USMLE questions

bacteria associated with sexually active women?? vs S epidermis??

-Staph saprophyticus -catalase +; coagulase - -Staph sapro is novobiocin resistant

where do you find uracil

RNA

the external jugular vein drains into

subclavian vein

what do the toxins of both shigella and E coli (EHEC) do?

Shiga toxin and shigalike toxin of E coli inactivates 60S ribosome subunit

what will you hear with aortic stenosis and what is the 3 most common causes of aortic stenosis?

crescendo decrescendo murmur at right sternal border 1. calcified bicupsid valve 2. calcified normal valve 3. rheumatic heart disease

what does neutrophil secreted elastase normally do to alveolar wall?

elastase breaks down elastin in the alveoli. Elastin provides elasticity to skin, pulmonary vessels, and pulmonary alveoli. with elastin, the fibers can stretch and recoil back to their original size.

Marfan syndrome mutation? predisposes to what?

-it is usually a common cause of cystic medial degeneration in younger pts. extracellular glycoprotein fibrillin 1 which is important for forming scaffold of elastic fibers -prediposes to aortic aneurysm and dissection

bacteria associated with complicated (including catheter associated) and uncomplicated UTI

E. coli -gram negative rod -actose fermenting

features of PSGN? what type of granular deposits?

SUBEPITHELIAL HUMP!!! -sits on top of basement membrane -where epithelial cells normally sit -"starry sky appearance" course granular deposits IgG, IgM, and C3 along basement membrane and mesangium-->lumpy bumpy appearance -on the epithelial side of the BM!!*** LUMPY BUMPY GRANULAR DEPOSITS OF IGG AND C3 diffuse glomerular hypercellularity, hypercellular and inflammed lab studies show decreased serum complement (C3) and elevated titers of streptococcal Ab**

Henoch-schonlein purpura pathogenesis? clinical sx? diagnosis?

VASCULITIS BC OF IMMUNE COMPLEX DEPOSITION -the most common vasculitis in children -PALPABLE PURPURA ON BUTT AND LEGS -GI pain and bleeding and hematuria bc of IgA nephropathy -you get IgA deposition**** within the mesangium which results in glomerular bleeding -follows an URI; bc when you get URI, you generate IgA which helps protect mucosal sites; with a URI, lots of IgA so people with this condition, will have IgA deposits which drives the vasculitis!!! deposits in mesangium and small vessels ID 758 READ ANSWER CHOICES

what is the left atrial appendage

a small sac like structure in the left atrium that is susceptible to thrombus forming

what drains into right brachiocephalic vein?

internal jugular vein and subclavian vein. the brachiocephalic vein drains into SVC

what do you see with early onset excessive alveolar elastin degradation?

lower lobe predominant emphysema

Which organ is least likely to be susceptible to arterial occlusion-->infarction?

the liver bc it has dual blood supply, the hepatic artery and portal vein.

filtration fraction formula

FF = GFR / RPF ID 1618

Bacteria that is a common cause of spontaneous bacterial peritonitis and nosocomial PNAs and UTIs

Klesbiella pneumoniae -gram negative rod -lactose fermenting ID 1146

PAH concentrations in the kidney

NOT REABSORBED BY ANY PORTION OF NEPHRON -some freely filtered into bowman's space -majority secreted from Proximal tubule -concentration of PAH is lowest in bowman's space

Class IV antiarryhtmics aka nondihydropyridine calcium channel blockers have what side effects? it is contraindicated in what type of pts?

bradycardia, AV block!! and constipation -dont give it to pts with CHF due to left ventricular systolic dysfunction bc it will worsen it

organisms seen with central venous catheter infections

gram + cocci such as staphyloccocus auereus

Renal blood flow formulas

the volume of blood that flows through the kidney RBF = renal plasma flow/(1 - Hct) RBF = PAH clearance/ (1 - Hct) RBF = (renal artery pressure - renal vein pressure)/ renal vascular resistance

Pneumonic to remember culture negative endocarditis

"HACEK" Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella due to Bartonella, Coxiella, Mycoplasma, Histoplasma, Chlamydia

what causes a right shift in O2 Hb curve

- increased H aka decreased pH -increased 2,3 BPG -increased temp

rheumatoid arthritis 1. which part of spine mainly involved 2. Ab? 3. which joints?

1. cervical so you can see C1-2 subluxation 2. +rhuematoid factor and anti CCP Ab 3. PIP, MCP, MTP *also see ulnar deviation; radial side more w osteoarhtriits

IgA deficiency clinical features

1. hx recurrent sinus, pulm, GI infections (ex. hx of pna episodes, sinusitis, giardia infection) 2. autoimmune disease (ex. celiac disease) 3. anaphylaxis during blood transfusions**

vitamin B12 is a cofactor for which 2 enzymes?

1. methylmalonyl CoA mutase converts methylmalonyl CoA-->succinyl CoA -methylmalonic acid builds up AND IMPAIRS MYELIN SYNTHESIS 2. methionine synthase converts homocysteine-->methionine -and converts methyl THF-->THF build up leads to impaired DNA synthesis

1. increased uric acid production is usually seen with? 2.

1. pt w high cell turnover (malignancies, lymphoprofierative disorders) or inborn errors of metabolism (glucose 6 P deficiency)

CD19, 20, 22 are which lineage?

B cell lineage

thick "cottage cheese" discharge vaginal inflammation lab findings? treatment?

Candida vaginitis (Candida albicans) normal pH , psuedohyphae fluconazole

immunodeficiency, albinism, neuro defects, nystagmus, immunodeficiency is due to a defect in neutrophil phagosome lysosome fusion (so you get giant lysosomal inclusions) keads to recurrent pyogenic ifnections caused by staph and strep

Chediak-Higashi syndrome

muscle weakness***, hypotonia*** hypoglycemia, hepatomegaly, and ketoacidosis **cytosolic accumulation of glycogen with abnormally short outer chains (limit dextrins)**** ID 1030

Cori disease due to debranching enzyme deficiency (in glyogenolysis)

glucocerebroside accumulation bc of beta-glucocerebrosidsase deficiency -hepatosplenomegaly, pancytopenia, and severe bone pain

Gaucher disease

loratadine is a second generation anti histamine that blocks periphlera ____ receptors

H1 histamine

erythropoiesis-stimulating agents (EPO, darbepoetin alpha) are associated with increased for

HTN and thromboembolic events used to treat anemia of CKD

prior to treatment with anthracycline antineoplastic drugs, (ex doxorubicin), do a baseline assessment of?

LV function with echo or radionuclide ventriculography

bacteria most likely associated with an indwelling bladder catheter

Pseudomonas aeruginosa -gram negative -OXIDASE POSITIVE -non-lactose fermenting

crypt abscess with PMNs rectum always involved, continuous involvement, extends up to cecum (remainder of GI tract unaffected) mucosa and submucosa (superficial) bloody diarrhea** (w or w/o abd pain) toxic megacolon (dilation of bowel), can lead to perforation. colon adenocarcinoma risk

Ulcerative colitis in crohn's, abd pain si ALWAYS PRESENT

obturator nerve function

adduction of thigh

prazosin

alpha 1 adrenergic antagonist

what should you avoid in tx insomnia in elderly bc of adverse side effects? so what do you give instead

avoid benzos, anti depressants and anti histamines so give ramelteon-->a melatonin agonist

what has anxiolytic, anti convulsant, and muscle relaxant effects

benzos

what is the mutation in familial erythrocytosis

beta globin mutation that results in reduced binding of 2,3 BPG this increases Hb oxygen affinity

c5,c6 reflex

biceps and brachioradialis reflex

ethosuximide MOA

blocks thalamic T type Ca channels

development of acute severe depression, with fatigue, vivid dreams, hypersomnia, and hyperphagia no physical sx which drug?

cocaine withdrawal

the enzymes in the lac operon do what

code for enzymes that help hydrolyze lactose into glucose and galactose

neurologic sx incompatible with any known neuro dz, often acute onset associated w stress

conversion disorder!!

calculous cholecystitis is due to gall stone impaction in the

cystic duct

when ventilation exceeds perfusion

dead space (like a PE)

familial dysbetalipoproteinemia

defects in ApoE so you get lots of chylomicron remnants and VLDL remnants eruptive and palmar xanthomas

chest pain that decreases when the pt sits up and leans forward (bc it decreases pressure on parietal pericardium)

describes acute pericarditis and you will find pericardial friction rub**

impaired left ventricular filling and poor ventricular wall compliance

diastolic dysfunction

what type of dysfunction with decreased left ventricle size

diastolic dysfunction bc can't fill as much due to the decrease in size -concentric** hypertrophy

LV pressure and volume in diastolic dysfuctnion

diastolic dysfunction is caused by things that decrease LV compliance, bc the wall is stiffer and less compliant, that is going to increase the pressure the volume will be the same

patient pays for each individual service at a discounted rate predetermined by providers and payers

discounted fee for service

the substantia nigra contains ___neurons

dopamine these neurons are depleted in parkinson's disease "small dopey is PARKING a car" small so decreased dopamine

where is the MLF located

dorsal pons

Campylobacter jejuni treatment

erythromycin -used instead of fluoroquinolones bc this organism is dvping increasing resistance

reactions that need biotin as a cofactor

for carboxylase enzymes, functions as a CO2 carrier pyruvate to oxaloacetate via pyruvate dehydrogenase (gluconeogenesis) acetyl CoA to malonyl CoA via acetyl CoA carboxylase (fatty acid synthesis) propionyl CoA to methylmalonyl CoA via propionyl CoA carboxylase (fatty acid oxidation)

what do you use to tx CMV infection

ganciclovir

which hemophilias are x linked recessive vs autosomal recessive

hemophilia A and B are X linked recessive hemophilia C are autosomal recessive

thiazide diuretics can lead to _____

hyperuricemia and precipitate a gout attack

where do you see both Cd4 and Cd8 cells expressed together

in cortex of thymus referred to tas double positive T cells or immature T lymphocytes

which regions of the lung will be affected with aspirating while sitting upright

in the basilar segments of the lower lobes

in pregnancy, progesterone is secreted by?

in the first trimester, progesterone is secreted by the corpus luteum (for successful implantation) in the second and third, progesterone is secreted by the placenta

where does IgA deposition occur in IgA nephropathy

in the mesangium dvp within 5 days s/p infection vs PSGN dvp 1-3wks after

mutation in primary pulmonary HTN what tx to give?

