STEP 1 (Part 1 - some Rx, mostly Kaplan and old Nbme's)

Adverse effects of metoclopramide

(1) Diarrhea (2) Drowsiness (3) Depression (4) Extrapyramidal effects (5) Neuroleptic malignant syndrome (6) Elevated prolactin (7) Torsades de Pointes

Neonatal respiratory distress syndrome

)-lung disorder of neonates, particularly premature infants, in which certain cells of the lungs fail to mature at birth to cause lung collapse that can result in suffocation -NRDS is caused by a lack of surfactant that results in alveolar collapse, resulting in poor blood gas exchange -if preterm delivery: give betamethasone bc corticosteroids stimulate surfactant production -if need surfactant then administer via endotracheal tube -symptoms: tx with bethamethasone (glucocorticoid) to prevent preterm delivery; if baby is already delivered tx with exogenous phosphatidycholine which is artificial surfactant (Unlike glucocorticoid administration, exogenous phosphatidylcholine post-delivery to neonate does NOT directly reverse pathology but does prolong survival of neonate as the baby`s physiological surfactant production increases to normal levels

What bugs stain with Giemsa stain?

*C*ertain *B*ugs *R*eally *T*ry my *P*atience *C*hlamydia *B*orrelia *R*ickettsia *T*rypanosomes *P*lasmodium H. pylori too

Secondary hyperaldosteronism

*Hypertension, hypokalemic metabolic alkalosis, but HIGH plasma renin. -Pathophysiology: *Kidney perception of low intravascular volume results in overactive renin-angiotensin system. Due to renal artery stenosis, renal fialure, CHF, cirrhosis, or nephrotic syndrome.*

What is the #1 and #2 causes of painless bleeding in the elderly?

- #1 is diverticulosis - #2 is angiodysplasia (tagged RBC studies can help locate the lesion)

What enzyme is absent in the zona glomerulosa that prevents cortisol and androgen synthesis from taking place there?

- 17-hydroxylase

glucagonoma

- Rare form of pancreatic cell tumor, Maligant - Mild Diabetes (especially the symptoms) + Rash

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 constituting 27.9% cases from 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

Whipple disease

- Tropheryma Whipplei infection (bug)...gram positive bacillus (found in soil) -causes GI and joint problems - Weight loss - Diarrhea - Arthritis - Fever - Adenopathy -detected by periodic acid-Schiff stain (PAS foamy macrophages)

CTLA-4

- binds CD80/86 - suppresses immune response to limit overactivation of the immune system - competes with (outcompetes) CD28, to bind CD80/86 -block with ipilimumab tx

MODY 2

- genetic mutation leading to a type of diabetes - mutations in gene for glucokinase in Beta cells - loss of function - Beta cell less responsible to rising glucose

milk alkali syndrome

- metabolic alkalosis - renal insufficiency - hypercalcemia - anorexia, dizziness, fatigue, headache, confusion, psychosis, dry mouth - caused by taking in too much calcium and absorbable alkali (eg osteoporosis meds, antiacids) - like calcium carbonate

PD-1

- suppresses immune response -tumors can express PD-L1 which when PD-1 is bound to this, it helps keep T cells from killing other cells

Anticholinergic toxicity

-"Hot as a hare, red as a beet, dry as a bone, mad as a hatter, blind as a bat."

Respondeat Superior

-"Let the master answer" an employer is vicariously liable for the behavior of an employee working within his or her scope of employment

pityriasis rosea

-"herald patch" followed days later by other scaly erythematous plaques, often in a "Christmas tree" distribution on trunk -multiple pink plaques with collarette scale -self resolving in 6-8 weeks -**literally means pink scurf or pink dandruff...so pink scaly skin that self resolves in 6-8 weeks

winged scapula

-"serrated long wing"! -long thoracic nerve innervates the serratus anterior muscle -injury to LTN causes paralysis of the serratus anterior, weakening upward rotation of the scapula (needed for full abduction or flexion at the shoulder) -so weakness in serr ant muscle results in "winged scapula"

Erb palsy

-"waiter tip" -traction or tear of upper trunk: C5-C6 roots -causes: for infants, lateral traction on neck during delivery cause this; for adults, trauma cause this -muscle deficit (Herb gets DIBs on tips): Deltoid, supraspinatus (results in arm hanging by side bc can't abduct), Infraspinatus (results in arm medially rotated bc cannot laterally rotate), Biceps brachii (results in arm extended and pronated bc can't flex or supinate) -memory aid: erb = urp = up hehe -affects musculocutaneous, part of axillary?, and suprascapular nerve off upper trunk

Adverse effects of thiazolidinediones

-(1) Weight gain -(2) Peripheral edema -(3) ⇒ Heart failure -(4) ↓ Bone mineral density

Subacute sclerosing panencephalitis

-(SSPE) -is a very rare late complication of measles acquired when the pt is younger than 2 yrs of age -defective virus persists in the brain (involving both grey and white matter) -symptoms, including changes in personality, behavior, and memory, myoclonic jerks, blindness, and spasticity, may appear 7 to 10 years after clinical measles infection

Depression of respiratory drive

-(hypoventilation) is a breathing disorder characterized by slow and ineffective breathing -in someone who is chronically hypoxemic and retaining CO2, raising the patient's O2 saturation above 89-92% can result in a depression of respiratory drive -As a result, additional CO2 retention may occur

When is alkaline phosphatase elevated?

-*cholestasis* -pregnancy -bone disease = increased bone turnover such as Paget's disease or certain cancers (prostate, breast) that create blastic lesions

How to treat organophosphate poisoning (insecticides)?

-1. ATROPINE first! (Fix peripheral AND CNS effects) (But only fixes muscarinic receptors - thus no change in the muscular paralysis) -2. Pralidoxime second (Fixes muscarinic AND nicotinic) (But only peripheral)

pelvic splanchnic nerve

-1. Empty urinary bladder 2. Control and closing of the internal urethral sphincter 3. Influence motility in the rectum 4. Sexual functions like erection

What are the causes of DIC?

-1. Gram-negative sepsis (most common) -2. Trauma -3. Malignancy -4. Pregnancy

Folate is involved in what mechanisms/reactions

-1. Homocysteine + methylated THF --> Methionine -2. dUMP --> dTMP (aids in synthesis of thymidine)

What is the best test for: 1. primary syphilis 2. secondary syphilis 3. tertiary syphilis 4. confirming syphilis

-1. examine biopsy of chancre with darkfield microscopy -2. RPR (confirm with FTA-ABS) -3. FTA-ABS or microhemagglutination (both can serve as confirm tests for secondary syph whereas VDRL or RPR will frequently revert to negative in this phase)

Likelihood that a CIN 3 (cervical intraepithelial neoplasia) or aka CIS (carcinoma in situ) or HSIL (high grade squamous intraepithelial lesion) will progress to invasive SCC or regress?

-10% can progress to invasive SCC -30% regress -60% persists at the same level of dysplasia

Pharyngeal pouches

-1st = eustachian tube, many portions of inner ear -2nd = palatine tonsils -3rd = thymus (ventral wing), L and R inferior parathyroid glands (from dorsal wing) -4th = superior parthyroid glands (dorsal wing), ultimobranchial body (forms c-cells and derived from neural crest cells) (ventral wing)

anterior 2/3rds of tongue

-1st and 2nd arches -lingual swellings and tuberculum impar -sensation: CN V (1st arch) -taste: CN VII (2nd arch)

Treacher Collins Syndrome

-1st and second arch syndrome -aka mandibularfacial dysostosis -neural crest fails to migrate -Mandibular hypoplasia -may lead to difficulty breathing -Facial abnormalities

First degree burn vs second vs third vs fourth?

-1st--NO blisters! -2nd--Blisters!! -3, 4th--not painful!

What is the probability of spontaneous pregnancy in women with Turner syndrome?

-2%, NOT zero -pregnancies associated with high rates of miscarriages, stillbirths, and malformed babies -If the woman has heart complications, pregnancy can be dangerous -aortic dissection which occurs in 10% of turner syndrome pregnancies, causes maternal death in 2% of these pregnant women

Difference between 21-hydroxylase deficiency CAH and 11β-hydroxylase deficiency CAH?

-21-Hydroxylase deficiency is marked by deficits in glucocorticoid and mineralocorticoid synthesis coupled with increased sex steroid production, and ultimately manifests with virilization and hypotension -In contrast, 11β-hydroxylase deficiency manifests with virilization and hypertension due to accumulation of a mineralocorticoid precursor (11-deoxycorticosterone)

Ataxia Telangiectasia (key findings to help you figure this out)

-3 A's: Ataxia (frequent falls) , spider Angiomas (telangiectasia), and IgA deficiency (recurrent sinopulmonary infections)

What week does the notochord form?

-3 weeks -notochord induces spinal cord

Where does hematopoiesis occur during the following embryological development timeline: 3 weeks, 1 month, 2-4 months, and after 7.5 months?

-3 weeks: yolk sac -1 month: liver -2-4 months: spleen and lymphatic organs -after 7.5 months: bone marrow

During DKA, which ketone is predominant?

-3-hydroxybutyrate -Keotacids, which include acetoacetate and 3-hydroxybutyrate, are normally produced in roughly equal amounts -However, in pathologic conditions such as poorly controlled diabetes and alcoholism, in which the concentration of NADH is high, the ratio shifts and 3-hydroxybutyrate predominates

What cephalosporins can you use to treat Pseudomonas infection?

-3rd gen - ONLY ceftazidime -4th gen - cefepime

What drug can treat klebsiella pneumonia?

-3rd generation cephalosporin (cefotaxime)

Ovotesticular disorder of sex development

-46,XX > 46,XY -Both ovarian & testicular tissue present (ovotestis); ambiguous genitalia. **Previously called true hermaphroditism

Cricothyroid muscle is derived from what embrological structure?

-4th pharyngeal arch -this muscle is involved in speech (altering tone of voice)

Zileuton (PO)

-5 lipoxygenase inhibitos -blocks conversion of arachidonic acid to leukotrienes

what is the tx for ulcerative colitis?

-5-ASA (sulfasalazine, mesalamine)

Finasteride

-5-alpha reductase inhibitor

When will the female form the most amount of primary oocytes?

-5th month in utero

Ascaris lumbricoides

-6-12 inch long, white, cylindrical nematode that is acquired by the ingestion of ova in fecally-contaminated soils -if symptomatic, early symptoms tend to be pulmonary, while later symptoms are GI

partial mole

-69 chromosomes, partial fetal tissue present -A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes

What are the functions of active T3 hormone?

-7 B's: -Brain maturation -Bone growth (synergism with GH) -Beta-adrenergic effects -Basal metabolic rate inc -Blood sugar inc -Break down lipids (inc lipolysis) -stimulates surfactant in Babies

Warthin's tumor

-8 times more common among smokers -aka papillary cystadenoma lymphomatosum -second most common salivary tumor -usually occurs in parotid -presents of cysts filled with fluid -cysts surrounded by dense lymphoid infiltrate -lymph tissue can aggregate into lymphoid infiltrate

For a dieting obese person, where do most of the glucose come from?

-80% of glucose in this case comes from fat breakdown, more specifically from glycerol backbone of TAGs, which enter gluconeogenesis

Burkitt's lymphoma

-8:14 translocation; associated with EBV -African (or endemic) Burkitt lymphoma (sometimes associated with Epstein-Barr virus infection) often presents with a large jaw lesion and jaw swelling

How do you calculate NNH (number needed to harm)?

-> 1/AR (attributal risk) -> AR = incidence of disease in exposed group - incidence of disease in unexposed group -incidence = # new cases of disease/total # of ppl that could have developed disease

What is the tidal volume of an average adult male?

-> 500 mL

What is the difference between attributable risk (AR) vs. absolute risk reduction (ARR)?

-> ARR = risk of control group - risk of intervention group -> AR = risk of exposed - risk of non-exposed

How to calculate reabsorption via kidney of a certain electrolyte?

-> Amount reabsorbed = amount filtered - amount excreted -> amount excreted = urinary sodium concentration * urinary flow -> Amount filtered = GFR * plasma concentration

What is the anion gap calculation formula?

-> Gap = Na - Cl - HCO3

What are three different ways to calculate TLC (total lung capacity)?

-> IRV + RTV + ERV + RV -> IC + FRC -> VC + RV

What equation is used to determine the extracellular fluid volume via the tracer?

-> V = A/C (A is the amount of tracer in compartment and C is the concentration)

How do you calculate alveolar ventilation?

-> VA = (Vt - Vd) * f where VA is alveolar ventilation, Vt = tidal volume, Vd = dead space, f = respiratory rate

What is the half life formula for a drug?

-> t(1/2) = (0.7 * Vd)/Cl -Cl is clearance

If a woman has 35-day periods, when does she ovulate?

-> take 35 - 14! so 21 days! -the time between ovulation and the onset of menstruation (luteal phase) is a relatively constant at 14 days, which is the lifespan of the corpus luteum -the follicular phase can be variable in length

What is the likelihood that a complete molar pregnancy will progress to choriocarcinoma?

->2-3%

What is the carrier frequency for a rare disease?

->2pq -if RARE disease, you can say 2pq = 2q (bc p is basically ~1)

O2 content means what? O2 saturation? PaO2?

->O2 content = O2 dissolved in blood + O2 bound to RBC ->O2 sat is how much blood is bound to RBC (would be dec if have CO poisoning) ->PaO2 is pressure of oxygen in the artery so it's the oxygen dissolved in blood (dec if have lung disease or at high altitude) -> so O2 content is basically the sum of oxygen dissolved in blood + oxygen bound to RBCs

Hepatits E

-A Calicivirus- is spread via contaminated food and water rare in the United States -symptoms similar to Hepatitis A, but infections in pregnant females are likely to be fatal to BOTH mother and fetus (associated with fulminant hepatitis in pregnant women) -Acute hepatitis E infection consists of two phases: a prodromal phase and an icteric phase. In the prodromal phase, typical symptoms include fever, myalgias, nausea, and vomiting. The icteric phase manifests with symptoms of cholestasis, such as jaundice, dark urine, pale stools, and pruritus -Acute hepatitis infections may be associated with focal hepatocyte damage, which results in patchy necrosis of liver cells -no vaccine/specific treatment

What do toxin A and B do of C. diff?

-A acts as a granulocyte attractant -B is cytopathic (damage to living cells)

zone of polarizing activity (ZPA)

-A block of mesoderm located just under the ectoderm where the posterior side of a limb bud is attached to the body -required for proper pattern formation along the anterior-posterior axis of the limb. -major signaling molecule is SHH (sonic hedgehog protein)

Turner syndrome

-A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. -webbed neck, coarctation of the aorta, a bicuspid aortic valve, a high arched palate, a low hairline, widely spaced nipples and a shield chest, horseshoe kidney, short stature and cubitus valgus -presents with ovarian dysgenesis - the degeneration of ovarian follicles, which are replaced by fibrous connective tissue and result in hypoplastic, "streak" ovaries incapable of producing adequate estrogen hormone -for management of short stature, girls with this syndrome are treated with recombinant human growth hormone to increase height at an early age and limit short stature -estradiol is used to induce puberty in girls with Turner's; therapy with progestins can be added to limit breakthrough uterine bleeding -inc FSH, inc LH, dec estrogen, dec inhibin

Graft vascular disease

-A complication of heart transplantation characterized by intimal thickening of the coronary arteries, resulting in progressive stenosis of the lumen -aka graft ateriosclerosis -chronic transplant rejection (remember this stage of rejection has to do with atherosclerosis)

gallstone ileus

-A condition in which gallstones erode from the gallbladder, creating a fistula to the small bowel that may cause a bowel obstruction-->obstructs at ileocecal valve (narrowest point) -can see air in biliary tree (pneumobilia) -rigler triad: radiographic findings of pneumobilia, small bowel obstruction, gallstone (usually in ilaic foss)

calmodulin

-A cyoplasmic Ca2+-binding protein -is particularly important in smooth muscle cells, where binding of Ca2+ allows calmodulin to activate myosin light-chain kinase, the first step in smooth muscle cell contraction - calmodulin only found in smooth muscle

Cardiac amyloidosis

-A disorder caused by deposits of an abnormal protein (amyloid) in the heart tissue, which make it hard for the heart to work properly. Also called "stiff heart syndrome." -It is characterized by amyloid infiltration of the myocardial wall, which leads to decreased ventricular compliance, an S4 heart sound, and signs/symptoms of diastolic cardiac dysfunction

Acquired Long QT Syndrome

-A disorder that causes a *delay in repolarization of the myocardium* -can be caused by a bunch of drugs: antiarrhythmic drugs, levofloxacin, haldol, many other drugs -congenital LQTS pts need to avoid these drugs

Res Ipsa Loquitur

-A doctrine under which negligence may be inferred simply because an event occurred, if it is the type of event that would not occur in the absence of negligence. Literally, the term means "the facts speak for themselves." -so obviously wrong (like finding a scissor left in body after surgery)

Achondroplasia

-A form of human dwarfism caused by a single dominant allele (autosomal dominant) -the homozygous condition is lethal -defect in the fibroblast growth factor receptor 3 (FGFR3), which causes an abnormality in cartilage formation -associated with advanced paternal age

Maple Syrup Urine Disease (MSUD)

-A genetic disorder characterized by the inability to metabolize branched-chain amino acids; symptoms include a maple syrup smell in the urine. -caused by a congenital deficiency in branched chain ketoacid dehydrogenase, an enzyme that breaks down isoleucine, leucine and valine -manifests as intellectual disability and physical retardation, feeding difficulty, urine with a sweet (maple syrup) odor, seizures, coma, and/or death -Treatment involves restriction of these three amino acids and thiamine supplementation

Cystic fibrosis

-A genetic disorder that is present at birth and affects both the respiratory and digestive systems -autosomal recessive (deletion of Phe508?) -recurrent upper respiratory infections, diarrhea, and meconium ileus -In men, infertility is a complication of CF due to obliteration of the vas deferens -A negative sweat chloride test does not rule out CF as a diagnosis -The pancreas is the most commonly affected organ in CF, leading to pancreatic exocrine insufficiency. This presents as a chronic, greasy stool with flatulence from malabsorption and can lead to fat-soluble vitamin deficiencies (low levels of vitamin A, D, E, K) as well as overall nutritional deficits -Women with CF also have thicker-than-normal cervical mucus, which can mean it takes longer to successfully conceive -Psuedomonas is most likely cause of pneumonia in CF pts

Malignant hyperthermia

-A hereditary condition of uncontrolled heat production (hyperthermia) that occurs when susceptible people receive certain anesthetic drugs -caused by rapid consumption of ATP—is an autosomal-dominant genetic disorder that affects skeletal muscles -A ryanodine receptor-mediated increase in the free-calcium concentration in the skeletal muscle is responsible for the rigidity

Oxytocin

-A hormone released by the posterior pituitary that stimulates uterine contractions during childbirth and milk ejection during breastfeeding.

Tay-Sachs disease**

-A human genetic disease caused by a recessive allele that leads to the accumulation of GM2 gangliosides within cells (think Pixorize's Tay sach's and neimann pick sketch--violin, sax shop) -deficiency of lysosomal enzyme beta hexoaminidase-A (HEXA gene) -leads to destruction of nerve cells, neurodegeneration, developmental delay, and appearance of onion skin lysosomes on EM biopsy

Duchenne muscular dystrophy

-A human genetic disease caused by a sex-linked recessive allele -characterized by falling and difficulty walking, pseudohypertophy of the calf muscles, deficient dystrophin, Gower's sign, inc risk of cardiomyopathy and arrhythmias

Identify the following structures

-A is ascending colon -B is pancreatic head -C is IVC -D is abdominal aorta -E is transverse colon -F is small intestine -G is descending colon

spontaneous pneumothorax

-A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space.

respiratory distress syndrome (RDS)

-A respiratory disorder that affects premature infants born without enough surfactant in the lungs. It is treated with respiratory support and surfactant administration -the combination of prematurity and gestational diabetes carries a significant risk of neonatal respiratory distress syndrome, which is caused by insufficient surfactant levels -Treatment maternal steroids before birth; exogenous surfactant for infant -Risk factors : prematurity, maternal diabetes (due to fetal insulin), C-section delivery (release of fetal glucocorticoids; less stressful than vaginal delivery)

Loeffler endocarditis

-A restrictive heart disease that causes endomyocardial fibrosis with associated eosinophilia; most common in tropical/temperate climates -histo: eosinophilic infiltrates in myocardium -a cause of restrictive/infiltrative cardiomyopathy (think of Sketchy's Dilated and Restricted cardiomyopathy sketch-right hand side with the old dude holding the log/hay-like fibrotic heart rod)

What is a sentinel event and how do you go about addressing it?

-A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury -All accredited organizations are expected to respond to sentinel events with a thorough and credible root cause analysis (RCA) and action plan

Dxx for pain radiating to the back

-AAA (abdominal aortic aneurysm) -aortic dissection -pancreatitis

Bilateral renal artery stenosis

-ACE inhibitors will precipitate acute renal failure -bilateral abdominal bruits and and history of peripheral vascular disease might contribute to this

HNPCC (Lynch syndrome)

-AD DNA mismatch repair defect → colorectal, endometrial, & other cancers (ovarian cancer and etc) -can cause colon cancer without polyps

Chromosome 5q contains what tumor suppressor gene?

-APC -beta-catenin is controlled by the APC protein

Antisocial personality disorder vs. conduct disorder

-APD is a person over 18 who is violent as hell, commits crimes, and assaults people -if the person is under 18, it's called conduct disorder

Hartnup disease

-AR defective neutral amino acid transporter on renal and intestinal epithelial cells -> tryptophan excretion in urine -the clinical syndrome that occurs in hartnup is that of niacin deficiency otherwise known as pellagra -photosensitivity is a symptom (can lead to rash)

Endocardial cushion defects

-AV canal defects -AV septal defects -ASD, VSD, Valvular malformations -common in Down Syndrome

annular pancreas

-Abnormal migration of the ventral pancreatic bud -Can compress duodenum, causing vomiting (biliary vomitting)

Small cell lung cancer (SCLC)

-Accounts for 20-25% of all bronchogenic carcinomas (look for CT with a bronchiol region mass) -may have paraneoplastic syndromes where ADH is high, lambert eaton muscle problems, low calcium -history shows smoking -neuroendocrine tumor and stains positive for Chromogranin A and neuron specific enolase and synaptophysin

What does interferon gamma do?

-Activates macrophages and TH 1 cells. -Suppresses T h 2 cells -Has antiviral and antitumor properties -main formation of granulomas

Waterhouse-Friderichsen syndrome

-Acute adrenal insufficiency due to disseminated meningococcal disease -pts have a systemic infection (sepsis) from Neissieria meningitides, which causes bilateral adrenal hemorrhage -pts with acute adrenal insufficiency (adrenal crisis) typically present in shock, which involves altered mental status, hypotension, and tachycardia -pts in shock can have cool, mottled-appearing extremities due to poor circulation (shock fever, petechial rash, etc)

Fever, RUQ pain, positive murphy's sign indicates what?

-Acute cholecystitis

Epiglottitis symptoms

-Acute onset of high fever -Dysphagia -Drooling -Muffled voice -Inspiratory retractions -Stridor -Cyanosis -Sniffing dog position (neck hyperextended) -xray: thumb sign

What product or hormone of the cortex of the adrenal gland is not stimulated by ACTH

-Aldosterone production! -zona glomerulosa produces aldosterone and this is regulated by angiotensin II and hyperkalemia

Adverse effect of ethanbutol

-Although ethambutol is generally well tolerated, one of the most common adverse effects of this medication is bilateral ocular toxicity manifesting as optic neuritis -Ethambutol toxicity can manifest with reduced visual acuity and red-green color blindness, which are symptoms of optic neuritis -Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye

prophylactic tx for influenza

-Although the most effective means of influenza prophylaxis is the seasonal vaccine (as given to this patient already), neuraminidase inhibitors can be offered as adjunctive prophylaxis in high-risk groups, including patients ≥65 years old, residents of nursing homes, pregnant women, morbidly obese patients, and people with certain chronic medical conditions -ex. oseltamivir and zanamivir

Panic disorder

-An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations -abrupt onset of symptoms that generally peak within 10 minutes

Diptheria

-An infectious disease in which a membrane forms, lining the pharynx; this lining can severely obstruct the passage of air into the larynx -caused by gram positive bacillus cornebacterium diphtheria -symptoms: sore throat, malaise, low grade fever, and cervical lymphadenopathy -pharynx classically shows a gray0white membrane composed of fibrin, inflamm cells, bacteria, and necrotic debris -rarely seen outside the developing world due to widespread vaccination -inactivates elongation factor 2 in human cells

How to confirm HIV diagnosis?

-An initial enzyme-linked immunosorbent assay (ELISA) detects the presence of antibodies, followed by a confirmatory HIV-1/2 antigen/antibody immunoassay if the initial ELISA results are positive -Further differentiation is then performed using an HIV-1/HIV-2 antibody differentiation immunoassay to determine HIV-1 or HIV-2 status -If this test is indeterminate an HIV-1 nucleic acid test can then be performed

Pt with breasts, scant axillary and pubic hair, and absent cervix and uterus so no mensturation...what does the pt have?

-Androgen Insensitivity Syndrome (AIS)--think jAImie lee curtiS -due to androgen receptor defect resulting in normal appearing female (46, XY DSD), scant pubic and ax hair, rudimentary vagina, absent fallopian tubes and uterus -inc testosterone, estrogen, and LH -male external genitalia are absent because DHT requires a normal androgen receptor -pts have cryptorchid testes located either in the inguinal canal or abdominal cavity....so inc risk of cancer and so typically removed surgically

What does angiotensin II do to the kidney?

-Angiotensin II Constrict Efferent -mneumonic: ACE -Angiotensin I is converted to angiotensin II via ACE

The most common ankle sprain overall affects what ligament?

-Anterior TaloFibular ligament (Always Tears First) -considered a low ankle sprain

What is the most common ligament affected in a common high ankle sprain?

-Anterior inferior tibiofibular ligament

Tocainide

-Antiarrhythmics Class IB - Na+ Channel Antagonist

Allotype

-Antigenic differences within a given class of Ig between members of the same species -differences dictated by genetic inheritance

Zileuton

-Antileukotrienes -5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes. -Used for asthma -Hepatotoxic

When you see a patient with pancytopenia and low reticulocyte, then what should you think?

-Aplastic anemia!! -bone marrow biopsy will show hypocellularity, predominance of fat cells and marrow stroma -also carbamazepine can cause aplastic anemia

familial dysbetalipoproteinemia

-ApoE2 mutation -inc cholesterol and TAGS

Dermatitis herpetiformis

-Autoimmune deposition of IgA and C3 at the tips of dermal papillae -Sign of systemic disease -manifests as group excoriations, erythematous and urticarial plaques, and grouped papules with vesicles -classically affects the buttocks, back and the extensor surfaces of the elbows and knees -strong association with gluten -sensitivity enteropathy (celiac)

dermatitis herpetiformis

-Autoimmune deposition of IgA at the tips of dermal papillae -presents as small papulovesicular lesions of the extensor surfaces of the elbows and knees -histo: dermal-epidermal separation with subepidermal blisters and neutrophilic accumulations -associated with celiac disease and IgA Abs against endomysial, tissue transglutaminase, and deamidated gliadin peptides within the intestinal tract -in skin, IgA cross-reacts with reticulin tonofibrils, disrupting cell anchoring and resulting in the dermo-epidermal separation

Brugada syndrome

-Autosomal dominant disorder most common in Asian males. -ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3. -⬆️risk of ventricular tachyarrhythmias and SCD. Prevent SCD with implantable cardioverter-defibrillator (ICD) -an inherited sodium channel abnormality that leads to arrhythmias in young men

What is the pathologic agent that causes Bird Fancier's?

-Avian proteins

Which macrolide does not inhibit the CYP system?

-Azithromycin (is the Eziption = exception)

What bacteria is gram positive and has a large boxcar shape morphology?

-B. anthracis (think like a black beamer bmw)

How to treat lead poisoning?

-BAL and EDTA

How can you tell if something is metabolic vs respiratory acidosis vs alkosis?

-BB says look at CO2 and pH, if change is both going same way then its metabolic...if CO2 is in normal range then resort to HCO3- and refer to chart

"palisading nuclei" skin cancer

-BCC -may present on sun-exposed areas of the face in the form of pearly papules with central ulceration and telangiectasias -histo: palisading pattern of basal cell like nuclei at the periphery of tumor nests can be appreciated -lesions can be locally invasive but almost never metastasize

What uses cGMP?

-BNP/ANP -NO -All vasodilators

Two common mutation causes of melanoma and what is the general difference between them?

-BRAF - gain of fxn (activate MAP kinase) -CDKN2A - loss of fxn (tumor suppressor gene p16)

diminished or absent lymph nodes/tonsils, commonly affects males with recurrent bacterial or enteroviral diseases that present after 6 months of age

-BTK!

You have RBCs problems and you went camping in the north east...what bug should you think of?

-Babesia!! -on microscopy, look for either rings and or maltese cross

Reasonable Patient Standard

-Basically what the average patient would need to know to make an informed decision

What is the first line therapy for osteoporosis prevention?

-Bisphosphonates are indicated as a first line therapy for the treatment and prevention of osteoporosis -bisphos are the safest and best tolerated agents for osteoporosis and associated with a reduced risk of non-vertebral fractures

Chloramphenicol MOA

-Blocks peptidyltransferase at 50S ribosomal subunit. -Bacteriostatic.

renal osteodystrophy

-Bone lesions due to secondary hyperparathyroidism due to chronic kidney disease (CKD)

Difference between type I and type II RTA

-Both proximal (II) and distal (I) RTA lead to a normal anion gap (<12) and hypokalemia, however proximal RTA causes a urine pH<5.5 because protons are secreted normally from the CT

Myc-C is associated with?

-Burkitt lymphoma -BurCit

Milrinone

-By inhibiting PDE3, milrinone increases intracellular cAMP levels in cardiac muscle and vascular smooth muscle -Increased cAMP in cardiac muscle cells leads to increased cardiac contractility, and increased cAMP in vascular smooth muscle cells leads to decreased peripheral vascular resistance

Diarrhea, fever, leukocytosis after taking broad spectrum antibiotics (especially in a hospital setting) can cause what?

-C. Diff associated colitis

What are the body's mediators for anaphylaxis?

-C3a, c4a, c5a (a for anaphylaxis) -a type I hypersensitivity reaction characterized by the release of vasoactive amines (histamine) that cause hypotension, skin-mucosal involvement, respiratory compromise, and/or gastrointestinal symptoms -hives, itching and/or flushed skin, swollen lips and tongue, periorbital edema, and conjunctival swelling

Cleidocranial dysotosis

-CCD...also called cleidocranial dysplasia (the kid from stranger things has this!) -birth defect that mostly affects the bones and teeth -collarbones are typically either poorly developed or absent, which allows the shoulders to be brought close together

What interaction induces B-cell isotype switching?

-CD40 - CD40L -CD40L is activated CD4 T cell that interacts with CD40 of the B cell that wants to class switch

what immune cell is responsible for maintaining CD4 levels in a pt with HIV not on meds?

-CD8 cells bc they help to achieve equilibrium by killing infected CD4 T cells to prevent expansion fo the infection -Eventually CD8 T-cells will be unable to control the infection

-when do CK, CK-MB, and troponin kick in and how long do they persist?

-CK and CK-MB -- elevated in plasma about 4 to 6 hours after infarction and remain elevated for 24 to 48 hours -troponin levels are elevated to 2 to 4 hours after infarction and remain elevated for up to 2 weeks

BCR-ABL gene

-CML (chronic myeloid leukemia) -normally found on separate chromosomes -but in abnormal cases, these are fused together -BCR is on chromosome 22 and ABL is on chromosome 9 -tyrosine kinase -BCR-ABL mutation happens when pieces of BCR and ABL genes break off and switch places

Deafness is a complication of which viruses?

-CMV and rubella

If see owl eye inclusion and pt is a transplant patient, what bug is likely to be the infectious pathogen?

-CMV!!! and don't you forget! you always get the transplant part wrong! -CMV is part of herpesviridiae viruses and so is DS DNA enveloped icosahedral virus

Seizure in an immunocompromised pt, along with a single ring-enhancing lesion of CT scan suggests what?

-CNS lymphoma (can be caused by EBV--primary central nervous system lymphoma is variable but can present with confusion, seizure, and memory loss, as well as ring-enhancing lesion on CT scan -differentiates from toxoplasmosis bc Toxoplasmosis more commonly demonstrates multiple ring enhancing lesions on CT -NOT JC virus bc a single ring-enhancing lesion would not be seen on CT scan--instead would show a hypodense patch or confluent white matter regions, and typically does not cause seizures but instead manifests with altered mental status, motor deficits such as hemiparesis or monoparesis, limb ataxia, gait ataxia, visual symptoms

What is the MOA of CO poisoning and what are the suspected lab values?

-CO binds to the oxygen-binding sites of hemoglobin with an affinity 250 times that of oxygen -This results in both decreased oxyhemoglobin saturation and decreased oxygen-carrying capacity -CO causes a left shift in O2-hb dissociation curve bc oxygen gets stuck and cannot unload to tissues as easily

What gases are diffusion limited?

-CO, O2 (in empysema, interstial fibrosis, etc) -can think about CO as loving hemoglobin so doesn't have a blood problem...also the DLCO (pretend this stands for "diffusion limited CO") is actually used to measure diffusion lol...so problem with diffusion

what is a good diagnostic test for pulmonary embolism?

-CT angiography is the best test for this -if have advanced chronic kidney disease, the dye of the CT angiography that is needed may result in renal failure and need for dialysis, so in this case use ventilation-perfusion scan as the next best test

What kind of stones are seen in Crohn's disease?

-Ca oxalate/phosphate

Dystrophic calcifications

-Calcium deposits in injured or dead cells -result of necrosis -local calcification -may indicate prior necrosis and may also cause disease (aortic stenosis)

Dystrophic calcification

-Calcium deposits on dead tissues in the setting of normal serum calcium and phosphate -you can get mitral annular calcification (MAC) found on echocardiography among older pts

ACE inhibitor adverse effects

-Captopril's CATCHH -Cough -Angioedema -Teratogen -Creatinine (dec GFR) -Hyperkalemia -Hypotension -Used with caution in bilateral renal artery stenosis bc ACE inhibitors will further dec GFR--> renal failure

Rocky Mountain Spotted Fever

-Caused by Rickettsia rickettsii -rash on palms and soles (migrating to wrists, ankles, then trunk), HA, fever. Endemic to East Coast (in spite of its name). -rare complications include seizure, thrombocytopenia, hyponatremia, and disseminated intravascular coagulation

How to tx VAP?

-Ceftazidime, a third-generation cephalosporin, is an appropriate treatment as is piperacillin-tazobactam, aztreonam, meropenem, doripenem, and ciprofloxacin (bc bug is pseudomonas)

What NSAID is still available on the market while the other drugs similar to it was taken off for cardiotoxicity?

-Celecoxib -which also doesn't cause ulcers wooO! (apparently ibuprofen may cause ulcers so watch out!)

Central vs. Nephrogenic Diabetes Insipidus

-Central: From Hypothalamus or Pituitary...water deprivation does not decrease urinary frequency/concentration -Tx with Desmopressin Nephro: Impaired renal response to ADH...no response to desmopressin

jaundice, fever, RUQ pain

-Charcot's triad of cholangitis (cholangitis - infection of biliary tract) -so this is acute cholangitis aka ascending cholangitis (this is a type of choledocholithiasis) -is a medical emergency requiring ERCP/endoscopic removal of the obstruction (diagnostic and therapeutic...MRCP is another test but just diagnosis)

Why should acetominophen not be taken in a pt with a history of chronic alcoholism?

-Chronic alcoholism induced CYP450 which is what metabolizes acetominophen into NAPQI (toxic metabolite = ROS) and so NAPQI increases -acetominophen also depletes glutathione metabolites

What macrolide most notably inhibits the CYP450 system?

-Clarithromycin -(Erythromycin inhibits CYP450 system as well. However, AZITHROMYCIN does not!!)

Cystic fibrosis mutation classification

-Class I: impaired CFTR protein synthesis -II (70%): impaired CFTR channel processing and trafficking -III: dec CFTR channel response to stimulation by ATP IV: dec CFTR channel conduction of ions V: dec number of CFTR channels or inc turnover

Umbilicus anastomoses

-Clinical sign: Caput medusae -Portal: Paraumbilical -Caval/systemic: Small epigastric veins (superificial veins) of the anterior abdominal wall

What is the only widely used centrally acting anti-hypertensive medication?

-Clonidine -Abrupt discontinuation of clonidine leads to severe rebound hypertension as a result of a sudden increase in sympathetic outflow

Difference between cohort and case control study?

-Cohort starts with exposure and measures disease (Relative risk can be calculated by using data collected during a cohort study to answer questions such as: What is the risk of a smoker developing COPD compared with that of a nonsmoker) -Case control starts with disease and looks at exposure

Cold temperature causes you body to do what?

-Cold temperature: Causes peripheral vasoconstriction and central vasodilation -so inc blood flow to kidney which lowers ADH -and also inc bf in central region which inc atrial stretching-->inc preload-->inc ANP

"Apple core" lesion on barium enema x-ray

-Colorectal cancer (usually left-sided)

osteogenesis imperfecta (OI)

-Common and severe bone impairment of genetic origin, affects the formation of collagen during bone development resulting in frequent fractures during fetal and new-born period -common finding = blue sclera and hearing loss (due to diminshed type 1 collagen content of middle ear structures, including the ossicles))

Straddle injuries

-Commonly cause injury to the urethra -More common in males -Accidents include walking a fence or beam, riding a horse or motorcycle -Rupture of the urethra at the bulbous segment after a crushing injury will lead to inability to void, blood in the urethral meatus, and scrotal swelling -Rupture of the bulbous urethra inferior to the external urethral sphincter (urogenital diaphragm) occurs from crushing injuries to the perineum, such as a straddle injury on the handrail during a skateboarding accident

osmotic demyelination syndrome

-Complication of aggressive correction of -HYPOnatremia. Axonal demyelination of pontine white matter. -"From low to high, your pons will die."

esophageal atresia

-Congenital absence of distal part of the esophagus -Food cannot pass from the baby's mouth to the stomach

Romano-Ward syndrome

-Congenital long QT syndrome -Autosomal dominant, pure cardiac phenotype (no deafness) caused by mutations in ANK2 gene causing disruption in ion channels and electrical currents in cardiac myocytes -Clinical symptoms include syncope, seizures, development of torsades de pointes and sudden cardiac death -Diagnosis is based on family history of sudden cardiac death, ECG findings, and exercise test -Treatment is aimed at decreasing the incidence of cardiac arrhythmias by using β-blockers and heart ganglion blocks

Dubin-Johnson syndrome

-Conjugated hyperbilirubinemia due to defective liver excretion -Grossly black liver -Benign -patients are generally free of symptoms but may experience intermittent bouts of jaundice as a result of an intercurrent illness

PDA murmur

-Continuous machine-like murmur

What bug is gram positive, club shaped and arranged in V or L shapes?

-Cornybacterium diphtheriae

What is the only approved anticoagulant approved to treat anti-phospholipid antibody syndrome?

-Coumadin! -see pic for anti--phospholipid antibody syndrome characteristics

craniopharyngioma

-Craniopharyngiomas are the most common supratentorial tumor of children. They are derived from Rathke's pouch, which is a fetal structure comprised of surface ectoderm, that eventually gives rise to the anterior pituitary gland. While they are technically benign tumors, craniopharyngiomas can cause hypopituitarism through mass effects on the pituitary gland. Additionally, these tumors can cause bitemporal hemianopsia due to compression of the nearby optic chiasm. Craniopharyngiomas appear calcified on CT, and surgical resection will show a cystic tumor filled with brownish / yellow motor-oil like fluid

What is the maintenance dose equation?

-Css could also just mean concentration in plasma -it takes four to five half-lives to achieve steady state

What does the E. coli fimbrae cause

-Cystitis is caused by Escherichia coli (E. coli), which uses its fimbriae present on the outside of the bacterial cell wall to attach to the epithelial cell walls of the urinary tract -This allows the bacteria to withstand the pressure of the fluid flowing past them and colonize in the urinary tract. Escherichia coli is a gram-negative bacillus (rod) bacteria which can be observed under microscope

What is D-dimer a measurement for?

-D-dimer is used to rule out the diagnosis of Pulmonary embolism in patients with a low or moderate pretest probability

Paget disease of the nipple

-DCIS that infiltrates the epidermis of the nipple -Nipple erythema, ulceration, and eczematoid changes. -cells stain positive for cytokeratin immunohistochemical stain -paget cells are large cells with clear cytoplasm surrounding hyperchromic nuclei - stain positive for mucin or PAS -adenocarcinoma associated

differentiation of genital tubercle depends on the presence of...?

-DHT -DHT induces the genital tubercle and urogenital sinus to differentiate into the penis, which allows for determination of fetal sex during a US examination

Etiology of schistocytes/MAHA?

-DIC -prosthetic heart valves -TTP -HUS

If vomiting contains bile, where is the obstruction?

-DISTAL to common bile duct (at ampulla of Vater--2nd part of duodenum)

Abatacept

-DMARD: blocks CD80 and 86, prevents T cell activation -selective costimulation modulator that inhibits T-cell activation and is indicated for RA and psoriatic arthritis, but not transplant rejection

Type 4 hypersensitivity MOA

-DOE NOT INVOLVE ANTIBODIES!!!! -two mechs each involving T cells: -1. direct cell cytotoxicity (CD8 cytotoxic T cells kill targeted cells) -2. Inflammatory reaction (effector CD4+ T cells recognize antigen and release inflammation-inducing cytokines) -Th1 cells sensitized to haptenated cells make cytokines that activate cytotoxic T lymphocytes and macrophages

Goodpasture syndrome

-Damage to alveolar and renal glomerular basement membranes by cytotoxic antibody -pt present with renal disease in conjunction with hemoptysis -auto-antibodies against the alpha-3 chain of type IV collagen

Lab levels of secondary hyperparthyroidism

-Dec in serum calcium -Inc in PTH, serum phosphate, and alkaline phosphatase

In patients with systolic heart failure, what is the primary problem?

-Decrease in L ventricular contractility

In patients with diastolic heart failure, what is the primary cause?

-Decreased compliance; the Left ventricle ejection fraction is normal

Fanconi syndrome

-Defect in proximal tubule -Can't reabsorb anything basically (so find aa in urine and glucose and other electrolytes) -Low energy state -Can be caused by old tetracycline -has glycosuria but normal glucose levels in plasma bc insulin is working (as opposed to diabetes where it has glucosuria and low glucose levels in plasma)

succinylcholine

-Depolarizing neuromuscular blocker that causes hyperthermia (graffiti anti-cholinesterase sketch) -depolarizing skeletal muscle relaxant that opens the nicotinic cholinergic receptor, thus causing K+ efflux -The mechanism of action of Succinylcholine involves what appears to be a "persistent" depolarization of the neuromuscular junction. This depolarization is caused by Succinylcholine mimicking the effect of acetylcholine but without being rapidly hydrolysed by acetylcholinesterase. This depolarization leads to desensitization

Blueberry muffin rash

-Description of rash characteristic of congenital rubella

Congenital diaphragmatic hernia

-Diaphragm doesn't fully develop allowing abdominal organs to migrate into the chest cavity -defective formation of pleuroperitoneal membrane -in utero herniation-->pulmonary hypoplasia -can also present with displacement of mediastinal components, low apgar scores (due to lung malformation and respiratory distress), absence of bowel gas in the abdomen

Mitral stenosis murmur

-Diastolic RUMBLE with opening snap. LOW frequency= Rumble -no left sided S3, S4 in mitral stenosis -time to opening snap is associated with severity of M stenosis (high left atrial pressure causes dec time to opening snap--short time to opening snap seen in severe disease)

Disruption vs. Deformation vs. Malformation

-Disruption is an extrinsic caused factor where growth is disrupted/affected -Deformation is an extrinsic factor that causes something to abnormally or mis-shapenly formed -Malformation is an intrinsic factor that where growth is disrupted/affected

Bacillary angiomatosis vs. HHV-8 (kaposie sarcoma)

-Distinguish under the microscope. HHV-8 = virus ∴ Lymphocytic infiltrate; B. henselae is neutrophilic infiltrate + granulomas

Developmental milestones age 3-5

-Don't Forget, they're still Learning -D: Drive (tricycle - 3 wheels at 3 yrs), Drawings (by 4yrs), Dexterity (hops on one foot at 4 yr; uses buttons or zippers/grooms self by 5 yr) -F: Freedom (comfortably spends part of day away from mother at 3 yr), Friends (cooperative play, has imaginary friends at 4 yr) -L: Language (understands 1000 words by 3 yr (3 zeros), uses complete sentences and prepositions by 4yr, Legends (can tell detailed stories by 4yr)

With what congenital disease is the atrioventricular septal defect most commonly associated with?

-Down syndrome -about 50% of infants with Down syndrome have heart defects -in Down syndrome, the superior and inferior cushions often fail to fuse, resulting in tricupsid and mitral valvular abnormalities, along with an ostium primum atrial septal defect

acamprosate

-Drug for alcohol dependence -used in chronic prevention of relapse in alcoholics

Anti-histone antibodies

-Drug induced SLE, rarely seen in regular lupus -Hydralazine? -Procainamide -Isoniazid?

When breaking bad news, what is the first most important thing to do?

-ESTABLISH PATIENT CONFIDENTIALITY AND PRIVACY -just bc they're family is there in the room with them, ask them to leave and then disclose the news -pt can over-ride physician's request and ask for family to stay for the news

What other toxin is very similar to cholera enterotoxin?

-ETEC's heat LABILE toxin bc they both stimulate adenylate cyclase by ADP ribosylation of GTP-binding protein (Gs subunit)

Pharyngeal pouch derivatives

-Ear, tonsils, bottom to top 1 = ear 2 = tonsils 3 = dorsal (bottom for inferior parathyroids) 3 = ventral (to-thymus) 4 = top = superior parathyroids

eccentric hypertrophy vs. concentric hypertrophy

-Eccentric: volume overload (regurg)--inc mass of ventricle and cavity size but normal thickness of wall -Concentric: pressure overload (stenosis)--super thick wall but normal mass and small cavity size

What parasite causes liver problems and anaphylactic shock?

-Echinococcus granulosis -major concern with hydatid cysts is the potential for anaphylaxis during a procedural intervention -careful dissection of the liver cyst must be preformed during surgery to prevent the release of echinococcal antigens into the bloodstream

Wiskott aldrich syndrome

-Eczema, recurrent respiratory infections, thrombocytopenia, all caused by X-linked recessive B and T lymphocyte deficiency, Caucasian -the mutation leads to impaired cytoskeleton formation in all blood cells, which appears to mostly affect T cell function -elevated IgE and IgA (EAT and games wasp sketch) -low IgG and IgM (EAT and games) -thrombocytopenia (broken plates on street in sketch)

Trisomy 18

-Edwards syndrome -Affected patients have low IQ (developmental delay), and an unique appearance including rocker-bottom feet, micrognathia (small jaw), low-set ears, clenched hands with overlapping fingers, a prominent occiput, and congenital heart disease (most commonly ASD & VSD) -The syndrome is typically fatal by 1 year of age

EMTALA

-Emergency Medical Treatment and Active Labor Act -Only applies to Emergency departments of hospitals that accept Medicare -Patient legal status, citizenship, ability to pay or other demographic factors are irrelevant -EDs can not transfer or discharge patients without informed consent of pt or caregiver -requires hospitals with an ED to provide medical screening exams to any patient who presents

What bug has cysts in the stool that are spherical in shape, 10-20 microns, and have granular cytoplasm containing up to four nuclei

-Entamoeba histolytica (2 nuclei shown in pic)

ferrochelatase

-Enzyme that catalyzes joining of iron and protoporphyrin to make heme in the mitochondria -deficiency is indicated in lead poisoning

Euthyroid sick syndrome

-Euthyroid sick syndrome (also known as nonthyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI); critically ill pts -> low TSH -> low T3/T4 -can look like central hypothyroidism -rT3 rises in critical illness (impaired clearance) -usually occurs during a systemic illness like pneuomnia

What type of genetic mutation in what gene leads to DMD and BMD?

-Exon deletions in the dystrophin gene -approx 15% of patients with DMD contain a deletion that encompasses exon 49 and 50 in the dystrophin gene (76 total exons in the gene) -when mutated RNA is spliced, a stop codon is introduced into exon 51, leading to premature termination of protein synsthesis and dysfxnal dystrophin is produced and degraded -eteplirsen is a synthetic oligonucleotide that specifically targets exon 51 of the DMD gene, causing the splicing machinery to skip exon 51, so exon 48-52 are spliced together, resulting in an in-frame splice

true or false: SJS is a CD4 T cell-mediated immune disorder that occurs about 1-3 weeks after drug exposure

-FALSE -SJS is a CD8 t cell mediated immune disorder that occurs about 1-3 weeks after drug exposure

T or F: neonatal physiological jaundice occurs int he first 24 hours

-FALSE! -it is neonatal physiologic jaundice,which occurs because neonatal conjugation enzymes are not fully mature or ready and spleen is removing excess red blood cells that carry Hgb F -please keep in mind that it NEVER occurs in first 24 hours. so if you find a neonate with jaundice in first 24 hours,it is always PATHOLOGICAL NOT PHYSIOLOGICAL

T or F: for an autosomal recessive condition, if a phenotypically normal child is born to parents that are both heterozygous for the condition, the probability that the child is a carrier is 1/4

-FALSE!!!!! -it is actually 2/3 bc you eliminate the possibility that they are affected

Infective endocarditis presentation

-FROM JANE -Fever -Roth spots -Osler nodes -Murmur -Janeway lesions -Anemia -Nail bed hemorrhages -Emboli

cleft lip is caused by?

-Failure of fusion of the maxillary and medial nasal processes (formation of 1* palate)

Ehlers-Danlos syndrome

-Faulty collagen synthesis -hyperextensible skin, tendency to bleed (easy bruising), and hypermobile joints -Multiple types. Inheritance and severity vary. -Can be autosomal dominant or recessive -May be associated with joint dislocation, berry and aortic aneurysm, organ rupture -Hypermobility type (joint instability): most common type -Classical type (joint and skin symptoms): mutation in type V collagen (COL5A1, COL5A2) -Vascular type (vascular and organ rupture): deficient type III collagen (can present with think skin with varicosities, easy bruising, absence of joint hyperextensibility, abnormal facial structure)

Hyperestrinism

-Feature of Liver Failure (HE) which causes levels of estrogen to be increased in the blood causing the following symptoms: -associated with palmar erythema (red swollen hands), spider angiomas, erectile dysfunction, and gynecomastia

desmoplasia

-Fibrous/collagenous stroma tissue formation in response to a neoplasm -usually seen with malignant neoplasms, although there are benign processes such as surgical scars that can also cause this

How to treat SVT (supraventricular tachycardia)?

-First, try carotid massage or valsalva (slows HR) -second, adenosine (if first methods don't work) -third, (if adenosine doesn't work - resistant cases) use procainamide

What do you want to measure to confirm hyperthyroidism in a pregnant lady?

-Free T4 -not T3 bc T3 is basically modulated at the tissue level (as in T4 is converted to T3 when needed so doesn't necessarily have to be high during hyperthyroidism but T4 will be!) -so since pregnancy inc thyroid binding globulin--it is possible she might have inc overall t4 but not have hyperthyroidism (overall t4 = bound t4 + free t4)...this is due to her inc amount of TBG which is bound to more t4, and since our bodies respond to concentration of free t4 only)...so check free t4

What kind of receptor is the GnRH receptor?

-G protein coupled receptor that uses phospholipase C as a 2nd messenger to inc inositol triphosphate (IP3)

P2Y12 adenosine diphosphate receptor

-G protein receptors found on platelet cell membranes and, when activated, cross-link platelets together to initiate plate aggregation in the form of a platelet clot -target of anti-platelet drugs such as clopidogrel, prasugrel, and ticagrelor -used to minimize further damage and formation of new clot (ex. STEMI) (NOT USED to treat CURRENT clots)

An african american pt has an x-linked recessive disorder which causes red cell hemolysis, what should you think?

-G6PD!

Differential diagnosis of newborn/neonatal vomiting

-GERD is much more common in infants due to an immature LES -not esophageal spasms (bc presents with intermittent swallowing difficulty)

What accounts for old age GFR decrease?

-GFR decrease is primarily due to glomerular destruction and dec glomerular numbers = glomerulosclerosis -aging it associated with an approx 1mL/min/year drop in GFR beginning at around 30 years

Liddle syndrome

-Gain of function mutation where there is increased Na+ reabsorption in collecting tubules (increased activity of ENAC channel). -Autosomal dominant -Results in hypertension hypokalemia, metabolic alkalosis, decreased aldosterone. -amiloride (blocks ENaC -mimics the effects of excess of aldosterone

What is it called when a wound is purple in color and has crepitus when palpating the area?

