot make HOCl(bleach) because of defective MPO and thus are susceptible to chronic infection.

Tender Love and Care for Nancy

Thiamine lipoate coenzyme A FAD NAD

UDP-glucuronyl transferase

This enzyme in the liver is responsible for transferring two molecules of Glucuronate (Glucuronic acid) onto bilirubin (Unconjugated/Indirect) to create bilirubin diglucronide (Conjugated/direct). This process makes bilirubin water soluble so that it can be transported into the bile.

Homocysteine methyl transferase

This enzyme takes Homocysteine and regenerates Methionine. Requires methyl THF and B12

Hibernating myocardium

Tissue that is persistently ischemic undergoes metabolic adaptation to prolong myocyte survival only takes days

Angiodysplasia

Tortuous dilation of vessels-> bleeding. Most often found in cecum, terminal ileum, and ascending colon. More common in older patients. Confirmed by angiography. pain is worse after arguing with his wife, and the symptoms resolve with rest

Decreased during peak stress compared to resting state?

Total systemic vascular resistance due to arteriolar dilation within active muscle to increase blood supply while constricting resting and splanchnic blood vessel

nematodes = roundworms

Toxocara, Enterobius, Trichuris, Ascaris, Trichinella, Strongyloidiasis, Ancylostoma, Necator. Tx: Albendazole (GI), Ivermectin (tissue).

Will CHF give you transudate or exudate in lungs? (high/low protein, LDH, glucose, total nucleated cell)

Transudate: low protein low LDH high glucose (not inflammatory so not using up glucose as would be in exudate) low cell count

CN IV

Trochlear Motor Down and inward movement of eye tilt head away from affected side

Constrictive pericarditis

Tuberculosis (developing world); systemic lupus erythematosus (developed world) takes weeks to months

Renal Angiomyolipoma associated with

Tuberous sclerosis (hamartomas, cardiac rhabdomyoma, facial angiofibroma, lef-shape patches on skin) benign tumor composed of blood vessels, smooth muscle, and fat

Lissencephaly is associated with deficient neuronal migration. what protein component is associated?

Tubulin

Superior vena cava syndrome

Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins

Primary amenorrhea associated with what syndrome

Turner syndrome (45,XO)

Posterior neck mass (cystic spaces separated by connective tissue) and bilateral nonpitting edema of hands and feet

Turner syndrome loss of paternal chromosome X, cycstic hygroma, lymphedema

Fomepizole

Tx of ethylene glycol overdose Inhibits alcohol dehydrogenase (unlike disulfiram)-->decreased breakdown of ethylene glycol into toxic metabolites

Hyperchylomicronemia associated with what -itis?

Type I familial dyslipidemia. Lipoprotein lipase deficiency or altered apolipoprotein C-II (LPL cofactor) = can't degrade TG circulating in chylomicrons, VLDLs. Increased chylomicrons, elevated cholesterol / TGs in blood Pancreatitis association

Arnold-Chiari malformation

Type I: herniation of cerebellar tonsils, asymptomatic/headache Type II: herniation of cerebellum and medulla, often causes hydrocephalus.

SLE is what type of hypersensitivity reaction?

Type III hypersensitivity

Hepatobiliary scan what will happen in cholecystitis

Type of nuclear medicine used to diagnose biliary obstruction, acute cholecystitis, or biliary atresia.

What are the stop codons?

UAA,UGA,UAG; AUG is the start

amyotrophic lateral sclerosis

UMN/LMN disease no sensory symptoms spasticity and wasting and vasiculation dysphagia-cant swallow tx: riluzole decrease glutamate spasitc and faccid with no sensory

orotic aciduria from (????) can be distinguished from ornithine transcarbamylase deficiency by the presence of megaloblastic anemia and absence of hyperammonemia.

UMP synthase deficiency

SGLT2 inhibitors side effects (4)

UTIs, vulvovaginal candidiasis, weight loss, decreased blood pressure

Thalamic Stroke

Unilateral hemisensory loss including face (R body, R face)

Vasopressin and desmopressin cause V2 receptor mediated increase in water and (???) permeability at the inner medullary collecting duct. The result rise in (???) reabsorption decreased (???) clearance enhances the medullary osmotic gradient allowing the production of maximally concentrated urine.

Urea

(???) wants out and (???) wants back in of proximal tubule

Urea wants out and bicarb wants back

Collect duct associated with what embryological orgin?

Ureteric bud

Ziehl-Neelsen stain

Use to stain Acid-fast bacteria (Nocardia, Mycobacterium)

what innervate muscles of mastication?

V3

Age-related macular degeneration

VEGF production due to retinal hypoxia causes subretinal neovascularization and leaky vessels Tx: vegf inhibitors and smoking cessation

renal cell carcinoma pathogenesis involves loss of (????) gene which is a tumor (supressor or activator)

VHL supressor increased IGF-1 and HIF --> vegf and PDGF

PT bleeding time increased

VII

hemophilia has decreased levels of (???) or (???) leading to inability to convert prothrombin into (????)

VIII or IX thrombin <--- treatment to help with clotting

(???) nerve: parasympathetic innervation

Vagus nerve: parasympathetic innervation

Secretion of what causes watery diarrhea, hypokalemia, and achlorhydria (production of hydrochloric acid in gastric secretions of the stomach is absent or low)?

Vasoactive intestinal peptide

VDRL

Venereal Disease Research Laboratory (test for syphilis)

BCL-2 inhibitor mechanism?

Venetoclax, increases activation of caspeases

(???) deficiency causes night blindness and thickened dry skin. It happens by (???) (???) or (???)

Vitamin A biliary obstruction exocrine pancreatic insufficiency or small bowel resection (bariatric/crohns)

Lateral Lesions to the Cerebellum

Voluntary movement of extremities PROPENSITY TO FALL TOWARD IPSILATERAL SIDE

spinda bifida cystica

What results from a failure of the neural folds to fuse along the spinal cord?

Fasciculus cuneatus

What tract carries the ipsilateral dorsal column fibers from the upper limbs in the spinal cord?

Berger disease (IgA nephropathy)

What type of GN, associated with celiac disease and dermatitis herpetiformis, has mesangial deposits of IgA, C3, properdin, IgG, and IgM?

sinusoidal capillaries

What type of capillaries have large pores within their endothelial cells and are the leakiest? liver, spleen, bone marrow

linkage disequilibrium

When a pair of alleles from two loci are inherited together in the same gamete more/less often than random chance would expect

Spinda Bifida Occulta

Which anomaly has a patch of dark hair on the skin above it?

WT1

Wilms tumor

kidney mass in child

Wilms tumor

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

Wiskott-Aldrich syndrome Due to mutation WASP and is Xlinked

low molecular weight heparin binds to what substance?

X and antithrombin III full weight heparin can bind to thrombin too

Alport syndrome

X-linked defect in Type IV collagen. Results in thinning/splitting of basement membrane. Clinical symptoms are: Isolated hematuria, sensory hearing loss and ocular disturbances.

Chronic granulomatous disease (what organism is most commonly infected)

X-linked mutation affecting NADPH oxidase causing dtysfunctioning neutrophils and oxidative burst Catalase +. Psuedomonas

How is G6PD deficiency inherited?

X-linked recessive

PTT

XII, XI, IX, VIII

Does diphtheriae need to have lysogenic conversion and what does that mean?

Yes, it's the uptake of virus by bacteria in order to cause disease. And still have diphtheriae even if vaccinated

familial cases ALS

Zinc copper superoxide dismutase deficiency= increased free radical damage= increased neuronal death

seborrheic keratosis look like

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

In androgenetic alopecia (AD, AR, polygen

a combination of heredity, hormones and age causes:

Chylothorax

a condition marked by lymphatic fluid in the pleural space caused by a leak in the thoracic duct. located at junction between left subclavian and jugular veins

Kluver-Bucy syndrome

a condition, brought about by bilateral amygdala damage, that is characterized by dramatic emotional changes including reduction in fear and anxiety HSV-1 encephalitis

Holoprosencephaly

a congenital disorder caused by the failure of the embryonic forebrain to sufficiently divide into the double lobes of the cerebral hemispheres. The result is a single-lobed frontal brain structure usually with severe skull and facial defects.

Oppositional Defiant Disorder (ODD)

a disorder characterized by age-inappropriate and persistent displays of angry, defiant, and irritable behaviors

Reye Syndrome (RS)

a disorder defined as a metabolic encephalopathy associated with other characteristic organ involvement. It is characterized by fever, profoundly impaired consciousness, and disordered hepatic function. ammonia everywhere

Chronic Lymphocytic Leukemia

a form of leukemia characterized by the accumulation of abnormal, mature lymphocytes lymphocytes are a type of white blood cell important for immunity) CD5 CD20

ankylosing spondylitis

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

red nucleus

a midbrain area that is primarily responsible for controlling the arm muscles

pharyngeal plexus

a network of nerves that lies along the posterior wall of the pharynx and consists of the pharyngeal branches of the glossopharyngeal nerve (CN IX) and the vagus nerve (CN X)

aplastic anemia

a normocytic-normochromic type of anemia characterized by the failure of bone marrow to produce red blood cells hypocellular marrow filled with fat cells and marrow stroma can be caused by autoimmune or infection

Thyroglossal duct cyst

a palpable cystic midline mass in the neck due to incomplete closure of the thyroglossal duct.

actinic keratosis

a precancerous skin growth that occurs on sun-damaged skin

Presenilin associated with what disease

a protein produced by a faulty gene that causes B-amyloid precursor protein to be converted to the abnormal short form; may be a cause of Alzheimer's disease

lung abscess

a pus-containing lesion of the lung parenchyma that results in a cavity formed by necrosis of lung tissue. v. smelly

lateral corticospinal tract

a set of axons from the primary motor cortex, surrounding areas, and midbrain area that is primarily responsible for controlling the peripheral muscles paralysis

basal ganglia

a set of subcortical structures that directs intentional movements direct-excitatory indirect-inhibitory (gaba) putamen-motor caudate-cognitive

confounding example

a third variable that is independently associated with both exposure and the outcome. Should not be an intermediate. Coffee Drinkers- Coffee Drinkers Often Smoke- Smoking Leads to lung Cancer age/race/socioeco status

Renal infarction cause by lack of collateral due to interruption of blood flow with increase lactate dehydrogenase being high. Could be caused by (???) causing emboli

a-fib

Mullerian aplasia

a.k.a. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome - no upper vagina, variable uterine development, all normal secondary sex characteristics (pubic hair, breasts) (MRKH have ovaries ± uterus, unlike AIS which have cryptorchid testes)

Cardiolipin

ab binds due to syphilis

artery that supplies testes come from what orgin?

abdominal aorta

Campylobacter can be caused by what?

abdominal symptoms after new puppy can also be caused by undercooked poultry

CN VI

abducens motor: lateral eye movement

Disseminated Intravascular Coagulation (DIC)-explain and best screening test

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues decrease platelet count, increased Pt/PTT, decrease fibrinogen sepsis, rattlesnake bite, adenocarcinoma elevated D-dimer is best screening test

Disseminated Intravascular Coagulation (DIC) (fibrinogen protein C factor VII)

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues decreased fibrogen decreased protein C decreased factor VII

Disseminated Intravascular Coagulation (DIC) associated with what on peripheral smear?

abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues schistocytes

syringomyelia

abnormal longitudinal cavities in the spinal cord cause paresthesias and muscle weakness cuts and burns without feeling and loss of feeling in bac

Lynch syndrome is AD disease cause by (???). It involves several genes MSH2 and MLH1. Essentially no police to patrol and act as spell checkers

abnormal nucleotide mismatch repair.

severe swelling and tenderness to hands and feet? (disease and blood abnormaility)

abnormal serum haptoglobin due to sickle cell disease vaso occlusive symptoms --> dactylitis

Translocation Down Syndrome and symptoms?

about 5% of down syndrome results from a robertsonian translocation between chromosomes 21 and 14 epicanthal folds, upslanting palpebral fissures and protruding tongue with excessive skin on nape of the neck

I-cell disease

absent enzyme marker in Golgi apparatus (mannose 6-phosphate); empty lysosomes lead to accumulations of enzymes in cytoplasm annose-6-phosphate tag cannot be added to proteins. Without this tag, proteins are incorrectly sent to the extracellular space rather than delivered to lysosomes.

Amatoxin-containing mushrooms mechanism

absorbed in GI tract --> go to liver via portal circulation --> where poly peptide and co-transporter concentrates toxin within liver cells --> amatoxin binds DNA dependent RNA polymerase II halt nRNA synthesis

Most sympathetic post ganglionic neurons release norepinephrine to activate adrenergic receptor on target tissues. Preganglionic fibers innervating adrenal medulla release (???). Adrenal medulla stimulated by (???)

acetylcholine ACTH

Chagas Esophagus

achalasia Snake recently fed and sunning itself - megaesophagus

cardiomegaly with poor feeding. enlarged lysosomes containing PAS + material. What is the deficiency and name of disease

acid a-glucosidase due to POMPE disease that is glycogen in lysosomes

ACE BATs right handed

acid, CO2, Exercise, 2,3-BPG, high Altitude, increase temp

granulomatous disorders express (???) to cause PTH-independent production of 1,25-dyhydroxyvitamin D.

activated macrophages

Beta-lactam cause what drug induced state to kidneys and effect what part of the kidney?

acute interstitial nephritis renal interstitium

eosinophils in urine sediments indicates what

acute interstitial nephritis, which is caused by an allergic reaction, typically to drugs.

TDT (DNA polyermase) a key marker for what leukemia?

acute lymphoblastic leukemia

downs syndrome associated with that cancer?

acute lymphoblastic leukemia

mediastinal mass with positive terminal deoxynucleotidyl transferase and CD3 and negative CD19. what is diagnosis?

acute lymphoblastic leukemia T-cell CD3 b-cell CD19

Myeloid cells with azurophilic rodlike granules (Auer rods) ???

acute myeloid leukemia

Vitamin A and cancer?

acute myeloid leukemia a-vitamin A

mesentery with fat cell destruction and calcium deposition is caused by what disease?

acute pancreatitis

anterior chest paint that is sharp in nature and difficult to take a deep breath. Worsened with laying flat and improves with sitting up. with pericardial effusion causes what and is caused by what?

acute pericarditis caused by virus or idiopathic or autoimmune

Aminoglycosides adverse effects

acute tubular necrosis (focal tubular epithelial necrosis): fractional excretion of sodium >2%

granular(muddy brown) cast are associated with what?

acute tubular necrosis (rhabdomyolysis)

acute myelogenous leukemia vs. chronic myelogenous leukemia

acute: older age, 15,000-20,000 leukocytes, significant increase blasts chronic: elevated >50,000, alaklin phosphatase decreased 9,22 translocation

teres minor action

adduction and external rotation

subscapularis action

adduction and internal rotation

coronary blood flow with a drop after the NE and then a rise. Which substance causes increased total coronary blood flow 1-2 mins after NE?

adenosine Dilated coronary crown: adenosine causes coronary dilation (mediated by A2 receptors)

Increase in resting blood flow to ischemic tissue can trigger coronary arteriolar vasodilation. Pharmacologic vasodilator are ??? and (???) which can mimic.

adenosine and dipyridamole

Most common cause of SCID

adenosine deaminase deficiency (also MHC class II)

supression of hypothalmus-pituitary-adrenal axis by glucocorticoid therapy is most common cause of adrenal insufficiency. in these patient, (???) can precipiated by stressful situation leading to what?

adrenal crisis leading to improper decrease in corticotropin releasing hormone decrease ACTH decrease cortisol

lung metastasis to what distal site?

adrenal gland

melanin-producing cells are derived from same embryolical derivative as what?

adrenal medulla --> neural crest schwann cells, odontoblast, melanocytes, enterochromaffin cells, laryngeal cartilage and tracheal cartilage

• Synaptophysin, chromogranin, and neuron-specific enolase+

adrenal medulla due to excessive production of catecholamines

Neuroblastoma involve what structures?

adrenal medulla sympathetic chain catecholamines breakdown produces and nontender immobile abominal mass is palpated

21-hydroxylase deficiency should suppress what hormone?

adrenocorticotropic hormone (ACTH)

Post strep glomerulonephritis bad if it's in (?age??). (???) is decreased due to complement activation with deposition

adult C3

Haldane effect leading to increase O2 saturation relative to pO2

affinity of hemoglobin for CO2 is decreased releasing it and protons are released (H+)

6 months of propylthiouracil. What's the underlying cause of ulcerative pharyngeal disease?

agranulocytosis

Trypanosoma cruzi

aka Chagas cause achalasia, megaesophagus, cardiomyopathy and megacolon

Earliest morphologic changes that occur after superficial thermal burn in erythema due to release of performed mediator aka (???) from (??). Deeper burns form blisters due to fluid extravasation through gaps between damaged venule endothelial cells.

aka histamine mast cells

what enzyme deficiency causes vomiting irritability to fruit juices?

aldolase B

Vomiting causes metabolic _____

alkalosis

Organism that causes proximal bornchiectasis, transient recurrent pulmonary infiltrates, and eosinophilia?

allergic bronchopulmonary aspergillosis --> aspergillus fumigatus

treatment of associated gout to tumor lysis syndrome with?

allopurinol

what is the drug that inhibits uric acid formation after cell lysis?

allopurinol

Type I interferons

alpha and beta Inhibit viral replication and activate host defenses Interfere with viral replication by infected cells Alert immune system cells that infection is present Make virus-infected cells more vulnerable to killer lymphocyte attack Almost all nucleated cells are susceptible to viral infections Almost all nucleated cells have the capacity to make Type 1 interferon as well as its cell-surface receptor halt protein synthesis of virus

Strep viridans

alpha hemolytic dental caries (S. mutans) and endocarditis (S. sanguis) strep. mitis

alpha-receptor mediated vasoconstriction caused by norepi can lead to tissue necrosis. If notice tissue becoming hard, stiff, cold, what medication would you give?

alpha-antagonist aka phentolamine

Hepatocellular carcinoma tumor marker?

alpha-fetoprotein

failure of fusion of neural plate leads to increase in what products into amniotic fluid?

alpha-fetoprotein and acetylcholinesterase

iron deposit in cytoplasm of what cell type is diagnostic of congestive heart failure? (lung)

alveolar macrophages

abx modifying enzyme that adds acetyl group to target drug is the most common mechanism of (???) resistance.

aminoglycoside resistance (gentamicin)

Antibiotics not used in pregnancy

aminoglycoside, fluoroquinolones, sulfa, tetracycline

Fungal wall cell membrane binders

amphotericin B, nystatin, conazoles

what structure is affected in HSV-1 encephalitis?

amygdala

What is the mechanism behind peripheral neuropathy in DM patient?

amyloid deposition

Alzheimer associated with down syndrome leads to increase in?

amyloid precursor protein (amyloid B fragment)

atrophic precentral gyrus and thin anterior roots of spinal cord with loss of neuron in the anterior horn causing demyelinization?

amyotrophic lateral sclerosis

Lynch syndrome

an autosomal dominant disease caused by abnormal nucleotide mismatch repair. Mutations in MSH2 (codes for MutS) and MLH1 (MutL) are most common. Ovarian endometrial and colorectal

Calcineurin

an essential protein in the activation of IL-2, which promotes the growth and differentiation of T cells.

graft-versus-host disease (GVHD)

an immune response initiated by T lymphocytes of donor tissue against the recipient's MHC antigen in (skin, gastrointestinal tract, liver); an undesirable response

Actinomycosis

anaerobic gram + filamentous bacteria; complication extracted dental abscess

study comparing ferritin concentrations in children, adolescent, adult, and senior would use what type of testing? a. analysis of variance b. chi-square test c. two-sample t-test d. correlation analysis

analysis of variance

Bicalutamide-why add it to prostate cancer regimen?

androgen receptor antagonist prevents testosterone surge effect from buserelin therapy

(??) is common in first several years after menarche and last few years before menopause

anovulation

Isolated hemi extremity motor deficits are mostly likely caused by why artery?

anterior cerebral artery

after hurting her knee patient is having anterior translation of tibia relative to the femur. What is the ligament involved?

anterior cruciate ligament

Ectoderm=surface ectoderm (???) + neural tube (???) + neural crest (???)

anterior pit, eye, ear, nose, skin brain/spinal cord/posterior pit. Pineal gland, retina neural ganglia, adrenal medulla, brachial arches, skull bones

brachial cyst

anterior to the sternocleidomastoid NOT MIDLINE

Doxorubicin (heart side effects)

anthracycline chemotherapeutic agent will form free radicals in myocardium. The side effect is cardiac fibrosis, which will present with Dilated Cardiomyopathy. increased pressure right atrium and left ventricular end-diastolic pressure

most specific for rheumatoid arthritis?

anti-cyclic citrullinated peptide antibodies

what serological marker for immunity of HBV

anti-hbs

Coagulation Factor Inhibitor(how do you tell the difference if its a factor VIII inhibitor and hemophilia A)

antibody against certain coagulation factor. -anti-factor VIII is most common -very similar to hemophilia A -- differentiate by MIXING STUDY -mixing study is when mix normal plasma with pt plasma. if it's hemophilia A, ptt gets better. HOWEVER, if it's coagulation factor inhibitor, PTT DOES NOT GET BETTER

Eosinophils mechanism of parasitic killing

antibody dependent cell mediated cytotoxicity stimulated by IL-5 and attach via IgG and IgA to release cytotoxic proteins like major basic protein

Hyperacute rejection is (???)-mediated reaction caused by (???) commonly anti-(???) antibodies or ABO blood group antibodies seen as immediate vascular injury and capillary thrombotic occlusion leading to necrosis of renal graft.

antibody-mediated reaction caused by IgG, commonly anti-HLA antibodies or ABO blood group antibodies

Treponema pallidum syphilis which evaluated by (???) antibodies or serologic testing, fever malaise arthralgia, rash increases aminotransferase

anticardiolipin

diphenhydramine impaired visual accommodation due to?

anticholinergic (acetylcholine) 1st gen also has anti-alpha adrenergic, anti-serotonergic

Antiemetic drugs side effect?

anticholinergic (dry mouth, urinary retention, constipation and blurry vision)

Huntington's cause (???) which means happens at earlier age

anticipation

Andexanet alfa

antidote for rivaroxaban, drives binding of rivaroxaban to bad target Xa Decoy receptor for reversal of Xa inhibitors.

systemic lupus erythematosus (SLE)

antigen antibody complexes deposit in multiple tissue with activation of complement

G6PD deficiency cannot be given what type of drug?

antimalarial drug

Azathioprine MOA (b-cell, T-cell, immunoglobulin, il-2)

antimetabolite precursor to 6-MP. inhibits lymphocyte proliferation by blocking nucleotide synthesis. decreased b-cell, t-cell, immunoglobulin, il-2

Primary biliary cholangitis

antimitochondrial antibodies, non suppurative granulomatous destruction of small and medium INTRAhepatic bile ducts, fibrosis in lobule starting from portal zones symptoms- pruritis (bile salts), fatigue, anorexia, painful hepatomegaly (can lead to portal HTN, cirrhosis, HCC)

Primary biliary cholangitis

antimitochondrial antibodies, non suppurative granulomatous destruction of small and medium INTRAhepatic bile ducts, fibrosis in lobule starting from portal zones. increased gamma-glutamyltranspepetidase, ANTIMITOCHONDRIAL ANTIBODIE symptoms- pruritis (bile salts), fatigue, anorexia, painful hepatomegaly (can lead to portal HTN, cirrhosis, HCC)

Streptococcus pneumoniae pathogenic factor?

antiphagocytic microbial capsule due to polysaccharide capsule

severe ripping chest pain + distant heart sounds mean what?

aortic dissection involving pericardial space acute tamponade

Blunt aortic injury occurs what part of aorta?

aortic isthmus (ligamentum arteriosum is fixed and immobile compared to rest)

• Heart murmur with bounding femoral pulses and carotid pulsation with head bobbing

aortic regurgitation increased back flow of blood causes left ventricular to hypertrophy and increase total stroke volume and is seen as a diastolic descresendo murmur

Angina often occur in (???) even in absence of obstructive CAD. It results from increased oxygen demand due to increased left ventricular mass and ventricular wall stress.

aortic stenosis

Valine, alanine, isoleucine have what characteristic in common?

apart of G protein coupled receptor; that function as anchoring to the cell membrane

spontaneous pneumothorax due to

apical subpleural blebs

Abdominal (???) must be penetrated to insert suprapubic cath

aponeuroses

Aminoaciduria

appearance of amino acids in urine

Where is CSF absorbed into the venous circulation?

arachnoid granulations

granulosa cell tumors

are estrogen-secreting primary ovarian tumors. The hyperestrogenemic state that results can cause endometrial hyperplasia and abnormal uterine bleeding. It also predisposes to endometrial adenocarcinoma

Nitrates

are metabolized to nitric oxide and s-nitrothiols in vascular smooth muscle cells leading to an increase in cGMP that stimulates vasodilation. Large veins are predominantly affected leading to increased venous capacitance and reduced venous return which decreases left ventricular wall stress and oxygen demand to relieve sxs.

nausea and vomiting in relation to chemotherapy affects what area?

area postrema

Oral bioavailability

area under oral curve divided by area under IV curve

Where do diverticula of colon usually arise, and what symptom does this cause

areas that lack structural integrity; usually located where vasa recta penetrate through smooth muscle lay of colon

nitric oxide is synthesized from (????) by nitric oxide synthase to improve vasodilation?

arginine

Pancoast tumor (non-small cell lung cancer)

arise near superior sulcus that compress brachial plexus that cause ipsilateral shoulder pain and weakness, partial ptosis, miosis, and anhidrosis. Aka Horner syndrome which involve cervical sympathetic ganglia.

Anastrozole MOA

aromatase inhibitor. It prevents the peripheral conversion of androgens to estrogen. Used in postmenopausal women with breast cancer to keep estrogen levels down in the appropriate postmenopausal range.

Hirschsprung disease

arrest migration of neural crest cell, rectum always involved, involves failure to pass meconium

Acute Rheumatic Fever histology

aschoff bodies

portal hypertension caused by portal vein thrombosis so (???) is uncommon

ascites

how do you test for frontotemporal injury on physical exam?

ask about relationship between two objects like watch and ruler

Fungal Rhinosinusitis

aspergillus

what is the organism that cause fever chest pain and cough dyspnea and heoptysis after prolonged neutropenia?

aspergillus

Nasal polyps with asthma like symptoms should make you think of what diagnosis?

aspirin intolerant asthma

Chagas disease associated with what secondary problem?

associated with cardiomyopathy (heart failure, arrhythmia, ventricular aneurysm)

HHV-8

associated with primary effusion lymphoma and Kaposi sarcoma in patients who are HIV-positive. Kaposi sarcoma: Malignant spindle cell tumor that originates from endothelial cells.

Angiomyolipoma associatd with what disease?

associated with tuberous sclerosis

"lead pipe" sign

associated with ulcerative colitis. The loss of haustra, the folds in the colon.

• Angular gyrus of dominant parietal lobe

association cortex and area that integrates multisensory information to comprehend events and solve problems. Damage causes inability to write, read, speech, carry out math problems, identify individual fingers on hand and causes left right disorientation.

Charcot-Leyden crystals - diagnosis? - what are they?

asthma derived from eosinophil

JC virus infect what cells in CNS

astrocyte and oligodendrocyte

GFAP positive

astrocytoma, oligodendrogliomas, ependymomas, and PN shealth tumor.