inactivating mutation of BMPR2, causing proliferation of vascular smooth muscle can also get it from a CT dz or HIV give endothelin receptor antagonists (bosentan, ambrisentan) bc endothelin normally promotes smooth muscle proliferation

how does glucagon increase serum glucose

increases glycogenolysis in the liver by activating glycogen phosphorylase and increase gluconeogenesis in the LIVER by activating pyruvate decarboxylase, phospoenolpyruvate carboxykinase) and decrease intracellular 2,6 bisphosphate levels which inhibits glycolysis

pink color on MacConkey agar means what?

lactose fermenter

what type of anemia would you see in alcoholics

macrocytic anemia bc tehy will have folic acid or B12 deficiency which will impair DNA synthesis

prolonged NO exposure may lead to reduced ____activity, causing ___anemia

methionine synthase megaloblastic

treating methemoglobinemia, which presents with grey or blue colored skin, SOB, and chocolate colored bloood

methylene blue reduces methemoglobin through the NADPH pathway

enlarged chorionic villi and avascular edematous stroma

molar preggo or spontaneous abortion

umbilicated pink papules due to poxvirus affected keratinocytes show eosinophilic cytoplasmic inclusions (molloscum bodies)

molluscum contagiosum

what to give for opioid OD

naloxone

carbamazepine gabapentin phenobarbital phenytoin

narrow spectrum tx for focal sz (simple and complex)

which blot for RNA

noRthern

both nocardia asteroides and mycobacterium Tb can present with pulmonary problems. what is the difference?

nocardia is a gram positive rod and appears as BEADED BRANCHING** FILAMENTS

which tract receives info from the area postrema, GI tract via the vagus nerve, vestibular system, and CNS

nucleus tractus solitarius

difference in location with secondary Tb

occurs in APEX of the lung; also see military pulm Tb (scattered across the entire lung)

Candida albicans contributes to the normal flora of..?? does candida cause lung disease?

of skin, MOUTH, vagina, and intestine ; bc you see it in the oral cavity, it is normal to see it in sputum cultures so the presence of it in sputum does not indicate disease NO!

what type of mechanical complication can you get 3-4 **days after an acute MI

papillary muscle rupture you will see acute mitral regurgitation and pulmonary edema

drainage from testes

para aortic nodes

which region is poorly developed in DiGeorge of the lymph node

paracortex thesis the area where dendrite cells present antigens they collect to the aggregated T lymphocytes in this region

what type of effusions occur frequently in bacteria PNA bc of exudative fluid accumulation within the pleural space?

parapneumonic effusions

the presence of lewy bodies is characteristic for

parkinsons

continous murmur hear best at the L infraclavicular region with maximal intensity at S2

patent ductus arteriosus - a small atrial septal defect can cause a continuous murmur in rare instances and only does so when its associated with mitral valve obstruction (Lutembacher syndrome)

intranuclear inclusions surrounded by a clear halo

pathognomonic for pulmonary cytomegalovirus

injury to posterior urethra is associated with___while anterior urethra is damaged with___

pelvic fractures -prostatic and membranous segment (posterior urethra) -membranous weaker bc not supported by surrounding structures straddle injuries -bulbous and penile segment (anterior urethra) -bulbous segment most suscpetible to straddle injuries while penile segment due to penetrating trauma or or instrumentation ID839

a dopamine agonist that directly stimulates dopamine D2 receptors

pergolide

eptifibatide

platelet glycoprotein IIb/IIIa inhibitor

patients can see providers outside of network needs referral from primary care provider

point of service

what is a nephritic syndrome that arises 2-3 weeks s/p strep infection (group A beta hemolytic strep)? -what virulence factor?

post streptococcal glomerulonephritis -carry M protein virulence factor***

what is inversely related to MAC

potency

common site of endometrial implants?

pouch of Douglas endometriosis is the presence of endometrial glands and stroma outside the uterus, causes dysmenorrhea and abd cramps 1-2 days before menstruation

the mutation in the Bruton kinase gene causes what in X linked agammaglobulinemia??

prevents bone marrow pre-B cells (CD19 and CD20) from developing into mature circulating B lymphocytes (CD19, CD20, CD21)

what is gliosis

proliferation of astrocytes in an area of neuron degeneration

rapidly spreading pruritic rash with erythematous papules and excoriations on hte extremities due to Sarcoptes scabiei mite delayed type IV hypersensitivity

scabies

you can get invasive pulm aspergillosus in pts that are

severely immuno and neutropenic will have fever and pleuritic chest pain

the difference between psychogenic polydipsia and diabetes insipidus

sodium is low with PP bc they are drinking so much water. treat with water restriction

decreases the secretion of secretin, CCK, glucagon, insulin, and gastrin

somatostatin somatostainomas (tumors from delta cells) pt presents with hypo/hyperglycemia, steatorrhea (from decreased secretion of secretin and decrease in GI motility), gallbladder stones

what needs to be omitted from diet in hereditary fructose intolerance

sucrose and fructose

what are the 3 layers of ectoderm

surface ectoderm neural tube neural crest

dvmpt of internal male genitalia, spermatogenesis, male sexual differentiator at puberty with muscle mass and libido vs dvmt of external male genitalia, prostate growth, male pattern hair growth,

testosterone DHT

bicalutamide

testosterone receptor antagonist used in the treatment of prostate cancer

what do you treat lyme disease wth? if preggo?

tetracyclines like doxycline amoxicillin

most common site for mets of choriocarcinoma

the lungs (SOB, hemoptysis) histo -prolfieration of cytotrophoblasts, and multinuclear syncytiotrophoblasts

dihydroorgotamine

used to treat acute migraine headache not good for vasospastic angina bc it constricts vascular smooth muscle

Red man syndrome is induced by____and mediated by___

vancomycin histamine release due to non IgE mediated mast cell degranulation

meckel diverticulum is due to failure of obliteration of the

vitelline or omphalomesenophric duct

describe the nutcracker effect aka left sided varicocele

when the aorta and superior mesenteric artery compress the left renal vein this causes increased pressure in the left gonadal vein

how do you acquire histoplasma capsulatum

when you inhale bird or bat droppings that contain fungal spores and then macrophages ingest them

when do you see fibrinoid necrosis

with injury in the blood vessel walls bc of vasculitis syndromes like polyarteritis nodosa, malignant HTN, DM results form immune complexes/proteins leaking through damaged intima and depositing in the vessel wall

when do you see loss of cremaster reflex

with testicular torsion or L1-2 injury bc this reflex is mediated by genitofemoral nerve which originates from L1-2 spinal nerves contraction of cremaster muscle-->pulls up ipsilateral testes

do you get schizocytes in DIC

yes

do you get hemolytic anemia in sickle cell disease? what does it cause?

yes causes juandice due to unconjugated bilirubinemia and promotes the formation of pigmented gallstones

can you falsely low HbA1c levels in a diabetic with beta thalassemia

yes, bc of the beta globin chain underproduction, you get hemolysis. so now you have an increase in red cell turnover which causes falsely low levels normally, glucose binds to HbA inside RBCs, so longer exposure of red cells to glucose will increase HbA1c values but w a thalassemia, RBC turnover is higher so the glucose doesn't bind for long

can alpha 1 antitrypsin deficiency affect the liver? why or why not?

yes. bc this enzyme is made in the liver!!! so with the first 2 decades of life, you are more concerned with liver involvement. pulmonary dysfunction takes decades to dvp.

can IgE levels be normal in a pt with asthma

yes. IgE will be high with extrinsic atopic allergic asthma but with non immune mediated asthma will have normal levels

can you get iron deposition in PNH?

yes. bc hemolytic anemia, so chronic hemolysis lead to iron deposition in the kidney, which can interfere with PT function and cause interstitial scarring and cortical infarcts

is excessive bleeding common in patients with significant renal dysfunction? why?

yes. due to accumulation of uremic toxins in the circulation which impair platelet aggregation and adhesion

do you get increased aldosterone and ADH secretion in nephrotic syndrome?

yes. loss of albumin decreases oncotic pressure which leads to hypovolemia and that triggers RAAS. NA and water retention which leads to edema

pneumonic for causes of acute pancreatitis how does increased triglycerides cause acute pancreatitis?

" I GET SMASHED" Idiopathic GALLSTONES Ethanol abuse Trauma Steroids Mumps virus Autoimmune dz Scorpion stings HPYERTRIGLYCERIDEMIA and HYPERCALCEMIA ERCP drugs normally, triglycerides can get broken down by pancreatic lipase into free fatty acids. fatty acids are carried in serum by albumin. when there is too much trig, there is too much fatty acids which damages pancreatic acinar cells

Kawasaki disease

"CRASH and burn" conjunctival injection Rash Adenopathy Strawberry tongue Hand foot changes (EDEMA) fever may develop coronary artery aneurysms****!!! ASIAN CHILDREN <4 YR OLD

pneumonic for cells derived from neural crest

"MOTEL PASS" melanocytes odontoblasts tracheal cartilage enterochromaffin cells laryngeal cartilage PARAFOLLICULAR CELLS OF THE THYROID ADRENAL MEDULA Schwann cells spiral membrane

guyon canal syndrome

"ulnar trap" when ulnar nerve injured near hook of hamate and pisiform bone of wrist ulnar nerve can also be injured at medial epicondyle of humerus

which drugs are responsible for drug induced lupus erythematous? what is the difference between drug induced lupus and SLE?