-Gas gangrene-- skin may become pale and then evolve to a gray or purplish red color -crepitus (describes any grinding, creaking, cracking, grating, crunching, or popping that occurs when moving a joint) is secondary to gas formation -associated with C. perfringes

Aspirin toxicity

-Gastric ulceration, tinnitus (CN VIII). Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding. Reye syndrome in children with viral infection. -Overdose initially causes hyperventilation and respiratory alkalosis, but transitions to mixed metabolic acidosis-respiratory alkalosis. -often causes tinnitus

Huntington's disease

-Genetic disorder that causes progressive deterioration of brain cells -caused by an autosomal dominant allele -symptoms do not appear until about the age of 30 -symptoms: psycho-behavioral problems and chorea (purposeless jerky/dancing movements) and dementia -pathology: caudate nuclei degeneration, with additional, though less prominent, degeneration of the putamen and nucleus accumbens--atrophy of the caudate and putamen can make the lateral ventricles appear very large when imaged (hydrocephalus ex vacuo)

Endoderm derivations

-Gi track (foregut, midgut, hindgut), lower respiratory (larynx, trachea, bronchi, and lung), GU (bladder, urethra, and lower vag), Pharyngeal pouches, forms of parenchyma (liver, pancreas, submandibular and sublingual glands, follilces of thyroid gland

Difference between Gilbert's syndrome vs. Crigler Njar?

-Gilbert's is impaired bilirubin conjugation -CN is absent hepatic glucuronosyltransferase (usually in kids with kernicterus)

What is the MOA difference between crigler najjar and gilbert's syndrome?

-Gilbert's syndrome: deficiency in UDP-glucuronyl transferase -Crigler najjar: complete deficiency of UDP-glucuronyl transferase (type I can cause kernicterus bc unconjug bilirubin is REALLY HIGH)

Celiac Sprue

-Gluten-sensitive enteropathy Diarrhea, malabsorption, weight loss -Test for Tissue Transglutimase antibody and Endymysial antibody Gluten restriction -autoimmune-mediated intolerance to gliadin (wheat) -Dermatitis herpetiformis is a skin condition seen in 25% of patients with celiac disease and appears as a pruritic, vesicular rash on the extremities

glycogen synthase deficiency

-Glycogen Synthase enzyme deficiency -Elevated blood glucose, lactate, & lipids after Carb meal. Low glucose & high ketone bodies during fasting. Defect in muscle tissue causes weakness & difficulty with exercise. -fasting hypoglycemia in the absence of hepatomegaly

Leuprolide

-GnRH agonist-->initial LH/FSH release, but then down-regulation-->decreased estrogen and testosterone Uses: -If given continuously: tx of metastatic prostate cancer, leiomyomas -If given in pulsatile manner: tx of infertility

Streptococcus sanguinis

-Gram (+) positive, catalase negative, alpha hemolytic nonmotile, non-spore forming cocci, facultative aerobic found in healthy human mouths found in dental plaque

Bacteroides

-Gram negative, bacilli, anaerobic -part of the bacterial flora of the mucous membranes including gastrointestinal tract, mouth, and genitals -can cause abscesses at any endogenous site, including central nervous system (CNS), head and neck, abdomen, and pelvis -clindamycin can tx this -capsule is antiphagocytic -penicillin resistance due to beta-lactamase production

positive nitrite test

-Gram-negative bacterial UTI (except S. Saprophyticus)

ribavirin

-Guanosine analogue-->inhibits viral RNA polymerase-->inhibits viral replication -blocks the Inosine monophosphate conversion to guanosine-MP to DNA -treats RSV bronchiolitis

What can H. pylori eventual cause at the gastro-esophageal junction?

-H. pylori causes inflammation by making alkaline media around them (urease + ve ) to allow them to survive in the acidic environment of the stomach and in turn the stomach increases its acid production due to the inflammation ( that's why we prescribe poi in the treatment of h. pylori) , anyway this process causes GERD by time Barrett esophagus by time adenocarcinoma in the lower third esophagus

What type of G protein is the H1 receptor? And what about H2?

-H1 is Gq (shown in sketchy pic) -H2 is Gs

What are the causes of a normal anion gap met acidosis

-HARDASS -hyperalimentation, addison disease, renal tubular acidosis, diarrhea, acetazolamide, spironolactone, saline infusion

Most murmurs increase in sound with more preload except:

-HCM -MVP

What is kaposi sarcoma?

-HHV8 -neoplastic lesions characterized by angiogenesis and proliferating spindle-shaped cells -most common AIDS-related malignancy and has no cure -often confused with bartonella henselae but is diff bc has LYMPHOCYTIC infiltrate, not neutrophilic -sex contact -dark violaceous plaques or nodules, representing vascular proliferations

What is the disease/condition when you have low platelets, increase bleeding time, and increase PTT?

-HIT (heparin induced thrombocytopenia) -potentially fatal disorder characterized by extreme thrombocytopenia and an increased risk of thrombosis -A direct thrombin inhibitor such as argatroban should be administered to prevent or manage thrombosis and the heparin should be discontinued as soon as the diagnosis is suspected -Protamine sulfate is used only to reverse the effects of heparin in cases of an overdose with associated bleeding

pt comes in with fever, sore throat, lymphadenopathy, hepatosplenomegaly...what should you suspect?

-HIV -HIV should always be suspected in pts presenting with mono-like symptoms but with a negative monospot test

In humans, what are the MHC class II molecules?

-HLA DP, DQ, and DR

In humans, what are the MHC class I molecules?

-HLA-A, HLA-B, HLA-C

Prior to starting abacavir, which of the following tests should most likely be ordered?

-HLA-B genotyping

What alleles is type 1 diabetes associated with?

-HLA-DR3 and HLA DR4 -Genetically susceptible individuals who are exposed to environmental triggers (such as viral infections, environmental toxins, and dietary components) are at risk of developing type 1 diabetes -also patients can present with weight loss!

Most anal cancers are squamous cell carcinoma associated with what?

-HPV virus, specifically serotypes 16 and 18--found in cervical, vulvar, penile, and oropharyngeal cancers

What bug is a gram-negative pleomorphic coccobacilli that can cause conjunctivitis?

-Haemophilus influenza

Heme synthesis

-Heme synthesis begins with glycine and succinyl-CoA--> to form ALA (aminolevulinic acid), catalyzed by the mitochondrial ALA synthase (rate-limiting step) and requires cofactor, Vitamin B6 (Pyridoxine) -Deficiencies in ALA synthase or Vitamin B6 result in sideroblastic anemia -ALA synthase can also be inhibited by high level glucose and hemin -ALA converted into porphobilinogen by the enzyme ALA dehydratase, which is inhibited by lead poisoning. -Porphobilinogen is turned into hydroxymethylbilane catalyzed by porphobilinogen deaminase, which is defective in Acute Intermittent Porphyria. -Hydroxymethylbilane -->uroporphyrinogen III-->coproporphyrinogen III (catalyzed by uroporphyrinogen decarboxylase, which is defective in Porphyria Cutanea Tarda) -Coproporphyrinogen is converted into protoporphyrin, which then undergoes iron chelation by the mitochondrial ferrochelatase, producing heme. -The action of ferrochelatase can also be inhibited by lead poisoning

HELLP

-Hemolysis, Elevated Liver enzymes, Low Platelets -A manifestation of severe pre-eclampsia -blood smear shows schistocytes (bc of MAHA) -can lead to DIC (due to release of tissue factor from injured placenta) and hepatic subcapsular hematomes-->rupture-->severe hypotension -tx with immediate delivery

Polyarteritis nodosa

-Hep B +, affects multiple medium-sized arteries EXCEPT PULMONARY -Transmural inflammation w fibrinoid necrosis -Patients often have a skin rash known as livedo reticularis, which is the purplish discoloration described in this patient

how does Hep B replicate?

-Hep B is a partially double-stranded DNA virus and synthesizes positive sense RNA which is used for a template for protein translation with the help of reverse transcriptase

If a medical staff accidentally sticks themself with a needle, are they more likely to contract bacterial septicemia, hep C, or HIV?

-Hep C! -the risk of acquiring HCV from a contaminated needlestick is greater than the risk of HIV -bacterial septicemia is unlikely

defective enveloped circular RNA virus is what bug?

-Hep D

transjuglar intrahepatic portosystemic shunt (TIPS) can cause what?

-Hepatic encephalopathy (He)-TIPS is a common trigger for this -why? bc the shunt bypasses the liver, allowing systemic shunting of ammonia -when have cirrhosis, always think about the ammonia problem!

Vitamin A excess during pregnancy can cause...

-High risk for spontaneous abortions -High risk of cleft palate and cardiac defects -microcephaly -Teratogenic in first trimester

Streptococcus bovis

-Highly associated w/ colon cancer. -One of the group D streptococci -significant association between S. bovis bacteremia and endocarditis in patients with carcinoma of the colon and other colonic diseases

Muscles near what joint will most likely be affected first in Duchenne's muscular dystrophy?

-Hips! -children use their arms to help get up from the ground (Gower's sign), signifying weakness of hip muscles

Down syndrome risks

-Hirschsprungs (due to failure of neural crest migration) -lymphoma (plant in pic) -AV septal defect (due to failure of neural crest migration) -ALL and AML (alligator in pic) -Alzheimers (devil mask in pic) -also presents with prominent epicanthal folds, biliary emesis, simian crease (single palmar crease)

small cell carcinoma histology

-Histologically, SCC is seen as round, oval, or angulated cells that contain small amounts of cytoplasm

Patient form Mississippi-Ohio-Missouri river valleys with calcifying lung lesions....what bug is responsible for this?

-Histoplasma (small 2-5 microns with no true capsule) OR -Blastomyces -also, calcifying lesions forming in the lungs are very suggestive of fungal infection

What disease does pt have if have enlarged hard lump/lymph node, weight loss, and binucleated cells?

-Hodgkin lymphoma -Reed sternberg cells are binucleated

Mitral regurgitation murmur

-Holosystolic (pansystolic), often loud, blowing, best heard at apex, radiates well to left axilla -5th intercostal space, mid-clavicular line

Ventricular septal defect (VSD)

-Holosystolic, harsh-sounding murmur Loudest at tricuspid area -small VSD-->more turbulence--> loud murmur

Job syndrome

-Hyper IgE syndrome -gene mutation responsible for the findings in Job syndrome is STAT3 -findings in Job syndrome can be recalled by using the mnemonic FATED: Facies that are coarse, Abscesses that are cold, retained primary Teeth (so two sets of teeth when there should just be one set of adult teeth), increased IgE, Dermatologic problems -IL-17, produced by TH17 cells, is necessary for appropriate neutrophil chemotaxis and is affected in this syndrome

Complete moles produce extremely high beta-hCG levels and can cause what endocrine finding?

-Hyperthyroidism

What uses cAMP pathway?

-Hypothalamus (CRH, GHRH) -anterior pit hormones (FSH, LH, ACTH, TSH) -parathyroid gland (PTH) -Others (glucagon, ADH V2 receptor for water, Histamine H2 receptor for stomach acid, hCG, MSH)

What are the causes of hypoxemia?

-Hypoventilation -Diffusion impairment -Severe V/Q mismatch -Pulmonary shunt -low atmospheric O2 -hypoxemia = below-normal level of oxygen in your blood, specifically in the arteries

What cytokine is directly secreted by Th1 cells?

-IFN-gamma!!!! which stimulate macrophages to help fight which in turn produce IL-12 -also produces IL-2 which stimulates growth and proliferation of all t cell subsets

Defect in what is the most common cause of severe combined immunodeficiency disease (SCID)

-IL-2

What are chemotactic factors for neutrophils (transmigration and chemotaxis)?

-IL-8, bacterial products, C5a, leukotriene B4 -pathoma pg. 13

Is Chlamydia trachomatis intracellular or extracellular?

-INTRACELLULAR! -obligate intracellular

How to tx DKA

-IV fluids -potassium replacement -IV insulin

Restrictive lung disease etiologies

-Idiopathic pulmonary fibrosis -Pneumoconioses -Sarcoidosis

Omalizumab (Sq injection)

-IgG monoclonal antibody -inhibits IgE binding to IgE receptor on mast cells and basophils

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 (R cardiac shadow on x-ray)

meconium ileus

-In cystic fibrosis, meconium plug obstructs intestine (at ileus) preventing stool passage at birth.

When are meds like montelukast or similar to montelukast used in asthma treatment?

-In patients with asthma that is refractory to corticosteroids alone, leukotriene pathway modifiers can be used as adjuvant therapy -Montelukast acts as a leukotriene receptor blocker with no effect on the production of leukotrienes

abnormal a waves

-In patients with atrial fibrillation, the jugular venous tracing shows abnormal a waves, indicating abnormal atrial contraction

Physiologic changes in pregnancy

-Increased blood volume (red cell mass expands, inc maternal EPO but also plasma volume expands mores so leads to--> dilutional anemia) -peripheral resistance falls -Increased cardiac output -Increased heart rate -Decreased blood pressure (slightly) -hypercoagulable state -ventilation increases -stimulates salt and water retention to cause isotonic volume expansionAutosom

Increasing prevalence does what to PPV and NPV?

-Increasing the prevalence of a disease will increase the likelihood that a positive test result is indeed positive (increases PPV) and increases the likelihood that a negative test may be a mistake (decreases NPV)

Crohn disease and nephrolithiasis

-Individuals with Crohn disease can develop fat malabsorption, leading to the increased lipids in the large intestine -These lipids can compete with oxalate for calcium binding in the GI tract, thereby causing decreased formation of calcium-oxalate aggregates (which are eliminated) and increased amounts of free oxalate (which is reabsorbed) -Oxalate then must be eliminated in the urine at high concentrations, which can lead to the formation of calcium oxalate kidney stones

Congenital long QT syndrome

-Inherited disorder of myocardial repolarization, typically due to ion channel defects (abnormal K/Na channels); ⬆️ risk of sudden cardiac death (SCD) due to torsades de pointes -Jervell and Lange-Nielsen Syndrome--happens in Norway and Sweden and occurs with congenital Long QT syndrome and occurs w/ congenital deafness

MOA of sulfonamides

-Inhibit dihydropteroate synthase (first step of folic acid synthesis)

Digoxin MOA

-Inhibition of Na/K-ATPase pumps in the heart -⇒ ↓ Ca2+ efflux due to inhibition of Na+/Ca2+ exchanger (bc inhibiting by inc in Na+ intracellulary)..so inc in Ca2+, which leads to inc in contractility

Trazodone

-Inhibition of: (1) 5-HTreuptake (2) 5-HT2 receptors (3) α1 receptors (4) H1 receptors -distinctive side effect is Priapism

What is the MOA of fluconazole and of the like?

-Inhibits conversion of Lanosterol → Ergosterol (Via inhibition of 14α-demethylase)

zanamivir MOA

-Inhibits influenza neuramminidase, decreasing release of progeny virus -inhibits virion release -similar MOA to all the other "mivir" drugs like oseltamivir and anamivir

Rifamycin

-Inhibits mRNA synthesis -Penetrates tissues; -antitubercular activity -inhibiting DNA-dependent RNA polymerase and are used in the prophylaxis of bacterial meningitis

Terbinafine MOA

-Inhibits the fungal enzyme squalene epoxidase--which affects lanosterol synthesis

What signals work through tyrosine kinase pathway?

-Insulin -growth factors (IGF-1, FGF, PDGF, EGF)

Griseofulvin MOA

-Interferes with microtubule function (specifically alpha and beta tubulin); disrupts mitosis. -Deposits in keratin-containing tissues (e.g., nails).

nystagmus

-Involuntary rapid eye movements -saccadic eye movements

What can be used as a marker for a mumps infection?

-It infects the parotid gland, which produces increased serum amylase and can be used as a marker for the infection -IgM will also be elevated during an infection of mumps

Premature ovarian failure

-It refers to a failure of estrogen production by the ovaries of a woman <40 -Its most commonly idiopathic. But it could also be due to adhesion, Hashimotos's, irradiation or chemo -high LH and FSH, low E

Jervell and Lange-Nielsen syndrome vs. Romano-Ward syndrome

-JLN has deafness -RW has NO deafness (romano)

Job syndrome (hyper-IgE syndrome)

-Job is A-DOPE AD STAT3 gene AR-HIES? -STAT3 is affected and regulates growth and differentiation of T helper cells (type 17--th17) Clinical features: 1) Abscesses and skin infections 2) atopic Dermatitis 3) Osteopenia 4) Pneumonia and other sinopulmonary infections (pneumocele) 5) hyper IgE, hyper Eos + --> coarse faces: broad nasal bridge, prominent forehead --> dental abnormalities - retention of primary teeth - double-row of teeth

What does the k-capsule of E. coli cause?

-K-capsule of E. coli is a virulence factor that helps to protect the bacteria from being engulfed by macrophages; it is responsible for causing pneumonia and neonatal meningitis

What are the urease positive bugs?

-KiSS PUNCH

What is kidney failure and what can lead to it?

-Kidney (renal) failure is when kidneys don't work as well as they should. The term "kidney failure" covers a lot of problems. These problems can result in kidney failure: -Your kidney doesn't get enough blood to filter -Your kidney is hurt by a disease (like high blood sugar (diabetes), high blood pressure, glomerulonephritis (damage to the kidney's tiny filters), polycystic kidney disease) -Your kidney is blocked by a kidney stone or scar tissue

deep labored breathing

-Kussmaul breathing

familial hypercholesterolemia

-LDL receptor defect -inc total cholesterol -inc LDL and apolipoprotein B-100 -little stringy things in the sketch is tendon xanthomas

hyperchylomicronemia

-LPL deficiency (lipid butter knife--cutting off fat) -inc TAGS (>1000mg/dl) -LPL (lipoprotein lipase) and its cofactor Apo C-II cleave and release TAGS from chylomicrons, thereby delivering dietary TGs to body tissues -impaired triglyceride breakdown therefore leads to extremely high TAG levels and chylomicrons

LYST gene

-LYSosomal Tracking gene -usually mutated in chediak-higashi syndrome

fluorescence in situ hybridization (FISH)

-Laboratory technique used for specific localization of genes and direct visualization of anomalies (e.g. microdeletions) at molecular level (when deletion is too small to be visualized by karyotype)

Birbeck granules are solely found in what cells?

-Langerhans cells -tennis rackets or rod shaped on EM

Length time bias vs lead time bias

-Lead-time is when a test diagnoses a disease earlier and as a result, the time from diagnosis until death appears prolonged making it look like the pt lives longer from earlier diagnosis...when really they just caught it earlier but disease progression does not change -Length time is when a screening test detects a large proportion of slowly progressing disease which makes it look like survival benefits of a screening test overvalued bc the aggressive disease can come up quick and be missed

What causes varicose veins?

-Leaky/faulty valves (blood flows backwards causing the veins to distend) due to chronically high venous pressure in legs -while upright for extended periods, venous blood pools int he legs and compromises vessel wall support over time

Where do the adrenal glands drain?

-Left adrenal -> renal vein -> IVC -Right adrenal -> IVC

What can increase SHBG (sex hormone binding globulin) and estrogen?

-Liver cirrhosis increases them (In both males and females, SHBG is synthesized in the liver, but for males it is also synthesized in the Sertoli cells. When there is liver cirrhosis, the estrogen can't be metabolized and builds up....? Estrogen induces SHBG synthesis) -hyperthyroidism inc SHBG -androgens hypothyroidism (maybe bc less estrogen made), nephrotic syndrome dec SHBG

GLUT-4 transporters

-Location: Skeletal Muscle & Adipose Tissue Insulin Sensitive*******

Winged scapula

-Long thoracic nerve (C5,6,7) damage -serratus anterior deficit -causes: axillary node dissection after mastectomy, stab wounds -inability to anchor scapula to thoracic cage-->cannot abduct arm above horizontal position

silhouette sign

-Loss of margin of normal structure due to loss of air-fluid interface

Amount of K+ and PO4- in a DKA pt

-Low electrolytes are seen in cells because they are traded with H+ in serum from metabolic acidosis -Amount of K+ or PO4- in cells is LOW but amount in serum is normal or high!

libman-sacks endocarditis

-Lupus associated sterile vegetations that form on BOTH sides of mitral valve

What gastric cancer is linked to H. pylori

-MALT lymphoma (see blue tissues on the left side of pic)

staghorn calculi are made of what kind of stones?

-MAP or cystine stones

Anytime you see low glucose, low or non-detectable ketones (and possibly high levels of ocatnoyl-glycine or other FA chains bound)...then you should think of?

-MCAD deficiency!!! -remember that the fatty acid acyl-coa dehydrogenase isn't working properly so cannot do beta oxidation and generate the FADH2

what is important for clearance of virus from infected cells by RSV?

-MHC class 1

MLF lesion

-MLF causes consensual adduction of the opposite eye (i.e. R eye looking left when L eye looks left)...so if convergence is intact, but consensual adduction is broken, this means that the MLF is disconnected

migrating myoelectric complexes

-MMC which is initiated every 90-120 mins between meals, beginning in the stomach and migrating to the ileum -have a general cleansing housekeeping function, sweeping undigested food residues/cellular debris/bacteria/inorganic materials through the intestine in prep for next meal -absence of this results in bacterial overgrowth syndrome

Sulfasalazine

-MOA: combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid; activated by colonic bacteria Clinical use: ulcerative colitic, Crohn's disease Toxicity: sulfonamide toxicity, reversible oligospermia -apparently it is first line treatment for UC

Buspirone**

-MOA: stimulates 5-HT (1A) receptors (partial agonist) -clinical use: GAD -DOES NOT CAUSE sedation, addiction, or tolerance -DOES NOT INTERACT with alcohol or cause sexual dysfunction -begins to take effect after 1-2 weeks -mnemonic: I get anxious if the bus doesn't arrive at one, so I take buspirone

Cardiac function curve and vascular function curve basics

-MSP = mean systemic pressure

What treats ectopic pregnancy?

-MTX -management of ectopic pregnancy may either be surgical or medical (MTX is medical)

What are the common causes of increase anion gap met acidosis?

-MUDPILES -methanol (formic acid), uremia, DKA, propylene glycol, iron tables/INH, lactic acidosis, ethylene glycol, salicylates (late)

How does macrolides specifically work?

-Macrolides function by binding to the 23S ribosomal RNA (rRNA) of the prokaryotic 50S ribosome, effectively blocking the translocation step of protein synthesis

Epithelioid histiocytes

-Macrophages with abundant pink cytoplasm; make up granulomas

Whipple's disease

-Malabsorption syndrome caused by Tropheryma whippelii -S&S: weight loss, diarrhea, and athralgias -malabsorption syndrome (with bacteria-laden macrophages) & polyarthritis -systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa -Cardiac symptoms, Arthralgias, and Neurologic symptoms are common.Diarrhea/steatorrhea occur later in disease course.Most common in older men -PAS the foamy Whipped cream in a CAN

DiGeorge Syndrome

-Maldevelopment of 3 and 4 pharyngeal pouches -fascial dysmorphia -cardiac shunt -lack of T-cells -thymic, parathyroid, and cardiac defects -cardiac surgery as an infant, recurrent infections, and a cleft lip and palate -caused by a microdeletion at chromosome 22q11 -CATCH-22, which stands for Cleft palate, Abnormal facies, Thymic aplasia, Cardiac defects, Hypocalcemia, and deletion of chromosome 22

what are the two classic conditions that lead to aortic dissection in a young pt?

-Marfan syndrome -bicuspid aortic valve -in addition, cocaine abuse is also associated with aortic dissection (can cause an abrupt rise in bp that may lead to aortic dissection)

Broad spectrum sunscreen

-Means that the sunscreen product has been shown to protect against both UV-A and UV-B radiation of the sun.

Ectopic uptake on pertechnetate study of the GI tact strongly suggests what?

-Meckel's diverticulum

Acute promyelocytic leukemia

-Median onset 65 yrs -histo: auer rods, myeloperoxidase + cytoplasmic inclusions seen mostly in APL, inc circulating myeloblasts on peripheral smear -Without proper treatment, patients with APL are at high risk for bleeding due to DIC (inc PT/INR and PTT; dec platelet count)

What are the drugs that cause AIN?

-Medications that cause interstitial nephritis include penicillins, cephalosporins, ciprofloxacin, macrolides, vancomycin, sulfonamides, proton pump inhibitors, and nonsteroidal anti-inflammatory drugs

Duty to warn

-Mental health professional's responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened -best first immediate action, then call police if cannot get a hold of target and maybe hospitalize the patient who expressed harming the target

Theophylline

-Methylxanthine -Likely causes bronchodilation by inhibiting phosphodiesterase increasing cAMP levels due to decreased cAMP hydrolysis. -Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity); metabolized by cytochrome P-450. -Blocks actions of adenosine. -toxicity: think like caffeine (nausea, vomiting (GI tox), seizures (neurotox) -can also treat COPD

Pontiac fever

-Mild flu-like syndrome, cough, and headache without any pulmonary parenchymal disease -caused by legionella pneumophilla

heteroplasmy

-Mitochondria in the same cell having different alleles of a particular gene -Presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrial inherited disease

Leber hereditary optic neuropathy

-Mitochondrial disorder creates a defective enzyme responsible for converting oxygen, fats, and simple sugars to energy. -Characterized by vision loss in teens/young adult, 90% males (usually permanent)

3 Causes of Holosystolic/pansystolic Murmurs

-Mitral regurg -Tricuspid regurg -VSD

Is the mean, median, or mode most likely to not be affected by outliers?

-Mode! -Mean is MOST affected!

Leukotriene receptor antagonists

-Montelukast (blocks at LTD4) -useful in aspirin sensitive asthma

Asbestos exposure can lead to what?

-Most common cancer associated with asbestos exposure is bronchogenic carcinoma, with malignant mesothelioma occurring significantly less often -Histopathologic findings of ferruginous bodies on lung biopsy suggest asbestos exposure -Smoking alone increases the risk of developing bronchogenic carcinoma, but not mesothelioma

Fibromuscular dysplasia

-Most commonly affects renal artery and carotid artery -can lead to concentric thickening of the renal artery wall, leading to decreased luminal diameter and renal blood flow -is a condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body -Fibromuscular dysplasia appears most commonly in the arteries leading to the kidneys and brain

Do all RNA viruses replicate in the cytoplasm?

-Mostly! -All RNA viruses replicate in the cytoplasm except influenza and retroviruses

Baclofen

-Muscle Relaxant -centrally acting skeletal muscle relaxant -used for spasticity from MS or secondary spinal cord injuries -common side effects: transient drowsiness, fatigue, hypotension -severe rxns: CNS and respiratory depression, as well as psychiatric disturbances and hallucinations -can cause brady cardia

cyclobenzaprine

-Muscle Relaxant -spasmolytic that is structurally related to TCAs and commonly prescribed for acute muscle pain/spasms -can cause sedation, has anticholinergic effects such as dry mouth, mydriasis, and tachycardia -rare side effects are respiratory depression, confusion, and widening of the QRS complex

McArdle's disease

-Muscle glycogen phosphorylase/myophosphorylase deficiency (think of Pixorize's McHurdle disease sketch with the second wind hurdler) -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 -presents with severe muscle cramps, pain, weakness during exercise and can present with rhabdomyolysis, resulting in red urine -inc in creatine kinase and myoglobin levels

What are acid fast bugs?

-Mycobacterium tuberculosis -Mycobacterium leprae -Norcadia (partially) -Cryptosporidium

Myenteric and submucosal plexuses are also known as?

-Myenteric = Auerbach -Submucosal = Meissner

What is built up in a pt who has B12 defiency?

-N5-methyltetrahydrofolate

What enzyme is responsible for respiratory burst?

-NADPH oxidase -if this is deficient then can't kill phagocytosed organisms with oxidative burst-->chonic granulomatous disease

Why is NAPQI toxic?

-NAPQI becomes toxic when GSH is depleted by an overdose of acetaminophen, Glutathione is an essential antidote to overdose. Glutathione conjugates to NAPQI and helps to detoxify it

Von Recklinghausen disease

-NF type 1 -multiple neural tumors (neurofibromas) anywhere on or in the body, numberous pigmented cutaneous lesions (cafe au lait spots), pigmented iris hamartomas (lisch nodules) -autosomal dominant (think of wrecking ball pixorize sketch)

Chromosome 17q contains what tumor suppressor gene?

-NF-1

CD 56

-NK cell marker

Is thyroid hormone a steroid hormone?

-NO -but is fat soluble and can cross membrane of cells

Is prednisone active or nah?

-NO -needs to be activated to prednisolone

Are mifepristone or misoprostol used for ectopic pregnancy?

-NO -use methotrexate for an ectopic pregnancy abortion

What is the pathologic agent that causes Silo Filler's?

-NO2 gas (from animal feed in a silo)

is osteoarthritis inflammatory or not?

-NOT inflammatory!

Treatment of mild osteoarthritis pain?

-NSAIDS

What are the normal values of Na+ and Cl-

-Na+ = 136-145 -Cl- = 95 - 105 -i think normal urine osmolarity is 500 -i think plasma osmolarity normal is 300

sacubitril

-Neprilysin inhibitor -usually combined with valsartan (ARB) to make ARNI

Distinguishing polyuric states

-Neurogenic DI: after fluid deprivation (<300); after desmopressin (>800) -Nephrogenic DI: after fluid dep (<300); after desmoplressin (<300) -Primary Polydipsia: after fluid dep (>800); after desmopressin (>800)

What is the first-choice treatment for urinary tract infections (UTIs) in pregnant women?

-Nitrofurantoin -A penicillin or a first-generation cephalosporin, such as cephalexin, can also be used to treat cystitis during pregnancy -these drugs are not contraindicated in this population and provide sufficient coverage of the organisms most frequently associated with UTIs (Escherichia coli and other gram-negative rods)

Pulmonary Capillary Wedge Pressure (PCWP)

-Normal PCWP 5 - 10 mmHg > 18 is inconsistent with weaning. - indicates Left ventricular failure. - Fluid overload. -basically is preload

Pt with Cushings or pt on corticosteroids can cause what bone problems?

-OSTEOPOROSIS!

Pygmalion effect

-Occurs when a researcher's belief affect the measurements between groups and ultimately biases the results of the study

Uniparental disomy

-Offspring receives 2 copies of a chromosome from 1 parent and no copies from the other parent.

TNF alpha and Mycobacterium tuberculosis

-One of Mt's virulence factors is the cord factor that creates a serpentine cord. It activates macrophages and induces the release of TNF-α contributing to the formation of caseating granulomas, thus perpetuating the infection -but also TNF-alpha effective in preventing re-activation

How to tx COPD acute exacerbations?

-Oxygen -Nebulized albulterol +/- ipratropium (known as combivent) -IV or oral corticosteroids (prednisone 60 mg daily or methylprednisolone 80mg IV q48hrs) -Antibiotics (severe hospitalized patients) - fluoroquinolones or amoxicillin/clavulanate -then treat for longterm chronic disease using GOLD criteria (based on FEV1)

What are the most common cancers that mets to to bone?

-PB-KTTL -Prostate/Breast > Kidney/Thyroid/Testes/Lung

What disease does a female pt with greasy, pale/light colored stools, and anti-mitochondrial antibodies have?

-PBC! -may also present with jaundice, pruritus, hepatosplenomegaly -typically w cholestatic pattern of LFTs (inc conjugated bilirubin, inc cholesterol, inc ALP, and inc GGT) -tx with ursodiol

What does prostaglandins vs ACE do to the kidney?

-PDA (Prostaglandins Dilate Afferent) -ACE (Angiotensin II Constricts Efferent)

Roflumilast (PO)**

-PDE-4 inhibitors -reduced inflammation -may relax airway smooth muscle

What are the intracellular hormones?

-PET CAT -Progesterone, estrogen, testosterone, cortisol, aldosterone, thyroid hormone

Explain PET - how it works

-PET shows consumption of glucose (detects malignant tumors/cancers) -cancer cells use aerobic glycolysis (there is O2 present but does glycolysis) so takes up a lot of glucose to generate enough ATP and this is picked up on PET

Four primary causes of E coli-induced diarrhea can be remembered by?

-PITcH: -EPEC -EIEC -ETEC -EHEC

PKA is activated by what? PKC is activated by what?

-PKA is activated by cAMP -PKC is activated by DAG which is activated from IP3 which is activated by PLC which is activated by Gq

Phenylketonuria

-PKU Genetic disorder caused by a mutation that causes the inability to metabolize the amino acid phenylalanine into tyrosine -If not treated, can lead to intellectual disability, seizures, and other serious disorders (congenital heart defects like coarctation of the aorta and hypoplastic left heart syndrome) -caused by a deficiency of phenylalanine hydroxylase (PAH) and required cofactor is tetrahydrobiopterin (BH4) -managed with a phenylalanine-restricted and BH4 supplementation -similar to alcohol effects on baby

causes of papillary necrosis

-POSTCARDS: -Pyelonephritis -Obstruction of urogenital tract -Sickle cell -Tb -Chronic liver disease -Analgesic/alcohol abuse -Renal transplant rejection -Diabetes mellitus -Systemic vasculitis

Which kidney disease shows dense subepithelial humps above the basement membrane?

-PSGN -Electron microscopy shows dense subepithelial humps on the glomerular basement membrane (PSGN also associated with subendothelial deposits too)

What characteristics on ECG are signs of hyperkalemia?

-Peaked T waves and PR prolongation on ECG are signs of hyperkalemia, which can be due spironolactone, a potassium-sparing diuretic, as well as ACE inhibitors

Mechanism of resistance for Penicillins (Penicillin G, V, Amoxicillin, Ampicillin, aminopenicillin); penicillinase resistant penicillin (dicloxacillin, nafcillin, oxacillin); cephalosporins; and carbapenems?

-Penicillin G, V, Amox, Amp, Aminopen -- beta lactamases/penicillinase whcih cleaves beta lactam ring -penicillin resistant penicillins like Dicloxa, naf, and ox--MRSA alters penicillin binding protein target site -cephalosporins--cephalosporinases which is a beta lactamase and struct change in PBP (transpeptidases) -carbapenems--carbapenemases

What is peripheral resistance referring to?

-Peripheral resistance is the resistance of the arteries to blood flow

schizoid personality disorder

-Person is a loner with little interest or involvement in close relationships with anyone (voluntary) -anhedonia (don't get joy from normal things)

What kind of mutation is found in cystic fibrosis?internal urrrr

-Phe508 deletion (funnel cups falling and being misfolded) which causes misfolding of the chloride channel, which is then retained in the RER

What drugs exhibit zero order elimination

-Phenytoin, ethanol, aspirin -PEA (a pea is round, and shaped like a 0 in zero-order)

What uses IP3?

-Phospholipase C converts PIP2 to IP3 -Hypothalamus (GnRH, TRH) -Posterior Pit (Oxytocin, ADH V1 receptor for vasoconstriction) -Others (Histamine H1 receptor for skin/lungs, Angiotensin II, Gastrin)

What is an AIDS-defining pneumonia?

-Pneumocystis jirovecii -use BAL (to obtain sample) and methanamine silver stain (to stain) and Pj will look like disc-shaped yeast -CD under 200 -this is an extracellular, atypical, monorphic fungus (yeast like)

What is the mneumonic for the autonomic innervation of the male sexual response?

-Point Squeeze and Shoot -Point = Pelvic splanchnic nerves (S2-S4) which is parasympathetic and leads to erection -Squeeze = Hypogastric Nerve (T1-L2) which is sympathetic and leads to emission -Shoot = Pudendal nerve which is visceral and somatic nerve and leads to ejaculation

Tetrodotoxin

-Poisoning can result from ingestion of poorly prepared puffer fish (exotic sushi) -Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization - blocks action potential without changing resting potential (same mechanism as Lidocaine) -Causes nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes. -Treatment is primarily supportive.

If a first trimester pregnant woman has grave's disease, what is the best treatment?

-Porpylthiouracil (PTU) and NOT methimazole because this is contraindicated during the first trimester of pregnancy due to its association with congenital malformations -radioactive iodine is also contraindicated throughout pregnancy

mosaicism

-Presence of genetically distinct cell lines in the same individual -somatic mosaicism--mutation arises from mitotic errors after fertilization and propagates through multiple tissues or organs -gonadal mosaicism--mutation only in egg or sperm cells. if parents and relatives do not have the disease, suspect gonadal (or germline) mosaicism

Iron poisoning

-Presents with nausea and vomitting (coffee ground vomitus) and Diarrhea and abdominal pain, GI bleeding and Metabolic acidosis. -Fe accumulates in mitchochondria and resulting in cellular damage. -Hypotension then occurs due to increased vascular permeability and venodialation (and can lead to shock)

Mitral valve disorders cheats

-Proclick (mitral valve prolaspse is systolic click) -Stenosnap (mitral stenosis has an opening snap)

Sonic Hedgehog Gene

-Produced at base of limbs in zone of polarizing activity --> apical ectodermal ridge -Involved in patterning along limb anterior- posterior axis -Involved in CNS and limb development; mutation can cause holoprosencephaly -muatation can cause abnormalities of the midline facial structures

What endocrine hormones use an intracellular receptor?

-Progesterone -estrogen -testosterone -cortisol -aldosterone -T3/T4 -vitamin D -PET CAT on TV

What hormone initiates thick endometrium with long, coiled glands that are lined by a columnar epithelium with prominent cytoplasmic vacuoles adjacent to the gland lumen?

-Progesterone!! -progesterone initiates a transition from the proliferative phase of the endometrial cycle to the secretory phase

Hepatorenal syndrome

-Progressive renal failure associated with hepatic failure characterized by a sudden decrease in urinary output, elevated blood urea nitrogen and creatinine levels, decreased urine sodium excretion, and increased urine osmolarity -One of the features of hepatorenal syndrome is that kidney anatomy is completely unaffected, and thus visualization of the kidneys by most modalities would reveal normal size and shape

What bug can cause malignant otitis externa?

-Pseudomonas aeruginosa is causative in 95% of cases -malign otitis externa also known as necrotizing otitis externa, is an invasive bacterial infection that involves the external auditory canal and skull base - can cause facial nerve weakness -It is a complication of external otitis externa that occurs in immunocompromised, elderly, and diabetic patients -infection can spread from the external ear to the temporal bone, sigmoid sinus, the base of the skull, meninges and brain

What gives rise to umbilical arteries?

-R and L umbilical arteries arise from the internal iliac arteries -after birth, these arteries obliterate and become the medial umbilical ligaments

Persistent S2 splitting

-RBBB or pulm hypertension -exhalation--delayed PV S2 -more inspiration PV S2 splitting -peRsistent has a Right sided delay

RBC can measure what body comparment?

-RBCs are restricted to the vasculature -usually around 5 L on average

In what stage or cycle in sleep do people dream?

-REM

primers are made up of dna or rna? which one?

-RNA

Dengue virus

-RNA flavivirus with 4 serotypes -clinical: nausea/vomiting, rash, headache, eye pain, muscle aches, joint pain, leukopenia, thrombocytopenia, and positive tourniquet test -plasma leakage or vascular leak syndrome can complicate the course of infection with dengue virus and result in fluid accumulation, shock and organ damage -dx via direct detection of viral components in serum by reverse-transcriptase PCR OR indirect detection of antibodies against the viral antigens such as nonstructural protein 1

Hepatitis E

-RNA hepevirus (naked SS positive sense RNA) -most similar to Hep A of the others -transmission is fecal-oral, especially waterborne -short incubation -clinical: fulminant hepatitis in Expectant (pregnant) women*** -prog: high mortality in pregnant women**! -No HCC risk -patchy necrosis of liver (seen in biopsy) -Enteric, Epidemic (e.g. parts in Asia, Africa, Middle East), no carrier state

Bronchilitis in infants should make you think of what?

-RSV (you could also think of parainfluenza which is croup) -signs are fever, labored breathing, and wheezing -nasal secretions/flaring -tachypnea and tachycardia -could have grunting and or intercostal retractions -common in colder weather -usually in kids under 2 yrs

What is the best first test to preform when you think pt has cholestasis?

-RUQ US -this differentiates extrahepatic from intrahepatic

Murmur ascultation

-RUSB--aortic stenosis -LUSB--Pulmonic murmurs and PDA -LSB (erb's point)--Aortic regurg, HCM -Apex--mitral murmurs -LLSB--tricuspid murmurs, VSD

The helium dilution technique can be used to measure what?

-RV and functional residual capacity, neither of which can be measured directly using simple spirometry -remember VC-RV like a VCR in an RV

therapeutic window

-Range of drug doses that can treat disease effectively/or just effective while staying within the safety range.

Diamond-Blackfan anemia

-Rapid onset anemia within 1st year of life due to intrinsic defect in erythroid progenitor cells -inc in HbF percentage (but total dec in total Hb) -short stature, craniofacial abnormalities, and upper extremity malformations (triphalangeal thumbs)

merkel cell carcinoma

-Rare neoplasm from merkel cell of epidermis -*neural crest-derived cell important for tactile sensation -* may resemble metastatic SCC from lung or certain lymphomas -*aggressive -histo: rare and typically appears as flesh colored or blue nodule Tx is aggressive surgery

X-linked aggamaglobulinemia

-Recurrent bacterial infections due to absence of B cells bc mutation in BTK, a tyrosine kinase gene whose functional absence results in defective b cell maturation -treat with IV-IG (IV immunoglobulins)

vertebrobasilar insufficiency

-Reduced blood flow in the posterior circulation of the brain -Vertigo, Dysarthria, diplopia, and numbness -brainstem, cerebellum, inner ear labyrinth -any external compression of the vertebral arteries can lead to decreased blood flow to the brain stem with consequent cranial nerve and/or cerebellar abnormalities

Refsum disease

-Refsum Disease is an autosomal recessive disorder of peroxisomes, resulting in the accumulation of phytanic acid in tissues -Specifically, the disease is caused by defects in alpha-oxidation, which is needed to metabolize phytanic acid into pristanic acid (priest on the left in pic) -Classically, patients present with scaly skin, ataxia, cataracts/night blindness, and shortening of the fourth toe.

Syndrome of Apparent Mineralocorticoid Excess (SAME)

-Renal aldosterone receptors bind cortisol -deficiency in 11-beta hydroxysteroid dehydrogenase -cortisol produces aldosterone effects -aldosterone levels are low

What is a single stranded diploid RNA virus?

-Retrovirus like HIV!!!!!!!!!

What is the side effect for tetracyclines for acne and is the MOA reversible of irreversible?

-Reversible! -side effect is photosensitivity

Felty Syndrome

-Rheumatoid arthritis, Splenomegaly, Neutropenia (triad) -may have target cells (codocytes) in peripheral blood--target cells are rbcs with a central "halo of pallor", meaning a white circle in the middle of the cell that resembles a target -as in liver disease, target cells are seen following splenectomy due to increased cell membrane size -the sinusoids in the red pulp of the spleen normally remove excess membrane from rbcs in the process called "splenic conditioning"

What bug should you think of when a pt presents with fever, headache, centripetal rash beginning on ankles and wrists after outdoor exposure in the eastern half of the US?

-Rocky Mountain spotted fever -rickettsia rickettsiae is the bug and it is an intracellular organism that infects endothelial cells, thereby causing vasculitis

markers of malignant melanoma

-S-100 -HMB-45 -MART-1/MalanA -SOX10 -malignant melanoma presents with an unusual met pattern both spatially and temporally

Step-wise treatment of asthma

-SABA -then low-dose ICS -then moderate-dose ICS -then high-dose ICS -then LABA -lastly oral corticosteroids

What are the retroperitoneal organs?

-SAD PUCKER

What structures are retroperitoneal?

-SAD PUCKER -Suprarenal glands (adrenal glands) -Aorta/IVC -Duodenum -Pancreas -Ureters -Colon- ascending, descending -Kidneys -Esophagus (thoracic portion) -Rectum (partially)

How to treat UTI who is allergic to peniccilin?

-SMX/TMP or nitrofurantoin

Paroxetine

-SSRI -used for: (1) Depression (2) Generalized anxiety disorder (3) Panic disorder (4) PTSD

fluoxetine

-SSRI (prozac) -can cause SIADH

Tx for anxiety disorder?

-SSRI (sertaline)

Tx for OCD

-SSRIs -TCA -clomipramine (TCA that is used in tx of OCD unresponsive to an SSRI)

Common causes of DIC

-STOP Making New Thrombi -Sepsis (gram neg) -Trauma -Obstetric complications -Pancreatitis (acute) -Malignancy -Nephrotic syndrome -Transfusion

Clinical trial phases

-SWIM -phase 1: testing if drug is safe -phase 2: does it work on disease..testing efficacy -phase 3: is this actually helping compared to gold standard/improvement -phase 4: after been on market, does it get to stay or should we withdraw it..surveillence/maintenance or market

Content of O2 consists of?

-SaO2 (oxygen saturation which is binding sites for O2 are the heme groups) + PaO2 (oxygen pressure which is oxygen molecules dissolved in plasma)

Type Vi polysaccharide capsule is a target of vaccination against what?

-Salmonella typhi

IFN-gamma

-Secreted by Th1 cells -Secreted by NK cells in response to IL-12 from macrophages; stimulates macrophages *to kill phagocytose pathogens.* -Also activates NK cells *to kill virus-infected cells.* Increases MHC expression and antigen presentation by all cells. -in summary: plays a crucial role in T-lymphocyte-mediated activation of macrophages, leading to formation of epitheloid cells and multinucleated giant cells in granulomas

ivabradine**

-Selectively inhibits funny current (sodium channels), thereby prolonging the slow depolarization phase (phase 4) and slowing the SA node firing rate (HR). No effect on contractility (inotropy) and/or relaxation -increases the R-R interval -Iva doesn't like Brad's funny comments

Methanol poisoning

-Severe anion gap metabolic acidosis, retinal damage (blindness), CNS depression, vomiting, pain -Toxicity via formic acid -Tx: Ethanol (competitively inhibits alcohol dehydrogenase), fomepizole (same mech as ethanol)

What are anti-SSA and anti-SSB associated with?

-Sjogren's syndrome -or neonatal lupus if present in pregnant women

Embryonic formations of the heart

-Smooth-walled part of both ventricles = bulbus cordis -Rough-walled parts of both ventricles = primitive ventricles

Complete penetrance but variable expressitivity

-So, penetrance actually gives you a percent of individuals who have a dominant allele that will also exhibit the dominant phenotype -And so, just to sum it up all over again, variable expressivity is essentially just when one genotype produces a variable of phenotypes

Renal abscess

-Sonographically, it appears as single or mult, round or oval mass with irregular borders and back wall enhancement; tissue characteristics are highly variable ranging from anechoic to echogenic & complex; may have highly echogenic areas due to gas formation -complication of pyelonephritis -typically the same organism that caused the original infection leads to this complication -lack of improvement with Ab treatment of pyelonephritis is typical of an abscess

Where is iodine deficiency common?

-Southeast Asia and Africa due to diet -Younger patients with thyroid deficiency secondary to lack of iodine in their diet will typically present with symptoms of neurologic impairment and growth delay -Iodine is a substrate that is needed for the proper synthesis of thyroid hormone, which has a permissive effect on growth hormone and maturation of the central nervous system

Furuncles and Carbuncles come from what bug?

-Staph aureus

Most common cause of septic arthritis

-Staph aureus

Impetigo is caused by what bug(s)?

-Staph aureus -Strep pyogenes -non-bullous form of impetigo can be cause by either -the BULLOUS form is caused by exfoliative toxin A from S. aureus

Chronic Asthma therapy

-Step 1: SABA as needed -Step 2: SABA, low dose ICS -Step 3: Medium ICS or low ICS and LABA -Step 4: Medium ICS and LABA -Step 5: High ICS + LABA -Step 6: High ICS + LABA + oral steroids -Step 2-6: can use LRTA, Zileuton (commonly used bc is an oral pill and generally well tolerated), Theophylline, Omalizumab -can't use FEV1 to guide therapy bc when no asthma attack, FEV1 returns to normal

Warfarin Embryopathy

-Stippled vertebrae -Stippled epiphyses - small round densities on x-ray -Flattened nasal bridge -Nasal hypoplasia -Choanal Atresia

How to fix structural vs electrical problems of the heart?

-Structural: echocardiography used for structural problems (literally heart ultrasound) -Structural: catheterization used for unblocking coronary artery (used for MI and emboli and stuff) -Electrical problem: pacemaker

Flailing and hemiballismus of right upper limb indicates lesion of which structure, ipsilateral or contralateral to flailing?

-Subthalamic nucleus causes hemiballismus, and its lesion is contralateral to affected limb -thus Hemiballismus on the right indicates lesion of contralateral left subthalamic nucleus

What are the general 2nd line T2 DM drugs if metformin cannot be used/or is unsuccessful?

-Sulfonylureas -Dpp 4 inhibitors (sitagliptin) -GLP-1 agonists (exenatide) -glitazones

Staph aureus virulence factors

-Super Ag-like toxin= activates APC without Ag--> cytokines -protein A= binds Fc region preventing opsonization -alpha toxin= holes in cell---> pus -exfoliative toxin= separates dermis and epi

Graves disease

-Symptoms include amenorrhea, heat intolerance, sweating, anxiety, weight loss, and hyperreflexia -This disease should always be on the differential in a female with amenorrhea and a negative pregnancy test (bc graves can lead to increase in sex hormone-binding globulin (SHBG) secretion from the liver, lowering the levels of free estradiol (because more estradiol would be bound to SHBG), interfering with mid-cycle LH surge and ultimately cause amenorrhea -bilateral skin thickening over the lower extremities bilaterally

Histaplasmosis

-Systemic Fungal infection thriving in soil; additive condition -disseminated histoplasmosis presents with non-specific symptoms (fever, night sweats, and weight loss) and may also cause diarrhea and mucositis

T or F: Chest wall compliance does not change with pulmonary edema or any other lung disease

-T

T or F: Diastolic murmurs are always pathologic

-T

T or F: During exercise, hepatic glycogenolysis provides the majority of the glucose that is used for energy during the first several hours but with prolonged exercise, glycogen levels dec and the relative contribution of gluconeogenesis inc

-T

T or F: If infected with salmonella enterica, antibiotics will prolong fecal excretion of the organism

-T

T or F: Patients with cerebral palsy are at inc risk of severe scoliosis and restrictive lung disease is a common complication of significant scoliosis

-T

T or F: Schiller-Duval bodies are described as resembling primitive glomeruli

-T

T or F: all inguinal hernias pass through the superficial inguinal ring, while only indirect inguinal hernias pass through the deep inguinal ring

-T

T or F: apoptosis happens in response to a viral infection

-T

T or F: gluconeogenesis is the primary source of glucose during prolonged bouts of intense exercise

-T

T or F: longer periods of time at high altitude stimulate the production of 2,3 bisphosphoglycerate in red cells

-T

T or F: most common psychologic disorder in pts with any terminal illness is major depression

-T

T or F: pregnancy among women with pulmonary hypertension is often fatal

-T

T or F: Gastrulation occurs in the third week

-T -Gastrulation converts the two layered embryo into a three layered embryo -the notochord develops in this third (middle) layer

T or F: High potassium level inhibits ammoniagenesis in the proximal tubule

-T -High potassium level inhibits ammoniagenesis in the proximal tubule, which impairs the ability of the kidney to excrete acid

T or F: Nasal polyps can be seen in up to half of patients with cystic fibrosis (CF)

-T -Patients with CF have obstructive lung disease caused by thick mucus that plugs the lungs, trapping the cilia of the cells that normally help to remove pathogens -Other manifestations of CF include pancreatic insufficiency--As a result, patients with CF will have symptoms of foul-smelling greasy stools, constipation, exercise intolerance, and infertility (men)

T or F: acetazolamide also reduces NH4 excretion?

-T -bc Acetazolamide is a CA inhibitor that inhibits HCO3- reabsorption and H+ secretion in the proximal tubule -secreted H+ is normally buffered by NH3 and excreted as NH4 so, by reducing H+ secretion, acetazolamide also reduces NH4+ excretion

T or F: a very minor exception to the statement that fatty acids cannot be converted to glucose are odd numbered fatty acids

-T -bc at end of beta oxidation, they release 1 molecule of propionyl-coa which can be converted to 1 molecules of succinyl-coa (2 step process) which can make one-half molecule of glucose

T or F: Blood flow to the skin is entirely dependent on the perfusion pressure

-T -bc lacks autoreg flow (not a survival organ like brain where if bf falls, perfusion does not)

T or F: Infants whose phenylketonuric mothers have not maintained adequate metabolic control during pregnancy have a high risk for intellectual disability, microcephaly, and low birth weight

-T -even if fetus is heterozygote for this autosomal recessive disorder, the fetus is still at risk for intellectual disability if the PKUic mother does not maintain low levels of plasma Phenylalanine bc it can cross the placenta and act as a teratogen -this is called maternal PKU syndrome

T or F: the lost secretions of body are isotonic

-T -ex. of isotonic loss is vomiting, diarrhea, blood -sweating is actually hypotonic fluid (losing more water than salt!!!)