Fixed split S2 (what congenital abnormality?)

atrial septal defect

wide splitting of S2 that does not change with respiration

atrial septal defects

decompensated heart failure (atrial size, ventricular size, ventricular wall thickness, and relaxation of ventricle-dilated/increased/not)

atrial size-dilated ventricular size-not dilated ventricular thickness-increased ventricular relaxation-impaired

A-fib is regulated by what?

atrioventricular node refractory period

Primary amenorrhea+tanner stage 1 nipples. what would be seen in pelvic exam?

atrophic ovaries

mitral regurgitation

audible S3

inferior colliculi

auditory reflexes

good pasture syndrome

autoantibodies against alpha 3 chain type IV collagen in glomerular and alveolar basement membranes (anti-GBM antibodies) look for kidney probz (protein/hematuria) and sob/hemoptysis

what is the best support of rheumatoid arthritis (diagnostic test)

autoantibody IgM reactive to IgG

what is being destroyed in multiple sclerosis?

autoimmune destruction of oligodendrocytes

Sjogren

autoimmune inflammation of exocrine glandes (aka salivary, lacrimal, vaginal) leading to dry mouth and increased rate of dental caries and other oral infection because loss of saliva. Will show lymphocytic infiltrates

Primary biliary cholangitis

autoimmune liver disease resulting in cholestasis with elevated alkaline phosphatas and antimitochondrial antibody. This will look like graft versus host disease

Best Oral antibiotic for child with penicillin allergy???

azithromycin

What treats spsticity related complicaton by multiple sclerosis?

baclofen which is an agonist at the GABA-B receptor (tizandidine also helpful a-2 adrenergic agonist)

where is the most common site of charcot-bouchard microaneurysms

basal ganglia

Acetylcholine synthesis

basal nucleus of meynert

When patient is incapacitated what can be shared to family with the patient best interest in mind under HIPPA (everything/something/nothing)?

basic information can be shared -->telling them they are stable

Adenomyosis

benign invasive growth of the endometrium into myometrium with enlargement of uterus with normal appearing endometrial tissue that may cause heavy, painful menstrual bleeding

what is associated with AD polycystic kidney disease in brain?

berry aneurysm

noncaseating granulomas in hilar lymph node with aerospace industry?

berylliosis

maternal diabetes can lead to what changes in the baby that cause hypoglycemia at birth?

beta cells hyperplasia and hyperinsulinism

sensorineural hearing loss and tinnitus, left-sided facial numbness, asymmetric smile, diminished corneal reflex response in left eye. A schwannoma is suspected where in the brain?

between cerebellum and lateral pons (cerebellopontine angle)

(????) strong supinator

biceps brachii

• Long term use of steroids cause suppression of hypothalamic-pituitary-adrenal axis, leading to (???). Sudden cessation precipitates adrenal crisis (hyponatremia, hypotension, syncope, occlusion)

bilateral adrenocortical atrophy involving zona fasciculata and reticularis

Waterhouse-Friderichsen syndrome: bilateral hemorrhagic infarction of (???) due to meningococcal meningitis from n. meningitidis.

bilateral hemorrhagic infarction of adrenal gland due to meningococcal meningitis from n. meningitidis.

administration of hydrophilic (???) reduce scholesterol secretion and increase biliary bile acid concentration

bile acids improve cholesterol solubility by reducing the amount of cholesterol secreted into bile and increasing biliary bile acid concentration

releasing factor 1

bind to ribosome and stimulate release of the formed polypeptide chain and dissolution of ribosome-mRNA complex

how to steroid hormones work aka binding?

binding to cytoplasmic receptor, translocation to the nucleus, and activation of transcription

annular ligament

binds head of radius to ulna, can tear known as nursemaids elbow where head of radius pops out of the ligament

consuming large amount of eggs causes what deficiency?

biotin deficiency

intracellular round oval protozoa with rod shaped kinetoplast seen on biopsy of enlarging pinkish papule/plaque. what is the organism and mode of transmission?

bite from infected sand fly -->leishmaniasis

pathogenesis of pigment gallstones

black: due to chronic hemolysis (sickle cell) brown: due to biliary tract infection (e. coli/liver fluke) both due to increased unconjugated bilirubin --> calcium bilirubinate precipitation

central scotoma

blind spot in the center of the visual field surrounded by an area of normal vision

-conazoles mechanism of action

block ergosterol synthesis via inhibition of lanosterol to ergosterol

Lidocaine mechanism of action

block sodium channels and is a weak base

Example of (???): Being unable to answer a question during the exam, but recalling it once the exam is over. Associated with 'imposter syndrome'.

blocking

Carbamazepine MOA

blocks Na channels

Proglottids

body sections of a tapeworm

Median nerve runs with (???) artery

brachial artery

Trypsin

breaks down proteins

c-myc oncogene what lymphoma

burkitt's lymphoma; gene product is a transcription factor 8,14

Amphotericin B toxic effects

by binding to cell membrane cholesterol causes: nephrotoxicity, hypokalemia, and hypomagnesemia

Nitric oxide pathway(???) cause vasodilation as does arachidonic acid (prostacyclin pathway aka aspirin) (???), endothelin pathway aka thromboxane A2 is increased causing vasoconstriction

cGMP cAMP

In order for vesicles of presynaptic terminals to release content they require?

calcium

Pseudogout crystals (calcium whattt)

calcium pyrophosphate

Pigment gallstones

calcium salts of unconjugated bilirubin brown stones --> due to infection resulting in release of beta-glucuronidase (seen in clonorchis sinensis liver fluke)

Nicotinic cholinergic receptor cause change in transmembrane (???), (???), and (???). Nicotinic receptor is an (???) channel

calcium, sodium, and potassium. ionic channel

what regulated Ca2+ in smooth muscle?

calveolae

fever abdominal pain and diarrhea with blood and mucus after eating at restaurant 3 days ago. Organism is gram-negative, oxidase-positive, curved rod. what is the organism? what is a complication of the organism?

campylobacter jejuni --> guillain-barre syndrome

Where can you find glucokinase

can be found in every cell including liver which also has hexokinase

Cardiogenic/Obstructive shock (pcwp, CO, SVR and treatment)

can be up or down PCWP(wedge pressure) DECREASED CO increase SVR (resistance) treat with inotropes/diuretic or relieve obstruction

Methacholine challenge

can be used in patients to diagnose Asthma, since it's a Muscarinic Cholinergic Agonist, it will increase Bronchial Smooth Muscle Contraction and Mucus Production. essentially send someone into asthma attack

tumor lysis syndrome (increase/decrease in potassium, uric acid, phosphorus, lactate dehydrogenase)

can develop from chemotherapy for cancers with rapid cell turnover. It is characterized by hyperphosphatemia, hypocalcemia, hyperkalemia (EKG changes), increase lactase dehydrogenase and hyperuricemia. Prevention of tumor lysis syndrome involves hydration and the use of hypouricemic agents such as allopurinol or rasburicase

Arginase deficiency

can lead to buildup of arginine and issues making urea. Patient would have spastic paresis of lower extremities and choreoathetoid movements. growth delay with elevated arginine it produces urea and ornithine and treatment with low protein diet

if there is a lesion that is easily scrapped off no matter the location on the tongue it is....

candida

catheter placement can put someone at high risk of what type of fungus infection?

candida --> pseudohyphae with blastocondidia

Strep pneumoniae is able to undergo transformation which allows bacterium to take up exogenous DNA fragment and express the encoded proteins. Strains of S. Pneumonia do not form (???) and can acquire the genes that code for (same as above) therefore gain virulence.

capsule

SOME KILLERS HAVE PRETTY NICE CAPSULES

capsules-step pyogenes, Neisseria gonorrhea, staph aureus A... IgA protease Neisseria, Hemophilus, S. pneumonia

disrubutive shock and a high increase in what output?

cardiac index of LV output

posterior (doral column) tracts

carry sensations for fine touch, position, vibration

what antifungal mechanism of action used fungal cell wall polysaccharide?

caspofungin

Huntington's disease affects what part of the brain?

caudate nucleus

Megaloblastic anemia

caused by B12 deficiency impaires DNA synthesis and causes cell cycle arrest and apoptotic cell death. B12 required for amino acid, purine, and thymidine synthesis

Mucor mycosis

caused by Mucor, Rhizopus, and absidia and cause sinus involvement. The classic picture is paranasal sinus involvement in diabetic immunosuppressed patient. Which form broad nonseptate hyphae that branch right angles.

Left ventricular systolic dysfunction caused by? and lead to increased?

caused by heart failure leading to increased angiotensin II, norepinephrine, and ANP

Minimal change disease

caused by immune dysregulation and overproduction of a specific cytokine that damages the podocytes (effacement). This leads to selective loss of albumin in the urine. , in contrast to non-selective proteinuria seen in other forms of nephrotic syndrome It often follows a recent infection, is seen in kids, and responds well to corticosteroids.

Clasp-knife spasticity with single sided motor weakness including face with initial resistance to flexion

caused by pyramidal motor system (corticobulbar/corticospinial tract) they run through precentral gyrus (motor tract)internal capsule to brainstem

mitral stenosis

caused by rheumatic fever will hear mitral sound during valve opening

Changes in action potential that cause Na to be pushed over like (type 1 antiarrhythmic)

caused more by disopyramide than lidocaine or disappearance in sketchy.

COPD causes (??) due to hypoxemia

causes erythropoietin due to hypoxemia which is sensed by renal cortex and medulla to help increase RBC to bolster oxygen carrying which leads to secondary polycythemia

BMPR2 inactivating mutation (what disease)

causes excess proliferation of smooth muscle leading to pulmonary hypertension. A/w young adult women, Think plexiform lesions.

which GI disease is associated with IgA deficiency?

celiac disease

increased creatinine kinase after injury is a sign of what?

cell membrane damage

Oncosis

cellular swelling

what phases stimulate gastric acid secretion?

cephalic or gastric phase

Lesions at the (???) vestibular schwannoma cause sensorineural hearing loss and tinnitus due to CN VIII

cerebellopontine angle

rapid correction of hyponatremia

cerebral pontine myelinosis

multiple sclerosis

cervical white matter dymylination random asymmetric lesion relapsing and remitting

Haemophilus ducreyi (it's so painful, you do cry ) Painful genital ulcer, inguinal adenopathy. Disease?

chancroid

Systemic mastocytosis

characterized by abnormal proliferation of mast cells and increased histamine secretion. This increases the production of gastric acid by parietal cells. Gastric acid hyper secretion therefore commonly occurs.

X-linked agammaglobulinemia- what is the mutation enzyme?

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

study evaluating association between sex (male/female) and myocardial infarction (yes or no) a. analysis of variance b. chi-square test c. two-sample t-test d. correlation analysis

chi-square test

case control study design: who is the control in a group testing AML caused by living conditions?

children who do not have disease regardless if exposed or not

cytoplasmic inclusions bodies + GU symptoms, what is the organism?

chlamydia

pyuria (wbc+) but no culture. what is the organism?

chlamydia or gonorrhoeae

gaba potential related to what ion?

chloride -75

enterotoxigenic escherichia coli (ETEC) is associated with what type of toxin?

cholera like enterotoxin

what cholesterol drug increases triglycerides most?

cholestyramine "Cho"lobster"amine scaring airship away: bile acid resins (cholestyramine, colestipol, colesevelam) cause hypertryglycemia (increased VLDL's)"

Pesticides/Herbicides antimuscarinic affects what site of the neuromuscular junction

cholinesterase inhibitor (block breakdown of acetylcholine)

Where is CSF produced?

choroid plexus

increased cardiac output, decreased TPR, and increased mean systemic pressure a. GI bleed b. chronic ateriovenous fistula c. myocardial infarction d. anaphylaxis

chronic arteriovenous fistula

What is the immunodeficiency? ■ A boy has chronic respiratory infections. Nitroblue tetrazolium test is +.

chronic granulomatous disease

Sarcoidosis, what labs

chronic inflammatory disease in which small nodules (non-caseating granulomas) develop in lungs, lymph nodes, and other organs hypercalcemia, hypercalciuria

basophils is seen in what types of leukemia?

chronic myeloid leukemia

ABL

chronic myeloid leukemia (still ABL to do things)

Primary myelofibrosis

chronic myeloproliferative disorder marked by clonal expansion of atypical megakaryocytes which are produced by cytokine TGF-B which stimulate fibroblast to lay down collagen leading to bone marrow fibrosis which will result in bone marrow "dry tap" due to fibrosis

The fecal elastase test is used to diagnose?

chronic pancreatitis

Dermatomyositis (what is it and what is the testing for it)

chronic systemic immunological disease involving inflammation of the skin, connective tissue, and muscles anti-Jo-1 antibodies

What is the last to disappear in the airway? cartilage cilia goblet mucous glands serous glands

cilia

how do you treat pulmonary abscesses?

clindamycin

how do you establish diagnosis of tetanus?

clinical diagnosis only (no toxin assay)

Vitamin k deficiency results from impaired (???). Newborns are at risk for vitamin K deficiency due to poor transplacental transfer of vitamin K and low content in breast milk. All newborns show receive vitamin K prophylaxis to prevent bleeding complications.

clotting factor carboxylation

what type of necrosis is seen in ischemic injury?

coagulative necrosis

Berry aneurysm especially in younger adult is most likely due to (???) due to hypertension in branches in aortic arch proximal leading to hemorrhage.

coarctation of aorta

Turner syndrome caused (???) causing diminished distal pulses with increased upper pulses

coarctation of aorta

drugs that block polymerization of MT

colchicine

Gout causes red irritation to joints can be treated with (???) by inhibiting leukocyte migration and phagocytosis by (???). Cause nausea and diarrhea

colchicine blocking tubulin polymerization

chronic pancreatitis is deficient in which enzymes that causes inability to digest triglycerides?

colipase/lipase

Wrinkles around eyes caused by

collagen fibril production decrease with increase in crosslinking

Anti-glomerular basement membrane antibodies react with (???), causing rapidly progressive glomerulonephritis with glomerular (???) formation on light microscopy. IF demonstrating linear deposits of IgG and C3 along GBM

collagen type IV crescent

prinicipal site of uric acid precipitation is where in in renal tubule?

collecting duct due to low urine pH (uric acid precipitate in normally acidic environment) -high urine flow and high pHalong the nephron prevents crystallization and precipitation of uric acid

• The metanephros or metanephric blastema gives rise to the glomeruli, bowman's space, proximal tubules, loop of Henle, and distal convoluted tubules. Ureteric bud becomes collecting systems

collecting tubules duct, major and minor calyces, renal pelvis, and ureters

APC/beta-catenin

colorectal cancer, pancreatic cancer

left atrial appendage

common location of a thrombus

Gynecomastia common side effect of what BP drug?

common side effect of eplerenone and spironolactone

A-Fib

commonly involved ectopic electrical foci in pulmonary veins that trigger fibrillatory conduction

Pharmacotherapy for oral candida?

conazole, NYSTATIN, amphotericin-B (for badddd)

PARK AT VENTURE AVENUE

conduction velocity fastest to slowest purkinjie, atrial muscle, ventricular muscle, AV node

Hypertension + hypokalemia (decrease renin, decrease aldosterone)

congenital adrenal hyperplasia deoxycorticosterone-producing tumor cushing syndrome exogenous mineralocorticoid

Patent ductus arteriosus

connection between aorta and pulmonary artery

innsular has a role in (???) and (???)

consciousness and emotion

diltiazem causes why GI symptoms?

constipation

injury to meyer's loop in temporal lobe

contra lateral superior quadrantoanopia

MCA occlusion results in (???) and (???) with involvement of (upper/lower) limb with relative preservation of (upper/lower) limb function and can cause aphasia.

contralateral hemiparesis and hemisensory loss of face upper limb lower limb

musculocutaneous nerve

coracobrachialis, biceps brachii, brachialis

AV node located near the opening of (???)

coronary sinus

(???) have the greatest effect on increasing surfactant production by accelerating maturation of type II pneumoncytes.

corticosteriods (betamethasone/dezamethasone)

superior laryngeal nerve reflex?

cough reflex (carrying sensation from superior to the vocal cords)

stapedius muscle is innervated by

cranial nerve VII (facial) "stapedius nerve"

Falciparum (Shape)

crescent shaped gametocyte

Hexoaminidase A

critical role in the brain and spinal cord (central nervous system). This enzyme is found in lysosomes, which are structures in cells that break down toxic substances and act as recycling centers. Within lysosomes, beta-hexosaminidase A forms part of a complex that breaks down a fatty substance called GM2 ganglioside.

Recombination refers to gene exchange that occurs through the (???). Reassortment describes the (???) in segmented viruses that infect the same host cell.

crossing over of 2 double-stranded DNA molecules mixing of genome segment

Polysaccharide capsular yeast

cryptococcus neoformans NOT CANDIDA

inhaling amyl nitrate allows Fe2+ --> Fe3+ leading to ability of Fe3+ to bind to what poision?

cyanide freeing cyanide from binding in mitochondria in cytochrome oxidase

54-year-old man with normal renal functions gets a heart transplantation. One year later, bp 170/110 and serum creatinine 2.1. Which drug caused these findings?

cyclosporine

dense bodies

cytoplasmic structure to which thin filaments of a smooth muscle fiber are anchored

Spectrin

cytoskeletal protein that is responsible for maintain shape of RBC

Duchene's Muscular Dystrophy (DMD) defective protein?

cytoskeleten

acute viral hepatitis is seen as elevated liver transferases with panlobular mononuclear cell infiltration. what is the cause of this?

cytotoxic T-cell-mediated apoptosis (councilman bodies)

Elevated CA19-9 levels are an indication of which cancer? A. Breast cancer B. Prostate cancer C. Colon cancer D. Pancreatic cancer

d. Pancreatic cancer

V/Q=infinity

dead space (PE)

red nucleus lesion

decorticate --> cor --> hands near heart --> red for blood

nigrostriatal is (increase of decrease) activity to cause EPS sxs

decrease

decrease vitamin D leads to what changes in calcium, phosphorus, parathyroid hormone?

decrease calcium decrease phosphorus increased parathyroid hormone

dilated cardiomyopathy (???) seen in familial DCM

decrease contractile function causing increase in ventricular cavity size. Result in decomp. Heart failure. TTN gene encodes sarcomere titin seen in familial DCM. Titin is the elastic protein that anchors the peta-myosin heavy chain to Z-disc

Propranolol does what to the thyroid hormones?

decrease conversion of T4 to T3 by inhibiting 5'-monodeiodinase

Pulsus paradoxus is defined by a (???) of greater that 10 with inspiration. It is most commonly seen in patients with cardiac tamponade but can occur in severe asthma, COPD, and constrictive pericarditis

decrease in systolic blood pressure

ascites affect on (plasma oncotic pressure/splanchnic vascular resistance, effective arterial blood volume, capillary permeability)

decrease plasma oncotic pressure decrease splanchnic vascular resistance decreased arteral blood volume normal capillary permeability

What changes to (serum bicarbonate/sodium levels/serum osmolality/potassium) will happen with loop diuretics?

decrease potassium and increase bicarbonate increased osmolality

Thrombotic thrombocytopenic purpura aka TTP

decreased ADAMS13 level uncleaved vWF multimers platelet trapping and activation caused by autoantibodies leading to hemolytic anemia. Must treat with plasma exchange

emphysema pulmonary function tests (FEV1/FVC, total lung capacity, DLCO)

decreased FEV1/FVC increased total lung capacity decreased diffusing capacity for CO (DLCO)

4 physiological changes of surfactant on lung? (surface tension, collapse, lung recoil, and compliance)

decreased alveolar surface tension decreased alveolar collapse decreased lung recoil increase compliance of lung

Aspirin toxicity metabolic changes Ph, PCO2, PHO3 (up/down)

decreased pH decreased PCO2 decreased HO3-

minimal change disease causes what changes in blood vessels

decreased plasma oncotic pressure

what is cause of recurrent hypoglycemic episodes in patient with DM-II and chronic kidney disease?

decreased renal insulin clearnace

Lab values for patient with addison disease or primary adrenal insufficiency? (sodium potassium chlorid bicarb)

decreased sodium increased potassium increased chloride decreased bicarbonate

what lab abnormality is seen in kleinfelter disease?

decreased testosterone increased LH and FSH increased estradoil

leakage of urine by coughing, lifting, sneezing cause by what?

decreased urethral spincter tone

HUS

decreased urine output few days after bloody diarrhea with increase BUN and creatinine... associated with raw beef caused by shiga toxin

What would be the response to orthostatic hypotension? (venous return, carotid sinus baroreceptor activity, cerebral blood flow)

decreased venous return, carotid sinus baroreceptor activity, cerebral blood flow

lactic acidosis due to end-organ hypoperfusion in septic shock impair tissue oxygenation and decrease (???) leading to build up of NADH shunting pyruvate to lactate

decreases oxidative phosphorylation

what artery is effected in midshaft fracture of right humerus?

deep brachial artery and radial nerve

hypoketotic hypoglycemia after fasting is caused by what defect?

defect in fatty acid beta-oxidation (acyl-CoA dehydrogenase)

Enterotoxin made in intestine-quick or slow? vomiting or diarrhea?

delayed and diarrhea C. perfringen ETEC and vibrio cholerase

Wilms tumor

deletion of WT tumor supressor gene HTN due to renin secretion WAGR syndrome

EEG waveform of sleep walking and bedwetting?

delta (N3)

Distal clavicle fx pulled down and anteriorly by what muscle?

deltoid

impaired abduction of arm 30- 100 degrees is caused by?

deltoid via axillary nerve

Nerve conduction study

demyelinating neuropathy lead to delayed nerve conduction velocity while axonal neuropathy lead to reduced signal amplitude.

What cells links innate and adaptive immune system?

dendritic cells

tennis racket-shaped bilamellar granule in cytoplasm. Abnormal cells in patient are derived from which cell?

dendritic cells

repression vs denial

denial: no normal always believe its not happening to them repression: dont remember it happening but knew it was happening at the time

why does deoxygenated blood can carry more carbon dioxide than oxygenated blood?

deoxyhemoglobin is better buffer of hydrogen ions than oxyhemoglobin

Folate deficiency inhibits synthesis of nucleic acids particularly the formation of (???). this leads to defective DNA synthesis that causes increased apoptosis of hematopoietic cells and megaloblastic anemia. (????) supplementation bypasses this enzyme and can reduce erythroid cell apoptosis.

deoxythymidine monophosphate thymidine

Junctional nevi occur at the ____-_____ junction

dermal-epidermal junction

structure located behind the esophagus (8)

descending aorta (17)

Two-sample t test

determines if the mean of 2 populations are equal

Blood/gas partition coefficient

determines the solubility of a gas in anesthetic in the blood which in turn determines the onset of action of the drug. Drugs with high coefficients are more soluble in the blood (drug A), demonstrate slower equilibration in the brain, and have longer onset times.

polyuria with low initial urine osmolality --> water diuresis caused by what 2 conditions?

diabetes insipidus (hypernatremia) primary polydipsia due to excess water intake (hyponatremia)

Kimmelsteil-Wilson lesions (ovoid shape lamellated appearance of PAS + mesangial matrix deposition) this is due to nephrotic syndrome caused by (???)

diabetic nephropathy

Nephrotic syndrome includes (???), (???), and (???)

diabetic nephropathy, membranous nephropathy, and minimal change disease

Nontyphoidal salmonella in an immunocompromised person has increased risk of what?

diarrhea but can cause osteomyelitis, or endocarditis. MOST AT RISK IS SICKLE CELL BUT CAN JUST HAVE IMPAIRED IMMUNITY

pathogenesis of calcific aortic valve disease?

differentiation of valve fibroblast into osteoblast like cells

SLE is associated with what type of nephritic syndrome?

diffuse proliferative glomerulonephritis

Congestive splenomegaly due to portal hypertension

dilated sinusoid, fibrosis of red pulp and hemosiderin-laden macrophages

Fenoldopam: cause arteriolar (???) while (???) renal perfusion and (????) natriuresis

dilation improving increasing

weakness of the transversalis fascia

direct hernia

Conn's syndrome

disorder of the adrenal glands that is caused by the excessive production of aldosterone

Transtentorial (uncal) herniation

displacement of the temporal lobe, presses on CN III and parasympathetic fibers -> impaired ocular movements, pupillary dilation -> Duret hemorrhages in midbrain and pons

where is the lowest osmolarity in renal tubule

distal convoluted tubules

lower root lesions

distal effects (hand level)

Risk is probability of developing disease over time. To calculate (???)

divide number of affected subjects by total number of subjects in exposure group. Aka (low carotene and Alzheimer's)/ (Alzheimer's total)

Squatting does what to venous return?

does not change venous return but increases SVR TOF: decreased right to left shunting and increases pulmonary blood flow and improves oxygenation status

Echinococcus granulosus-adverse side effect

dog/sheep tapeworm that cause hydatid cyst (eggshell calcification) --> spilling of cyst can cause anaphylactic shock

blunt abdominal trauma abruptly increase intravesical pressure and rupture bladder (????) spilling uring into intraperitoneal cavity

dome

adenocarcinoma that arise from urachal remnant will we seen where?

dome of the bladder

VZV or zoster is double stranded DNA that infect (???) and lead to shingles that can lead to (???) and (???) cells (positive on Tzanck smear).

dorsal root ganglia intranuclear inclusion and multinucleated giant

oculomotor never

down and out

L4

down on all 4's aka knees

splenic vein

drains spleen, pancreas, and stomach; branches to inferior mesenteric vein

Insulin and epinephrine drive (???ion) into the cell. Aldosterone provides long-term reduction of intracellular (???)

drive K+ into the cell K+

Canal of Schlemm

duct in the anterior chamber that carries filtered aqueous humor to the veins and bloodstream

Hypovolemic shock causes activation of what system with increase of what electrolyte and secretion of what hormone

due to blood loss that cause activation of renin-angiotensin system that increase sodium reabsorption and increase secretion of antidiuretic hormone which reabsorbs water. Increase urea reabsorption in mediate by ADH

downs syndrome has risk of developing what abdominal condition?

duodenal atresia decreased AFP in screening

increased vascular permeability

during inflammation, this causes loss of high protein fluid (exudate) with reduction of intravascular osmotic pressure and increased interstitial osmotic pressure causing further impairment of return of fluid to blood vessels (venules) producing marked inflammatory edema high ratio of pleural fluid to serum total protein or lactate dehydrogenase

dystonia vs chorea vs. myoclonus

dystonia: sustained involuntary muscle contractions usually affecting a single muscle myoclonus: sudden brief shock-like muscle contraction. Jerk like motion seen in CJ disease chorea: involuntary muscle activity that flows from one muscle group to another looks like dancing gait

tanner stage 2

earliest changes breast bud public hair scrotal change

Meckel diverticulum

ectopy

PAS reaction

effective in highlighting polysaccharides

Cryptococcus

effects immunocompromised meningoencephalitis is most common presentation. India ink staining in CSF or mucicarmine in lung tissue

• Ace inhibitors cause activation of renin-angiotensin which cause impaired (???) arteriole dilation

efferent

aorta is why type of artery?

elastic artery

Emphysema is a destruction of the alveoli of the lungs. loss of (???) leads to collapse of airways udring exhalation.

elastic recoil

multiple myeloma

elderly with hypercalcemia, normocytic anemia, bone pain, elevated gamma gap or renal failure. With renal failure cause by light chain cast nephropathy.