*Procainamide *hydralazine Isoniazid with drug induced lupus, +Anti nuclear Antibodies (ANA) and +anti histone Antibodies (YOU rarely DONT SEE ANTI -dsDNA present like you do in SLE!!) procainamide is metabolized by hepatic acetylation so slow acetylators are at greater risk

catalyzes the conversion of cholesterol to pregnenolone

desmolase first step in the synthesis of steroid hormones

first change is non enzymatic glycolsylation of the vascular basement membrane resulting in hyaline arteriosclerosis hyaline arteriosclerosis = deposition of eosinophilic hyaline materal in the intima and media of small arteries and arterioles then you get increased glomerular filtration pressure bc effernt arteriole is more affected hyperfiltration; sclerosis of the mesangium w formation of Kimmestiel wilson nodules** evenutally progresses to nephrotic syndrome ACE inhibitors slow the progression of hyperfiltration induced damage

diabetes mellitus in the kidney

what spares the parasympathetic efferents of CN3, diabetic neuropathy or an aneurysm?

diabetic neuropathy bc it causes central ischemia, which affects CN3 but spares peripheral para so the pupil will be normal sized and reactive to light

disorganized non peristaltic contractions due to impaired inhibitory innervation within the esophageal myenteric plexus presents with liquid and solid dysphagia and chest pain due to inefficient propulsion of food into the stomach

diffuse esophageal spasm

which lymphoma presents with a rapidly enlarging nodal (neck, abd, mediastinum) or extra nodal symptomatic mass

diffuse large B cell lymphoma

what is the most common type of renal problem in SLE

diffuse proliferative glomerular nephritis (nephritic)

toxicity of what? colorvision alterations, confusion, weakness, cardiac arrhythmias, ELEVATED K

digoxin toxicity -blocks Na/K ATPase which then causes an increase in intracellular Na and Ca, which leads to increased cardiac contractility

bromocriptine and cabergoline are

dopamine agonists

which tracts do you lose in Friedrich ataxia

dorsal column and dorsal root--> loss of position and vibration sense spinocerebellar and lateral corticospinal tract-->gait ataxia and spastic muscle weakness

forms the pancreatic tail, body, superior aspect of the head, and accessory pancreatic duct

dorsal pancreatic bud

side effect of chloramphenicol

dose dependent = anemia, leukopenia, thrombocytopenia dose indendent = irreversible = aplastic anemia

sx of tracheoesohpageal fistula with esophageal atresia how does it form?

drooling, choking, coughing, and cyanosis with feeds (bc of reflux of breast milk and aspiration into the trachea/lungs) forms whenever the primitive gut fails to divide and separate esophagus and trachea. normally the trachea dvps from a diverticulum that forms from the primitive foregut. the diverticulum lengthens and separates to form resp tract, while foregut becomes esophagus

whenever you see multiple ring enhancing lesions in an HIV patient

due to toxoplasmosis suggests toxoplasmic encephalitis

Failure of recanalization associated with?

duedenal atresia Down Syndrome

what type of ulcers do you get with Zollinger Ellison syndrome? which MEN syndrome is it associated with?

duodenal and jejunal ulcers THE ULCERS ARE LOCATED BEYOND THE DUODENAL BULB!!! MEN1 with pancreatic endocrine tumors like ZE syndrome, glucagonoma, VIPoma, insulinomas

failure of gut recanalization is a possible mechanism for dvmt of

duodenal atresia

iron absorption

duodenum and proximal jejunum

how can you diagnose thiamine deficiency and what do you not want to do if someone has chronic thiamine deficiency

dx w erythrocyte transketolase activity do not give glucose infusion without thiamine supplementation bc you can cause acute cerebral damage

COPD = emphysema and chronic bronchitis which causes the destruction of idntraalveolar walls and diminishes elastic recoil of lungs, which results in air trapping which causes airway inflam and mucus hyper secretion, which further exacerbates the airflow limitation

emphysema chronic bronchitis

distended abd veins with ascites, and palmar erythema usually seen in pts with? you see splenomegaly secondary to?

end stage liver disease to portal HTN and seen in cirrhotic pts. not associated with acute hepatitis

where is the AV node located

endocardial surface of the right atrium near the insertion of the septal leaflet of the tricuspid valve and the orifice/opening o the coronary sinus

atypical endometrial cells that form glands

endometrial adenocarcinoma -occurs usually post menopausal and manifests w vaginal bleeding

dysmenorrhea, chronic pelvic pain, and infertility

endometriosis (endometrial glands usually implanted in ovaries) -endometrial glands sensitive to estrogen

bc pregnancy is a hyper coagulable state, what is the best treatment option for a DVT?

enoxaparin (lovanox) a low molecular weight heparin heparins don't cross placenta

cytokeratin is a good marker for what type of tumor

epithelial derived bc it makes up the cytoskeleton of most epithelial cells

____lies right behind left atrium so left atrial enlargement can cause?

esophagus; can cause dysphagia

which enzymes not functioning in essential fructosuria vs hereditary fructose intolerance

essential -fructokinase (fructose-->fructose 1 P) a benign condition bc fructose 1 P can be converted to fructose-6-P by hexokinase*** and it can be metabolized in glycolysis hereditary -aldolase B (fructose 1 P -->DHAP to glyceradlehyde) hypoglycemia and vomiting s/p fructose ingestion

ethanol estradiol 2. what do bisphosphonates inhibit

estrogen replacement therapy can increase risk of breast cancer 2. inhibits osteoclast mediated bone resorption

which nerve and muscle is at risk of getting injured during thyroidectomy?

external branch of the superior laryngeal nerve, it innervates the cricothyroid muscle (bc its close to superior thyroid artery and vein) the internal laryngeal is responsible for supraglottic sensation the rest of the laryngeal muscles are innervated by the recurrent laryngeal nerve

in men, what does pudendal nerve innervate so damage of it can cause?

external urethral sphincter, anal sphincter, sensory to external genitalia -external sphincter paralysis, loss of penile sensation, fecal incontinence

side effect of typical anti psychotics

extra pyramidal sx ADAPT Acute Dystonia {hours to days} Akathisia (restlessness) {days to months} Parkinsonism Tardive dyskinesia {months to years} caused by DOPAMINE D2 RECEPTOR BLOCKADE IN NIGROSTRIATAL PATHWAY

how is Hep A transmitted? common in areas with? outbreaks result from?

fecal oral route areas with overcrowding and poor sanitation from contaminated water or food, AND RAW OR STEAMED SHELLFISH IS A COMMON CULPRIT IN USA

the median nerve runs between the ___and ___muscles before crossing the wrist within the carpal tunnel

flexor digitorum superficialis and flexor digitorum profundus muscles

to tx benzo OD

flumazenil which is a GABA receptor antagonist

may be associated with HIV, heroin use, and sickle cell disease** effacement of foot processes on EM no immune complex deposits; negative IF

focal segmental glomerulosclerosis

people with chronic hemolytic anemia have an increase in ____requirements due to increased erythrocyte turnover

folic acid

epiglottis and piriform recess with swallowing

food is diverted by epiglottis laterally through the piriform recesses into the esophagus

buspirone

for generalized anxiety disorder (2nd line) stimulates 5HT1 A receptors does not interact w alcohol "I am always anxious if the BUs will be ON time, so I take BUSpirONe"

how to treat a panic disorder

for immediate: benzodiazapenes unless the pt has a hx of substance abuse!! long term: SSRI/SNRI; plus CBT

how does thyroid gland form

forms from evagination of the pharyngeal epithelium and descends to lower neck lowest part of evagination forms thyroid gland the remaining part forms the thyroglossal duct failure of migration causes thyroid to reside anywhere on thyroglossal duct's path

pick bodies are seen in

frontotemporal dementia aka Pick disease personality changes and aphasia

vomiting and lethargy after breastfeeding. impaired liver function (hypoglycemia, hyperbilirubinemia); E coli sepsis

galactosemia from GALT deficiency

what does AIRE gene do

gene responsible for expression of self antigens so mutations here will lead to autoimmune disease-->endocrine disorders

an oral glucose tolerance tolerance test is the preferred method for screening for?

gestational diabetes and cystic fibrosis related diabetes

spinal stenosis (most commonly caused by degenerative arthritis) -which ligament effected and sx?

get narrowing of spinal canal so compression of nerve roots-->LE pain, numbness, weakness onset of pain w walking extension of lumbar spine (standing walking upright) narrows canal and worsens sx while flexion (walking uphill, leaning on stroller) relieves pain LIGAMENTUM FLAVUM

granulomatous vasculitis granulomatous inflammation centered on the media with intimal thickening/fibrosis, elastic lamina fragmentation, and giant cell formation lesions are segmental so you need to biopsy a long segment of vessel

giant cell arteritis histo similar to takayasu-->but aortic branch involved instead

asides from low immunoglobulin levels, pts with X linked agammaglobulinemia have increased susceptibility to recurrent sinopulm infections, and ____gastroenteritis

giardia lamblia

can cross corpus callosum (butterfly glioma) pseudopallisading pleumorphic tumor cells**** found in cerebral hemispheres

glioblastoma multiforme

patient pays for all expenses associated w a single incident of care with a single payment. most commonly used during elective surgeries, as it covers the cost of surgery as well as the necessary pre and post operative visits

global payment

3rd pharyngeal/aortic arch (associated nerve and derivative)

glossopharyngeal nerve (CN9) -pharyngeal arch gives rise to parts of hyoid bone and stylopharyngeus muscle aortic arch forms COMMON and INTERNAL carotid arteries

what is the general sensation and gustatory innervation of the posterior 1/3 of the tongue

glossopuarngneal CN9

where does the missense occur in sickle cell disease

glutamic acid to valine substitution at position 6

side effect of niacin

gouty arthritis

length of brief psychotic disorder

greater than 1 day but less than 1 month

PTSD disturbance must last -insomnia, FLAHSBACKS, dissociative sx**, emotional detachment following the traumatic incident, avoidance, experiencing a potentially life threatening situation!!

greater than 1 month

most common cause of neonatal meningitis

group B strep followed by E Coli and Listeria monocytogenes

acute post infectious polyneuropathy characterized by nonspecific prodromal malaise and nausea followed by progressive, ASCENDING PARALYSIS

guillain barre syndrome

guillan barre vs botulinum

guillan barre -ASCENDING PARALYSIS -there is segmental demyelination and an endoneurial inflammatory infiltrate botulinum -DESCENDING PARALYSIS

what do you need to monitor after complete mole removed?

hCG levels to make sure its gone, you want to make sure no mets when hCG levels don't fall, this means that it is an invasive mole that invades myometrium can also be choriocarcinoma which is malignant form

the inhaled anesthetic that causes hepatotoxicity

halothane bc metabolized by cytochromee P450 system

benign lung tumor that is composed of lung tissue and hyaline cartilage. often calcified on imaging coin lesion w "popcorn calcifications"

hamartoma (another benign lesion is a granuloma--often due to Tb or fungus, especially histoplasma in the midwest***)

H2 blockers help treat? ` ID 10999

help reduce gastric acid secretion

dilated pupils**, yawning**, piloerection, lacrimation**, hyperactive bowel sounds** n/v/d, abd cramping, muscle aches

heroin withdrawal (Opioid)

vesicles, ulcers, then crusting fever, inguinal lymphadenopathy lies in the sacral dorsal root ganglia and can be reactivated to cause recurrent genital lesions

herpes virus type 2 genital herpes usually caused by herpes virus 2 HSV1 usually causes oral vesicles

different mitochondrial genomes within a single cell

heteroplasmy

describe V/Q at base of lungs

high V, high high Q = low V/Q

trendelenburg gait

hip drops down as ipsilateral foot is lifted off ground when there is injury to contralateral superior gluteal nerve or gluteus medium muscle L4-S1 injections in supermedial, inferomedial, inferolateral regions of butt risk injury to sciatic nerve inject in anterolateral region (von Hochstätter triangle)

what stimulates gastric parietal cells to secrete HCl?