T or F: suspect pulmonary embolus arising from a femoral vein thrombosis in a bedridden patient who develops sudden onset of chest pain, dyspnea, and cyanosis

-T -fat emboli is much less likely than PE from fem vein thrombosis

T or F: ATN is reversible if treated and fatal if untreated

-T -in ATN, renal tubule epithelium can regenerate as long as the basement membrane is intact

T or F: All children born to HIV-positive mothers are born with positive immunoassay results

-T -only 20% of children born to infected mothers are actually infected with the virus -testing for infants require virological testing for diagnosis--so PCR or viral cultures on tissues are necessary to dx

chronic mucocutaneous candidiasis

-T cell dysfunction -heterogenous group of immune system defects-->impaired cell-mediated immunity against Candida sp. -classic form caused by defects in AIRE -recurrent oral thrush and vaginal yeast infections

T or F: In pts with a left dominant circulation, the PDA (posterior descending artery) arises from the left circumflex

-T!

T or F: Pregnant women with Graves disease must be compliant with anti-thyroid medications as noncompliance can lead to transplacental transfer of TSI antibodies leading to neonatal hyperthyroidism

-T!

T or F: first degree fam members have an inc incidence of both UC and Crohn disease, supporting the idea that these two diseases are actually different ends of the same spectrum

-T!

T or F: hyperchromatic nuclei (small blue cells) is a nonspecific feature of many malignancies associated with neural crest

-T!

T or F: mechel diverticulum typically presents in children with intussusception or painless rectal bleeding

-T!

T or F: pregnancy inc thyroid binding globulin

-T!

T or F: with psychotic disorders, hallucinations are more commonly auditory and there are no alterations in orientation (like schizophrenia) whereas delirium would more commonly have visual or tactile hallucinations and disorientaiton

-T!

T or F: for respiratory problems with graphs, check the slope...if slope is less steep then this is obstructive; if slope is the same, then maybe restrictive (check volume in this case which should be lower than normal)

-T! -also if you see answers in the same category for these problems, it isn't that category of problems then! so rethink if obstructive or restrictive!

T or F: Trophoblast cells do not express many MHC class I antigens

-T! -also placenta secretions block immune response

T or F: production of IgM is possible without T-cell help

-T! -and continues against the envelope glycoproteins (gp120 and gp41) bc those antigens are constantly being altered by the process of random mutation (genetic drift) -p24 and p17 proteins are less likely to be altered, so antibody responses to these HIV proteins will not continue to be produced -in the final stages of the disease, the patient is left making constant, repetitive primary immune responses (IgM) to the changing envelope antigens -any B memory responses, which can produce IgG, will be at lower amounts than the constantly newly-evolving IgM amounts

T or F: CO2 diffuses across the blood brain barrier and acidifies cerebrospinal fluid. The chemo receptor neurons, which are pH-sensitive, drive compensatory increases in ventilation and cardiac output when stimulated appropriately.

-T! -changes in lung fxn are sensed primarily by central chemoreceptors -chemoreceptors monitor arterial PCO2

T or F: The "window" period refers to the period in infection when neither hepatitis B surface antigen (HBsAg) nor its antibody (HBsAb) can be detected in the serum of the patient

-T! -notice the antigen shit ends before the window period -notice Anti-Hbc is all throughout

T or F: nerves themselves do not derive from the pharyngeal arches

-T! -pharyngeal arches give rise to muscles, bones, and cartilage -nerves associated with each arch derive from neural crest cells and neuroectoderm tissue that migrate to the pharyngeal arches

T or F: palpitations and diaphoresis result from a sympathoadrenal response to hypoglycemia

-T! -this response involves the release of norepinephrine and epinephrine from the adrenal medulla -other symptoms of hypoglycemia resulting from sympathetic activation include tremor, anxiety, hunger, and paresthesias

T or F: tumor lysis can also show up during tx for AML?

-T! not just t cell lymphoma treatment !!

T or F: H. pylori is present in the vast majority of patients with duodenal ulcers and nearly all pts with gastric ulcers whose ulcers have not been caused by chronic use of aspirin or NSAIDS

-T!!

T or F: as a general rule, motility disorders of the esophagus (e.g. achalasia, esophageal spam) lead to dysphagia to both solids and liquids whereas mechanical obstruction (e.g. strictures, rings, malignancy) usually causes dysphagia to solids only

-T!!

T or F: loss of E-cadherin promotes metastasis

-T!! -Individuals who have inherited a mutation in the gene encoding E-cadherin, CDH1, are at high risk of developing gastric adenocarcinoma and infiltrating lobular carcinoma of the breast

T or F: supplemental oxygen will inc PAO2 (alveolar) and PaO2 (arteriole) in any patient, but PAO2 will inc to a greater extent

-T!! -so therefore, the alveolar-arterial PaO2 gradient will also increase

Causes of infant vomitting with no bile?

-TEF, EA -hypertrophic pyloric stenosis (most common cause of gastric outlet obstruction in infants; palpable olive-shaped mass in epigastric region; visible peristaltic waves, ~2-6 weeks old; more common in first born males; associated with macrolide exposure; results in hypokalemic hypochloremic met alkalosis (secondary to vomiting of gastric acid and subsequent volume contraction); thickened and lengthened pylorus; tx with pyloromyotomy

How does aging affect the lung function values/compartments?

-TLC does not change with age, although most other measure of lung function decline after age 30 years -RV and FRC increases with age due to airway collapse at low lung volumes. Collapse occurs due to the loss of elastic fibers and decreased radial traction on airways (senile emphysema) -inc A-a gradient

TLRs vs. NLRs

-TLRs are found on cell membranes and within endosomes -NLRs preform a similar function but are intracellular

What drug taken during the third trimester of pregnancy can cause kernicterus?

-TMP-SMX

What is the first line treatment for UTI?

-TMP-SMX -can be used for prophylaxis of UTIs

First line treatments for UTI?

-TMP-SMX is a first-line treatment for an uncomplicated cystitis -However, its use is contraindicated in patients with sulfa allergy; Other first-line treatments for uncomplicated UTI include nitrofurantoin and fosfomycin

Fever and sepsis inducing cytokines

-TNF- alpha, IL-1 and IL-6

T or F: ALWAYS disclose mistake to patient, apologize for the mistake, and own it

-TRUE

T or F: Once a patient (young minor) gives birth, she is emancipated

-TRUE

pathogenesis of toxic shock syndrome

-TSST-1 superantigen -activates all T helper cells non-specifically --the superantigen crosslinks the T-cell receptors and major histocompatibility complex (MHC) class II antigens of unrelated T lymphocytes and macrophages (in the absence of antigen recognition), causing their polyclonal stimulation and the production of dangerous amounts of their cytokines -the cytokines that are overproduced during the superantigen pathogenesis are IL-1, IL-6, and TNF-alpha (from macrophages), and IL-2 and IFN-gamma from th1 -This causes a toxic overproduction of cytokines, which leads to drop in blood pressure and the associated signs and symptoms -These signs and symptoms are the body's way of trying to remove the toxin.

infant has developmental problems, muscle weakness, startled easily by sound, cherry red spot on fundoscope

-Tay-Sachs -disease caused by faulty degradation of GM2 gangliosides, which accumulate in lysosomes

Airborne infectious diseases bugs

-Tb, SARS, measles, chicken pox, aspergillosis

The tuberculin (PPD) test is a type IV hypersensitivity reaction by sensitization of what?

-Th1 CD4 lymphocytes

FVC (forced vital capacity)

-The amount of air forcefully expired after a maximal inspiration

Why does ATP concentration not fall a lot during normal skeletal muscle twiches?

-The energy for muscle contraction comes from ATP, which in turn comes from the metabolism of glucose and fatty acids. But so little ATP is actually stored in the muscles that just a few twitches could quickly exhaust the supply. Soooo, there is another phosphate compound stored in the muscles, creatine phosphate, which is formed by linkage of a phosphate group to the substance creatine. Creatine phosphate cannot be used directly to power muscle contraction, but it can transfer its phosphate group to ADP to form ATP: Creatine phosphate + ADP + H+ ---> Creatine + ATP -This ATP then acts as the direct energy source for contraction -The muscle stores enough creatine phosphate to enable it to contract strongly during the several seconds it takes before the machinery of glycolysis and cellular respiration can produce additional ATP

Isotype

-The five major classes of Igs: IgG, IgA, IgM, IgD, IgE

What is responsible for erection, emission, and ejection?

-The mnemonic "Point, Squeeze, and Shoot" makes this information easier to remember: The Parasympathetics make the penis Point (S2-4); the Sympathetics Squeeze (T11-L2), causing semen to move into the urethra; and the Somatic nerves Shoot, ie, ejaculation

incidence

-The number or rate of new cases of a particular condition during a specific time -calculate: number of new cases/ number of people at risk

Medicare Part A

-The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care.

Medicare Part B

-The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies.

Significance level

-The probability of a Type I error. A benchmark against which the P-value compared to determine if the null hypothesis will be rejected. See also alpha.

What is the pathologic agent that causes Bafassosis?

-Thermophilic actinomycetes (in mold sugar cane)

What is the pathologic agent that causes Farmer's lung?

-Thermophilic actinomycetes in hay -IgG antibodies develop against the actinomycetes and the IgG binds and forms immune complexes that deposit in alveolar walls

Limited systemic sclerosis/scleroderma

-Think Sketchy's sjorgen's sketch with Cressendei and the dragon's -limited skin involvement confined to fingers and face -associated with CREST syndrome (Calcinosis cutis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia -positive anti-Centromere antibody

Cross-reaction with pre-existing IgE antibodies is due to what?

-This is seen in transfusion reactions when allergens in plasma of donated blood products cross react with the pre-existing IgE antibodies of the recipient causing urticaria

Pt comes in with confusion/dizziness/fatigue, fever, petechiae, low hb and platelet count, high LDH, and high BUN and creatinine. Blood smear shows schistocytes.....what do they have?

-Thrombotic thrombocytopenia purpura (TTP) which is caused by a deficiency of vWF metalloproteinase (ADAMTS-13), leading to the accumulation of large vWF multimers resulting in thrombosis -triad: thrombocytopenia (dec platelets), MAHA (dec hb, schistocytes, inc LDH), acute kidney injury (inc Cr) -Triad + fever and neuro symptoms

AIDS (low CD count) and mass lesion shown on MRI...what is the most likely diagnosis?

-Toxoplasma gondii--mass lesion with bright signal peripherally and a dark core (ring enhancing lesion) -Toxoplasmosis is acquired via the ingestion of contaminated meat (typically pork) and to a lesser extent contaminated cat litter

TA-GVHD (Transfusion-associated graft-versus-host disease)

-Transfusion-associated graft-versus-host disease (TA-GvHD) is a rare complication of blood transfusion, in which the immunologically competent donor T lymphocytes mount an immune response against the recipient's lymphoid tissue -so to minimize this problem, you need to irradiate the blood--this is important and necessary for immunocompromised patients with SCID, Di George, etc

SMA syndrome

-Transverse portion (third part) of duodenum is entrapped between SMA and aorta, causing obstruction -classic patient: recent, massive weight loss -rare cause of bowel obstruction

Plummer-vinson syndrome

-Triad of dysphagia, esophageal webs, iron deficiency anemia -inc risk of esophageal squamous cell carcinoma ("Plumber DIES") -may be associated with glossitis

Ebstein's anomaly

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

T or F: Any process that interferes with absorption of bile acids in the terminal ileum can lead to gallstones

-True

T or F: Calcitonin rarely affects serum calcium due to compensation by normally functioning Parathyroid glands (PTH production), and is associated with symptoms of diarrhea and skin flushing

-True

T or F: Daily Aspirin therapy has been show to reduce risk of colon cancer

-True

T or F: The treatment for DIC relies heavily upon treating the disease

-True

T or F: Up to 20% of small cell lung cancer (SCLC) tumors secrete adrenocorticotropic hormone (ACTH)

-True

T or F: Saliva is isotonic at high flow rates and hypotonic at low flow rates as the ductal epithelium has more time to modify the secretion by reabsorbing Na+ and Cl- and secreting K+

-True -also Secretion of HCO3- increases with salivary flow -normal flow rates: at normal salivary flow rates, saliva in the mouth tends to be hypotonic and slightly acidic compared with plasma

T or F: albumin is a negative acute phase reactant

-True -level will fall with acute inflammation of the colon

T or F: Severe hyponatremia can lead to seizure activity, anorexia, nausea, and vomiting and altered mental status

-True -malaise and confusion are typical symptoms of hyponatremia

T or F: Horseshoe kidney inc risk of UTIs

-True -structural abnormalities of the kidney inc risk of obstruction and therefore UTIs

T or F: Klebsiella can also cause pleural friction rub sounds on auscultation

-True!

T or F: Patients with T2DM frequently have amyloid deposits in the pancreatic islets

-True!

T or F: What may be statistically significant may or may not be meaningful to patients.

-True!

T or F: a negative PPD test result is insufficient to rule out tb in a pt with advanced HIV infection bc the suppression of CD4+ cells by HIV infection can result in anergy toward the tuberculin antigen

-True!

T or F: TSH stimulates thyroid hormone secretion and thyroid hormones are required for normal growth and development

-True! -Dwarfism occurs bc thyroid hormones normally stimulate the growth of long bones

T or F: Varicocele can be associated with renal cell carcinoma

-True! -do an abdominal CT to rule out RCC

T or F: screening and treatment must occur regardless of citizenship, legal status, or ability to pay

-True! -The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that any patient who comes to the ED of a participating hospital requesting examination or treatment for a medical condition must be provided with an appropriate medical screening examination to determine if they are suffering form an emergency medical condition (EMC) -screening must occur regardless of citizenship, legal status, or ability to pay -if have EMC, hospital is obligated to provide the patient with treatment until they are stable or transfer them to another hospital only if the original hospital is unable to provide adequate care in conformance with the statute's directives

carotid bruit

-Turbulent blood flow heard with auscultation over the carotid artery. (Due to carotid narrowing or plaque) -associated w atherosclerosis

Type 1 Sliding hiatal hernia vs Type 2,3,4 Paraesophageal hiatal hernia

-Type I: sliding hiatal hernia (95%) -displacement of GE junction above diaphragm (hourglass appearance) -Paraesophageal (type 2,3,4) is when GE junction is in normal location but there is a protrusion of stomach fundus--defect in phrenoesophageal membrane and can hear bowel sounds in lung fields

Hantavirus

-Type of RNA virus -Hantavirus pulmonary syndrome and Korean hemorrhagic fever are caused by viruses in the genus Hantavirus -hantavirus pulmonary syndrome, which starts with fevers, headaches, severe myalgias, gastrointestinal upset, dizziness, and chills -Patients initially have no respiratory symptoms. As the disease progresses, however, the virus causes capillary leak syndrome in the lungs, resulting in pulmonary edema -contracted through exposure to deer mouse droppings or urine

Implied consent

-Type of consent in which a patient who is unable to give consent is given treatment under the legal assumption that he or she would want treatment. -may treat the pt on the basis that he/she came voluntarily to the clinic or hospital*

orotic aciduria: what enzyme is messed up that causes this condition?

-UMP synthetase is messed up which is involved in pyramidine synthesis -**keep in mind since it affects pyramidine/dna synthesis then it will affect other organs/cells that rapidly divide like (ex. RBC 's can't divide-->could cause megaloblastic anemia) -accumulation of orotic acid can spill into the urine which could form whitish needle shaped crystals

Pleural effusion vs. pulmonary edema

-Unlike pulmonary edema, in which fluid collects inside your lungs, pleural effusion is when it builds up in the layers of tissue that line the outside of your lungs and the inside of your chest -soooo that is why pleural eff has dec fremitus sounds but pulmonary edema has inc fremitus sounds (An increase in tactile fremitus indicates denser or inflamed lung tissue)

Simon focus

-Upper lobe reactivation focus of TB -one of the most contagious forms -often calcified

Ziehl-Neelsen stain

-Use to stain Acid-fast bacteria -aka carbon fuchsin

disulfiram

-Used in tx of alcohol cessation. -Inhibits acetaldehyde dehydrogenase-->increased acetaldehyde when drinking (toxic)-->N/V-->incentive not to drink -Other drugs known to cause disulfiram-like reactions include metronidazole, griseofulvin, chloramphenicol, chlorpropamide, and some cephalosporins, and sulfonureas T2DM meds -Sorry Pals, Can't Go Mingle

V1 vs V2 ADH receptors

-V1 regulates bp (acts on vascular smooth muscles) -V2 regulates serum osmolality (acts on kidney)

What factor rises high after 1 hour of execercise?

-VEGF -VEGF is an important vascular endothelial cell growth factor -many tissues secrete VEGF in response to hypoxia -regular exercise can lead to signifiant endothelial proliferation and growth of new capillaries in muscle

Truncus arteriosus often occurs with what other structural abnormality?

-VSD

Where is lipoprotein lipase found?

-Vascular endothelial surface (luminal surface of endothelial cells lining the capillaries) -LPL releases TAGS from the chylomicron core by hydrolyzing them to more easily absorbed FAs (which in turn shrinks the chylomicron size due to removal of these TAGS as FA and glycerol) -this enzyme requires apolipoprotein C2 as an activator

In a type I hypersensitivity reaction, what is vasodilation cause and what does permeability cause?

-Vasodilation is responsible of rubor, calor -Only when the permeability is increased, fluid exudates -->edema/swelling

Pott's disease

-Vertebral tuberculosis -Tuberculosis occurs in specific patient populations such as homeless patients, immunocompromised patients, patients with HIV, and IV drug users -can cause back pain

what drug or kinds of drugs are contraindicated for WPW afib?

-WPW--wolf Parkinson White syndrome -in WPW, artrial impulses may also reach the ventricle over the bypass tract which can lead to ventricular heart rates of 300 or more -for this reason, drugs that slow conduction over the AV node (digoxin, beta blockers, CCBs, or adenosine) are CI bc you want to speed up the AV node to overtake the afib

Acute transplant rejection

-Weeks to months -Cellular: CD8+ T cells activated against donor MHCs or CD4+ t cells -Humoral: similar to hyperacute, except antibodies develop after transplant. -is there is positive C4d staining then this is a humoral graft rejection; if negative then is a cellular rejection

How to treat septic shock if not responsive to volume resuscitation?

-When septic shock is refractory to volume resuscitation, activation of α1-receptors with a drug, such as norepinephrine, causes vascular smooth muscle contraction, leading to a quick rebound in blood pressure

Methemoglobinemia

-When the heme portion of hemoglobin has oxidant damage (Fe3+) which results in the loss of the RBC's oxygen carrying capacity. (Drugs etc) Normal PaO2, low SaO2 *Chocolate-colored blood* -treat with methylene blue

How does a cleft palate occur?

-When the palantine shelves (maxillary prominences) fail to fuse with each other OR the primary palate (fused medial nasal prominences)

Beckwith-Wiedemann syndrome

-Wilm's tumor AND "WIDE" features (macroglossia, omphalocele, enlarged organs, hemihypertrophy -abnormal genomic imprinting at WT2 locus -have an inc risk of hepatoblastoma

Chronic granulomatous disease

-X-linked mutation affecting NADPH oxidase cause dec in superoxide --> dysfunctioning neutrophils and dysfunctioning oxidative burst (think Sketchy's arcade games) -inc risk of pneumonia and granulomas -can test for this by doing a Dihydrorhodamine test-->lack of green fluorescence OR Nitroblue tetrazolium test-->lack of blue fluorescence bc lack superoxide

Bruton's agammaglobulinemia

-X-linked recessive (tyrosine kinase gene mutation blocks B-cell maturation) -inability or very limited ability to produce cytoplasmic mu heavy chains -pre B cannot develop into B cells -S. pneumoniae infections

Duchene Muscular Dystrophy (DMD)

-X-linked recessive disorder caused by mutation in the DMD genet that codes for the protein dystrophin -Diagnosis at 3-5 years old, fatal by age 20 -children develop a waddling gait from using the stronger distal muscles to walk -dystrophins normal role is to bind intracellulary to actin, a muscle protein used to generate muscle contractions

Adrenoleukodystrophy

-X-linked recessive disorder, and it is the most common peroxisome disease -caused by a mutation in ABCD1, which impairs the transport of very long chain fatty acids (VLCFAs) into the peroxisome--impairs beta-oxidation of these fatty acids, and causes their accumulation -most severely affected tissues are the CNS white matter (causing neurologic defects), the adrenal cortex (causing adrenal insufficiency), and the Leydig cells in the testes (causing hypogonadism)

Can down syndrome present with future alzheimer's?

-YES -Also, Down Syndrome is most often caused by meiotic nondisjunction (95%), although Robertsonian translocation (4%) or mosaicism (1%) are less common causes (see far right of pixorize pic)

Wharton's jelly

-Yellow-white gelatinous material surrounding the vessels of the umbilical cord

What microbe mimics appendicitis?

-Yersinia eneterocolitica -few more facts, found in contaminated, unpasteurized milk, pork, and occasionally from blood transfusion -likes cold climates -is motile at 25 C and non motile at 37C

Is pheochromocytoma associated with MEN2A and MEN 2B?

-Yes!

Polyarteritis Nodosa (PAN)

-Young adults. -Hepatitis B seropositivity in 30% of patients. -Fever, weight loss, malaise, headache. -GI: abdominal pain, melena. -Hypertension, neurologic dysfunction, cutaneous eruptions, renal damage. -Typically involves renal and visceral (skin, GIT, heart) vessels, not pulmonary arteries-> SPARES THE LUNGS!! -Immune complex mediated. -Transmural inflammation of the arterial wall with fibrinoid necrosis. -Innumerable renal microaneurysms (see picture) and spasms on arteriogram. **negative for ANCA

Zero order vs First order kinetics

-Zero - constant amount per unit of time (ex. a chemo drug will kill a constant NUMBER of cancer cells) -First - constant proportion per unit of time (ex. a chemo drug will kill a constant PROPORTION of cancer cells)

What stain can M. tuberculosis be identified by?

-Ziehl-Neelsen stain, also known as the acid-fast stain, which penetrates the waxy coat of the pathogen -Acid alcohol is used to decolorize non-acid-fast cells; acid-fast cells resist this decolorization

Leukemoid reaction

-a benign leukocytosis (> 50,000) that occurs in response to underlying severe infection/hemorrhage, malignancy, or acute hemolysis. -Smear can show increased bands, early neutrophil precursors (myelocytes, and granules (Döhle bodies) in the neutrophils.

Seborrheic keratosis

-a benign skin growth that has a waxy or "pasted on" look -stuck on/coin like appearance -begin as sharply defined, brown macules and develop into raised pigmented squamous epithelial proliferation with keratin filled cysts-pseudocysts and verrucous surfaces

pheochromocytoma

-a benign tumor of the adrenal medulla that causes the gland to produce excess catecholamines -Phenoxybenzamine is an irreversible α1- and α2-receptor antagonist used first in the treatment of a patient with a pheochromocytoma to control blood pressure. -an extremely important point to remember is give beta blocker after alpha blocker for the treatment of a patient with a pheochromocytoma because giving a β-receptor blocker first can result in a further spike in blood pressure due to blockade of the β2-receptor-mediated vasodilation

What artery supplies blood to the posterior left ventricle of the heart?

-a branch of the RCA

rheumatoid arthritis

-a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked -morning stiffness that improves throughout the day -anti-citrulline peptide antibody (ACPA) is the most specific marker of rheumatoid arthritis

Disc herniantion

-a common cause of acute-onset low back pain, especially after heavy lifting or trauma -other symptoms: pain, weakness in the distribution of the impinged nerve root (eg. L5 = weak dorsifelxion, S1 = weak plantarflexion) -usually cause by trauma, degenerative change -worsens with spinal flexion, positive straight leg test -use MRI to image

Papillary edema on fundoscopy...what does this mean?

-a condition in which increased pressure in or around the brain causes the part of the optic nerve inside the eye to swell -Symptoms may be fleeting disturbances in vision, headache, vomiting, or a combination

Gastroparesis

-a condition in which the muscles in the stomach slow down and work poorly or not at all, preventing the stomach from emptying normally

erysipelas

-a contagious disease of the skin and subcutaneous tissues caused by infection with streptococci organisms; redness and swelling of affected areas -Streptococcus pyogenes (think step pie sketch with red gloves)

Agranulocytosis

-a deficiency of granulocytes in the blood, causing increased vulnerability to infection -early signs of this complication include fever and sore throat

Osteoarthritis

-a degenerative joint disease in which the cartilage covering the surface of bone becomes thinner and rougher -onset in a pt's fifth decade of life, after years of wear and tear -no hereditary component -classic physical examination finding, especially in affected women, is the presence of Bouchard and Heberden nodes, which are grossly visible bulges in the proximal and distal interphalangeal joints, respectively caused by osteophyte formation -chronic disease of degenerating joints in which pieces of cartilage and bone are broken off into the joint space, causing pain and restriction of joint movement

Cheyne-Stokes breathing

-a distinct pattern of breathing characterized by quickening and deepening respirations followed by a period of apnea -this is a subtype of central sleep apnea seen in pts with heart failure and stroke -periods of apnea result in accumulation of CO2--CNA respiratory centers are abnormal and respond slowly to accumulate CO2--when breathing rate eventually increases, respirations increase rapidly to compensate for accumulated CO2

Chordee

-a downward curvature of the penis, often associated with hypospadias

7-dehydrocholesterol

-a form of pre-vitamin D3 synthesized in the skin from UBV -converted to Cholecalciferol (inactive form of vit. D3)

Struma ovarii teratoma

-a form of teratoma composed predominantly of thyroid follicular tissue -can present with hyperthyroidism, as well as symptoms of ovarian tumor: abdominal bloating and ascites

Pierre Robin sequence

-a group of craniofacial defects associated with abnormal development of the first pharyngeal arch -first arch gives rise to the maxilla, zygomatic bone, and mandible (first arch syndromes involve craniofacial abnormalities of the face, jaw and tongue) -associated with small jaw, retraction of the tongue (glossoptosis), a cleft palate, and upper airway obstruction

Ventilator-associated pneumonia (VAP)

-a health care-acquired infection (HAI) that develops in a person requiring invasive mechanical ventilation (via endotracheal intubation or tracheotomy tube) for at least 48 hours -Symptoms include fever or hypothermia, new purulent sputum, or a change in respiratory support requirements -Both chronic lung disease and convalescence in the intensive care unit are risk factors for VAP -often caused by the gram-negative bacillus Pseudomonas aeruginosa -Sedative medications required for intubation can cause depression of native ciliary elevator function of natural respiration; this increases a patient's susceptibility to certain respiratory pathogens and can lead to VAP

Propofol

-a lipid-based intravenous anesthetic infusion used for general anesthesia that is commonly associated with hypotension due to systemic vasodilation and sympathoplegia

Mesothelioma

-a malignancy of the pleura associated with asbestosis, a condition that results from exposure to asbestos in roofing, insulation, and shipbuilding materials -characterized by hemorrhagic pleural effusions and pleural thickening, and is sometimes evidenced by psammoma bodies on histology

transitional cell carcinoma

-a malignant tumor of the urinary tract that is often found within the urinary bladder or within the renal pelvis

trans activation

-a mech by which retroviruses can produce a protein that serves as a TF for other viral genes -seen in HTLV when it causes adult T cell leukemia/lymphoma

Bordeline personality disorder

-a mental health condition in which a person has long term patterns of unstable or turbulent emotions

What kind of room do you put a Tb patient in?

-a negative pressure room

curare

-a neurotoxin that causes paralysis by blocking acetylcholine receptors in muscle -A muscle relaxant used in anesthesia (and, in the past, in arrow poisons by South American Indians). Curare competes with acetylcholine, a chemical that carries information between nerve and muscle cells, and blocks transmission of the information -depolarizing blockade

Athlete's heart

-a nonpathological enlarged heart, often found in endurance athletes, that results primarily from left ventricular hypertrophy in response to training -eccentric hypertrophy type

borderline personality disorder

-a personality disorder characterized by lack of stability in interpersonal relationships, self-image, and emotion; impulsivity; angry outbursts; intense fear of abandonment; recurring suicidal gestures -basically unstable as HELLLLLL

avoidant personality disorder

-a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

Silicosis

-a pneumoconiosis characterized by dry cough and shortness of breath, which slowly progresses over time -caused by inhaling silica dust in the lungs and usually occurs after working in occupations including foundry work, quarrying, ceramics, glass work, and sandblasting -Risk factors include exposure to rock or minerals, such as sand, and smoking -When silicosis is present, chest x-rays will often reveal notable "eggshell" calcifications in the upper lobes, a finding that helps to distinguish it from other pneumoconioses

adapter protein

-a protein that acts as a connecting molecule -critical to intermolecular interactions and plays a role in the regulation of signal transduction initiated by engagement of surface receptors on all cell types

Schizophrenia

-a psychological disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression -intensifies during stress

Schizophreniform disorder

-a psychological disorder characterized by symptoms of schizophrenia present for a period of 1-6 months during which the symptoms may or may not have interfered with functioning

Somatization disorder

-a psychological disorder involving combinations of multiple physical complaints with no medical explanation -management = numerous, scheduled, short visits with the same medical provider

toxic shock syndrome (TSS)

-a severe illness characterized by high fever, rash, vomiting, diarrhea, and myalgia, followed by hypotension and, in severe cases, shock and death -results in a clinical triad of fever, shock, and a desquamating rash in the setting of a retained foreign body, such as nasal packing or a tampon, which provides a rich nutrient source (blood) for the bacteria -Staphylococcus aureus produces a superantigen, toxic shock syndrome toxin (TSST-1), which activates a large population of T lymphocytes by cross-linking MHC II and T-cell receptors

carnitine

-a small, organic compound that transports free fatty acids from the cytosol into the mitochondria for oxidation

Bruit

-a sound heard over an artery or vascular channel, reflecting turbulence of flow -most commonly, a bruit is caused by abnormal narrowing of an artery -you typically hear them over the aorta, renal arteries, iliac arteries, and femoral arteries

Hypersensitivity pneumonitis

-a spectrum of immune-mediated disorders characterized by diffuse inflammation of interstitial lung, terminal bronchiole, and alveoli -due to either type III/or type IV mech

Prednisone

-a steroid, is often used in the initial treatment of IBD, such as Crohn disease and ulcerative colitis

Aortic stenosis murmur

-a systolic ejection-type, crescendo-decrescendo murmur -severe--late peaking murmu, soft/quiet S2, pulsus parvus et tardus

Schistosoma haematobium

-a trematode associated with bladder carcinoma in Egypt and Africa and can result in squamous metaplasia of the bladder which can lead to cancer (squamous cell carcinoma)

pyelonephritis

-a type of UTI that general begins in your urethra or bladder and travels to one or both of your kidneys -presents with fevers, flank pain (costovertebral angle tenderness), nausea/vomiting, chills), WBC in urine +- WBC casts, neutrophils infiltrate renal interstitium -causes ascending UTI, hematogenous spread to kidney -renal transplant patients are at inc risk of this bc lack sphincter between the allograft ureter and their natural bladder, allowing bacteria to ascend to the kidney more easily

What explains the patient's findings: -end systolic volume = 40cc -end diastolic volume = 60 cc -aortic valve opening volume = 55 cc -a.) mitral regurg -b.) aortic regurg -c.) aortic stenosis -d.) mitral stenosis -e.) systolic heart failure

-a.) mitral regurg -look up cardiac loop/cycle graph -we are talking about the isovolumetric contraction part and if end diastolic volume decreases by 5 by the time the aortic valve opens, that means you are losing some blood and the only way you can lose blood at this point is via the mitral valve (regurg)

Mittelschmerz

-abdominal pain that occurs midway between the menstrual periods at ovulation -etiology of the pain is either related to follicular growth that occurs just prior to ovulation, or irritation of the lining of the peritoneum cause by blood from a ruptured follicle

functions of type II pneumocytes

-ability to proliferate during lung damage -production of pulmonary surfactant -remember that screeining test for fetal lung maturity is sphingomyelin (L/s) ratio in amniotic fluid and healthy is > or equal to 2 and NRS is less than 1.5

Disseminated Intravascular Coagulation (DIC)

-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 -widespread activation of clotting -> deficiency in clotting factors -> bleeding state

Bronchiectasis

-abnormal dilation of the bronchi with accumulation of mucus -A CT scan will confirm the diagnosis, which shows dilated bronchi with signet ring appearance or "honeycombing" -Chest x-ray will show "tram track" lines due to inflammation and fibrosis of the bronchial walls -CT findings include dilated airways with thickened walls -Recurrent upper respiratory infections—coupled with a chronic cough with copious sputum, dyspnea, and hemoptysis—are characteristic of bronchiectasis -Associated conditions include bronchial obstruction, Kartagener syndrome, cystic fibrosis, and allergic bronchopulmonary aspergillosis

Diaphragmatic hernia

-abnormal displacement of organs through the muscle separating the chest and abdomen -may occur due to congenital defect of pleuroperitoneal membrane or from trauma

esophageal stricture

-abnormal narrowing of the esophagus which typically present with dysphagia to solids only -long-standing, uncontrolled GERD predisposes to the development of esophageal strictures, barrett esophagus and esophageal adenocarcinoma

Loud P2

-abnormally loud closure of the pulmonic valve as part of the second heart sound; usually due to pulmonary hypertension -normally P2 not heard at apex, if hear it here, then it is "loud"

Agenesis

-absent organ due to absent primordial/embryonic tissue

Bundle of Kent

-accessory pathway from atria to ventricle) bypasses AV node, ventricles depolarize earlier with characteristic delta wave (may result in reentry current and supraventricular tachycardia

empyema

-accumulation of pus in the pleural cavity -pleural effusion

Baker's cyst

-accumulation of synovial fluid in the knee joint

Catecholamines are released from chromaffin cells when stimulated by?

-acetylcholine

For behavioral questions, what structure should you follow to answer these? (I made this up haah)

-acknowledge the pt's emotions/feelings...would you like to talk about it?...tell me about blah? -then figure out the problem...ask open ended questions about medical history

Rosacea

-acneiform disease of chronic vasodilation in the central face that often manifests when patients are 30-60 years old -early stage is characterized by facial erythema aggravated by hot weather, hot drinks, spicy food, stress, alcohol, nicotine, caffeine and Demodex mites -characterized by tiny red pimples and broken blood vessels -Topical metronidazole is a first-line therapy. Oral tetracycline can be used in severe cases

steroids MOA

-act by inactivating NF-KB, a protein complex that controls genes involved in immune and inflammation processes and the TF that induces production of TNF alpha and other inflamm agents -so they basically inhibit the synthesis of virtually all cytokines -This helps to prevent the inflammatory response that is responsible for acute asthma exacerbations

Classically activated macrophages (M1)

-activated by IFN-gamma -generate ROS, lysosomal enzymes, release vasodilator NO

Glucagon works through what receptor?

-activates adenylate cyclase and increases cyclic AMP production in cardiac myocytes

What does glycogen phorphorylase kinase do?

-activates glycogen phosphorylase which breaks down glycogen -(and protein kinase a activates glycogen phosphorlyase kinase)

BNP activates what?

-activates guanylate cyclase and increases cGMP

Active vs passive tension

-active is tension due to contracting -passive is tension due to stretching -> total tension = active + passive tension

What is the MOA of botulinum toxin?

-acts at the neuromuscular junction to cause muscle paralysis by inhibiting the release of acetylcholine from presynaptic motor neurons

Complications of stanford type A aortic dissection?

-acute aortic regurg -cardiac tamponade -stanford type A includes type I which is dissection of entire aorta (ascending + descending) -stanford type IIA is ascending only

what are nsaids indicated for in regards to RA?

-acute flares (short term tx)

Diffuse cortical necrosis

-acute generalized *cortical infarction* of both kidneys -likely due to a combination of vasospasm and DIC -characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury

Lymphocytic infiltrates with ballooning degeneration of hepatocytes makes you think of what?

-acute hepatitis

delirium

-acute onset of mental status changes that wax and wane -may present as impaired awareness, easy distraction, confusion, and/or disturbances of perception -pts may also be agitated or obtunded -recent mem is usually impaired, and speech may be rambling, perseverating, nonsensical, pressured, or incoherent -usually due to a physiological cause -usually reversible

Katayama fever

-acute schistosomiasis -present with a pruritic papular or urticarial rash on the feet and lower legs and flulike illness with fever, dry cough, and headache -primary risk is travel to endemic areas (Africa, South Africa, and Southeast Asia) -caused by trematode that lives in freshwater snails -longterm complications--hepatic fibrosis, spinal cord lesions, infertility, and bladder cancner -eosinophils found in approx 60% of pts -treat with corticosteroids to reduce inflamm and praziquantel

How to treat radioactive iodine (125 I) exposure?

-administer potassium iodide which will compete with the radioactive iodine for binding

What two disease are associated with berry aneurysm?

-adult polycystic kidney disease -ehlers danlos syndrome (type III?)

Marcus Gunn pupil

-afferent pupillary defect -the swinging light test can lead to the diagnosis of Marcus--Gunn pupil (relative afferent pupillary defect) -this symptoms is a result of optic neuritis secondary to demyelination of the optic nerve (basically can be a symptom of MS) -stimulation of unaffected eye leads to pupillary constriction of both eyes -stimulation of the affected eye can lead to a relative dilation of both eyes

CHADS-VASc score

-afib treatment based on coagulation state -this is a stroke risk score -score 0-1 = aspirin -score> or equal to 2 is warfarin or other anticoag

when during inspiration or expiration is the pulmonary vascular resistance the lowest? -max expiration -after expiration of a normal tidal volume -after inhalation of a normal tidal volume -max inspiration -max expiration with breath hold

-after expiration of a normal tidal volume (bc During inspiration, increased lung volumes cause alveolar expansion and lengthwise stretching of the interstitial alveolar vessels. This increases their length and reduces their diameter, thus increase alveolar vessel resistance)

DM T2 insulin levels

-after much time, endogenous insulin levels will be hellllllla low

Mayer-Rokitansky-Küster-Hauser syndrome

-agenesis of Müllerian, or paramesonephric duct (agenesis/atresia of top of vagina, uterus, or both) -presents are primary amenorrhea in women with normal breast and body hair development -cannot get pregnant and deliver the fetus due to lack of uterine/vaginal development

Mayer-Rokitansky-Kuster-Hauser syndrome

-aka Mullerian agensis -may present as primary ammonrrhea due to lack of uterine development in females w fully developed secondary sexual characteristics -primary amenorrhea in women with normal breast and body hair development -congental absence of upper part of vagina and, usually an absence of the uterus and fallopian tubes -gestational surrogacy is used if pt wants to have a genetic child

Glucose-6-phosphatase

-aka Von Gierke disease (ref Pixorize's Von Gierke's jerky sketch) -characterized by profound fasting hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, and hepatomegaly due to both glycogen and fat accumulation, and seizures

Granulomatosis with polyangitis

-aka Wegener -Upper respiratory tract: preforation of nasal septum, chronic sinusitis, otitis media, mastoiditis -Lower respiratory tract: hemoptysis, cough, dyspnea -Renal: hematuria, red cell casts -Triad: focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, necrotizing glomerulonephritis -PR3-ANCA/c-ANCA (anti-proteinase 3) -CXR: large nodular densities -Tx with cyclophosphamide, corticosteroids

test efficiency (EBM)

-aka accuracy -accuracy = TP + TN/Total tested population

Granuloma inguinale**

-aka donovanosis -painless, beefy red ulcer that bleeds readily on contact -uncommon in US -Klebsiella (calymmatobacterium) granulomatis -cytoplasmic donovan bodies (bipolar staining seen on microscopy), biopsy and stain with giemsa stain to visualize these intracytoplasmic donovan bodies

Leiomyoma

-aka fibroids -benign neoplastic proliferation of smooth muscle arising from myometrium (most common tumor in females) -related to estrogen exposure (common in premenopausal women, often multiple, enlarged during pregnancy and shrink after menopause -gross: multiple, well defined, white WHIRLED masses -usually asymptomatic but can have abnormal uterine bleeding, infertility, and a pelvic mass

Wilson's disease

-aka hepatolenticular degeneration -autosomal recessive mutation in hepatocyte copper-transporting ATPase (ATP7B gene on chromosome 13) -characterized by copper accumulation in multiple organ systems -pt presents with liver disease before the age of 40--clinical features include signs of liver disease, personality disturbances, parkinsonian features, and Kayser-Fleischer rings -D-penicillamine and trientine, which are copper chelators, are the preferred treatments to slow disease progression

Henoch-Schönlein purpura

-aka immunoglobulin A vasculitis -most common childhood systemic vasculitis -often follows URI -classic triad: skin (palpable purpura on buttocks/legs), arthralgias, GI (abdominal pain associated with intussesception) -autoimmune disease marked by abdominal pain, lower leg vasculitis, joint pain, and hematuria -vasculitis secondary to IgA immune complex deposition -associated with IgA nephropathy (Berger disease)

nasopharyngeal carcinoma

-aka lymphoepithelioma -most common adult tumor in Southern China and childhood tumor in certain african regions -EBV infects nasopharyngeal epithelial cells and transforms them into cancer cells -histologically, the tumor is comprised of anaplastic cells surrounded by normal-appearing lymphocytes -malignant epithelial cells are immunoreactive for cytokeratin -can cause epistaxis and nasal obstruction -3 types: 1. keritinizing (most common); 2. non-keratinizing (radiosensensitive/better prog); 3. basaloid

Monckeberg sclerosis

-aka medial calcific sclerosis -uncommon -affects medium-sized arteries -calcification of internal eslatic lamina and media of arteries-->valvular stiffening WITHOUT OBSTRUCTION -"pipestem" appearance on x-ray -does not obstruct blood flow and intima not involved

What is chronic persistent hepatitis?

-aka minimal chronic hepatitis -disease state with minimal symptoms and mildly elevated enzymes

struma ovarii is mature or immature and is also known as?

-aka monodermal form of mature (not cracked in sketch) teratoma

I-cell disease

-aka mucolipidosis II (think Pixorize's ice cold cell (I-cell) with the boss and the praying mantis's assembly line) -caused by a defective UDP-N-acetylglucosamine-1-phosphotransferase, the enzyme that phosphorylates a terminal mannose (mannose-6-phosphate tag in golgi) moiety on enzymes destined for inclusion in lysosomes -abnormal vacuolization and inclusion bodies in the cytoplasm -by age of 6 months, there is failure to thrive (and other developmental delays) as well as abnormal skeletal development, gingival hyperplasia, cloudy cornea, coarse features, and restricted joint movement -can show elevated serum acid hydrolases and glycosylases

Intrahepatic cholestasis of pregnancy

-aka pruritis gravidarum -disorder is reversible form of cholestasis that affects pregnant women in the second or third trimester -Sx: Intractable nocturnal pruritus on palms and soles of feet without skin changes -Dx: 10-100x increase in serum bile acids -Tx: Ursodeoxycholic acid treatment of choice. Sx may be relieved by antihistamines and cholestyramine

Buerger disease

-aka thromboangiitis obliterans -necrotizing vasculititis causing segmental thrombosis in arteries and veins of the extremities (especially in the digits) -typically occurs in heavy smokers -may present with Raynaud phenomenon, paresthesias, claudication, ulceration/gangrene of fingers and toes -main tx: smoking cessation

acute pancreatitis is caused by?

-alcohol and biliary tract disease (gallstones) are the main pre-disposers of this disease

Alcohol's effect on ADH

-alcohol suppresses ADH release and thereby increases urinary water excretion (you pee a lot when you drink)

What happens to ATP, myoglobin oxygen, and creatine phosphate during exercise?

-all decrease

Pulmonary arterial hypertension (PAH) treatments

-all lover PVR (pulm vascular resistance) -Epoprostenol (aka prostacyclin -PGI2, potent vasodilator (IV)) -Bosentan (antagonist endothelin-1 receptors (PO)) -Sildenafil (inhibits PDE-5 in smooth muscle of lungs (PO))

Rhus dermatitis

-allergic contact dermatitis that occurs from the genus of plants called Toxicodendron (ex. poison ivy)

Norepinephrine receptor selectivity?

-alpha 1 > alpha 2 > beta 1

How does DKA affect potassium?

-although dka inc serum potassium, negative potassium balance causes the excretion of potassium to be greater than the intake -bc osmotic diuresis dec K+ reabsorption, volume depletion leads to inc activity of aldosterone which inc K+ excretion, and ketoacids in urine carry a negative charge that draws sodium and potassium into the tubular lumen

What happens to pulmonary microcirculation during exercise?

-although pulmonary vascular resistance is very low at rest (PVR), it can dec further, as in exercise, during which blood flow increases (via both recruitment and distensibility -as first aid puts it, when you exercise (you inc cardiac output, so there is vasodilation of apical capillaries--> V/Q ratio approaches 1) -https://www.medschool.lsuhsc.edu/physiology/courses_respiratory_mgl3.aspx (if need more help)

Unilateral pleural effusion...always consider?

-always consider bacterial cause bc unilateral -also bacterial pleural effusion will/can cause exudative effusions (has one or more of the following: pleural fluid protein/serum protein> 0.5, pleural fluid LDH/serum LDH>0.6, pleural fluid LDH more than two-thirds the normal upper limit for serum)

Which antibiotics interfere with the formation of the initiation complex?

-aminoglycosides (30s) -linezolid (50s) -interfere with initation codon functions

What kind of stone does Proteus produce?

-ammonium magnesium phosphate (15%) -aka struvite stones which are caused by infection of urease positive bugs that hydrolyze urea to ammonia-->urine alkalinization (commonly form staghorn calculi)

What substance contributes to the cytotoxic effect of H. pylori on gastric mucosa?

-ammonium!! -H. pylori damages the gastric mucosa in part by inc mucosal levels of ammonium (ammonium is cytotoxic and directly damages epithelial cells in stomach) -in addition, ammonium potentiates the cytotoxic effects of vcauolating toxin A (VacA) produced by H. pylori

What is potentiation and where in the body is this utilized?

-an added/synergistic effect -parietal cells have Ach, histamine, and gastrin receptors which all inc gastric acid secreted--these three pathways interact synergistically (potentiation) so disrupting one pathway dec the ability of the others to stimulate acid secretion

dermoid cyst

-an almost always benign, cystic, mature teratoma usually found in the ovaries

Erythromycin

-an antibiotic, can act as a motilin agonist, making it useful in the treatment of gastroparesis. It often causes diarrhea, nausea, and abdominal pain -can also be used to treat certain skin and pulmonary infections caused by Haemophilus, Streptococcus, and Staphylococcus species -is a macrolide antibiotic used to treat atypical pneumonia and other conditions caused by Legionella, Chlamydia, and Neisseria species -mechanism of action of erythromycin involves the inhibition of translocation of the ribosome from one codon to the next codon, thereby causing premature termination of translation. It does so by binding to the 50S ribosomal subunit

Immune Thrombocytopenic Purpura (ITP)

-an autoimmune disease characterized by a low platelet count and easy bruising or bleeding through skin or mucous membranes -on blood smear, platelets may be abnormally large bc of inc platelet production -ITP can occur in children or adults but often occurs in women of childbearing age -It is an acquired thrombocytopenia caused by autoantibodies against platelet antigens, where the platelets are marked for phagocytosis by macrophages in the spleen. -ITP can also be drug induced and has an association with acetaminophen and trimethoprim/sulfamethoxazole (both of which were taken by this patient

acute intermittent porphyria

-an autosomal dominant defect that produces an altered porphobilinogen deaminase (aka uroporphyrinogen 1 synthase); have buildup of ALA (think of Pixorize's Poor 3 Bills by the dam) -differentiator from other porphyrias: absence of cutaneous rash or other cutaneous lesions such as blistering or scarring -symptoms: severe ab pain, neurological problems, psychiatric distrubances

What is the source of the cause for Kartagener syndrome?

-an autosomal recessive disorder by a dynein arm defect affecting the movement of cilia

Fanconi anemia

-an autosomal recessive disorder that results in marrow hypofunction and, eventually, pancytopenia -often accompanied by multiple congenital abnormalities, including hypoplastic bone anomalies -Clinically, patients present with short stature and skin pigmentation, including café au lait spots during childhood -Progressively increasing mean corpuscular volume (MCV) is one of the early signs before peripheral blood cytopenia becomes evident -due to increased chromosomal breakage caused by a defect in a multiprotein complex required for DNA repair, which makes patients more sensitive to chemotherapy and radiation -also have an increased risk of developing myelodysplastic syndrome (40% of cases) and acute myeloid leukemia (15% of cases)

Clostridium septicum**

-an cause gas gangrene, but unlike other Clostridium species like Clostridium perfringens, no trauma is necessary at the site of the infection -thought that the infection is established by hematogenous spread from the gastrointestinal tract -associated with colorectal cancer and other defects of the bowel

familial hyperlipidemia

-an elevation of serum lipid levels -In these people, the liver makes excessive cholesterol and other fats. -A condition that runs in families and results in high levels of serum cholesterol and other lipids.

Near miss

-an error occurs but no harm is done to the patient

Rathke pouch makes what?

-an evagination of oral ectoderm that forms the anterior pituitary gland (adenophysis)

Regression

-an immature defense mech-->involuntarily turning back the maturational clock to behaviors previously demonstrated under stress (contrast with fixation) -ex. a previously toilet-trained child begins bedwetting (enuresis) again follow the birth of a sibling -can result from a sense of neglect following the birth of a sibling

Central venous catheterization: pros and cons

-an important means of delivering long-term drug therapy -moreover, it serves as a means of measuring central venous pressure -However, numerous adverse effects are associated with central lines, including infection, thrombosis, vein stenosis, and, as in this patient's case, venous air embolism

ankylosing spondylitis (AS)

-an inflammatory arthritis of the spine -clinical features include chronic pain/stiffness in the spine and sacroiliac joints -Stiffness and tenderness of the neck and lower back pain with decreased range of motion due to inflammation of the sacroiliac joint and vertebral column are characteristic -The fusion of sacroiliac joints and lumbar vertebrae (bamboo spine on x-ray) is often seen on x-ray of the vertebral column -most common in the lumbosacral region -pts with AS frequently carry the gene for human leukocyte antigen B27 (HLA B27)

Meperidine

-an opioid analgesic used for moderate to severe pain

In an alcoholic patient with fever, rust-colored productive cough, and cavitary lung lesion, foul smelling sputum, suspect what kind of bugs?

-anaerobes of the oral normal flora causing a lung abscess (like Bacteroides, Peptococcus, and Fusobacterim)

What happens physiologically during vigorous exercise?

-anaerobic metabolism creates lactic acid, lowering pH in the pulmonary arteries, which carry systemic venous blood to the lungs to be oxygenated -The pulmonary artery is the only artery in the body that carries deoxygenated blood -more V/Q matching--from apex to base becomes more uniform; -the increased oxygen needed by the muscles can be attained by increased oxygen extraction from hemoglobin, leading to a decrease in mixed venous oxygen saturation -Pulmonary blood flow increases during exercise because cardiac output increases to ensure adequate oxygen delivery to muscles and carbon dioxide delivery to the lungs for exhalation -no change in PaO2 and PaCO2 but inc in venous CO2 and dec in venous O2

ethylene glycol toxicity presentation

-anion gap metabolic acidosis -flank pain -hematuria

a person is fructose intolerant. What should they not eat/drink? -diet soda -mlik -pizza -potatoes -rice

-answer is diet soda -fructose is found in sucrose, a disaccharide in table sugar and other sweets -pts should also avoid sorbitol which can be converted to fructose by the enzyme sorbitol dehydrogenase -sorbitol is commonly used as a sweetener in diet soda and other "sugarless" products like chewing gum

Fluoroquinolones should not be taken with what drug?