Decreased lung compliance

elderly, pneumonia, pulmonary edema, ARDS(decreased surfactant), atelectasis, fibrosis lungs are hard to fill

• GERD in pregnancy causes elevated (???) and (???) levels with relax smooth muscle leading to decrease LES tone.

elevated estrogen and progesterone levels with relax smooth muscle leading to decrease LES tone.

Hepatoxicity cause by inhaled-anesthetic (acute) which will show elevated (???), (????), (???), and (???)

elevated serum aminotransferase, prolonged prothrombin time, leukocytosis, and eosinophilia

Increased lung compliance

emphysema (lung easier to fill)

Decreased albumin is due to chronic (???)

end stage liver disease

infusion of normal saline following hypovolemic shock causes what to change in the heart?

end-diastolic sarcomere length

diabetic neuropathy pathology?

endoneurial arteriolar hyalinization

Hereditary pulmonary arterial hypertension develops in two steps. An abnormal BMPR2 gene predisposition to excessive (???) and (???) proliferation and insult cause remodeling.

endothelial and smooth muscle

activation of toll like receptors by bacterial components is caused by what bacteria?

endotoxin from gram-negative bacteria

Dipeptidyl Peptidase-4 Inhibitors look like GLP-1

enhance activity of incretins, stimulate release of insulin from pancreatic B cells, decrease hepatic glucose production

coronary sinus

enlarged vessel on the posterior aspect of the heart that empties blood into the right atrium

This leads to widening of where in huntingtons disease?

enlargement of lateral ventricles

(???) normal colonic flora that is capable of growing in hypertonic saline and bile. catalase negative and lead to endocarditis?

enterococcus faecalis (cystoscopy)

symptoms began with colicky abdominal pain following introduction of solid food to the infant's diet. History of gluten sensitivity. Which cell is dysfunctional?

enterocytes

Cholera toxin

enterotoxin similar to e. coli, ADP ribosylation activating adenylate cyclase

what is the one medication to give to improve cardiovascular outcomes regardless of cholesterol levels?

enzyme inhibitor (HMG-CoA reductase inhibitior)

Component of cytosol of mitochondria

enzymes responsible for glycolysis, fatty acid synthesis, and pentose phosphate pathway reside in cytosol including transketolase

Hodgkin's lymphoma increase (???-ophilia)

eosinophilia

antibodies against neutrophil myeloperoxidase?

eosinophilic granulomatosis with polyangiitis (churg-strauss) (p-anca)

HER2 oncogene

epidermal growth factor receptor with tyrosine kinase activity leading to increased proliferation

Faulty position of genital tubercle in 5th week gestation

epispadias (while faulty closing of labia minor is hypospadias)

keratin is a marker for what cell type?

epithelial cell

What are the issues that arise hours after type I hypersensitivity reaction?

epithelial damage by major basic protein

What is most common characteristic of granuloma?

epithelioid histiocytes

vitamin K activated by?

epoxide reductase in the liver

Dihydroergotamine (side effect)

ergot alkaloid that treat migraines and induce vasospastic angina as it constricts vascular smooth muscle via stimulation of alpha and serotonergic receptors.

Parvovirus B19 "slapped cheek" replicate in (????) precursor in the bone marrow

erythrocyte

thoracic aortic aneurysm can compress surrounding organs causing what symptoms?

esophagus --> dysphagia left recurrent laryngeal nerve --> hoarseness phrenic nerve --> dyspnea

pathophysiology of SIADH leads to (???-volemic) hyponatremia

euvolemic

what is the underlying mechanism of elevated body temp in malignant hyperthermia?

excessive myoplasmic calcium accumulation

acromegaly

excessive production of GH leading to cardiac growth via left ventricular hypertrophy

Hyperosmotic volume contraction

excessive sweating without fluid replacement DI alcohol

Is glutamate excitatory or inhibitory?

excitatory

infraspinatus action

exertnal rotation

DNA polymerase III (???) activity which cause removal of mismatched base pairs during DNA replication via (???) or DNA poly I has (???) which allows it to remove the RNA primase but not polII

exonuclease activity DNA replication via 3' to 5' or DNA poly I has 5' to 3' which allows it to remove the RNA primase but not polII

Staphylococcal toxic shock syndrome:

exotoxin mediated disease resulting in hypotension, organ failure, and diffuse erythematous rash related to tampons or nasal wound packing result ing nonspecific stimulation of total T cells and massive release of inflammatory cytokine by binding T cell receoptros by bacterial secretory products

Cricothyroid

external laryngeal nerve

The homunculus shows us that the representation of body parts in the cortex does not relate to body part size. The body parts with the greatest neural representation are

face

Niacin side effects

facial flushing - which is due to prostaglandins and not histamine, thus this can be treated with aspirin. Hepatotoxicity can occur with HIGH doses of niacin, and attacks of gout (due to increase serum uric acid levels) Hyperglycemia (acanthosis nigricans) niacin used as treatment for hypertriglyceridemia

arches and associated cranial nerves: pharyngeal/aortic arch 2?

facial nerve and stapedial artery

Hemophilia B (Christmas disease)

factor IX deficiency

bicornuate uterus caused by what structure failure?

failed lateral fusion of paramesonephric duct

Decreased lipoprotein lipase activity with milky plasma

familial chylomicronemia syndrome acute pancreatitis (sx: hyper triglycerides, pancreatitis, and lipemia reitinalis) skin xanthoma may be present but no tendon or xanthelasmas

CF patient lack ability to digest what vitamins?

fat soluble --> ADEK

celiac disease leads to malabsorption of what (???)

fat soluble vitamins including vitamin D

Extension leg by quads- (???) nerve that access through (???) ligament...

femoral inguinal ligament

total cholesterol 200, HDL 50, triglycerides 550. Which drug to prescribe?

fenofibrate Upregulates LPL -> increase in triglyceride clearance and it will activate PPAR-A to induce HDL synthesis

phospholipid content of amniotic fluid checks for?

fetal lung maturity (example of phospholipid: dipalmitoyl phosphatidylcholine, lecithin

In spite of appropriate therapy she dies 2 days later. Liver autopsy shown. Which of the following is the primary component of the material shown on the hepatic surface?

fibrin 1-3 days after: yellow pallor on liver lots of neutrophils! Fibrinous so material shown on hepatic surface is made up of fibrin

Rapid Progressive Glomerulonephritis deposition are comprised of what products?

fibrin and macrophages

Flame shaped hemorrhages

fibrinous necrosis due to HTN

achondroplasia is activation of what receptor causing what symptoms?

fibroblast growth factor receptor 3 (FGFR3) leading to short stature it is autosomal dominant so will come out 50% inheritance

CREST syndrome is associated with what abnormality in esophagus?

fibrous replacement of muscularis in lower esophagus

E. coli adherence

fimbriae

urinary frequency and urgency caused by BPH. +hair growth after administration. what is the medication used to treat and what is the mechanism used?

finasteride --> decreased peripheral androgen 5-alpha-reduction

CMV on HIV patient (<50)

first line ganciclovir phosphorylation... then

flexor digitorum superficialis

flexes wrist and middle phalanges of fingers 2-5 (median nerve)

Coracobrachialis

flexes, adducts arm/humerus

cervicofacial actinomyces

fluctuant lesion and fistula over the mandible FILAMENTOUS, BRANCHING GRAM-POSITIVE BACILLI YOU MISS THIS SHIT A LOT, GET YOUR LIFE TOGETHER

Methotrexate

folate antagonist leading to decreased tetrahydrofolate and increased dihydrofolate polyglutamate

what deficiency causes hypersegmented neutrophils

folate deficiency

Common peroneal (fibular) nerve

foot eversion and dorsiflexors of foot resulting in foot drop

CN V2 travels through

foramen rotundum

valsalava maneuver

forcibly exhaling against closed glottis that require rectus abdominis muscle to provide pressure

spondylolisthesis

forward slipping of one vertebra over another

problem metabolizing sugar in fruits but can have normal diet? +copper reduction test

fructokinase

histone protein H1 function and location

functions to maintain the structure of each nucleosome and packaging located on outside of histone core

sideroblastic anemia caused by isoniazid causes decrease in what enzyme?

g-aminolevulinate dehydratase

decreased cholecystokinin release due to lack of enteral stimulation after gastrectomy leads to what build up?

gallstones

First line therapy for CMV is (???). Which blocks viral synthesis by (???). However, it also blocks host (???) which lead to hematologic side effects including neutropenia, anemia, thrombocytopenia

ganciclovir DNA polymerase DNA polymerase

seborrheic keratosis associated with what cancer?

gastric adenocarcinoma (GI malignancy)

H. pylori adverse side effects?

gastric lymphoma

PUd with chronic blood loss anemia and elevated gastrin level are associated with what type of tumor?

gastrin-secreting pancreatic tumor

high cholesterol with gallbladder disease what cholesterol lowering medication should be avoided?

gemfibrozil (and cholestyramine) Elevated statin-punk eating crispy chicken: Fibrates combines with statins increases risk of myopathy 15. Sea"gall" stones: fibrates can cause cholesterol gall stones

Fragile X involves what gene problem?

gene methylation

mitochondrial myopathy

genetic mitochondrial abnormalities that prevent muscles from producing energy, causes weakness and intolerance to exercise and muscle deterioration

Epidermolysis bullosa

genetic skin disease characterized by blisters caused by any mechanical friction, resulting in large open sores and extreme skin fragility cause by impaired assembly keratin into filaments

increased unconjugated bilirubin under stress?

gilbert syndrome

Example of HSV-1 primary infection

gingivostomatitis

what adverse side effect is associated with aspirin and why would you give them?

given after TIA and can cause GI bleeding

Deep inguinal lymph nodes

glans penis and cutaneous portion of posterior calf

canal of schlemm blockage results in what disorder?

glaucoma

tubulin

globular protein subunit forming the hollow cylinder of microtubules colchicine

minimal change disease leads to overproduction of (???) that damages podocytes leading to effacement and (???) properties in basement membrane

glomerular permeability factor anionic properties (loss of negative charge) of BM

arches and associated cranial nerves: pharyngeal/aortic arch 3?

glossopharyngeal nerve and common carotid artery/internal carotid artery

Beta blocker overdose treated with ???

glucagon

Gaucher disease

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

Gaucher disease (explain what it is and characteristic of enzyme replacement)

glucocerebrosidase (β-glucosidase) def. → ↑ glucocerebroside *aseptic necrosis of femur*, Gaucher cells (lipid-laden Mφ's, crumpled tissue paper), hepatosplenomegaly enzyme-replacement therapy are large protein that cannot be orally absorbed, given IV. Endocytosis via receptor binding on cell surface

main way to maintain blood pressure after 2 days of no food?

gluconeogenesis pyruvate --> oxaloacetate --> phosphoenolphyruvate

can glucose and amino acids cross BBB?

glucose and amino acids cross slowly by carrier mediated transport mechanism

Polyol pathway glucose in eye

glucose is converted to sorbitol

G6PD

glucose-6-phosphate dehydrogenase

Myopathy with normal CK

gluococorticoid induced polymyalagia rheumatica

Which amino acid is a substrate for vit k dependent carboxylase?

glutamate

NAPQI is a toxic intermediate is formed by in small amounts by metabolism of acetaminophen. Depletion of hepatic (???) stores by NAPQI leads to acute APAP toxicity and acute liver injury.

glutathione

what muscle attaches to the greater trochanter of the femur?

gluteus medius

patient that complains of poor exercise endurance followed by cramping and urine changes but improves with glucose intake. what the enzyme deficiency?

glycogen phosphorylase (mccardle disease) glycogen --x--> glucose-1-phosphate

selective muscarinic antagonists

glycopyrrolate hyoscyamine propantheline can help decreased cholinesterase inhibitors

Pretibial myxedema and (??) ophthalmopathy are specific feature of (???). They are caused by autoimmune response directed against TSH receipt that result in accumulation of (???) that affect tissue aka TRAb

graves' disease glycosaminoglycan

hair lice-organism?pediculus humanus capitis-what disease

hair lice

Ectopic pregnancy

happen in tubal ligation and will appear as decidualized endometrium consisten with dilate coiled endometrial glands and vascularized edematous stroma due to increased progestrerone

continuous capillaries

have a wall where the endothelial cells fit very tightly together.

Why does E. coli cause of neonatal meningitis

have capsular antigen

Dark intranuclear inclusions that stain with supravital stain and represent hemoglobin that is denatured from oxidative stress is called?

heinz bodies

median eminence of hypothalamus

help control pituitary

Atropine

help treat sinus bradycardia

granulocyte colony stimulating factor

helps stimulate production of WBC (granulocyte) BEN has a lot of pimples-basophil, eosinophil, neutrophil

influenza vaccine stimulates the formation of neutralizing antibodies against (???) preventing ???

hemagglutinin antigen preventing viral entry

Bruise recovery mechanism

hematoma -heme oxygenase convert heme to biliverdin which is green biliverdin reductase to yellow pigments bilirubin

bleeding after tooth extraction and history of hemarthrosis are suggestive of (???)

hemophilia

Hantavirus transmission occurs primarily via inhalation of aerosolized particles excreted in rodent urine and rodent bites. Infection is associated with two acute syndromes

hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS).

Basophilic granules contain (2 things)

heparin and histamine; can generate leukotrienes (slow contraction of smooth muscle)

Alkaline Phosphatase (Alk Phos) evaluates what? and what should be tested with it?

hepatobiliary disease and y-glutamyl transpeptidase (biliary tract marker) should be assessed with

Hemochromatosis lead to what disease?

hepatocellular carcinoma

RIPE therapy (pydrazinamide) side effects

hepatotoxicity, hyperuricemia

cystocele

hernia of the urinary bladder into the vagina During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?

Hypertensive hemorrhage

high blood pressure --> vessel distension --> bulging and bleeding in the brain

neonates have decreasing effectiveness of drugs due to?

high body water content

Sheehan syndrome (Prolactin/ACTH/TSH/Aldosterone levels)

high estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply. Peripartum hypotension (likely from blood loss) can cause ischemic necrosis of the pituitary leading to panhypopitutiarism. Patients commonly will develop failure of lactation due to deficiency in prolactin. Prolactin/ACTH/TSH/Aldosterone - decreased, decreased, decreased, increased (Aldosterone is up because blood delivery is decreased to juxtaglomerular cells ---> renin ---> ang II ---> incr aldo.)

Legionella pneumonia (what electrolyte distrubance will you see)

high fever, headache, confusion, diarrhea, hyponatremia, many neutrophils but few or no organism (lipopolysaccharide inhibits gram staining) and treat with fluoroquinolones IF YOU SEE ATYPICAL PNEUMONIA WITH DIARRHEA AND HYPONATREMIA THEN YOU CAN PRETTY MUCH SAY ITS THIS

what is ion is responsible for resting membrane potential?

high potassium efflux and SOME sodium influx

Chancroid

highly infectious nonsyphilitic venereal ulcer one of the few painful lesions haemophilus ducreyi

Trandelenburg sign

hip dip away from affected side

cells affected first by hypoxia to brain?

hippocampus (hypocampus)

Treatment w/ all-trans retinoic acid is started. In response to the therapy, the fusion protein will most likely attract which of the following proteins to form a pre-transcriptional complex? (histone ??)

histone acetylase Tx APL with Vit A derivative that can bind mutated receptors of cells stuck in blast stage (promyelocytes) and allow them become PMNs.

what organism presents like TB with multiple calcifications and calcified mediastinal lymph nodes?

histoplasmosis

Minimal change disease associated with what cancer?

hodgkin lymphoma

supression

holding back or restraining

Pyridoxine (b6) can be used to treat (???)

homocystinuria

Somatostatin

hormone that inhibits release of growth hormone and insulin VIP, gastrin, cholecystokinin

triglyceride metabolism during fasting uses what type of lipase?

hormone-sensitive lipase --> turns it to free fatty acid and glycerol

Pembrolizumab MOA

humanized monoclonal antibody that binds PD-1 (Programmed Death-1) receptors on T-cells and inhibits the negative immune regulation caused by PD-1 receptor activation by PD-L1. This leads to increased T-cell anti-tumor activity and is most effective in tumors overexpressing PD-L1.

caudate nucleus most associated with what disease?

huntington

what two diseases have too much dopamine?

huntingtons schizophrenia

treatment of calcium stones

hydrochlorothiazide - increases tubular reabsorption of Ca2+ cellulose phosphate - binds calcium in intestine

how is CNS necrosed?

hydrolytic enzyme induced tissue digestion (liquefactive necrosis)

Ion channel myopathies

hyper or hypokalemic periodic paralysis

Xanthelasma result from ?

hyperlipidemia or dyslipidemia

Giving levothyroxine can cause (???) leading to (???) (???) and worsening angina pectoris

hyperthyroidism A-fib, high output heart failure

Sarcomere protein mutation

hypertrophic cardiomyopathy

what causes chvostek sign (tapping on face illicit twitching)?

hypocalcemia

Phosphodiesterase Inhibitors adverse effects

hypokalemia, hypotension, ventricular dysrhythmias decreased visual acuity

Autoimmune polyendocrine syndrome

hypoparathyroidism, adrenal insufficiency, candida (thryoiditis, type 1 diabetes, ovarian failure) AIRE gene defect, autoreactive T cells aren't deleted

Acute Respiratory Distress syndrome

hypoxia and bilateral pulmonary infiltrates and associated with pneumonia, sepsis, trauma, and pancreatitis with normal pulmonary capillary wedge pressure endothelial damage

cecum what artery?

ileocolic

what nerve is most injured during appendectomy?

iliohypogastric nerve

Kartagener syndrome

immotile cilia due to microtubular dynein arm defect.

Most common cause of nephritic syndrome is (???) aka post strep, membranoproliferative, lupus. IgA nephropathy is associated with normal serum complement levels due to weak complement-fixing activity of IgA compared to IgG and IgM

immune complex deposition

Adrenoleukodystrophy

impaired addition of CoA to long chain FA; FA accumulates damaging adrenal gland & white matter

incomplete emptying of the bladder and persistent involunatry dribbling?

impaired detrusor contractility or bladder outlet obstruction

Hep B vaccine prevents infection via what mechanism?

impaired virion entry into hepatocytes

lead intoxication

impairs mito iron transport -leads to hypochromic anemia ferrochelatase

beta blockers and hypertrophic cardiomyopathy

improve by increase in LV volume by: reduce heart rate, and reduce LV contractility

variable-ratio schedule

in operant conditioning, a reinforcement schedule that reinforces a response after an unpredictable number of responses slot machine

variable-interval schedule

in operant conditioning, a reinforcement schedule that reinforces a response at unpredictable time intervals

fixed-ratio schedule

in operant conditioning, a reinforcement schedule that reinforces a response only after a specified number of responses

fixed-interval schedule

in operant conditioning, a reinforcement schedule that reinforces a response only after a specified time has elapsed

PKU (phenylketonuria)

inability to convert phenylalanine into tyrosine which lead to large concentrations of phenylalanine metabolites. Hypopigmentation result from excess phenylamine on melanin. Deficiency in phenylalanine hydroxylase

What causes poor wound healing in vitamin C deficiency?

inadequate hydroxylation of collagen polyprptide

adaptations of hypothermia? (5)

incrased sympathetic activity peripheral vasoconstriction increased muscle tone shivering increased thyroid function

Lactose intolerance causes (decrease/increase) breath hydrogen content, (reduced/elevated) stool pH, and (reduced/elevated) stool osmolality

increase reduced pH elevated osmolality

competitive inhibitor bind at active site and impede substrate binding these do what to Km and Vmax?

increase Km and leave Vmax unchanged

Wilson Disease what is increased and where is it supposed to be excreted that it cannot be?

increase brain copper content that is normally removed by bile and excreted into the stool.

patient will have a increase in what due to prematurity and decreased surfacant?

increase elastic recoil

diabetic ketoacidosis potassium changes?

increase extracellular potassium decreased intracellular potassium

diabetic nephropathy

increase in albumin over time. 1st. Glomerular hypertrophy and dilation of afferent arterioles and constriction of efferent cause increase GFR 2nd. Mesangial expansion, thickening BM, increasing albumin 3rd. mesangial nodules, proteinuria, nephrotic syndrome and decrease GFR.

Tuberoinfundibular pathway decrease causes what symptoms

increase prolactin

Will ACE inhibitors increase or decrease plasma renin levels?

increase renin levels other causes to increase renin (low sodium intake, diuretics HCTZ, ACE and ARB)

Methylmalonic acidemia (increase in what and decrease in what)

increase urine propionic acid and ammonia with decrease in glucose and urine ketone. Due to methylmalonyl-CoA mutase deficiency which will cause lethargy vomiting.

pulmonary embolism causes (increased/decreased) dead space ventilation.

increased --> leading to V/Q mismatch

Kleinfelter's Syndrome (LH/FSH/testosterone/sperm count)

increased LH increased FSH decreased testosterone absent sperm count inhibit levels decrease due to sertoli cell damage --> leydig cell dysfunction resulting in testosterone leading to feedback of increasing FSH and LH.

Treatment for hairloss causes what changes to (testosterone, dihydrotestosterone, estadiol)

increased T decrease dihydrotesterone increase estadiol FINASTERIDE

Aging causes what changes in the heart to increased blood pressure (isolated systolic hypertension)?

increased arterial stiffness and decrease in compliance of aorta and major peripheral arteries

Pathognesis of migraines:

increased cerebral excitability allowing wave of cortical spreading depression. Trigeminal afferents releasing calcitonin gene-related peptide involves pain transmission

effects of androgen abuse (5-ish)

increased hematocrit acne testicular atrophy gynecomastia deepening of voice

hypovolemia due to loss of sodium or water causes (hematocrit/albumin/uric acid) to rise or fall?

increased hematocrit increased serum albumin concentration increased uric acid concentration

celiac disease characterized by by (????) lymphocytes

increased intraepithelial lymphocytes

maternal serum alpha-fetoprotein dieases associated w.(increased-3/decreased-1)

increased levels: 1. open neural tube defect 2. ventral wall defect (omphalocele, gastroschisis) 3. multiple gestation decreased levels: 1. aneuploidies (aka trisomy 18 or 21)

carotid sinus massage

increased parasympathetic activity

Digoxin

increased parasympathetic tone to help slow ventricular rate. Positive inotropic effect via inhibition of sodium-potassium ATPase pump.

chronic kidney disease parathyroid changes

increased parathyroid production with decreased calcium

elevated TRH and TSH, but low thyroxine May also have what other hormone imbalance?

increased prolactin secretion

What is the mechanism of resistance for phenylephrine?

increased receptor internalization by arrestins causing tachyphylaxis (diminished response to drug)

Hemolytic anemia due to oxidative stress (sulfa drugs) is due to G6PD Changes in lab values will show (increase/decrease in reticulocytes/lactate dehydrogenase/haptoglobin)

increased reticulocyte increase lactate dehydrogenase decrease haptoglobin (due to binding to free dead RBC)

heart failure with preserved ejection fraction due due to LV diastolic dysfunction causes what changes to vascular?

increased systemic vascular resistance with concentric left ventricular hypertrophy

what is a suggestive feature of DM-II?

increased waist circumference, htn, metabolic syndrome

Do medications cause IgE-independent or dependent mast cell activation?

independent by activation protein kinase A and PI3 kinase

hydrocele relates to what other GU problem?

indirect inguinal hernia due to patent process vaginalis

variable expressivity

individuals with the same genotype have related phenotypes that vary in intensity

what is the purpose of conjugating vaccines?

induce more robust immune response through B and T cell activation

Legionella pneumophila involves what type of cells and cytokines

infection involve T helper cell, interferon-y, IL-2, intracellular pathogen

Elementary bodies of chlamydia cause what?

infectivity

what artery supplies rectus abdominis and does not have supporting sheath leading to more susecptible hemorrhage?

inferior epigastric artery

what landmark distinguishes indirect from direct inguinal hernia?

inferior epigastric vessels

what is the location of IM injection if patient is currently have left FOOT drop and weakness in knee flexion and ankle plantarflexion?

inferior lateraln quadrant of buttock inferomedial quad of buttock superior portion of posterior thigh

myasthenia gravis found to have thymoma or thymic hyperplasia which is derived from 3rd pharyngeal pouch. What other structure is derived from 3rd pharyngeal pouch?

inferior parathyroid (superior is 4th for some damn reason)

external hemorrhoids are supplied by what set of veins?

inferior rectal vein --> internal pudendal --> internal iliac vein

Pulsatile stimulation of GnRH is used for treatment of what condition?

infertility due to anovulation

Sacroiliitis associated with what HLA?

inflammation of the sacroiliac joint associated with HLA-B27 associated with nongonococcal urethritis

Myopathy that increase creatinine kinase

inflammatory myopathy, statin-induced myopathy, hypothyroid myopathy

Isoosmotic volume expansion (example/darrow-yannet)

infusion of isotonic saline

FSH levels in males feedback hormone

inhibin (fish love inhibiting tests)

Proton Pump Inhibitors (lansoprazole)

inhibit H+.K+ atpase pumpe leading to decrease histamine release, decrease ach, and decrease gastrin

Golgi tendon organs prevent damage to MSK system?

inhibit contraction if too much tension

HSV encephalitis is treated via what mechanism of drug?

inhibition of viral DNA polymerase (acyclovir)

• Achalasia is caused by (???) in distal esophageal wall and characterized by absence of esophageal peristalsis and incomplete relaxation of hypertonic LES. TX: (???) inhibits ACH release resulting in inhibition of cholinergic neurons and cause LES relaxation

inhibitory ganglion cells Botulinum toxin

Metformin what mitochondrial enzyme?

inhibits mitochondrial glycerophosphate dehydrogenase and complex I and upregulates AMP-activated protein kinase. The effects are decreased hepatic glucose production and lipogenesis and decreased intestinal glucose absorption and increase peripheral glucose uptake. Renal clearance.

Isoniazid inhibits the synthesis of

inhibits mycolic acid synthesis which is needed for cell wall. The mycolic acid allows mycobacteria to be acid fast.