histamine (released from ECL cells), binds to H2 receptors on parietal cells vagal stimulation (releases Ach, binds to M3 receptors) gastrin (released from G cells, binds to CCKB receptor; also binds to CCKB receptor on ECL cells which stimulates histamine secretion)

what happens when preformed histamine granules is released? (pathoma)

histamine induced vasodilation and increased vascular permeability; vasodilation occurs at arterioles and leaking of fluid occurs in post capillary venule* pathoma

what are O2 and CO2 levels during a panic attack

hyperventilation so you will have a decreased pCO2. hypocapnia causes decreased cerebral perfusion and therefore neuro sx

incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina

imperforate hymen

when is beta HCG detectable

in serum, one week after fertilization and detectable in urine 2 weeks after

decreased chest wall compliance increases or decreases CO2 levels

increase CO2 levels; bc decreased compliance would increase work of breathing which causes resp muscle fatigue and alveolar hypoventilation

fibrates MOA (ex. gemfibrozil, fenofibrate)

increase lipoprotein lipase so increases oxidation of fatty acids also inhibits cholesterol 7 alpha hydroxylase, so you have reduced bile acid production which decreases cholesterol solubility and favors formation of cholesterol stones

what is a huge risk with antipospholiid syndrome

increase risk of venous and arterial thrombosis and spontaneous abortion

deficient alveolar ventilation causes ___CO2 levels, which causes _______.

increased, respiratory acidosis

st john's wort is an ___of Cytochrome P450

inducer

where is brocas area

inferior frontal gyrus of frontal lobe L

a chimeric IgG1 monoclonal Ab to TNF alpha

infliximab

what does methotrexate inhibit?

inhibits dihydrofolate reductase a folate antimetabolite that blocks purine and pyrimidine synthesis

what does progesterone inhibit during pregnancy?

inhibits the anterior pituitary AND also suppresses FSH and LH release therefore high progesterone levels inhibit prolactin

parvovirus B19 manifestations

initially, nonspecific period of ha, coryza, GI sx. heavy viral shedding and viremia children: erythema infectious (fifth dz); rash on cheeks with circumoral pallor and fever; generalized rash on arms, legs, trunk adults: acute symmetric arthropathy, involves PIP, metacarpal, knee and ankle joints chronic hemolytic anemia: transient aplastic crisis the 2 listed above are characterized by formation of immune complexes with minimal viremia

how do you treat a pleural effusion? (what procedure)

insert a chest tube into 4th or 5th intercostal space at the anterior axillary or mid axillary line

how can erythrocytes produce no ATP

instead of doing glycolysis, they convert 1,3 BPG to 2,3BPG

explain the process of liquefactive necrosis with a brain infarction

interruption of blood flow to brain causes irreversible ischemic changes to neurons lysosomal enzymes are released from these neurons which result in degradation of the tissue in this area phagocytic cells then come in and remove the necrotic tissue-->this leaves a cavity then astrocytes come in and proliferate around the necrotic area with the formation of a scar (gliosis)

rheumatoid arthritis can cause a variety of pulm manifestations, the most common is____

interstitial lung disease. methotrexate used for RA tx and can also cause interstitial pneumonitis and fibrosis

what reduces gastric acid secretion?

intestinal phase ileum and colon secrete peptide YY which bind to ECL cells and prevent gastrin stimulated histamine release from ECL cells (while cephalic and gastric phase stimulate gastric acid secretion)

which regions of the lung will be affected with aspirating while supine

into the posterior segments of the right upper lobes and superior segments of the right lower lobes

how does AAT look in a liver biopsy

intracellular granules within periportal hepatocytes. globules are stained reddish pink with the periodic acid schiff reaction and resist digestion by diastase (an enzyme that breaks down glycogen)

a prussian blue stain detects____ golden cytoplasmic granules in macrophages that turn blue with Prussian blue staining is consistent with?

intracellular iron hemosiderin laden macrophages -if it turns blue that means there is iron in it. macrophages digest RBCs and convert the iron in the Hb to hemosiderin

zinc fingers help bind to DNA. so which type of hormones will contain zinc fingers binding domains?

intracellular receptors bc these receptors go into the nucleus and bind to DNA to regulate gene expression ex. steroid receptors (estrogen, aldosterone, cortisol), thyroid hormone, and fat soluble vitamin receptors

what are charcot bouchard aneurysms

intracerebral hemorrhages associated with HTN common locations = basal ganglia, cerebellum, thalamus, pons involves small penetrating branches of the cerebral arteries ID498

what to prophylax preggo moms with if they are + for group B strep (strep agalactiae)

intrapartum pencillin, with ampicillin as an alternative to prevent sepsis, meningitis, pna

problem with long term use of hydroxychloroquine

irreversible retinal damage

encapsulated gram negative lactose fermenting bacilli

klesbiella

what is the most potent chemotactic eicosanoid?

leukotriene B4-->stimulates neutrophil migration to sites of inflammation

which inflamm mediators in atopic/extrinsic allergic asthma produce bronchospasm that is relieved by pharm antagonists?

leukotrienes LTC4, LTD4, LTE4 and acetylcholine

what type of necrosis do you see after hypoxic CNS injury

liquefactive necrosis

congenital absence of gyro

lissencephaly brain surface has a smooth appearance

what is lithium induced nephrogenic diabetes insipidus

lithium is usedto treat bipolar disorder and it inhibits ADH in the collecting tubules

how do you get liver disease with alpha antitrypsin deficiency

liver disease dvps due to intrahepatocyte accumulaiton of polymerized AAT molecules. THIS CAN PROGRESS TO CIRRHOSIS-->2nd most common cause of death in these individuals and hepatocellular carcinoma.

Wilson disease. where do you see copper accumulation? how is extra copper eliminated?

liver, eye, brain copper-->liver where it is incorporated to form ceruloplasmin-->secreted into plasma (circulating copper) unabsorbed copper and old ceruloplasmin are secreted into the bile and exerted into the stool

exposure to arsenic (pesticides), thorotrast (a former radioactive contrast medium) and polyvinyl chloride (a plastic widely used in industry)

liver/hepatic angiosarcoma expresses CD31 = PECAM1 (platelet endothelial cell adhesion molecule) -it is expressed on surface of endothelial cells

what houses norepinephrine secreting neurons that participate in fight or flight? it is located in the dorsal pons.

locus ceruleus "NEw LOok"

what is the area that is described as a a paired pigmented brainstem nucleus located in the posterior rostral pons near the lateral floor of the 4th ventricle

locus ceruleus which synthesis NE

what type of neurons and where do you lose it in parkinsons

loss of dopamine neurons in substantial nigra pars compacta

agammaglobulinemia causes an absence of B cells. which area in the lymph node doesn't form?

lymphoid follicles and germinal centers don't form in the lymph node cortex

a cause of hyperCa of malignancy is 1,25 dihydroxyvitamin D tumor type? mechanism? diagnostic ?

lymphoma increased calcium absorption decreased PTH and increase Vitamin D

cross linking in elastin monomers is facilitated by what?

lysyl oxidase

CD14 cell surface protein is a receptor for

macrophages A SURFACE MARKER FOR THE MONOCYTE-MACROPHAGE LINEAGE

semi membranous insertion site

medial condyle of tibia most medial of hamstring muscles

remnant of umbilical arteries

medial umbilical ligaments

adult brain tumor with whorled pattern; psammoma bodies

meningioma

what are zinc containing enzymes that degrade components of the ECM and BM, which are composed primarily of laminin and collagen IV and VII

metalloproteinases

fetal genitourinary tract is derived from (2) i took pic

metanephric blastema and ureteric bud (dorsal outgrowth of mesonephric duct) metanephric blastema = renal parenchyma ureteric bud = renal pelvis and ureters through dilation and canalization

what histo finding do you see in Reye syndrome

micro vesicular steatosis of hepatocytes without inflammation, necrosis and cerebral edema when 5-14yo use asa for URI 1. hepatic dysfunction-->increased ALT, AST, ammonia, bilirubin and prolonged PT and PTT 2. encephalopathy-->bc of toxic effect of hyperammonemia on CNS leading to cerebral edema

what is the most common vasculitis associated with abx use

microscopic polyangitis

the glands are tubular, narrow, and lined with pseudo stratified, elongated, mitotically active epithelial cells stratum functional contains compact, non edematous stroma no secretions in lumens, uterine glands increased in length

mid proliferative phase

which artery in epidural hematoma

middle meningeal artery

most common childhood nephrotic syndrome

minimal change disease -effacement of foot processes -may be associated with Hodgkin Lymphoma

the red nucleus is located in the anterior midbrain and participates in __-

motor coordination of the upper extremities

what is the primary means of eliminating MEDIUM particles that lodge in the bronchi and PROXIMAL bronchioles

mucociliary transport

what is familial hypercholesterolemia and what other organ is involved and why?

mutations in the LDL receptor gene most of plasma LDL is cleared by LDL receptors in the liver with this mutation, get fast progression of atherosclerosis -->complications include coronary artery disease "LDL PARTICLE UPTAKE BY HEPATOCYTES

red acid fast bacilli and caseating granulomas

mycobacterium Tb

CTG expansion sustained muscle contraction (myotonia) difficulty loosening one's grip cataracts seen in almost all patients

myotonic muscular dystrophy

what is characterized by poorly regulated rapid eye mvmt (REM) sleep. it frequently causes excessive daytime sleepiness but pts also have cataplexy, sleep atacks, hallucinations, and sleep prarlysis

narcolepsy

brain natriuretic peptide induces a diuretic, natriuretic and vasodilatory effect by antagonizing the actions of RAAS. inhibiting _____leads to increased levels of endogenous natriuretic peptides which promote beneficial effects in heart failure

neprilysin (a metalloprotease that cleaves and inactivates endogenous peptides)

neuroendocrine markers in small cell carcinoma

neural cell adhesion molecule (NCAM or CD56) neuron specific enolase*, chromogranin*, and synaptophysin some small cell carcinomas also express neurofilaments

neural crest cell migration (weeks present during gestation) (give rise to ganglion cells of Meissner and Auerbach plexus)

neural crest cells move caudally at 8th week, present in proximal colon at 12th week, in the rectum Hirschsprung disease -->rectum and anus always involved bc cells migrate caudally

side effect of valproic acid

neural tube defects so it is contraindicated in pregnancy giving folate (B9) helps reduce the risk

opsoclonus myoclonus syndrome (non rhythmic conjugate eye movements and involuntary jerking mvmts of the trunk and limbs) <2yo w abd mass periorbital ecchymosis from mets elevated catecholamine levels **biopsy is dx w small round blue cells and Homer Wright rosettes

neuroblastoma

pts dvp bilateral cranial nerve VIII (8) schwannomas and multiple meningiomas

neurofibromatosis type 2 (autosomal dominant nervous system tumor syndrome)

what is an adverse reaction to anti psychotic medications characterized by diffuse muscle rigidity, high fever, automoinc instability (HTN and tachy), and altered sensorium creatine kinase elevation due to rhabdo

neuroleptic malignant syndrome **blokcing dopamine receptors in the brain

if something stains for synaptophysin, that means it is of ___origin

neuronal

loss of neurons and functional groups of neurons reactive gliosis

neuronal atrophy; progressive degernative disease a glial scar = formed by astrocytic processes

which polypeptide neurotransmitter plays a role in appetite and pain perception

neuropolypeptide Y

physical features with glucagonoma

new onset diabetes mellitus (hyperglycemia) necrolytic migratory erythema -->painful rash overtime, erythematous papules coalesce to form large indurated plaques with central clearing that appears brown found in groin, face, extremities

are Hi histamine receptor antagonists good for treating asthma?