-anti-acids drugs -bc fluoroq have decreased bioavailability because antiacids contain calcium and/or magnesium salts that chelate the fluoroquinolone and dec its absorption via the intestinal tract

characteristic of drug induced lupus

-anti-histone-Antibodies ("you'll be history")

infliximab

-antibody against TNF-alpha -used in rheumatoid arthritis, Crohn's -"chimeric"--both mouse (murine) and human components, antigen-binding portion of the molecule murine, and constant Fc domain-human -risk of reactivation TB--PPD screening done prior to treatment -risk of other infections such as bacterial, hepatitis, zoster

flumazenil

-antidote for benzodiazepine overdose

Prochlorperazine

-antiemetic agent that blocks dopamine receptors in the chemoreceptor trigger zone (color pro in sketch) -indicated for severe nausea and vomiting as well as nonpsychotic anxiety -AE: neuroleptic malignant syndrome and extrapyramidal symptoms

ethylene glycol poisoning

-antifreeze -> converted to oxalic acid -> renal failure -main component of antifreeze and is converted to glycolic and oxalic acid by alcohol dehydrogenase -It results in a high anion gap metabolic acidosis and oxalate anions combine with calcium to produce calcium oxalate crystals that obstruct the renal tubules, causing renal failure and hematuria -treat with fomepizole (can also treat methanol toxicity with this; if not this than treat with ethanol, dialysis)

serotonin syndrome

-any drug that inc 5-HT -psychiatric associated drugs: MAOIs, SSRIs, SNRIs, TCAs, vilazodone, vortioxetine, buspirone -Nonpsychiatric drugs: tramadol, odansetrone, triptans, linezolid, MDMA, dextromethorphan, meperidone, St. John's wort -3 A's: inc Activity (neuromuscular; eg. clonus, hyperreflexia, hypertonia, tremor, seizure), Autonomic instability (hyperthermia, diaphoresis, diarrhea). Altered mental status -tx with cyproheptadine (5-HT2 receptor antagonist)

Congenital Adrenal Hyperplasia (CAH)

-any of several genetic mutations that can cause a female fetus to be exposed to adrenal androgens, resulting in partial masculinization at birth -condition during prenatal development in which the adrenal glands produce high levels of androgens; sometimes associated with masculinization of external genitalia in genetic females; and sometimes associated with higher rates of masculine-stereotyped play in genetic females

Occlusion of the left middle cerebral artery can result in?

-aphasia -spastic paresis of the contralateral lower face and upper limb -anesthesia of contralateral face and upper limb -consider the left cerebral hemisphere as dominant

What are three adverse effects that PTU and methimazole share?

-aplastic anemia -agranulocytosis -drug induced lupus

Alcohol withdrawal symptoms

-appear within 6-12 hrs after stop ingesting alc -abd cramping -vomiting -tremors -restlessness -inability to sleep -TACHYCARDIA (SNS stuff) -HTN -transient hallucinations or illusions -anxiety -increased RR, temp -tonic clonic seizures -diaphoresis

Difference between sign and symptoms of ectopic pregnancy vs. appendicitis?

-appendicitis: most likely positive psoas sign -preggars: negative psoas sign, elevated b-hcg, amenorhea -both can present with lower abdominal pain/tenderness with rebound and guarding in RLQ

Doxepin

-approved for use in the tropical treatment of eczematous dermatitis (atopic dermatitis, eczema, or lichen simplex chronicus) -oral tricyclic antidepressant (TCA)

posterior third of the tongue

-arches 3 and 4 -sensory: glossopharyngeal nerve IX of 3rd arch -some posterior taste: CN X of 4th arch

Bronchogenic cyst

-are abnormal growths of tissue that are congenital (present from birth). They typically have thin walls and are filled with fluid or mucous. Most bronchogenic cysts are found in the mediastinum, the part of the chest cavity that separates the lungs; an incidental finding when a chest-x-ray was preformed for an upper respiratory illness -formed by abnormal budding of the embryonic foregut but do not develop into lungs

medullary thyroid carcinoma

-arise from parafollicular C cells, which produce calcitonin -elevated calcitonin can cause diarrhea and facial flushing

Bronchioalveolar carcinoma

-arise from terminal bronchioles or type 2 pneumocytes and is NOT associated with tobacco smoking -considered an in situ (non-invasive) form of adenocarcinoma, arising from type II penumocytes, that grows and expands along the alveolar lining -chest x-ray shows features of peripheral pneumonia-like consolidation, rather than a mass lesion

What happens to arterial oxygen saturation at high altitude?

-arterial O2 saturation decreases at high altitude when compared to normal sea level measures due to low availability of oxygen

most compromised arteries?

-arteries that do not anastamose

Psoriatic arthritis

-arthritis tends to develop after the rash in most patients -seronegative spondylarthropathy (group of joint disorders characterized by a lack of RF, axial skeleton involvement (spine/sacroiliac joint), path changes in the ligament (not synovium) and an HLA-B27 assoication), and GI/GU infections -can develop anterior uveitis, which can be diagnosed with slit-lamp examination

Relationship of passive and active tension of the muscle

-as passive tension inc (when muscle is being stretched), then active tension decreases -inverse relationship

PID

-ascending infection of the reproductive tract most commonly caused by C. trachomatis or N. gonorrhea -Long-term complications associated with PID include chronic pelvic pain, infertility, and ectopic pregnancy (extrauterine embryo implantation)

Fetal Hydantoin Syndrome

-associated w/ phenytoin use in pregnancy -growth deficiency -abnormal facial features (broad, short nose; wide-spaced eyes; malformed ears; microcephaly; classically cleft lip and cleft palate)

large, bulky vegetation with adjacent leaflet perforation

-associated with acute bacterial endocarditis

tiny vegetations along the line of closure of the valve leaflet

-associated with marantic endocarditis, a non-bacterial thrombotic endocarditis that can be associated with a protracted illness like cancer (most often found on autopsy)

Maternal thalidomide

-associated wtih variable cardiac manifestations and phocomelia, wherein the limbs are underdeveloped or absent -used in multiple myeloma and leprosy treatment

REMEMBER....non selective beta blockers make lung problems worse by constricting beta 2! (esp. what disease?)

-asthma and stuff like asthma (COPD, emphysema, etc)

When will pulmonary vascular resistence be the lowest?

-at FRC (the sweet spot which is at the end of passive expiration bc during inhalation at the end, inc alveolar vol so this stretches the vasculature but if dec volume too much it also narrows the vessels--so there is a sweet spot)

At steady state, what happens to creatinine excretion rates?

-at SS, creatinine production and excretion rates are constant -if change in creatinine clearance, would cause a change in creatinine excretion in the very short term (in minutes) and then goes to steady state

what disease presents with being confined to a wheel chair, recurrent respiratory/sinus infections, and threadlike red lines throughout skin?

-ataxia telangiectasia (AT)-disorder caused by a mutation in the ATM gene that prevents repair of double stranded DNA breaks through non-homologous end joining -high risk for DNA damage from ionizing radiation, which can lead to cancer

Atherosclerotic vs dissecting aneurysm

-atherosclerotic is more abdominal aneurysm; risk factors include inc age, male, fam history, tobacco use; may present as a palpable pulsatile abdominal mass -dissecting is more aortic arch and due to hypertension; associated with cystic medial degeneration; risk factors include hypertension, bicuspid aortic valve, connective tissue disease (marfan); historically associated with tertiary syphilis (obliterative endarteritis of the vasa vasorum); aortic root dilation may lead to aortic valve regurg

V waves

-atrial filling (pressure created by blood returning from the systemic circulation) -large v waves--when extra blood is added to right atrium like in tricuspid regurg

Endocardial cushions

-atrial septum -ventricular septim -AV valves (mitral/tricuspid) -semilunar valves (aortic pulmonic)

2,4-dinitrophenol

-attaches to protons and allows them to enter into the mitochondria without going through the ATP-generating system -uncoupler, produces heat

complex partial seizure

-attacks of confusion, & loss of awareness (present but not responding to things) -you might also make nonpurposeful movements (for example, you might smack your lips, rub your hands, or swallow) -electrical activity localized to 1 hemisphere

Risperidone

-atypical antipsychotic -dopamine receptor antagonist -txs tourettes -in sketch, it is part of the "Quiet please, only whispering (risperidone) is appropriate"

olanzapine

-atypical antipsychotic use to treat schizophrenia, depression, (treatment resistant), or OCD, and tourettes -blocks histamine, alpha-1, and muscarinic receptors

Pneumocystic jirovecii

-atypical pneumonia due to over-replication of type 2 pneumocytes and their production of surfactant rich exudates, which fill the alveolar sacs and eventually cause death by asphyxiation (kaplan) -an opportunistic infection in premature infants and patients with AIDS! -typically visualized by microscopy using methenamine silver stain, spherical in shape/disc-shaped

Multiple sclerosis

-autoimmune condition characterized by loss of oligodendrocytes and demyelination of the central nervous system (UMN lesion) -can present with optic neuritis leading to painful eye movements and visual disturbance, and internuclear ophthalmoplegia leading to medial rectus palsy and horizontal nystagmus -periventricular white matter plaques on brain MRI is pathognomonic -acute plaques: lymphohistiocytic infiltration and myelin byproduct digestion -older plaques: hyperplasia and hypertrophy of astrocytes transform the plaque into a gliotic area

systemic lupus erythematosus (SLE)

-autoimmune disease in which immune system attacks connective tissue throughout body such as in joints and skin -C3 is the most abundant complement protein and since lupus is an inflammatory disorder that consumes complement, this leads to a dec in C3 levels

Bullous pemphigoid

-autoimmune disease where Ab are made that bind to dystonin (bullous pemphigoid antigen) and sirupt the hemidesmosome structure -as a reulst, the epithelial sheet of skin separates from the basal lamina, allowing for the accumulation of fluid in this space and resulting in the formation of tense subepidermal blisters -nikolsky sign is negative

celiac disease

-autoimmune response triggered by gluten foods -presences of IgA antibodies against tissue transglutaminase (tTG), which is concentrated in intestinal smooth muscle endomesium -GI diarrhea symptoms, dermatitis herpetiformis, and can lead to osteomalacia and osteoporosis

How does renal blood flow (RBF) remain constant/autoregulate in the kidney?

-autoreg is primarily through afferent arteriolar constriction -autoregulation happens through two main principles--myogenic response and tubuloglomerular feedback (TGF) -myogenic response: vascular smooth muscle cells contract reflexively in response to rising wall tension (inc systolic blood pressure) caused by increasing perfusion pressure. Contraction dec RBF and this mech accounts for 40-55% of autoreg here and is rapid -TGF: when SBP rises, GFR rises which inc delivery of NaCl to the macula densa which then release various signaling molecules (ATP and adenosine) which diffuses via mesangial cells to the afferent arteriole, where they stimulate contraction. TGF occurs w a 10-15 sec delay and accounts for 25-35% of autoreg response

Hypercholesterolemia is dominant or recessive?

-autosomal DOMINANT

Familial hypocalciuric hypercalcemia (FHH)

-autosomal dominant -decreased urinary Ca2+ excretion and increased serum Ca2+ -caused by inactivating mutations of Ca2+ sensing receptors (CaSR) that regulate PTH secretion -pts present with a strong family history of hypocalciuric hypercalcemia -symptoms include polyuria, constipation, and neuropsychatric disease -inappropriately normal or elevated PTH and elevated Mg levels -the CaSR is a G protein coupled membrane receptor

Peutz-Jeghers syndrome

-autosomal dominant -development of noncancerous growths called hamartomatous polyps in the gastrointestinal tract -caused by a mutation in STK11, which is a tumor suppressor gene -numerous hamartomatous polyps in the GI tract, which can lead to intussusception -hyperpigmented spots on the mouth/lips, hands, and genitalia -Complications include increased risk for breast and GI cancers

adult polycystic kidney disease (APKD)

-autosomal dominant -normal renal function until middle age -renal failure, hematuria, flank pain, hypertension, and often anemia (secondary to a failure of renal erythropoietin production) -extrarenal manifestations: liver cysts, and circle of Willis berry aneurysms/subarachnoid hemorrhage, hepatic cysts, pancreatic cysts, diverticulosis, flank pain + hematuria due to recurrent kidney/stones/UTI

SCID due to mutation in ADA (adenosine deaminase deficiency)

-autosomal recessive -2nd most common cause of SCID

Homocystinuria

-autosomal recessive -caused by defects in cystathionine synthase, methionine synthase, vitamin B6, and MTHFR--> overaccumulation of homocysteine in the body -Lens subluxation -*thrombosis* -marfanoid habitus and kyphosis, caused by defects in collagen cross-linking -intellectual disabiliity -hypopigmented skin and hair -can treat. with pyridoxine for the b6 deficiency

Hereditary fructose intolerance

-autosomal recessive -lack of aldolase B (see owl on counter) which leads to the accumulation of fructose-1-phosphate -fructose-1-phosphate binds free phosphate -pts become symptomatic only after consuming fructose, so infants often present after eating fruit, juice or honey -symptoms--vomiting, hypoglycemia, jaundice, and liver cirrhosis

Jervell and Lange-Nielsen syndrome

-autosomal recessive -characterized by long QT interval and sensorineural deafness -caused by a mutation in KCNE1 and KCNQ1 genes which work together to form potassium channels -high risk for developing torsades de pointes and sudden cardiac death -beta blockers and implantable cardiac defibrillator use

Abetalipoproteinemia

-autosomal recessive deficiency of Apolipoprotein B-48 and B-100 (these include VLDL and chylomicrons) -in the GI, the inability to form chylomicrons causes steatorrhea and malabsorption of fat soluble vitamins--so pts presents with steatorrhea (greasy, foul-smelling stools) and growth failure

Cystinuria

-autosomal recessive disorder caused by impaired renal reabsorption of several amino acids (cysteine, ornithine, arginine, lysine (COLA or ends in "ine")...so they are inc in urine -cystine kidney stones, which are hexagonal under the microscope -cyanide-nitroprusside test can be used to determine cystine concentrations in the urine -Treatment focuses on preventing the formation of kidney stones, and includes alkalinizing agents like potassium citrate and acetazolamide, as well as chelators like penicillamine

Aklaptonuria

-autosomal recessive disorder resulting from defects in the metabolism of tyrosine -caused by a deficiency of homogentisate oxidase, resulting in the accumulation of homogentisic acid -Homogentisic acid forms a pigment, and its buildup leads to ochronosis, or a bluish-black discoloration of sclera and connective tissue -urine that turns black upon prolonged exposure to air is observed -toxic to cartilage, which can lead to a clinical presentation of joint pain and arthritis in patients

albinism

-autosomal recessive disorder resulting from tyrosinase deficiency or defective tyrosine transport in melanocytes -Melanocytes are derived from neural crest cells of the neuroectoderm that migrate into the mesenchyme of the developing dermis in the embryonic period

Guachers Disease

-autosomal recessive lysosomal storage disease caused by a deficiency in Beta-glucocerebrosidase (think pixorize's Goucher and son's kosher deli) -glucocerebroside in the liver and spleen leads to hepatosplenomegaly, which distinguishes Gaucher disease from some of the other lysosomal storage diseases -accumulation in the bone marrow may also lead to pancytopenia, osteoporosis, and aseptic necrosis -Build-up in macrophages leads to the appearance of Gaucher cells under the microscope, which are characterized by tissue-paper cytoplasm and dark nuclei

Gitelman syndrome

-autosomal recessive mutation that inactivates the thiazide-sensitive Na+-Cl- cotransporter in the distal convoluted tubule -Reabsorptive defect of NaCl in DCT (like a thiazide diuretic) -Leads to hypokalemia, hypomagnesemia, metabolic alkalosis, and hypercalcemia (hypokalemia and hypomagnesemia-->muscle cramping and weakness) -hypertension is not seen bc of the NaCl wasting caused by the loss of Na+-Cl- cotransporter

Friedrich Ataxia

-autosomal recessive, GAA trinucleotide repeat disorder (think GAA for GAAit) -absent frataxin causes free radical injury and mitochondrial dysfunction, resulting in neuronal degeneration (dorsal root ganglia, CN 7,10,12, posterior column) -present with dysarthria, gait ataxia, and impaired position sense and vibration

REMEMBER: For social science questions, when given the option, always try to get more information from the patient, unless emergent treatment is warranted

-avoid unfounded assumptions or judgements about the patient!

surgical neck fracture of humerus affects what nerve?

-axillary

quadrangular space

-axillary nerve and posterior circumflex humeral artery run through here (AP) -formed by the teres minor, teres major, long head of the triceps, and surgical neck of the humerus

Allopurinol is contraindicated with what other drug?

-azathioprine -interferes with the metabolism of azathioprine's toxic metabolite, 6-mercaptopurine, which can lead to fatal hematologic disorders, such as aplastic anemia -Azathioprine and 6-MP (it's metabolite) are metabolized by xanthine oxidase so they inc when taken concomitantly with allopurinol or febuxostat

Respiratory burst

-bacterial killing by generating hydrogen peroxide and hypochlorous acid

Mech of resistance of aminoglycosides

-bacterial transferase enzymes inactivate drug by acetylation, phosphorylation, or adenylation

Which class of GABA-A agonists are CYP-450 inducers?

-barbituates -like phenoBarbital

Which areas of the brain are affected in kernicterus?

-basal ganglia and hippocampus -other areas include lateral thalamic nucleus, the geniculate bodies of the thalamus, and some brainstem nuclei

What is the most important factor for healing in terms of regeneration of skin/no scar formation?

-basement membrane remains intact is the most important -if intact, can do regeneration and no scar formation

microsatellite instability

-basically regions of repeats (like GTCGTC) and mismatch repair usually fixes these -mismatch repair genes MLH1 and MSH2 are mutated -associated with lynch syndrome (see satellite on roof in pic) -areas of dna with dinucleotide repeats (an ex of microsatellites) are often associated with strand slippage during DNA replication, allowing changes in the number of repeats on the newly synthesized strand. This mismatch repair enzyme normally corrects this replication error

Locked-in syndrome

-basilar artery stroke -also called ventral pontine syndrome bc affects this area (red area in pic)--so hits this area which affects corticospinal and corticobulbar tracts, leading to bilarteraly paralysis (quadriplegia) BUT patient can blink (upper brainstem intact) -contrast with vegetative state where motor fxn is intact but corical dysfxn

Why does cocaine during pregnancy cause prematurity?

-bc cocaine causes placental abruption so the fetus has to be delivered because it can no longer survive in the uterus (no blood supply anymore). So it has to come out, and it will happen earlier than it would if there was no abruption ->premature

What are three ways in which CO2 can be transported in blood?

-bc deoxyhemoglobin is better buffer of H+ ions than oxyhemoglobin, this is why deoxygenated blood can carry more carbon dioxide for a given PCO2 than oxygenated blood

Why doesn't atropine block vagal stimulation of gastrin release?

-bc gastrin release via vagus is not through Ach but actually through gastrin releasing peptide (GRP)

why is chronic alcoholism + acetominophen bad?

-bc leads to P450 enzyme induction -chronic ethanol consumption activates the microsomal ethanol-oxidizing system (MEOS) in the liver which is associated with a rise in cyt p450 met -the acetaminophen metabolite NAPQI is produced via p450 met and is toxic to the liver

why does a pt with aplastic anemia have a dec in mixed venous PO2?

-bc there is a problem with the number of hemoglobin amount so less hemoglobin carriers of oxygen so when get to the tissues, the tissue are gunna suck up as much oxygen off of the limited amount RBC/hemoglobin so there will be less O2 going back to the lungs

Where are teratomas derived from?

-bc they contain ectoderm, endoderm, and mesoderm, they are thought to derive from the primitive streak -the sacrococcygeal region is the most frequent teratoma tumor site

Why is amoxicillin sometimes paired with clavulanic acid?

-bc treats bacteria that are resistant to penicillin meds due to beta lactamases -so potassium clavulanate is added to amoxicillin to treat infections caused by beta lactamase-producing bacteria

Why do you get increase conjugated bilirubin when you have choledocholithiasis?

-bc with cholestasis, the conjugated bilirubin in the hepatocyte would be transported back into the sinusoidal circulation, producing a conjugated hyperbilirubinemia -conjugated bilirubin is water soluble so can be filtered by the kidney and appear in the urine, unlike unconjugated bilirubin

Where should an intercostal nerve block be administered?

-below the rib and lateral to the angle of the rib to be anesthetized

Sleep stages

-beta waves is highest freq, lowest amplitude -awake: beta waves when eyes open and alpha waves when eyes closed -delta waves are the lowest freq, highest amplitude -during stage 2--TWOoth grinding occurs -during stage 3--wee and fee in N3 (bedwetting and sleepwalking)

PDA is a connection between?

-between aorta and left pulm artery

What weakens the gastric mucosal barrier?

-bile salts (bc allows for gastric contents like bile to penetrate through the barrier for reabsorption) -histamine -NSAIDS -aspirin -H. pylori -Gastrin PROTECTS the barrier bc helps maintain the strength and integrity of the gastric lining by initiating cell division in the proliferative zone of the gastric mucosa

How is urobilinogen formed?

-bilirubin is secreted in bile and metabolized by the gut bacteria to urobilinogen which remains int he gut and after further metabolism, provides the pigmentation to the stool

Why does TMP-SMX cause kernicterus?

-bilirubin is the breakdown product of heme and it transported by albumin in the blood to the hepatocyte for conjugation -maternal use of TMP-SMX can cause displacement of bilirubin from albumin-->kernicterus

MOA of steroid hormones

-bind to a cytosolic receptor then translocate to the nucleus

Troponin

-binds calcium and mediates Ca2+ activation of contraction in skeletal and cardiac muscle -TnC = Ca2+ binding protein -TnI = inhibitory subunit (suppresses actin/myosin interaction in absences of Ca2+) -TnT = tethering subunit (links Tn complex to tropomyosin, which associates with actin thin filament) -found in skeletal and heart (cardiac) muscle fibers that regulate muscular contraction

What does allosteric activators do?

-binds to locations on an enzyme away from the active site, inducing a conformational change that increases the affinity of the enzyme's active site(s) for its substrate(s)

Botulinum toxin causes what symptoms

-binds to motor neurons and prevents the release of Ach (think about botox) -causes descending muscle paralysis -also presents with anti-muscarinic activity--tachycardia, mydriasis and elvated body temp bc of dec Ach activity at M receptors

after checking the serum concentration of phenylalanine and serum tyrosine for possible PKU newborn screening, what should be tested next?

-biopterin -a required cofactor for deficient enzyme phenylalanine hydroxylase (PAH) is tetrahydrobiopterin (BH4)-a small percentage of PKU cases (about 2%) are caused by deficiency of BH4

G6PD

-bite cells and heinz bodies -can cause hemolytic anemia -inherited defect in the gene encoding the enzyme G6PD, which generates NADPH as part of the HMP shunt -glutathione peroxidase requires NADPH to function normally and protects human cells from free radical damage

Ecthyma gangrenosum

-black necrotic lesions on skin -Classically associated with *Pseudomonas aeruginosa* -caused by pseudomonas bacteremia -typically in immunocompromised patients

Ketoconazole

-blocks ergosterol synthesis in fungi -also blocks 1st step in cortisol synthesis (desmolase (side chain cleavage)) -can be used to treat Cushing's syndrome -Also potent inhibitor androgen synthesis (key side effect = gynecomastia)

inc VLDL secretions leads to? Lipoprotein lipase deficiency is a condition of?

-both are of elevated TAGS

sporadic mutation

-both hits are somatic -pretty hard to get both hits as opposed to germline mutation where you already start with one mutation and you just need 1 more hit -characterized by unilateral retinoblastoma

Where is Broca's area located?

-bottom of the frontal lobe

Gynecomastia

-breast enlargement in males due to inc Estrogen compared with androgen activity (isolated firm, rubbery, mobile subareolar discrete mass (pain and nipple discharge may be present in some cases) -physiologic in newborn, pubertal, and elderly males, but may persist after puberty -other causes include cirrhosis, hypogonadism (ex. Klinefelter), testicular tumors, and drugs (Spironoloactone, Hormones, Cimetidine, Finasteride, Ketoconazole: "Some Hormones Create Funny Knockers") -basically a benign proliferation of ductal and stromal elements of the breast

Parvovirus in adults can cause what symptoms?

-brief febrile illness accompanied by myalgias and malaise -Sketchy says arthralgias and edema -potential sequelae of in-utero parvovirus infection is hydrops fetalis (occurs when fluid moves from the fetal inravascular space and into the fetal interstitial space, accumulating in serous cavities and/or soft tissues -this extravascular fluid accumulation can manifest as ascites, skin edema, pleural effusions, and pericardial effusions in the fetus

How to differentiate bulimia nervosa and anorexia nervosa?

-bulimia will often have normal or overweight range BMIs -anorexia nervosa significantly restrict caloric intake, they will often have body mass indices (BMIs) below 18.5 kg/m^2

What disease has autoantibodies directed against skin basement membrane antigens?

-bullous pemphigoid

What is the sensation of DM neuropathy?

-burning or electric pain -neuropathic pain is a burning pain

T or F: encapsulated organisms are more difficult to phagocytize

-but opsonization (enhancement of phagocytosis with IgG and/or C3b) is the most important mech for removing these pathogens from the bloodstream

How are the lower extremities being profused in a pt with coarctation of the aorta?

-by collateral anterograde flow via the internal thoracic arteries and anterior intercostal arteries (which branch of the subclavian arteries) -retrograde flow is via anastomosis with posterior intercostal arteries -rib notching occurs when increased flow through the intercostal arteries slowly enlarges these arteries resulting in resorption of bone along the lower borders of the ribs

Tacrolimus (FK506)

-calcineurin inhibitor -blocks T-cell activation by preventing IL-2 transcription -similar to cyclosporine (inc risk of diabetes, neurotoxicity; NO gingival hyperplasia or hirsutism) -highly nephrotoxic (both calcineurin inhibitors are nephrotoxic--cyclosporine and tacrolimus)

What is a hallmark of cellular injury?

-calcium influx -is one of the underlying mechs/causes of necrosis and activates calcium dependent phospholipases which breakdown membrane phospholipids -membrane damage allows cellular contents to enter the serum

what is the most common cause of kidney stones (nephrolithiasis)?

-calcium oxalate (the composition of approx 70% of kidney stones) -these are envelope-shaped crystals -caused by idiopathic hypercalciuria (most common cause)

Kidney stones by shape

-calcium oxalate can also look like dumbbell shaped -calcium phosphate stone is wedge shaped prism

what kind of stones are pts w/ hyperparathyroidism at risk for?

-calcium phosphate stones

Myesthenia Gravis ice pack test MOA

-can aid in the diagnosis of myasthenia gravis -Cold temperatures inhibit acetylcholinesterase and thus, increase muscle strength via inhibition of the breakdown of acetylcholine and the neuromuscular junction -This leads to increased acetylcholine availability

Pleomorphic bacteria

-can assume several shapes bc have no rigid walls -ex. Anaplasma, ehrlichia, chlamydiae, rickettsiae, mycoplasma, ureaplasma ("plasmas")

Staph saprophyticus

-can cause UTIs in sexually active females and classically associated with nitrite negative urine in females with new or increasing sexual activity (also known as honeymooner's cystitis) -responds well to fluoroquinolones, TMP/SMX, and nitrofurantoin

Chronic rheumatic heart disease...what are the cardiac problems?

-can cause mitral stenosis and left atrial enlargement (predisposes to the development of atrial fib) -at risk of a-fib (non-distinct P waves)

T or F: gout can cause stones?

-can cause stones YOU IDIOT -can cause uric acid stones!!!!!

Urachal remnant

-can lead to adenocarcinoma of bladder -key feature is cancer at dome of bladder -classic case--adult with painless hematuria, tumor at dome of bladder, path showing adenocarcinoma

Radioiodine therapy

-can permanently treat hyperthyroidism by gradual absorption into and ablation of thyroid tissue -some pts may become permanently hypothyroid thus requiring a lifetime levothyroxine supplementation -CI is pregnancy and Graves disease with severe orbitopathy (radioiodine can further stimulate orbital fibroblasts which can worsen Graves ophthalmopathy)

Beta blocker overdose

-can present with symptoms of cardiogenic shock, including pale and cool extremities, bradycardia, and hypotension -treatment of choice is glucagon, which increases intracellular cAMP in cardiac myocytes via activation of G-protein-coupled receptors

renal cell carcinoma

-cancer of the kidneys -classic triad is flank pain, flank mass and hematuria (only in 10% of pts though) -most pts present with nonspecific signs or asymptomatic hematuria -cigarette smoking is a major risk factor -can potentially produce erythropoietin

What bug causes an infant diaper rash?

-candida (which is part of the normal flora)--think of yeast infections bc kind of similar

Dronabinol**

-cannabinoid that contains a synthetic analogue of delta-9-THC (found in marijuana) -stimulates cannabinoid receptors and is indicated for chemo-related nausea and vomiting as well as chemo or aids-related anorexia and weight loss

How do you measure ICF?

-cannot be measured directly, so has to be calculated from TBW - ECF volume

Acetazolamide

-carbonic anhydrase inhibitor -can be taken prophylactically or therapeutically to alleviate the symptoms of acute mountain sickness, also known as altitude sickness or high altitude pulmonary edema -leads to alkalinization of the urine and a metabolic acidosis

acetazolamide

-carbonic anhydrase inhibitor -improve oxygen delivery -used as a prophylaxis for high elevation symptoms (headaches, nausea, fatigue, shortness of breath)

What drug is used to induce uterine contractions to prevent/minimize postpartum hemorrhage?

-carboprost

What drug is used to increase uterine control to postpartum hemorrhage?

-carboprost (PGF 2-alpha analog)

Cardiac tamponade vs. constrictive pericarditis?

-cardiac tamponade would have an acute presentation with worsening vital signs than constrictive pericarditis

What is the function of the peroxisome?

-catabolism of very long fatty acids and amino acids

Abscesses are commonly produced by what kind of organisms?

-catalase-positive organisms

What is the first step of respiratory burst?

-catalyzed by NADPH oxidase

What happens when the caudal fold of the ventral wall fails to close? And what about the rostral fold?

-caudal fold failed closure-->bladder exstrophy -rostral fold failed closure-->sternal defects like ectopia cordis/ectopic heart

Rhambomyolysis can do what to the kidney?

-cause acute kidney injury/ acute tubular necrosis

Acute cholestatic hepatitis

-caused by Macrolides (erythromycin) -can lead to jaundice

central line--associated bloodstream infection (CLABSI)

-caused by S. epidermidis, S. aureus, and E. faecalis

Scabies**

-caused by Sarcoptes scabeii mite -causes intense pruritus (worse at night) and characteristic serpiginous burrow skin lesions over the wrist, finger, webs, and genitals; -common in crowded environments (dorms, prisons, barracks, daycares, nursing homes) -tx: topical 5% permethrin (inhibit voltage gated sodium channels leading to delayed repolarization, paralysis, and death of mites) lotion; if disseminated or severe then tx with oral ivermectin -transmitted via skin to skin contact

Human granulocytic ehrlichiosis (HGE) or anaplasmosis (HGA)

-caused by anaplasma phagocytophilum -intracellular bacterium that is transmitted via the ixodes tick -pathognomonic is presence of morulae (berry-like clusters of organisms) inside granulocytes

Myesthenia Gravis

-caused by antibodies to acetylcholine receptors at the neuromuscular junction--disorder in the transmission of impulses from nerve to muscle cell -Initial presentation involves painless weakness of the ocular and bulbar muscles that worsens with activity and improves with rest -S&S are worsening fatigue, weakness in one eyelid, and a feeling of heavy headedness later in the day

hookworm infection

-caused by necator americanus -pt presents with pruritic maculopapular eruption at the location of larval penetration, often between toes, mid-epigastric pain, nausea, and diarrhea -later pts lose weight and develop microcytic anemia, bc the worms attach to the intestinal wall, where they ingest blood

subacute endocarditis

-caused by s. viridans -can cause subacute endocarditis, generally in the setting of previously diseased heart valves and recent dental procedures -FROM JANE symptoms: F = fever R = roth spots O = osler nodes M = murmur J = janeway lesions A = anemia N = nail bed hemorrhage E = emboli

Rheumatic fever

-caused by strep pyogenes (past pharyngitis infection) -causes fibrous ring/bridging of calcifications of the leaflets/annulus (chronic RF can cause mitral stenosis which is these calcifications described)

Pressure volume hysteresis in the lungs

-caused by surface tension -inspiration begins with smallest volume (molecules close together and strongest surface tension) -expiration begins at high lung volumes (opposite of inspiration here and intermolecular forces are low)

exertional rhabdomyolysis

-causes hyperkalemia which stimulates aldosterone release from the adrenal cortex-->Inc K secretion and inc Na+ reabsorption

Primary adrenal hyperfunction

-causes inc secretion of cortisol, aldosterone, and adrenal androgens

Klebsiella pneumoniae

-causes pneumonia in alcoholics!!(remember triple A) -presents with red, gelatinous sputum -gram-negative, oxidase-negative bacillus that is lactose-fermenting -treat with a third-generation cephalosporin with or without an aminoglycoside -affects upper lobes

Cocaine during pregnancy can cause...

-causes vasoconstriction -many of same problems as smoking -placental abruption -preterm birth -miscarriage

What are the effects of stimulating muscarinic-3 cholinergic receptors?

-causes vasodilation -BUT REMEMBER...cause bronchoconstriction (bc it's PSNS)

DIC symptom presentation and causes

-causes: gram-negative sepsis (most common), trauma, malignancy, pregnancy (obstetric complications like abruptio placentae, retained placenta..etc) -IVs and arterial lines are common medical interventions that can cause bleeding and oozing indicative of DIC

Rigor mortis

-ccurs because the dead muscle cells are not regenerating their stores of ATP (which become depleted 3 to 4 hours after death) -Without ATP being available to bind to myosin, actin cannot be released from myosin and the actomyosin complex is maintained, leading to rigidity of the muscles as they remain in a contracted state

Which COX inhibitor is a sulfa drug?

-celecoxib

What NSAID does not affect the GI mucosa and what is the MOA?

-celecoxib--selective COX-2 inhibitor that blocks prostaglandin synthesis -it reduces pain, fever and inflammation and causes vasoconstriction of the afferent renal arteriole -used for acute symptom control in RA

General lymph node drainage of GI structures

-celiac nodes: drain foregut (esophagus, stomach, part of duodenum, liver, gallbladder, superior portion of pancreas -superior mesenteric: midgut (duodenum 3rd and 4th parts to 2/3rds of transverse colon) -inferior mesenteric: hindgut (1/3 of trans colon to upper part of the anal canal) -internal iliac nodes: drain the bladder and deep perineum -REMEMBER the paraaortic nodes drain the gonads! NOT the internal iliacs! -lymph node drainage follows reverse arterial blood supply!

diarrhea, bone pain, abdonimal tenderness makes you think what?

-celiac's disease -associated with dermatitis herpetiformis, leads to osteomalacia (malabsorption) and osteoporosis (anti bone) -dx via small bowel biopsy (villous blunting and crypt hyperplasia)

reversible injury

-cellular and mt swelling -membrane blebbing -nuclear chromatin clumping -ribosomal detachment

What is the most common cause of bloodstream bacterial infections?

-central line

CLABSI

-central line associated blood stream infection -symptoms: fever, chills, erythema at skin surrounding central line site, hypotension and sepsis (severe cases)

Hepatic encephalopathy

-central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma -first line tx: lactulose (acidifies colon contents -> NH3 turns to NH4+ and gets excreted and no longer cross membrane for absorption)

Jugular venous distension, a reflection of right atrial pressure, can be used to estimate what?

-central venous pressure

Microsatellite instability

-change in length of microsatellite due to insertion/deletion compared to normal tissue -> failure of error correction by DNA repair -> defective MMR (mismatch repair) -> frameshift mutation in coding region -> ex. TGF-b-II in HNPCC (Hereditary nonpolyposis colorectal cancer)

Definition of compliance

-change in volume over change in pressure

diabetic mastopathy

-characterized by dense fibrous breast tissue with focal lymphocytic infiltrates -occurs in type I diabetics

DIC (disseminated intravascular coagulation)

-characterized by endothelial cell damage, which releases tissue factor and triggers the coag cascade, resulting in formation of microthrombi and consumption of platelets, fibrinogen, and clotting factors -there is concurrent stimulation of the fibrinolytic system and the breakdown of microthrombi

Primary polydipsia

-characterized by excessive water intake in the setting of normally functioning kidneys -commonly seen in psychiatric patients -With water deprivation, the urine osmolality should immediately and robustly increase as the kidneys begin to retain water

Conversion disorder

-characterized by experiencing sensory or motor symptoms but with no correspondence to a consistent physical finding -symptoms include motor or sensory deficits, seizures, or mixed symptoms -not intentionally produced by the patient, who truly experiences the discomfort and distress OR explained by other medical conditions -often precipitated by psychological stressors

REM rebounding

-characterized by inc in the number and intensity of dreams for several days -can occur with discontinuation of meds or drugs known to suppress REM which are alcohol, barbiturates, stimulants, TCAs, SSRIs, lithium, and monoamine oxidase

Primary amyloidosis

-characterized by insoluble AL fibril protein (from Ig Light chains) -seen in Plasma cell disorders (eg. multiple myeloma)

carcinoid syndrome

-characterized by intermittent cutaneous flushing, intestinal hypermotility (water diarrhea, vomiting), and bronchoconstriction (wheezing, dyspnea)

Conn syndrome (primary hyperaldosteronism)

-characterized by low renin, hypertension, hypokalemia, episodic paralysis/weakness, and paresthesias -common causes include idiopathic bilateral adrenal hyperplasia and aldosterone-secreting adrenocortical adenomas

How to recognize eiosinophils on EM images

-characterized by the presence of intracytoplasmic granules that contain crystalline cores -crystalline material contains major basic protein (helps to destroy parasite and contributes to epithelial damage) -google eiosinophils EM images

what are classic symptoms of aortic dissection?

-chest pain radiating to the back, widened mediastinum on imaging and blood pressure differential between the left and right arms -aortic dissection may lead to a number of complications: -disruption of carotid artery bf may cause stroke -disruption of coronary artery bf may cause ischemia, most commonly involving the right coronary artery -widening of the aorta may disrupt aortic valve closure leading to aortic regurg and acute heart failure -blood may enter the pericardial space causing cardiac tamponade

Inspiration does what to the systolic arterial pressure, HR, RVEDV, LVEDV compared to expiration?

-chest wall moves outward and diaphragm tenses--> dec intrathoracic pressure and inc intraabdominal pressure -dec intrathoracic pressure--> dec RA pressure--> inc RA filling--> inc RV preload--> inc RV EDV -dec pulmonary vascular pressure--> inc intravascular volume (pulmonary vessels are thin-walled and readily distend)--> dec LA filling--> dec LV preload--> dec LVEDV--> dec LV stroke volume--> dec systolic arterial bp

Clonorchis sinesis

-chinese liver fluke -ID'ed by prominent opercular ridge on far right of image

Which antibiotics interfere with the formation of the peptide bond?

-chloraphenicol (50s) - inhibits activity of peptidyl-transferase

Why is chloroquine and primaquine used to treat malaria pt?

-chloroquine inhibits heme polymerization -primaquine kills hypnozoites

Chylothorax

-chlylous effusions (chylothorax) are exadative effusions with high lipid content (milky white appearance) that originate from lymphatic channels -most commonly related to disruption or obstruction of lymphatics by trauma or malignancy (lymphoma, adjacent tumors) -lymphoma is the most common non-traumatic cause

What emboli with needle shaped clefts

-cholesterol emboli -occlude small arteries -lookout for post surgery

Mech of resistance of fluoroquinolones

-chromosome-encoded mutation in DNA gyrase, plasmid mediated resistance, efflux pumps

Cachexia

-chronic condition in which the muscles weaken and waste -TNF-ɑ, IL-1, IL-6, and C5a are acute inflammatory cytokines responsible for fever, weight loss, and recruitment of late phase cytokines, which ultimately modulate the process of cachexia

Obesity-Hypoventilation Syndrome (Pickwickian Syndrome)

-chronic fatigue and dyspnea, and their labs are characterized by hypercapnia secondary to chronic hypoventilation -In the absence of intrinsic pulmonary disease, obesity hypoventilation syndrome is associated with a normal A-a gradient -symtoms: hypersomnolece, loud snoring, fatigue, impaired concentration, thick neck -normal or restriction PFTs -resp acidosis with met compensation, secondary polycythemia from chronic hypoxia

Ground glass appearance of liver cells is what kind of hep B infection?

-chronic hep B infection -also is characterized by chronic inflammation with continuing necrosis of hepatocytes -ground glass in lower half of pic (finely granular eosinophilic cytoplasm)

What are the etiologies for anemia of chronic disease?

-chronic infections -neoplastic disorders (like hodgkin lymphoma!) -chronic kidney disease -autoimmune diseases (SLE, RA, etc)

Sarcoidosis

-chronic inflammatory disease in which small nodules (granulomas) develop in lungs, lymph nodes, and other organs -present with dyspnea and an elevated angiotensin-converting enzyme level -Chest x-ray typically demonstrates bilateral hilar lymphadenopathy and interstitial infiltrates -Treatment is with corticosteroids, which can cause Cushing syndrome

Chronic bronchitis

-chronic productive cough lasting at least 3 months over a min of 2 years -associated with smoking -hypertrophy of bronchial mucous glands -leads to inc thickness of mucus glands relative to bronchial wall thickness (Reid index inc to >50% where as normal is <40%)

Normal function of what is required for proper left-right orientation of the heart within the thorax?

-cilia -cilia play a critical role in normal looping and establishment of the left-right orientation of the heart in the chest

On an electron micrograph cross section, what shows a "9+2" arrangement of microtubules?

-cilia! -basal bodies/centrioles are arranged in triplets and can be found at base of microtubule

Which H2-receptor antagonist is a major P450 inhibitor?

-cimetidine

What drug is indicated for the management of secondary hyperparathyroidism in patients with chronic kidney disease or parathyroid carcinoma?

-cinacalcet which increases the sensitivity of the parathyroid calcium-sensing receptor to calcium (causing a reduction in PTH-->reduces the rate at which calcium is released from bone) -in sketchy pharm (the archeology site sketch--pthd paleontology belt line)

Citrate is an activator for what and inhibitor for what enzymes?

-citrate can move freely from the mitochondria into the cytosol using the citrate shuttle -acts as a negative allosteric regulator of PFK 1 (enzyme that catalyzes the commited step of glycolysis) -acts as a positive allosteric effector of cytosolic acetyl CoA carboxylase (rate limiting step for FAS)

Pringle's maneuver

-clamping vessels of the portal triad (at the free edge of the lesser omentum, the hepatoduodenal ligament) to control bleeding during hepatic procedures -if bleed continues: IVC or hepatic veins is the culprit

Where is claudin located in the kideny?

-claudin along with occludin make up the tight jxn -tight jxn is found in the thick ascending limb of kidney (TAL) bc tight jxns between cells prevent the passage of water and solutes via the paracellular pathway

disseminated mycobacteria avium complex (MAC)

-clinical features: fever, night sweats, abdominal pain, and diarrhea -lab abnormalities: anemia, elevated serum alkaline phosphatase and lactate dehydrogenase -no pulmonary involvement

Rectum anastomoses

-clinical sign: internal hemorrhoids (non-painful?) -portal: superior rectal veins (inferior mesenteric vein) -caval: inferior rectal veins (internal iliac vein)

ADP receptor inhibitors

-clopidogrel, ticlopidine, prasugrel, ticagrelor -used to treat peripheral artery disease, MI, acute coronary syndrome, and to prevent coronary stent thrombosis -rare side effect of bone marrow toxicity (neutropenia/agranulocytosis)

Schizoid personality disorder

-cluster A -predominant symptom would be social isolation and would have few if any acquaintances -unlikely to be odd/eccentric--not really associated with magical thinking -"anNOID/annoyed by people so isolates themself"

Schizotypal personality disorder

-cluster A personality disorder characterized by reduced capacity to form close relationships, cognitive or perceptual disturbances (believing in telepathy), and eccentric behavior (the weirdo disorder) -under periods of stress, individuals with schizotypal personality disorder may have brief episodes of psychotic behavior -"they're weird TYPE of person"

Explain why neoplastic growth can lead to coagulative necrosis?

-coagulative necrosis is usually due to ischemia -so rapid neoplastic growth can create discrepancies between a tumor's vascular supply and tumor size -this can cause ischemia, depletion of cellular ATP, and culminate in coagulative necrosis (loss of nuclei but the preservation of cellular outlines)

Why does hypertension proximal to the aortic coarctation develop?

-coarctation lower pressure in the renal arteries, activating RAAS due to dec in afferent arteriolar pressure (AA), decreased glomerular filtration pressure, and dec NaCl presentation to the macula densa which all cause the juxtaglomerular (JG) cell Ca2+ levels to fall, which causes an inc Ca2+-inhibited adenylate cyclase activity--> inc cAMP--> inc PKA--> inc renin release

Atelectasis

-collapsed lung; incomplete expansion of alveoli -dec breath sounds and dullness over the collapsed lung area -Chest x-ray will be significant for pulmonary lucency (less dense) on the side of the collapse -Risk factors for atelectasis include smoking history, obesity, and the postoperative period (commonly occurring within the first 72 hours) -atelectasis is one of the most common postoperative pulmonary complications, particularly following abdominal and thoracoabdominal procedures

atelectasis

-collapsed lung; incomplete expansion of alveoli -typical exam findings include dec breath sounds and dullness over the collapsed lung area -opaque part of x ray -mediastinal shift toward the side of the collapse lung

what is the antibiotic of choice for MAC infections?

-combined therapy with clarithromycin (or azithromycin) + ethambutol (with addition of hAART -tx is macrolides that bind to the 50S subunit of bacterial ribosomes, inhibiting mRNA tl and protein synth

What two ducts come together to form the ampula of vater?

-common bile duct and pancreatic duct

what is adjacent to the bicep femoris tendon?

-common fibular nerve

Diffuse scleroderma

-common sclerosis of skin, manifesting as puffy, taut skin without wrinkles, fingertip pitting -widespread skin involvement, rapid progression, early visceral involvement -associated with anti-Scl-70 antibody (anti-DNA topoisomerase-I antibody) and anti-RNA polymerase III

isthmus of aorta

-common site for postductal coarctation of the aorta -region of the aorta between the ligamentum arteriosum and the descending aorta

common triggers of asthma?

-commonly triggered by exercise (especially in the cold), viral upper respiratory tract infections, allergens, and stress -Agents most commonly associated with acute asthma attacks include aspirin, food-coloring agents such as tartrazine (a yellow food dye), β-adrenergic antagonists, and sulfating agents

Compensated vs decompensated heart failure

-compensated HF is characterized by a normal resting CO (cardiac output) -decompensated HR is depressed CO

dicumarol

-competitive inhibitor of Vitamin K epoxide reductase/ deplete stores of vitamin K -used as an anticoagulant

What does immunofluorescence reveal in SLE?

-complement and IgG deposition at the dermal-epidermal junction

Rotenone poison

-complex 1 inhibitor of ETC -poison -Rotenone = one

Antimycin poison

-complex 3 inhibitor of ETC -An-3-mycin = 3

Fitz-Hugh-Curtis syndrome

-complication of PID secondary to N. gonorrhoeae or Chlamydia infection -should be suspected in a woman presenting with RUQ pain in addition to symptoms consistent with PID (fever, vaginal discharge, and abdominal pain) -Can lead to perihepatitis (Fitz-Hugh-Curtis syndrome)—infection and inflammation of liver capsule and "violin string" adhesions of peritoneum to liver

What does a septate uterus look like and what is a complication of this?

-complication: spontaneous abortion

Ghon complex

-composed of multinucleated giant cells and epithelioid cells and is associated with lymph node involvement/ caseating granulomas with multinucleated giant cells and epithelioid cells surrounding an area of central necrosis -associated w tb

Struvite stones

-composite mix of magnesium ammonium phosphate -aka infection stones -caused by proteus mirabilis, P vulgaris, and moranella morganii use urease to split urea into ammonia and CO2, making urine more alkaline -dirty white -radio-opaque on xray (less than calcium oxalate stones)

Hypospadias

-congenital abnormality in which the male urethral opening is on the undersurface of the penis, instead of at its tip -due to failure of urethral folds to fuse -more common than epispadias -associated with an inc freq of UTI, sterility, inguinal hernia, cryptochidism, chordee (all things that are mostly going "down") -can be seen in 5-alpha reductase deficiency

What is one of the common causes of pulmonary hypoplasia in infants?

-congenital diaphragmatic hernia -ab organs herniate into the chest through a defect in diaphragm and limit lung development

Cretinism

-congenital hypothyroidism -6P's: pallor, puffy face, protuberant tongue, pot-belly, protruding umbilicus, poor brain development (intellectual disability)

Hirschsprung's disease

-congenital megacolon resulting from absence of autonomic ganglia in a segment of smooth muscle that normally stimulates peristalsis -condition caused by failure of neural crest cell migration to the intestinal wall including the submucosa where these cells form the Meissner's plexus

young child pt comes in with deafness, saddle nose, bowing of tibia....what should you think?

-congenital syphilis!!! -bowing of tibia is saber shins! -when given a congenital bacterial problem....write out torches and try to match the symptoms!

Cardinal ligament

-connects cervix to side wall of pelvis, contains uterine vessels

Chromosome 13q contains what tumor suppressor gene?

-contains the Rb tumor suppressor gene which is associated with retinoblastoma and osteosarcoma

Wilson disease

-copper overload disease which results in cirrhosis--failure to excrete copper to bile; -ATP7B mutation (hepatocyte copper-transporting ATPase) -formation of free radicals-->cirrhosis and hepatosplenomegaly -can cause hemolytic anemia, neuro symptoms (parkinsonian symptoms, dysarthria, dementia, movement disorders) -characteristic eye finding is kayser-fleischer rings - D-penicillamine dramatically alters the course

Morphology of borrelia burgdorferi

-corkscrew-shaped spirochete

Where is the central artery located in the penis?

-corpus cavernosum -the male urethra is located in the corpus spongiosum*

Syndrome of Apparent Mineralcorticoid Excess (SAME)

-cortisol activates mineralcorticoid receptors in kidney (MRs) -11-beta-HSD2 converts cortisol to cortisone (which can no longer bind to the MRs) -this is a hereditary of 11beta-HSD deficiency-->inc cortisol in kidney-->inc mineralcorticoid receptor activity in kidney -metabolic alkalosis, hypokalemia, hypertension, dec aldosterone -autosomal recessive, can acquire this disorder from glycyrrhetinic acid (in licorice) -tx: K+ sparing diuretics (dec mineralcorticoid effects) or corticosteroids (dec cortisol prdt)

How does cortisol in gluconeogenesis?

-cortisol is a steroid and steroids can cross the cell membrane and enter the nucleus and bind to DNA and regulate gene transcription

what is the male homolog to bartholin gland?

-cowper glands

Avobenzone

-cream that provides protection against the full spectrum UVA1 and UVA2 but NOT UVB

How can you relieve portal hypertension?

-create a portocaval shunt

Is creatinine re-absorbed in the kidney?

-creatinine is synthesized by the muscle at a relatively steady rate, is freely filtered, and is not reabsorbed by the proximal tubule -about 10-15% of the unfiltered creatinine is secreted into the proximal tubule lumen by epithelial transporters, inc its fractionaly delivery to 1.1-1.15 by the end of this tubule segment (line B) -in chart, above 1 on the y axis is secreted substances and below one is re-absorbed substances

Cushing ulcer

-cushing reflex causes peripheral vasoconstriction and hypertension, which allows cerebral perfusion pressure to be maintained in patients with elevated intracranial pressure (ICP) -are associated with conditions that inc ICP, such as epidural hematoma

ciprofloxacin is CI with ?

-cyclosporine bc inhibits cyp450 metabolism of cyclosporine

What conditions of pts would need pancreatic enzyme replacement?

-cystic fibrosis -chronic pancreatitis -post pancreatectomy

NOD-like receptors (NLRs)

-cytoplasmic proteins that detect either microbial components or signs of cell damage -once activated, many NLRs assemble into a multi-protein complex called the inflammasome which activates caspase-1 that generates IL-1 to initiate an inflammatory response

Acute transplant rejection is predominantly mediated by type of cells?

-cytotoxic T lymphocytes (CD8), leading to cytotoxic graft cell death and release of proinflammatory cytokines

DAMPs

-damage associated molecular patterns -these are components of normal human cells that bind to TLRs and are important for initiating the inflammatory response to necrosis

Calciphylaxis

-dangerous skin complication of chronic renal failure -pts with chronic renal failure develop hyperphosphatemia--serum phosphate binds to calcium, pulling calcium from the circulation and causing hypocalcemia -calcium phosphate crystals deposit in the walls of blood vessels...this can lead to ischemic necrosis of the skin

Sudden cardiac death

-death from cardiac causes within 1 hour of onset of symptoms, most commonly due to a lethal arrhythmia (ex. VF) -associated with CAD (up to 70% of cases) - this is a major risk factor!, cardiomyopathy (hypertrophic, dilated), and hereditary ion channelopathies (ex. long QT syndrome, brugada syndrome) -prevent with ICD

Does bronchospasm inc or dec FEV1, FVC

-dec -bronchospasm, seen in asthma, tends to dec ratio below its typical normal value of 80%

Adverse effects of anabolic steroids?

-dec HDL/inc LDL -erythrocytosis (many RBCs) -small testes (suppression of FSH/LH) -azoospermia -gynecomastia (inc conversion to estradiol)

Niacin in treatment of hyperlipidemia

-dec VLDL, LDL, and TAGs -inc HDL -MOA: inhibits lipolysis in adipose tissue and reduces hepatic VLDL secretion

What effect does hypertension have on arteriole density ?

-dec arteriolar density -bc an inc in bp causes a reflex arteriolar constriction through local autoregulatory mechanisms. The high pressure causes capillary blood flow to exceed tissue needs, washing out vasodilatory metabolites (e.g. adenosine, K+, and others) and the arterioles constrict -chronic vasoconstriction is followed by arteriolar disassembly, which reduces vessel density

What lab level will be abnormal if pt has osteoporosis?