Terbinafine used in tinea corporis what mechanism of action?

inhibits squalene epoxidase (squealing pig pin)

Etoposide MOA

inhibits topoisomerase II

Multi-compartment model

initially high in central compartment then quickly move to well-perfused peripheral compartment aka brain liver kidneys then redistributed to skeletal muscle fat and bone, will happen in highly lipophilic drugs like propofol

acute tubular necrosis

injury and necrosis of tubular epithelial cells, necrotic cells plug tubules, decreasing GFR. These brown, granular casts are seen in the urine. labs are similar to long term postrenal azotemia. proximal tubule affected

PART OF BRAIN: Limbic System (emotions)

insular cortex

what treatment causes increase serum bicarbonate and sodium levels and decrease in serum osmolality and potassium?

insulin and normal saline: -decreased ketone production lead to increased serum bicarbonate -intracellular shift of potssium -rehydration normalize sodium levels and decrease serum osmolality

Raltegravir

integrase inhibitor

h. Infections slow to respond to antibiotic therapy. multiple erythematous lesions of skin some with superficial ulceration. WBC 21,000. Biopsy shows no neutrophils in dermis or epidermis. Culture of lesion grows Staphylococcus aureus. Defective?

integrin

Vimentin

intermediate filament in mesenchymal cells and responsible for securing organelles inside cytosol and resistance to mechanical stress

coarse reticular pattern in lung?

interstitial fibrosis

what phase decrease gastric acid secretion?

intestinal phase

Stress urinary incontinence occurs due to preggers and causes increased (???) from gravid uterus. Pressure exceed pressure point to maintain closure of urethral valve which causes them to pee.

intraabdominal pressure

AD polycystic kidney disease causes what type of aneurysem?

intracranial berry aneurysm arises causing subarachnoid hemorrhage noted as worst headache of their life

Strep agalactiae tx of mother?

intrapartum ampicillin

Strep pneumonia

invasive disease and recommended vaccine. Pneumococcal polysaccharides vaccine is unconjugated that induces T-cell humoral immune response. Conjugated vaccines attached protein antigen and create robust T cell mediated humoral immune response. Cough+gram + diplococci

Ulcerative colitis characteristic finding on biopsy?

involvement of only mucosa and submucosa colon only

partial gastrectomy decreases absorption of what?

iron--> absorption duodenum and proximal jejunum (also B12, folate, fat soluble viatmins and calcium

Amiodarone-what can it cause

is 40% iodine. It can cause hypothyroidism due to decreased production of thyroid hormone. But it can also cause hyperthyroidism due to increase synthesis.

Dandy-Walker malformation

is a development anomaly characterized by hypoplasia/abscene of the cerebellar vermis (issues with walking) and cystic dilation of the 4th ventricle with posterior fossa enlargement. Patients often present during infancy with developmental delay and progressive skull enlargment. Non-commnicating hydrocephalus is also possible.

NF-kB

is a pro-inflammatory TF that induces cytokine production. Its activity can be decreased in Chron's disease, resulting in crhonic GI inflammation from the addaptive immune system creating an exaggerated response to gut microbes.

Maple Syrup Urine Disease

is caused by a defect in alpha keto acid dehydrogenase, leading to an inability to degrade branched amino acids (isoleucine, leucine, and valine). This illness classically results in poor feeding and dystonia as well asthe maple syrup scent (burnt sugar) in the patients urine after first couple days of life.

Beta-endorphin

is one endogenous opioid peptide dervied from the same precursor that ACTH and MSH are, suggesting a link between stress axis and the opiod system

resistance to intracellular catalase peroxidase after being diagnosed with T.B. what drug is ineffective?

isoniazid 5. Sleeping: INH can be used alone to treat latent TB infections 6. Mycolic acid cacti on wall: INH works at the bacterial cell wall inhibiting mycolic acid production 8. Aggravated G Tailed Cat: INH is activated by catalaseperoxidase (KatG) (tail makes a G Shape) 9. Silenced G tailed cat: resistance to INH by downregulating KatG 10. Bandit in stockings and gloves: INH may cause peripheral neuropathy 11. Slow acetyl-gunslinger: INH metabolized by the liver enzyme Nacetyltransferase - slow acetylators have higher risk of side effects 12. Pair of dices (sixes) Neuropathy is caused by a Vit B6 excretion promoted by INH, INH promotes and excretion 13. Ungloved hand holding dice: administration of INH and pyridoxine prevents peripheral neuropathy 14. Motion lines: INH may cause seizures

what adrenergic drug increases contractility and decreases vascular resistance?

isoproternol B1:contractility B2:vasodilation

B cells undergo what in the lymph tissue?

isotype switching

Positive-sense single-stranded RNA can be translated directly to proteins using its (self/host) ribosomes

its host

Subungual splinter hemorrhages in the nail beds are among the classic signs of ______________________.

janeway lesion and are related to bacterial endocarditis

Lesions of the (???) can result in (???) syndrome, which is characterize by dysfunction of cranial nerve IX, X, and XI. Symptoms include (???)

jugular foramen dysphagia, hoarseness, and loss of gag reflex on Ipsi side with deviation toward normal side.

Celecoxib - Pertinent Pharmacokinetics (why would you give this?)

just as effective as traditional NSAIDs at suppressing inflammation and pain; somewhat lower risk for GI side effects(PUD); increased risk of MI or stroke; extensive plasma protein binding, hepatic metabolism; renal excretion

Where is renin produced?

juxtaglomerular cells

what is a common finding of squamous cell carcinoma of esphagus?

keratin pearls and intercellular bridges

abundant clear cytoplasm of carcinoma is associated with what organ?

kidney (mets to lung, osteolytic bone lesion and liver) can also be signet cell carcinoma of stomach but no polycythemia

what organ is located near 12th rib?

kidneys

Hemolytic Uremic Syndrome (HUS)

kids<10: Ecoli O157:H7; undercooked meat activates platelets and endo damage Similar CF to TTP; CNS less frequent; Bloody diarhea 75% Rx: plasmapheresis and corticosteroids

encapsulated gram negative bacilli that grow pink mucoid colonies on macconkey agar with pneumonia like symptoms?

klebsiella pneumoniae

17 yo M with bilateral breast enlargement with learning disability. sense of smell normal and tesitcles are small and firm. What is the diagnosis?

kleinfelter disease (47,XXY)

what findings are associated with 47 chromosomes?

kleinfelter syndrome (47, XXY) Tall stature, gynecomastia, azoospermia

Albanism

lack of melanin with melanocytes

Rh negative

lacking Rh factor on surface of blood cells, has anti-D IgG antibodies to attack fetus

ALK

large cell lymphoma non small cell lung cancer

Fragile X Syndrome

large ears, long faces, macroorchidism

Gallstone ileus

large gallstone passage through fistula into small bowel where it obstructed in ileocecal junction. Looks like small bowel obstruction and may reveal gas within gallbladder and biliary tree

Eye only directed inferiorly and laterally with dilation and nonreactive-only intact is (?eye muscle??)

lateral rectus

Phrenic nerve impaction

lead to sharp pain in shoulder due to C3-C5 nerve roots

Hippocampus function

learning and memory

Pulmonary capillary wedge pressure closely reflects (??) and (???) pressure. (???) leads to increase in LA pressure that is reflected as elevated wedge pressure with normal other findings.

left atrial left ventricular end diastolic Mitral stenosis

most posterior part of the heart

left atrium

Posterior Descending Coronary Artery supplied by what artery in left dominant heart

left circumflex artery

Esophageal varices arise from what blood supply (veins)

left gastric

what structure has less blood flow during systole and max during diastole?

left ventricular myocardium

what artery supplies legs (homunculus) and what artery supplies the arms?

legs-anterior cerebral artery arms-middle cerebral artery

does multiple sclerosis change length or time constant

length constant

Krabbe disease

leukodystrophy; deficiency of galactocerebroside beta-galactosidase; galactocerebroside accumulates in macrophages

(???) effectively treat asthma by binding to leukotriene receptors on bronchial smooth muscle cells and block effect of cysteiny-containing leukotrienes leading to bronchodilation and decreased permeability

leukotriene receptor antagonist like montelukast and zafirlukast

stress urinary incontinence and using kegel exercise targets what muscle?

levator ani muscles

scattered scaly pink papules and plaques are diagnosistic of what?

lichen planus (T cell mediated response to junction of dermis and epidermis)

• SCID dysfunction. Leading to (???). Absent (???) and (???) are seen with no (???) shadow

life-threatening infections at infancy of both virus and bacterial. T cells and hypogammaglobulinemia thymic

-navir should have what type of testing done?

lipid levels and glycemic levels

what microbial component is disease causing in neisseria meningitidis ?

lipo-oligosaccharide Burning Envelopes - N. Meningitides Invades hemotogenously leading to a massive Immune response generated but LOS (lipooligiosaccharides) proteins, these are Neisseria's version of LPS, it grows so much of it that it outgrows the surface area of the bacteria and begins blabbing off. These blebs of LOS envelope that lead to a massive inflammatory response. "LOS envelopes caught fire Dark Spots on Carpet - Characteristic petechial rash leading to thrombocytopenia leading to DIC

Abscess cavities of lungs filled with purulent exudate from Klebsiella on autopsy. Pattern of necrosis in lung tissue? (fibrinoid, gangreous, caseous, liquefactive)

liquefactive Associated with bacterial abscesses and brain infarcts! Caseous is associated with ischemia and infarcts in most tissue except the brain. Fibrinoid is associated with immune reaction in vessels Gangrenous is associated with distal extremity after chronic ischemia

Cephalosporin resistant organisms

listeria, MRSA, enterococci, atypicals (mycoplasma, chlamydia)

exception of hemoatongenous spread carcinoma?

liver lungs

upper border of 10th rib needle insertion puts patient at risk of what structure?

liver injury

acquired methemoglobinemia results from

local anesthetic, nitrate Fe2--> Fe3 Fe3 unable to bind to oxygen oxygen affinity heme increases result in cyanosis

vitiligo

localized loss of skin pigmentation characterized by milk-white patches

esophagus CT

located between the trachea (air filled) and the vertebral bodies in the superior thorax.

Central pontine myelinolysis CT and buzz word

locked-in syndrome

main source of norepi in brain

locus ceruleus

neurofibrillary tangles

long, wavy filaments that replace normal neurons and are characteristic of Alzheimer's disease +TAU

what is a drug that targets intermittent diarrhea? and mechanism?

loperamide - Accentuation of μ-opioid myenteric plexus receptor Utopia: Opiate agonists (diphenoxylate, loperamide) treat diarrhea 18. MUssage: opioids treat diarrhea by activating mu-opioid receptors in the GI tract 19. Lop-eared rabbit: Loperamide treats diarrhea (mu-opioid agonist that does not cross the BBB no analgesia or potential for addiction)

homonymous hemianopsia causes

loss of PCA on contra lateral side

isoosmotic volume contraction (example/darrow-yannet diagram)

loss of blood diarrhea

Liver lipoprotein synthesis caused by

low oncotic pressue hypoalbuminemia

chronic diarrhea causes why type of uric acid stone?

low pH (DM and metabolic syndrome can also cause low ph)

alpha-2 adrenergic and somatostatin (raise or lower) insulin secretion.

lower

What vascular beds are most susceptible to atherosclerosis?

lower abdominal aorta and coronary arteries

Arteriolar vasodilators (hydralazine minoxidil)

lower blood pressure by reducing systemic vascular resistance but due to sympathetic activation it will increase HR, contractility and CO. It will stimulate renin-angiotensin-aldoserone and result in sodium and fluid retention. Not used as monotherapy but good adjunt

Anterior horn

lower motor neuron, spinothalamic tract v. lateral: pain temp, crude touch

are people exposed to asbestosis more likely to get mesothelioma or lung cancer?

lung cancer

anthracosis

lung disease caused by the inhalation of coal dust

penetrating right sided stab wound along upper surface of clavicle between lateral border of sternum and midclavicular line. what structure is injured?

lung pleura

Brain metastasis

lung>breast>prostate>melanoma

Cryptococcus primary infection is the (???) then the brain

lungs

do carcinoma spread via lymph or blood?

lymph

example of high endothelial venules

lymph nodes

Transduction can be specialized for generalized depending of being (???)

lytic vs. lysogenic

pancreatitis probably due to alcohol. what test would be ordered to distinguish it?

macrocytosis --> MCV

Gonorrhea histology and treatment

macrolide and cephalosporin 3rd gen

Antimicrobial with p450 inhibitor and increased QT?

macrolides

what medications are known that cause prolonged QT

macrolides fluoroquinolone sotalol (class III) antiarrhythmics haloperidol

Ewing sarcoma

malignant bone tumor of mesenchymal stem cells with metasis to lungs uniform small round cell sbyfibrous septae and scant clear cytoplasm

astrocytoma

malignant tumor of astrocytes (glial brain cells) in children and stain GFAP

multiple myeloma

malignant tumor of bone marrow cells which causes m protein peak on SPEP showing highpeak of gamma-globulin region

Gestational choriocarcinoma

malignant tumor that arise from trophoblast and will be seen as vaginal bleeding and significant increase in B-hCG and can spread to lung. Composed of anaplastic cytotrophoblast and syncytotrophoblast without villi.

branched chain ketoacid dehydrogenase deficiency

maple syrup urine disease I LOVE VERMONT (isoleucine, leucine, valine)

protein that form microfibrils by surrounding elastin? dx?

marfans syndrome --> fibrillin

how do brain abscesses spread via what cells?

mastoid air cells

squamous cell carcinoma lung

may produce PTHrP (parathyroid hormone) pink keratin pearls/intercellular bridges

large Arteriovenous conc gradient for gas anesthetic

means alot is taken up by peripheral tissue while not a lot is given to the brain (where its supposed to work) leading to slower onset of action

Kolpik spots appear during the prodromal stage and remain during the first few days of the exanthem stage. They are pathognomonic for (???). The exanthem usually begins on the face, frequently behind the ears, then disseminates to the rest of the body (palms and soles typically spared). (???) complications include bacterial superinfection, viral giant-cell pneumonia and acute encephalitis. SSPE, a late complication (~7 years after infection), is a lethal generalized demyelinating brain inflammation caused by persistent measles virus infection.

measles bacterial superinfection, viral giant-cell pneumonia and acute encephalitis.

Subacute sclerosing panencephalitis

measles infection of the brain (demyelinating); slow progressing, persistent - progressive, debilitating, leading to death; infection in infancy, signs arise years later

Pramipexole

mechanism of action is direct stimulate of dopamine receptor

Misoprostol (prostadlandin analog to help uterine contraction) and mifepristone

mechanism of action is progesterone antagonist... progesterone stimulates secretory endometrium to create environment favorable implantation. Mifepristone binds to progesterone receptor and block to result in apoptosis and necrosis of uterine decidua

branch point of anterior communicating artery lacks (???) layer leading to increase susceptibility of rupture.

media layer

Homunculus-where are legs

medial

femoral neck fracture leading to osteonecrosis is supplied by what artery?

medial circumflex artery (supply most of femoral head and neck

abduction of thumb

median nerve

distal shaft of humerus associated nerve?

median nerve

what is the difference in size of medullary kidney disease vs ARPKD?

medullary kidney is shrunked

RET

medullary thyroid cancer pheochromocytoma

MEN 2B

medullary thyroid cancer, pheochromocytoma, Marfanoid neuromucco- gangliomas

gait instability and ataxia with primitive cells and many mitotic figures?

medulloblastoma

compound melanocytic nevi

melanocytic nevus with collection of melanocytes in both the epidermis and dermis with no inconspicuous nucleoli and no mitotic activity

BRAF

melanoma

BRAF mutation associated with what cancer?

melanoma

Integrins

membrane proteins that maintain the integrity of basolateral membrane by binding to collagen and laminin in basement membrane

"Tram-track" appearance of capillary loops of glomerular basement membranes on light microscopy

membranoproliferative glomerulonephritis

C3 convertase antibody renal?

membranoproliferative glomerulonephritis

lupus and nephrotic syndrome?

membranous nephropathy

Hib can cause what serious side effect?

meningtitis

Microglia origin

mesoderm, like macrophages

reverse transcriptase polymerase chain reaction (RT-PCR) detects levels of (???)

messenger RNA

Aspirin toxicity metabolic changes

metabolic acidosis with respiratory alkalosis "hyperventilation"

What DM medication increases peripheral tissue glucose uptake?

metformin

Defect in methylene tetrahydrofolate reductase lead to decreased enzyme activity which impairs conversion on homocysteine to what?

methionine

leucovorin(N-formyl-tetrahydrofolate) helps decrease toxicity from (methotrexate or 5-FU)

methotrexate

what drug side effects cause painful mouth ulcers and nausea with elevated AST and ALT for rheumatoid arthritis?

methotrexate (mucosa ulceration, alopecia, pancytopenia, hepatotoxicity and pulmonary fibrosis)

• Trimethoprim and (???) target same intracellular targets by preventing reduction of folic acid to tetrahydrofolate

methotrexate (pyrimethamine)

B12 deficiency causes elevated levels of what?

methylmalonic acid and homocyteine

Family visited rural Louisiana 5 months ago and ran around barefoot. Conjunctivae are pale. Labs shows normal wbc with 15% eosinophils. Stool prep shows parasite egg (picture). Cause of fatigue? diagnosis is Ancyclostoma

microcytic anemia American Dude - Ancyclostoma duodenale and Necator americanus 8. Grappling Hook and red boots - Hookworms Found in rural southern US that ended the blood stream when you walk barefoot. 9. Arrow pointing up to lungs then GI tract - The larvae will go straight to the lungs and ascend to bronchiole tree and then get coughed up and mature in the intestine 10. Iron hanging - Can develop severe iron deficiency anemia

benzopyrene-induced lung cancer over reactions what enyzme?

microsomal monooxygenase (CYP 450)

• Trigeminal nerve is at level of (????)

mid pons

what artery supplies wernickes area?

middle cerebral artery

thyroid gland embryological

migration

HbC and HbS result form (???) mutation

missense mutation

If you trade it out then it is (???) or (???) or (???)

missense or nonsense or silent

muscle fibers with blotchy red appearance is indicative of what organelle problem?

mitochondrial myopathies

presentation of CMV in adult

mono-like

characteristic finding of hashimoto thyroiditis?

mononuclear infiltrate with lymphocytes and plasma cells that often have germinal centers

acyclovir mechanism

monophosphorylated by thymidine kinase. Guanosine analog ; inhibits viral DNA polymerase by chain termination

How is Dengue Fever transmitted? and what other oraganism are spread this way?

mosquitos --> malaria, chikungunya

Minimal change disease is (???) common nephrotic syndrome in children.

most

Von Gierke's Disease

most common glycogen storage disease defect in glucose 6 phosphatase leads to periods of very low blood sugar between meals needs continuous feeding to maintain blood sugar levels glucose 6 phosphate builds up in the cell and cannot be broken down into glucose - so the liver enlarges and is damaged over time

Pituitary tumor

most common is prolactinoma which causes lactation and oligomenorrhea due to suppression of GnRH production which show has pituitary lactotrophs while pituitary somatotrophs will presents as acromegaly. Can also have sign like bitemporal hemianopsia

Granulosa cell tumor

most common sex cord stromal tissue, predominantly women in their 50s, often produce estrogen and/ or progesterone and present with abnormal uterine bleeding, sexual precocity, breast tenderness with call exner bodies

Superficial inguinal lymph nodes (palpable from skin)

most cutaneous lymph from umbilicus down including orifice of anal canal

Pilocytic astrocytoma

most likely a pilocytic astrocytoma or a medulloblastoma in a child in the cerebellum (medulloblastomas are located exlcusively here) These two tumors can be differentated on brain imaging. Pilocytic astrocytomas have both cystic and solid features, while medulloblastomas are always solid.

Stroke in internal capsule

mostly motor symptoms

Broca speech area

motor aspect of speech

pharyngeal constrictor muscle

motor fibers of vagus nerve

poliomyelitis

motor neurons in the anterior horn of the spinal cord degenerate due to viral infection

DM ketoacidosis can cause facial pain with black escae due to (???) which histo exam of affected tissue is need for diagnosis. Broad nonseptate hyphae with right-angles. Need debrement and antifungal (???)

mucormycosis amphotericin B

infant with ambiguous genitalia gonadal cells contain Y chromosome and there is no uterus. What substance causes the uterus to be absent?

mullerian inhibitory factor (responsible for regression of paramesonephric ducts that give rise to interal genitalia in female)

Multiple Sclerosis Symptoms

multiple and varied neurologic symptoms with remission and exacerbations. onset is slow. Paresthesias in one extremity, trunk, or face. weakness or clumsiness in hand or leg. visual disturbances, emotional disturbances, vertigo, bladder dysfunction. apathy, memory loss, lack of judgement, inattention.

Perivenular inflammatory cells associated with what disease?

multiple sclerosis

oligoclonal IgG bands in CSF?

multiple sclerosis

Raynauds with exertional dyspnea and lower extremity swelling with normal pulmonary function testing is caused by what disorder?

multiple sclerosis causing thickening of pulmonary arterioles leading to pulmonary arteriole htn. This is due to proliferation of T cells with secretion of cytokines TGF-b which stimulate fibroblast to increase collagen. Normal pulmonary functioning rules our fibrosis

What type of pharmacologic therapy can be used to treat urinary incontinence problems? (beta, alpha, nicotinic, or muscarinic?)

muscarinic antagonism

insulin dependent glucose uptake

muscle cells and adipocytes

malignant hyperthermia leads to widespread muscle (??). which can be treated by (???) which directly inhibits intracellular (???) release from ryanodine receptor

muscle rigidity Dantrolene bye inhibiting intracellular calcium release

Mesoderm= muscles, heart, lymph, kidneys

muscles, heart, lymph, kidneys

what nerves innervates the biceps and what cutaneous innervation does it have?

musculocutaneous nerve innervate lateral forearm

Lynch syndrome (HNPCC)

mutation in mismatch repair genes. FAP: mutation of the tumor suppressor gene APC.

Charcot-Marie-Tooth

mutation in myelin that present with distal muscle weakness and atrophy of calf muscle looking like a stork leg deformity.

Autosomal recessive polycystic kidney disease

mutation in pkdh1 for fibrocystin oligohydramnios and have sxs of potter sequence: flattened facies, limb deformities, pulmonary hypoplasia due to compression of fetus.

Silicosis increases risk of (??micro??)

mycobacteria

+AIDS. epithelioid histiocytes with foamy cytoplasm and numerous acid-fast intracellular organism. thats negative for TB. what is the organism?

mycobacterium aciums

skin anestheisa and hypopigmentation with tingling sensation in hands caused by organism invading schwann cells?

mycobacterium leprae

multiple sclerosis

myelin sheath destruction. disruptions in nerve impulse conduction medial longitudial fasciculus

what is responsible for the green colored sputum in pneumonia?

myeloperoxidase

acute myelogenous leukemia positive for what marker?

myeloperoxidase (MPO) --> auer rods

what muscles innervated by V3

mylohyoid

Altered smell or taste with meningitis sxs

naegleria fowler

MSSA tx

nafcillin/oxacillin

Marfan syndrome

necrosis of aorta result in dissection

what process do lymphocytes who undergo high affinity tineraction with MHC molecules expressed on thymic medullary epithelial?

negative selection

most common meningitis in children/teenagers and how does it spread?

neisseria meningitidis --> nasal --> blood --> brain

monoclonal antibodies that block PD-L1 and PD-1 are effective against cancers that expression high levels of (???)

neoantigen on their surface (because cytotoxic cells can finally detect and remove)

premature infant with bulging fontanelle hypotension seizures and coma. Where is the hemorrhage?

neonatal intraventricular hemorrhage

Focal segmental glomerulosclerosis associated with what type of patient?

nephrotic syndrome; AIDS and IV heroin abuse

Amphotericin B toxicity

nephrotoxicity --> anemia and electrolyte abnormalities (hypokalemia) hypokalemia and hypomagnesemia --> weakness and arrhythmia

spinothalamic tract

nerve pathway from the spine to the thalamus along which pain/temp/touch impulses are carried to the brain

NAVL

nerve, artery, vein, lymph inguinal region

Neurofibromastosis derived from what embryologically?

neural crest

Valproate causes what embyonic defects?

neural tube defect (myelomeningocele)

NF1

neuroblastoma, sarcoma

MYC

neuroblastoma, small cell lung cancer

cysticerci or fluid filled larval cyst in brain with seizures

neurocysticercosis --> taenia solium

schwannomas found at cerebellopontine angle bilaterally and attached to CN VII occur in what disease?

neurofibromatosis (NF) type 2 chromosome 22

What is origin of brain cancer with synaptophysin (transmembrane glycoprotein found in presynaptic vesicles of neuron) positive and GFAP negative?

neurons

RIPE therapy (isoniazid) side effects

neurotoxicity (B6), hepatotoxicity

Corticosteroids on WBC include increased (???) count and decreased (???), (???), (???), and (???) counts. Increased neutrophil result from demarginating on previous attached vessel wall.

neutrophil lymphocyte, monocyte, basophil, and eosinophil

primary cells involved in COPD

neutrophils, macrophages, and CD8+ T lymphocytes with increase elastase seen

• Nonnucleoside reverse transcriptase inhibitors do not require intracellular phosphorylation

nevirapine and efavirenz

Subgaleal hemorrhage occur to what population?

newborn during vacuum assisted delivery -blood -crosses suture lines -boggy scalp, pallor, tachycardia -forward, lateral positioning of ears -risk for jaundice, severe blood loss -neck swelling between periosteum and galea aponeurosis

T4

nipple

in lactase deficiency is there any changes to intestinal mucosa?

no

is enterovirus associated with birds?

no SKETCHY YOU DID ME WRONG, ITS FECAL ORAL

Etomidate vs. propfol (why would you give etomidate)

no cardiovascular depressant effect

IL-12 receptor deficiency, or a defect in the Interferon Gamma receptor

no granuloma formation

does metoprolol cause vascoconstriction?

no its selective (a-->n)

What does Hep C lack which makes its surface membrane susceptible to mutations?

no proofreading 3'-->5'

Does extravasation of red blood cells occur in pulmonary arterial hypertension?

no thats left ventricular hypertrophy

is a petechail/ecchymotic rash seen in toxic shock?

no, its erythroderma or macular rash

Adenoviridae

non-enveloped virus with linear, double-stranded DNA and icosahedral nucleocapsid. Transmitted via contaminated water or fecal-oral route. Causes pharyngitis, conjunctivitis, pneumonia, hemorrhagic cystitis, gastroenteritis, myocarditis, and epidemic keratoconjunctivitis. LIVE NON-ATTENUATED VACCINE THAT CAUSES IGA

Polyomaviridae

non-enveloped, double-stranded, circular DNA viruses that most commonly affect immunosuppressed (HIV and transplant) patients. Common members include JC virus (progressive multifocal leukoencephalopathy) and BK virus (nephropathy and/or hemorrhagic cystitis).

myasthenia gravis patients are extremely sensitive to what type of agents?

nondepolarizing agents (vecuronium)

(???) exacerbate hypoglycemia and mask hypoglycemia symptoms mediated by norepinephrine/epinephrine.

nonselective beta blockers

• Chronic kidney disease (???) anemia due to (???)

normocytic inadequate production of erythropoietin (reduces apoptosis and increase differentiation)

multiple myeloma plasma cells cause what 4 things?

normocytic, normochromic anemia hypercalcemia increased monoclonal immunoglobulin (light chain cast nephropathy) insoluble fibrils leading to amyloid ligh-chain amyloidosis

Where does T4/T3 bind?

nuclear/retinoid x binding to DNA

Zidovudine

nucleoside reverse transcriptase inhibitor blocks viral replication by acting like nucleoside/tide analogues that do not have 3' hydroxyl group resulting in termination due to lack of phosphodiester bond formation.

synthesis location of GABA

nucleus accumbens

notocord becomes

nucleus pulposus

vomiting center

nucleus tractus solitarius in medulla

Multiple Myelomas

numerous plasma cells with perinuclear paleness and clockface chromatin. They will crowd bone marrow and impair hematopoiesis leading to decreased immune cells. This leads to recurrent bacterial infections.

decreased tactile fremitus

obstruction - bronchus, pleural effusion, pneumothorax, emphysema

acute appendicitis is caused by what?

obstruction of appendicular lumen

pineal gland mass

obstructive hydrocephalus and dorsal midbrain syndrome (supranuclear vertical gaze disturbance caused by compression of the superior tectal plate) headache, emesis, intermittent blurry vision, inability to gaze upwards