no they are good for treating chronic urticaria and allergy sx but not good for asthma

when there is obstruction of the normal flow of CSF from the ventricles to the subarachnoid space

non communicating hydrocephalus ventricles above the obstruction are enlarged while the ones below are normal

what type of hydrocephalus can occur with dandy walker malformation

non communicating hydrocephalus bc of the atresia of the foramina of luschka and magendie

what type of blockers immediately cause a progressive reduction with train of four stimulation?

non depolarizing NMJ blockers

how is the PT and PTT and fibrinogen in TTP-HUS

normal

how is the pupillary light reflex when there is a lesion of the lateral geniculate nucleus or the optic radiation

normal

Na levels in primary aldosteronism

normal you have increase in volume bc increase in Na, you have increased renal blood flow and ANP gets released, causing Na to be excreted

how does the mucosa look like in its with primary lactate deficiency?

normal lactose-->glucose and galactose excess lactose attracts water -->osmotic diarrhea

how is the bleeding time with any of the Hemophilias

normal bleeding time but prolonged PTT

how do the kidneys look in newborns w autosomal dominant PKD

normal. cysts are present at birth but too small to be detected on US. over the years they enlarge, compression of the renal parenchyma occurs and pt becomes asx

inhalation with heart and what happens with cardiac tamponade

normally -when you inhale, that creates a negative pressure which pulls blood into the heart (so it helps increase venous return) -the right ventricle dilates into the pericardial space to accommodate increased volume WITHOUT affecting LV with cardiac tamponade -with inspiration, the RV cannot move into the pericardial space bc its filled with fluid so the RV pushes the septum to the LEFT -therefore, decreased left ventricular diastolic volume, stroke volume AND DECREASED SYSTOLIC BLOOD PRESSURE**

how do you get V/Q mismatch whenever you give high oxygen concentrations to a patient with COPD? v/q mismatch is the major cause of oxygen induced hypercapnia***

normally in COPD, they have areas of hypoventilation in their lung. so the body compensates by moving perfusion from those areas via hypoxic vasoconstriction to areas with higher ventilation so now V/Q ratio is closer to 1 bc the perfusion now matches ventilation more closely whenever you give someone O2, it causes there to be increased perfusion in the areas of hypoventilation (reverses hypoxic vasoconstriction). the increased perfusion/blood is coming from areas of normal ventilation so now the normal alveoli are losing blood supply which increases V/Q ratio giving you dead space (blood is diverted from well ventilated regions) https://www.youtube.comwatch?v=YS17o0VC-14 "oxygen induced hypercapnia)

how do you get vancomycin resistance in Vancomycin resistant Enterococcus

normally vancomycin binds to D-alanyl-D-alanine binding site in the cell wall. with resistance, there is an alteration in the vancomycin binding site to D-alanine-D-lactate -the resistance is acquired during peptidoglycan cell wall synthesis

what happens in midgut malrotation

normally, at 6 weeks, the mid gut (supplied by SMA), herniates through umbilical ring and rotates 90 degrees counterclockwise. midgut returns in abd 8-10 weeks and turns an additional 180 degrees counterclockwise so that the gut is fixed to posterior abd INCOMPLETE COUNTERCLOCKWISE ROTATION (180 degrees) will result in MIDGUT MALROTATION -cecum in RUQ instead of RLQ Ladd's fibrous bands also end up connecting the retroperitoneum in the RLQ to the right colon/cucum by passing over the duodenum-->causing INTESTINAL OBSTRUCTION the mesentery is also susceptible to twisting around the superior mesenteric artery-->volvulus (volvulus is when the bowel twists on itself and can obstruct the vascular supply)

relationship of fatty acids and insulin resistance physical sign of insulin resistance

normally, insulin prevents lipolysis in adipose tissue with insulin resistance, you have increased lipolysis therefore increased free fatty acids ACANTHOSIS NIGRICANS (darkening of skin in folds and creases)

an absent thymic shadow indicates?

not good quantity and functioning of T cells

dx of gonococcal cervicitits

nucleic acid amplification testing sx: purulent or mucopurulent discharge; friable cervix with easy bleeding

where does ribosomal RNA transcription occur

nucleolus

which part of the cell is involved with maturation and assembly of ribosomal subunits

nucleolus

what houses the cell bodies of cholinergic neurons? in alzheimers, these neurons secrete decreased amounts of Ach

nucleus basalts of Meynert "A CHoice May Not BE Salient" ACh Meynert

what is caused by restricted expansion of the chest wall due to severe obesity. this leads to hypoventilation with a chronically elevated PCO2 and reduced PO2

obesity hypoventilation syndrome (pickwickian syndrome) RESTRICTIVE DISEASE

what is the initiating event of obstructing the acute appendicitis?

obstruction of the lumen

does L to right shunt cause hypoxemia and when do you see it?

occurs with cardiac septal defects so arterial blood is shunted from L heart which has higher pressure to R heart with lower pressure. bc arterial blood has higher PO2 then venous blood, L--R shunt does not cause hypoxemia

adjustment disorder length

occurs within 3 months of an identifiable psychosocial stressor (ex. divorce, illness) lasting less than 6 months once the stressor has ended if stress continues more than 6 months, then it is GENERALIZED ANXIETY DISORDER

how to treat carcinoid syndrome for sx pt

octreotide

forced vital capacity in COPD is normal or decreased bc

of expiratory airflow obstruction which lowers the total expiratory volume FVC is the TOTAL amount of air that can be forcibly exhaled from the lungs after taking the deepest breath possible while FEV1 measures how much air a person can exhale during a forced breath in the first second

tumor that involves the white matter of the cerebral hemispheres chicken wire capillary pattern

oligodendroglioma

what is an effective subcutaneous injection to give to asthmatics to reduce dependence on both oral and inhaled steroids and why?

omalizumab!! it is an anti-IgE antibody it is a recombinant IgG1 monoclonal antibody that binds to IgE so it inhibits IgE from acting with its receptor on mast cells..etc to decrease allergic response

where in the nephron does ADH act and what happens

on medullary segment of the collecting duct and increases urea** and water reabsorption It also acts on cortical segment to increase water reabsorption the medullary intersitium is the region of highest osmolarity in the kidney ADH acts on V1 receptor to cause vasoconstriction and increase prostaglandin release acts on V2 receptors to result in antidiuretic response (DESMOPRESSIN ACTIVATES V2)

what do you give neonates for neonatal abstinence syndrome? (due to maternal drug use)

opioid therapy (morphine, methadone)

what intoxication? -miosis, depressed mental status, decreased RR, decreased bowel sounds, hypotension, bradycardia

opioids give naloxone to tx

what helps reduce the risk of ovarian cancer?

oral contraceptives, breast feeding, multiparity increased risk with Lynch syndrome (combo of ovarian, colon, breast, and endometrial cancer), BRCA1,2 mutations, post menopausal hormonal therapy, infertility...etc CA-125 is a marker for ovarian cancer (not sensitive or specific for ovarian cancer however bc its expressed by epithelial cells lining reproductive tract)

where do the umbilical arteries originate and what does it carry?

originate from the fetal internal iliac arteries and carry deoxygenated blood back to the placenta via umbilical cord

how does heat stroke cause end organ damage and how to treat heat stroke

oxidative P ceases and ATP becomes rapidly depleted, leading to end organ damage (>108) rapid external cooling

**isolated elevated levels of alkaline phosphatase biopsy shows mosaic pattern of lamellar bone with irregular haphazard oriented sections separated by prominent cement lines; thick sclerotic bone that fractures easily

paget disease stage 1: osteoclastic 2; mixed 3; osteoblastic cement lines represent previous areas of bone resorption

substance P mediates

pain signals so more substance P = more pain

what is dactylitis and it is a common presentation in young children with what disease?

painful swelling of the hands and feet, results from small infarctions in the bones of the extremities sickle cell disease

vagus nerve works on the ___nervous system, and when it is stimulated, ___is released which causes _____in the airways by acting on the ____receptors. which drug is an anticholingeric agent and derivative of atropine that blocks the action of Ach at the muscarininc receptors

parasympathetic; Ach; bronchoconstriction; muscarinic ipratropium

complication with thyroidectomy and what to do

parathyroid glands can be damaged so hypocalcemia need to give oral calcium and vitamin D(calcitriol is the active form) ***

what is unchanged with nitrate poisoning which leads to methemoglobin formation

partial pressure of oxygen in the blood, this is the amount of oxygen dissolved in the plasma -BC THIS IS NOT RELATED TO HB FUNCTION Fe (hb)-->Fe3+ (methemoglobin) -binds tightly to cyanide, causes dusky skin discoloration, and can't carry O2

which enzymes are deficient in PKU

phenylalanine hydroxylase or BH4 deficiency tx w low phenylalanine diet and BH4 supplementation BH2-->BH4 via dihydrobiopterin reductase

balanced translocation between chromosome 9 and 22 that produces an oncogenic fusion gene (BCR-ABL) associated with CML

philadelphia chromsome

what do you treat an atropine or scopolamine overdose with ?

physostigmine bc it is an AchE inhibitor which allows more Ach in the synapse to move the drugs off the of receptor

the compulsive consumption of a non food and or non staple food source for >_ 1 month 3 types -earth/soil rich substances -raw starch such as flour or cornstarch -ICE**

pica -associated with nutritional deficiencies

which recess lies on either side of the laryngeal orifice and bound medially by aryepiglottic folds and laterally by thyroid cartilage and thyrohyoid membrane.