-dec estrogen (if premenopausal) OR deficient calcium and vit. D (dec bone mineralization) -fractures of the vertebra (Compression), hip (neck of femur), wrist (colles) are all common fractures in the extremities for osteoporosis patients

Growth hormone's effect on insulin

-dec insulin sensitivity (so insulin less effective)-->can hyperglycemia in pregnant women

Mech of resistance of tetracyclines

-dec uptake or inc efflux out of bacterial cells by plasmid-encoded transport pumps

What are the factors that cause a left shift to the oxygen-hemoglobin dissociation curve?

-decrease in H+ -dec in CO2 -dec in 2,3 bpg -dec in altitude -dec temperature -CO poisoning -MetHb (methemoglobin) -HbF (fetal hemoglobin)

What is a classic sign of worsening mitral stenosis?

-decreased intensity of the heart murmur and S1 as the valve narrows and opens less during each beat -characterized by a late diastolic murmur and a diminished S1 sound

ACE inhibitors effect on renal vessels

-decreases efferent arteriole tone

Chronic Granulomatous Disease (CGD)

-defect in NADPH oxidase → ↑ susceptibility to infections with catalase + organisms (S. aureus, Aspergillus, etc...) -diagnosis made through neutrophil function testing as Dihydrorhodamine (DHR) is oxidized via the respiratory burst to produce a green fluorescence within cells that may be detected with flow cytometry

Vascular Ehlers-Danlos Syndrome

-defect in type III collagen (tree in pic) -the far right is vascular ED syndrome (red hose at the bottom of the tree) -can also have berry aneurysms that can rupture -uterine rupture in pregnancy is also a feared complication -aortic dissection

Leukocyte adhesion deficiency (LAD)

-deficiency of CD 18 -impaired adhesion of leukocytes to blood vessel walls -autosomal recessive -Sx: -Recurrent bacterial infections (bumpy skin and mucus surfaces in sketch) -Loss of teeth (due to periodontitis) (no gums in sketch) -Lack of purulence (sparkling clean game in sketch) -Delayed separation of umbilical cord (unsevered rope) -Leukocytosis (leukocytes trapped in circulation) (

How long does it take for cardiac remodeling/hypertrophy/compensation to take place?

-definitely a while -usually responding to chronic conditions -so usually not the answer if pt experiences a "sudden onset"

How do you treat pre-eclampsia?

-delivery is the only definitive therapy for preeclampsia

Heinz bodies are?

-denatured hemoglobin inclusions that are readily removed by the spleen

Type II membranoproliferative glomerulonephritis

-dense deposit disease of the basement membrane of glomeruli and tubules -the underlying pathophysiology is related to C3 nephritic factor

Chronic COPD Therapy

-depends on stage -mild, FEV1>80%: as needed SAMA -moderate, FEV1 50-79%: SAMA as needed and LAMA -severe, FEV1 30-49%: SAMA as needed and LAMA and ICS -very severe, FEV1 <30%: SAMA, LAMA, ICS, oxygen/surgery -refractory: theophylline or roflumilast -all pts w/ COPD need to be vaccinated and smoking cessation is VERY important

Rhabdomyolysis

-destruction of muscle to produce myoglobin -presents with elevated creatinine kinase levels, dark urine, acute kidney injury -hyperkalemia and hyperphosphatemia, hypocalcemia (bc calcium from outside the cells deposits into necrotic tissues which happens during the acute phase) -absence of red blood cells on microscopy

Karyolysis

-destruction of the nucleus resulting in cell death -nuclear fading

Total body water is measured by what?

-deuterium oxide (D2O), antipyrine (non-steroidal anti-inflammatory drug), or tritiated water (3H2O)

How does hydronephrosis and dilated ureter contribute to renal failure?

-developed renal failure characterized by bilateral hydronephrosis and dilated ureters, suggesting "backup" of urine likely due to obstruction from prostatic hypertrophy. This "backup" puts back pressure into the kidney tubules and ultimately bowman's space, and thus causes increased hydrostatic pressure in Bowman's space leading to decreased GFR and renal failure

Hcg is produced by?

-developing blastocyst (and later syncytiotrophoblastic), which begins around 6-8 days post-fertilization -levels double every 2-3 days in early pregnancy until about 10-15 weeks gestation, when placental progesterone negatively feeds back to greatly reduced hcg production

Babies with low 1 and 5 apgar scores are at risk of developing what?

-development of cerebral palsy and epilepsy -the 1 minute score has not been shown to be predictive

MEN 1 syndrome

-development of multiple tumors (PPP) which secrete hormones -Parathyroid hyperplasia and or parathyroid hormone secreting adenomas -Pancreatic and duodenal endocrine tumors: most often gastrin-secreting, less commonly insulin-secreting or glucagon-secreting -Pituitary tumors which can secrete prolactin ,GH, or ACTH -multiple angiofibromas and/or lipomas may be seen too

Efferent arteriosclerosis is rarely seen except in ?

-diabetes

In the US, what disease is most common in pts with over 3 grams of proteinuria per 24 hours

-diabetic nephropathy

Framing effects

-diagnostic decision-making unduly biased by subtle cues and collateral information

adult respiratory distress syndrome

-diffuse alveolar damage that is also known clinically as acute lung injury (ALI) -is a clinical syndrome of acute respiratory failure resulting from diffuse injury to the alveolar/capillary barrier -bilateral infiltrates and opacity are usually seen on chest x-ray

DIC can cause what damage to the kidney?

-diffuse cortical necrosis

MOA of thyroid hormones

-diffuses to the nucleus and binds its receptor there

Digoxin poisoning

-digoxin has a lot therapeutic index -hyperkalemia is commonly precipitated in digoxin toxicity -early symptoms of toxicity include GI and ECG changes -later symptoms of digoxin toxicity include CNS and visual effects may be seen -Works on Na/K ATPase pump poisoning it in overdose leading to HYPERKALEMIA -Fab antibody can be used as an antidote

nitroglycerine in heart failure does what?

-dilates veins -preload falls due to a pooling of blood -and if preload falls, then so does CO

telangeictatic lesions

-dilation of blood vessels; star-like pattern

ACE inhibitors do what to the arterioles?

-dilation of both the afferent and efferent arterioles, with preference to the efferent arteriole dilation

urine specific gravity < 1.010

-dilut urine -DI diagnosis -high specific gravity means very concentrated

What prostaglandin drug is a PGE2?

-dinoprostone -used to facilitate labor or terminate pregnancy

Aliskiren

-direct renin inhibitor

Cromolyn sodium

-directly binds to mast cells, thereby preventing their degranulation and release of histamine and leukotrienes -This treats the inflammation and bronchoconstriction of the airways that is characteristic of mild persistent asthma -inhaler/nebulizer

Down syndrome are at inc risk of alantoaxial instability which can lead to what?

-displacement of the cervical vertebrae at the alantoaxial joint (involving C1 and C2 = atlas and axial bones) may cause spinal cord compression -new upper motor neuron findings (inc muscle tone, upgoing Babinski, hyperreflexia) in a patient with Down syndrome should prompt imaging of the cervical spine

Dextrocardia

-displacement of the heart to the right -can be seen with kartagener disease

rhabdomyolysis

-dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal failure can result) -basically compression of muscles -damage to muscle tissue, as necrosis occurs, potassium and phosphate are released from cells leading to hyperkalemia and hyperphosphatemia and calcium from outside the cells deposits into necrotic tissues leading to hypocalcemia -overtime, calcium levels return to normal, but in the acute phase of rhabdomylosis, hypocalcemia is common

hypertension, mental status changes, high cardiac output is WHAT type of shock?

-distributive shock (i.e. septic and anaphylaxis) -THIS IS THE ONLY SHOCK WITH INC CARDIAC OUTPUT!!!!

What is the adverse effect of metronidazole?!!

-disulfram-like reaction!!

sublimation

-diversion of unacceptable impulses into more acceptable ones -a way for a person to convert unproductive, mentally uncomfortable, emotional states into constructive and more socially acceptable actions or behaviors -ex mother whose child died of a disease becomes active in a state or national org designed to help families with the disease OR male exec who is attracted to a female associate becomes her mentor/advisor

What is the most common cause of lower GI bleeds?

-diverticula

Delivery bad news..what do you do?

-don't deflect, be straightforward

You always get toxic shock syndrome wrong!!!! Look for FEMALE, RASH, HYPOTENSION, RASH, FEVER, MENSTRUATION, DIARRHEA!!!!

-don't forget it!

epispadias

-dorsal location of meatus due to faulty positioning of genital tubercle -Exstrophy of the bladder is associated with Epispadias

Ethylene glycol toxicity

-drunken CNS depression *high anion gap metabolic acidosis* coma or *blindness* *renal failure* -treat with Fomepizole

Is epstein-barr virus a DNA or RNA and is it ds or ss?

-ds DNA virus!

What three proliferative fibrocystic changes inc the risk of breast cancer?

-ductal hyperplasia (pathoma) -atypical epithelial hyperplasia -sclerosing adenosis

the mesonephric ducts in the male form what?

-ductus deferens and the epipdydmis -in the female these degenerate

Fixed S2 splitting

-due to ASD (systolic ejection murmur) -exhalation and inspiration have the same S2 split (PV is delayed) -flow across ASD leads to increased right sided flow

Fragile X syndrome

-due to an alteration in the FMR1 gene on the x chromosome (dominant x linked mutation) -FMR1 encodes for FMRP protein (required for appropriate neuronal development) -presence of expanded trinucleotide repeat in the 5' untranslated region of the mRNA produced from the gene (CGG repeat - COG wheel from X windmill pixorize sketch) -presents with moderate mental retardation, elongated (donkey) face, large everted ears, megaoorchidism, mitral valve prolapse

carpal tunnel syndrome during pregnancy

-due to compression of the median nerve in the carpal tunnel (between the flexor retinaculum and carpal bones) -affects as many as 50% of pregnant women -mainly due to fluid retention -management is typically with a wrist splint (serves to maintain the wrist in a neutral position and lessens the pressure on the carpal tunnle by limit wrist flex/extension -usually resolves spontaneously after delivery

physical findings in lung disease

-dull on percussion is filled stuff in lungs -hyperresonant on percussion is bc lots of air in lungs -all dec breath sounds except consolidation (lobar pneumonia, pulmonary edema) -fremitus is only increased when there is consolidation -i think simple pneumothorax is when air leaks out into pleural space and so lung shrinks and tension pneumothorax is like a stab wound to the chest where air from atmosphere goes into pleural cavity (negative pressure) and pushes lungs and everything over)

What is the name for failed recanalization of the duodenum resulting in polyhydramnios, bile-containing vomitus, and a distended stomach?

-duodenal atresia (often associated with Down Syndrome) -probably due to failure of recanalization -associated with Down syndrome (elevated beta HCG and fetal nuchal translucency on US) -double bubble sign on xray (due to distention of duo, tight pylorus in the middle, and distention of stomach...see xray pic) -bilious vomitting after first feed

A band, I band, Z line, H zone, M line

-during contraction the H band and I band get smaller, the A band stays the sAme

When does atrial repolarization occur?

-during the QRS complex; it is not seen on the ECG because it is masked by the much greater electrical activity in the ventricle

Factors that cause aspiration pneumonia?

-dysphagia -NG/ET tubes -upper GI tract disorders -prolonged vomiting -Individuals with reduced consciousness have an impaired cough reflex with incomplete glottic closure that predisposes to the development of aspiration pneumonia

Actinic cheilitis

-dysplastic lesion of the lip mucosa, similar to actinic keratosis of the skin (variant of actinic keratosis, which is the precursor lesion when located on skin) -actinic lesions of any area are often associated with chronic sun exposure and are precursor lesions to SCC

Aortic regurgitation murmur

-early diastolic murmur-high pitched "blowing" -decrescendo

S3

-early filling -diastole, low pitched -commonly seen in acute HF -very specific sign of high left atrial pressure -can be heard in normal hearts (young patients, pregnant women)--these patients are suckers; vigorous LV relaxation lowers pressure rapidly -best heard with bell and if pt is lying in left lateral decubitus position--loudest at apex -think of Ken -tucky

Ejection clicks

-early in systole -before carotid pulse -bicuspid aortic valve

What are the criteria for a good quality pulmonary function test?

-early rise -sustained plateau -at least 6 seconds in duration -reproducible -free from artifact -if not met, repeat the PFT

What is the most common cause of a symptomatic Meckel's diverticulum?

-ectopic gastric tissue: gastric and/or pancreatic ectopic mucosa -Meckel's presents with painless melena, and dx with technetium-99m

ectopic pregnancy vs. hydatidiform mole

-ectopic pregnancy: empty uterus, rapid onset of pain (in lower abdomen) -hydatiform mole: HUGE ASS UTERUS (don't forget it!)

Regulation of acid secretion by gastric parietal cells

-effects of individual stimulants are multiplicative

typical findings of cardiac tamponade

-elevated jugular venous pressure and distant heart sounds -a fall in systolic pressure during inspiration (pulsus paradoxus) is a classic finding -ECG may show sinus tachycardia, low voltage or rarely electrical alternans

what is the key distinguishing feature that distinguishes portal hypertension from right heart failure?

-elevated jugular venous pressure bc should not be present in portal hypertension -pts with rare causes of right herat failure (constrictive pericarditis, restrictive cardiomyopathy) are sometimes misdiagnosed with a primary liver disorder, especially true in patients like the man in the question who have risk factors for chronic liver disease

What are exceptions to informed consent?

-emergency life threatening conditions (apparently ectopic pregnancy counts..!) -waiver by patient -pt is incompetent -therapeutic privilege

How do you treat methemoglobinemia?

-emergency tx and supportive measures include the administration of high-flow oxygen as well as methylene blue

How to manage v tach?

-emergent electrical cardioversion (delivery of an electrical shock to the heart will abort the arrhythmia and often restore sinus rhythm

Where does the oculomotor nerve emerge from the midbrain specifically?

-emerges from the interpeduncular fossa of the midbrain and then passes between the superior cerebellar and the posterior cerebral arteries

Direct inguinal hernia

-emerges through the posterior wall of the inguinal canal known as the fascia transversalis -protrude medial to the inferior epigastric vessels, superior to the inguinal ligament, lateral to the rectus abdominis muscle, and pass through the inguinal (hesselbach's) triangle

If a spleen is removed in a patient, what bacteria is the patient most susceptible to?

-encapsulated bacteria -Strep. Pneumo (think Sketchy's Strep pneumo sketch-the knight with a sickle cell bc those pts have asplenia), Neisseria meningitis, H. influenzae

Reye syndrome

-encephalopathy and liver damage in children following an acute viral illness; linked to aspirin use -Elevated serum ammonia levels-->encephalopathy -Elevated AST and ALT -Microvesicular fatty change (see liver mat in the pic) -Mitochondrial damage; fatty acids accumulate

What part of the tubule in the kidney is known as the diluting segments?

-end of the thick ascending limb and early distal tubules--where solute reabsorption reduces the tubule solute load but the renal epithelium is impermeable to water

Two most common causes of aortic regurg?

-endocarditis and aortic dissection -aortic regurg has widened PP

Layers of the heart

-endocardium, -myocardium, -epicardium (visceral pericardium) -pericardial cavity -parietal pericardium -pericardium (fibrous layer)

Cyclic pelvic pain, bleeding, and infertility in a woman points to what repro condition?

-endometriosis -will find proliferative endometrial tissue on biopsy -can have ovary involvement and weird other sites -endometriosis scar tissue/adhesions can cause uterus to stick in a backwards position (retroflexed) -rule out cancers bc no wieght loss and symptoms not constant throughout month or getting progressively worse -CYSTS -EXTREME PAIN DURING PERIODS

HTLV-1**

-enveloped, ssRNA virus with reverse transcriptase activity and infects CD4+ T-lymphocytes (is a retrovirus) and is endemic to southern Japan and Caribbean -same category as HIV virus, but does not cause T-cell lysis so normal CD4 count and immune fxn -can lead to delayed adult T cell leukemia/lymphoma 20-30 years after initial infection (aggressive and often progresses to death in less than one year)--elevated CD4 and 8 count (opposite of HIV) -less common presentation is tropic spastic paresis (TSP) which is demyelination of spinal cord motor neurons--> Upper motor neuron symptoms and spasticity

What does urease do?

-enzyme that breaks down urea to form ammonia and carbon dioxide

portal hypertension high risk feared complication

-eosphageal varices rupture (high risk of recurrance and mortality) -the azygous vein is a major accessory pathway for venous return in patients with end-stage liver disease and critical portal hypertension -with portal hypertension, blood flows from the left gastric vein->esophageal veins-> azygous vein->SVC

What kind of hemorrhage is noted by a biconvex shaped hematoma on CT?

-epidural hematoma -epidural hemorrhages are due to rupture of middle meningeal arteries -epidural hematomas commonly have loss of consiousness, then a lucid interval before quick decline to coma

The diagnosis of pancreatitis requires two of the following three criteria....?

-epigastric pain, elevated lipase three times the upper limit of normal, and imaging findings consistent with pancreatitis

What metabolite is responsible to stimulating hormone-sensitive lipase in adipocytes?

-epinephrine

IgA nephropathy (berger disease)

-episodic hematuria that usually occurs concurrently with respiratory of GI tract infections (IgA is secreted by mucosal linings) -renal path of IgA vasculitis (HSP) -LM--mesangial proliferation -IF--IgA based IC deposits in mesangium -EM--mesangial IC deposits

What is herpes's histology

-epithelial cells with intranuclear inclusion bodies (multinucleated giant cells)

Sites of ascultation

-erb's point can be used for pulmonic and aortic regurg

What can you suspect if a pt has erythematous skin lesions, some of which have targetoid appearance?

-erythema multiforme -involves palms and soles and may have mucosal involvement -expression of herpes simplex virus antigens by infected keratinocytes triggers CD8+ cytotoxic effector cells and CD4+ helper cells, inducing apoptosis -other causes: meds (penicillin, sulfonamides, allopurinol) and infection (HSV 1 or 2, mycoplasma pneumo)

Portal hypertension worst complication

-esophageal varices rupture -esophageal vein bears the burden and the esophageal venous plexus majorly drains into the azygous vein

Retroperitoneal organs

-esophagus (lies in front of the vertebral column in the posterior mediastinum and extends between the level of the C6-T11 vertebrae -pancrease--positioned in the transpyloric plane between L1 and L2 vertebrae in the retroperitoneum (crushing abdonimal injuries are more likely to affect the pancreas

What factors causes TBG to rise and to fall?

-estrogen raises TBG -Liver failure lowers TBG

What is the strongest predisposing risk factor of sarcoidosis?

-ethnicity--usually african american

What is the driver for the development of metabolic disease and essential hypertension?

-excess fructose consumption -lots of fructose causes in in uric acid, which inc plasma renin levels, thereby activating the RAAS system, as well as causing vascular smooth muscle proliferation and atherosclerotic changes in the pre-renal vasculature -fructose found in soda, sweetened pastries, and sources of sugar -sodium consumption worsens hypertension in the setting of existing disease but is not associated with its initial development

polyhydramnios

-excessive amniotic fluid -amniotic fluid is produced by fetal kidneys (fetal urine) and removed by fetal swallowing and intestinal absorption -excess fluid is caused by increases in urinary excretion or impaired swallowing/digestion -women usually develop a rapidly expanding abdomen and increased amniotic fluid index

Heparin

-exerts its anticoagulant action by accelerating the activity of ATIII to inactivate thrombin; but doesn't lyse existing clots

Dantrolene

-exerts its effect by preventing the release of calcium from the sarcoplasmic reticulum of skeletal muscle, thereby preventing muscle contraction -used to treat malignant hyperthermia

what toxin does Psuedomonas produce?

-exotoxin A that ADP-ribosylates and inhibits eurkaryotic elongation factors-2 (eEF-2), which is a GTP-binding protein involved int eh eurkaryotic translation of proteins

A girl taking levothyroxine when healthy results in what consequence to her thyroid?

-experiences atrophy -bc has so much T4 so this negatively feeds back on pituitary so dec TSH release, therefore removed normal stimulation of thyroid gland

median umbilical ligament

-extends from the anterior/superior border to the umbilical region -remnant of urachus

honeycombing on CT scan in the lungs tells you what?

-extensive interstitial fibrosis

Calcium bilirubinate stones are indicative of?

-extravascular hemolysis

What nerve is a concern for parotid surgery?

-facial nerve bc it courses superfically through the parotid gland

Mucormycosis

-facial pain, headache, and black necrotic eschar in the nasal cavity in a patient with DKA is highly suggestive -Mucosal biopsy would show broad no septate hyphae with right-angle branching. -caused by Rhizopus sp. and Mucor sp. -fungal infection and classically starts in sinuses

How is cleft palate formed?

-failed fusion of the embryologic palatine prominences -when the palatine shelves (maxillary prominences) fail to fuse with each other or the primary palate

How is a cleft lip formed?

-failed fusion of the maxillary and nasal prominences -multifactorial etiology

preeclampsia results from what?

-failure of cytotrophoblasts to adequately invade and enlarge uterine spiral arteries

cardiogenic shcok

-failure of the heart pump secondary to damage of the heart muscle due to myocardial infarction, cardiomyopathy, congestive heart failure, myocardial contusion or severe valve disease -presents with weak or absent pulses with abnormal heart rhythm, tachycardia, low BP, and severe shortness of breath or respiratory distress

congenital umbilical hernia

-failure of umbilical ring to close after physiologic herniation of the midgut -small defects usually close spontaneously

x descent

-fall in venous pressure that occurs due to atrial relaxation -if excess blood volume is added to the right atrium during this period, the x descent will be blunted or absent (pressure will not fall as it should)--this classic condition to cause this is tricuspid regurgitation

bone fractures can lead to what lung problems?

-fat embolism (rare--and this presents with cerebral signs, petechial rash, and retinal fat globules) -adult respiratory syndrome (ARDS) which is more common

What kind of embolus stains positively with Sudan black?

-fat embolus -fat embolus should be considered highly likely in patients with evident or suspected long bone fractures and respiratory distress after trauma

pancreatitis can lead to what kind of cell injury/death?

-fat necrosis -bc pan enzymes are blocked from being secreted and lipase is the only active enzyme secreted from pan (all others are zymogens) so can lead to fat breakdown, triggering inflammation and fat necrosis with chalk-white soap deposits

septic arthritis triad

-fever (low grade) -pain -decreased range of motion

How do you treat CLL?

-first line treatment is with Bruton's kinase inhibitor, such as ibrutinib (irreversible inhibitor of Bruton tyrosine kinase, which is part of the B-cell and cytokine receptor pathways--these pathways allow for the survival of malignant B-cells, such as those in CLL. Inhibition of these pathways dec the proliferation and survival of malignant cells)

What are the main two confirmatory tests? And when do you use each?

-first trimester (10-13 weeks): confirm with chorionic villus sampling -second trimester (15-20 weeks): confirm with amniocentesis

What is the most likely cause of edema in a pregnant woman?

-first trimester of pregnancy is accompanied by a 40-50% expansion of blood volume -expansion occurs through increased fluid retention and leads to hemodilution -resulting fall in plasma protein concentration reduces plasma colloid osmotic pressure, which is the principle force retaining fluid within the vasculature -increased fluid filtration leads to edema

What is fixed splitting and what pathology/condition is it found in?

-fixed splitting is found in ASD -also it means that the pulmonic valve is not closing at the same time as aorta due to an ASD defect-->this is a L to R shunt so more blood from the LA is going to the RA which inc preload and then the RA volume inc is emptied into the RV (whose volume also increases due to the extra blood) and this extra volume causes the pulmonic valve to close later than normal -it is fixed splitting bc the valve closure delay is not dependent on inspiration

Dientamoeba fragilis

-flagellated protozoa -FLAGELLATE -unlike other intestinal protozoan parasites, these dudes do NOT have a cyst stage!!!!

seborrheic keratoses

-flat, greasy, pigemented squamous epithelial proliferation of immature keratinocytes with keratin filled cysts (horn cysts) -looks "stuck on" -lesions occur on head, trunk, and extremities -common benign neoplasm of older persons -Leser-Trélat sign (see pic)--rapid onset of multiple seborrheic keratoses (indicates possible malignancy--i.e. GI adenocarcinoma)

Empty Can Test

-flexion and internal rotation of the shoulder followed by resistance to observe for weakening of the supraspinatus muscle -basically only for supraspinatus injuries because that motion of your arm traps the supraspinatus tendon against the humerus head and causes pain?

cystic hygroma

-fluid-filled structure, initially surrounding the neck; may extend upward to the head or laterally to the body -congenital malformation resulting in lymph accumulation in jugular lymphatic sacs; it is caused by congestion of the lymphatic system in the neck -are associated with a higher incidence of fetal aneuploidy and malformations -These cysts are often seen in patients with Turner or Down syndrome

What drug can cause tendinitis, particularly Achilles tendinitis?

-fluoroquinolones

What is the most commonly used treatments for traveler's diarrhea?

-fluoroquinolones -or azithromycin

What drug can you take with methotrexate to prevent methotrexate related side effects?

-folic/folinic acid

Subacute thyroiditis (de Quervain thyroiditis)

-follows a viral infection with a painful enlargement of the thyroid gland -initial state of hyperthyroidism which can be followed by hypothyroidism -characterized by granulomatous (cages in sketch) inflammation with multinucleated giant cells (dice in sketch) -pts will subsequently recover to euthyroid state (green bowtie guy) -viral infection-->initial inflammation-->destroys thyroid follicles-->leads to release of preformed hormone and hyperthyroid-->lead to hypothyroidism (when unable to produce thyroid hormone)

case series report

-follows more than one patient with similar presentations, treatments, and/or outcomes -individuals in case reports and case series reports are not compared to control groups -case report only involves one patient

When is a women's oocytes arrested at Prophase I vs Metaphase II?

-for most of a woman's life, her oocytes are arrested in prophase of the first meiotic division -Oogonia enter meiosis I to form primary oocytes (formed by month 5 of fetal life) and are arrested the first time in prophase I and remain arrested until puberty -at puberty, during each monthly cycle, a primary oocyte becomes unarrested and completes meiosis I to form a secondary oocyte (arrested at meiosis II) and a polar body

FEV1

-forced expiratory volume in one second

Causes of renal papillary necrosis

-form of nephropathy involving the necrosis of the renal papilla -In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis -A mnemonic for the causes of renal papillary necrosis is POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol abuse, renal vein thrombosis, diabetes mellitus, and systemic vasculitis

Reactive arthritis

-formerly known as Reiter syndrome - classic triad: conjunctivitis, urethritis, and arthritis -"can't see, can't pee, can't bend my knee" -Bilateral conjunctivitis and monoarthritis in a patient within 1 month of a gastrointestinal or genitourinary infection are suggestive of reactive arthritis -bugs responsible: ShY ChiCS (Shigella, Yersinia, Chlamydia, Camplobacter, Salmonella) -Reactive arthritis, ankylosing spondylitis, psoriatic arthritis, and inflammatory bowel disease-associated arthritis are known as the "seronegative arthropathies" and are associated with an HLA-B27 serotype

What does the urachus form and what does failure of the urachus to be obliterated cause?

-forms the median umbilical ligament, which connects the upper end of the bladder to the umbilicus -failure of the urachus to be obliterated causes a urachal fistula and drainage of urine through the umbilicus

Therapeutic index

-formula: TD50/ED50

mallory bodies

-found in alcoholic and fatty liver disease -these are eosinophilic cytoplasmic inclusions that do not stain positively with PAS -mallory bodies are condensed cytoskeleton proteins

Mercury during pregnancy

-found in fish/seafood -fetal brain highly sensitive to mercury -delayed milestones -rarely blindness, deafness, or cerebral palsy

Activation of the V1-receptor does what?

-found in the vascular smooth muscles results in activation of Gq protein second-messenger cascade and contraction of vascular smooth muscle, leading to an increase in total peripheral resistance.

Where is the internal jugular vein found anatomically?

-found lateral to the common carotid artery, anterior to the vagus nerve, and within the carotid sheath

Where are sustentacular cells found?

-found within carotid and aortic bodies, where they provide a supportive role for chemoreceptors -they can also be found in other places too

karyorrhexis

-fragmentation of nucleus -typical changes of necrosis

What are dermatophytes?

-fungi that invade the skin, hair, or nails -He shook her hand when he MET her: -Microsporum -Epidermophyton -Trichophyton

serratus anterior functions and paralysis symptom

-fxn: protracts the scapula and rotates it upward; major muscle in pushing and reaching movements -paralysis of this results in winging of the scapula -the primary role of the serratus anterior is to stabilize the scapula during elevation and to pull the scapula forward and around on the thoracic cage

Achalasia is caused by damage to...?

-ganglion cells in the myenteric plexus (Auerbach's plexus)

gastroschisis vs ompahlocele causes?

-gastroschisis--congential defect of the ventral wall development due to failure of the embryonic lateral folds to fuse -omphaloceles are also abdominal wall defects but they are due to a failure of the intestines to return back into the abdominal cavity

What artery runs through the gastroplenic ligament? what runs through the splenorenal ligament?

-gastrosplenic: short gastric arteries -splenorenal: splenic artery

generalized vs specialized transduction

-generalized: error of lytic virus life cycle, any chromosomal DNA can be transferred -specialized: error of temperate virus life cycle, genes near the virus insertion site may be transferred

In a plasmodium infection, what contributes to the high, cyclic fevers?

-generally correspond to the release of merozoites from lysing erythrocytes -life cycle: mosquito inoculates human with sporozoites through its bite. Sporozoites travel to liver where they infect hepatocytes (latent phase with typical incubation period of 1-3 weeks). The infected liver cell becomes a schizone (a cell that divides by shizogony and forms two daughter cells) that ruptures and releases merozoites into the bloodstream. These daughter parasitic merozoites infect erythrocytes, which develop trophozoites. the next stage can either lead to the release of gametocytes which must be ingested by a mosquito to continue transmission or the schizonts that release merozoites into the blood stream that go on to infect hepatocytes

diphtheroids

-generally nonpathogenic pleomorphic bacilli named for the similarity of their appearance to Corynebacterium diphtheriae -normal flora organisms in the oropharynx -the difference between the pathogen and a normal flora diphtheroid is established using the ELEK test, which is shown in the image, and is used to detect the diphtheria toxin -in C diphtheriae, toxin production occurs following infection of the bacterium with a temperate phage that encodes the toxin

When would you use pramlintide?

-generally reserved for type 2 diabetes patients unresponsive to traditional therapies (this is an amylin analog) -current tx guidelines have this med listed as a second or third line therapy for type 2

Congenital adrenal hyperplasia

-genetic disease in which the adrenal gland is overdeveloped, resulting in a deficiency of certain hormones and an overproduction of others -could affect any of the three enzymes in the picture

Williams or Williams-Beuren syndrome

-genetic disorder caused by a partial deletion of the long arm of chromosome 7 -characteristic facial appearance described as "elfin"--borad forehead, wide mouth, small chin, and long/broad philtrum (upper lip); impaired development and intellectual disability -may develop renal artery stenosis so may also develop hypertension

Turner syndrome patients are at higher risk of developing what kinds of conditions?

-genetic mutations that are x-linked recessive bc now they only have one x

Pts with primary amenorrhea due to 5-alpha reductase deficiency is found to have what?

-genital hyperplasia

What test do you apply to confirm identity of candida?

-germ tube test -candida is weird and does not follow the normal "yeast in the heat, mold in the cold"--it actually flips it -so candida is yeast in the cold (forming pseudohyphae) and mold in the heat (germ tubes)

Li-Fraumeni syndrome

-germline mutation of one p53 gene -Commonly-associated malignancies can be remembered with the mnemonic SBLA cancer syndrome: Sarcoma, Breast, Leukemia, and Adrenal gland cancers -autosomal dominant disorder characterized by early-onset of cancer

What does granuloma look like?

-giant cells are circled in the photo (also called Langhans giant cell) and tells you that this is a granuloma

What kind of gifts can physicians can accept from their patients?

-gifts of minimal value -gifts that directly benefit patients can be accepted

What is the appropriate birth control to use for a girl who wants birth control and has severe cramps and bleeding

-give a LARC = IUD--specifically the progesterone containing form (levonorgestrel-containing IUD) which dec menstrual bleeding and dysmenorrhea -the other two IUDS--the copper one exacerbates menstrual bleeding and dysmenorrhea and the etonogestrel one causes irregular uterine bleeding

What do you do to treat hypotension in a shock pt?

-give them IV fluids (0.9 % saline)

How to treat a beta blocker overdose?

-glucagon

Bethamethasone

-glucocorticoid -Pregnant mothers at risk of delivering prior to 34 weeks' gestation should be given corticosteroids before delivery in order to increase neonatal surfactant levels -Increased surfactant reduces alveolar collapse and the risk of respiratory distress syndrome by decreasing alveolar surface tension and increasing alveolar compliance

What are the essential hormones that must be replaced in Sheehan's syndrome?

-glucocorticoids (def of this can cause hypotension w shock, vomit, abdo pain, hyponatremia, hypoglycemia, weight loss) -thyroid hormone (not as medically urgent but can produce fatigue, cold intolerance, and weight gain) -remember--mineralcorticoids are produced by adrenal cortex -with Sheehan's syndrome, you can experience cranial nerve palsies

glucokinase regulatory protein (GKRP)

-glucokinase regulatory protein (GKRP) translocates glucokinase to the nucleus in the setting of low glucose -when glucose concentration rises, glucokinase is released from GKRP and moves to the cytosol to participate in glycolysis

Inguinal hernia strangulation

-goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the groin -enters internal inguinal ring lateral to inferior epigastric vessels -caused by failure by processus vaginalis to close (can form hydrocele) -may be noticed in infants or discovered in adulthood -more common in males -follows the pathway of testicular descent and covered by all 3 layers of spermatic fascia -keep an eye out for a "reducible scrotal mass"

Where does post-translational modification of proteins happen?

-golgi

Torsion of the spermatic cord affects what artery?

-gonadal arteries which arise from the aorta

what should you think about when a pt has red sputum and presents with nephritic syndrome?

-goodpasture syndrome! OR wegner's!

key difference between Goodpastures and Wegener's?

-goodpastures does not involve the upper airways like the nasal passages and sinuses whereas Wegener's does -Goodpastures just involves lower airways (lungs?)

Grade vs stage

-grade refers to the histopathologic appearance of the tumor cells -stage refers to the extent of tumor invasion and is evaluated by TNM (tumor size, nodal involvement, metastasis)

Grading breast cancer is based on what? Staging of breast cancer is based on what?

-grading is based on histology -staging is based on distribution of disease

Haemophilus ducreyi

-gram negative coccobacillus (in parallel short chains) -chancroid (painful penile ulcer and inguinal lymphadenopathy with purulent discharge) -sexually transmitted gram-negative rod -very rare in developed nations -painful erythematous papule turned pustule and eventually painful ulcer

lipoteichoic acid

-gram positives (attachment to host cells) -trigger many host defencses, including production of cytokines and activation of complement

Neisseria gonorrhea has what morphology?

-gram-negative diplococcus

sertoli cell tumor

-gray-white to yellow -microscopically form cordlike structures resembling semniferous tubules -NO reinke crystals

Where does great saphenous vein drain to what lymph nodes? Where does small saphenous vein drain?

-great saphenous vein drains to inguinal lymph nodes (runs on medial side of whole leg) -small saphenous vein drains to popliteal fossa lymph nodes

irritable bowel syndrome (IBS)

-group of gastrointestinal symptoms associated with stress and tension -presents with bloating, chronic abdominal discomfort, altered bowel habits, relief of ab pain with defecation -can be diarrhea-predominant, constipation predom or both -first line tx is lifetyle mod + diet changes

What are two most significant diseases of the male breast?

-gynecomastia and male breast cancers

Murmurs that affect afterload

-hand grip - increase afterload -amyl nitrate - dec afterload (vasodilate)

Any young adult pt in the four corners region of the United states (utah, arizona, new mexico, and colorado) who has been otherwise healthy and presents with acute respiratory distress syndrome may have...?

-hantavirus

Detemir mechanism of action

-has added FA side chain that causes it to bind reversibly to albumin -once bound it slowly dissociates over time, giving a prolonged metabolic effect -based on these modifications, detemir begins working in 1-2 hours and lasts for more than 12 hours

Metformin mechanism

-has lipolytic effects that lowers serum free FA concentrations, reducing the amount of substrate available for gluconeogenesis -decreases serum lipid concentrations (including TAGs and LDL cholesterol) and inc the conversion of glucose to lactate -lactate levels remain elevated bc of decreased liver uptake of lactate for conversion to pyruvate as part of gluconeogenesis

A patient came in who had experienced a MI and later he couldn't move the right side of his body. What happened and what caused this?

-he had a stroke -this was due to a mural thrombosis that formed in the heart

What is considered part of the middle compartment of the mediastinum?

-heart, great vessels (aorta and pulmonary arteries), and esophagus

What are the light chains and dark chains of IgG made up of?

-heavy chain is gamma and light chain is either kappa or lambda (for IgG)

What is this describing, "blood smear stained with methylene blue shows small blue granules located near the periphery of some of the erythrocytes"?

-heinz bodies

maxillary sinus

-helps form the orbital floor

Patient complains of painful urination, is 6 yrs old, has blood in urine, and negative for nitrites and leukocyte esterase. What does the patient have and what are the key characteristics?

-hemorrhagic cystitis (caused by adenovirus infection) -pts with hemorrhagic cystitis have red blood cells in the urine w absence of nitrites and leukocyte esterase; urine cultures will be negative -school-aged children present with dysuria and hematuria (gross or microscopic) and can also have low-grade fevers and upper respiratory symptoms (cough and congestion)

nonenveloped RNA virus with a capsid surface is what bug?

-hep E

Pregnant women with jaundice and elevated liver enzymes should make you think what?

-hepatitis E!! -can cause fulminant hepititis (rare syndrome of massive necrosis of liver parenchyma and a decrease in liver size)

What are the EPO secreting tumors?

-hepatocellular carcinoma -renal cell carcinoma -hemangioblastoma -pheochromocytoma -remember: in real primary polycythemia vera, EPO level is LOW not high...if it is high, then it's a paraneoplastic syndrome

What ligament contains the portal triad: the proper hepatic a., portal v., cystic bile duct?

-hepatoduodenal ligament

splenectomy is indicated for what heme disease?

-hereditary spherocytosis -bc it is an intrinsic hemolytic anemia where the spleen is destroying the rbc even though they could technically function fine -splenectomy will prevent premature removal by the spleen -NOT sickle cell bc not intrinsic spleen problem but a vasoocclusive crisis problem

Latent conditions

-hidden issues within individual health care systems that contributed to an adverse event -ex. "accidents waiting to happen" include organizational processes (i.e. workload, handwritten prescriptions) and management decisions (staffing levels, culture of lack of support for interns)

What level of cardiac output and systemic vascular resistance are indicated in septic shock?

-high CO -low SVR

Keloid

-high inc in collagen synthesis (types I and III) -disorganized -extends beyond borders and is claw like -frequent recurrance, -higher incidence in ethnic groups with darker skin

Bivalirudin

-high specific direct inhibitor of thrombin and, unlike heparin, its mechanism of action is independent of antithrombin III -indicated for unstable angina, directly inhibits thrombin and is approved for use in persons with HIT -indicated in pts with or without HIT undergoing PCI (percutaneous coronary intervention)

You give a drug IV and 1 minute later the pt has low blood pressure (90/50), is pruritic, warm, and has facial flushing. What molecule is responsible for this?

-histamine (fast degranulation--happened 1 minute later and can be itchy and cause flushing) -you need to know that opioids cause IgE independent mast cell degranulation

Burkitt lymphoma's starry sky

-histologically has a "starry sky" appearance and an 8;14 translocation with MYC oncogene expression -African/endemic Burkitt lymphoma can present as a jaw, ovarian, breast, or GI tract mass -EBC has been related to the development of African/endemic Burkitt lymphoma, AIDS CNS B cell lymphoma, mixed cellurity of hodgkin disease and nasopharyngeal carcinoma

What fungus is seen as multiple tiny oval forms within macrophages?

-histoplasma -biopsy of lesion shows intracellular yeast forms in the macrophages in humans...grows as mold in the wild

Paroxysmal nocturnal hemoglobinuria

-history of aplastic anemia -impaired synthesis of glycosylphosphatidylinositol (GPI), resulting in the inability to anchor DAF (CD55) and CD59 to the cell membrane -pancytopenia, hyperbilirubinemia, inc serum LDH, dec haptoglobin, venous thrombosis and hemoglobinuria

Churg-strauss

-history of asthma, sinusitis, and high eosinophilia in the setting of peripheral neuropathy (i.e. lower extremity numbness and tingling) is characteristic of allergic (eosinophilic) granulomatosis and angiitis, formerly known as Churg-Strauss syndrome -a small-vessel vasculitis associated with peri-nuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) -think of sketchy's golf sketch with the guy sneezing ("churg")

What can minimal change disease be associated with?

-hodgkin lymphoma -lymphomas in general bc they are also cytokine mediated

Hospice care

-holistic, compassionate care given to dying people and their families -don't take away support

hPL

-human placental lactogen -rises throughout pregnancy in proportion to fetal mass

What is a big indication that tells you something is a non-anion gap metabolic acidosis?

-hyperchloremia -high levels of Cl-

What are myocardial contraction bands caused by?

-hypercontraction of the sarcomeres due to massive calcium influx -This is secondary to what is called "oxygen paradox" or "calcium paradox" as illustrated in the histology slide in the question -The calcium paradox occurs after MI reperfusion, causing release of reactive oxygen species (ROS) and activation of phospholipases (PLs) -massive calcium influx, and result in hypercontraction of the sarcomeres

What could this a sign of: abnormal vaginal bleeding, heavy bleeding during period, intermittent bleeding between periods

-hyperestrogenic signs--> could indicate a granulosa cell mass (thickened endometrial stripe), endometrial hyperplasia, etc

How can type II diabetes cause ADH resistance?

-hyperglycemia inc glucose delivery to the proximal tubule and exceeds its absorptive capacity, causing an osmotic diuresis -high volume flow through the renal tubule washes out the corticopapillary osmotic gradient established by the loop of Henle -this gradient is required for reabsorption of water from the collecting ducts, so hyperglycemia can cause ADH resistance -prolonged osmotic diuresis results in HHS (hyperosmolar hyperglycemic state) and dehydration

DKA: key features

-hyperglycemia, met acidosis -nausea, vomiting, confusion, and kussmaul breathing -weight loss with excessive eating + peeing (due to inadequate glucose entry into the organs)

Acanthosis nigricans is associated with

-hyperinsulinemia (insulin resistance) and elevated androgens -hyperpigmented skin plaques located on intertriginous sites and occur in symmettric distribution -at risk for PCOS, T2 DM, and metabolic syndrome

Peaked T waves

-hyperkalemia -early ischemia (Hyperacute)

What does tall peaked T waves indicate on ECG?

-hyperkalemia!

Pseudohyponatremia

-hyperlipidemia or hyperproteinemia (MS) increase plasma osmolality (or normal Posm) and hyponatremia

hyperplastic polyps vs. tubular adenoma polyps

-hyperplastic--usually in rectosigmoid region and small polyps -tubular adenoma--larger polyps (see pic)

Aortic dissection is strongly associated or caused by?

-hypertension

Ventricular hypertrophy is commonly found on autopsy among patients with what other condition prior to death?

-hypertension -when pressure int eh aorta rises, left ventricular myocytes must generate more force to open the aortic valve--leading to hypertrophy of individual myocytes as well as the left ventricle overall

What are the complications of acidosis?

-hyperventilation, increased intra-cerebral pressure from vasodilatation, hyperkalemia, and a right shifted oxyhemoglobin dissociation curve -myocardial contractility can be depressed

What are causes of low anion gap?

-hypoalbuminemia (bc albumin is part of the anions that contribute to the gap) -multiple myeloma (IgG is cationic and lowers measured + ions like sodium)

Motor of tongue

-hypoglossal (XII) -one exception: palatoglossus (CNX)

Dandy-Walker syndrome

-hypoplasia of cerebellar vermis; hydrocephalus -rare congenital malformation that is not associated with a distinct chromosomal abnormality

causes of hypoxia

-hypoxemia -infarc -anemia -CO poisoning -CN methemoglobin

What is the purpose of winter's formula?

-if actual PCO2 matches the calculated winter's PCO2, then you have a compensated met acidosis -if actual PCO2 is higher than calculated, then you have a mixed met acidosis and respiratory acidosis -if actual PCO2 is lower than calculated, then you have a mixed met acidosis and respiratory alkalosis

Effects of SVR/TPR changes on cardiovascular function curve

-if dec TPR = SVR, than less afterload so CO inc -if dec TPR = SVR, then less resistance in arterioles so then more blood flows through capillaries and into veins and back to heart -if inc TPR, inc afterload so dec CO -if inc TPR, inc resistance in arteries so less blood goes into capillaries and in veins so less blood returns to heart -TPR affects the arterioles so affects CO and venous return

What should you think of pathologically if pt has S3 heart sound?

-if right side then think tricuspid regurg -if left side then think mitral regurg -indicates ventricular overload

What two situation in which it is justified to withhold the truth from the patient?

-if the physician has compelling evidence that disclosure will cause real and predictable harm (eg, disclosure that would make a depressed patient actively suicidal) -if the patient expresses an informed preference to have the truth withheld. Patients in this situation might ask that the physician instead consult family members. It is critical that the patient give thought to the implications of abdicating their role in decision-making. The principle of autonomy in medicine refers to a physician's need to respect an individual's right to self-determination and create conditions necessary for autonomous choice. If a patient makes an informed decision to have information withheld, their preference should be respected

In any adult with more than two cases of consolidated pneumonia in 1 year (this patient also had pneumonia 5 months prior), or more than four upper respiratory infections (URIs) in 1 year, the physician should consider...?

-immunodeficiency -Selective IgA deficiency is the most common immunodeficiency. Although most patients with selective IgA deficiency are asymptomatic, patients are at risk for the development of anaphylactic reactions following blood transfusions

Cyclosporine

-immunosuppressant drug that is used to prevent transplant rejection and treat autoimmune diseases -suppresses the immune system by inhibiting calcineurin, an enzyme necessary for IL-2 production -By inhibiting calcineurin, cyclosporine leads to a fall in IL-2 levels, which impairs T cell growth and activation -This results in an overall suppression of the immune response -most important SE: nephrotoxicity, gout or hyperuricemia, gingival hyperplasia, and hirsutism -minor SE: hyperlipidemia, neurotoxicity, and hypertension

Patients with Roux-en Y gastric bypass are treated with what? (this surgery is a gastric bypass procedure in which the distal stomach, duodenum, and proximal jejunum is bypassed)

-impairs absorption of iron -so need intravenous iron for replacement (IV)

Mitral valve prolapse

-improper closure of the mitral valve -billowing of mitral valve leaflets above the annulus -common cause of mitral regurg -causes a systolic click

Chronic obstructive pulmonary disease (COPD)

-in COPD especially ephysema, destruction of alveoli results in inc compliance????? -alveolar destruction decreases elastic recoil and moves the equal pressure point into the non-cartilaginous airways--which causes airflow obstruction that results in air trapping??????

What does patchy papillary necrosis occur?

-in SCC or trait, NSAIDS use, DM, renal stones in urinary pelvis and pyelonephritis

In about how many % of patients does the foramen ovale not close, leading to the formation of a patent foramen ovale (PFO)?

-in about 25%

skewed lionization

-in cells of females, one X chromosome is inactivated in a process called lionization -the other x chromosome remains active -if a significant number of x chromosomes carrying the disease gene remain active among female carriers, symptoms of the disease may occur--this usually leads to milder muscular features than is seen among affected males

Epiglotitis

-in child, drooling, fever, stridor, tripod position, inability to swallow, history of recent illness -H. influenza--vaccine is toxoid + polyribitol phosphate

liquefactive necrosis vs coagulative necrosis

-in coag, proteolytic enzymes are destroyed allowing tissue architecture to remain intact (see with ischemic organ damage such as MI)--usually associated with infarct or toxicity involving the heart, liver, and kidneys -in liquefactive, occurs when enzymes remain functional thereby destroying large amounts of tissue (occurs with abscesses and in the brain following stroke)

How to treat inflammatory bowel disease?

-in general, use 5-ASA (mesalamine (usually mostly for UC and NOT crohns), sulfasalazine) -more specifically, mild to moderate flares--use mesalamine oral therapy (first line) or sulfasalazine (second line bc side effects) -severe UC flares, IV high dose corticosteroids -can best manage acute exacerbations of crohns with steroid (prednisone)

corneal deposits that occur in most patients on long term amiodarone therapy can lead to what changes in vision?

-in most cases, they lead to no visual changes or eye pathology

Why is carcinoembryonic antigen (CEA) level measured?

-in order to monitor effectiveness of treatment

During ammoniagenesis, where does the ammonia come from?

-in the PCT, the ammoniagenesis pathway uses glutamine to generate the ammonia needed to help buffer urinary acid -ammoniagenesis degrades one glutamine forming two ammonia ions and alpha ketoglutarate

When does coagulative necrosis occur?

-in the setting of ischemia

Placental aromatase deficiency

-inability to synth estrogens from androgens -masculinization of female (46, XX DSD) infants (ambiguous genitalia), -inc serum testosterone and androstenedione -can present with maternal virilization during pregnancy (fetal androgens cross the placenta)

Anemia does what to CO, SC, BP and all that crap?

-inc CO by inc HR and SV -dec SVR bc less RBC...so considering both these bullet points--> pulse pressure increases

What inc vs dec during pregnancy?

-inc CO, GFR, hepatic metabolism, volume of distribution (in response to met needs of the uterus and placenta, the maternal plasma volume increases-->inc volume of distribution) -dec in GI absorption (lots of vomitting and nausea), protein binding (albumin),

What does PTH do to serium levels of electrolytes?

-inc Ca2+ -dec PO4 -inc Vit D3 prdt (Activates this) -PTH = Phosphate Trashing Hormone

When you increase the sensitivity of a test, what also changes?

-inc NPV -bc inc Sn, SNOUT (rule out)--so you are better at ruling out-->inc NPV (means if you test negative, you are even more likely to be truely negative)

Inc vs. dec pulse pressure

-inc PP can be due to: arteriosclerosis, aortic regurg, inc CO, inc HR, hyperthyroidism (THINK HIGH OUTFLOW) -dec PP can be due to: heart failure, aortic stenosis (Think LOW OUTFLOW) -also PP is usually affected by mainly systolic pressure?

Bainbridge reflex (atrial reflex)

-inc RA filling--> inc atrial wall stretch--> inc B-receptor afferent activity--> inc HR

hypertriglyceridemia

-inc VLDL -modest inc in TAGS (200-500mg/dl)

Common bile duct obstructions cause cholestasis and increased serum what?

-inc conjugated bilirubin which can spill into the urine -pts would be noted to have a darker urine and lighter stool color bc of biliary obstruction

Inc vs. dec diastolic pressure

-inc diastolic pressure can be due to: mitral stenosis (bc ms causes dec in SV, so less blood in systemic vasculature, causing constriction of vessels-->inc diastolic blood pressure (TPR) -dec diastolic pressure is due to: aortic regurg, patent ductus arteriosus (losing blood from baseline so dec TPR...basically surpass baroreceptors so no compensatory mech here to affect the TPR )

what are the lifestyle modifications for nephrolithiasis?

-inc fluid intake -low sodium diet -inc citrate intake -low oxalate intake -low protein diet

Estrogen effects

-inc growth of follicle -inc SHBG -raises HDL and lowers LDL

Two main triggers of ductus arteriosus closure

-inc in O2 and dec in prostaglandins (loss of placenta)

Purtussis toxin causes

-inc insulin production leading to hypoglycemia -lymphocytosis promotion -blockade of immune effector cells -inc histamine sensitivity

What causes hemochromotosis?

-inc iron absorption in GI tract -inc loading of iron onto transferrin -no way to get rid of iron so have to limit amount of iron coming in (so regulate this)

Increased lung volumes do what to pulm vascular resistance (PVR)

-inc lung volumes stretch alveolar vessels (make longer w smaller diameter)----> so inc PVR

Steroids have what effect on bone?

-inc osteoclastic bone resorption -AND dec osteoblastic bone formation

Physiologic adaptations during pregnancy

-inc renal perfusion and inc GFR-->dec serum creatinine (bc get's peed out) -disproportionate inc in plasma volume compared to with red blood cell volume--> dec hemoglobin concentration and hematocrit -dec serum albumin and total protein levels as a result of hemodilution

Selective IgA deficiency

-inc susceptibility to mucosal pathogens -inc incidence of atopic allergy (high IgE) -inc risk for transfusion reactions

Physiologic S2 splitting

-inc venous return delays P2 by 40-60 ms -single to split with inspiration

What does a pathological S3 heart sound indicate?