What does a fat embolism look like histologically

occurs following long bone fx, triad: -respiratory distress -neurologic impairment -petechial rash

Confounding

occurs when exposure-disease relationship is muddled by effect of a confound variable or extraneous factor. Bladder cancer and alcohol use but not including smoking use as a factor. Leads to false associations

CN III

oculomotor n. motor only leaves skull through superior orbital fissure innervates the muscles of the eye

CMV esophagitis

odynophagia or pain with swallowing, dysphagia, and linear shallow ulceration of lower esophagus with intranucular inclusion bodies

What nerve cell is destroyed in multiple sclerosis?

oligodendroglia

False diverticulum

only mucosa and submucosa outpouch (no muscularis externa) (eg zenkers)

tanner stage 3

onset of growth spurt penile length darker, coarser heair breast mount labia majora middle finger=pencil penis

what is the commonality of potassium or chloride?

opening of voltage gated ion channels with a negative equilibrium potential

Trematodes

operculated eggs (rules out nematodes). Schistosoma mansoni/haematobium/japonicum. Periportal fibrosis characteristic of S. mansoni. Bladder inflammation/cancer characteristic of S. haematobium (chronic inflammation by eggs)

what two nerves are responsible for pupillary light reflex?

optic nerve (CN II) -afferent oculomotor nerve (CN III) -efferent

RIPE therapy (ethambutol) side effects

optic neuropathy

Bioavailability of suppository vs. oral. what is different?

oral bio-first pass metabolism by liver while rectal drug allow for partial bypass of first pass metabolism due to portal venous sytem via superior rectal veins but below drain to middle and inferior rectal veins allowing for systemic circulation

rank (Kidney, spleen, myocardium, CNS, Liver) in order of amount of blood

organ susceptibility ranked greatest to least: 1. CNS, 2. Myocardium 3. Kidney 4. Spleen, 5. Liver

Focal seizures

originate from single hemisphere, manifestation of temporal lobe epilepsy that discharges to mesial temporal lobe aka hippocampus, amygdala and Para hippocampal gyrus usually due to hippocampal sclerosis from childhood febrile seizures.

what region is influenced by parathyroid hormone?

ossification front due to effect on osteoclast

osteogenesis imperfecta, impairment of what process?

osteoid production by osteoblasts (type 1 collagen is predominant collagen in osteoid)

What is a drug that blocks binding of RANK to RANKL (receptor activator of nuclear factor kappa B?

osteoprotegerin and cause inhibition of osteoclast formation and survival leading to decreased bone absorption

What is a secondary cancer to RB?

osteosarcoma

true diverticulum

outpouching lined by all layers: mucosa, submucosa, muscularis propria and adventitia meckels diverticulum

Meckel's diverticulum

outpouching of distal ileum that causes bloody stools and abdominal pain

turner syndrome causes infertility by what mechanism?

ovarian failure (in-vitro fertilization)

anti-group A strep antibody can cross react with what?

own tissue and lead to cardiac and CNS complication

Pseudomonas

oxidase positive treated with cefepime (4th gen), gram - rods, most common pneumonia in Cystic Fibrosis patients, osteomyelitis in dm or IV drug user, most common burn pt, ecchymosis gangrenous, otitis externa, ribosylation causing elongation

Abnormal retinal vascularization in neonate (who is given surfactant oxygen and CPAP) (???) damage by (???cytokine)

oxygen damage by VEG-F

Clopidogrel bind (???) receptor

p2y12 ADP receptor

metabolic alkalosis with resp. compensation (ph, HCO3, PaCO2)

pH > 7.45 HCO3 > 26 PaCOs high >40

Hardy-Weinberg equation

p^2 + 2pq + q^2 = 1

Osteosarcoma

pain and soft tissue swelling with spindle-shapeed stromal cells

rheumatoid arthritis what joints are affected? what testing can be done?

pain in small joints or cervical spine and positive for anti-ccp antibodies. Rheumatoid factor is test by antibodies IgM specific for Fc component of IgG

Restriction endonucleases

palindrome aka tacocat

fenistrated capillary

pancreas, GI, kidney

Removal of pancreas- decreased (???) decrease degradation of (???) with okay absorption of (???)(D-xylose)

pancreatic amylase polysaccharides monosaccharides

thyroid cancer with finely dispersed chromatin and large overlapping nuclei giving ground glass appearance

papillary carcinoma

Phrenic nerve injury

paralysis of the diaphragm shoulder probz

MEN 2A

parathryoidhyperplasia, medullary thyroid cancer, pheochromocytoma

Drug that increases serum calium AND urine phosphate exretion

parathyroid hormone analong (teriparatide)

Cancer can release (???) not PTH but very similar so acts the same

parathyroid hormone related protein

MPTP added into illicit drugs leads to what type of neurologic disease?

parkinson

what disease has a large amount of acetylcholine?

parkinson

Adenosine use

paroxysmal supraventricular tachycardia acting by hyperpolarizing the nodal pacemaker and conducting cells to briefly block conduction through the AV node. Most common side effects include flushing, chest burning, hypotension, and high-grad AV block

Caudate putamen and globus pallidus part of (???)

part of EPS

High altitude leads to respiratory (????). what are the blood gas values?

partially compensated respiratory alkalosis hyperventilation increase bicarbonate excretion to decrease serum HCO3 increase pH decreased PaO2 (due to being up high) decreased PaCO2 (breathing too much) decreased HCO3 (delayed metabolic acidosis)

Only single stranded DNA

parvovirus

continuous murmur heard at left infraclavicular region with intensity at S2

patent ductus arteriosus

pathophysiology of indirect inguinal hernia

patent processus vaginalis

conduct disorder

patterns of behavior in which the rights of others or basic social rules are violated

paclitaxel vs. vincristine which Mechanism? -Inhibits microtubule disassembly

paxitaxel (vincristine prevents microtubule polymerization)

• PITcH

pediatric, inflammatory, travelers, coli, hamburger

Cauda Equina syndrome (which nerves)

pelvic splanchnic nerves (s2-4 keep poo off the floor) provide parasympathetic innervation to bowel and bladder and impairment due to syndromes causes constipation and difficulty urinating. Also include lower back pain and leg weakness

Penicillin's and cephalosporin function by irreversibly binding to (???)

penicillin-binding protein CALLED TRANSPEPTIDASES

If strep bovis is isolated in cultures, what must you evaluate the patient?

perform colonoscopy for colon cancer R/O

Adult T cell leukemia/lymphoma

peripheral T cell origin -> HTLV-1(japan/caribbean), CD4+, usually aggressive lytic bone lesion w/ RASH

Bronchietctasis

permanent dilation of bronchi due to airway tone loss CF, kartagener (cilia loss), tumor, necrotizing infection, allergic bronchopulmonary aspergillosis

Contracture Scar

permanent tightening of skin (fibrous tissue not as elastic as connective tissue) due to actin containing fibroblast and increased metalloproteinase activity

atrophic gastritis (autoimmune gastritis) adverse side effects?

pernicious anemia

where does oxidation of very long chain fatty acids occur?

peroxisomes

Purpura vs Petechiae vs Ecchymoses

petechiae- <5mm purpura 5mm-1cm

what is the enzyme that converts norepinephrine to epinephrine due to increased cortisol?

phenylethanolamine-N-methyltransferase (PNMT)

MEN2B conditions?

pheo, thyroid, neuronal tumors (andrenal medulla)

• Glucagon activate kinase while insulin activates (???)

phosphatase

Sevelamer

phosphate binder, nonabsorbable anion-exchange resin that binds to intestinal phosphate to reduce absorption.

Tissue necrosis caused by gram-positive rods. what is the organism and mechanism?

phospholipid splitting caused by C. perfringens --> lecithinase

placenta over cervical os. Dx?

placenta previa

The (???) is not transcribed from DNA instead added as a posttranscriptional modification downstream of consensus sequence. Tail protect mRNA for degradation within cytoplasm

poly-A tail

Bacillus anthracis can come from sheep wool. what is the virulence factors? (2)

polypeptide capsule and exotoxins like bordetella pertussis

S pneumoniae: (???) means resistance of phagocytosis

polysaccharide capsule means resistance of phagocytosis

Haemophilus influenzae virulence factor

polysaccharide capsule with polyribosylribitol phosphate that binds factor H

4-month-old boy PE shows enlarged tongue and generalized hypotonia. Increased lactate, pyruvate, glucose, and uric acid. CXR shows cardiomegaly. Biopsy of skeletal muscle shows increased glycogen. diagnosis and Enzyme impaired?

pompe disease - alpha-1,4-Glucosidase

• Neural crest arises from 3rd and 4th pharyngeal pouch which affect inferior and superior parathyroid and thymus. Which will result in hypocalcemia and T cell deficiency. Sxs

poor feeding, unusual muscle movement, hypoplastic mandible, low ears, bifid uvula, and cleft palate with decreased soft-tissue attenuation in right anterior mediastinum.

Large cell neuroendocrine carcinoma

poor prognosis

acute intermittent porphyria

porphobilinogen deaminase deficiency

mesolimbic is the ONLY ONE WITH INCREASED ACTIVITY causing what symptoms seen in schizophrenia

positive symptoms

hematuria (child) hypertension and periorbital edema

post strep glomerulonephritis

where is primary somatosensory? (pre or post central gyrus?)

postcentral gyrus

pelvic fractures damage what area of urethra

posterior urethra

Anal fissure are usually located

posteriorly below dentate line

Spinal stenosis occurs in lumbar region and presents with (???), (??), and (???) the most common cause is (???) of spine that results in narrowing

posture-dependent lower extremity pain, numbness, and weakness degenerative arthritis

what is the only ion that leaves the cell during delorization?

potassium (NOT CHLORIDE, SODIUM, CALCIUM)

Potassium iodide and radioactive iodine

potassium competitively inhibits the radioactive iodine and is often administered after nuclear accidents to protect the thyroid and decrease risk of thyroid carcinoma

Triamterene (why type of diuretic)

potassium sparing diuretic

Tanner stage 1

pre puberty for both

where is primary motor? (pre or post central gyrus?)

precentral gyrus

congenital hydrocephalus (leads to what if untreated)

presents with macrocephaly and poor feeding. Imaging shows enlarged ventricles. Untreated hydrocephalus leads to spasticity (muscle hypertonicity) due to stretching of periventricular pyramidal tracts, developmental delays, and seizures.

pulmonary artery occlusion pressure

pressure created by fluid volume in left side of the heart, indicator of left atrial pressure, measured via balloon catheter wedged into small pulmonary vessel

law of laplace

pressure is directly proportional to surface tension and inversely proportional to radius of alveolus collapsing pressure=2xsurface tension/radius

Anti-mitochondrial antibodies

primary biliary cirrhosis

Hypertension + hypokalemia (decrease renin, increase aldosterone)

primary hyperaldosteronism: aldosterone-producing tumor (conn's syndrome) bilateral adrenal hyperplasia

BMPR2 mutation causes what disease

primary pulmonary HTN

Cystic fibrosis

problem with sodium chloride channels causing decrease in sodium into cell and chloride out of cell this causes salt and chloride wasting from the sweat which should be supplemented

what is the role of astrocytes? and what do they look like?

produce scar tissue

Type II pneumocytes

produce surfactant and ability to proliferate in response to injury. Act as progenitor cell for type 1 pneumocytes who cannot regenerate on their own

Carbon tetrachloride (CCl4) does what to hepatocytes? (mitochondrial dysfunction or free radical injury)

produces free radical injury and injures hepatocytes. P450 oxidizes it creating CCl3 which is a free radical. lipid peroxidation

What hormone increases most after ovulation?

progesterone

Cancer cells avoid the immune system by overexpressing what ligand?

programmed death-ligand (binds to PD-1 on cytotoxic T cells and inhibits response)

demyelination in the subcortical and periventricular white matter. what organim?

progressive multifocal leukoencephalopathy caused by JC virus

Chronic lymphocytic leukemia proliferation of (???) (???-positive) which inhibit (???) which leads to anemia, thrombocytopenia and infection. Elevated leukocyte count with (????).

proliferation of B-cell (CD20-positive) which inhibit apoptosis which leads to anemia, thrombocytopenia and infection. Elevated leukocyte count with smudge cells.

Gliosis

proliferation of astrocytes in an area of neuron degeneration leading to a glial scar.

Heparin function on coagulation factors

prolonged PT and PTT and decreased activity of Xa

epinephrine + lidocaine-why is epi given

prolongs duration of action of anesthetic agent due to remained at site of injection

Proprionic acidemia defective conversion of propionyl-CoA to methylmalonyl-CoA what is the defective enzyme and what essential amino acid is this caused by?

propionyl CoA carboxylase odd chain fatty acids

Ritonavir

protease inhibitor protein processing

Central obesity+HAART therapy+disordered lipids and insulin

protease inhibitor (-navir)

insulin increases glycogen. activation of what enzyme promotes this affect?

protein phosphatase

Cyclin D1 promotes progression through G1 phase. Cyclin D1 is most likely Select one: a. A tumor suppressor gene b. A proto-oncogene

proto-oncogene

Cryptosporidium parvum

protozoa

paraesophageal hernia

protrusion of the fundus into the chest above the level of T10 (its the rarer form of a hiatal hernia). Vs. sliding hiatal hernia is profusion of the cardia of the stomach through esophagus (hourglass sign on X ray)

umbilical hernia

protrusion of the intestine through a weakness in the abdominal wall around the umbilicus (navel) due to incomplete closure of umbilical ring

upper root lesions

proximal effects

Diphtheria toxin like what organism toxin?

pseudomonas

flexion of thigh by (???) muscle lumbar plexus and iliacus by femoral nerve

psoas and sartorius

difficulty maintaining erection but stated abruptly but still able to have nocturnal erection. what is the cause?

psychogenic sexual dysfunction happen abruptly following severe medical or emotional stress. usually situational with ability to still become erect at night. libido is normal

Horner syndrome (sympathetic chain lesion) where on vertebrae?

ptosis, miosis, anhidrosis

Proliferative vasculopathy

pulmonary arterial hypertension

where in the heart is the pressure changes with a max of 25 mg Hg and minimum of 10 mm Hg?

pulmonary artery

condition that causes engorged pulmonary capillaries with intra alveolar acellular pink material that is more prominent at the bases

pulmonary edema

Emphysema is opposite of (???) in response to compliance or volume vs. pressure graph

pulmonary fibrosis

scleroderma most common cause of death?

pulmonary htn

ASD causes what irreversible changes in the heart?

pulmonary vessels

Asthma and COPD can cause (???) in absence of significant pericardial disease. B-agonist control acute asthma and COPD by causing bronchial smooth muscle relaxation via increased intracellular cAMP.

pulsus paradoxus

Toxoplasmosis treatment

pyrimethamine and sulfadiazine

Enterotoxin ingestion-quick or slow? vomiting or diarrhea?

quick mostly vomiting staph and bacillus

presents with fever, headache, altered mental status, and a variety of other neurologic signs and symptoms including spasms. It can be transmitted by a variety of vectors. If this patient was able to report he was the victim of a bat bite while spelunking, that history would be most supportive of a diagnosis of (???)

rabies encephalitis tx: inactivated vaccine

Fractured Humerus (nerve)

radial nerve

wrist drop

radial nerve

examples of plasmin overactivity? How can you tell difference btw DIC?

radical prostatectomy, cirrhosis of liver d-dimer will be normal LOOKS LIKE DIC BUT NO ELEVATED D-DIMER

Biopsy of mitochondrial myopathy (key word)

ragged red fibers

Beta 2 adrenergic and glucagon-like peptide (raise or lower) insulin secretion.

raise

transposon insertion

random movement of DNA elements

anxiety is most associated with what structure in the brain?

raphe nuclei

Serotonin synthesis

raphe nucleus

Galactosemia

recessive genetic disorder; characterized by body's inability to tolerate galactose decrease galactose and lactose absent glactose-1-phosphate uridylytransferase

endonuclease function

recognize distortion of DNA and excise and stretch single stranded DNA to allow DNA polymerase in to repair it and sealed by DNA ligase

Dermal edema

recognized by dilated lymphatics (not visible in normal skin), widened spaces between blood vessels and perivascular collagen (perivascular edmea) or widened space between dermal collagen fibers (interstitial edema). A common feature of many inflammatory dermatosis, especially allergic dermatitis and urticaria

Rasburicase MOA

recombinant uricase that catalyzes metabolism of uric acid to allantoin converts uric acid into more soluble metabolite

What might happen if you infuse vancomycin too fast?

red man syndrome, non-allergic drug reaction with release of histamine that are non-IgE mediated

what changes in post synaptic muscle cell will be seen in myasthenia gravis?

reduced amplitude of motor end plate potential

Central obesity can cause restrictive lung disease (ERV, FRV, FEV, FVC, Total lung capacity?

reduced expiratory reserve volume and functional residual capacity but forced expiratory volume, forced viral capacity, and total lung capacity are also decreased.

Cilostazol mechanism in relation to CAMP and arteries

reduces platelet activation by inhibiting platelet phosphodiesterase so CAMP doesn't break down. Leading to increasing CAMP which decrease platelet aggregation, and also works as an arterial vasodilator and treats peripheral artery disease

Zanker's Diverticulum-what is the innervation?

regurg undigested food motor fibers from vagus nerve

how does the nf-kb signal transduction pathway from IL-1 binding to IL-6 induction?

release NF-kB after under going phosphorylation

Phentermine mechanism of action

release of norepinephrine

Hepsidin

released by the liver in response to inflammation. binds and inhibits iron channels on surface of enterocytes to reduce iron absorption (anemia of chronic disease)

Splicing is performed by spliceosomes which (????). Mutation may result in inappropriate removal of exon and retention of intron

remove introns containing GU at the 5' splice site and AG at the 3' splice site.

VHL

renal cell carcinoma (Pheo, hemangioblastoma)

Chronic graft rejections will show progressive gradual decline in (???). Histo shows obliterative vascular wall thickening with (???) atrophy and interstitial (???).

renal function tubular atrophy and interstitial fibrosis.

Leptospirosis is a zoonotic infection caused by Leptospira. Transmission through water contaminated with urine. Will have self-limited, flulike sxs that may develop into (???) failure

renal or hepatic

What is a potential nephrogenic problem that can arise from having sickle cell trait?

renal papillary necrosis

EPO produced by

renal peritubular interstital cells

Opiods have 2 major metabolites and ??? eliminated

renally --> if kidneys are messed up then will lead to build up of metabolites

Action of telomerase

replace lost chromosomal ends of telomeres (cancer cells use this) that prevents chromosomal shortening

what ratio is increased in COPD?

residual volume/total lung capacity ratio

diabetic ketoacidosis (acid base graph)

respiratory acidosis

Pacinian corpuscles

respond to changes in deep pressure and vibration (fires when pressure is first administered and when it is removed)

human placental lactogen

responsible for mild glucose intolerance in pregnancy

Wernicke encephalopathy

results in foci and necrosis of mammillary bodies due to B1(thiamine deficiency). B1is used by pyruvate dehydrogenase (convert pyruvate into acetyl-CoA, alpha-ketoglutarate dehydrogenase (citric acid cycle), branched-chain dehydrogenase (catabolism of branched-chain amino acid), and transketolase (use in pentose phosphate pathway for conversion of ribulose 5-p to glycolysis intermediate)

Therapeutic supplemental O2 can result in

retinopathy of prematurity intraventricular hemorrhage bronchopulmonary dysplasia (RIB)

arterial puncture above inguinal ligament increases risk of (???) hemorrhage

retroperitoneal hemorrhage

RNA-dependent DNA polymerase (reverse transcriptase)

retrovirus or Hep B virus

Telomerase

reverse transcriptase taht lengthens telomeres by adding TTAGGG at the 3' end. stem cells (ex: epidermal basal cells) have long telomeres due to high activity and proliferate indefinitely

Nucleolus is primary site for (???) synthesis and (???).

ribosome synthesis and assembly.

age 6-12

ride bicycle law of conservation achieved

where in the heart is the pressure changes with a max of 6 mg Hg and minimum of 1 mm Hg?

right atrium

What nerve runs in area of ablation to praoxysmal supraventricular tachycardia?

right phrenic nerve

which side of lung is it easier to aspirate to?

right side

IV drug user with staph infection common side effect with heart

right sided endocarditis

where in the heart is the pressure changes with a max of 25 mg Hg and minimum of 2 mm Hg?

right ventricle

elevated right atrial pressure with decreased pulmonary capillary pressure is seen in what condition?

right ventricular infarction

how to determine severity of tetralogy of fallot?

right ventricular outflow tract obstruction (cause shunting)

Toxoplasmosis

ring enhancing lesion on CT of head with HIV patient prophylaxis with TMP-SMX

Sporothrix

risk factor = trauma to skin (eg, a thorn from rose). Dimorphic, cigar-shaped yeast. Ascending lymphangitis tx: itraconazole, amphotericin B if severe.

Age 5

romantic feelings for others sphinter control

congenital cataracts. ddx?

rubella

Neisseria gonorrhea

ruptured ectopic pregnancy is possible after infection. Ruptured ectopic pregnancy can cause Abd pain, vaginal bleeding, and hemodynamic instability. PID is most common cause by gonorrhea and chlamydia.

Diagnose trichomonas

saline microscopy

inflammation of peyer's patch. organism?

salmonella

Salmon swim upstream

salmonella highly motile

asteroid bodies + non-caseating granuloma

sarcoidosis

what regulated Ca2+ in skeletal muscle?

sarcoplasmic reticulum

22 yr old female with dyspnea fever 15 lb weight loss and syncopal episodes found to have diastolic rumble with large mass in left atrium. what will histology show?

scattered cells within a mucopolysaccharide stroma (atrial myxoma) mid-diastolic murmur

What cell is destroyed in guillain-barre syndrome?

schwann cells

Dengue hemorrhagic fever is more frequent in individuals who experience repeat infection with a (????)

second serotype (especially serotype 2).

Hypertension + hypokalemia (increase renin, increase aldosterone)

secondary hyperaldosteronism: renovascular hypertension malignant hypertension renin-secreting tumor (reninomas) diuretic use

CN III (oculomotor nerve palsy) what aneurysm and sxs

secondary to aneurysm of posterior communicating artery. Sxs include mydriasis, ptosis, and down and out deviation

Carcinoid tumor of the lung

secretes serotonin, can cause carcinoid syndrome (flushing, diarrhea, wheezing, salivation) chromogranin positive polyp like mass

A2y2

seen in fetal which has high affinity for oxygen... a2b2: seen in adult a-thalassemia: y4 or intermedia b4

Meissner's corpuscles

sensitive to changes in touch receptors in the dermis

CN V

sensory and motor V1,V2,V3 touch pain temp to face and mastication

Merkel's discs

sensory receptors that convert information about light to moderate pressure on the skin slowest and respond to sustained not changes example:

wound dehiscence

separation of the layers of a surgical wound previously closed; may be partial, or superficial only, or complete, with disruption of all layers

distributive shock (pcwp, CO, SVR and treatment)

sepsis/anaphylaxis/CNS decrease PCWP(wedge pressure) up or down CO DECREASED SVR (resistance) treat with IV fluids, epi, pressure, abx

low systemic vascular resistance is due to peripheral vasodilation which occurs in?

septic shock (distributive shock)

TNF-a is a proinflammatory cytokine that induces insulin resistance through the activation of (???)

serine kinases

Scaled skin syndrome

serine protease-break desmosomes by alpha toxin in staph

Impaired tetrahydropiopterin synthesis leads to deficiency in what neurotransmitters?

serotonin (phenylketonuria) tx: low phenylalanine diet and BH4 supplementation

what diarrheal disease needs only a few organism to cause disease? a. E. coli b. shigella c. salmonella d. vibrio cholerae

shigella (others: campylobacter, e. histolytica, and giardia)

V/Q=0

shunt (oirway obstruction)

multiple chest infection of african american child with bone pain and dyspnea. What is the condition?

sickle cell disease

BPH can lead to bladder outlet obstruction which can cause what changes to kidney?

significant pressure-induced parenchymal atrophy and CKD

Sandblaster who comes in for difficulty breathing and cough. Fibrotic nodule seen in the upper lobe.

silicosis (impairs phagolysosomes formation by macrophages)

poliomyelitis

single stranded RNA virus destruction of anterior horn LMN lesion flaccid paralysis

Vitamin D synthesis

skin first step; liver and kidneys complete process

lumbar puncture (LP) layers

skin, ligament, epidural space, dura, arachnoid, STOP (NO PIA)

N2 sleep

sleep spindles

ischemic myocardium may release growth factors to stimulate formation and maturation of collateral vessels. (??) development of stable plaque allowed for for collateral vessels to arise.

slow

What effects would verapamil administration have on pacemaker cells?

slowed spontaneous depolarization

first pharyngeal arch syndrome

small jaw, cleft palate, glossoptosis (posterior placement of tongue) due to failed migration of neural crest cells

exogenous smile

smile present at birth

risk factor for pancreatic adenocarcinoma

smoking, chronic pancreatitis, MEN syndromes

What cells directly responsible for synthesizing fibrous cap of atheroma?

smooth muscle cells

Pufferfish poisoning is caused by tetrodotoxin and neurotoxin that acts on (???) channels preventing (???) and (hyperpolarization/depolarization)

sodium channels sodium influx depolarization

posterior cricoarytenoid muscle

sole abductor of the vocal folds (close vocal cord)

What is the treatment for VIP secreting tumor?

somatostain

basal plate regulated by:

sonic hedgehog gene

is tetanus spastic or paralytic

spastic

• Lesch-Nyhan syndrome (HGPRT deficiency)

spastic cerebral palsy self-mutilation hyperuricemia and early death. Not able to convert hypoxanthine or guanine to GMP and converts to xanthine instead causing increase uric acid

How do you separate intron from exon?

spicing

Increased alpha-fetoprotein in amniotic fluid/maternal serum indicative of what?

spina bifida

Friedreich ataxia mechanism and common cause of death?

spinocerebellar degeneration predominantly spinal ataxia. With most common death being due to hypertrophic cardiomyopathy

The 9th, 10th and 11th rib protect most of the

spleen

Sickles cell is characterized by repeated splenic infarction that ultimately result in (???) which predispose to (???) bacterial organism. Cells sticking.

splenic atrophy and fibrosis encapsulated

Watershed areas of the colon

splenic flexure and rectosigmoid junction seen as necrosis in hypotension

laceration of what structure causes hiccups and left shoulder pain?

splenic rupture (phrenic nerve c3-5)

what type of bacteria can survive at 212F or 100C?

spore formers (clostridium and bacillus)

haematobium associated with what type cancer?

squamous cell carcinoma

why type of esophageal cancer is common in alcoholics?

squamous cell carcinoma of esphagus

Parvovirus

ssdNA, nonenveloped, linear, smallest DNA virus B19 virus = -- aplastic crises in sickle cell disease -- "slapped cheek" rash in children = erythema infantosum (fifth disease) -- RBC destruction in fetus leads to hydrops fetalis and death -- Pure RBC aplasia -- rheumatoid arthritis-like symptoms in adults

Age 2

stack 6 cubes walking 2 work sentences scribbling 200 words

Age 3

stack 9 cubes tricycle alternation feet going up stairs fixed gender identity draw a circle