piriform recess

Fish bones and chicken bones can become lodged in...? and ____nerve can be damaged by the bones or attempt to remove them

piriform recess; internal laryngeal nerve

pol genes and HIV

pol gene mutations are associated with gaining resistance to anti retroviral drugs (polonged use of HAART) resistance to protease inhibitors and reverse transcriptase inhibitors

what type of hydramnios will you get with a fetus that has esopageal or duedenal atresia?

polyhydramnios bc the fetus cannot swallow the amniotic fluid

autoimmune liver disease with destruction of intrahepatic bile ducts and lymphocytic inflammation

primary biliary choangitis -autoimmune liver disease so you see it with other autoimmune disorders elevated serum alk phos, and antimitochondrial Ab is positive

autoimmune granulomatous destruction of bile ducts

primary biliary cirrhosis -common in women -anti mitochondria Ab present

anti mitochondrial Ab found in 2. HLA B27 is seen with

primary biliary cirrhosis, which typically present with cholestatic sx 2. with seronegative spondyloarhtropathies (ankylosing spondylitis, reactive arthritis, arthritis associated with IBD, psoaritic arthritis)

primary vs secondary erythrocytosis

primary is with low EPO levels, caused by myeloproliferative disorders like polycythemia vera secondary is high EPO levels caused by chronic hypoxia from high altitudes, smoking, or COPD

function of Type II pneumocytes

produce pulmonary surfactant and can proliferate in response to an injury (they can make more Type I and type II pneumocytes)

complications of psoariasis

psoariatic arthritis nail pitting uveitis

____could be pierced by a penetrating injury to the second intercostal space at the left sternal border

pulmonary trunk

internal vs recurrent and external laryngeal nerves

recurrent and external carry motor fibers to muscles involved in vocal cord function

a rare form of marrow failure characterized by severe hypoplasia of marrow erythroid elements (low erythrocyte count, low percentage of reticulates, low Hb) WITH normal levels of WBCs and platelets

red cell aplasia

what is major basic protein released by? what does it do? what does it contribute to in atopic extrinsic asthma?

released by eosinophils (pink in stain) and functions to kill helmiths it contributes to the bronchial epithelial damage sustained by pt w atopic asthma-->BRONCHOCONSTRICTION late phase rxn

which increases more in obstructive diseases, RV or TLC?

residual volume!!! TLC increases primarily through the expansion of RV

what is the problem with leukocyte adhesion deficiency 1

results from the absence of CD18 so you cant synthesize and form beta integrins no pus formation and delay of separation of hte umbilcal cord

reversible or irreversible cell injury = disaggregation of granular and fibrillar elements of the nucleus AND disaggregation of polysomes

reversible

broad ribbon like hyphae with rare septations

rhizopus causes lung disease in immuno pts

broad based hyphae with irregular branching and rare septations

rhizopus causes rhino orbito cerebral infection in immuno pts

what type of endocarditis do you get with IV drug users

right infective endocarditis which involves tricupsid valve due to Staph aureus

what is the most common cause of osteomyelitis in children with sickle cell disease

salmonella followed by staph aureus and e coli

non caseating granulomas (giant cells present)in African American females in multiple organs restrictive lung disease most likely due to TH1 CD4 helper T cell response elevated ACE, hypercalcemia**

sarcoidosis

african american cough and dyspnea bilateral hilar adenopathy pulmonary reticular infiltrates hypercalcemia elevated serum ACE level NON caseating granulomas describes what?

sarcoidosis -formation of noncaseating granulomas** which produce ACE and the active form of vitamin D (1,25 dihydroxy cholecalciferol) so pts have elevated levels of Ca and ACE levels!!

glycopyrrolate, hyoscyamine, propantheline

selective muscarinic antagonists helps improve side effects of AchE inhibitors without affecting their action on skeletal muscle which uses nicotinic receptors

is the most common epithelial ovarian malignant cancer that presents in a post meno woman who has an adnexal mass without excess hormonal activity psammoma bodies are concentrically laminated, calcified spheric deposits found often bilateral*

serous cystadenocarcinoma

a small pulse amplitude (pulsus parvus) with a delayed peak and slower upstroke of the arterial pulse (pulsus tardus)

severe aortic stenosis

chemotherapeutic agents listed are associated with what? daunorubicin doxorubicin epirubicin idarubicin what blocks it?

severe cardiotoxicity -forms free radicals-->swelling of sarcoplasmic reticulum-->lose cardiomyocytes SEEN IN DILATED CARDIOMYOPATHY dexrazoxane which blocks free radical formation

caused by a variety of mutations in different genes that result in impaired T and B cell development and function

severe combined immune deficiency (SCID) so you get bad cell mediated and humoral immunity and dvmpt of severe viral and bacterial infections

irritation of the parietal pleura causes what sx?

sharp pain which is worse with inspiration!! you can get irritation of the pleura from anything that causes inflamm of the pleura like infection, PE, uremia, PNA

what is the most important risk factor to dvping chronic bronchitis

smoking

first and second most common cause of hematogenous osteomyeltisi in kids

staph aureus and then strep pyogees (group A strep)

how to differentiate streptococci from staphylococci

strep = catalase negative staph = catalase +

germ cell tumor of the ovary that causes hyperT by secreting thyroxine

struma ovarii

ability to decompose hydrogen peroxide

suggestive of presence of catalase which indicates Staph (in clusters not chains)

scrotum drainage

superficial inguinal lymph nodes

why is it called normal pressure hydrocephalus

the impaired CSF absorption is chronic so the ventricles enlarge slowly, which allows the CSF pressure to normalize

the genital tubercle becomes penis in men and clitoris in women. genital tubercle normally grows in cranial direction. if it doesnt, what happens in males?

the urethral opening is on top of penis shaft (epispadias)

the vas deferens is a duct from epididymis to the ejaculatory duct and also stores and protects sperm. what happens with vasectomy? (the epidydimis also stores, matures and transports sperm)

the vas deferens gets transected but there can still be viable sperm distal to the ligation s/p 3 months

complication with roux en y gastric bypass surgery in terms of small intestinal bacterial overgrowth

these bacteria produce vitamin K and folate causes a deficiency in B12,vitamin A, D, and E, iron, and zinc

Campylobacter jejuni Entamoeba histolytica Giardia lamblia Shigella what is all in common?

they all can cause diarrhea with only a small number of organisms

what do K sparing diuretics do and where do they act?

they antagonize the effects of aldosterone on the late vital tubule and cortical collecting duct***

explain why you get thrombosis and pancytopenia in PNH

thrombosis bc release of prothrombotic factors from the lysed RBCs and paletels pancytopenia from stem cell injury

_______is a monoclonal antibody targeting HER2/neu receptor that is effective against breast cancer

trastuzumab

what do you give breast cancer patients that have HER2+

trastuzumab bc it prevents activation of tyrosine kinase HEr2 is a tyrosine kinase receptor

how to treat PTSD

trauma focused CBT antidepressants = SSRI, SNRI -SSRI have best efficacy prazosin for nightmares

an atypical antidepressant typically used for insomnia. high doses needed for anti depressant effects. side effects: sedation, nausea, priapism***, orthostatic hypotension

trazodone "traZZZZoBONE" due to sedative and male specific side effects if priapism left untreated, can cause damage to penile tissue and permanent erectile dysfunction serotonin modulator (blocks 5Ht2), blocks alpha 1 adrenergic (hypotension), and H1 receptors (sedating)

c7,c8

triceps reflex

what do you treat nocardia with?

trimethoprim-sulfamethoxazole

T/F. Methotrexate causes a side effect of pulmonary fibrosis and MUCOSITIS!**

true lose mucosal integrity bc of DNA damage which causes cytokine release nad cytokines damage the epithelium

T/F. soemtimes with histoplasma capsulatum infection, some people can dvp acute pulmonary disease

true ; it can also cause lymphadenopathy

chymotrypsin, phospholipase A2, and elastase are all activated by?

trypsin if trypsin is not activated, leads to protein and fat malabsorption bc trypsin activates enzymes required for both lipid and protein digestion

a cause of hyperCa of malignancy is bone mets tumor type? mechanism? diagnostic?

tumor type -breast -multiple myeloma mechanism -increased osteolysis diagnostic -decreased PTH and PTHrP -decreased vitamin D

type 1 vs type II muscle fibers

type 1 -aerobic metabolism, so high myoglobin (O2 storage) and mitochondrial concentrations (aerobic respiration) type II -get ATP from anaerobic glycogenolysis and glycolysis type IIa -in between type I and II and generate APT via aerobic metabolism

sub endothelial deposits associated with Hep B and C infection thick glomerular basement membrane with tram track appearance due to immune complex deposition so granular IF

type I membranoproliferative glomerulonephritis type II is INTRAMEMBRANOUS DEPOSITS and associated with C3 nephritic factor***(autoAb that stabilizes C3 convertase)

which one always presents with bloody diarrhea

ulcerative colitis

afferent limb for aortic arch baroreceptors

vagus nerve

Beta 2 receptor w lung

vasodilator

pie in the sky

visual info from lower retina-->temporal lobe (Meyer's loop)-->lingual gyrus

what is chloride shift in RBCs do you have more Cl in arterial or venous blood??

when carbonic anhydrase forms bicarb from CO2 and water. then the bicarb leaves the RBC into the plasma and Cl diffuses into the RBC to take their place more Cl in venous blood bc venous blood is deoxygenated blood which has high CO2 and low O2. so CO2 from the tissues diffuses into the RBCs CO2+H2O -->H2CO3-->H+ + HCO3- H+ combines with Hb HCO3 out of cell and CL comes in

graft vs host disease

when donor T cells from the graft recognizes the host MHC antigens are foreign and participate in host cell destruction this is different from acute and chronic graft rejection bc GVHD involves other organ systems

what is the difference between a localized carcinoid tumor and metastatic carcinoid tumor

when the tumor is localized and confined to the intestine, the vasoactive substances get metabolized in the liver via first pass metabolism when the tumor spreads to the liver, the vasoactive substances do not go through first pass and enter systemic circulation, causing carcinoid syndrome -if the tumor is also located extra intestinally, it can cause the same thing too

how to tell the difference of riscocetin test with vWF disease and Bernard Soulier syndrome

when you add riscocetin, they both will result in abnormal plaletet aggregtaion BS syndrome is defect in glyoprotein 1b receptor however with BS syndrome, when you add normal plasma that has normal vWF, you will still not get any platelet aggregation bc the receptor is the problem

when do you lose cardiomyocyte contractility after the onset of total ischemia? when does ischemia become irreversible?

within 60 seconds ischemic injury irreversible after 30 minutes with ischemia levels, ATP levels fall while lactate levels rise

what do you give to preggo moms at risk for premature labor to help with patient survival?