-inc ventricular filling pressure (ex. mitral regurg, HF) -common in dilated ventricles -in young patients and athletes and pregnant women, this is a normal sound

vascular function curve

-inc volume or venous tone (via SNS or transfusion), shifts graph to the right -dec volume (hemorrhage or dec SNS), shifts graph to the left

polycystic ovarian syndrome

-inc. LH, dec. FSH (the inc in LH will cause an inc in androgen production leading to free androgens being converted to estrogen in the adipose-->oligomenorrhea) -inc. estrogen + androgens -Up to 50% of PCOS patients have metabolic syndrome, which is associated with obesity, insulin resistance, hypercholesterolemia, and an increased risk for endometrial cancer -PCOS primarily manifests with hirsutism, acne, and virilization

what do competitive inhibitors do to km and Vmax?

-increase Km -no change to Vmax

Glucocorticoids do what to serum cholesterol and TAG levels?

-increase both -bc they are stress hormone that prepare the body for fight or flight -they inc serum levels of glucose and lipids so they may be used as fuel during times of stress -inc serum glucose by increasing gluconeogenesis and decreasing peripheral glucose uptake -also inc serum cholesterol and TAGs by activating lipolysis

PDH deficiency

-increase in pyruvate, increase in lactate and alanine, decrease in Acetyl CoA and ATP, leads to lactic acidosis, neurological defects, lack of corpus callosum, long philtrum and is usually fatal at an early age -bc get lactic acidosis, this results in an increased anion gap metabolic acidosis with low serum bicarb

How does endurance training affect skeletal myocytes?

-increase the number of mitochondria per cell -with endurance training, muscles are limited by the ability to produce ATP and thus the number of mt per cell increases as adaptation

Chronic hypoxia (secondary to conditions like chronic obstructive pulmonary disease) can be associated with inc what (hint* outside of lungs)?

-increased erythropoietin (EPO) production and secondary erythrocytosis -EPO is a cytokine produced by interstitial oxygen-sensing cells of the renal cortex

Net effect of PTH

-increased serum calcium -decreased serum phosphate

Thyroid storm

-increased temp, pulse and HTN -key clinical features are the abrupt onset of fever, tachycardia, and hypertension in a patient with preexisting thyroid disease after a clinical trigger such as surgery -hypercalcemia (due to inc bone resoprtion) and hyperglycemia (elevated serum glucose is part of flight or fight response)

Estrogen has what effect on TBG?

-increased total estrogen (eg, hormone-replacement therapy, pregnancy, oral contraceptives) increases TBG by increasing the glycosylation of TBG and slowing its serum clearance

What does carotid massage do?

-increases pressure on carotid sinus-->stretch --> increases baroreceptor firing --> increase AV refractory period --> decreases HR

ESR (erythrocyte sedimentation rate)

-increases with presence of acute phase reactants -increases when there is fibrinogen to allowing for rbc clumping -decreases when too many rbcs bc repels each other

When you see the primitive streak formed, what can you assume?

-indicates gastrulation has started

Pulmonary capillary wedge pressure measures what?

-indirect estimate of the LA pressure -ALSO can estimate LV end diastolic pressure (preload) except in pts with mitral stenosis

indomethacin vs prostaglandins

-indomethacin closes patent ductus arteriosus whereas prostaglandins keep PDA open

rosacea

-infalmmatory facial skin disorder characterized by erythematous papules and pustules, but no comedones -may be associated with facial flushing in response to external stimuli (ex. alcohol, heat) -phymatous rosacea can cause rhinophyma (bullous deformation of nose)

How are infants diagnosed with HIV?

-infant infections cannot be detected using immunoassays (due to maternally transferred antibodies) -use HIV viral load instead--so PCR or viral cultures on tissues are necessary to dx

bacteremia leads to what symptoms?

-infection including fever, chills, sweats, and malaise

In a young adult with sore throat, fatigue, cervical lymphadenopathy...what should you consider as the dx?

-infectious mononucleosis (Mono!)!! -remember that it is associated with EBV

Where does inferior vagina come from vs. superior vagina come from?

-inferior comes from urogenital sinus -superior comes from mullerian ducts

keratoconjunctivitis

-inflammation of the cornea and conjunctiva -can be associated with HSV-1

Anterior uveitis

-inflammation of the iris and ciliary body -presence of a haze due to a protein accumulation and fibrin exudate -tx: anti-inflammatory drugs

Pott disease

-inflammation of the vertebrae, usually caused by tuberculosis -basically tb of the spine

if young patient has fever, abdominal pain, diarrhea (some bloody), weight loss, anemia, what should you think of?

-inflammatory bowel disease -UC has bloody diarrhea or poop -Crohns is associated with anti-sacchromyces

symptoms of dyspnea, fever, headache, cold chills, nausea, vomiting, and diarrhea are classic symptoms for what?

-influenza

Sickle cell disease presentation

-information about the "painful swollen fingers" or dactylitis is another hint that points toward sickle cell disease -Patients with sickle cell disease tend to present at a young age with painful vaso-occlusive crises, which occur when sickled RBCs occlude capillaries and restrict blood flow -Sickle cell patients are vulnerable to encapsulated bacteria, such as Salmonella, because of the loss of splenic function -Patients with sickle cell disease are particularly at increased risk of Salmonella osteomyelitis

Why does insulin increase more when you eat glucose as opposed to getting injected with glucose?

-ingestion of glucose causes release of incretins, including gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) -incretins stimulate insulin secretion -this effect is exploited by incretin mimicking drugs like exenatide and liraglutide and the "gliptins", such as sitagliptin, which raise GIP and GLP-1 levels by blocking the enzyme that degrades them

MOA of statins

-inhibit HMG-CoA reductase; inc LDL receptors

What is the MOA of glucocorticoids?

-inhibit NFkB -Suppress both B and T cell function by dec transcription of many ck -induce T cell apoptosis -used in many autoimmune and inflammatory disorders

calcineurin inhibitor

-inhibit the action of calcineurin which is an enzyme that activates T-cells of the immune system -two main calcineurin inhibitors are cyclosporin and tacrolimus (acts by complexing w FK binding protein 12)--both common parts of anti-rejection drug regimens after transplantation

Bleomycin

-inhibits DNA synthesis by binding to DNA and causing single-strand and double-strand breaks -AE: pulmonary fibrosis -may be used in the treatment of melanoma, sarcoma, squamous cell carcinoma, Hodgkin lymphoma, non-Hodgkin lymphoma, and germ cell tumors -pulmonary fibrosis, the most worrisome adverse effect of bleomycin -A typical chest X-ray description of this finding would be "ground glass opacities."

Pencillin MOA

-inhibits bacterial cell wall formation by inhibiting bacterial transpeptidase and preventing the formation of peptidoglycan

Valprocic acid effect in utero

-inhibits maternal folic acid absorption, leading to neural tube defects, esp spina bifida

Colchicine

-inhibits microtubule formation by binding to tubulin monomers, causing arrest of mitosis

inhibin

-inhibits secretion of FSH -secreted from granulosa cells/sertolic cells -also synthesized by the placenta

MOA of macrolides

-inhibits translocation and binds to 50s ribosome (remember most Ab that are bacteriostatic inhibit 50s and NOT 30 (except doxy and aminoglycosides))

CD28-B7 interaction does what?

-initial T cell activation in the adaptive immune response -CD28 is expressed on immature T cell and B7 is expressed on APCs

Dextrose 5% in water (D5W)

-initially a hypotonic solution

Muscle stretch reflex

-initiates in response to the stretch of a muscle as can occur when a tendon is struck with a reflex hammer -muscle spindles detect this stretch, and send a signal back to the spinal cord via la afferent fibers (spindle afferents), and synapse on anterior horn cells -alpha and gamma motor neurons fire, sending signals to the extrafusal muscle fibers and muscle spindles respectively to contract (thereby decreasing stretch that had ben detected)

femoral nerve innervates what muscles in the leg?

-innervates all of the muscles of the anterior compartment of the thigh which are primarily hip flexors and knee extensors -sensory--anterior thigh, medial leg -motor--quadriceps, iliacus, pectineus, sartorius

Obturator nerve roles

-innervates the muscles of the medial compartment of the thigh (adductor longus, adductor brevis, anterior portion of the adductor magnus, and gracilis) -provides cutaneous sensory innervation to the medial aspect of the thigh

intubation

-insertion of a tube into the trachea -a procedure that's used when you can't breathe on your own -Your doctor puts a tube down your throat and into your windpipe to make it easier to get air into and out of your lungs

Accessory muscles of respiration

-inspiration (neck) = scalenes (raise ribs), sternocleidomastoids (raise sternum) -exhalation (abdomen) = rectus muscle, internal/external obliques, transverse abdominis, internal intercostals

Carvallo's sign

-inspiration draws blood volume to the lungs -rIght sided murmurs inc with Inspiration -lEft sided murmurs inc with Exhalation

Insulin favors anabolic or catabolic pathways?

-insulin favors ANABOLIC pathways

Glargine mechanism of action

-insulin with modified aa structure -soluble in acidic solution for dosing -precipitates at body pH after SQ injeciton -insulin molecules slowly dissolve from crystals -low continuous level of insulin (onset is about 1-1.5 hours and duration is about 11-24 hours)

MOA of lithium on kidney

-interferes with ADH signaling at collecting ducts

What branch of what major blood vessel supplies the superior part of the bladder?

-internal iliac artery

Where does the cervix drain?

-internal iliac nodes

Lymph drainage above the pectinate line flows to what?

-internal iliac nodes -pectinate line marks the transition from the rectum to the anus -lymph drainage below the pectinate line drains to superficial iliac nodes

GH (growth hormone) and TH (Thyroid hormone) relationship

-interplay between the two hypothalamic-pituitary axes involved in GH and TH secretion -anterior pituitary somatotropes (secrete GH) and thyrotropes are both under negative feedback control by somatostatin, which provides an opportunity for cross-talk and may explain why hyperthyroid patients have reduced GH

Causes of infant vomitting with bile?

-intestinal atresia: duodenal atresia (failure to recanalize; xray double bubble sign; associated with down syndrome) -intestinal atresia: jejunal and ileal atresia (disruption of mesenteric vessels (typically SMA) which leads to ischemic necrosis of fetal intestine-->segmental resorption: bowel becomes discontinuous; xray shows dilated loops of small bowel with air-fluid levels) -maybe volvulus

Ezetimibe

-intestinal cholesterol absorption inhibitor

Inhalants

-intoxication of inhalants cause disinhibition, euphoria, slurred speech, disturbed gait, disorientation, drowsiness -withdrawal: irritability, dysphoria, sleep disturbances, headache

MOA for cryptosporidium

-intracellular multiplication within the intestinal epithelium

Is chlamydia intracellular or extracellular?

-intracellular! -so when treating, need TH1 lymphocytes (cytotoxic lymphocyte)

Germinal matrix hemorrhage (GMH)

-intraventricular hemorrhage, a cause of brain injury in newborns, especially preterm infants -frequent lesion in premature babies who also have hyaline membrane disease and the respiratory distress syndrome

Red "currant-jelly" stool with colicky bouts of abdominal pain and vomiting suggests?

-intussusception--> compromised blood supply leads to intermittent severe, abdominal pain often with currant jelly dark red stools -majority of cases in infants, unusual in adults -most common pathologic lead point: meckel's diverticulum (children) and intraluminal mass/tumor (adult) -on exam, pt may draw their legs to chest to ease pain, sausage shaped mass on palpation -may be associated with IgA vasculitis (HSP), recent viral infection (adenovirus, peyer patch hypertrophy creates lead point)

desmoplastic stromal response should make you think of?

-invasive ductal carcinoma -shows up as numerous small invasive glandular structures surrounded by desmoplastic stromal response (fibrosis and chronic inflammation)

internal urethral sphincter

-involuntary smooth muscle -normally closed to retain urine and also is closed during ejaculation to prevent retrograde ejaculation -can be injured during a TURP surgery (transurethral resection of the prostate

Jod-Basedow phenomenon

-iodine-induced hyperthyroidism -thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete (filled/well supplied) -Occurs when a pt with iodine deficiency and partially autonomous thyroid tissue (autonomous nodule) is made iodine replete -can happen after iodine IV contrast or amiodarone use (opposite to Wolff-chaikoff effect)

Pancoast tumor - symptoms on the ipsilateral or contralateral side?

-ipsilateral (same) side -PAM is horn-y (Horn-er) -P = pitosis (drooping eyelid); A = anhidrosis (absence of sweating + flushing on affected side of face); M = miosis (pupil constriction)

Microcytic anemia

-iron deficiency -could be due to chronic blood loss -reduced hemoglobin and low mean corpuscular volume (MCV)

What conditions can affect HbA1c/glycoslyated hemoglobin results?

-iron deficiency anemia inc values -B12/folate deficiency inc values -bc the older the RBC, the higher the degree of glycosylation -so things that cause RBC lysis and affect turnover rates/low rates of RBC erythropoiesis will cause a compensatory increase in the life span lifespan of RB--> will cause an inc in HbA1c

Pappenheimer bodies

-iron granules in sideroblastic anemia

Oral hairy leukoplakia

-irregular, white painless plaques on lateral tongue that cannot be scraped off -EBV mediated -occurs in HIV pts, organ transplant recipients

bronchopulmonary dysplasia

-is a chronic respiratory disease that most often occurs in low-weight or premature infants who have received supplemental oxygen or have spent long periods of time on a breathing machine (mechanical ventilation), such as infants who have acute respiratory distress syndrome --> leading to damage to structurally immature lung by oxygen and positive pressure ventilation -caused by abnormal alveolar septation-->poor gas exchange

Germline mosaicism

-is a mutation that is present in the gametes of an individual -The mutation may only affect a certain proportion of the gametes and does not affect the carrier of the mutation, only their offspring -It is typically observed in autosomal dominant disorders, such as osteogenesis imperfecta

What is special about ethacrynic acid?

-is a non-sulfa drug but can be used as a loop diuretic in people with sulfa allergies

What do you use echocardiogram for?

-is a type of US -can check heart structure (valves, HOCM, etc) and flow

Unpacking effect

-is a type of bias that occurs when the doctor fails to obtain the proper information from the patient to accurately diagnose the condition.

Amniotic band syndrome

-is a type of extrinsic error called disruption where normal tissue growth is arrested -fetal structures entrapped by fibrous bands in utero -often involves limbs or digits

What is Kussmal breathing?

-is a type of hyperventilation that is the lung's emergency response to acidosis -Kussmaul breathing causes a labored, deeper breathing rate -It is most commonly associated with conditions that cause metabolic acidosis, particularly diabetes

ARDS (acute respiratory distress syndrome)

-is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs--is associated with decreased PaO2/FiO2 ratio (less than 300), bilateral infiltrates on chest x-ray study, and no clear signs of cardiac dysfunction (normal pulmonary capillary wedge pressure)

desquamative interstitial pneumonia

-is a type of restrictive lung disease that presents with insidious dyspnea and a nonproductive cough -Risk factors include being middle-aged with a significant history of cigarette smoking -Distribution can be similar to idiopathic pulmonary fibrosis, involving the basilar peripheral lung parenchyma, and typically follows a restrictive lung disease pattern. However, it is important to note that DIP is distinct from usual interstitial pneumonia (UIP), both pathologically and clinically. A CT scan of the chest of a patient with DIP does not usually show the honeycombing seen in UIP. Instead, diffuse ground-glass opacities are present, usually involving the lower lobes and sometimes with small superimposed cysts

Gentamicin tx for pseudomonal infection

-is an aminoglycoside tradionally used for pseudomonal infections, but now superseded by other drugs because of increasing resistance

docusate MOA

-is an anionic surfactant (i.e. surface-active agent) that reduces surface tension at the oil-water interface of the feces, allowing water and lipids to penetrate the stool -helps hydrate and soften the fecal material, facilitating natural defecation--stool softener!!

nitrofurantoin

-is an antibacterial commonly used in the treatment and prophylaxis of uncomplicated cystitis -can cause a drug rxn that can lead to G6PD and pulmonary fibrosis

Type II hypersensitivity

-is an antibody-dependent process in which specific antibodies bind to antigens, resulting in tissue damage or destruction -If the antigen is present on cell surfaces, antibody binding can result in cell lysis through the in situ fixation of complement

CD14 is a marker for what?

-is an endotoxin receptor that can be used as a marker to count macrophages -(PS. CD28 activates T cells when binds)

Proprotein convertase subtilisin/kexin type (PCSK9)

-is an enzyme that breaks down LDL receptors in the liver

N-acetylglutamate

-is an essential activator for carbamoyl phosphate synthase I, and is the rate-limiting enzyme of the urea cycle

lipoprotein lipase (LPL)

-is an extracellular enzyme found on capillary walls in adipose tissue, muscle, and the heart -breaks down TAGS into FAs -a drug that inhibits LPL will lead to a clinical picture similar to hyperchylomicronemia (type I dyslipidemia)...in this disorder, TAGS are makedly elevated (often>1000 mg/dl) and this leads to recurrent pancreatitis

idiopathic pulmonary fibrosis

-is an interstitial (restrictive) lung disease and interstitial lung diseases are pulmonary problems with DEC diffusion (Dlco), and INC A-a gradient -repeated cycles of lung injury and wound healing with inc collagen deposition -"honeycombing" lung appearance -traction bronchiectasis and digital clubbing

Botulinum toxin MOA

-is an intramuscular toxin produced by Clostridium botulinum -blocks neuromuscular transmission by preventing acetylcholine (ACh) release at NMJ

What is HIT caused by?

-is caused by antibodies that bind to complexes of heparin and platelet factor 4 (PF4), activating the platelets and promoting a prothrombotic state -so they are anti-platelet antibodies

Polycythemia vera

-is characterized by an increase in hemoglobin, hematocrit, RBCs; dec in EPO due to negative feedback -the plasma volume is increased. This compensation results in making the blood less viscous, although still with increased viscosity relative to normal blood -caused by a myeloproliferative disorder that results from a JAK2 mutation, a non-receptor tyrosine kinase -present with pruritis that is worse after taking a hot bath or shower, headaches, facial plethora (redness of the facial skin), and transient visual disturbances, and have a history of strokes or deep venous thrombosis (DVT)

O antigen

-is component of LPS found in gram-negative bacteria only

Dacryocystitis

-is infection of the tear (lacrimal) sac usually due to a blockage in the tear (nasolacrimal) duct -usually occurs in elderly women due to idiopathic duct stenosis -can also occur due to trauma or neoplasm -presents with acute pain, tearing, erythema, and swelling of the nasolacrimal sac

Why on earth is TNF produced?

-is produced by immune system to stimulate the expression of endothelial adhesion molecules, induce an acute phase response, and alter body metabolism

steatorrhea

-is the presence of fat in the feces -can be seen in fat malabsorption syndromes including among children with abetalipoproteinemia -deficiency of fat soluble vitamins including vitamin E also occurs with fat malabsorption

Isolated AST elevation and epigastric pain is what disease?

-ischemia heart disease -MI is associated with elevation of CPK, troponin, LDH, and AST (without accompanying ALT increases or other liver enzymes) -female patients can present with atypical signs and symptoms of acute MI: jaw pain or epigastric pain (atypical presentations are particularly more common in women than men)

What is the most common reason for painless transient monocular vision loss (aka amaurosis fugax)?

-ischemia which can be due to atherosclerosis, embolus, vasculitis, hypercoag disorders, venous stasis or systemic hypoperfusion

What causes ATN?

-ischemia--secondary to dec renal bf (hypotension, shock, sepsis, hemorrhage, HF) -results in death of tubular cells that may slough into tubular lumen (PCT and thcik ascending are highly susceptable to injury -nephrotoxic--secondary to injury resulting from toxic substances (aminoglycosides, radiocontrast, lead, cisplatin, ethylene glycol), crush injury (myoglobinuria), hemoglobinuria -proximal tubules are susceptible to injury

transvaginal pudendal nerve block is injected towards what structure?

-ischial spine

The single most important test for diagnosis of Legionnaires' disease is?

-isolation of the organisms using a buffered charcoal yeast extract agar, which contains L-cysteine, iron, vancomycin, and dyes to prevent overgrowth of competing organisms and to stain the organism of itnerest

What Tb drug is an inhibitor of CYP450?

-isoniazid

Loop diuretics causes what kind of volume loss (hypertonic, isotonic, or hypotonic)?

-isotonic volume contraction -can't re-absorb salts and water follows

Where does a DIRECT inguinal hernia bulge out through?

-it bulges out through the inguinal TRIANGLE (medial border is rectus abdominus, lateral border is inferior epigastric arteries, and inferior border is the inguinal ligament) -indirect inguinal hernia goes through the inguinal canal

What does pneumonia do to the V/Q ratio?

-it causes it to dec bc dec in ventilation due to lobe being plugged and inc inflammation which leads to vasodilation

If you increase the concentration of PAH in the plasma, what happens to renal clearance?

-it dec and approaches that of inulin -use clearance PAH formula: C = UV/P

How does emphysema affect FEV1/FVC, vital capacity, and DLCO?

-it decreases all -obstructive disease so dec FEV1/FVC -destroys alveoli so reduces SA for gas exchange and therefore reduces DLCO (diffusion) -decreases vital capacity which is made up of expiratory reserve volume, tidal volume, and inspiratory reserve volume

How does desmopressin treat vWD?

-it directly stimulates vWF and factor 8 release from endothelial cells

What does anemia do to pulse pressure (PP)?

-it increases the pulse pressure (widens it) -PP = systolic bp (SBP) - diastolic bp (DBP); systolic is dependent on CO and SV and diastolic is TPR -so if you have anemia, this limits how much O2 blood can carry, forcing dependent tissues to compensate for the reduced supply through a locally-mediated reflex vasodilation-->SVR dec so PP inc -the fall in mean TPR caused by increase flow to the periphery triggers baroreflex-->inc in CO via inc in HR and SV which contribute to inc in SBP and therefore widen PP

cardiac function curve

-just affects the heart -inc ionotropy shifts the graph up (via SNS via exercise) -dec ionotropy shifts graph down (HF, etc)

What lab values are affected in osteoporosis?

-just bone mass decreases! -normal Ca2+, Phosphorus, ALP, and PTH

Infants with jaundice and some anemia condition makes you think of what major complication?

-kernicterus! -kernicterus is the deposition of unconjugated, lipid soluble bilirubin in the brain, particularly the basal ganglia

Wnt-7a

-key for dorsal development -activates LMX-1 gene in mesoderm to make dorsal side (presence makes dorsal) -engrailed1 represses Wnt-7 to make ventral side (absence makes ventral)

Urate nephropathy

-kidney damage caused by precipitation of urate crystals within the kidney tubules of a person with gout -deposition of urate crystals in the tubules and interstitium - usually follows aggressive chemotherapy (massive release of urines), lead poisoning or in gout -prevent by giving allopurinol prior to chemotherapy

Type III hypersensitivity

-labeled immune complex -antigens combine with antibodies and deposit in tissues & blood vessels, causing inflammation & tissue destruction.

Aplasia

-lack of development of an organ or tissue

what features of a causative pathogen can make it resistant to physical and chemical disinfectants?

-lack of envelope -the lack of an envelope is responsible for its high resistance to physical and chemical disinfectants, allowing the virus to survive on environmental surfaces for long periods of time

fibrillin

-large extracellular matrix proteins associated with both elastic and non-elastic microfibrils

Fasciolopsis buski

-large intestinal fluke that can cause abdominal pain, diarrhea, and intestinal mucosal abscesses

Parathyroid oxyphil cells

-larger and lighter staining than the parathyroid chief cell -can be found in clusters in the center of the section and at the periphery -appear at the onset of puberty, but have no known function

S4

-late filling sound -diastole, low pitched -head in pts with stiff left ventricle -rapid late filling of LV due to atrial kick--not heard in a fib -think of Ten-a--see

Non-ejection click

-late in systole -AFTER carotid pulse -mitral valve prolapse

Monospot test

-latex agglutination assay that uses horse erythrocytes to induce agglutination in a positive test -heterophile antibodies are IgM antibodies that react with sheep and/or horse RBC and induce agglutination -antibodies appear in the pt's blood in the first several weeks of infectious mono and wane after several months -EBV antibody titers such as IgG and IgA directed against the viral capsid antigen of the virus

What are the branches of the celiac artery?

-left gastric artery, splenic artery, common hepatic artery

ligamentum teres is a remnant of what?

-left umbilical vein

Maneuvers that can inc preload/venous return

-leg raise -squatting

Structures made up of type 4 collagen

-lens of the eye, basement membrane (basal lamina)

depigmentation and anesthetic cutaneous lesions makes you think what?

-leprosy or hansen disease -M leprae has a predilection for skin and cutaneous nerves -loss of peripheral nerve fxn leads to many of the disfiguring features of the disease-->sustain repeated injuries

Congenital nevus

-lesions are benign, circumscribed, light-brown to black plaques with associated hair growth -histo: nevus cells grow deep into the dermis along hair follicles, sebaceous glands, and neurovascular structures -giant nevi can cover significant areas of the arm and/or trunk

When you see flat purple lesions and plaques on vulva, what should you think of?

-lichen planus (purple) -has mucosal whitish, lacy bands (wickham striae) of keratosis -chronic vulvar burning and/or pruritus, insertional dyspareunia (painful intercourse), vaginal discharge -on microscopy--see sawtooth infiltrate of lymphocytes at dermal-epidermal junction, increase of stratum granulosum

where does the long thoracic nerve lie?

-lies on the medial wall of the axilla and is prone to injury during axillary surgery

Pharyngeal clefts

-lined by ectoderm -1st = develops into external auditory meatus -2nd - 4th = form cervical sinus (temporary cavity in embryo that obliterates during development)

What does autoclave sterilization kill?

-literally everything (bacteria, fungi, virus, and spores) except prions -also kills/removes spores!

Arthus reaction

-local reaction seen in the skin after subcutaneous or intradermal injection of an antigenic substance -type III hypersensitivity reaction -localized dermal injury due to inflamed blood vessels

arthus reaction

-local reaction seen in the skin after subcutaneous or intradermal injection of an antigenic substance -type III hypersensitivity: antigen-antibody complexes forma and deposit in tissues or blood vessel walls (they deposit in skin, joints, and kidneys

Golgi tendon organs

-located within muscle tendons near myotendinous junction -monitor changes in muscle length and tension using type Ib sensory neurons -fxn to cause activated muscle to relax

Locus hetergeneity vs. allelic hetergeneity

-locus = mutations at different loci can produce a similar phenotype (ex. albinism) -allelic = different mutations in the same locus produce the same phenotype (ex. beta thalassemia)

Bupivacaine

-long-acting amide-based anesthetic capable of causing cardiac arrhythmias and hypotension -One of the most common local anesthetics used in delivery is bupivacaine -long-acting amide-based local anesthetic that blocks voltage-gated sodium channels and prevents depolarization -The mechanism of action of bupivacaine allows greater cardiotoxicity than other drugs in this class -can produce arrhythmias and hypotension if administered intravenously

What is the most appropriate means of monitoring for early renal disease in a diabetic patient?

-look at urine albumin concentration

Pearson correlation

-looking for a linear relationship between two sets of interval data only -ex. researchers trying to determine whether weight was correlated with fasting blood glucose values

Noncompetitive inhibitor vs. Partial agonist

-looks the same but noncomp has to be administered with both drugs while partial can stand on its own/measure effects by just administering partial agonist

holosystolic murmur of mitral regurg

-loudest at the cardiac apex -common in pts with dilated cardiomyopathy -leak from the left ventricle into the left atrium during systole -listen to a recording

Epinephrine receptor selectivity?

-low dose: beta > alpha -high dose: alpha predominates

pericarditis

-low grade fever, pleuritic chest pain that worsens with respiration and improves with leaning forward, pericardial friction rub, pulsus paradoxus, somestimes pericardial effusion -can be related to early post-MI infarc, later post-MI infarc (dressler syndrome)

What drug is indicated for dvt during pregnancy?

-low molecular weight heparin (dalteparin, enoxaparin) -LMWH is contraindicated by kidney insufficiency bc undergo renal clearance

Goodpasture

-lung + Kidney. hemoptysis and dyspnea. Dx: biopsy. Tx: plasmapheresis, cyclophosphamide, steroids -condition of autoantibodies against components of the glomerular basement membrane -autoantibodies develop against the alpha-3 chain of type IV collagen (type II hypersensitivity reaction which is autoantibodies against tissue antigens) -crescent in the pic stands for crescent kidney glomerulonephritis

Of breast cancer vs lung cancer, which stains postive for mucin?

-lung cancer does -breast cancer does NOT stain positive for mucin

most common cause of mediastinal mass?

-lymphadenopathy, either from lymphoma or metastatic cancer

Most common cause of acute appendicitis in children?

-lymphoid hyperplasia -commonly occurs as a response to viral infection or vaccination

Hurler's syndrome

-lysosomal storage disease -lack enzyme alpha-L-iduronidase and accumulate heperan and dermatan sulfate (glycosaminoglycans) -this syndrome and Hunter's syndromes are unique from other lysosomal storage diseases like Tay Sachs and Fabry which involve the accumulation of lipids -pt presents with coarse facial features (enlarged skull, wide nasal bridge, and flattened midface), often have recurrent midface and resp infections, corneal clouding and hepatosplenomegaly

Sirolimus (rapamycin)

-mTOR inhibitor (broken motor in pic); binds FKBP (fork in pic). -Blocks T-cell activation and B-cell differentiation by preventing response to IL-2 -used for kidney transplant rejection prophylaxis (think of Sir Basil's kidney transplant) -kidney sirvives!!! -AE: pancytopenia, insulin resistance, hyperlipidemia; NOT NEPHROTOXIC -rapamycin (wrap-per in pic)

Which antibiotics interfere with translocation?

-macrolides and clindamycin (50s) -inhibit translocation of peptidyl-tRNA from acceptor to donor site

Kupffer cells

-macrophages in liver sinusoids

Maternal diabetes as a teratogen

-macrosomia (large baby) -neonatal hypoglycemia -congeital heart defects (transposition of great arteries) -sacral agenesis (incomplete development of sacrum so can lead to sirenomelia which is mermaid syndrome)

What can affect the macula densa

-macula densa cells of the DCT contain chemoreceptors that detect Low Na+ (low blood pressure) and Low blood flow -located in thick ascending tubule -they use an NCCK channel to work and sense things -any drug proximal the macula densa that inc Na+ into the urinary tubule (except K+ sparing diuretics apparently and drugs that affect the NCCK channels they use to sense things) can cause macula densa to inc glomerular aff arteriolar resistance

Cysteine stones

-made of cysteine (amino acid) which leaks into the urine -yellow or light pink -radiolucent on x-ray -has a genetic component (autosomal recessive disease)

Leydig cell tumor

-mainly benign and has a 10% chance of being malignant -produce androgens, estrogens, or rarely, corticosteroids -gross exam is golden brown color -characteristic of Reinke (pale-staining, rod-shaped crystals) are pathognomonic

Pharmacologic therapy for Graves disease

-mainly includes the use of thioamides, such as propylthiouracil and methimazole, which decrease thyroid hormone synthesis -Propylthiouracil works by blocking tyrosine iodination and coupling and decreasing peripheral conversion of T4 to T3

hyperosmolar nonketotic coma

-major complication of type 2 diabetes mellitus -large amounts of glucose in the blood are eliminated by the kidney, causing an osmotic diuresis that leads to dehydration and hypotension -serum electrolytes are variable in hyperosmolar nonketotic states

Vaccine against h. influenzae's b capsule causes what type of immunological reaction?

-major virulence factros is the polysaccharide capsule, which is a poor inducer of T-cell dependent responses in young children -however, by conjugating the PRP polysaccharide component of the capsule to a protein antigen such a toxoid, a T-cell dependent response is stimulated and a PRP-specific isotype class switching from IgM to IgG occurs

Of the sublingual, submandibular, and parotid gland, which contains the most mucus producing cells and which contains the most serous producing cells?

-majority mucus: sublingual gland -mixed mucous and serous: submandibular gland -majority serous: parotid gland

hyperplastic arteriolosclerosis

-malignant htn --> ONION LIKE CONCENTRIC THICKENING OF ARTERIOLE WALLS via LAMINATION OF SM AND DUPLICATION OF BM

Wilm's tumor

-malignant tumor of the kidney occurring in childhood (age usually is 2-4 yrs) -palpable flank mass, unilateral mass that classically does NOT cross the midline -the most common renal malignancy of childhood -sometimes accompanied by abdominal pain and hematuria -Wilms tumor can present as part of the WAGR syndrome, which consists of Wilms tumor, Aniridia (absent iris), Genitourinary malformation, and mental-motor Retardation. It is also associated with hemihypertrophy (in which one side of the body is larger than the other), commonly seen in individuals with Beckwith-Wiedemann syndrome -histo: triphasic pattern (blastemic, stromal and epithelial cells types) + can see glomeruli

SCC (squamous cell carcinoma)

-malignant tumor of the squamous epithelium -sheets of polygonal cells with crisp eosinophilic cytoplasm and intracellular bridges -nuclei vary in size and shape -stain positive for antibodies to high molecular weight cytokeratin

Glucagonoma

-malignant α-islet cell tumor; -hyperglycemia and rash

Medicare Part C

-managed care health plans offered to medicare beneficiaries under the medicare advantage program -a privately-administered, government approved medical insurance that may sub for original medicare

Autosomal dominant polycystic kidney disease

-manifests in patients 40-50 years old with enlarged kidneys, hypertension, and renal failure -can cause berry aneurysm (balloon on guys head popping), hypertension, hepatic cysts (red ballon near liver), pancreatic cysts, diverticulosis, hematuria, flank pain, and inc risk of UTIs

What signals work through JAK/STAT pathway?

-many cytokines (IFN gamma, IL2, IL6) -bone marrow (Erythropoietin, G-CSF (granulocyte-colony stimulating factor), thrombopoietin) -Others (prolactin, growth hormone)

Dysgerminomas

-markers are inc LDH or inc beta-hcg -look like a fried egg on histo (sheets or nests of large, undiff polygonal cells with clear cytoplasm, distinct cell membranes, and centrally placed nuclei) -malignant germ-cell tumors of the ovary which commonly occur in younger women, appear grossly as white or tan, firm, lobulated masses

What is T-bet?

-master transcription factor for Th1 cells -CD4+ th1 cells secrete IFN-gamma and IL-2 to activate Macrophages and CD8+ t cells -when IFN-gamma and IL-12 are present during activation, it will induce the master transcription factor T-bet, which will drive the activated CD4+ t cell towards a Th1 phenotype

Prader-Willi Syndrome

-maternally derived genes are silenced (imprinted) -disease occurs when the Paternal allele is deleted or mutated -results in hyperphagia, obesity, intellectual disability, hypogonadism, and hypotonia -associated with a mutation or deletion of chromosome 15 of paternal origin -mad all the time and eats a shit ton of food -Prader has mutated/messed up Papa

Pheochromocytomas may be part of what syndrome/diseases?

-may be part of multiple endocrine neoplasia (MEN) type 2A syndrome or MEN type 2B syndrome -MEN 2A, or Sipple syndrome, includes pheochromocytoma, medullary carcinoma of the thyroid, and hyperparathyroidism due to hyperplasia or tumor -MEN type 2B syndrome includes pheochromocytoma, medullary carcinoma of the thyroid, and multiple mucocutaneous neuromas or ganglioneuromas. Both syndromes are linked to the RET oncogene

Thyroglossal cyst

-may lie at any point along the migratory pathway of the thyroid gland but is almost always in the midline of the neck -most common form of congenital neck cyst -thick fibrous capsule around cyst -elevates with swallowing and tongue protrusion

what does catalase positive mean?

-means produce bubbles when placed in hydrogen peroxide

Lumbosacral refers to what region?

-means the lower back region -periumbilical is the front midline region area

Albumin

-measures plasma

Male with painless rectal bleeding - currant jelly stools makes you think what?

-meckel's diverticulum--rule of 2's...here are the non-obvious ones: two ectopic tissue types (gastric and pancreatic), two main presentations (bleeding or obstruction)

Supracondylar fracture of humerus damages what nerve?

-median nerve

MCAD deficiency

-medium chain acyl-CoA dehydrogenase (ACADM gene) def. → no FA β-oxidation when low blood glucose → hypoketotic hypoglycemia (can't make ketone bodies) -presents with: seizures, hypoketotic hypoglycemia, death, hyperammonia, liver dysfxn, fatty acyl carnitine/coa accumulates

well circumscribed tumor that comprises of sheets of large, anaplastic cells with "pushing borders" surrounded by abundant lymphoplasmacytic reaction

-medullary carcinoma -this rare subtype is seen in women with BRCA1 mutations

CSF shows low glucose level, increased white blood cell count, and increased protein indicate what?

-meningitis!

FAS

-mental retardation -smooth philtrum -short palpebral fissures -thin vermillion border -congenital heart defects -limb defects -below avg for height and weight -structural defects of brain -EVERYTHING ABOUT THESE BABIES IS SMALL

Adrenal cortex is derived from what embryological germ layer?

-mesoderm

What germ layer is the adrenal cortex derived from?

-mesoderm (also forms bone tissue, fat tissue, muscle tissue, kidneys, ovaries/testes, bone marrow, and the heart and circulatory system)

name 3 signs of aspirin toxicity

-metabolic acidosis -respiratory alkalosis -tinnitus (presents first) (hyperthermia)

What stage in meiosis are oocytes of a woman after puberty that is about to ovulate?

-metaphase of meiosis II

new -onset, non traumatic low back pain in an older man should raise suspicion for...?

-metastatic prostate cancer -typically present with osteoblastic lesions, elevated serum alkaline phosphatase, inc ESR (due to systemic inflammation from disseminate malignancy)

Mech of resistance of macrolides

-methylation of 23S rRNA-binding site prevents binding of drug

What are the drugs you can use to treat chronic hypertension in a pregnant woman?

-methyldopa -labetalol -nifedipine -hydralaxine (for severe hypertension)

How to treat Methemoglobinemia?

-methylene blue and vitamin C

which selective beta 1 blocker can cause dyslipidemia?

-metoprolol

What are microvilli made of?

-microfilaments (actin)

microvilli vs cilia?

-microvilli- small fingerlike projections that increase surface area; use actin filaments -cilia- much longer, motile, visible (no human ciliated cells that freely move around); use microtubules

What are the differences between minimal change disease and focal segmental glomerulosclerosis?

-minimal: most common cause of nephrotic syndrome in children, normal glomeruli on H&E stain (lipid may be seen in proximal tubule cells), excellent response to steroids -focal segmental golerulosclerosis (FSGS): most common cuase of nephrotic in hispanics and african americans, may be associated with HIV, heroin use, and sickle cell disease, focal(some glomeruli) and segmental (only part of the glomerulus) sclerosis on H&E stains, poor response to steroids and may progress to chronic renal failure

mitral regurgitation

-mitral insufficiency; incompetent mitral valve allows regurgitation of blood back into left atrium during systole -caused by mitral valve prolapse(MVP) and a systolic click suggests this

what is the pulmonary vascular resistance equation?

-mitral regurg dec PVR bc backward flow raises left atrial pressure and pulm venous pressure, forcing the right ventricle to generate higher pulmonary arterial pressures in order to maintain forward flow -inc pulm perfusion pressures dilates collapsed vessels, thereby dec PVR

Cardiopulmonary arrest causes what kind of acidosis?

-mixed acidosis -cardiopulmonary arrest is defined as the complete cessation of effective circulation and ventilation

Foul smelling, putrid sputum suggests what kind of infections?

-mixed anaerobic bacteria

What bug causes diffuse benign umbilicated skin colored warts?

-molluscum contagiosum (part of the poxviruses family) -poxviruses contain their own dna-dependent rna polymerase so they can replicate in the cytoplasm (unique to dna viruses) -poxviruses cause intracytoplasmic inclusions called guarnieri bodies and they also syntehsize their own envelope -common in wrestlers and children in daycare and school situations

Basiliximab

-monoclonal antibody blocks IL-2 which activates T cells

Hyperkalemia causes urine to be less or more acidic?

-more acidic! -hyperkalemia decreases proximal tubule ammonia generation and collecting duct ammonia transport, leading to impaired ammonia excretion that causes metabolic acidosis -hyperkalemia causes diminished ammonia production because potassium shifts into cells causing proton shifts out of cells, resulting in intracellular alkalosis in the renal tubules. In response, ammonia production by the proximal renal tubular cells is decreased -in short, hyperkalemia -> more acidic urine

ANOVA

-more than two groups are being evaluated on the basis of one interval variable -ex. researchers were trying to determine whether there was a statistically significant difference between the average height in three age cohorts: children aged 5-9, 10-14, and 15-19

Myasthenia gravis

-most common NMJ disorder -autoantibodies to postsynaptic ACh receptor -clinical: ptosis, diplopia, weakness, worsens with muscle use -associated with thymoma, thymic hyperplasia -pyridostigmine (AChE inhibitor reverses symptoms)

Pulmonary hamartoma

-most common bengin tumor of the lung -hamartomas contain disorganized but normal tissue from organ in which they are found -lesions contain fat, epithelial cells, fibrous tissue, and cartilage -grow slowly over years

Pleomorphic adenoma

-most common benign tumor of superficial lobe (most common) salivary glands; -parotid most common site -painless, mobile mass at angle of jaw -mixed tumor - one type is epithelial glandular cells and other is stromal cells that produce cartilage and sometimes bone -risk factors: prior radiations -Tx: surgery +/- radiation -can have reocurrance bc have irregular margins so may be left behind during surgery

Acute tubular necrosis

-most common cause of acute kidney injury in hospitalized patients -spontaneously resolves in many cases -can be atal, especially during initial oliguric phase (in FEna) -granular casts (muddy brown) -3 stages: inciting event, maintenance phase (oliguric; lasts 1-3 weeks, risk of hyperkalemia, met acidosis, uremia) recovery phase )polyuric; BUN and serum creatinine fall; risk of hypokalemia and renal wasting of other electrolytes and minerals

Senile calcific aortic stenosis

-most common cause of aortic stenosis in patients over 65 -"wear and tear" phenomenon of the aortic valve -with aging, aortic valve collagen is destroyed, and calcium deposits on the leaflets

hypertrophic pyloric stenosis

-most common cause of gastric outlet obstruction in infants (1:600) -palpable olive-shapaed mass in epigastric region, visible peristaltic waves, non bilious projectil vomiting at 2-6 weeks old -more common in firstborn males, associated with exposure to macrolides -results in hypokalemic hypochloremic met alkalosis (secondary to vomiting of gastric acid and subsequent volume contraction) -US shows thickened and lengthened pylorus -tx: surgical incision of pyloric muscles (pyloromyotomy)

Fragile X

-most common genetic cause of mental retardation in which a defective gene results in a weak spot on the X chromosome which makes it susceptible to breakage -the major features are delayed development, intellectual disability, and physical manifestations including a long, narrow face, and large forehead, chin, and ears -testicular enlargment usually occurs around 8-12 years of age as boys approach puberty -caused by expanded trinuclear repeat segments (CGG repeats int he FMR1 gene on the x chromosome)--this expansion leads to dna methylation of the FMR1 gene which silences gene activity

Vitamin B6 deficiency

-most common in patients taking -isoniazid/INH (for TB) or oral contraceptivesIsoniazid inhibits pyridoxine phosphokinase, which converts pyridoxine to PLP (active form) -Due to its many functions, deficiency presents with many symptoms, including: Peripheral neuropathy & Sideroblastic anemias due to role as cofactor for ALA synthase, presents as microcytic, hypochromic anemia -Convulsions/seizures, hyperirritability, seborrheic dermatitis, glossitis also seen (nonspecific, low-yield)

Fibrocystic change

-most common in premenopausal women 20-50 years -present with premenstrual breast pain or lumps; often bilateral and multifocal -nonproliferative lesions include simple cysts (fluid-filled duct dilation, blue dome), papillary apocrine change/metaplasia, stromal fibrosis--risk of cancer is not usually increased -proliferative lesions include sclerosing adenosis (acini and stromal fibrosis associated with calcifications and slight inc risk of cancer) and epithelial hyperplasia (cells in terminal ductal or lobular epithelium and inc risk of carcinoma with atypical cells)

Mucoepidermoid carcinoma

-most common malignant salivary tumor -key risk factor: prior radiation -occurs in parotids (can also cause pain) -commonly found in minor salivary glands -mixture of squamous (epidermoid) cells and mucus-secreting cells -intermediate hybrid cells

Basal cell carcinoma

-most common skin cancer -sun-exposed areas of body (ex. face) -locally invasive, but rarely mets -WAXY, pink, pearly nodules, commonly with telangiectasis, rolled borders, central crusting or ulceration -also appear as nonhealing ulcers with infiltrating growth or as a scaling plaque (superficial BCC) -basal cell tumors have "palisading" aligned nuclei

Neuroblastoma

-most common tumor of the adrenal medulla in children (usually <4 years old) -originates from neural crest cells + can occur anywhere along the sympathetic chain -abdominal distension, firm irregular mass that can cross the midline, opsoclonus-myoclonus syndrome (dancing eyes and dancing feet) -inc catecholamine metabolites in urine -Homer wright rosettes on microscopy; small blue cells forming pseudorosettes -associated with N-myc oncogene

Porphyria cutanea tarda

-most common type of porphyria, and it results from a defective uroporphyrinogen decarboxylase enzyme, usually due to a sporadic mutation -The uroporphyrinogen decarboxylase enzyme is involved in Heme Synthesis at the conversion of uroporphyrinogen to coproporphyrinogen -associated with Hepatitis C -Elevated uroporphyrin and upstream heme precursors cause the clinical findings of PCT, which include tea-colored urine, and cutaneous findings such photosensitivity and hyperpigmentation -presents with blistering cutaneous photosensitivity

alcohol disinfectants are affective against what kind of pathogen and how?

-most effective at against bacteria (which contain a lipid cell membrane) and enveloped viruses -it disrupts lipid membranes, although there is also some ability of these substance to denature proteins

Hurler syndrome

-mucopolysaccharidosis, deficient a L iduronidase, accumulations of heparin sulfate and dermatan sulfate in heart, brain, liver, and other organs, progressive, hepatosplenomagaly, dwarfism, gargoyle-like facies, stubby fingers, corneal clouding, mental retardation, death by 10 years of age p57

Increased bed rest and decreased calorie intake during illness often leads to...?

-muscle atrophy -a major underlying mechanism of muscle atrophy is protein degradation in skeletal myoctyes (through ubiquitination)

What happens to the vessels when skeletal muscles contract during exercise?

-muscle contraction compresses blood vessels running between the muscle fibers, increasing vascular resistance, and decreasing blood flow -net blood flow increases due to metabolic vasodilation of arterioles, but flow increases occurs between contractions, not during them

Symptoms of hyperkalemia include?

-muscle fatigue -palpitations -peaked T waves on EKG

What are extrafusal fibers?

-muscle fibers -refer to the bulk of the muscle belly, that is, the part of the muscle that generates force when contracted -innervated by alpha motor neurons (part of the efferent arc)

Mesoderm derivations

-muscle, bone/cartilage, blood/lymph/CV organs, adrenal cortex, spleen, kidney/ureter, dura mater, gonads and internal repro organs, nucleus pulposus

FAP is associated with what mutation and in what chromosome?

-mutation in the APC gene, located on chromosome 5 (5q22)--polyp has 5 letters!

Beta thalassemia MAJOR moa

-mutation in the splice site

Alport syndrome

-mutation in type IV collagen X-linked leads to glomeruloneprhitis, eye problems, and sensorineural deafness. -Can't see, can't pee, can't hear a buzzing bee.

Primary Myelofibrosis

-myeloproliferative disorder in which bone marrow is replaced by fibrous tissue -fatigue complaints -tear drop cells is characteristic on blood smear -bone marrow biopsy often leads to a dry tap meaning an inability to remove fluid and cells due to fibrous tissue accumulation

When the left ventricular wall moves paradoxically, think of __________________ secondary to occlusion of the left anterior descending artery

-myocardial infarc

How does resistance training affect skeletal myocytes?

-myocytes are limited by the actin and myosin content as this determines the max weight that can be resisted -actin myosin (protein synthesis) content rises but mt density does not change

Renal Artery Stenosis (RAS)

-narrowing of the renal artery, most commonly because of correctable hypertension, suspected when 1 kidney is atrophied while other is normal, common cause is fibromuscular dysplasia in kids. Doppler flow will have RI of > .70, normal artery is low resistant and continous -ACE inhibitors are CI with this disease

Samter triad

-nasal polyps, asthma, aspirin sensitivity

Branchial cleft cyst

-neck mass -2nd cleft cysts are most common -location based on cleft of origin -anterior to sternocleidomastoid muscle -fistula can develop and can become infected -mass does not move with swallowing -contrast with thyroglossal duct cyst which is a midline neck mass that moves with swallowing and formed during development of thyroid gland

Newborn who develops colic and bloody diarrhea in the first week of life....what should you suspect?

-necrotizing enterocolitis--which causes intestinal ischemia and occurs most commonly in premature, low birth-weight infants -is a complication of prematurity that leads to necrosis of the intestinal mucosa and intramural gas -may be complicated by intestinal gangrene, gastrointestinal bleeding, intestinal perforation, and sepsis -the affected infants are usually premature or low birth weight and are usually bottle-fed only -gas in the bowel (pneumatosis intestinalis) is commonly seen on a radiograph -perforation of the bowel due to transmural necrosis leads to pneumoperitoneum

rhabdomyosarcoma

-neoplasm of striated muscle and is a childhood tumor -most common site is the H&N, followed by the genitourinary region -desmin is a component of skeletal muscle cells and can be appreciated on immunohistochem to dx this disease -small round blue cells -a variant of this disease is botryoid rhabdomyosar which is a grape cluster appearance and affects mucosa-lined structures (see pic)

NSAIDS effect on the kidney

-nephotic syndrome and interstitial nephritis -constrict afferent arteriole and there dec GFR -This decrease in peritubular blood flow may increase the risk for acute kidney injury, especially in patients with CKD

What is the most common tumor of the adrenal medulla in kids?

-nephroblastoma (Wilms tumor) -most common primary renal cancer in children -dervied from metanephric blastema

Lithium causes what kind of urine disorder?

-nephrogenic diabetes insipidus--an inability to concentrate urine due to impaired renal tubule response to vasopressin (ADH)

Antithrombin III deficiency can be acquired from what condition?

-nephrotic syndrome (due to loss of antithrombin in urine)

What does the articopulmonary septum need to form?

-neural crest cells

Sturge-Weber

-neurocutaneous disorder -port-wine stain over trigeminal nerve (v1 and v2 distribution) -eye / vision involvement (leukocoria-absent red reflex, sometimes associated with glaucoma) -other characteristics: ipsilateral leptomeningeal angiomatosis, intellectual disability, and SEIZURES, and maybe muscle weakness (hemiparesis) -may also develop pheochromocytomas

tuberous sclerosis

-neurocutaneous disorder that includes many organs systems, including multiple neoplasms of the brain, kidney, skin and heart -TSC1/TSC2 (encodes hamartin and tuberin) mutation on chromosome 16, autosomal dominant, variable expression -HAMARTOMAS: Hamartomas in the CNS and skin, Angiofibromas, Mitral regurgitation, Ash leaf spots, cardiac Rhabdomyoma, autosomal dOminant, Mental retardation, renal Angiomyolipoma, Seizures, Shagreen patches -butterfly facial angiofibromas, subependymal nodules in ventricles, subependymal giant cell astrocytomas

small cell carcinoma

-neuroendocrine tumor; secrete ACTH and ADH and or Abs against presynaptic Ca2+ channels (lamber-eaton) or Abs against neurons (encephalitis, etc) -small round blue cells (see blue cellular room in pic) = called kulchitsky cells -associated with amplification of myc oncogenes is common

Carcinoid tumors

-neuroendocrine tumors that develop in intestines and frequently involve the appendix (Sketchy's reptile sketch in the sewers) -when they mets outside of intestine (e.g. to the liver), first pass elimination is bypassed, and serotonin can enter the systemic circulation causing carcinoid syndrome -can cause right-sided endocardial fibrosis and thickening of heart valves secondary to exposure to serotonin

most posterior mediastinal masses are what kind of tumors?

-neurogenic tumors

a neonate who develops irritability and refusal to breastfeed may suggest what?

-neurologic issues

Congential neutropenia

-neutrophils are the only low lab value and happens in children/newborns

Smoking during pregnancy

-nicotine induces vasoconstriction which reduces placental blood flow -CO competes with O2, and dec oxyhemoglobin -leads to low birth rate and inter uterine growth restriction, placental anomalies, preterm labor, SIDS (sudden infant death syndrome)

What does SVT look like on EKG

-no discernable p waves -narrow QRS complex (atrial) -fast HR (tachycardia) -can present with palpitations

Paradoxical S2 splitting

-no split during inspiration and split during expiration -could be electrical causes (LBBB, RV pacing) -mechanical causes (delayed LV outflow--LV systolic failure, aortic stenosis, hypertrophic cardiomyopathy) -parodoxicaL = Left sided delay

Can men with CF reproduce?