3-year-old boy with progressive fever and skin lesions during 24 hours. T 102.9 F, pulse 120, RR 20, bp 110/60. PE shows large, flaccid, bullous lesions over trunk and abdomen. Another finding in pt?

staph --> can be found in nares

what is the virulence mechanism behind coag-negative staphylococcus?

staph epidermidis, synthesis of extracellular polysaccharide matrix leading to biofilm

Secondary pneumonia due to flu

staph, strep pneumonia, and HIB

Severe myopathy is a side effect of what drug specific to cholesterol (2)?

statin gemfibrozil (impair clearance of statin) Pic:"Elevated statin-punk eating crispy chicken: Fibrates combines with statins increases risk of myopathy"

What does cyclophosphamide cause renally?

sterile hemorrhagic cystitis

airway plugging + cellular infiltration in an asthmatic. what is the drug of choice?

steriod. fluticasone

Distal clavicle fx pulled superior medially by what muscle?

sternocleidomastoid and trapezius muscles

what artery supplies broca area?

still middle cerebral artery

sickle cell patients are more susceptible to what 3 organisms?

strep pneumo neisseria meningitidis haemophilus influenzae

Bleed on the bottom of the brain- immediate diagnosis and what vessels

subarachnoid hemorrhage from barry aneurysm (branch point of anterior communicating artery)

coarctation of the aorta collateral circulation

subclavian --> internal thoracic --> anterior intercostal --> post. intercostal --> descending thoracic aorta

rupture of cortical bridging veins

subdural hematoma

Angiogenesis factors(2) in neoplastic and granulation tissue are?

substances that stimulate the growth of new blood vessels. One of the best known is vascular endothelial growth factor(VEGF); others include those derived from fibroblasts (fibroblast growth factor FGF) and platelets. vegf and FGF

In Parkinson's disease, what area of the basal ganglia has a decreased amount of dopamine?

substantia nigra

Mesna

sulfhydryl compound that binds to toxic metabolites including acrolein in urine to help with urinary excretion of chemo drugs.

antidiabetic agent that elevates C-peptide?

sulfonylurea(glyburide) or meglitinides

Sandpaper rash with scarlet tongue

superantigen

Lateral compartment of leg innervation

superficial peroneal nerve

oculomotor nerve arise between what two arteries?

superior cerebellar artery and posterior cerebral artery

Abduction of thigh supplied by gluteus (???) nerve that exit through (???)

superior gluteal nerve that exit through sciatic foramen

arches and associated cranial nerves: pharyngeal/aortic arch 4?

superior laryngeal nerve and true aortic arch/subclavian arteries

3rd part of duodenum is closely associated with what artery?

superior mesenteric artery

Innervation of Trochlear (CN IV)

superior oblique

CN V1 travels through

superior orbital fissure

Innervation of oculomotor (CN III)

superior rectus, medial rectus, inferior rectus, inferior oblique, levator superioris

extension of thigh supplied by gluteus- (???)nerve...

supplied by interior gluteal nerve

deficiency in insulin leads to deficiency in insulin ability to suppress what?

suppress glucagon release

Cicardian rhythm driven by ??

suprachiasmatic nucleus

rotator cuff muscles

supraspinatus, infraspinatus, teres minor, subscapularis

(???) is stored and transported to surface by lamellar bodies of type II pneumocytes

surfactant (decrease surfactant cause increase alveolar tendency to collapse)

Fever, nasal discharge, sore throat, non-productive cough

susceptible to disinfect and due to lipid bilayer envelope (influenza) due to abrupt onset and systemic manifestation. Alcohol based disinfections work by dissolving lipid bilayer of enveloped virus... non enveloped like adenovirus, rhinovirus, enterovirus, and polio are less susceptible.

what metastasis site is common for breast cancer WITH SKIN DIMPLING

suspensory ligament

Polymyositis causes (symmetric/asymmetric) (distal/proximal) muscle weakness due to infiltrates with (???) T lymphocytes and myocyte damage.

symmetric proximal CD8+

Ketamine uses for intubation?

sympathomimetic --> bronchodilation while preserving respiratory drive

Rash that covers hands and feet

syphilis

loss of pain & temperature sensation in bilateral UE, sparing of position & fine touch? (location in spinal tract)

syringomyelia (lateral spinothalamic tract)

A chronic, progressive, systemic autoimmune disease of the skin that is characterized by hardening and shrinking of the skin is

systemic scleroderma

Henoch-Schoenlein Purpura (HSP)

systemic vasculitis cause by circulating IgA antigen immune complexes within walls of small vessels and renal mesangial. Manifestation include palpable lower extremity purpura and abdominal pain arthralgia and hematuria

Acute Promyelocytic Leukemia stain positive for what enzyme?

t(15,17) balanced translocation, associated with DIC, responds to retinoic acid therapy Auer Rods myeloperoxidase

Acute Promyelocytic Leukemia

t(15;17) translocation -> defect in retinoic acid -> Rx = vitamin A -> increase maturation. increased risk of DIC

Relative risk is??

taking (risk equation)/ (normal level of carotene/total normal carotene/did not develop Alzheimer's)

Neurodegeneration and cherry-red macular spot with no hepatosplenomegaly?

tay-sachs

example of drug that decreases bacterial inactivation of piperacillin

tazobactam (beta-lactamase inhibitor)

Patients who are intoxicated (have or lack) of medical decision capacity

temporary lack of medical decision capacity

surgical landmark for appendicitis

teniae coli (3 longitudinal bands of muscle around colon, converge @ appendix)

Head and neck squamous cell carcinoma (HNSCC) pathological findings-histology

term used for cancers of the oral cavity, pharynx, and larynx -eosinophilic cytoplasm with intercellular bridges and keratin pearls(irregular foci of keratinization)

Para-aortic or retroperitoneal lymph (major drainage)

testes

Iron supplement can interact with (???) drugs and have drug-drug interaction causing decreased absorption. Iron calcium aluminum and magnesium

tetracycline

Antibiotics given for tick borne (???) (don't give to ??? due to ???)

tetracycline children due to enamel probz

(???) toxin block block Na+ channels leading to inhibition

tetrodotoxin from puffer fish

positive punishment

the administration of a stimulus to decrease the probability of a behavior's recurring

Spondylolysis

the breaking down of the vertebral structure

meiotic nondisjunction ex:

the event in which chromosomes do not segregate equally during meiosis down syndrome

jugular venous pressure tracing

the first peak - the a wave, is generated by atrial contraction. This is absent in patients with a-fib.

medial geniculate nucleus

the part of the thalamus that relays auditory signals to the temporal cortex and receives input from the auditory cortex (medial=music)

Reid index (lung thickness)

the ratio of the thickness of the mucous gland layer in the bronchial wall submucosa to the thickness of teh bronchial wall BETWEEN THE RESPIRATORY EPITHELIUM AND BRONCHIAL CARTILAGE. progressive mucous gland enlargment is the major contributer to this thickness increase in bronchitis.

negative punishment

the removal of a stimulus to decrease the probability of a behavior's recurring

precentral gyrus

the strip of frontal cortex, just in front of the central sulcus, that is crucial for motor control

Beriberi

the thiamin-deficiency disease; characterized by loss of sensation in the hands and feet, muscular weakness, advancing paralysis, and abnormal heart action

• Glut 2

the two most important organs for glucose transport. Liver and pancreas

Kallmann syndrome

there is an absecne of GnRH secretory neurons in the hypothalamus due to defective migration of olfactory neurons. The patients have central hypogonadism, delayed puberty, and DO NOT HAVE THE ABILITY TO SMELL.

Pink, PAS-positive globules in hepatocytes

these are the accumulation of A1AT in the ER of hepatocytes (alpha-1-antitrypsin mutated protein)

Metolazone what kind of diuretic?

thiazide diuretic

what drug is used to help treat diabetes insipidus along with water supplementation?

thiazide diuretic

what part of renal loop do loop diuretic act on (thin descending limb or thick ascending limb)

thick ascending limb

Crohn disease characteristic finding on biopsy?

thickening of muscularis mucosae --> can result in bowel obstruction

what drug would you give for someone coming in complaining of medial hypertrophy, intimal fibrosis, and decreased intraluminal diameter of lungs?

this is pulmonary hypertension and treatment is bosentan

C6 dermatome

thumb (thumbs up looks like a 6)

antibodies against thyroid peroxidase involve what process?

thyroglobulin iodination --> hashimotos(hypothyroid)

Deep posterior compartment

tibial nerve

inspiratory capacity (??+???)

tidal volume + inspiratory reserve volume

vital capacity

tidal volume + inspiratory reserve volume + expiratory reserve volume does not include residual volume

what helps cause the blood brain barrier?

tight junctions

Arsenic poisoning

toxicity can result from exposure to pesticides/insecticides (so can Ach overexposure so keep that in mind too). Presents with abdominal pain, vomiting, diarrhea, hypotension (from volume loss), and a garlic breath odor. Tx: Dimercaprol (pharm)

increased head circumference with chorioretinal lesion in both eyes with enlarged ventricles and scattered intracranial calcification is caused by what disease?

toxoplasmosis

what is the treatment for acute myelocytic leukemia?

trans retinoic acid

valproic acid affects histone deacetylase. This drug is most likely to affect which procress of dna/rna processes in patient?

transcription

GnRH analogue MOA (leuprolide)

transient increase, then decrease in both testosterone and DHT (finasteride = discordant decrease in DHT)

Löffler syndrome (aka Pulmonary eosinophilia, Loeffler syndrome)

transient respiratory disorder characterized by accumulation of eosinophils in the lungs due to an allergic reaction to a drug or certain infections (usually parasites). Symptoms are usually mild and resolve spontaneously.

Human multidrug resistance gene (MDR1) expressed by many tumors causes what type of pump to be activated?

transmembrane ATP-dependent efflux pump protein that actively removes chemotherapeutic agent particular hydrophobic agents

Transport of glucose into cells of most tissue occurs by means of facilitated diffusion. Glucose moves from areas of high concentration to low concentration with help of(???). Stereoselective and like D-glucose

transmembrane glucose transport (GLUT)

pressure changes are typically (exudate or transudate)

transudate

impaired abduction of arm above 100 degrees is caused by?

trapezius injury

Mitral valve replacement 1 month ago with gram positive cocci cluster that are catalase positive and coag-negative (bug and treatment)

treatment is vancomycin staph epidermis and most are penicillin resistant

Gout

treatment with NSAID or colchicine with renal failure PUD or contraindication patients. Which causes impaired leukocyte migration by disrupting microtubule formation in GI mucosa and develop diarrhea, nausea, and vomiting.

Crossover study

treatments are switched to serve as own controls

what is the location of IM injection if patient is currently have left hip drop every time he raises his left foot?

trendelenburg sign superomedial quadrant

Holosystolic murmur that increase in intensity on inspiration most likely represent (????). Other murmur is (???) that do not increase in intensity with inspiration

tricuspid regurgitation mitral regurgitation or VSD

infective endocarditis in IV drug users normally attacks where?

tricuspid regurgitation (right side)

VZV rash on face can affect (???) nerve leading to(???)distribution including forehead side of nose and periorbital but periorbital area can lead to blindness due to acute keratitis.

trigeminal ganglia V1 distribution

arches and associated cranial nerves: pharyngeal/aortic arch 1?

trigeminal nerve and maxillary artery

episodic facial pain with sudden onset with severe electric shock like pain that lasts for seconds. Touching face can trigger episode. Dx?

trigeminal neuralgia

Where does calcium bind after being released from sarcoplasmic reticulum?

troponin

HPV can attach in (throat cancer derivitive) too because its stratified squamous epithelium

true vocal cords

Pancreatic enzymes are activated by trypsinogen conversion to trypsin. (???) and (???) itself are a trypsin inhibitor. Hereditary pancreatitis is a mutation in SPINK-1 gene

trypsinogen conversion to trypsin Serine peptidase inhibitor Kazal-type 1 and trypsin itself

Anaphylactic reaction mechanism and what can be used as a marker for mast cell activation

tryptase is specific mast cell and can be used as marker for mast cell activation. It can be mediated by antigen-specific IgE antibodies attached to high-affinity receptors and triggered by receptor aggregation

serum ferritin in males and females would use what type of testing? a. analysis of variance b. chi-square test c. two-sample t-test d. correlation analysis

two-sample t-test

scar tissue is associated with what collagen?

type 1

scar tissue related to what type of collagen?

type 1

RF

type II, AG: type III hypersensitivity

Poison ivy dermatitis

type IV delay type hypersensitivity caused by T-cells

zinc finger make what?

type of transcription factor in which a stretch of amino acids surrounds a zinc molecule steroid (estrogen, aldosterone, crotisol), thyroid hormone and fat soluble vitamin receptors

Phenylketonuria what amino acid becomes essential?

tyrosine

GFR relation to serum creatinine

uncorrected serum creatine is secreted by proximal tubules so it overestimates the GFR by 10-20%

COPD exacerbation caused by infection with (???) respiratory pathogen. most common bacterial is (???) and virus is (???)

upper haemophilus influenzae rhinovirus

amyotrophic lateral sclerosis

upper and lower motor neuron signs NO LOSS OF PAIN OR TEMPERATURE

strok of MCA will affect what part of the body?

upper limb and face

Impaired transport of ornithine from matrix to mitochondria.... Improved with restriction of protein due to receiving amino acids but not in excessive so no excess ammonia is produced. Ornithine is necessary for proper function of (??) cycle which disposed waste (??) generated by catabolism of (??)

urea nitrogen amino acids and increase ammonia.

elevated arginine

urea cycle

Fetal unilateral hydronephrosis caused by obstruction most likely is caused by?

ureteropelvic junction

Sudden, overwhelming urge to urinate

urge incontinence due to detrusor hyperactivity

Systemic lupus testing?

use anti-dsDNA or ab against double stranded DNA

Cimetidine

used for acid reduction

Neprilysin inhibitor MOA

used in chronic heart failure and increase ANP and BNP by cardiomyoctes to allow for increased GFR, diuresis, decreased aldosterone, vasodilation, and increased capillary permeability

budesonide mechanism of action

used in ulcerative colitis as a glucocorticoid by inhibiting proinflammatory transcription of NF-kB

Gower sign

using hand to get up can be seen in Duchenne muscular dystrophy caused by deletion in dystrophin on X chromosome. Dystrophin in structural component of skeletal muscle fibers that stabilize sarcolemma by linking acting cytoskeleton to transmembrane protein aka dysophiglycans.

what is the best way to decrease amount of neonatal tetanus?

vaccination of mother allowing for transplacental IgG

what are the odd chain fatty acids?

valine isoleucine methionine threonine

preferred anticonvulsant for absence seizure

valproic acid (ethosuxamide)

D-ala-D-ala

vanco binds this domain in peptidoglycan and inhibits cells wall synthesis penicillins are structurally similar

MRSA tx

vancomycin or metronidazole

thromboangiitis obliterans-what do hands and feet look like?

vascular inflammatory disease that usually affects the lower extremities; also called Buerger's disease

absence of large segment of jejunum and ileum with distal ileum winding around thin vascular stalk. what is responsible?

vascular occlusion

Ibuprofen is a cox inhibitor which is a would cause inhibition of (???) of afferent arteriole

vasodilation

hypercoaguable state (OCP use or pregger) + increased intracranial pressure: dx?

venous sinus thrombosis

Paradoxical brain emboli (PBE) most common caused by what septal defect

venous to arterial emboli -ASD

pulmonary embolism cause hypoxemia due to?

ventilation/perfusion mismatch

Hanta/sin nombre

ventilator because rapid congestive heart failure pulm+cardio sxs

Synthesis of Dopamine brain area

ventral tegmentum substantia nigra

Dopamine location of synthesis

ventral tegmentum and SNc

(????) should be suspected with back pain +fever following a bacteremia

vertebral osteomyelitis

Charcot-Bouchard aneurysms

very small brain aneurysms from longstanding htn typically in BG, internal capsule, white matter...can rupture intracerebrally

Multiple UTI especially after sex could me anatomical problem, such as (???) to develop acute pyelonephritis

vesicoureteral reflux

Dorsal column

vibration proprioception and light touch

wounded right leg in water accident and shows with hemorrhagic bullae to food with elevated lactic acid. curved gram-neg. rod?

vibrio vulnificus

Rotavirus mechanism

villous blunting of duodenum and jejunum

drugs that block MT depolarization at low concentrations and polymerization at high concentration

vinblastine or vincristine

return from mexico with anorexia, nausea, and dark color urine +right upper abdominal pain, what is the organism and what will be seen on liver biopsy?

viral hepatitis via Hep A virus hepatocyte swelling

superior colliculus

vision

total lung capacity

vital capacity + residual volume

ataxia vitamin deficiency?

vitamin B1 (STOP FORGETTING THIS) vitamin B12

g-aminolevulinate dehydratase deficiency can be caused by what vitamin deficiency?

vitamin B6

what vitamin is deficient in exclusively breast fed infants?

vitamin D and K

Sarcoidosis can activate 1-alpha hydroxylase to increase what?

vitamin D to active form and make hypercalcemia

gut microbiome increases what vitamins production? (may happen after gastrectomy)

vitamin K and folate

what medication blocks glutamate residue coboxylation?

warfarin

Atrial arrhythmia+coag problem=treat with ???

warfarin (weak acid)

Rapid Progressive Glomerulonephritis + nasal symptoms (goodpasture symptoms or wegener). would (c-anca or p-anca) be positive

wegener c-anca

Side effect of pioglitazone

weight gain and edema (sodium reabsorption) do not give to people with congestive heart failure

Cachexia is mediated by

weight loss, muscle atrophy, fatigue in chronic disease (cancer, AIDS, heart failure, COPD) - Mediated by TNF-alpha, IFN-gamma, IL-1, and IL-6 "cytokine release"

observer bias

when observations may be skewed to align with observer expectations ex: using pathologics with prior knowledge of study or participants

Directive Counseling useful in what situation?

when only one option is avaliable

Neurofibromatosis type 1

which cause neurofibroma and café-au-lait and lisch nodules and are autosomal dominant

6-mercaptopurine is inactivated by what enzyme

xanthine oxidase

do eukaryotes have multiple origins of replication?

yes (not prokaryotes)

GLUT 4 transporter

you have 4 extremities to help use skeletal muscle

what anchors actin filaments?

z disc

Social smile present @

~4 months

Basic HIV infection/initial replication

• HIV enters the body, then attaches to the CD4 receptor on target cells with its gp120 glycoprotein. Viral envelope fuses with host cell, capsid enters the cell. For fusion, CD4 receptor and a co-receptor (CCR5 in macrophages, and CCR5 or CXCR4 in T-cells) must be present. Patients without CCR5 receptors appear to be resistant to HIV. Patients w/mutations have either homozygous (substantial resistance) or heterozygous CCR5 mutations (slower course).

Prerenal azotemia

↑ BUN and creatinine; ↓ renal blood flow (e.g. heart failure, hypovolemia)

EBV = HHV-4. Seroprevalence, what receptor to infect cells

≥ 65% in children. Oncogenic potential: can immortalize and transform host B cells. Uses CD21 receptor to cause infection in B cells.

Insulin Independent Glucose Uptake

"BRICK-L" = Insulin Independent -Brain, RBCs (Glut 1) -Intestine (Glut 2) -Cornea -Kidney (Glut 2) -Liver (Glut 2)

Protease inhibitors (name/MOA/toxicity)

"Navir tease a protease" MOA: stops cleavage of HIV polypeptide into functional parts, thus preventing maturation of new viruses Clinical use: HIV Toxicity: hyperglycemia, GI intolerance, lipodystrophy (buffalo hump); nephropathy, hematuria (indinavir) -Ritonavir inhibits P450 enzymes

Rat Poison TX

"Superwarfarin" Tx: fresh frozen plasma for it's clotting factors

subarachnoid hemorrhage

"Worst headache of my life"

medical student talks to you in crowded elevator about patient. Wants to know CT scan results. how do you respond?

"lets wait until morning rounds to discuss all the patients" dont give out any info even "I have the results"

long thoracic nerve injury

"winging of the scapula" general weakness of serratus anterior muscle serratus anterior sit on top

• Glut 1 and Glut 3

#1 organ in body is brain, RBC has 3 letters

Consequences of renal failure

(1) Na+/H20 retention - CHF, pulm edema, HTN (2) hyperkalemia, metabolic acidosis (3) uremia (4) anemia (5) renal osteodystrophy (6) dyslipidemia (7) growth retardation and developmental delay in children

(??) in normally produced by liver in response to growth hormone by somatotropic cells in hypothalamus

(IGF-1 )

Cushing's disease

(Remember: *UP, UP, UP, DOWN, UP*) - HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia

Buy AT 30, CCEL at 50

(aminoglycosides, tetracycline) (chloramphenicol, clindamycin, erythromycin (macrolide), linezolid)

subdural hemmorhage

(hemato-mas) occurs less often today because of improved obstetric techniques. Typically, tears of the major veins or venous sinuses overlying the cerebral hemispheres or cerebellum (most common in newborns of primaparas and large new-borns, or after an instrumented birth) are the cause. Increased pressure on the blood vessels inside the skull leads to tears. Subdural hemorrhage can be asymptomatic, or the neonate can exhibit seizures, enlarging head size, decreased level of con-sciousness, or abnormal findings on a neurologic examination, with hypotonia, a poor Moro reflex, or extensive retinal hemorrhages. Subdural hematoma requires aspiration; can be lifethreatening if it is in an inaccessible location and cannot be aspirated.

where would HPV of the throat metastasis first?

(jugular) lymph nodes

NAVL

(lateral to medial) nerve, artery, vein, lymph

small cell carcinoma

(~20% of cases) contains lymphocyte-like cells may produce ADH or ACTH

DHFR (dihydrofolate reductase)

* Enzyme which converts Folic acid to Tetrahydrofolate * Competitively inhibited by non-reducible methotrexate so that folic acid can't be converted, and bases aren't synthesized: anti-cancer mechanism.

Antiphospholipid syndrome

* Symptoms: *Hypercoagulable state associated with SLE.* Lab Values: *Elevated PTT that isn't corrected with 1:1 mixing with fresh frozen plasma. False positive VLDR (anticardiolipin). can lead to recurrent miscarriages

Acute Hypoparathyroidism

*Positive Chvostek and Trousseau Signs (indicates potential tetany) *Numbness and tingling of fingers decreased calcium reabsorption decreased calcium release from bone

mesothelioma histology

*pleural thickening* is the most important by far. *electrom microscopy* shows cells with numerous, long, slender microvilli and abundant tonofilaments.!!!!!!!! spindle cells positive for cytokeratin

mesocortical pathway + or - sxs of schizo

-

monoclonal spike of IgG kappa. A chest x-ray shows cardiomegaly with bilateral pleural and pericardial effusions. An x-ray of the spine shows a lytic lesion. Echocardiography shows an echodense thickened left ventricle and poor diastolic compliance. A photomicrograph of a specimen obtained on myocardial biopsy is shown. Which of the following is the most likely cause of the cardiac findings in this patient?

- Amyloid infiltration

severe chest pain, shortness of breath, stridor, hoarseness, difficulty swallowing and nonproductive cough. Long-standing hx of hypertension. Smokes 2 packs of cigarettes for 45 years. T 99 F, pulse 80, rr 15, bp 160/94. PE shows visible pulsation above the manubrium of the sternum and displacement of the trachea to the right. Murmur second right intercostal space. Dx?

- Aortic aneurysm

The precursor protein that produces HMG-CoA reductase is most likely initially produced in which of the following area on this labeled diagram of a hepatocyte?

- F, Rough Endoplasmic Reticulum (ER)

Repression (defense mechanism)

- Involuntary blocking of unpleasant feelings and experiences from ones awareness. EX: An accident victim can remember nothing about the accident

Glyburide mechanism of action?

- K+ channel blocking stimulates insulin release from beta cells (not in type 1) membrane ion channels - promote insulin release - stimulate release of insulin from pancreatic islets - they bind with and thereby block ATP sensitive potassium channels in cell membrane

nasal hemianopia (where in brain)

- Loss of vision of one nasal field - Results from a lesion of the lateral chiasm

ECG shows prolonged QT. Decreased activity in which ion causes this?

- Outward (delayed) rectifying potassium channel

Sciatic neuropathy

- Posterior hip dislocation, acetabular fracture, inappropriately placed IM injection in buttocks - Most common cause is compression of lumbosacral roots by disc material - Weakness of foot and ankle muscles and muscles of knee flexion - Loss of Achilles tendon reflex - Sensory loss in foot and lateral leg below knee

sublimation (defense mechanism)

- Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD.

Carcinoid syndrome

- Serotonin overproduction - Tumor of serotonin producing cells in GIT → APUD (Amine Precursor Uptake Decarboxylase) Cells - Slow-growing but often malignant type of neuroendocrine tumor, originating in cells of neuroendocrine system - Most commonly found in the foregut (35.6% cases) with lung, bronchus and trachea where they rarely metastasize (except in case of pancreas). - Sx = Cutaneous flushing accompanied by sweating, GI hypermotility → causing diarrhea, Bronchospasm - Increased 5-HIAA excretion of in urine

28-year-old man infertility, weight lifter and takes anabolic steroids. Mechanism of infertility?

- Suppression of gonadotropins

2-month-old boy well child exam, mother with no concerns. 25th percentile for length and 30th percentile for weight. Cardiac exam shows blowing holosystolic murmur best heard at lower left sternal border. Cause?

- Ventricular septal defect

adenoma to carcinoma sequence

- involved mutation from the normal colonic mucosa to adenomatous polyp to carcinoma - via mutation in APC, K-ras, and p53

B-ALL

-B-ALL is MC type = CD10, CD19, CD20 -excellent response to chemotherapy -required prophylaxis to scrotum and CSF** -PIC** - meninges of brain with ALL -prognosis is gen good and based on cytogenic abnormalities -t (12,21) = good prognosis = more common in kids -t(9,22) = poor prognosis - more common seen in adults (ph+ALL) -ph = Philadelphia chromosome

Common variable immunodeficiency

-Defect in B-cell differentiation. Many causes. -Can be acquired in 20s-30s; increased risk of autoimmune disease, lymphoma, sinopulmonary infections. -Decreased plasma cells, decreased immunoglobulins.

Leukocyte adhesion deficiency (type 1)

-Defect in LFA-1 integrin (CD18) protein on phagocytes; impaired migration and chemotaxis; autosomal recessive. -Recurrent bacterial skin and mucosal infections, absent pus formation, impaired wound healing, delayed separation of umbilical cord (> 30 days). -Increased neutrophils. -Absence of neutrophils at infection sites.

Parvovirus B19 causes

-Fifth Disease-Congenital parvovirus B19 infection → hydrops fetalis-Aplastic crisis in patients with hemolytic anemias (e.g. sickle cell disease, thalassemia)

West Nile Virus symptoms

-High fever -Headache -Rash -Confusion -Paralysis -potential meningitis/Encephalitis

Paracortex of lymph node

-Houses T cells. Region of cortex between follicles and medulla. Contains high endothelial venules through which T and B cells enter from blood. Not well developed in patients with DiGeorge syndrome. -Paracortex enlarges in an extreme cellular immune response (e.g., viral infection).

Cauda Equina Syndrome

-Injury at the L1 level and below resulting in a LMN lesion -Flaccid paralysis w/no spinal reflex activity

Dantrolene (mechanism and use)

-Mechanism: prevents release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle. -Use: malignant hyperthermia and neuroleptic malignant syndrome (a toxicity of antipsychotic drugs).