you give corticosteroids like beta or dexamethasone bc it increased Type II pneumocyte maturation so they can increase surfactant production which hellps decrease resp distress

results of Sheehan syndrome

you have a pt s/p baby delivery and she cannot lactate. during delivery, there is a lot of blood loss. the anterior pituitary is fed by the venous system which is a much lower pressure system so with an infarct, the AP will be more affected During pregnancy, the pituitary is enlarged due to estrogen induced hyperplasia of lactotrophs but blood supply doesn't increase ISCHEMIC NECROSIS OF PITUITARY GLAND hypocortisol, hypothyroid

how can you get secondary hyperaldosteronism

you have an increase in renin synthesis which causes an overproduction of aldosterone high renin and high aldosterone levels ex. renovascular HTN, malignant HTN, renin secreting tumor, diuretics

how do kidney stones form in pt with Crohn's disease

you have fat malabsorption in the ileum, so then the fat binds to Calcium now oxalate gets reabsorbed in the gut

S4 sound

you hear it with decrease in left ventricular compliance such as with a stiff left ventricle like restrictive cardiomyopathy and left ventricular hypertrophy S4 normal in older pts but pathologic in younger

what is the best medication to give for motion sickness and why/ what side effects do you see?

your get motion sickness when there is conflicting input with the vestibular, visual and somatosensory systems. integration of these systems occur at the vestibular nuclei via M1 and H1 neurotransmission therefore, you want to block this transmission 1. antimuscarinic agents (scopolamine) 2. anti histamines (meclizine, dimenhydrinate) anticholinergic side effects = blurry vision, dry mouth, urinary retention, constipation

name 2 LTD4 receptor antagonists that offer long term control of atopic asthma by increasing airway caliber and reducing mucosal inflamm?

zafirlukast and montelukast

defective peroxisomal biogenesis and presents wth craniofacial abnormalities, like wide store and large anterior fontanelle, hepatomegaly, and near defects

zellweger syndrome

list examples of delayed type hypersensitivity rxn

-contact dermatitis -granulomatous inflammation -tuberculin skin test -candida extract skin rxn

what causes a left shift in O2 Hb curve

-decreased H aka increased pH -decreased 2,3 BPG -decreased temp "think Lungs, Left shift)

What is the problem with using digoxin in the elderly? what are some of the toxicities?

-digoxin is renaly cleared and with normal kidney function, has a half life of 1.5 days. When pts age, their renal function decreases a lot. Elderly can still have a normal creatinine level bc creatinine comes from muscle tissue and muscle mass decreases with age. -visual changes and GI abnormalities

what do activated macrophages in sarcoidosis (and other granulomatous disease!!) express that leads to production of excess 1,25 dihydroxyvitamin D and hyperCa?

1 alpha hydroxylase bc 1 alpha hydroxylase converts 25 hydroxyvitamin D-->1,25 dihydroxyvitamin D in the kidneys

when do you see reactive gloss and vascular proliferation around the necrotic area and liquefactive necrosis? vs when you see glial scar formation

1-2 weeks vs >2 weeks

types of down syndrome

1. 21 (47, XX, +21) 2. translocation down syndrome with chromosome 14 and 21 -fusion of 2 long arms and fusion of 2 short arms -the affected parent is asx with this genotype 3. unbalanced robertsonian translocation -46XX, t(14,21) -when translocated chromosome gets fertilized

mcCune Albright syndrome 1. mutation and what does it cause?

1. GNAS gene mutation which encodes G protein-->constant G protein activation/cAMP/adenylate cyclase which leads to gain of function of the affected cells -perisistent activation leads to increased melanocyte activity -->cafe au lait macules with irregular borders*

1. _______is characterized by an eczematous exudate over the nipple and areola and is due to ductal spread of malignant cells to the nipple surface 2. small firm mobile breast masses that occur due to proliferation of breast stroma and ducts, with stroll proliferation compressing the ducts to slits

1. Paget disease of the nipple 2. Fibroadenomas

medications used to terminate pregnancy. MOA? 1. misoprostol 2. mifepristone 3. methotrexate

1. Prostaglandin E1 agonist -causes cervical softening and uterine contractions 2. Progesterone and glucocorticoid antagonist -bc progesterone is needed to maintain pregnancy, without it-->necrosis of the uterine decidua 3. folic acid antagonist -inhibits trophoblast division which hinders implantation

which organelle 1. drug detox; lipid, phospholipid, and steroid synthesis 2. protein modification, sorting and transport 3. oxidation of very long and branched chain fatty acids; hydrogen peroxide degradation 4. synthesis of integral membrane and secretory proteins

1. SER 2. golgi 3. peroxisomes 4. RER

function and innervation of rotator cuff muscles 1. supraspinatous (most commonly injured bc impinged b/n humeral head and acromion) 2. infraspinatous 3. teres minor 4. subscapularis

1. abduction and supra scapular nerve 2. external rotation and supra scapular nerve 3. adduction and external rotation; axillary nerve 4. adduction and internal rotation; upper and lower sub scapular nerve

1. deltoid innervation and mvmt 2. triceps innervation 3. infraspinatous nerve and mvmt 4. trapezius innervation; elevates rate and stabilize scapula

1. abduction of arm and axillary nerve; inured due to sudden or forceful loading of arm in abduction 2. radial nerve (C6-8, T1) 3. supra scapular nerve, externally rotates arm; injured w supraspinatous due to falls or overuse in older pt 4. cranial nerve XI; inured in whiplash MVA

what are the steps that a tumor penetrates the basement membrane

1. detach by decreasing E cadherin expression 2. adhere to BM by increasing expression of laminin which is an adhesion molecule 3. invade BM by secreting proteolytic enzymes like metalloproteinases

1. most common cause of nodular glomerulosclerosis? features?

1. diabetic nephropathy; Kimmelstiel-Wilson nodules Diabetic nehpropathy presents w glomerular BM thickening and increased mesangial matrix deposition. so overtime, expansion of the mesangium leads to the formation of nodules which compress the glomerular capillaries can lead to nephrotic syndrome and renal failure ID884

calcium channel blockers 1. affect arterial smooth muscle, causing vasodilation with little or no effect on cardiac conduction or contractility 2. affect the myocardium, slowing heart rate and reducing contractility

1. dihydropyridines -nifedipine, amlodipine, felodipine 2. non-dihydropyridine -verapamil, diltiazem

which lymph nodes recieve drainage from 1. from testes? 2. glans penis and superficial nodes (and clitoris) 3. from scrotum

1. para aortic nodes 2. deep inguinal nodes 3. superficial inguinal nodes superifical and deep inguinal nodes drain into external iliac nodes-->also drains deep lymphatics of abd wall below umbilicus

1. produces yellow gold pigments 2. produces green blue pigments 3. produces red pigments

1. staph aureus 2. Pseudomonas aeruginosa 3. Serratia marcascens

1. where in the ovary is androgens and progesterone synthesized? under influence of ? 2. after androgens are made, they go to _______which contain the enzyme ____to convert androgens to estradiol. stimulated by?

1. theca interna; LH 2. granulosa cells; aromatase; FSH v

which arch muscles of facial expression and stapedius lesser horn and upper body of hyoid bone; stapes, styloid process

2

when does rheumatic fever occur and is caused by what?

2-4 weeks after group A streptococcal pharyngitis (you get it if its not treated) due to molecular mimicry: anti strep Ab attack cardiac and neuronal antigens TREAT strep WITH PENICILLIN EARLY in order to reduce incidence of rheumatic heart disease and reduce problems with MITRAL VALVE

21 hydroxylase deficiency vs leydig cell hyperplasia

21 = increase in 17 hydroxyprogesterone and testosterone leydig = will not see increase in 17.... -excessive testosterone ,androstenedione, and DHEA

which arch right and left common carotid arteries and internal carotid arteries hyoid bone

3

mnemonic to remember serotonin syndrome

3 A's -increased neuromuscular ACTIVITY -AUTONOMIC STIMULATION -AGITATION sx of neuromuscular hyperactivity include clonus, hyperreflexia, hypertonia, tremor, sz, sx of autonomic stimulation include hyperthermia, diaphoresis, and diarrhea

niacin deficiency

3 D's Dermatitis, Diarrhea, and Dementia Niacin = B3 is synthenized from tryptophan and is needed to make NAD and NADP

withdrawal from alcohol in hours CHRONIC ETHANOL USE CAUSES DOWNREGULATION OF GABA RECEPTORS

3-36 hours: anxiety, insomnia, diaphoresis, palpitations, GI upset, tremors*** 6-48 hours: sz 12-48 hours: alcoholic hallucinxsis 48-96 hours: delirium tremens

RNA polymerase I functions exclusively to transcribe the _______ gene into a single template that is subsequently processed into mature 18S, 5.8S, and 28S rRNAs

45S pre-rRNA

in delayed hypersensitivity rxns, when do you see the effects following antigen exposure?

48 to 72 hours s/p antigen exposure

what is elevated in urine in carcinoid syndrome

5-HIAA ( a serotonin metabolite)

which arch recurrent lagyneal nerve right and left pulmonary arteries and ductus arteriosus intrinsic muscle of larynx except for cricothyroid muscle

6

which translocation is associated with Burkitt lymphoma

8:14 which is c-myc on the Ig heavy chain c-myc increases transcription

describe the type of vaccines (2) for strep pna (given to young children and elderly)

90 types of strep pna are distinguished based on their capsular polysaccharide 1. pneumococcal polysaccharide vaccine:bc polysaccharides alone cannot be presented to T cells, this induces a relatively T cell independent B cell response that is less effective 2. pneumococcal conjugate vaccine: -contains capsular polysaccharides from 13 serotypes that have been covalently attached to the recombinant inactivated diphtheria toxin. this protein conjugation induces active immunity via T cell dependent B cell response, resulting in improved immunogenicity due to formation of higher affinity Ab ID734

formula for alveolar ventilation

= (tidal volume - dead space volume) * breaths/min it does not include dead space volume bc it refers only to the volume of new air reaching the gas exchange areas per minute

delusional disorder

>_ 1 delusion for <_ 1 month in the absence of other psychotic sx behavior is not obviously bizarre and functioning is not significantly impaired apart from the direct impact of delusions an overriding delusion WITH A SPECIFIC THEME!

what happens to the LV volume with A FIB?

A FIB causes a loss of normal atrial contraction so the LV preload decreases and causes hypotension AND also causes pulm edema bc buildup of blood in LA and pulmonary veins -pts with aortic stenosis are really dependent on atrial contraction to maintain LV filling bc many have LV hypertrophy

which leukemia has Auer rods

AML

what does ubiquitin do

ATP dependent attachment to other proteins to label them for degradation

the human multi drug resistance gene codes for what to help resist chemotherapy

ATP dependent efflux pump

What type of channel is the CFTR transmembrane protein?