-no! -infertility in males due to congenital absence of vas deferens (boy getting hit in the crotch is now infertile in sketch)

NNRTIs

-non-nucleoside reverse transcriptase inhibitors -are ineffective in patients with HIV-2 infections -nevirapine, efavirenz, and rilpivirine -do not require intracellular phosphorylation and inhibit viral replication by competitively binding to reverse transcriptase

Propanolol

-non-selective beta blocker

Pancoast tumors are associated with what kind of lung tumors?

-non-small cell carcinoma: adeno, squamous, or large cell

Mullerian duct dysgenesis

-normal appearing external genitalia, normal breast and pubic and axillary hair development, and primary ammenorrhea -normal ovaries, E and P levels, and normal LH/FSH levels -absent upper vagina and/or uterus

why are calcium and phosphate levels normal in Paget disease?

-normal bc PTH and vitamin D, the primary drivers of calcium homeostasis, are not involved in the pathogenesis -ALK is inc bc is a marker found on active osteoblasts and is inc due to inc compensatory osteoblast activity

What is the epithelial change in GERD to barrett's?

-normal esophageal epithelium which is non-keratinizing squamous cells that transform into nonciliated columnar epithelium (with some mucin containing goblet cells)

physiological splitting

-normal variation in S2 heard as two separate components during inspiration (aortic valve closes before pulmonic valve bc when inspiration occurs, you inc negative thoracic pressure which inc preload and causes the pulmonic valve to close later)

Pathogenesis of diabetic neuropathy

-not completely understood -peripheral neuropathy is driven by inc sorbitol levels -accumulation of sorbitol may cause osmotic nerve damage through several mechs including impairment of Schwann cell function

Ameliorable adverse events

-not preventable but the severity of the adverse event could have been reduced if appropriate actions occured

can glucocorticoids be used chronically?

-not safe to use chronically bc could get cushings and whatnot

Pyknosis

-nuclear shrinkage -typical change of necrosis

Where does T3 bind to?

-nuclear/retinoid x binding to DNA

Signs and symptoms of hypocalcemia

-numbness and tingling of fingers and circumoral (around mouth) region hyperactive reflexes -positive Trousseau's sign (carpopedal spasm with hypoxia) -positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped) -tetany muscle -think about the hyperparathyroid SKETCH (far right in the back of the sketch is hypocalcemia)

α1-antitrypsin (AAT) deficiency

-obstructive lung disease and abnormal liver function test results, especially with no history of cigarette or alcohol use and a family history of lung and liver disease, should raise suspicion for α1-antitrypsin (AAT) deficiency -In the lungs, the lack of AAT causes panacinar emphysema as a result of lack of inhibition (via AAT) of neutrophil elastase. AAT accumulates in the liver, causing cirrhosis. This is an independent risk factor for hepatocellular carcinoma (HCC)

when is the methacholine challenge used?

-occasionally used in patients with normal pft's but a high suspicion for asthma

when does ventricular septal rupture occur?

-occur following ST-segment elevation myocardial infarction, usually of the left anterior descending artery (LAD)

lactational mastitis

-occurs during breastfeeding -inc risk of bacterial infection through fissures/cracks in nipple resulting from stress of breastfeeding -S. aureus is most common pathogen -treat with Ab and continue breastfeeding

White infarct

-occurs in solid organs with a single (end-arterial) blood supply (ex. heart, kidney)

Projection

-occurs when someone attributes their own wishes, desires, thoughts, or emotions to someone else -ex. a man who has committed adultery becomes convinced that his wife is having an affair even though there is no evidence of it

Defecation reflex

-occurs when the internal anal sphincter relaxes and the external anal sphincter contracts

paraesophageal hernia

-occurs when the lower part of the esophagus, the stomach, or other organs move up into the chest

strangulated inguinal hernia

-occurs when the vascular supply of the bowel is compromised secondary to incarceration of hernia contents -can present with severe abdominal pain, vomiting, hypotension, and peritoneal effusion -incarcerated is used to define a hernia that is no longer reducible but the vascular supply is not compromised; strangulated hernia is when vascular supply is compromised -present as painful to palpate, may be febrile, have symptoms of bowel obstruction (ab pain, dec bowel sounds, vomit, hypotension) -peritoneal aspiration show inc ammonia and gram stain of peritoneal fluid show enteric flora

Obstructive shock

-occurs when there is a physical obstruction of the heart or great vessels that dec cardiac output -common causes are cardiac tamponade, constrictive pericarditis, tension pneumothorax, PE, aortic dissection or stenosis, vena cava syndrome, or abdominal compartment syndrome -symptoms--hypotension, tachycardia, distant heart sounds, dec breath sounds

councilman bodies

-occurs with yellow fever -liver biopsy of yellow fever classically demonstrates eosinophilic degeneration of hepatocytes with condensed chromatin known as councilman bodies

How to treat carcinoid syndrome?

-octreotide

How are case control studies analyzed by?

-odds ratio

How can you get CO poisoning?

-odorless gas from fires, car exhaust, gas heaters

pericarditis is associated with what type of viral infections?

-often associated with infections, including coxsackievirus, an RNA virus in the picornaviridae family

restrictive cardiomypathy

-often have prominent right heart failure -jugular venous pressure can be elevated -abdomen and liver may be distended mimicking liver disease -"pulsatile liver" is a classic finding in severe right heart as tricuspid regurg is transmitted to the abdomen

Rhabdomyomas are often seen in what condition?

-often seen in tuberous sclerosis -most frequent primary cardiac tumor in children (typically found within first year of life) -histology is hamartomatous growths; spider cells -benign tumor derived from striated muscle (skeletal or cardiac)

Ethics: Justice

-one of the four core principles -must be equitable, not necessarily equal -equitable = fair and impartial/valid in equity as distinct from law

Fetal Alcohol Syndrome

-one of the leading preventable causes of intellectual disability in the US -can lead to pre-post-natal developmental retardation, microcephaly, facial abnormalities (smooth philtrum, thin vermillion border, small palpebral fissures), limb dislocation, heart defects -heart-lung fistulas and holoprosencephaly in the most severe form -mech can be due to impaired migration of neuronal and glial cells

Red infarct

-one of the two types of infarcts (the other is a white infarct) -occurs in venous occlusion and tissues with multiple blood supplies (ex. liver, lung, intestine, testes) and with reperfusion (ex. after angioplasty) -reperfusion injury is due to damage by free radicals -also known as hemorrhagic--occurs with venous occlusion and tissues with multiple blood supplies -"dark purple red hemorrhagic appearance"

unstable angina

-one type of acute coronary syndrome (ACS), which is typically caused by rupture of a pre-existing atherosclerotic plaque with superimposed thrombosis in a coronary artery -intractable angina at rest or worsening episodes of angina -does not respond to rest and/or nitroglycerin -no elevation in myocardial enzymes (unlike in NSTEMI and STEMI) and variable ECG changes

Liquifactive necrosis

-one type of necrotic process--associated with foul-smelling sputum (but non specific) -found in bacterial abscesses and brain infarcts -due to neutrophils release lysosomal enzymes that digest the tissue -early: cellular debris and macrophages -late: cystic spaces and cavitation (brain) -Neutrophils and cellular debris seen with bacterial infection

Lispro, Apart, Glulisine

-onset is 15 min, peaks 1 hour, lasts 2-4 hours -active form of insulin is a monomer consisting of a single insulin protein structure, but insulin can form hexamers which have a slow rate of absorption -these are modified to limit hexamer formation

Cryptosporidium parvum

-oocytes found in stool in image, stained with giemsa stain

Diazoxide

-opens K+-ATP channels in vascular smooth muscle, resulting in membrane hyperpolarization -opening K+-ATP channels on pancreatic beta cells results in hyperpolarizaiton and dec calcium entry through voltage gated calcium channels, resulting in dec insulin secretion in response to glucose -also bc voltage gated calcium ion channel is switched off, AP generation is inhibited--> as a result, vascular smooth muscle relaxes causing vasodilation

naloxone

-opioid antagonist

Optic nerve vs optic tract

-optic nerve is before chiasm -optic tract is after chiasm

Fasciculations

-or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers -sign of LMN lesion

What is first line treatment for C. diff?

-oral vancomycin!

Common complications associated with mumps?

-orchitis -parotitis -pancreatitis (not in sketchy) -meningitis

U wave

-origin unclear -deflection that comes after the T wave (usually upward deflection) -may represent repolarization of purkinje fibers -can be normal but also seen in hypokalemia

Wilms tumor

-originates from embryonic renal cells, metanephros, and manifests as a unilateral palpable mass in a young child -It is the most common renal malignancy in children age 2-4 years -presents with large, palpable, unilateral flank mass, and/or hematuria and possible HTN

Osteomyelitis vs. acute sickle cell crisis in a sickle cell patient...how to tell the difference?

-osteomyelitis is an infection so more likely to be associated with fever and high leukocyte count (neutrophils--> bacteria) -acute sickle cell crisis is mainly just severe pain

Different kinds of ASDs

-ostium means hole -septum primum (red) is supposed to migrate downwards and connect to cardial cushion (bottom of atrial chambers -the ostium secundum forms within the septal primum before the ostium primum closes by fusion of the septum primum with the endocardial cushions

Neurofibromatosis 2

-over 90% of pts with NF2 develop bilateral acoustic neuromas (hearing loss on one side-can't hear high frequency sounds, feeling fullness of ear, ringing in the ear (tinnitus) on side of tumor, dizziness, balance problems or unsteadiness) -NF2 gene is located on chromosome 22 -Additional clinical manifestation include neurofibroma, gliomas, and schwannomas of cranial and spinal nerves

In what regions of the body can you typically hear bruits?

-over aorta, renal arteries, iliac arteries, and femoral arteries

Acute asthma exacerbations tx

-oxygen -nebulized albuterol -IV or oral corticosteroids (prednisone 60 mg daily or methyprednisolone 80 mg IV q48hrs) -rarely used (sometimes used if pt is VERY sick): ipratropium or IV Magnesium sulfate)

In patients with chronic obstructive pulmonary disease, what is the only therapy shown to improve mortality?

-oxygen!

polymyalgia rheumatica

-pain and stiffness in proximal muscles (eg. shoulders, hips, neck) often with fever, malaise, weight loss -does not cause muscular weakness -more common in women over 50 -associated with giant cell (temporal) arteritis -inc ESR, inc CRP, normal CK -rapid response to low-dose corticosteroids

What is pathognomonic for a scaphoid fracture?

-pain and tenderness at the anatomic snuffbox after a fall on out-stretched hands -failure to restore or protect potentially compromised circulation to scaphoid can lead to avascular necrosis of the proximal portion of the bone-->post traumatic arthritis

Abdominal Aortic Aneurysm rupture

-pain radiating to the back -risk factors include diabetes and hypertension and hypercholesterolemia-->atherosclerosis -pulsatile abdominal mass, an abdominal bruit, and hemodynamic instability are physical findings

Seminoma

-painless, homogenous testicular enlargement -most common testicular tumor -analogous to ovarian dysgerminoma -does not occur in infancy -large cells in lobules with watery cytoplasm and "fried egg" appearance on histology, inc PALP (placental Alkaline Phosphatase) -highly radiosensitive, late mets, excellent prognosis -presents as a solid, fleshy, testicular mass composed of enlarged malignant cells with prominent nucleoli and characteristic associated lymphocytic infiltrate

Apical lung neoplasm

-pancoast tumors is a subset of lung cancers that invade the apical chest wall--results in mass effect

Zollinger-Ellison syndrome

-pancreatic gastrinoma, a gastrin secreting tumor that induces parietal cells the the stomach to secrete acid -acid hypersecretion causes recurrent ulcers in duodenum and jejunum -presents with abdominal pain (PUD and distal ulcers), diarrhea (malabsortion), and epigastric pain -positive secretin stimulation test: gastrin levels remain elevated after administration of secretin, which normally inhibits gastrin release -somatostatin has no effect on the gastrinoma gastrin -may be associated with MEN 1

chronic sever upper ab pain, maldigestion, alcoholism, and several small densities on ab x-ray is shown, what is the diagnosis?

-pancreatitis -chronic pancreatitis can cause calcifications of the pancrease that are visible radiologically as opacticities or opaque lesions -up to 30% of pts with chronic pancreatitis eventually develop diabetes

What should you think of when a pt comes in with severe acute abdominal pain that radiates to the back?

-pancreatitis!!

Immune Reconstitution Inflammatory Syndrome (IRIS)

-paradoxical worsening of pre-existing OI or malig when ART initiated due to improvement in immune function; highest risk with low CD4 and high viral load -associated with inititaition of highly active ART (HAART) in pts with HIV -when HAART is initiated, the meds control viral replication and allow CD4 cells to inc in numer which is termed immune system "reconstitution" -this can cause worsening of a preexisting infection due to increased immune activity

Lamber-Eaton myasthenic syndrome

-paraneoplastic neuromuscular disorder that develops in the setting of small cell lung cancer (associated with smoking history) -characterized by the formation of autoantibodies to voltage gated Ca2+ channels at the NMJ, leading to dec Ca2+ influx into the presynaptic neuron and dec Ach release into synapse (think Sketchy's ice cream truck/CalciYUM part of the Myasthenia gravis sketch) -presents with muscle weakness, can involve facial and oral muscles (ptosis, diplopia, speech and swallowing difficulties) -is marked by proximal muscle weakness and dec deep tendon reflexes, which improve after prolonged muscle contraction

Alternate pathway (M2)

-participate in tissue repair -activated by cytokines other than IFN-gamma (like IL-4 and IL-13)

passive form of surveillance

-passive notification by surveillance sites and reports are generated and sent by local staff -ex. incident reports are completed after a near miss or unsafe situation and do not actively stop or prevent errors in real-time

Angelman syndrome

-paternally derived UBE3A is silenced -disease occurs when the Maternal allele is deleted or mutated -Seizures, Ataxia, severe Intellectual disability, inappropriate Laughter (set SAIL for Angel island) -UBE3A on maternal copy of chromosome 15 -5% of cases are due to paternal uniparental disomy -MDs are angels (Maternal Deletion)

Streptococcus mitis

-pathogen to tooth abscess, endocarditis -is a type of Strep viridans group (along with S. mutans, S. sanguinis)

Trendelenburg sign

-patient stands on one leg, and the hip on the unsupported side drops -can be caused by weakness of the abductors of the hip, the gluteus medius and gluteus minimus, on the supported side -remember it affects the muscles of the side that is working

Central sleep apnea

-patient with marginal ventilation when awake -hypoventilate when awake -fall asleep-->apnea periods -CNS disease (encephalitis) -neuromuscular diseases (polio, ALS) -severe kyphoscoliosis -narcotics -Cheyne-Stokes breathing (cyclic breathing and delayed detection/response to changes in PaCO2 and common in heart failure and stroke patients)

Bohr shift

-pay attention to the axis

Damage to the pelvis can cause urinary incontenance in which a patient can't empty their bladder. The nerve damaged in this situation would be?

-pelvic splanchnic nerves innervating the internal urethral sphincter -step 5 is messed up in this photo

What kind of autoimmune skin condition is characterized by "widespread flaccid, painful blisters on the skin and oropharynx"

-pemphigus vulgaris -presents as painful blisters or bullae on the skin or oral mucosa -most common tx is oral corticosteroids; if not treated, it can prove fatal because of systemic infections

What drains into the superficial inguinal lymph node?

-penis, vagina (below the hymen), vulva, scrotum, and anal canal below the dentate line -superficial inguinal LN drain the skin and superficial fascia of the lower limb, gluteal region and abdominal wall below the umbilicus -the superficial LN --> deep inguinal -->external iliac nodes

Root cause analysis

-performed when serious adverse events occur in hospital -the goal is to ID the direct and indirect contributors to adverse events

Paroxysmal cough makes you think what?

-pertussis toxin...bordetella infection (need DTap vaccine) -will also see high levels of lymphocytes

Zenker diverticulum

-pharnygoesophageal false diverticulum -esophageal dysmotility causes herniation of mucosal tissue at Killian triangle between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor -presents with dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass -Elder MIKE has bad breath: -Elderly -Males -Inferior pharyngeal constrictor -Killian triangle -Esophageal dysmotility -Halitosis (bad breath)

What nerve lies on top of the anterior scalene?

-phrenic nerve lies on top

Fetal alcohol syndrome

-physical and cognitive abnormalities in children caused by a pregnant woman's heavy drinking

Inulin

-plant polysaccharide injected to determine GFR; is neither secreted nor absorbed by the kidney, so its appearance in the urine is directly proportional to its filtration rate -measures extracellular fluid volume

Mech of resistance against chloramphenicol

-plasmid encoded acetyltransferase inactivates the drug

What do fibrinolytic drugs target?

-plasminogen to convert it to plasmin, which directly cleaves fibrin, both between and within the fibrin polymers (breaking up thrombi and potentially restoring blood flow to ischemic cardiac muscle)

How does HLA get inherited?

-please note that the likelihood of a child to have the same HLA combo as another child in the family is 1/4

Rales may be heard in what?

-pneumonia -cases of pulmonary edema

Hyperresonance to percussion occurs with?

-pneumothorax -emphysema

Mech of resistance against linezolid?

-point mutation of rRNA

Esophageal atresia causes __________ during pregnancy?

-polyhydramnios -because the fetus is unable to swallow amniotic fluid—an important factor in the turnover of amniotic fluid -treatment is immediate surgical repair

Location of the spleen

-positioned in the left upper quadrant of the abdomen, most often deep to the left 9th, 10th, and 11th ribs

What will you find in the hep B serology during the window period

-positive for HbE Ab and HbC Ab -NEGATIVE for any HbS anything (HbS Ag and HbS Ab)

Etiology of Paget Disease of Bone

-possible viral (pathoma) -etiology is uncertain but may be viral - paramyxoviruses infection of osteoclasts (Kaplan)

Subepithelial bumps or humps on EM are indicative of?

-poststreptococcal (post-infectious) glomerulonephritis (PSGN)

What is angiotensin II's effect on the renal tubules?

-potent vasoconstrictor of both afferent and efferent arterioles -However, efferent arterioles are more sensitive to angiotensin II than afferent arterioles, and this difference in sensitivity has consequences for its effect on GFR -Briefly, low levels of angiotensin II produces an increase in GFR by preferentially constricting efferent arterioles, while high levels of angiotensin II produces a decrease in GFR by constricting both the afferent and efferent arterioles

Pemphigus vulagris

-potentiall fatal -more common in older adults -T2 hypersensitivity -IgG antibodies against desmoglein-1 and or desmoglein-3 (desmosomes which connect keratinocytes in the stratum spinosum) -acantholysis (seperation of keratinocytes, "row of tombstones" on H&E stain -oral mucosa involved -positive nikolsky sign -reticular pattern around epidermal cells

Molluscum contagiosum

-poxvirus (Sketchy's shipping center sketch - snail mail part) -dumbbell-brick shape -also in the same family as smallpox and cowpox -common cause of benign, wart like/umbilicated lesions in young adults (painless)/nonerythematous, pearly, dome-shaped papules -common disease of childhood and often spreads via direct skin to skin contact or via indirect contact such as with sharing bath towels -associated with use of swimming pools

What are the two ways to get pre-renal azotemia?

-pre-renal: BUN:Cr is >15 (increased) 1. increased urea synthesis (inc in BUN but no change in creatinine, can be found in burn pts) 2. decreased renal perfusion (would see dec urine output and hypotension or something along those lines)

N-acetylcysteine

-precursor for the synthesis of the antioxidant glutathione -excess glutathione normally forms conjugates with the toxic metabolite acetaminophen, NAPQI, which accumulates and causes liver damage after glutathione depletion -replenishing glutathione with NAC will improve elimination of NAPQI and prevent further liver injury

Actinic keratosis

-premalignant lesions caused by sun exposure...small and scaly -small, rough, erythematous or brownish papules or plaques -risk of SCC is proportional to degree of epithelial dysplasia -histo: hyerpkeratosis (thickened stratum corneum); parakeratosis (nuclei very clear in stratum corneum); dysplasia (keratinocytes hyperchromatic and large nuclei go up almost all the way to top--not normal)

Abruptio placentae

-premature separation of the placenta from the uterine wall -occurs during 3rd trimester -manifests as painful vaginal bleeding that appears dark red due to the darker appearance of venous blood -often associated with a significant smoking history presents with sudden onset abdominal pain, vaginal bleeding, fetal tachycardia, and a tender uterus

pt has a positive PPD test and a unremarkable chest x-ray/ He has no significant past medical history and takes no meds. No cough or dyspnea. What is the next appropriate step?

-prescribe a drug that inhibits mycolic acid synthesis bc pt has latent infection -isoniazid therapy does the previous described mech of action

allergic rhinitis (hay fever)

-presents with clear rhinorrhea, pale-blue nasal mucosa, and cobblestoning of the posterior pharynx -caused by a Th-2 mediated immune response to allergens -IL-4 promotes Th2 differentiation and B cell class switching to IgE antibodies -in pic, eel is inc amount of IgE, door is IL-4, and the helper means helps T cells differentiate into T-helper cells (th2)

Brief psychotic disorder

-presents with symptoms consistent with schizophrenia but for LESS THAN ONE MONTH

Kartagener syndrome

-primary ciliary dyskinesia, is due to a dynein arm defect that results in impaired ciliary function that can lead to subfertility in women and infertility in men, recurrent upper respiratory tract infections, and situs inversus (dextrocardia, more specifically -Dynein arms are heavy chains with coils and stems that attach from a microtubule pair within the axoneme of cilia or flagella toward an adjacent pair -Can cause bronchiectasis, recurrent sinusitis, chronic ear infections, conductive hearing loss, and situs inversus (eg, dextrocardia on CXR)

When is ECT used and what are the side effects?

-primary indication for ECT is major depression refractory to antidepressant medication -can cause cognitive impairment (acute confusion, anterograde amnesia, and retrograde amnesia) -memory loss is usually short-term but occurs in 75% of the pt population -inc risk for cardiac ischemic events and seizures (low incidence), may also experience dental and or tongue injuries and headaches -ok to use on preggar women

Lymphogranuloma venereum

-primary lesion is usually a self healing papule or shallow ulcer -painful, enlarged, abscessed lymph nodes termed "buboes" contain stellate abscesses -caused by C. trachomatis -in contrast, granuloma inguinale (Klebsiella granulomatis) is PAINLESS ulcers

Hashimoto's thyroditis is the most important risk factor for what complication?

-primary lymphoma of the thyroid (non-hodgkin b cell lymphoma) -B cell archers in sketch

What is the name of a cell that has a single layer of flat epithelial cells found in the ovary?

-primary oocyte

Antiphospholipid syndrome

-primary or secondary autoimmune disorder (most commonly in SLE) -diagnosed based on clinical criteria including history of thrombosis (arterial vs venous) or spontaneous abortion (recurrent miscarriages) along with laboratory findings of lupus anticoag, anticardiolipin, anti-beta 2 glycoprotein I antibodies -anticardiolipin antibodies can cause false positive VDRL/RPR -lupus anticoag can cause prolonged PTT that is not corrected by the addition of normal platelet-free plasma

primary vs secondary vs tertiary prevention

-primary prevention reduces the number of NEW cases of disease by eliminating risk factors or through immunization -secondary prevention identifies disease at a pre-clinical state, which increases the likelihood of treating or curing a disease before it progresses and becomes more difficult to manage -tertiary prevention reduces the likelihood of disease recurrence or exacerbation in individuals who have already been diagnosed with a disease (like taking disulfram for alcohol abuse)

Splitting

-primitive defense mech in which objects or people are thought of as either "all bad" or "all good" -world is pictured in extreme terms rather than a more realistic blend of good/bad qualities

What is the likelihood that an autosomal dominant disease will get passed on to the next generation?

-probably 50% -we generally assume that the affected parent is heterozygous so ya 50% (i think homozygous dom would be too lethal)

PDSA model

-process improvement model to test changes in real clinical setting -impact on patients: Plan (define problem and solution), Do (test new process), Study (measure and analyze data), Act (integrate new process into workflow) -involves small scale, rapid tests of new initiatives -interventions with promising results are then selected for larger scale implementation -takes the simple concept of "trial and error" and transforms it into the PDSA model that can be used to make improvements in health care

Stratification of a study

-process of dividing members of a population into subgroups -This may be done by gender, age, or other demographic factors

Root Cause Analysis (RCA)

-process that looks backwards at an event to prevent its future occurence -"a retrospective process for identifying the basic or causal factors that underlie variation in performance" -RCA is a powerful tool used to improve systems, mitigate harm, and prevent recurrence of adverse events (by identifying root cause and generating action plans) without directing individual blame -RCA uses records and participant interviews to identify all the underlying problems (eg, process, people, environment, equipment, materials, management) that led to an error -What happened? Why did it happen? What can be done to prevent it from happening again?

Azathioprine

-prodrug immunosuppressant used for transplant rejection that is converted to active met that inhibit de novo purine synthesis -active met: 6-MP which is degraded by xanthine oxidase so need dose reduction if administering allopurinol too

Where is dopamine produced and where does it travel to inhibit prolactin?

-produced in the hypothalamus and transported to pituitary lactotrophs via the hypophyseal portal system

Isospora belli

-produces self-limited intestinal infections, mostly in the tropics -fever and diarrhea may last weeks to months -stool-borne cysts are asymmetrical, and are typically almond-shaped

Apoptosis

-programmed cell death -characterized histologically by cell shrinkage, hyperchromatic pyknotic nuclei, and apoptotic bodies composed of cytoplasm and nuclear fragments

chronic pancreatitis

-progressive condition caused by repeated bouts of acute pancreatitis -early exocrine deficiency--abdominal pain, pancreatic insufficiency, malabsorption (including lipid-soluble vitamins A, D, E, K) -late endocrine deficiency is diabetes mellitus -can also present with prolonged bleeding bc deficiency of vitamin k

What is the most common secreting pituitary adenoma?

-prolactinoma

gliosis

-proliferation/hypertrophy of glial cells; usually in response to CNS damage -usually a synonym for astrocytosis -is a reactive proliferation of astrocytes that occur after injury -is a chronic, nonspecific finding of many lesions, including demyelinating plaques of MS

What causes Torsades de pointes?

-prolonged Q-T intervals

Primary oocyte is arrested in what stage?

-prophase I

What stage in meiosis are oocytes arrested in prepuberty?

-prophase of meiosis I

human placental lactogen (hPL)

-protein hormone -produced by syncytiotrophoblast -higher levels as placenta grows during pregnancy -blocks effects of insulin (raises blood glucose which is good for baby, promotes breakdown of FA by mother for fuel, promotes breakdown of proteins for fuel)

What part of the kidney converts vit. D to active form?

-proximal tubule

What is the pathogenesis of C. diff?

-pseudomembranes of fibrin and inflammatory debris

maxillary sinus histology

-pseudostratified ciliated columnar epithelium with goblet cells bc it is an extension of the nasal cavity

Spinal tuberculosis can spread along where?

-psoas major shealth, producing a "psoas abscess" (abscess in the groin) - attaches to transverse processes and the bodies T12 and L1-5 -psoas mainly flexes the thigh at the hip and minimally externally rotates the hip

what kind of stone is a cancer pt with diffuse large B-cell lymphoma at risk for while he is receiving multi-agent chemotherapy?

-pt is undergoing chemo which places him at risk for hyperuricemia--chemo results in cell death which releases purine that are metabolized to uric acid -so most likely to have uric acid stone -uric acid stones are famous for being non-visible on plain x-ray but shows up on CT scans and so CT scans are preferred modality for kidney stones (in general)

left atrial thrombus formation occurs in patients with what conditions?

-pts with a fib. and other atrial arrhythmias

acute respiratory distress syndrome (ARDS)

-pts with sepsis are at risk for ARDS -inflamm mediators from sepesis cause endothelial dysfunction and damage which allow proteinaceous fluid leakage into the alveoli, leading to diffuse pulmonary edema and hypoxemia -also present with low grade fever, patchy infiltrates on lung imaging

The two most common social phobia (social anxiety disorder)

-public speaking -restroom performance (using the public restrooms)

lateral pterygoid

-pulls the head of the mandible anteriorly, allowing the jaw to open widely -The other muscles of mastication close the jaw -Remember "Lateral Lowers" and "M's Munch" (Medial pterygoids, Masseter, teMporalis)

What is a pulmonary complication of right sided infective endocarditis?

-pulmonary abscess (red towels on camel's hump is abscess)

a large ventricular septal defect in a 2 year old baby will affect pulmonary blood flow and pulmonary artery pressure in what way?

-pulmonary blood flow increases bc now have blood coming from LV too so more blood and so more blood flow -pulmonary artery pressure increases bc increase pressure of LA and therefore increases pressure of pulmonary artery

What are the blood supply to the lungs?

-pulmonary circulation -bronchial circulation -so the lung has dual supply of blood

diastolic heart failure

-pulmonary congestion despite normal stroke volume and cardiac output -normal left ventricular ejection fraction -primary problem is a dec in left ventricular compliance

6-mercaptopurine

-purine (thiol) analog that decreases de novo purine synthesis -activated by HGPRT -azathioprine is metabolized into 6-MP -use for preventing organ rejection, RA, IBD, SLE, used to wean pts off steroids in chronic disease, and treat steroid-refractory chronic disease -AE: mylosuppresion, GI and liver toxicity, inc risk of toxicity with allopurinol or febuxostat

Apoptosis picture

-purple arrow: cytoplasmic blebbing (round elongated structures extend from the main cell body -red arrow: nuclear blebbing (nucleus shows the same irregular type of blebs or protrusions) -blue arrow: apoptotic bodies (portions of the cell cytoplasm, organelles, and nuclear material are divided and packaged into apoptotic bodies)

What causes Strep pyogenes fever and rash?

-pyrogenic exotoxins A-C -rash is classically a diffuse, erythematous and symmetrical rash with rough, sandpaper-like texture -S. pyogenes pharyngitis, followed by this rash, is known as scarlet fever

Gluconeogenesis

-pyruvate can be turned into oxaloacetate in the mitochondria via pyruvate carboxylase

What are some findings consistent with severed aortic stenosis disease?

-quiet S2 -late peak of intesity of the murmur -weak carotid upstrokes

midshaft fracture of humerus affects what nerve?

-radial

What nerve is affected if patients have a difficult time stabilizing the wrist when attempting to make a tight fist?

-radial nerve -making a tight fist requires the wrist to be stabilized with the wrist extensors

Calcium oxalate stones

-radio-opaque on xray (white spot) -black/dark brown -forms in acidic urine -risk factor is hypercalcemia and hyperoxaluria (inc oxalate excretion due to defect in liver metabolism or via diet heavy in oxolate rich foods such as rhubarb, spinach, chocolate, nuts, beer) -associated with diet and ethylene glycol abuse

Hyperacute transplant rejection

-rapid (within 24 hours) rejection of a graft -caused by preformed antibodies against the donor HLA or ABO blood antigens--Ab's activate complement and lead to cell lysis, which exposes the basement membrane, leading to activation of coag cascade, thrombosis, infarc, recruitment of Nuetrophils and MOs...etc

Autoimmune polyendocrine syndrome

-rare autosomal recessive disorder -mutations of AIRE gene (AIRE also associated with chronic mucocutaneous candidiasis -triad: mucocutaneous candidiasis, autoimmune hypoparathyroidism, addison's disease

Primary Ciliary Dyskinesia (PCD)

-rare autosomal recessive disorder affecting the dynein arm of cilia -Conditions that arise as a result of PCD are most notably ectopic pregnancy and recurrent ear, sinus, and upper respiratory infections

blackwater fever

-rare complication of malaria -pt returning from an endemic area with paroxysms (sudden episodes) of fever associated with anemia and splenomegaly -severe intravascular hemolysis, hemoglobinuria, and renal failure -associated with rbc surface antigens

Tuberous sclerosis

-rare disorder -genetic disease that leads to the development of widespread benign tumors -classic skin findings include ash-leaf spots (circular pale areas of skin) and angiofibromas on the face (papules or small bumps) -the hallmark tumor of TS is the hamartoma-a benign tumor that resembles the tissue of origin -in brain, cortical hamartomas often cause seizures -classic cardiac manifestation of TS is a cardiac rhabdomyoma (made up of bizarre and enlarged myocytes)

Cri-du-chat syndrome

-rare genetic disorder caused by the deletion of the short arm of chromosome 5 -developmental delay and an unusual cry in children -french words for "call of the cat", a name given to this disorder bc babies have a characteristic high pitched cry that can sound like a cat -facial features--small head and widely spaced eyes -many have congenital heart disease including ventricular septal defects and PDA

Multifocal leukoencephalopathy

-rare infection of the brain that is caused by the JC (John Cunningham) virus. People with a weakened immune system are most likely to get the disorder. People may become clumsy, have trouble speaking, and become partially blind, and mental function declines rapidly

Liposarcoma

-rare malignant soft tissue tumor found in middle-aged and elderly people -most common locations for liposarcoma are the thighs and retroperitoneum -composed of pleomorphic lipocytes, with cytoplasm filled with lipid vacuoles (positive for fat stains, such as Oil red O)

fanconi syndrome

-rare renal disorder where proximal tubule function is impaired -presence of phosphate and aa in the urine -hallmark: glycosuria in the setting of normal serum glucose -phosphate however is lost in the urine and serum levels dec -rare disorder of kidney tubule function that results in excess amounts of glucose, bicarbonate, phosphates (phosphorus salts), uric acid, potassium, and certain amino acids being excreted in the urine

Janeway lesions

-rare, non-tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler's nodes -seen most often in patients who use IV drugs or have indwelling catheters

uterine rupture

-rarer causes of vaginal bleeding in pregnancy -A patient with uterine rupture will normally present during delivery and have a history of cesarean delivery -On physical examination, fetal parts will commonly be palpated

vasa previa

-rarer causes of vaginal bleeding in pregnancy -In a patient with vasa previa, vessels transverse the membrane over the the internal opening of the uterus -Vasa previa can lead to exsanguination and fetal death

How do you rate an APGAR score?

-rates neonates according to Appearance, Pulse, Grimace, Activity, and Respiration -score is taken at 1 minute and 5 minutes after birth -on each parameter, a max score of 2 is possible for a possible score of 10

What is the normal ratio of kappa to lambda?

-ratio is 2-3:1 -if way more than normal then it is a monoclonal proliferation of one cell type

What is hematocrit?

-ratio of the volume of RBCs to total volume of blood

Bartter syndrome

-reabsorbing defect in the thick loop of Henle affecting the Na/K/2CL co-transporter AR (like al loop diuretic) leads to hypokalemia, metabolic alkalosis and hypocalcemia (hypercalciuria)

How does Ca2+ cross the TAL of the kidney?

-reabsorbs Na+, K+ and 2Cl- -indirectly induces paracellular reabsorption of Mg2+ and Ca2+ through the + lumen potential generated by K+ backleak

What electrolytes are absorbed at the brush border of early PCT?

-reabsorbs all glucose, and amino acids -reabsorbs MOST bicarb, Na+, Cl-, phosphate, K+, water, and uric acid -isotonic absorption -generates and secretes NH3, whcih enables the kideny to secrete more H+ -PTH inhibits Na+/PO4 3- cotransport--> inc phosphate excretion -ATII stimulates Na+/H+ exchange--> inc Na+, H2O and HCO3- reabsorption (contraction alkalosis)

Reiter syndrome

-reactive arthritis, triggered following urogenital or enteric infections -symptoms generally appear 1 to 3 weeks after initial infection, and include conjunctivitis, urethritis, and arthritis -HLA-B27 is associated with this disease -aspirated joint fluid resembles that of RA (both inflammatory)

golgi tendon organs

-receptors that sense movement of the tendons, which connect muscle to bone -mediate the reverse myotactic reflex, where they initiate relaxation of muscle if it is contracting too strongly

What does c5a do?

-recruits neutrophils to infection site

Speaking muscles are derived from what embryological structure?

-recurrent laryngeal nerve supplies the intrinsic muscles of the larynx except cricothyroid and is derived from the 6th pharyngeal arch

Obstructive sleep apnea

-recurrent soft tissue collapse in the pharynx -strongest risk factor is obesity -can cause low levels of O2 at night and ramp up the CV system and cause HTN, pulm HTN, arrythmias, sudden death -can also be a trigger erthyropoiesis -order a polysomnograph/sleep study -treat with weight loss, CPAP (first line), surgery

bulimia nervosa

-recurring episodes of binge eating with compensatory purging behaviors at least weekly over the last 3 months -BMI often normal or slighlty overweight -associated with parotid gland hypertrophy (may see inc serum amylase), enamel erosion, mallory-weiss syndrome, electrolyte disturbances, metabolic alkalosis, dorsal hand calluses from induced vomiting (russel sign) -tx with psychotherapy, nutritional rehab, antidepressants, bupropion is CI due to seizure risk

Uric acid stones

-red brown -rhomboid shaped -radiolucent (transparent on xray) -risk factors (consuming a lot of purines like eating shellfish, anchovies, red meat, organ meat) and can cause gouty arthritis -can be associated with gout or tumor lysis syndrome

Xanthine stones

-red brown in color -byproduct of purine breakdown -radiolucent on xray

Red muscle fibers (type I) vs white muscle fibers (type II)

-red fibers: endurance and posture-maintaining muscles, inc myoglobin (red color), inc mitochondrial content, inc capacity for AEROBIC metabolism -white fibers: fast responses; sprinter's legs, dec myoglobin (white), dec mitochondrial content, dec capacity for aerobic metabolism, larger diameter and more hypertrophy with strength conditioning (if fast then have FAT muscles bc burn less calories than long distance runners...to help you remember)

Desensitization to allergen

-reduces allergic response in some pts and has been shown to promote the proliferation of T-reg cells -inc numbers of T-reg that counteract the Th2 allergen responses as well as inc the concentration of IgG that can inhibit the activity of IgE

Reaction formation

-refers to an unconscious defense mechanism where the person takes on an attitude or belief that is the opposite of his or her true beliefs and desires -commonly seen in pts with OCD

contraction metabolic alkalosis

-refers to the increase in blood pH that occurs as a result of fluid losses (volume contraction)

Haldane effect

-refers to the observation that Hb gies up CO2 when PO2 rises, which facilitates gas exchange in the lungs -conversely, when Hb releases O2 to tissues, its ability to bind and transport CO2 is increased

Locus heterogeneity

-refers to the situation in which a similar phenotype is caused by mutation at two or more different genes or loci

Wound healing two types

-regeneration--occurs when stem cells are present and can replace loss of tissue (like in the lung the type 2 pneumocytes are in the basement membrane) -repair--damaged tissue is replaced by a scar (granulation tissue is the initial phase of repair...and then scar)..pg. 21 of pathoma

What does the SPF indicate?

-relative measure of how long a sunscreen will protect you from UVB rays -sunburn is caused primarily by exposure to UVB radiation

How are cohort studies analyzed by?

-relative risk ratio

Hypoglycemia in a diabetic pt triggers the release of what?

-release of epinephrine, a stress hormone which causes symptoms like (anxiety, blurred vision, confusion, dizziness, heart palpitations, hunger, nervousness, shakiness, sweating, tremors), alerting you that something is wrong

What does IkB do?

-releases NF-kB after undergoing phosphorlyation

MOA of bordetella purtussis

-releases an AB5-type exotoxin known as pertussis toxin (PT) -inside the cell, this toxin is responsible for the ADP-ribosylation of the Gi subunit of the heterotrimeric G protein complex -ADP-ribosylation prevents the Gi from inhibiting adenylyl cyclase, thus resulting in inc levels of cAMP in the cells -the toxin also prevents entry of lymphocytes into lymph nodes, which can cause a significant lymphocytosis in the blood

anchoring heuristic

-relying on initial diagnostic impression, despite subsequent information to the contrary -ex. repeated positive blood cultures with Actinobacillus that were dismissed as contaminants and the pt really had actinobacillus

Infliximab

-remains in the serum and binds soluble tumor necrosis factor (TNF-alpha) molecules and inhibits binding to TNF-alpha receptor

Urachus

-remnant of allantois -connection between bladder and umbilical cord -in adult: median umbilical ligament -may cause adenocarcinoma of bladder

this type of kidney related cancer is associated with older male smokers, as well as those with genetic abnormalities in the vHL gene?

-renal cell carcinoma

renovascular disease

-renal impairment due to ischemia from renal artery stenosis or microvascular disease -dec renal perfusion (one or both kidneys)--> inc renin--> inc angiotensin --> HTN -main causes is atherosclerotic plaques (proximal 1/3 of renal artery, usually in older males, smokers) OR fibromuscular dysplasia (distal 2/3 of renal artery or segmental branches, usually young or middle aged females)....see pic -chronically, patients can have refractory HTN with negative family history of HTN, asymmetric renal size, epigastric/flank bruits -most common cause of secondary HTN in adults; other large vessels are often involved

where is cuboidal epithelium found?

-renal tubules, thyroid follicles, and on the surface of the ovary

What happens or needs to happen when you life heavy/heavier weights?

-requires the muscle to increase the amount of force that it develops during contraction, which is achieved through summation (2 mechs) -1. frequency summation -> inc frequency of motor nerve APs (need to summate the weak twitches to get good sustained muscle contraction) -2. multiple fiber summation -> recruit additional fibers (more fibers involved, you are stronger)

Histology of rheumatoid nodules

-resemble granulomas -fibrinoid necrotic center surrounded by palisading epithelioid cells

What acid base disturbance is associated with pulmonary embolism?

-respiratory alkalosis

vital signs of a pt with a thrombus at the bifurcation of the pulmonary artery has what kind of acid/base disorder? bp = 132/78 pulse = 96/min respiratory rate = 36/min oxygen saturation = 94% on room air

-respiratory alkalosis -pts with PE may become hypozemic due to areas of V/Q mismatch in the lungs -hypoxemia triggers tachypnea, which is hyperventilation

what do von willibrand factors do?

-responsible for platelet adhesion -if have von willibrand disease--then results in reduced binding of vWF to gp1b receptors on platelets and factor 8 -negative ristocetin test that can turn positive (cause aggregation) if add normal serum

glossopharyngeal nerve function

-responsible for swallowing and the gag reflex -motor innervation to stylopharyngeus muscle of the pharynx -parasympathetic inncervation to parotid -taste sensation to the posterior 1/3 -Innervates the oropharynx, carotid body and sinus, posterior 1/3 of the tongue, middle ear cavity and Eustachian tube

Manifestations of systemic amyloidosis

-restrictive cardiomyopathy -macroglossia, hepatomegaly -nephrotic syndrome -hematologic (easy bruising, splenomegaly) -neurologic neuropathy -carpel tunnel syndrome -Think about amyloid sketch

What does restrictive and obstructive pulmonary disease do to FRC?

-restrictive dec FRC bc literally can't even get air in so FRC dec -obstructive inc FRC due to air trapping

Long QT syndrome

-result from abnromal Na+ or K+ channels and include Jervell and Lange-Nielsen (JLNS) syndrome and Romano-Ward syndrome -JNLS is associated with deafness, whereas romano ward is limited to cardiac only -these syndromes do predispose individuals to sudden cardiac death but far less common -typically present at younger ages (average age is 32)

CFTR channel

-results from a defect in an ATP-dependent chloride channel (CFTR) that is regulated by protein kinase A phosphorylation

Duodenal atresia

-results from a failure in the recanalization of the duodenum's lumen -classic features include early bilous vomiting and a double bubble picture in x-rays -associated with Down syndrome

allergic urticaria

-results from degranulation of mast cells which release inflammatory mediators such as histamine -typically an IgE mediated process -mast cell degranulation results in dilated superficial lymphatic channels and intradermal edema, leading to the development of pruritic wheals

Vit B12 deficiency

-results from poor absorption not poor intake -Anemia (RBCs different sizes and shapes) which leads to fatigue, light headedness, etc.. -If left untreated it can lead to paralysis of nerves and muscles that it irreversible

Hirschsprungs results from what?

-results from the failure of neural crest cells to form the myenteric plexus in the sigmoid colon and rectum

Magnesium toxicity

-results in loss of deep tendon reflexes, sinoatrial and atrioventricular node blockade, drowsiness, respiratory depression, and ultimately cardiac arrest

Vitamin B12 deficiency

-results in megaloblastic anemia, angular cheilitis, glossitis, and both motor and sensory symptoms such as paresthesias -Prolonged deficiency causes irreversible nervous system damage -Pernicious anemia is the most common cause of B12 deficiency in patients without a clear travel history or a restrictive diet such as veganism

Pt with erthymatous skin macules, arthritis, subcutaneous nodules, heart problem and a history of respiratory infection 2 weeks ago, most like has what? !!!!

-rheumatic fever (type II hypersensitivity) -JONES!!!!! -YOU ALWAYS MISS THIS

In patients unable to tolerate isoniazid, what other drug is indicated to treat latent TB infection?

-rifampin

Where in the respiratory system is foreign body aspiration most likely to occur?

-right lung bc right bronchus is wider with less angle (more vertical path to lung)

Right middle and lower lobes of the lung in 3d space (anatomy)

-right middle lobe of lung arises from the anterior wall -right lower lobes of lung arises from the posterior wall

Lymphatic circulation

-right upper body--> right lymphatic duct -> right subclavian vein -rest of body: thoracic duct -> left subclavian vein

Schatzki rings

-rings formed at gastroesophageal junction, typically due to chronic acid reflux -can present with dysphagia

placental CRH

-rises sharply around week 28, and may play a role in initiating labor and stimulating fetal lung maturation -may play a role in initiating labor and stimulating fetal cortisol production necessary for fetal lung maturation

Prednisone long term consequence

-risk of hip fractures (due to osteoporosis)

osteoclast cell

-ruffled border, which contain lysosomes and phagosomes -amoeboid movement (Do Not Mistake For Cell Blebbing) -should be a large cell and have multiple nuclei

What causes a spontaneous pneumothorax?

-rupture of emphysematous bleb

Irreversible injury

-rupture of lysosomes and autolysis (necrosis) -plasma membrane damage (necrosis) -increased mt permeability (apoptosis) -nuclear pyknosis (condensation)--apop and necro -nuclear karyorrhexis (fragmentation)--apop and necro -nuclear karyolysis (fading)--only in necro! (apop bodies form instead for apop)

When will the sarcomere length of left ventricle myocytes be greatest?

-sarcomere length of ventricular myocytes is greatest when the left ventricular volume is at its largest point -this occurs at the end of diastole when ventricular filling is complete

squamous cell carcinoma

-scaly, red plaque with ulceration and bleeding -second most common skin cancer -associated with immunosuppression, chronic healing wounds, and occasionally arsenic exposure -commonly appears on face, lower lip, ears, hands -locally invasive, may spread to LN, and will rarely mets -histopath: keratin pearls -actinic keratosis is a scaly plaque that is a precursor to SCC

fibrous bridging between thickened, calcified leaflets

-scarring of the mitral valve due to a history of acute rheumatic fever

When pt comes in with chronic kidney disease/failure and bone pain/fracture/problems....think...?

-secondary hyperparathyroidism

calcintonin

-secreted by parafollicular cells (c cells) of the thyroid -DEC bone resorption of Ca2+ -inc serum Ca2+ causes inc calcitonin secretion -opposes actions of PTH -only has to do with Calcium!!!!

Surfactant

-secreted by type 2 pneumocytes (make surfactant and also for regeneration) -mix of lecithins (Lipid substance)--especially dipalmitoylphosphatidycholine

When and where is B-type (brain) natriuretic peptide secreted?

-secreted from ventricular myocytes in response to increased wall tension, like in congestive heart failure -BNP acts on the renal collecting tubule to decrease sodium reabsorption, promoting both natriuresis and diuresis, especially in volume-overloaded states

Vibrio Cholera

-secretes an exotoxin that permanently activates the Gs subtype of G-proteins on affected cells -this activates adenyl cyclase and increase intracellular levels of cAMP

Hep B tests

-see chart -I think anti-HbcAg only shows up if it was an actual infection in the past

Cutaneous sensation of arm and forearm

-see chart -cutaneous nerves of arm/forearm come off branches of medial cord

Landmarks of dermatomes

-see pic

What does granulation tissue looks like? what does it consist of?

-see pic

Systemic juvenile idiopathic arthritis

-seen in <12 year old -can present with daily spiking fevers, salmon pink macular rash, arthritis -frequently presents with leukocytosis, thrombocytosis, anemia, inc ESR, inc CRP -tx: nsaids, steroids, methotrexate, TNF inhibitors

irregular beads of calcification on the annulus of the mitral valve

-seen in elderly pts (with no association with rheumatic fever)

keratoacanthoma

-seen in middle aged and elderly individuals -rapidly growing, resembles SCC -presents as dome-shaped nodule with keratin filled center -rapidly growing (4-6 weeks) and may spontaneously regress -on histo: has crater filled keratin

First-trimester pregnancy-induce hyperthyroidism

-seen when rare mutations in the thyroid-stimulating hormone (TSH) receptor render it abnormally sensitive to hCG, which is structurally similar to TSH (share a common subunit) -this causes pregnancy-related hyperthyroidism that peaks at 10 weeks and then dec in parallel with hCG levels

Bethanechol MOA and AE

-selective muscarinic agonist that mimics the action of acetylcholine neurotransmitter at muscarinic receptors -Stimulation of these receptors, found in the detrusor muscle of the bladder, promotes detrusor contraction and voiding -AE: gastrointestinal tract, urinary tract, respiratory system, eyes, and exocrine glands are particularly affected; diarrhea, excessive urination, dyspnea (due to bronchoconstriction and increased bronchial secretions), miosis, and sweating may occur

Clopidogrel

-selectively inhibits ADP binding to platelets and thereby prevents GPIIb/IIIa complex activation, thus inhibiting platelet aggregation -ADP receptor inhibitors end in "grel" (dog Grill in sketch) -tx pts with cardiovascular diseases like peripheral artery disease, angina, MI, stroke and acute coronary syndromes -is an antiplatelet agent which is considered one of the primary treatment measures of angina pectoris since they prevent thrombus formation -this is the drug of choice in pts with a CI to aspirin

amanita phalloides pathogenesis

-selectively inhibits RNA polymerase II and III -has alpha amanitin

muscle spindles

-sensory strucutres embedded within skeletal muscles that monitor muscle length (play a role in coordinating the activity of opposing muscle groups) -innervated by type 1a and II sensory neurons -when an agonist muscle (biceps) contracts, the spindles are stretched and respond by generating APs which are relayed to spinal cord. The spinal cord contains local motor reflex circuits that coordinate agonist and antagonist muscle activity--> incoming APs stimulate interneurons which, in turn, inhibit the motor neurons controlling antagonist muscle (triceps)

Embryo develop twin separation timeline

-separation 0-3 days of fertilization: separate chorion and amnion -separation 4-8 days: shared chorion (diamniotic/monochorionic) -separation 9-12 days: shared chorion and amnion (monoamniotic/monochorionic) -incomplete separation after the 12th day of fertilization = conjoined twins -shared from out to in (3-4 day periods) - so chorion gets shared first (earlier separation), then amnion, then fetus body

H. influenzae causes what type of secondary infections?

-septic arthritis (NOT in sketchy) -bacteremia (NOT in sketchy) -epiglottitis, meningitis -Otitis media (in SKETCHY) -P.S. H. infleunzae b capsule is composed of polyribosylribitol phosphate polysaccharide (PRP) which binds to and becomes coated with the host's serum factor H, a complement mediator that degrades C3b

developing diaphragm is derived from the?