- Physiologic shunt

-Mismatching of ventilation and perfusion with the lung -Results in insufficient ventilation to provide the oxygen needed to oxygenate the blood flowing through the alveolar capillaries

Omalizumab

-Monoclonal anti-IgE antibody. Binds mostly unbound serum IgE and blocks binding to FcεRI. -Used in allergic asthma resistant to inhaled steroids and long-acting β2-agonists.

Hyper IgM syndrome

-Most commonly due to defective CD40L on Th cells class switching defect; X-linked recessive. -Severe pyogenic infections early in life; opportunistic infection with Pneumocystis, Cryptosporidium, CMV. -Increased IgM, double decreased IgG, IgA, IgE

IL-2 secreted by and stimulates growth of what?

-Secreted by all T cells -Stimulates growth of helper, cytotoxic, and regulatory T cells, and NK cells.

Acute hemolytic transfusion reaction

-Type II hypersensitivity reaction. -Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs). leads to complement mediated cell lysis -Presents with fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular hemolysis), jaundice (extravascular).

CN VIII

-Vestibulocochlear Nerve -Balance and hearing

branched chain ketoacid dehydrogenase

-analogous to PDC and a-Ketoglutarate DH -2nd step of branched chain amino acid catabolism enzymes that is found on the mitochondrial inner membrane. Catalyzes the oxidative decarboxylation of branched, short-chain alpha-ketoacids.

Bisacodyl MOA

-contact laxative which acts on the large intestine to produce strong but brief peristaltic movements -stimulates sensory nerve endings to produce parasympathetic reflexes which results in peristalsis of the colon -local axon reflexes and segmental reflexes are stimulated, which produces widespread peristalsis of the colon

T-ALL

-express markers ranging from CD2-CD8 -blasts do NOT express CD10 -presents as mediastinal thymic mass in teenager (T = t + t) -acute lymphoblastic lymphoma* (mass in mediastinum)

CN VII

-facial -assess mouth for taste -assess the face for symmetrical movement dual upper motor neuron

CN IX

-glossopharyngeal -assess mouth for taste -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech -salivation -motor and sensory -increase heart rate and bp

etidronate - mechanism

-onate, bisphosphonate which can be used in osteoporosis by inhibiting bone removal by osteoclast.

Biotin Cofactors (3)

-pyruvate carboxylase (pyruvate to oxaloacetate) -acetyl-CoA carboxylase (acetyl-CoA to malonyl-CoA) propionyl-CoA carboxylase (propionyl-CoA to methylmalonyl-CoA)

CN XI

-spinal accessory -assess the shoulders for strength

CN X

-vagus -assess mouth for movement of soft palate and the gag reflex -assess swallowing and speech -dysphagia hoarseness/dysphagia/palate collapse/uvula away from side/increase hr

x-link recessive- potential the grandchild has it?

.5% grandmother passed to mother .5% mother passed to child .5% child is a boy

Probability of test coming back negative with 95% negative in disease of 8 patients will be?

.95^8

Evolution of myocardial infarction

0-24 hr: coag necrosis 1-3 day: neutrophil, fibrinous pericarditis 4-7 day: macrophage, ruptures 7d-1m: granulation tissue >1 month: scar tissue, HF, arrythmia, dressler syndrome

Cube stacking 3 to 4 cubes: (age) 6 cubes: (age)

1 year 2 year

granulomatous diseases (sarcoidosis, TB) can have parathyroid independent conversion of vitamin D vis expression of (???) in activated macrophages.

1-a-hydroxylase (looks like excessive vitamin D intake)

• Polysaccharide capsule of bacteria usually provoke a (???) immune response so need to be attached to toxoid to become (???) mediated

1. B cell 2. T cell

Important neutrophil chemotactic agents

1. C5a 2. IL-8 3. LTB4 4. Kallikrein 5. Platelet-activating factor

Acidosis vs alkalosis problems steps to check

1. Check pH 2. Check how long it has been. 3. Check HCO3 --> PaCO2

Causes of hypokalemia: (5 causes)

1. Decreased intake (starvation) 2. Intracellular translocation (insulin, B-adrenergic activity aka albuterol dopamine, acute mi, alcohol withdraw, Alkalosis, increased cell production aka AML) 3. GI loss 4. Urinary loss (hyperaldosteronism) 5. Sweat loss.

(HMO/PPP) cheapest (HMO/PPO) most expensive

1. HMO 2. PPO

Causes of hypophosphatemia

1. Primary hyperparathyroidism 2. Insulin treatment --> shifts phosphate intracellularly 3. Refeeding syndrome (calories provided to a patient after a prolonged period of starvation serve as a stimulus for tissue growth, which consumes phosphorus in the form of ATP. 4. Alcoholics

Cricothyrotomy

1. Skin 2. Superficial cervical fascia that include platysma 3. Deep cervical fascia 4. Cricothyroid membrane

(VZV/smallpox) lesion are asynchronous, (VZV/smallpox) lesions are synchronous. (VZV/smallpox) lesions are primarily truncal, (VZV/smallpox) lesions may be more peripheral.

1. VZV 2. smallpox 3. VZV 4. smallpox

Irreversible ischemic neuronal and glial cell injury leads to changes that promote edema through?

1. cytotoxic (ionic) edema --> lead to accumulation of intracellular Na and water in cells 2. vasogenic edeam

In (???), the individual redirects the aggression towards an innocent victim; unlike (???) in which your feelings are extended onto another person.

1. displacement 2. projection

chronic myeloproliferative disorders with JAK2 mutation? 3

1. essential thrombocytopenia 2. polycythemia vera 3. myelofibrosis

disorders(4) treated with desmopressin (and mechanism)?

1. hemophilia A 2. type 1 von willebrand disease increase circulating factor VIII and endothelial secretion of vWF to stop bleeding 3. central diabetes insipidus 4. nocturnal enuresis bind V2 receptors in renal tubular cells leading to increased aquaporin channels increase water reabsorption and decreased urine output

Acute tamponade (3 signs)

1. hypotension 2. jugular venous distention 3. muffled heart sounds

Reporting Impaired Professionals (hiarchy)

1. immediately call on-call supervisor 2. (non-emergent) contact physician health program 3. report state licensing board

G protein coupled receipt that activates (???) membrane phospholipids are brown down into DAG and IP3. (???) is subsequently activated by DAG and calcium.

1. phospholipase C 2. Protein Kinase C

how are monoclonal antibodies eliminated? (2 ways)

1. target-mediated drug clearance-internalization upon binding to target 2. non-specific-taken up by reticuloendothelial macrophages and vascular endothelial cells

Phenytoin mechanism

1.Locks voltage gated Na+ channels in the INACTIVATED state. 2.Only works on ACTIVE channels. 3.↑ REFRACTORY period preventing propagation of further action potentials. 4.100% oral absorption

how to determine total peripheral resistance of circuit?

1/r1+1/r2+1/r3=1/total peripheral resistance MUST DIVIDE TOTAL BY 1

What are "Red neurons" and when are they seen?

12 hours to develop after lacunar stroke and are eosinophilic changes in cytoplasm of neuron

microscopic changes that include red neurons (eosinophilic cytoplasm, loss of nissl substances) occur how long after ischemic stroke?

12-24 hr

Knee Bursae

13 located at knee joint

Polycystic ovary syndrome androgen excess increase (??? enzyme) decreased progesterone anovulatory cycles endometrial hyperplasia and adenocarcinoma

17a-hydroxylase

Vitamin K carboxylase what factors?

2, 7, 9, 10 c and s

(???) deficiency causes increased levels of 17-hydroxyprogesterone and testosterone which lead to (???) hyperplasia.

21-hydroxylase deficiency adrenal cortical hyperplasia males:early virilization and increase linear growth female:ambiguous genitalia hypotension

Chronic kidney disease results in impaired conversion of (vitamin D) to (vitamin D)

25-hydroxyvitamin D 1,25-dihydroxyvitamin D

MEN1(multiple endocrine neoplasia type 1) affect what organs, cause what electrolyte abnormality, and cause compression of what structure in the brain?

3 P's aka parathyroid pituitary and pancreas that usually present with renal stone. increased Ca+. Visual field defects caused by compression of optic chiasm

most susceptible to teratogen?

3-8 week of development

absence seizure

3Hz spike-and -wave with blank stare

MEN1

3Ps (think diamond) Parathyroid Pituitary (prolactinoma or GHoma) Pancreatic (ZE, insulinoma, VIPoma, glucagonoma)

pertussis

4 week cough with sneezing runny nose and cold that resulted in bout of severe coughing with vomiting after gram-negative coccbacillus

after MI when does early coag necrosis, edema, hemorrhage, and wavy fibers happen?

4-12 hours

von Hippel-Lindau disease

40% RCC. 75% simple renal cysts. Hemangioblastomas CNS. Retinal angiomas. Pancreatic cysts. Pancreatic neoplasms. 50-80% Pheochromocytomas (multiple, bilateral, extraadrenal). -hemangioblastoma (retinal/brain/spinal cord) -cyst like tumor -cyst cause deafness -clear cell renal carcinoma -autosomal dominant on chromosome 3

Medication dose to fix component of bladder outlet obstruction and reduce prostate volume?

5-alpha reductase inhibitors (finasteride, dutasteride) take a while to work

Atrial myxoma features

50% of primary cardiac tumors. Most common primary benign cardiac tumor. Most (75% to 80%) are in LA. May mimic rheumatic valvular disease clinically. seen at amorphous extracellular matrix

Flow decreased by factor of 16 then radius decrease by (25%/40%/50%/75%)

50% or ½ Flow=(P1-P2)xr^4/nL .... Radius is raised to 4th power...

6, 8, 10 thorancentesis

6 midclavicular 8 midaxillar 10 paravertebral

when is it legal to drive after seizure?

6m-1y

what part of vitamin D synthesis involves the sun?

7-dehydrocholesterol --> cholecaliferol

Carbon Dioxide Transport 3 type of transport:

70% as bicarbonate ion (CARBONIC ANHYDRASE) 23% bound to hemoglobin 7% dissolved in plasma

B-hCG level first detectable

8 days after ferilization (Day 6-7 is blastocyst impantation)

Contemplation stage

: The individual starts to consider the behavior

Absolute risk reduction

=event rate in control group-event rate in treatment group

Hawthorne effect

A change in a subject's behavior caused simply by the awareness of being studied (observer effect)

multiple sclerosis

A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech

Multiple sclerosis

A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech IGg bands eye problems

intermediate filaments

A component of the cytoskeleton that includes filaments intermediate in size between microtubules and microfilaments.

fasciculus gracilis

A division of the Dorsal Columns System specifically dealing with the LOWER EXTREMITY

limbic system

A doughnut-shaped system of neural structures at the border of the brainstem and cerebral hemispheres; associated with emotions such as fear and aggression and drives such as those for food and sex. Includes the hippocampus, amygdala, and hypothalamus.

Sydenham's chorea (involuntary muscle twitching associated with what disease?)

A form of chorea (involuntary muscle twitching) associated with rheumatic fever, usually occurring in childhood.

Leptin

A hormone produced by adipose (fat) cells that acts as a satiety factor in regulating appetite.

Secretin

A hormone secreted by the small intestine (duodenum) in response to low pH (e.g., from stomach acid). It promotes the release of bicarbonate from the pancreas to act as a buffer.

red nucleus

A large nucleus of the midbrain that receives inputs from the cerebellum and motor cortex and sends axons to motor neurons in the spinal cord.

eosinophilic esophagitis

A long history of dysphagia in a kid, especially one with other eosinophilic disorders like eczema or asthma, raises suspicion. EGD shows eosinophilia infiltration of esophageal mucosa (>15/hpf). It's in response to a food allergy. Use antacids and PPIs while withdrawing any new foods to find the offending culprit.

Hypothalamus

A neural structure lying below the thalamus; it directs several maintenance activities (eating, drinking, body temperature), helps govern the endocrine system via the pituitary gland, and is linked to emotion and reward.

intradermal nevus

A nevus in which nests of melanocytes are found in the dermis, but not at the epidermal-dermal junction.

Ubiquitin

A protein that attaches itself to faulty or misfolded proteins and thus targets them for destruction by proteasomes

Confidence Interval (CI)

A range of values, calculated from the sample observations, that is believed, with a particular probability, to contain the true value of a population parameter. A 95% confidence interval, for example, implies that were the estimation process repeated again and again, then 95% of the calculated intervals would be expected to contain the true parameter value. Note that the stated probability level refers to properties of the interval and not to the parameter itself which is not considered a random variable.

Chi-square test

A significance test used to determine if a linear relationship exists between two variables measured on interval or ratio scales.

West Nile Virus (replication within what organism?)

A virus that lives in hundreds of species of birds and is transmitted among birds by mosquitoes.

Follicular conjunctivitis caused by serotype (???) of chlamydia

A, B, C

Retro peritoneal structures

AAD PUCKER S: suprarenal (adrenal) gland A: aorta/IVC D: duodenum (second and third part) P: pancreas (except tail) U: ureters C: colon (ascending and descending) K: kidneys E: (o)esophagus R: rectum

Lead poisoning symptoms

ABCDEFG Anemia Basophilic stripping --> inability to degrade RNA Colicky pain, constipation Difficulty concentrating Encephalopathy Foot drop Gum (lead line)

First dose hypotension: drug associated and risks

ACEI: predisposing risks: hyponatremia, hypovelemia (diuretics), low baseline BP, high renin, or aldos, renal impairment, heart failure.

Beta-endorphin is produced from the same prohormone as

ACTH

G-protein coupled receptors associated with what?

ACTH ADH epinerphrine glucagon

Anterior pituitary releases what hormones

ACTH, TSH, gonadotrophic hormone, prolactin, and growth hormone

The 15:17 translocation involves what receptor?

ACUTE myelogenous leukemia -retinoic acid receptors

Tuberous sclerosis

AD result in cutaneous angiofibroma

Thrombotic Thrombocytopenic Purpura (TTP)

ADAMSTS13 deficiency or autoantibody Normal PT/PTT Can't cleave vWF into monomers Microthrombi creating schistocytes CNS abnormalities Rx: plasmapheresis and corticosteroid

diabetes insipidus

ADH administration will increase urine osmolality in central DI vs. nephrogenic which will not. This is released in paraventricular and supraoptic nuclei of hypothalamus. (or posterior pituitary: this will cause transient that is normally replenished over time)

dense granules of platelets contain

ADP histamine 5-HT seratonin calcium CASH

most common congenital defect that results in sideroblastic anemia?

ALAS deficiency (aminolevulinic acid synthetase)

Downs syndrome associated with what?

ALL AML--> leading to excess lymphoblast

h X-linked recessive disease has deafness, hematuria and progressive renal failure. Protein abnormality?

ALPORT SYNDROME type IV collagen

Zinc-copper superoxide dismutase mutation

ALS --> SOD leads to increase free radical injury

subfornical organ can respond to what hormone in renin-angiotensin system?

ANG-II

portal hypertension in child think?

AR polycystic kidney disease

ankle sprain

ATF

Antithrombin III deficiency what happens after giving heparin

ATIII normally enhaved by heparin or HLM; Normally neutralizes activated serine proteases Deficiency: causes thrombosis: no increase in PTT after heparin dose

ATP concentrations maintain high even after continuous exercise due to what reason?

ATP is quickly regenerated from creatine phosphate

Suprspinatus Action

Abduct the shoulder and Stablize the head of humerous

wobble hypothesis

Ability of the tRNAs to recognize more than one codon; the codons differ in their third nucleotide.

32-year-old woman has operation for hyperparathyroidism. Three parathyroid glands found but one does not appear in normal superior location on right side. Embryologic event that led to this? normal english: which pharyngeal pouch is the superior parathyroid derived from?

Abnormal migration of endoderm from fourth pharyngeal pouch

(???) blocks central glutamate receptors and reduces cravings for alcohol.

Acamprosate

lateral pterygoid

Action: grinding movement, depresses and protracts mandible and moves it from side to side. can cause maintained dislocated position of mandible

Auer rods on blood smear are misformed what?

Acute myelogenous leukemia (AML) lysosomes

Pharyngoconjunctival fever

Adenovirus

tanner stage 5

Adult breast, areola recedes, nipple retracts Pubic hair coarse and full - inverted triangle

Treatment of uric acid stones

Alkalinize urine (potassium citrate), allopurinol

superficial inguinal nodes

All Skin from the belly button down, including the anus, excluding the testes and posterior calf

Pas positive liver biopsy with sob

Alpha-1-antitryspin

Alanine to glucose requires what amino group to be transferred?

Alpha-ketoglutarate

Nucleus basalis of Meynert

Alzheimer disease cognitive and memory function

Cystine stones (associated with what abnormality)

Aminoaciduria a rare cause of kidney stones that occur seen in children. They are related to cystinuria. Treatment is hydration and alkalinization of the urine. They may *also form staghorn calculi.*

• What anti-fungal binds to ergosterol and alters cell membrane permeability?(???) and what should be routinely monitored? Serum (???) and (???) levels

Amphotericin Serum potassium and magnesium levels

Familial Adenomatous Polyposis (FAP)

An autosomal dominant trait resulting in the development of polyps and benign growths in the colon. Polyps often develop into malignant growths and cause cancer of the colon and/or rectum. FAP germline mutation of tumor suppressor gene adenomatous polyposis coli (APC)

tyrosine kinase activity associated with what?

An enzyme that catalyzes the transfer of phosphate groups from ATP to the amino acid tyrosine on a substrate protein. insulin growth receptors

GABA-where in brain located? what ion does it work on? and what synthesis it? what cofactor is needed?

An inhibitory neurotransmitter in the brain located in nucleus accumbens allows Cl- into cells glutamate decarboxylase B6

Scaphoid fracture (complication)

Anatomical Snuffbox > Radial artery here Avascular necrosis, most commonly injured wrist bone

(???) can cause increased amniotic fluid due to impaired fetal swallowing or increased fetal urination due to high cardiac output (immunization, parvo feto-maternal hemorrhage)

Anencephaly (others are GI obstruction, atresia's)

HLA-B27 association to what disease?

Ankylosing spondylitis

Bosentan (mechanism, use, toxicity)

Antagonizes endothelin-1 receptors, reducing vascular resistance in the pulmonary vessels; used in pulmonary hypertension Pharmacology Respiratory Boss man stan: bosentan treats pulmonary HTN End o' the line: bosentan is an endothelin inhibitor Dilated red sleeves: bosentan (an endothelin inhibitor) causes vasodilation Liver spot on shirt: bosentan is associated with fatal hepatotoxicity

Obturator nerve (L2-L4)

Anterior hip dislocation Thigh adduction deficit Medial thigh sensory deficit passes through obturator canal (internal medial thigh) and controls adduction of thigh and sensation to medial thigh.

Axillary nerve injury

Anterior shoulder dislocation Paralysis of deltoid, teres minors, sensation over lateral upper arm.

What medication can cause redistribution of fat?

Antiretroviral medication

head bobbing

Aortic regurgitation (widening pulse pressure)

bone marrow dry tap seen in what cases: (2)

Aplastic anemia Myelofibrosis

what altered protein is associated with increased risk of alzheimers?

ApoE4

what is the association with late onset alzheimer?

Apolipoprotein E epsilon 4

All DNA viruses

Are double stranded (except parvovirus) Are Icosahedral (except pox) Replicate DNA in nucleus (except pox)

Craniopharyngioma

Arise from squamous epithelial remnants of anterior lobe of pituitary gland. Commonly are symptomatic due to large size. Most common suprasellar mass in children. Peak incidence between 5 and 10 years of age and 50 and 60 years. Solid and cystic components are typical. Large cystlike sellar/suprasellar mass with enhancing rim and some calcification. cholesterol crystals

Schwannoma normally affect what nerve

Arises from Schwann cells. Commonly affects vestibulocochlear (VIII) and trigeminal (V) nerves. Cystic degeneration is common, especially in larger lesions. T1 hypointense to gray matter and T2 hyperintense to gray matter. Intense enhancement.

Streptococcus pneumoniae sketch

Armor - Polysaccharide Capsule is major virulence factor 5. Chin is exposed - Optochin sensitive, optochin inhibits the growth of strep pneumo 6. Double Lance - Lancet shaped diplococci 7. Mud on horses legs - Bile soluble, meaning it does not grow in Bile

Rhinovirus, what receptors?

Attaches to ICAM-1 receptors (CD54) on respiratory epithelial cells.

intercalated discs

Attachment sites between the transverse lines between cardiac muscle cells

Acute Myeloid Leukemia

Auer rod, MPO, older adult 3 subtypes

Chediak-Higashi syndrome

Autosomal recessive protein trafficking defect Can't "railroad" the phagosome to the lysosome - Neutropenia because you can't pull the two cells apart during division - Giant granules because you can't distribute the Golgi products and they fuse - Defective hemostasis because of abnormal dense granules in platelets (same principle as above) - Albinism - melanocytes distribute pigment to other cells - Peripheral neuropathy - some nerves are really long

Friedreich's ataxia

Autosomal recessive trinucleotide repeat disorder (GAA, frataxin gene). Leads to impairment in mitochondrial functioning. Staggering gait, frequent falling, nystagmus, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy (Cause of death). Presents in childhood with kyphoscoliosis. Friedreich is Fratastic: he's your favorite FRAT brother, always stumbling, staggering and falling but he has a big heart so its okay

Metachromatic leukodystrophy

Autosomal-recessive lysosomal storage dz, most commonly due to arylsulfatase A deficiency. Builup of sulfatides leads to impaired production of myelin sheath.

medial longitudinal fasciculus

Axon tract that carries excitatory projections from the abducens nucleus to the contralateral oculomotor nucleus; important in coordinating conjugate eye movements.

Chlamydia treatment

Azithromycin (or doxycline)

Heart failure have improved long term survival with (HTN drugs)

B-blocker, ACE inhibitor, ARB, and aldosterone antagonist (K sparing diuretic)

Waldenstrom's macroglobulinemia

B-cell lymphoma that produces monoclonal IgM(it's a BIG Ig), patients present with generalized lymphadenopathy. There will be M-spike due to IgM. No lytic bone lesions. Causes serum viscosity leading to defective platelet aggregation, Treat with plasmaphoresis

tay-sach deficiency with what accumulation?

B-hexosaminidase A deficiency with GM glanglioside accumulation

what vitamin is absorbed in terminal ileum?

B12

Gait unstable when eyes closed, vibration decreases and mild symmetrical loss of strength affecting proximal lower extremities

B12 deficiency that will affect dorsal column and spinocerebellar tract due to gastrectomy

subacute combined degeneration

B12 deficiency → degeneration of dorsal columns, LCST, spinocerebellar tracts (abnormal myelin from lack of methylmalonyl-CoA mutase activity)

isocitrate dehydrogenase requires what cofactor?

B3 (NAD+ --> NADH)

(???)VALVE seen by early systolic click over right second interspace

BICUSPID AORTIC VALVE

friable blood vessels is a sign of what condition in the bladder?

BPH

Gilbert's syndrome

Benign congenital unconjugated hyperbilirubinemia

Hemoglobin S (sickle Cell) contains valine in place of glutamic acid at the sixth amino acid position of the (???) globin chain. This promotes (???) interaction among Hb molecules and results in HbS polymerization and erythrocyte sickling.

Beta hydrophobic

what type of drug decreases uterine contractions?

Beta-2 agonist

Esmolol on the effect of EKG?

Beta-blocker prolong PR interval (B) -Do not affect QRS or QT interval -due to increased AV nodal refractory period

superior orbital fissure of sphenoid bone

Between greater and lesser wing on the sphenoid bone, transmits oculomotor, trochlear, and abducens nerves. Also a branch of opthalmic CN V1 --> adduct eye and corneal reflex

lead time bias

Bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death.

Bile soluble-(???) bile insoluble-(??) strep species

Bile soluble-step pneumonia bile insoluble-virdins

(???) to one of its ligands downregulate immune response to inhibiting cytotoxic T cells. Many types of cancer evade immuno-detection by increasing expression (???) on their surface. (??) antibodies upregulate T-Cell response and promote tumor cell apoptosis

Binding of programmed cell death protein 1 (PD-1) PD-L1 PD-1

Protein A ( in staph)

Binds Fc region of IgG. Prevents opsonization and phagocytosis. Expressed by S. aureus.

Haptoglobin

Binds free hemoglobin after RBC lysis to be destroyed by spleen, decreased levels in sickle cell, thalessemia, lead poisoning,etc.

Haptoglobin function

Binds free hemoglobin after RBC lysis to be destroyed by spleen, decreased levels in sickle cell, thalessemia, lead poisoning,etc. SCHISTOCYTES BINDS IN DISEASE CAUSING DECREASE IN NUMBER

(??anti-cancer drug??) binds with Fe and O2 DNA scission causing pulmonary fibrosis

Bleomycin

Cavernous sinus thrombosis

Blood clot in w/I cavernous sinus. This cavity houses internal carotid artery and CN III, IV, V and VI). PmHx of sinus or facial infection. Pt c/o severe HA, high fever, decreased LOC, unilateral periorbital edema, photophobia, proptosis and inability to move eye appropriately.

Bone metastasis most to least common?

Bone Mets (most to least common): Prostate, breast>lung, thyroid, kidney mets are more common than primary tumors

osteoclast

Bone-destroying cells

Elisa test what spirochete?

Borrelia then confirm western

Peroxisomes

Break down very long chain fatty acids and produce hydrogen peroxide digest alcohol

BRCA1 and BRCA2

Breast cancer Ovarian cancer

HER2/neu

Breast cancer Ovarian cancer

Theophylline

Bronchodilator phosphodiesterase inhibitor,which raises intracellular cAMP, activates PKA, inhibits TNF-alpha and inhibits leukotriene synthesis, and reduces inflammation and innate immunity nonselective adenosine receptor antagonist, antagonizing A1, A2, and A3 receptors almost equally, which explains many of its cardiac effects

Dengue Fever

Brown rubber dingy - Dengue fever a. Guy in boat that's sweating w/ mosquitos - Aedes egyptei mosquito b. Oar of Bone broken into 2 pieces - Infects bone marrow, type 2 c. Red blood cells - increased risk of bleeding, hemorrhagic fever d. Blue and red ribbons - renal failure is common, septic shock and even death e. Treatment - on your own, supportive and well hydrated like hep C many serotype

Bifurcation Common Carotid Artery

C4

bicep reflex caused at what spinal level?

C5-C6

(???) box function as promoter of transcription (also TATA) and act as binding sites for transcription factor and RNA polymerase II.

CAAT

(???) located 70-80 bases upstream, TATA box is promoter region that binds transcription and (???) during initiation of transcription. Located 25 base pairs upstream

CAAT box RNA polymerase II

17a-hydroxylase deficiency

CAH that presents with HYPERTENSION and SEXUAL INFANTISM/AMBIGUOUS GENITALIA. hypogonadism, hypertension, and hypokalemia

DiGeorge

CATCH-22

Azathioprine monitoring

CBC, LFT Antimetabolite precursor of 6-mercaptopurine. Inhibits lymphocyte proliferation by blocking nucleotide synthesis leading to immunosuppression

What is at the 3' end of tRNA in both eukaryotes and prokaryotes?

CCA tail

Where is hormone released from that causes gallbladder contraction?

CCK (Cholecystokinin) is a Gut Peptide. CCK is released from I enteroendocrine cells (meaning that these cells act on neural muscarinic pathways) found in the upper small intestine (duodenum and jejunum). CCK delays gastric emptying, stimulates gall bladder contraction and pancreatic secretion, and reduces food intake, all of which optimize digestive capacities - Enteroendocrine cells of the small intestine (CCK)

leukocytosis with increased neutrophils leads to more immature forms leading to decreased Fc receoptor (CD????)

CD16

• Giardia lamblia show near absence of cells bearing what marker?

CD19

Regulatory T cells (express and secrete what cytokines?)

CD25(IL-2) and FOXP3 Suppress CD4/8 to protect gut flora, fetus, etc. Secretes IL10 and TGFB

Mycosis fungoides

CD4 T cell neoplasm; skin lesions with Pautrier's microabscesses

TB has relation to (???) lymphocytes

CD4 t

granuloma formation: mechanism (what two cytokines are involved)

CD4+ Helper T cell secretes IL-12 => Th1 subtype Th1 cells secrete IFN-y => activates macrophages

HIV (drug given and bug concerned about)

CD4<200: PCP (TMP-SMZ), <100: Toxo: (TMP-SMZ), <50: azithromycin (mycobacterium avium)

Transplant patient, pneumonia and intranuclear cytoplasmic inclusions bodies (owl eyes) point to opportunistic infection with (???), an enveloped virus that contains double stranded DNA genome.

CMV

HIV patient with multiple ulcers and mucosal erosions that show large cells with basophilic intranuclear and intracytoplasmic inclusion is reactivation of what infection?

CMV (herpesvirus)

cribriform plate

CN I (olfactory)

middle cranial fossa

CN II - VI - through sphenoid bone

Sensation to anterior 2/3 of tongue

CN V3

maxillofacial injury followed by difficulty chewing food with jaw deviations is caused by what nerve injury and travels through what foramen?

CN V3 --> foramen ovale

posterior cranial fossa

CN VII-XII - through temporal or occipital bone

EBV is associated with what CNS cancers?

CNS lymphoma

is cerebral perfusion dependent on O2 or CO2?

CO2 (and pressure-MAP and intracranial pressure)

systemic scleroderma

CREST syndrome aka calcinosis, Raynaud, esophageal dysmotility, sclerodactyly and telangiectasias with anti-centromere antibodies being specific or anti-DNA topoisomerase

lobar consolidation (pneumonia) cause what findings?

CXR: opacificatoin, consolidation, air bronchograms leakage of protein rich fluid into alveolar airspace

CREST syndrome

Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia due to systemic sclerosis

Dystrophic calcification hall mark of what?

Calcium deposits on dead tissues in the setting of normal serum calcium and phosphate --> necrosis

Micro associated with Guillain-Barre syndrome? (???) (???) degrees!!!! (and Flu) type II

Campylobacter 42 degrees!!!! (and Flu) type II

• Micro associated with reactive arthritis (HLA-B27)? (???) or (???)

Campylobacteria (can't see can't pee can't climb a tree) or chlamydia

Slipped-strand mispairing

Can lead to a frame-shift mutation and early stop codon.

Radial nerve injury

Can occur by repetitive pressure (like crutches) at the axilla. Findings include weakness of forearm extension, hand and finger extensors (wrist drop). Sensory loss over posterior arm and forearm dorsolateral hand and thumb. Triceps spaired with a more distal lesion.

Treatment of trigeminal neuralgia

Carbamazepine

what is the treatment for trigeminal neuralgia?

Carbamazepine

Loops can cause what electrolyte imbalances and how is it off set?

Carbonic anhydrase inhibitors like acetazolamide block sodium bicarb to offset metabolic acidosis caused by loop diuretics. If hypokalemia can use spironolactone

Fungi express beta-glucans on cell surface and that triggers innate immune response. Which tx decreases glucan expression?

Caspofungin

(???) can arise from long term steroid use due to (???)oxidative injury

Cataracts photooxidative injury

what are the 3 stages of pertussis?

Catarrhal stage lasts one to two weeks and is characterized by symptoms of an upper respiratory infection such as low-grade fever, nasal congestion, and rhinorrhea. The paroxysmal stage lasts two to eight weeks and is characterized by paroxysms of coughing followed by an inspiratory whoop. The last stage is the convalescent stage, which may last for weeks to months, and is characterized by a subsiding cough.

anterior spinal artery occlusion

Cause: Ant. spinal artery occlusion Pathology: -Spares nothing except Dorsal Column -All else BILATERAL signs -Spastic paralysis -Loss of pain and temperature -UMN+LMN lesion signs

Bullous impetigo

Caused by toxin-producing strain of S. aureus, begins as red macules that progress to bullous (fluid-filled) eruptions on an erythematous base; exfoliative toxin A target desmoglein 1 often requires systemic antimicrobial

Acute hypocalcemia mechanism behind blood transfusion?

Causes - *neck surgery (parathyroidectomy), pancreatitis, sepsis, tumor lysis syndrome, acute alkalosis (HYPERVENTILATION - cause pH to inc, loss of H+ ions to surrounding, albumin more likely to bind Ca2+), chelation (blood (citrate) transfusion), EDTA, lactate, foscarnet (all listed chelators will bind Ionized Ca2+ and dec active Ca2+ in blood)* - *remember always check magnesium levels in hypocalcemia workup (look up other flashcard on this concept) b/c hypomagnesemia can cause inactivation of PTH + dec sec PTH + directly cause Hypocalcemia* Clinical Features - muscle cramps, Chvostek (carpal pedal spasm - forceful contraction of hand) + Trosseau sign - paresthesias - hyperreflexia/tetany - seizures - potentially tetany, laryngospasm, seizures, encephalopathy, and heart failure Tx - IV calcium gluconate/chloride

What is minimal change disease?

Causes volume overload and proteinuria this results form T-cell dysfunction leading to production of permeability factor and causing podocyte foot process fusion and decrease anionic properties of GBM. this leads to selective filtration of negatively charged plasma proteins

amygdaloid nucleus

Center for rage and violence.

Acute monocytic leukemia Characteristically infiltrates???

Characteristically infiltrates gums

Deferoxamine used for

Chelator: bacterial product; chelates iron very avidly, aluminum less so thalessemia major --> prevent iron accumulation after rbc transfusion

Age 4

Children are convinced that certain toys (such as dolls or trucks) are appropriate for one gender but not the other Draw cross

His initial therapeutic response is good to chloroquine, but he develops recurrent parasitemia 2 months later. Which of the following best explains the recurrence ?

Chloroquine is ineffective on the exoerythrocytic malaria tissue stages

(???) are collection of squamous cell debris that form a mass behind tympanic membrane. That can be congenital or acquired from infection, trauma, or surgery. Can cause hearing loss due erosion

Cholesteatoma

Megaloblastic anemia caused by folic acid and B12 deficiency. (???) has increase folic acid requirement due to increased erythrocyte turnover and developing macrocytosis.

Chronic hemolytic anemia

what antiarrhythmic agent causes QRS prolongation with little effect on QT interval duration?

Class 1C (flecainaide)

Congenital Rubella Syndrome

Classic triad of defects is sensorineural hearing loss, cataracts, and cardiac defects (e.g., patent ductus arteriosus). Additional features include low birth weight, purpura/petechiae, a blueberry muffin rash, hepatosplenomegaly, osteitis, microcephaly, and other ocular manifestations (e.g., salt and pepper retinopathy, microphthalmos, congenital glaucoma).

Ulnar nerve injury

Claw hand deformity Hyperextension of the MCP joint flexion at the PIP joints of the 4th and 5th

PCOS and Pregnancy

Clomiphene citrate

What bacteria causes bowel necrosis and performation showing many inflammatory cells?

Closteridium difficile (Picture shows pseudomembrane)

What compound decreases muscle action potential

Clostridium Botox

Paget disease of bone (osteitis deformans) causes what effects to calcium/phosphorus/ alk phos>

Common idiopathic alteration of bone exhibiting abnormal resorption and deposition, resulting in distorted and weakened bones "bowing of legs" with thickening of cortical and trabecular bones normal calcium, normal phosphorus, increased alk phos

Thoracic Outlet Syndrome

Compression syndrome of upper limb neurovascular bundle at the level of scalene muscles and first rib. 70% with arterial injury have a cervical rib.

Peroxisomes histology

Contain oxidase enzymes that detoxify alcohol, hydrogen peroxide, and other harmful chemicals

Sternocleidomastoid

Contraction of one side: laterally flexes neck, rotates head to opposite side; Contraction of both sides together: flexes neck mastication

Benedikt's Syndrome

Contralateral athetosis, ataxia and CN3 palsy

A stroke in the ACA will result in what signs?

Contralateral hemiparesis of leg(more than arm), Contralateral sensory loss (same as motor), blunted affect

Adenosine deaminase deficiency cause what cancer?

Converts adenosine to inosine in purine salvage pathway. Excess ATP, dATP in nucleotide pool = imbalance so decreased lymphocyte count (major cause of SCID, severe combined immunodeficiency dz, e.g. "bubble boy") can cause hairy cell leukemia (lymphocyte-derived cancer)

HGPRT

Converts hypoxanthine to IMP and guanine to GMP

most common VIRAL meningitis

Coxsackievirus

String sign on x-ray

Crohn's disease

mycoplasma pneumonaie leads to formation of (???) that attach to rbc and activate complement and cause erythrocyte lysis. (???) fall after 4 weeks

Cross-reacting IgM antibodies

(???) diagnosed with India ink in CSF. Treatment is (???). Yeast with (???). Soap bubble lesions on HIV patient CT

Cryptococcal meningitis tx: amphotericin B and flucytosine with fluconazole maintenance therapy thick polysaccharide capsule

Mucicarmine stain-what organism?

Cryptococcus neoformans

MCC diarrhea in AIDS; acid-fast oocysts

Cryptosporidium parvum (basophilic)

Homocystinuria

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

what amino acid is essential in patient with increased Methionine levels +hypercoagulability and thromboembolic occlusion?

Cysteine --> homocycstinuria cannot form cystein from homocystiene

Child with nasal polyps makes you think of what disease?

Cystic Fibrosis

Serotype of chlamydia that cause std

D through K

what part of vitamin D synthesis involves the liver?

D3 --> 25-hydroxyvitamin D 25-hydroxylase

hypovolemic shock (pcwp, CO, SVR and treatment)

DECREASE PCWP(wedge pressure) decrease CO increase SVR (resistance) treat with IV fluids

Ionizing radiation induces DNA damage through (???) and the formation of (???)

DNA double-strand fractures O2 radicals

What is malignant hyperthermia treated with? and how does it work?

Dantrolene- decrease Sarcoplasmic Ca release

Right urethral obstruction what will happen to GFR and filtration fraction in kidney?

Decrease and decrease.. GFR depends on hydrostatic pressures and FF=GFR RPF(renal plasma flow)

Thiazolidinediones MOA

Decrease insulin resistance and increase uptake and use of glucose Inhibit glucose and triglyceride production by increasing PPAR-y gene regulation

Thiazide diuretics MOA

Decrease sodium reabsorption at distal convoluted tubule; net loss of sodium and potassium

Nef gene in HIV needed for what?

Decreases CD4 and can't cause AIDS

Anterior compartment of leg innervation

Deep peroneal nerve

Fanconi syndrome

Defect in proximal tubule Can't reabsorb Low energy state Can be caused by old tetracycline glycosuria but normal glucose serum levels

tabes dorsalis

Degeneration of dorsal columns and dorsal roots due to tertiary syphilis, resulting in impaired proprioception and locomotor ataxia. Associated with charcot's joints, shooting (lightning pain) (see image 12 in First Aid), Argyll Robertson pupils (Reactive to accommodation but not light), absence of DTRs, positive romberg, and sensory ataxia at night.

Tabes dorsalis

Degeneration of dorsal columns and dorsal roots due to tertiary syphilis, resulting in impaired proprioception and locomotor ataxia. Associated with charcot's joints, shooting (lightning pain) (see image 12 in First Aid), Argyll Robertson upils (Reactive to accommodation but not light), absence of DTRs, positive romberg, and sensory ataxia at night.

Positive predictive value

Dependent on prevalence of disease and is the pobabilty that someone who test positive actually has the disease. TP/ (TP+FP)

Temporomandibular disorder

Deviation of jaw toward painful side upon opening TMJ disc moves anterior and medially due to contraction of the lateral pterygoid muscle pterygoid muscle is innervated by CN V3

• Hyperosmotic volume contraction

Diabetes insipidus, dehydration, and profuse sweating

Should at patient on HAART treatment change if HIV count is low?

Don't take anything out. HIV patients should be kept on thier HAART regimen, which includes 2 NRTIs and one other drug PI/NNRTI/etc). By keeping these same medications we are not allowing the virus to become resistant against them directly. The virus has mutated in a "different" direction and we can try to add another drug to combat that new mutation.

Restless leg syndrome treatment

Dopamine agonist: Pramipexole *think about it: movement relieves pain, Dopamine agonist helps

Anti-histone antibodies

Drug-induced Lupus from SHIPP - Sulfonamides, Hydralazine, Isoniazid, Procainamide, Phenytoin

Neurokinin-1

Drugs against it are anti-emetic Aprepitant, fosaprepitant prevent substance P release (last resort)

Glanzmann thrombasthenia mechanism and treatment?

Due to a genetic GPIIb/IIIa deficiency; platelet aggregation is impaired lead to increased bleeding abciximab (GP IIb/IIIa receptor antagonist) inhibits binding of receopto to fibrinogen

Correlation-Vivax and (???) antigen and (???) and falciparum

Duffy sickle cell

atypical cytotoxic T cells is due to what virus and histology?

EBV

Non-fermenter of sorbitol via SMAC (MacConkey Agar with Sorbitol)

EHEC

Phthrius pubis (crabs, pubic or crab louse)

Ectoparasites (arachnids, insets) Crabs or phthiriasis STD, pruritus; eggs (nits) that are cemented to hairs in the region tx: topical permethrin

Schistosoma mansoni (what type of spine?) S. haematobium (what type of spine?)

Eggs have a prominent lateral spine. S. haematobium: Eggs have a prominent terminal spine.

prolonged expiration with pursed lips?

Emphysema (pink puffer) Pursing lips helps create back pressure that helps keep walls open

(????) anatagonist lower pulmonary arterial pressure and improve dyspnea

Endothelin antagonist

(???) and (???) can be located anywhere in DNA sequence but can work

Enhancers silencers

Trypsinogen converted to trypsin by

Enterokinase/enteropeptidase, a brush border enzyme on duodenal and jejunal mucosa

Widespread, red, sandpaper-like rash on extremities. Purulent exudate over tonsils. Dx streptococcus pyogenes (group A) infection. Cause of skin findings?

Erythrogenic toxin streptococcal pyrogenic exotoxins, are secreted by strains of the bacterium Streptococcus pyogenes. SpeA and SpeC are superantigens, which induce inflammation by nonspecifically activating T cells and stimulating the production of inflammatory cytokines.

Plummer-Vinson syndrome

Esophageal webs with iron deficiency anemia, koilonychia (spoon shaped nails) and shiny red tongue

Plummer-Vinson syndrome

Esophageal webs, atrophic glossitis(smooth tongue), and iron deficiency anemia

Tamoxifen (mechanism, use, toxicity)

Estrogen receptor antagonist at the breast; used for breast cancer; partial agonist at the uterus, can cause endometrial hyperplasia Pharmacology Reproductive

What causes oxygen-hemoglobin dissociation curve shift left aka more oxygen bound at certain pressure?

Everything down except pH SOOO (decreased temperature, CO2, 2,3-BPG)

Adenosine deaminase deficiency, causes what condition?

Excess ATP and dATP -->feedback inhibition of ribonucleotide reductase--> prevents DNA synthesis --> lymphocyte count (decreased). leads to SCID

Leukamoid reaction

Excessive WBC response to something outside of the BM. WBC >30-50,000, Mostly neutrophils. As inflammatory stimulus resolves so does leukocytosis

Dressler's syndrome

Exposure of antigens in pericardium to immune systems which causes auto-immune pericarditis that happens 6-8 weeks post-infarction. Fibrinoid pericarditis.

Menopause occurs at average 51 and diagnosed with amenorrhea and elevated (???) for confirmation

FSH level

Desmopressin increases which bleeding factors?

Factor VIII and vWF

hemophilia A

Factor VIII deficiency, sex-linked recessive. Spontaneous hemarthosis. Excessive bleeding. Prolonged PTT (normal PT). Treat by replacing factor & fresh frozen plasma. Genetic counseling

(???) AR disorder defective (???) activity with increased synthesis and decreased clearance of chylomicron particles

Familial chylomicronemia lipoprotein lipase

(???) AR disorder characterized by elevated cholesterol and triglyceride level. ApoE3 and ApoE4 leading to decrease clearance of chylomicrons and VLDL remnant. Develop xanthomas and premature atherosclerosis

Familiar dysbetalipoproteinemia

NADPH is used for

Fatty acid synthesis, Cholesterol synthesis, Reduction of glutathione, Respiratory burst

Dengue fever symptoms

Five to 7-days of fever. Extreme myalgia—in the lower back, arms, and legs, and arthralgias of the knees and shoulders; Headache, maculopapular rash, vomit and nausea may occurr. Recuperation occurs within a week or so.If infected with another form of the same infectious agent, the previous symptoms are experienced with hemorrhage from the nose and gums and petechiae in the mouth and other mucous membranes.

what flexes tip of your finger?

Flexor digitorum profundus tendon

(???) does not require intracellular activation to bind and inhibit DNA polymerase in herpes virus and HIV

Foscarnet

(???) is analog of pyrophosphate that treats CMV that chelate calcium and promote nephrotoxic renal mag wasting. hypocalcemia and hypomagnesemia

Foscarnet

Macroorchidism, large jaw, intellectual disability associated with what disease?

Fragile X syndrome

If you insert or delete (non multiples of 3) nucleotide what is the mutation?

Frameshift

Stimulation of V2 receptors at medullary collecting duct

Free water increase

fructose 1-phosphate aldolase deficiency

Fructose 1-Phosphate --> Glyceraldehyde + DHAP

Where does TSH bind?

G protein coupled receptor

p53 causes (???) arrest when damaged DNA is detected

G1 arrest

inhibitory neurotransmitters

GABA and glycine

Tetanus toxin directly impairs what neurotransmitter?

GABA and glycine (NOT GLUTAMATE)

most common meningitis in neonate

GBS, E. coli, listeria

What is the most important marker for astrocytes? and what is astrocyte function

GFAP remove excess neurotransmitter, repair scar formation

Listeria (Santa's list) is common food borne illness with outbreaks particularly in dairy products. Healthy patients have (???) sxs. Patient with impaired cell immunity have (???) and in preggers have (???)

GI invasive infection/meningitis adverse fetal outcome like fetal death and premature birth

RIPE therapy (rifampin) side effects

GI side effects, rash, red-orange body fluids, cytopenia

Endoderm

GI, liver, pancreas, lungs, thyroid

what antidiabetic causes weight loss

GLP-1 agonist (pancreatitis)

Ras protein is activated via receptor tyrosine kinases when bound to what (ATP, Ca+, cAMP, GTP, IP3)?

GTP

HIV has what genes (3)

Gag, Pol, Env

bilateral cataracts, vomiting, decreased oral intake, and hepatomegaly... what enzyme deficiency in 20 day old?

Galactose-1-phosphate uridyltransferase (GALT)

• FYI

Generally accepted fasting plasma glucose levels in diabetes, prediabetes and normal are in mg/dL (mmol): ≥ 126 (≥ 7.0), 100-125 (5.6-6.9), and < 100 (< 5.6).

sickle cell anemia mechanism

Genes code for abnormal type of hemoglobin, which is a point mutation on 6th codon of beta globin causing valine to be substituted for glutamic acid, which leads RBCs to have an *abnormal crescent shape*.

Pseudocholinesterase Deficiency Syndrome

Genetically transmitted trait that decreases the amount of acetylcholinesterase available at the NMJ to break down ACH during muscle stimulation due to genetic polymorphism

(???) is produced by stomach in response to fasting; levels surge leading up to meals and fall after eating. (???) stimulates appetite and promotes weight gain. When patients undergo gastrectomy, they have reduced (???) levels, leading to weight loss.

Ghrelin

What disease has a genetically low level of UDPglucuronate transferase, resulting in elevated free unconjugated bilirubin?

Gilbert's syndrome

What is gliosis?

Gliosis is scar tissue and is often found in area of brain from which epileptic activity arises - May interfere with normal chemical and structural environment of neurons, making them more likely to fire abnormally seen 1 month after injury

Insulin release by pancreatic beta cells is stimulate by increased glucose metabolism and ATP production. (???) function as a glucose sensor in pancreatic beta cells by controlling the rate of glucose entry into glycolytic pathway. Mutation in (same as above) gene lead to state in which higher glucose levels are required to stimulate insulin secretion and are a cause of maturity-onset diabetes of the young.

Glucokinase

Benign drinker who has low blood sugar decreases what cycle? (???) due to increase in (???) ratio

Gluconeogenesis due to increase in NADH/NAD+ ratio

Fibrinogen receptor

GpIIb/IIIa

vWF receptor

GpIb

ankylosing spondylitis symptoms

Gradual onset: -Low back pain/stiffness worse in the morning radiating to buttocks -Better with activity -Enthesopathy (achilles tendonitis, plantar fasciitis, sausage digitis) -Anterior uveitis -Loss of lumbar lordosis and increased thoracic kyphosis limited chest expansion (respiratory/CV/eye complications)

Vibrio vulnificus

Gram negative enteric rod-causes food poisoning and necrotizing fasciitis

Chloramphenicol cause in neonates?

Gray baby by decreased glucuronyl transferase

LOTS of EBV manifestations - more likely among immunocompromised pts

Guillain-Barré syndrome (GBS)-Meningoencephalitis-Primary CNS lymphoma Hematological system: -Hemophagocytic lymph histiocytosis

Urease needed for what bacteria to grow in stomach?

H. pylori

Alpha Thalassemia

HBA 16p HB bart (all 4 alleles missing, hydrops fetalis, neonatal death, no tx) HbH (3 alleles missing, macrocytic anemia, transfusions) Alpha trait (mild) screen populations at risk for mutations in cis 90% deletions 10% sequencing Diseases in which there are insuffiecient alpha-globin chains due to gene deletions cis is worse than trans

what serological maker for chronic infection of HBV?

HBsAg

aggressive breast cancer

HER +

mutation of basolateral surface of hepatocytes that interacts with tranferrin is due to what mutation?

HFE mutation --> detect falsely low iron levels on hepatocytes leading to hemochromatosis increasing expression of divalen metal transporter 1 (DMT1) to bring in more iron

A young child with multiple injuries on his lips and tophi on the skin

HGPRT deficiency (Lesch Nyhan disease)

3-5 day high fever followed by blanching maculopapular rash. What is the organism?

HHV-6

Roseola

HHV-6

CMV colitis

HIV CD4<50. bloody diarrhea, abdominal pain, normal stool exam. Dx- colonoscopy and biopsy show multiple ulcers, erosions, CMV cells with inclusion bodies. Tx- ganciclovir 1st line, foscarnet

Cryptosporidium

HIV-associated (CD4 < 200) chronic watery diarrhea, acid-fast cysts in stool Tx: nitazoxanide; can be eradicated only by intact immune system.

virus that cause laryngeal cancer?

HPV

eosinophilic intranuclear inclusions in multinuclear squamous cells

HSV

most common meningitis in unvaccinated

Haemophilus influenzae

Weakness with pallor abd distension and splenomegaly, pancytopenia and no bone marrow aspirate

Hairy cell leukemia-lymphocytes with cytoplasmic projections with fibrosis causing dry tap

Brown-Sequard Syndrome

Hemi-section of the cord - ipsilateral (same side) spastic paralysis and loss of position sense - contralateral (opposite side) loss of pain and thermal sense

Hemolysis in G6PD deficiency

Hemolysis IS D PAIN Isoniazid, Sulfonamides, Dapsone, Primaquine, Aspirin, Ibuprofen, Nitrofurantoin

Vitamin E deficiency

Hemolytic anemia, posterior and spincocerebellar tract demyelination Looks like B12 def but without labs or hypersegmented neutrophils

( ???and ???) increase risk of hepatocellular carcinoma due to chronic infection but (???) is also linked to production oncogenic protein and insertion into host chromosome

Hep B and Hep C Hep B

Heparin induced thrombocytopenia

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

Heparin induced thrombocytopenia (Heparin causes a decrease in platelet count because of the formation of a complex with ???)

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

Heparin induced thrombocytopenia (mechanism)

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

PE bronzed skin, hepatomegaly, arthritis. Increased saturation of transferrin and ferritin. Liver biopsy increased iron content and cirrhosis Greatest risk?

Hepatocellular carcinoma (hemochromatosis)

(???) is used to transport Fe3+ into mucosa of intestine... hemochromatosis is a defect in this protein (???) that causes increase in amount of iron absorbed... We have no way to get rid of iron unless you just bleed out.

Hephaestin

C1 inhibitor deficiency

Hereditary angioedema Autosomal dominant C1 inhibitor targets - C1 and clotting factors XII, kallikrien. Without it - you have excessive production of bradykinin. Cause life-threatening mucosal edema after trauma or stress.

Virus families associated w/syncytia

Herpesviridae, retroviruses, paramyxoviridae

hyperosmotic volume expansion

High NaCl intake

(???) inhibits lactation and prevention of prolactin binding of alveolar cells in breast

High progesterone

Hyaditidiform Mole

Higher than normal beta-HcG and bigger than normal uterus.

meningioma on histology

Histology shows spindle cells with a "whirled pattern with psammoma bodies*!!!!

Reed-Sternberg cells

Hodgkin's lymphoma; binucleated or multinucleated giant

(???) hydrolyzes stored triglycerides to free fatty acids. Activity is increased in response to (???), (???), and (???)signaling.

Hormone-sensitive lipase glucagon, beta adrenergic stimulation, and ACTH signaling.

(???) increases maternal insulin resistance during second and third trimesters, leading to a rise in serum glucose to help provide adequate nutrition to the growing fetus. Gestational diabetes occurs when the rise in maternal insulin secretion is inadequate to prevent glucose levels from reaching excessively high levels.

Human placental lactogen

Caudate loses Ach and GABA

Huntingtons disease

mild hirsutism and velvety brown, thickened skin at the base of the neck and around axillae. Patient has which condition that associated with her diagnosed PCOS?

Hyperinsulinemia

Mucomycosis

Hyphae growing in and around vessels can look like rhinosinusitis caused by aspergillus but must look at narrow hyphae with septate

CN XII

Hypoglossal Tongue movement Motor

• The 60-40-20 rule refers to total body water (60% of body mass), ECF (???) ICF (???)

ICF (40%), and ECF (20%).

Darrow-Yannet Diagram

ICF ECF volume concentration https://www.medicowesome.com/2013/08/darrow-yannet-diagrams-simplified.html?spref=pi

cavernous sinus

III, IV, VI, and V1 pass through and VI is most likely to be affected first by hemorrhage of ICA

what cytokine is involved with improvement of fibroblast proliferation and epithelization to help heal non healing wound?

IL-10