-septum transversum, pleuroperitoneal folds, body wall, and dorsal mesentery of the esophagus

Hox genes (homeobox genes)

-series of genes that controls the differentiation of cells and tissues in an embryo -regulators of limb AP axis development -mutation can lead to abnormal digits/toes (sundactyly is fusino of two digits)

Uremia

-serious complication of chronic kidney disease that leads to significantly elevated levels of urea in the blood, a signal of deteriorating kidney function -Symptoms can include confusion, weakness, nausea, vomiting, among other symptoms -is one cause of high anion gap metabolic acidosis

Patau syndrome (trisomy 13)

-severe intellectual disability (developmental delay) -cutis aplasia, gastroschisis/omphalocele, holoprosencephaly (microcephaly and cyclopia), microphthalmia, rocker-bottom feet, cleft palate, and polydactyly -may present with congenital heart defects (commonly ASD & VSD) -first trimester labs in pregnancy are remarkable for decreased PAPP-A and β-hCG, which may suggest a diagnosis of Patau syndrome -similar to Edward syndrome (trisomy 18) but would not have clenched hands or overlapping fingers -SHH gene mutation can cause loss of ventral midline development, resulting in holoprosenceph

How does low magnesium affect hypocalcemia? (what is the mech)

-severe magnesium depletion can result in improper functioning of the CaSR channel, a membrane protein receptor on the surface of chief cells in the parathyroid galnd -CaSR is responsible for detecting low levels of calcium and triggering the release of PTH in response

Calcium oxalate stone

-shaped like a dumbbell -most common -can result from ethylene glycol (antifreeze) ingestion, vitamin c abuse, hypocitraturia (associated with dec urine pH), malabsorption (Crohn disease) -tx: thiazides, citrate, low-sodium diet

sharp ends vs blunt ends

-sharp ends are the active errors -blunt ends are the latent errors -active errors occurs at the level of frontline operator (ex. wrong IV pump dose programmed)--has an immediate impact -latent errors occurs in processes indirect from operator but impacts patient care (ex. different types of IV pumps used within same hospital)--an accident waiting to happen

Acute pericarditis

-sharp stabbing chest pain (improves while sitting up and leaning forward) -pericardial friction rub -DIFFUSE (multi-lead) ST segment elevations (REMEMBER...diff from MI bc that is more localized ST elevations)

What does pt have if she is a female athlete who intensely exercises while chronically dieting

-she has Functional hypothalamic amenorrhea (FHA) aka exercise-induced amenorrhea -this leads to functional disruption of pulsatile GnRH secretion--> dec LH, FSH , and estrogen -pathogenesis: dec letpin (due to dec fat) and inc cortisol (stress, excessive exercise) -associated with eating disorders and female athlete triad (intense exercise and diet + amenorrhea + osteoporosis)

Fasciola hepatica

-sheep liver fluke -bile duct obstruction in infected humans -rare in US -fluke in picture is ID'ed by prominent "shoulders" on the anterior end

Metastatic neoplasia of spine

-should be strongly considered in older adults, particularly men with back pain, as it is often a sign of bones lesions due to prostate cancer -presents with difficulty maintaining a stream during urination, further suggesting cancer originating in the prostate

Of the causes of hypoxemia, which cause an A-a gradient?

-shunt -V/Q mismatch -diffusion

What can predispose a pt to develop folate deficiency and macrocytic anemia?

-sickle cell anemia

HbS indicates what

-sickle cell disease -Glu gets substituted for Val

diabetes insipidus fluid shifts graph

-similar to lost in desert one -bc DI is when you pee too much bc ADH pathway is messed up so you pee out more than you drink in --> dec volume, inc serum sodium bc more salt is concentrated so--> inc osmolarity

If giving a vaccine that has capsular antigens, what must you do to make sure you can an IgG immune repertoire to develop?

-since many capsules are made of polysaccharides, and since T cells can only recognize proteins/peptides off of MHC, you need to add a protein adjuvant with the vaccine so that you can stimulate the helper T lymphocytes to induce class switching in B cells

what test should the pt receive 2 weeks after sexual exposure to HIV, as they are experiencing lymphadenopathy, sore throat, myalgias, maculopapular rash, and fever?

-since viral RNA level is very high, and HIV RNA can be detected in 10 to 14 days following exposure, use HIV RNA quantification -HIV antibodies take time to develop and may not be detectable for 20 to 40 days (ELISA test can detect as early as three weeks following exposure)

functions of the endoplasmic reticulum

-site of synthesis of secretory (exported) proteins -N-linked oligosaccharide addition to lysosomal and other proteins -Nissel bodies (RER in neurons) synthesize peptide neurotransmitters for secretion -free ribosomes: unattached to any membrane; site of synthesis of cytosolic, peroxisomal, and mitochondrial proteins

What is Kartagener syndrome characterized by?

-situs inversus, chronic sinusitis, and bronchiectasis

intrafusal fibers

-skeletal muscle fibers that comprise the muscle spindle and are innervated by gamma motor neurons -fibers are proprioceptors that detect the amount and rate of change in the length of a muscle

Weckenbach (mobitz I)

-slowing of AV node -Type 1 Second-degree AV block -dropped QRS complex

first degree heart block

-slowing of PR interval to >200 msec (1 big box)

Myc-L is associated with?

-small cell carcinoma of the lung

high-pitched ("tinkly") bowel sounds indicate what?

-small intestinal obstruction (SBO) -drugs that stimulate the intestinal tract like metoclopramide or laxatives is CI with pts with bowel obstruction

Uvula

-small projection hanging from the back middle edge of the soft palate

Do alcohol based hand sanitizers or do soap-based products effectively destroy bacterial spores?

-soap-based products (antimicrobial soaps and warm water is best for C diff and Bacillus anthracis)

In appendicitis, infection of what layer causes localized pain?

-somatic pain is parietal peritoneum -general/not localized pain is visceral peritoneum

CD 21 is what kind of marker?

-specific to mature B cells!! -receptor for Epstein-Bar virus

What diuretic is used in a hepatic ascites pt?

-spironolactone

Pelvic splanchnic nerves

-splanchnic nerves that arise from sacral spinal nerves S2, S3, S4 to provide parasympathetic innervation to the hindgut

What does Bcl2 do?

-stabilized mt membrane so cytochrome C cannot leak out (so inhibits apoptosis)

Staging vs. grading

-staging involves all these other physicians (TNM)--need oncologists, surgeons, and radiologists to help with looking at tumor size, nodes, and mets -grading was just pathologist and all they do is look at microscope slides all day (tumor cell appearance and arrangement)

Hawthorne effect

-states that people act differently when they know they are being watched or measured

What is first-line tx for ADHD?

-stimulants such as methylphenidate/amphetamines which work by inc release of dopamine and norepinephirine

Causes of postrenal azotemia

-stones, bph, neoplasm, congenital anomalies

senna glycoside

-stool softener -stimulate peristaltic activity on the intestine

What does valsalva do?

-stops venous blood flow bc contracting on the vena cava limiting blood into the heart

What do ito cells do?

-store vitamin A in characteristic lipid droplets when they are quiescent and produce ECM when they are activated -v-ITO-min A -also known as stellate cells

Baroreceptor

-stretch/pressure receptors located in the aortic arch and the carotids -when stretched, they are stimulated and will fire signals

Distribution of muscle in the esophagus

-striated only: upper 5-30% and upper eso sphincter -both striated and smooth: middle one-third -smooth only: lower one-third and lower eso sphincter

causes of sudden death

-stroke, pulmonary embolism, and aortic dissection -most common in older pts is cardiac arrest due to coronary atherosclerosis (sudden onset of ischemia due to atherosclerotic plaque rupture leading to a fatal arrhythymia (i.e. v fib)

Cyanide poisoning

-strongly binds to the iron within cytochrome oxidase, thus interfering with the electron transport chain and inhibiting cellular respiration -commonly seen in the setting of household fires and presents with nonspecific symptoms such as headache, vomiting, flushing, and bright red venules on fundoscopy -A bitter, almond-like odor on the breath is a unique feature of cyanide poisoning -tx with nitrite, hydroxycobalamin, or thiosulfates -cyanide, carbon monoxide, azide, inhibit complex IV (-ides are 4 letters)

SSPE

-subacute sclerosing panencephalitis -common secondary event to rubeola -SSPE typically presents 7-10 years after initial infection with the virus and results from the failure of mature viral particles to form -This action leads to persistent replication of the virus and nonproductive infection, eventually resulting in demyelination of CNS neurons -Be suspicious of SSPE in a patient who has an unknown vaccination history, is from an endemic area, and presents with myoclonus and worsening dementia -Measles virus (rubeola) is capable of causing subacute sclerosing panencephalitis (SSPE), which results in dementia, myoclonus, and personality changes, striking 2-10 years after initial infection

subisotypes

-subclasses within the isotypes of antibodies -IgG has four subisotypes and IgA has two subisotypes

what kind of hematomas present as a crescent moon shape on CT?

-subdural hemoatoma -can be caused by shearing of the bridging veins in subdural bleeds

fats and aa can be used as substrates for gluconeogenesis in the liver through what conversion molecule?

-succinyl-coa --> succinate which can enter TCA?????

jaundice with positive coombs test means what?

-suggest immune hemolytic anemia (ex. ABO or Rh incompatibility)

How do you treat PSGN?

-supportive therapy

-M protein

-surface molecule found in group A strep (pyogenes) that prevents phagocytosis

Roux-en-Y gastric bypass

-surgery for severe obesity and can predisopose for dumping syndrome, which is best treated by eating frequent, small meals that are high in protein and relatively low in simple carbs -dumping syndrome caused by osmotic effects of ingesting high levels of simple carbs following gastric bypass surgery

What causes are the biggest causes of hospital acquired infections (HAI)?

-surgical site infections and indwelling devices (account for approx half of all HAIs)

neonatal HIV

-suspect w/ thrush, generalized LAD, hepatomegaly, and FTT -Dx HIV PCR (not ELISA since mom's ab can cause false-positive), requires Bactrim ppx for PCP pneumonia, give IV ZDV to all neonates of infected mothers

diaphoresis

-sweating

Classic triad of pheochromocytoma !!

-sweating, headaches, and tachycardia

C. perfringes necrotizing fasciitis

-symptoms from alpha toxin include skin discoloration/bruising, fever, altered mental status, sepsis and severe pain, out of proportion with the external appearance -present with soft tissue crepitus (crackling) due to methane and CO2 gas production from the infecting bacteria -lab findings: inc CRP, WBC< creatinine, glucose, low sodium and low hemoglobin

Primary biliary cholangitis

-symptoms: pruritis (bile salts), fatigue, affects middle aged women and progresses to cirrhosis, xanthelasmas, xanthomas (high cholesterol), granulomatous formation, inc ALK and conjugated hyperbilirubinemia -antimitochondrial antibodies -destruction of small and medium INTRAhepatic bile ducts, fibrosis in lobule starting from portal zones

SIADH

-syndrome of inappropriate antidiuretic hormone -a paraneoplastic complication of small cell lung cancer -diagnostic criteria: hypotonic hyponatremia (dec Posm, dec Na), normal liver renal and cardiac function, clinical euvolemia, normal thyroid and adrenal function, urine osmolality> 100mOsm/kg -tx with demeclocycline

BH4 is necessary for what?

-synthesis of neurotransmitters dopamine and serotonin

Dopamine's relationship with the kidney

-synthesized in the proximal tubule -dilates aff and eff arterioles which inc RPF and there is little change in GFR

Cosyntropin

-synthetic ACTH

Rapid Plasma Reagin is usually positive in?

-syphilis -also referred to as RPR

severe anemia does what to the SVR, splanchnic bf, blood viscosity, and arteriolar diameter?

-systemic vascular resistance (SVR) is dec bc less oxygen getting to tissues so body reflex vasodilates (arteriolar diameter inc) in response -since dec in RBCs or hematocrit and whatnot, dec in blood viscosity which further (and mainly) dec SVR -during anemia, blood is shunted away from splanchnic vascular bed which can cause GI problems

Tertiary syphilis clinical presentation

-tabes dorsalis (degeneration of dorsal columns and roots of spinal cord) -Arygll-robertson pupils (pupils that constrict with accomodation but not with light) -gummas (granuloma) -hutchinson teeth (incisors and molars take on a triangular or peglike appearance) and mulbury molars (multiple rounded rudimentary enamel cusps on the permanent first molars)

Rapoport-leubering shunt in the RBCs

-takes 1,3-BPG --> 2,3-BPG instead of 3-PGA -takes place in RBCs -leads to 2,3-BPG which causes the oxygen graph to shift to the right

If take out the duodenum, what do you affect and what increases?

-taking out the duodenum takes out the I, S, and K cells -I cells secrete CCK -S cells secrete secretin -K cells secrete GIP -gastric acid secretion increases bc it is no longer regulated/inhibited by the secretin and GIP feedback loops

What does the vaccination of Haemophilus target?

-targets polyribosylribitol phosphate (type b polysaccharide capsule), which is its main virulence factor

Quellung reaction

-technique used to ID the capsular serotype of Strep pneumo

What does the p-value tell us?

-tells you whether or not a finding is actually significant (different) -represents false positive (type I error alpha) when p is less than 0.05 -represents a false negative (type II error beta) when p is greater than 0.05 if you know that there is significance

what is a first line agent in HIV-2 infections?

-tenofovir, which is an NRTIs and undergoes intracellular phosphorylation and inhibits viral rep by competitively binding to reverse transcriptase -side effects = mt toxicity and fanconi syndrome (associated with loss of proximal tubule function and results in urinary protein, phosphate and glucose wasting)

Aspirin exacerbated respiratory disease (AERD)

-term used to refer to hypersensitivity of all COX inhibitors -Patients who have higher than normal levels of enzymes that cause leukotriene formation can develop AERD and experience SOB and wheezing -treat with a leukotriene antagonist like Montelukast -present with triad of rhinosinusitis, asthma, and nasal polyposis

Neurosyphilis

-tertiary syphillis -tabes dorsalis: degeneration of dorsal columns and dorsal roots. Loss of pain sensation and peripheral reflexes, impairment of vibration and position senses, progressive ataxia -can have. a gumma (granuloma) lesion in the CNS

Adverse effects of exogenous steroid usage?

-testicular atrophy, acne vulgaris, aggressive behavior, gynecomastia, and infertility -Labs would show decreased levels of LH

Which antibiotics interfere with the amino-acid incorporation?

-tetracyclines (30s) -dalfopristin/quinupristin (50s) -block attachment of aminoacyl tRNA to acceptor site

what are the most common masses that arise in the anterior mediastinum?

-the "terrible T's": -thymoma -teratoma/germ cell tumor -terrible lymphoma -thyroid tissue masses (most common and account for about half of anterior mediastinal masses) *-the mediastinum is the most common location for extragonadal GCTs (germ cell tumors) in adults, including teratomas and seminomas

How to calculate confidence interval of the mean?

-the (SD/sqrt.(n)) is the standard error of the mean (SE or SEM) -if the SD is larger, the chance of error is greater -if the sample size is larger, the chance of error in the estimate is less

What gases are perfusion limited?

-the 2's have a perFUSE problem -O2 (normal), CO2, and N2O

Inulin measures what body compartment?

-the ECF -excluded from cells but distribute freely throughout ECF

afterload is measured by?

-the MAP value which is diastolic pressure plus one third the difference between systolic and diastolic pressure (aka PP) -whoever has the highest MAP, has the biggest afterload

What part of the kidney tubules has a brush border?

-the PCT!

What heart structure is found in along the sternal border of the 3rd intercostal space?

-the SA node of the RA -also think about APTM and where they are ascultated

alcoholic liver disease mallory body

-the black lace and pink splotches on the women's dress thingy is the mallory body

What happens in staphylococcal scalded skin syndrome?

-the epidermis separates at the stratum granulosum as a result of binding of epidermolytic toxins A and B to desmoglein 1 (desmosomes) in this layer -positive nikolsky sign

Femoral canal

-the femoral ring/canal is bounded medially by the lacunar ligament -anteriorly by the inguinal ligament -posteriorly by the pubis, and -laterally by the femoral vein

incomplete penetrance

-the genotype does not always produce the expected phenotype -Not all individuals with a mutant genotype show the mutant phenotype

Koliocytes

-the hallmark of HPV infection. They are pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclear halo-like clearing

Where is renin released?

-the juxtaglomerular cells of the kidney -if you have chronic kidney disease then renin release may be impaired

What anastomoses is responsible for hematemesis if the pt has portal hypertension?

-the left gastric vein and esophageal veins anastomses can cause hematemesis

when does maximal coronary blood flow occur?

-the majority of coronary blood flow occurs in early diastole -this is in contrast to other arterial structures where most blood flow occurs in systole -this is because, during systole, myocardial contraction limits coronary blood flow--once systole ends and myocardial relaxation begins, coronary blood flow is maximal

Hypokinesis

-the muscle of the heart does not contract as much as most peoples' hearts do

primum type atrial septal defect

-the ostium primum is a gap located between the septum primum and the endocardial cushions -when the septum primum completely fuses with the endocardial cushions, the ostium primum is closed -failure of the septum primum to fuse completely with the endocardial cushions leaves a persistent ostium primum, known as primum type atrial septal defect

When a patient is being non-compliant, how does the physician help to change that? (patient missing appointments etc)

-the physician should spends more time with the patient bc the most common reason for noncompliance is a bad physician-patient relationship

Parathyroid chief cells

-the predominant cell type characterized by round nucleus surrounded by scarce cytoplasm -They produce and secrete PTH in response to low extracellular calcium levels detected by receptors in the cell membrane

Antiphospholipid antibody syndrome (APS)

-the presence of lupus anticoagulant (one of the three types of antiphospholipid antibodies) in a patient with SLE suggests the diagnosis of APS -characterized by hypercoagulability, recurrent fetal losses, and a prolonged PTT that is not corrected with 1:1 fresh-frozen plasma -Although the lupus anticoagulant prolongs PTT in vitro, it predisposes to clot formation in vivo

What does statistical power mean?

-the probability of a hypothesis test of finding an effect if there is an effect to be found -this is the true positive!

where is the SA node located in the heart (anatomically)?

-the right atrial posterolateral wall near the SVC

Where do the right and left gastroepiploic arteries come from?

-the right gastroepiploic artery is a branch of the gastroduodenal artery -the left gastroepiploic artery is a branch of the splenic artery

When someone is tested positive for HIV1/2 antibody/HIVp24 antigen combination immunoassay, what do you do next?

-the samples are subsequently tested to differentiate infections with either HIV-1 or HIV-2 using antibody differentiation immunoassays -positive for both immunoassays and p24 antigen testing should be interpreted as positive for HIV infection

Calsequestrin

-the sarcoplasmic reticulum contains calsequestrin, a high capacity Ca2+-binding protein that acts as a Ca2+ sponge -Calsequestrin allows the SR to store Ca2+ until its release is required to facilitate contraction -SERCA (sarco endoplasmic reticulum Ca2+ ATPase) is brings in the Ca2+ from the sarcoplasm

Second pharyngeal cleft

-the second pharyngeal cleft is normally obliterated by the overgrowth of the second pharyngeal arch -if not totally obliterated, it will become a lateral cervical (branchial) cyst (found on lateral neck along anterior border of SCM) -2nd pharyngeal arch covers 2nd 3rd and 4th pharyngeal clefts to fuse with cardiac ridge, thereby obliterating clefts 2-4 -cervical sinus formed by the fusion of these tissue masses is a normally a transient structure but may persist as a branchial or lateral cervical cyst

conduction velocity

-the speed at which an action potential is propagated along the length of an axon--usually sped up by myelin!

What is the most commonly injured organ of the abdomen and lies deep to the left 9, 10, and 11th ribs?

-the spleen! -receives blood from splenic artery, which is one of the three branches of the celiac trunk

-what does the central sulcus separate?

-the strip that C falls in is the pre-central gyrus (primary motor cortex) -the strip that F falls in is the post-central gyrus (primary somatosensory cortex)

Oxygen-induced hypercapnia mechanisms

-the traditional explanation for hypercapnia with oxygen therapy is hypoventilation. Peripheral and central chemoreceptors respond to lower oxygen levels with an increase in respiratory rate. This increases alveolar ventilation which enhances CO2 exchange. Removal of this stimulus with excessive oxygen therapy can result in the retention of CO2. -a second mech is via the Haldane effect which is the decreased binding of CO2 to hemoglobin in high oxygen environments. Increased amounts of oxyhemoglobin reduce the ability of red blood cells to take up CO2 from peripheral tissues for transport to the lungs. This decreases hemoglobin binding of CO2 and contributes to the hypercapnia in COPD patients treated with o2 therapy`

idiotype

-the types of unique antibodies found within one individual -every antibody molecule has a different idiotype (antigen specificity) unless it has been made by a clone cell

Therapeutic Privilege

-the withholding of relevant information from a patient when the physician believes disclosure would likely do harm

Almost all RNA viruses are linear except which ones?

-these are all circular -Delta virus -Arenavirus -Bunyavirus

Flat, uniformly pigmented macules and patches...what are these?

-these are café-au-lait spots -isolated spots are common in the general population but the presence of more than five spots is highly suggestive of NF-1

LFA-1 and ICAM-1

-these are involved in the neutrophil homing process -LFA-1 is an integrin and it binds to the i-CAM ligand -this interaction causes the strong adhesion necessary to promote the arrest of white blood cells on the surface of the endothelium -selectins are important in the rolling step and integrins (such as LFA-1) are important in firm binding) which leads to migration of the cells between endothlial cells -memory aid: select the ones you want to roll with and roll slowleeee and then lets finally hAlt to take out our i-cam

What are CV complications of hypertension?

-they are ischemia and hemorrhagic stroke -untreated hypertension leads to vascular remodeling; this often includes hypertrophy of arteries and arterioles -wall to lumen ratio increases as the walls of the blood vessels thicken, the lumen usually narrows, increasing resistance--> ischemia and organ damage

HHS often develops among pts when what?

-they cannot comply with insulin therapy -or in those with infections (most commonly pneumonia and urinary tract infections)

Steriods have what effect on glucose serum levels

-they inc them bc they promote gluconeogenesis -PEP carboxykinase is a cytosolic enzyme that catalyzes an irreversible step in gluconeogenesis, converting oxaloacetate to phosphoenolpyruvate

What do CD4 or CD 8 markers indicate?

-they indicate NON-precursor t cells so not-activated/mature

What vitamin is associated with cardiomegaly/dilated cardiomyopathy?

-thiamine deficiency

Acanthosis nigricans

-thickening (velvety, hyperkeratotic, hyperpigmentation) and darkening of skin near axillary region -A/w Diabetes Type II/metabolic syndrome/insulin resistance and gastric carcinoma

what kind of bug is Treponema pallidum?

-thin spirochete (extracellular spirillar prokaryote) with endoflagella

Polymyositis

-think Sketchy's bbq cookout with all the meat and the overweight lady cooking at the grill -progressive symmetrical proximal muscle weakness, characterized by endomysial inflammation wtih CD8+ T cells -most often involves shoulders -positive ANA and inc CK -positive anti-Jo-I, anti-SRP, and anti Mi-2

Giant cell (temporal) arteritis

-think about Sketchy's Scandinavian women wearing glasses on the balcony sketch -most common of the arteritides; thought to be autoimmune reaction directed against unknown vessel wall antigen -most commonly affects branches of carotid artery -usually in elderly females, unilateral headaches, possible temporal artery tenderness, jaw claudication -may lead to irreversible blindness due to ophthalmic artery occlusion -associated with polymyalgia rheumatica

Kallman syndrome

-think of primary amenorrhea (first thing you should notice)...this is the first hint that it's an amenorhea problem -isolated gonadotropin deficiency associated with anosmia (can't smell) -impaired migration of GnRH neurons from the olfactory bulb to the hypothalamus -boys can present in newborn period with a micropenis or cryptorchidism; girls present with delayed thelarche (breast budding) and menarche -Dx: confirmed by low LH, FSH, and serum testosterone levels or the identification of a genetic mutation associated with K syndrome

What are the AE of topical corticosteroids?

-thinning of the skin (dermal atrophy), skin discoloration, lichenification (thickening of skin), folliculitis, talengiectasias, and contact dermatitis

What does a slit lamp examination of the eyes do/test for?

-this helps to diagnose Wilson disease which will show Kayser-fleischer rings

how does the omphalocele or gastrochisis defects form?

-this is a ventral wall defect -the lateral fold fails to fuse or close

What happens when amniotic fluid enters the maternal bloodstream?

-this is called an amniotic fluid embolism--respiratory distress immediately follows amniotic fluid embolism -typically occurs during labor or postpartum but can be due to uterine trauma -can lead to DIC -rare, but high mortality -types of pulmonary emboli: an embolus is like a FAT BAT (Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor)

Baby with a missing patch of skin/hair on scalp...

-this is called aplasia cutis -associated with methimazole (tx for hyperthyroidism) usage during pregnancy

How to increase Micheli's menton's constant?

-this is km -by using a competitive inhibitor like statins that act on HMG-Coa reductase (rate limiting step in cholesterol synthesis)

reperfusion injury

-this is when blood returns to ischemic tissue (like having an MI and then getting a stent put in afterwards) which results in production of O2-derived free radicals, which further damage tissue -this leads to a continued rise in cardiac enzymes (ex. troponin) after reperfusion of infarcted myocardial tissue

Where does urine collect if there is a urethral tear at the bulbar region of the urethra?

-this region is the spongy urethra, which is within the bulb of the penis and corpus spongiosum of the penis

Patients with bicuspid aortic valves are at signifantly increased risk of?

-thoracic aortic aneurysms -aortic dissection

Alteplase

-thrombolytic agent in acute myocardial infarction, acute thrombotic stroke, and pulmonary embolism -acts by binding to fibrin and converting tissue plasminogen to plasmin, thereby promoting fibrinolysis -no indicated when PCI is anticipated!

Budd-Chiari syndrome

-thrombosis of hepatic veins -may occur as a complication of thrombogenic and myeloproliferative disorders -establish dx with hepatic venography

Thyroid vs thymus embryo development

-thyROID--thyroid diverticulum arises form floor of primitive pharynx and descends into neck, normally disappears but may persist as a cyst or pyramidal lobe of thyroid, foramen cecum is normal remnant of thyroglossal duct -thyroglossal duct cyst--anterior midline neck mass that moves with swallowing or protrusion of tongue -thyMUS--derive from 3rd pharyngeal pouch and parathyROID glands derive form here too

Human granulocytic anaplasmosis

-tick-borne infection caused by the bacterium Anaplasma phagocytophilum, a small bacterium infecting typically neutrophils transmitted by Ixodes ticks -most widespread tick-borne infection in animals in Europe

What are the sources of Francisella tularensis?

-ticks, rabbits, and deer flies

What causes DIC in the setting of obstetric complications?

-tissue factor -DIC develops as a result of decidual cells releasing tissue factor

What is the Elek test?

-to determine if strain of C. diptheria is producing toxin -Comprised of filter paper with anti-diphtheria toxin abs

NAPQI

-toxic metabolite of acetaminophen -is a reactive oxygen species -drug toxicity usually affects zone 3 of the liver

Ring enhancing lesions in brain in immunocompromised pt should make you think what?

-toxoplasma gondii -intracellular protozoan parasite

Klumpke palsy

-traction or tear of lower trunk: C8-T1 -infants: have this due to upward force on arm during delivery -adults: have this due to trauma (grabbing a tree branch to break a fall) -muscle deficits: messed up intrinsic hand muscles (lumbricals, interossei, thenar, and hypothenar) -results in claw hand (lumbricals should normally flex MCP and extend DIP and PIP but do opposite here) -affects ulnar and part of median nerve -memory aid: klumpke is lower bc grab a clump from the "ground"

transudation vs exudation

-trans has lower pleural protein:serum protein -exud has a no change or around 1:1 ratio of pleural p:serum p

Displacement

-transfer of emotion from one setting to another that is generally more manageable -ex. mother taking her anger out on her son, who in turn, yells at his little sister

Aminoglycoside resistance

-transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation.

osteomyelitis xray

-translucent circle/oval lesion on bone

Boerhaave syndrome

-transmural esophageal rupture due to violent retching "been heaving syndrome" -shows changes on xray such as left-sided effusion and penumomediastinum -signs of disease may include pneumothroax, pleural effusion, subcutaneous or mediastinal emphysems, tachnpnea, tachycardia -surgical emergency

mannitol's effect on ICF, ECF, and osmolarity

-traps sodium in tubule, so water stays in tubule, and since more sodium is trapped then water from intracellular compartments move out into tubule -this inc osmolarity in both ICF and ECF, and increases volume in ECF and dec volume in ICF -**note the terms "contraction" as in contraction alkalosis and "expansion" always refer to the ECF

Deferoxamine

-treatment for hemochromatosis -chelates iron

Risks of beta agonist overuse include?

-tremor -reflex tachycardia -hypokalemia

renal cell adenocarcinoma

-triad: hematuria, flank pain, and palpable flank mass

Hypertrophic osteoarthropathy (HOA)

-triad: periostitis, digital clubbing and painful arthropathy of the large joints, especially involving the lower limbs -usually associated with hypoxemia associated with lung cancer (especially adenocarcinoma), mesothelioma, bronchiectasis, etc -in pts with COPD, the development of HOA or clubbing should make you strongly concerned for lung cancer--COPD alone typically does not cause HOA -the most frequent cause of an acute onset of hypertrophic osteoarthropathy is a lung neoplasm; rule out with chest radiography

What blunts the x descent on a venous pressure tracing?

-tricuspid regurgitation

Clomipramine**

-tricyclic antidepressant -has anticholinergic side effects

How to diagnose giardia?

-trophozites in stool -cysts in stool

What part of the kidney consumes the most oxygen?

-tubular absorption bc it is mostly by active transport using ATP

Tubular adenoma histology

-tubular looking -has a mini lil pedunculated stalk

tumor suppressor vs. proto-oncogene

-tumor suppressor--inhibition of cell cycle regulation -proto-oncogene--pushes it through cell cycle

xanthomas

-tumor-like dermal collections of foamy macrophages (histiocytes) containing cholesterol and lipids -composed of lipid-laden macrophages and may also contain multi-nucleated giant cells

What are the light and dark chains of IgA made up of?

-two alpha heavy chains (like in IgA) -2 kappa light chains

a pt with severe obesity with excessive urine output suggests what?

-type 2 DM

Dasatinib

-tyrosine kinase inhibitors of bcr-abl (encoded by phildelphia chromosome fusion gene in CML (camel in the sketch)) and c-kit (cockpit in the sketch) (common GI stromal tumor) -AE: fluid retention (bottles in the sketch) -used for CML, GISTs -imatinib (mat on chair in sketch) and nilotinib are also similar drugs -dasatinib is the dashboard bubble in the sketch

What kind of receptors do insulin act through?

-tyrosine kinase receptors, where autophosphorylation of tyrosine residues occur

fracture of medial epicondyle of humerus affects what nerve?

-ulnar

What supplies the innervation for the adductor pollicus muscle?

-ulnar nerve which passes through the cubital tunnel and also provides sensory innervation to MEDIAL palm

Identification

-unconscious adoption of someone else's traits or activities -ex. a medical student begins to dress and act like an attending physician in an effort to bolster their self esteem

Confabulation

-unconsciously makes up explanation to fill in gaps in recent memory -can occur in chronic alcohol use, such as those with wernicke-korsakoff syndrome (see bottom right pick for the chronic alcohol use...the right side of the apple core is korsakoff)

hypocalvaria

-underdeveloped skull bone -ACE inhibitor teratogen defect

Anaplastic thyroid cancer is also called?

-undifferentiated cancer

microvascular remodeling

-untreated hypertension can lead to this -typical changes include an increase in arteriolar wall thickness, presumably to help the vessels counter the chronically increased blood pressure

Stridor occurs with?

-upper airway obstruction, typically involving compression of the trachea or foreign body in the mainstem bronch

Urine anion gap (UAG)

-urinary sodium plus urinary potassium minus urinary chloride -used as a surrogate to measure urinary ammonium -neg UAG indicates high ammonium excretion -positive UAG indicates ammonium excretion is impaired -type IV RTA is associated with dec excretion of ammonium

What is the prostate gland derived from?

-urogenital sinus (which also develops into the bulbourethral glands, bladder, and urethra under the influence of DHT)

How do you know if a pt has infective endocarditis?

-use Duke's criteria: Fever Roth spot Osler nodes Murmur Janeway lesions Anemia Nail bed hemorrhages Emboli

How to test for HIV in babies?

-use HIV viral load test -This method of testing is recommended for babies with suspected HIV due to maternally transferred antibody

How to treat lichen simplex chronicus?

-use an antipruritic med like diphenhydramine + topical steroid

What tx do you use for chloroquine resistant malaria OR a pt with malaria with a history of psoriarsis?

-use atovaquone and proguanil (use if pt is unable to tolerate chloroquine therapy (also chloroquine is associated with reactivation of psoarisis) -chloroquine is tx of choice if malaria is uncomplicated and there are no CI for its use

How to treat secondary hyperparathyroidism related osteolysis?

-use cinacalcet

How to calculate GFR?

-use creatinine clearance -> GFR = C(Cr) = UV/P ; where U = urinary creatinine concentration; V is urine volume rate; and P is plasma creatinine concentration -i think this over estimates GFR a little?

student t-test

-use for two groups being evaluated on the basis of one interval variable -ex. researchers were trying to dertermine whether there was a statistically significant difference between the avg. height in males and females

What are two kinds of surface receptors for extracellular hormones?

-use surface receptors to drive cellular changes (tyrosine kinase, JAK/STAT) -use 2nd messengers to drive cellular changes (cAMP, cGMP, IP3)

methotrexate

-used for chemo and autoimmune diseases -mimics folic acid and competitively inhibits dihydrofolate reductase, which dec the level of tetrahydrofolate available for thymidine nucleotide synthesis -without sufficient thymidine, dna synthesis is impaired which primarily affects rapidly-dividing cells including WBCs, bone marrow cells, and GI epithelial cells -side effects--dec GI epithelial cells can lead to mucositits (redness and burning in the mouth with ulcer formation)

Winters formula

-used only for met acidosis Pco2 = 1.5 [HCO3-] + 8 +/- 2 -measured PCO2 = predicted PCO2 then pure met acidosis -measured PCO2 > predicted PCO2 then met acidosis + resp acidosis -measured PCO2 < predicted PCO2 then met acidosis and resp. alkalosis

Why is prednisone used to treat RA and what effect does it cause on electrolyte levels?

-used sometimes when persistent synovitis is seen in multiple joints despite sufficient dosage of NSAIDs -bc it can take several weeks to months for the therapeutic effect of DMARDs to become evident, agents such as prednisone are needed as "bridge therapy" until the DMARDS become effective -hypocalcemia, fluid retention, hypertension, hypokalemia (due to mineralcorticoid effect of corticosteroid)

when to use administration of a bronchodilator + repeat of PFT?

-used to differentiate asthma from other processes -if the FEV1 improves by 12% or 200 mL with the administration of a bronchodilator, obstruction is considered reversible and asthma is the likely diagnosis -next step after PFTs show some airway obstruction and need to differentiate out asthma from other stuff on differential

what is the novobiocin test is used for?

-used to differentiate coagulase-negative staph--S. saprophyticus is novobiocin-resistant, while S. epidermidis is novobiocin-sensitive

Ursodiol

-used to treat cholesterol gallstones -acts primarily by reducing cholesterol synthesis and secretion into bile and is effective in dissolving cholesterol gallstones

Quinine

-used to treat malaria caused by infection with Plasmodium falciparum and can precipitate development of cardiac arrhythmias, such as torsades de pointes, a life-threatening ventricular arrhythmia

What is fluorescence-activated cell sorting (FACS) used for?

-uses antibodies coupled to fluorescent markers to determine cell surface molecules on intact cells -so detects CD markers shit

Acetyl CoA carboxylase

-uses biotin as a cofactor -converts Acetyl Coa to malonyl coa of Fatty acid synthesis mechanism

Wedge-shaped necrosis of kidney

-usually focal and is seen with acute renal infarc due to trauma, thrombus, or embolus

vegetations on valve mean what?

-usually mean bacteria infecting heart valves

clinical features of mononucleosis

-usually occurs in young adults who present with headache, fever, malaise, lymphadenopathy, pharyngitis, hepatosplenomegaly, periorbital edema, rash, and a palatal enanthem -drug interaction with amoxacillin/ampicillin-->pt gets rash

What nerve innervates the uvula and palate elevation?

-vagus nerve

What psych drug can cause dose-dependent thrombocytopenia in about 5% of patients?

-valproic acid -can also cause hepatotoxicity, pnacreatitis, alopecia, and is a teratogen (spina bifida)

Maneuvers that dec preload/venous return

-valsalva -standing

What is a key marker of pheochromocytoma?

-vanillylmandelic acid

The renal medulla is supplied by what source of blood?

-vasa recta -ischemia in these regions can cause patchy papillary necrosis, hematuria, proteinura, and sometimes cortical scarring -sickle cell occlusion usually affects vasa recta or glomerular capillaries bc these are small vessels

Virchow's triad and pregnancy

-venous stasis inc: due to generalized inc in vascular compliance and compression of the iliac vein and IVC by the gravid uterus -endothelial injury: delivery can cause endothelial injury at the placental implantation site, int eh pelvis or perineum due to obstetric lacerations, or in the uterus itself int he event of C section delivery -hypercoagulability: pregnancy associated with changes in many coag factors including inc in factor I, II, V, VII, VIII, X, and XII, a dec in free protein S, and resistance to activated protein C -therefore pregnancy and postpartum period are risk factors for venous thromboembolism

MI complication that can appear weeks to moths later

-ventricle wall aneurysm -stroke -systolic heart failure due to aneurysm -dressler syndrome (remember sketch on the far right side with all the moon lanterns?)

what is a complication of an anterior wall MI that leads to pericardial effusion?

-ventricular free wall rupture

What hypertension treating drug is a rare cause of elevated serum prolactin?

-verapamil

Pancreatic adenocarcinoma

-very aggressive, often mets at presentation (1 yr survival after diagnosis) -histo: disorganized glandular structure with cellular infiltration -tumor more comm at pancreatic head-->obstructive jaundice -CA 19-9 marker, and CEA marker (less specific) -risk factors: tobacco, chronic pancreatitis, DM, 50+ yrs, jewish and AA males -Presents with: abdom pain radiating to back, weight loss, migratory thrombophlebitis--redness and tenderness on palpation of extremities (trousseau), obstructive jaundice with palpable nontender gallbladder (courvoisier sign)

Menetrier disease

-very rare condition characterized by markedly thickened gastric rugal folds, accompanied by hyperplasia of mucous glands and protein-losing enteropathy (appears as brain gyri on imaging)

Esmolol

-very short acting β1 selective antagonist that acts to slow down conduction through the atrioventricular node and can be used to treat supraventricular tachycardias, such as atrial fibrillation, atrial flutter, and atrioventricular node reentrant tachycardia -Since it is so short acting, it is used as trial therapy to ensure the patient can tolerate β-blockers

How can clots in the venous system travel to the brain?

-via patent forament ovale

What kind of bugs are capable of genetic reassortment/genetic antigenic shift?

-viruses with segmented genome: ROBA (Reoviridae, Orthomyxovirus, Bunyaviridaa, and arenaviridae)f

Scurvy - what is wrong mechanistically?

-vit C deficiency--which is an essential cofactor for the hydroxlyation of proline and lysine residues on preprocollagen chains

vitamin C's role in scurvy

-vit C is necessary for collagen synthesis -collagen is rich in the aa proline -hydroxylation of proline to form hydroxyproline in collagen requires vit C

What vitamin causes walking problems, spasticity of arms and legs, and is associated with a gastrectomy?

-vitamin B12 deficiency -Cobalamin (B12) deficiency is characterized by neurologic symptoms, as myelin synthesis is impaired in a syndrome known as subacute combined degeneration -Specifically, the lateral corticospinal tract, spinocerebellar tract, and dorsal columns are affected -Labs show elevated methylmalonic acid (MMA) levels, a finding not observed in folate deficiency

What does a sunken fontanelle and dry mucous membrane mean?

-volume depletion -can present on x-ray with a dilated stomach and proximal duodenum ("double-bubble" sign) along with some normal bowel gas pattern, due to incomplete intestinal obstruction

Functional Residual Capacity (FRC)

-volume of air remaining in the lungs after a normal tidal volume expiration

What are the primary complications of AKI?

-volume overload, hyperkalemia, met acidosis, hypocalcemia, hyperphosphatemia

Complication of intestinal malrotation

-volvulus which can lead to bilious vomiting in newborn

Chromosome 3p contains what tumor gene?

-von Hippel-Lindau gene -VHL protein is involved in regulation of a protein called hypoxia inducible factor 1 alpha

What anti-coagulant drug can cause skin necrosis?

-warfarin -this is associated with warfarin's ability to cause acute protein C deficiency -the first factors affected by warfarin are those with the shortest half-life, protein C and factor VIIa -thus warfarin has an initial paradoxical procoag effect bc of rapid reduction in protein C--this can lead to a state of hypercoag and thrombosis in the cutaneous microvasculature

What causes direct inguinal hernias?

-weakness of transversalis fascia

calcium phosphate stone

-wedge shaped prism -dirty white -and forms in alkaline urine -risk factor is hypercalcemia -also culled brushite -form in persistently elevated urine pH (above 6.0)

Calcium phosphate stone

-wedge-shaped prism -inc pH -tx: low-sodium diet, thiazides

What gluconeogenesis reaction is affected by alcohol consumption?

-well since alcohol metabolism MAKES NADH, then you have a buildup of NADH and the conversion of malate to oxaloacetate (gluconeogenesis pathway bc malate can leave TCA cycle and make oxalo which can be converted to PEP) is inhibited bc this rxn also makes NADH

What happens when the diaphragm is paralyzed, will it move downward or upward or stay the same?

-when diaphragm is paralyzed or weakened, contraction of the intercostals then causes the pressure int eh pleural space to become more negative and the diaphragm to be sucked upward toward the thorax

When should patients be treated with pharmacologic therapy at diabetes diagnosis?

-when hemoglobin (A1C) is above 7.5% -if less, and motivated, a 3 to 6 month trial of lifestyle modification is appropriate (nutrition counseling, weight loss, and exercise)

pulmonary hypertension cutoff

-when mean pulmonary artery pressure is greater than or equal to 20 mmhg

When should you not use finasteride when treating BPH pts?

-when pt has hepatic dysfunction bc finasteride is metabolized by CYP system -use selective alpha-1 receptor blocker instead

When does maximum velocity of muscle shortening occurs?

-when the afterload or the force of the load is the least it can be (so lightest load) -the maximum velocity of shortening will be greater if myosin ATPase activity is high

When can patient confidence be broken?

-when there are threats of harm to self or others in order to protect the pt or potential victims -physicians have the duty to protect victims, not just warn them--so call the police to apprehend the patient and/or protect the potential victim as well as making a reasonable effort to contact the potential victim

microsatellite analysis

-widely used for DNA profiling, also known as genetic fingerprinting -macrosatellites are repeated units of typically 2-6 bp, and the length of the entire repeat is generally less than 150bp--these tandem repeats (STRs) create a molecular fingerprint of an individual, as no two person would have the same pattern of distinct STRs originating in different chromosomes inherited from their parents -using this technique, it it possible to ID the parents of a child due to the presence of STR bands in the child's sample that rep STR bands from each of the parents -use for kinship analysis (paternity testing)

Thenar eminence wasting is seen when?

-with a median nerve injury

Wolffian ducts derivatives

-with appropriate levels of testosterone, the mesonephric (wolffian) duct develops into the seminal vesicles, epididymis, ejac ducts, vas def, ureter (an outpouching of the wolffian duct form uteric bud-->ureter)

how do you treat ethylene glycol poisoning?

-with fomepizole

What asthma drug won't work anymore or as well when airway remodeling has occured?

-with severe chronic asthma can lead to irreversible airway thickening and obstruction that cannot be entirely reversed with inhaled β-2 agonist therapy

Levonorgestrel

-works by preventing ovulation, thickening the cervical mucus to prevent sperm entry, thinning the endometrial wall to prevent implantation -plan B

Ornithine transcarbamylase deficiency

-x linked deficiency in an enzyme involved in the urea cycle (which transforms nitrogen to urea for excretion) -pts with this present with lethargy, poor feeding, vomiting, hypervent, seizures and cerebral edema -dec level of citrulline

SCID due to mutation in cytokine receptors

-x-linked recessive

Menkes disease

-x-linked recessive disorder of copper transport -mutation in ATP7A, which is a copper efflux protein in the intestines -low blood copper levels are observed, but intestinal copper buildup can be seen -Low copper levels lead to impaired function of copper-dependent enzymes, importantly impairing collagen cross-linking by the enzyme, lysyl-oxidase -haracteristic brittle kinky hair ("kinky hair syndrome"), failure to thrive, and hypotonia in children

pyruvate dehydrogenase deficiency

-x-linked recessive metabolic disorder in which there are defects in the PDC which normally converts pyruvate to acetyl-coa -reduction of acetyl-coa impairs the TCA and synthesis of ATP, resulting in neurologic defects (motor delay, poor muscle tone, seizures, ataxia, abnormal eye movements, poor visual tracking) -inc lactate and inc alanine

Can asthma be triggered by environmental factors?

-yes

can an infusion reaction occur following the administration of amphotericin B?

-yes -infusion reactions develop fever, chills, vomiting, and headache during or immediately following the initial infusion of drug (these symptoms are related to release of prostaglandins which are lipid molecules that can cause vasodilation)

Is pheochromocytoma associated with MEN 2A and 2B?

-yes!

How would you measure total enzyme concentraton

-you need to look at the concentration needed to reach vmax

Clues to diagnosis with heart murmurs

-young female, otherwise healthy -> MVP -healthy, young athlete, syncope -> HCM -immigrant or pregnant -> mitral stenosis -IV drug user -> tricuspid regurgitation -Turner syndrome or aortic coarctation -> bicuspid AV or early stenosis or aortic regurg -Marfan -> MVP

Antileukotrienes prescribed as adjunctive tx for asthma

-zileuton, montelukast, and zafirlukast

What zone of the liver is affected by viral hepatitis first?

-zone 1 (periportal)

Ventilation-perfusion ratio

-zone 1: V and Q dec, V/Q inc, PaO2 inc, PaCO2 dec -zone 3: V and Q inc, V/Q dec, PaO2 dec, PaCO2 inc -ventilation and perfusion are highest at the base and decrease when you ascend to the apex -see BnB "Ventilation-Perfusion Ration chart"

what zone of the liver contains the p450 oxidase enzyme system?

-zone 3

What zones of the liver does drug metabolism take place?

-zone 3 (centrilobular)

which zone of the right lung has the highest PaCO2?

-zone 3 of the lung -bc zone three has more perfusion and less ventilation (switched in zone 1), so the V/Q ratio is lowest here and therefore buildup of PaCO2 is highest here

Pseudohypoparathyroidism

-↓ Ca2+ with normal to ↑ PTH; end-organ resistance to PTH (hypercalcemia, hyperphosphatemia) -aka albright's hereditary osteodystrophy -kidney and bone unresponsiveness to PTH (usually abnormal PTH receptor function) -clinical features - short, shortened fourth and fifth metacarpals, round facies, mild mental retardation

What are three characteristics of hyperplastic polyps?

1) Benign 2) Abundant goblet cells (epithelial proliferations) 3) Serrated (or sawtooth) at surface

Virchow triad of DVT

1. Endothelial damage (e.g. surgery, trauma) 2. Venous stasis (immobilization, surgery, severe heart failure) 3. Hypercoagulable state (birth control, malignancy, lupus, genetic)

What does muscle biopsy demonstrate in polymyositis and dermatomyositis?

1. Inflammation 2. Myocyte necrosis 3. Regeneration of muscle fibers 4. Fibrosis 5. Endomysial inflammatory infiltrate (polymyositis) -think sketchy's cookout with a crowd, cooking chicken legs on the grill

Samter's triad

1. Nasal polyps 2. Asthma 3. Aspirin sensitivity -Aspirin-sensitive asthma is caused by cyclooxygenase (COX) inhibition, which leads to the overproduction of leukotrienes and subsequent airway constriction

Aortic arch derivatives

1. max = maxillary a 2. = stapedial a and hyoid a 3 = CARotid 4 a-4-ta, AORTA; subclavian 5. doesn't exist 6. pulmonary arteries and ductus arteriosis -PDA comes from 6th arch

Gout presentation

1. sudden excruciating pain, redness, tenderness, of big toe after binge drinking with beer 2. Fever common - have to distinguish btw. gouty attack from infection 3. Great toe, ankle, feet, knees

pharyngeal arches

1: Mastication/Jaw 2: Facial nerve - muscles of facial expression like stapedius, stylohyoid, platySma, posterior belly of digastric (think Smile) 3: Glossopharyngeal like taste - Stylopharyngeus which is innervated by the GP nerve (Swallow STYLishly) 4 and 6: Pharynx/Palate - 4th is more of simply swallow (superior laryngeal) and 6th is more of speak (recurrent inferior laryngeal) 5: rudimentary and does not give rise to any adult structures When at the restaurant of the golden arches, children tend to first chew(1), then smile(2), then swallow stylishly(3) or simply swallow(4), and then speak(6)

What ratio of lethicin:sphingomyelin indicates mature fetal lungs?

2:1

Klinefelter syndrome

A chromosomal disorder in which males have an extra X chromosome, making them XXY instead of XY -testicular atrophy, extra bar body, hyaline seminiferous tubules/sertoli, dec testosterone and inhibin, inc FSH LH and E, gynocomastia, dysfunctional sertoli

Bicornuate uterus

A uterus with paired uterine horns extending to the uterine tubes

Attributable risk

AR = [a/a + b] − [c/c + d] -risk difference is used to quantify risk in the exposed group that is attributable to the exposure

Cardiac output equation

CO = HR x SV CO = (rate of oxygen consumption) / (arterial oxygen - venous oxygen)

CREST syndrome

Calcinosis, Raynaud's, Esophageal Dysmotility, Sclerodactyly, Telangiectasia -limited scleroderma--more limited variant of scleroderma and characterized by CREST

Ejection fraction equation

EF= SV/EDV =(EDV−ESV)/EDV

Filtration fraction

FF = GFR/RPF Normal = 20%

What is the key element in the apical ectodermal ridge that cause limb growth in proximal distal direction?

Fibroblast growth factor

Filtration Fraction (FF)

GFR/ RPF -normal FF is 20% RPF = RBF(1-hematocrit)

azathioprine

Immunosuppressant Mech: Antimetabolite precursor of 6-mercaptopurine, interferes with metabolism and synthesis of nucleic acids and toxic to proliferating lymphocytes. -Clinical: Kidney transplant, autoimmune disorders. Tox: Bone marrow suppression. Active metabolite is metabolized by XO so toxic effects are increased with allopurinol.

Maintenance dose formula

MD = Css x Clearance (Css is concentration at steady state) -and if bioavailability percentage is present then take MD and divide by the decimal version of it

bicornuate uterus

Malformed uterus having two horns.

Gaussian distribution

Normal or bell-shaped distribution of values symmetrically clustered around the mean

Congenital bacterial infections

T = toxoplasma O = others (syphilis, R = Rubella C = CMV H = Herpes

VACTERL

V-vertebral anomalies A-anal atresia C-cardio anomalies T-TEF E-esopageal atresia R-renal anomalies L-limb anomalies

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) -low-grade lymphoproliferative disorder in older patients that may present with lymphadenopathy, splenomegaly, infection, and autoimmune hemolytic anemia -Peripheral blood smear demonstrates a preponderance of small, mature-appearing lymphocytes and smudge cells (see pic) -patients with CLL have an increased risk of infection and autoimmune hemolytic anemia

Dullness to percussion occurs over?

areas of: -consolidation -effusion -atelectasis

an early systolic ejection click is seen in...?

bicuspid aortic valve -pts with this are at significantly increased risk of thoracic aortic aneurysms and dissection

Hydrocephalus ex vacuo

dilated ventricles secondary to brain atrophy (seen in Alzheimer's)

satellite phenomenon

enables growth on a blood agar plate: co-culture with Staph aureus, which lyses blood cells and releases factors X and V

incomplete fusion of the processus vaginalis leads to what?

hydrocele

Rathke's pouch

in the roof of early oral cavity, an upward growth of tissue breaks loose and forms the anterior part of the pituitary gland -Contacts a downward growth of tissue from the brain and forms posterior pituitary gland

Oligomycin poison

inhibits ATP synthase

Where is the left recurrent laryngeal?

literally loops to carry the aortic arch (that's what it looks like)

Peginterferon

long acting preparation of interferon alpha; Interferon is bound to polyethylene glycol (PEG) which delays elimination of interferon; -is a medication used to treat hepatitis C and melanoma -Side effects are common. They may include headache, feeling tired, mood changes, trouble sleeping, hair loss, nausea, pain at the site of injection, and fever -new-onset depressive episode???

What is C3b involved in?

opsonization

true or false: the heart rate is determined by the refractory period of the AV node

true

True or false: teratomas are tumors that contain elements of all three germ layers

true!

true or false: Ac-Coa cannot be used as a substrate for glucose

true!

Prolactin secretion is regulated via a negative feedback mechanism by dopamine, which is released through the?

tuberoinfundibular tract

How to calculate type II error (beta)

type II error = 1- power

When is hepatic glycogenolysis the main means of glucose?

when a pt is fasting and this lasts for 16-24 hours of fasting IN THE ABSENCE OF EXERCISE -exercise accelerates depletion of glycogen, so the rate of gluconeogenesis increases to maintain plasma glucose during prolonged exercise

What does protein C do?

when activated, inactivates factor V and factor VIII

Wolf-Parkinson-White Syndrome

∙An accessory conduction pathway from atria to ventricles through the bundle of Kent, *causing premature ventricular excitation because it lacks the delay seen in the AV node.* ∙Treatment is *radiofrequency ablation.* ∙Want to avoid AV nodal blocking agents. ∙Look for delta wave -characterized by an aberrant accessory pathway leading to decreased ventricular filling during diastole -may result in reentry circuit and SVT