ATP gated so 2 ATP molecules bind which allow the transport of Chloride down its electrochemical gradient -Cl mvmt allows the transport of Na and water across the membrane

There is _______whenever the atria and ventricles depolarize independently of each other

AV dissociation AV nodal cells can become pacemakers when conduction between SA and AV nodes is impaired

alzheimers has a decrease in which neurotransmitter

Ach

which mediators are involved in vasodilation with the vascular endothelium?

Ach bradykinin serotonin Substance P shear forces

succinylcholine MOA complications?

Ach receptor agonist hyperCa, hyperkalemia, and malignant hyperthermia

Donepezil, rivastigmine, and galantamine

AchEsterase inhibitors used to tx alzheimers

hypotension, abd pain, vomiting, weakness, fever, how do you treat? you also see hyponatremia and hyperpigmentation

Addison's disease (addison crisis) treat with hydrocortisone or dexamethasone and IV fluids bc they can't make glucocorticoids it is opposite of cushings

a hypersensitivity rxn to aspergillum which leads to chronic inflammatory damage. usually seen in individuals with asthma or cystic fibrosis bc hypersensitivity = increased eosinophilia, high IgE levels will see bronchiectasis on CT scan bc of repeated exacerbations

Allergic bronchopilmonary aspergillosis broncho= larger airways

pleural thickening, calcified lesions (pleural plaques)** of the posterolateral middling zones and diaphragm fibrosis of lung and pleura (plaques) with increased risk for lung carcinoma and mesothelioma

Asbestosis -seen in construction workers, plumbers, and shipyard workers "golden brown fibers associated with iron" = asbestos fibers

what appears as septate hyaline hyphae on sputum analysis? that form acute angle V shaped branches

Aspergillus

which deficiency is associated with neuro sx and what type of anemia do you get w it

B12 deficiency megaloblastic anemia

cofactor for phenylalanine hydroxylase and tyrosine hydroxylase what is the problem when it is deficient?

BH4 (dihydrobiopterin reductase) -->BH2 you are gonna have elevated levels of phenylalanine and you are going to have LOW dopamine levels bc tyrosine can't be converted to dopamine no dopamine = no neurotransmitters EPI, NEPI, serotonin no dopamine = more prolactin!!

what type of stones would you expect to see in chronic hemolysis

BLACK pigmented stones bc there is increased amount of unconjugated bilirubin in bile radioopaque on xray bc lots of Calcium carbnonate and phosphates

mutation in pulmonary arterial HTN and what does the mutation cause. what is the second insult in pulm arterial HTN?

BMPR2 mutation (auto dominant) which causes smooth muscle proliferation second insult such as infection, drugs..etc activates the disease which involves increased endothelin (vasoconstrictor), decreased nitric oxide (vasodilator) an decreased prostacyclin (vasodilator and platelet inhibitor) end result -vasoconstriction with smooth muscle proliferation -intimal thickening and fibrosis -increased pulm vascular resistance -progressive pulmonary HTN

in alzheimers, there is a decrease in Ach level most notable i which area? which enzyme is decreased in activity? what other area in the brain is involved in alzheimres?

Basal nucleus of meynert choline acetyltransferase hippocampus

hypotension elevated JVP muffled heart sounds

Beck triad in cardiac tamponade

Ohio and Mississippi River valleys; GREAT LAKES REGION; found in soil pulmonary: pna disseminated form is common and severe culture: branching hyphae biopsy: large, round yeasts with doubly refractive wall and single broad based bud

Blastomyces dermatitis

omohyoid originates from what nerve roots

C1-3

how to calculate the probability of parents having a child with cystic fibrosis when they are both healthy? assume they are carriers

CF is auto recessive so the probability of child getting it is 1/4 (1/2 chance to get mutant allele from both parents). multiply 1/4 by the frequency of allele in that population

what expansion occurs in fragile X syndrome

CGG

pulmonary congestion is a finding with? pulmonary vascular obstruction is a finding with?

CHF pulmonary embolism or vasculopathy

which lymphoma is associated with JaK STAT

CML characterized as a myeloproliferative disorder

common causes of esophagitis in HIV pts?? when you see Pneumocytsis jirovecii, this usually infects immunocompromised its w HIV w CD4 cell counts <200

CMV-->large shallow linear ulcerations candida herpes simplex virus

gag reflex afferent and efferent limb

CN IX (glossopharygneal) and efferent limb is CN X

to treat lead poisoning

CaNa2EDTA

features of CREST syndrome

Calcinosis Raynaud's phenomenon Sclerodactyly (skin tightening over the fingers due to collagen deposition) Telangiectasia's CREST is a variant of systemic sclerosis

inflammatory gastroenteritis that can be acquired from domestic animas (cattle, sheep, DOGS, chickens) via fecal oral route. initially watery then bloody diarrhea. abd pain may mimic appendicitis. most common infectious agent associated with Guillan Barre syndrome

Campylobacter jejuni

which antigen is Rh

D antigen

what does carbidopa inhibit

DOPA decarboxylase which converts L dopa to dopamine in the periphery

agenesis of cerebellar vermis which leads to cystic enlargement of the 4th ventricle that fills the enlarged posterior fossa

Dandy Walker syndrome

22q11.2 deletion associated with tetralogy of Fallot truncus arteriosus transposition of the great arteries characterized by thick aplasia (T cell deficiency) and hypoparathyroidism (hypoCa)

DiGeorge Syndrome

pigment accumulation within hepatocytes

Dubin Johnson syndrome -causes conjugated hyperbilirubinemia

Displacement of a malformed tricuspid valve into the RV -presents as cyanosis and heart failure from severe tricuspid regurg

Epstein's anomaly

onion skin appearance on x ray malignant proliferation of poorly differentiated cells derived from neuroectoderm diaphysis of long bones 11;22 translocation**

Ewing Sarcoma -small round blue cells that resemble lymphocytes

inhibits cholesterol absorption from GI tract? ___is the most effective agent from raising HDL levels but does not reduce risk of CV events ____activates peroxisomal proliferative activated receptor alpha, a transcription factor that increase lipoprotein lipase activity

Ezetimibe Niacin (B3) fibrates

mneumonic to remember TTP

FAT RN Fever microangiopathic hemolytic Anemia Thrombocytopenia Renal failure Neuro sx*** like ha, confusion sz

achondroplasia is due to abnormalities in the

FGF receptor so results in congenital short limbed dwarfism (FGFR3 gene) fibroblast growth factors regulate chondrogenesis and osteogenesis and FGF induces proliferation of osteoblastic precursor cells and anabolic function of mature osteoblasts

what can you give to reverse the toxicity of methotrexate

FOLINIC ACID = LEUCOVORIN bc it is converted to THF and doesnt need dihydrofolate reductase

alpha galactosidase A deficiency which causes globotriaosylceramide (ceramide trihexoside) accumulation -neuropathic pain and angiokeratomas in adolescence and multi organ involvement in adulthood

Fairy disease

cataracts from _____ deficiency

GALK (galactokinase) (galactitol accumulation)

How can Group A streptococcus (GAS) pharyngitis lead to rheumatic fever via antigenic mimicry?

GAS and cardiomocytes have similar antigen protein sequences so if immune system mounts a response against GAS, it might also cause myocarditis and valve destruction over time

nocturnal cough, hoarseness, improvement with PPI, basal zone hyperplasia, elongation of the lamina propria papillae, scattered eosinophil and PMNs

GERD vs eosinophilic esophagitis-->intraepithelial eosinophils, also PPIs don't help

infiltration of the intestinal lamina propria with atypical lymphocytes

GI MALT lymphomas associated with chronic H pylori infection

which glut transporter is only responsive to insulin? where is it expressed?

GLUT4, expressed in skeletal muscle cells and adipocytes GLUT 1, 2, 3, 5 are insulin independent 1- in BBB 2-in pancreas beta cells 3-placenta and neuronal glucose transport 5-spermatocytes and GI tract

-agraphia (inability to write) -acalculia (inability to carry out math questions) -finger agnosia (inability to identify individual fingers on the hand) -left to right disorientation what syndrome and what part of brain?

Gerstmann syndrome angular gyrus of dominant parietal lobe area is needed for integrating multi sensory info to comprehend events and solve problems

with branches of carotid artery -muscle of jaw (jaw claudication) -temporla artery (ha) -opthalmic artery (visual disturbances) also have flu like sx with muscle pain=polymalgia rheumatica inflammatory infiltrate composed of lymphocytes (CD4) and M and multinucleate giant cells and intimal fibrosis; intimal thickening, elastic lamina fragmentation *elevated erythrocyte sedimentation rate and C reactive protein** how to treat?

Giant Cell (temporal) arteritis tocilizumab bc it blocks IL-6; this dz produces a lot of IL-6 and glucocorticoids DONE WAIT FOR BIOPSY, AND TREAT WITH CORTICOSTEROIDS dx with temporal artery biopsy (Dr Darrow lecture -->Th17 pathway is involved!)

what happens when dobutamine binds to beta 1 receptors

Gs protein GTP binding adenyl cyclase activation increased cAMP production Calcium channel activation and increased cytosolic Ca confo change in troponin complex, which facilitates actin-myosin binding and increasing myocardial contractility

what is the most important risk factor for dvping aortic dissection

HTN cystic medial degeneration, which may be seen in CT diseases, also predisposes pt to aortic dissection

what are non tender, macular, and erythematous lesions located on palms and soles seen in infective endocarditis? They are the result of?

Janeway lesions; they are the result of septic emboli from valve vegetations

a weak anti androgen that decreases synthesis of testosterone in the Leydig cells of the testes. it also inhibits steroid hormone production by the adrenals

Ketoconazole

a primary gastric tumor that has mets to the ovaries. histo includes nests of signet ring cells. and large amounts of mucin displacing the nucleus

Krukenberg tumor

conus medullaris syndrome refers to lesions at

L2

what heart problem can you get with SLE and where is it located

Libman Sacks Endocarditis the non bacterial thrombi are on both sides of the mitral valve, can be on aortic valve

complication of kawasaki dz

MI

genetic defects of insulin secretion

MODY = maturity onset diabetes of youth impairs glucose sensing and insulin secretion by pancreatic beta cells (problem w glucokinase**) glucokinase has lower affinity than hexokinase so it is a glucose sensor and it varies the rate of glucose entry based on blood glucose levels mutations in glucokinase decreases metabolism of glucose, less ATP formation, and diminished insulin secretion

what is a good stain for whipple disease

PAS bc disease caused by Tropheryma whippelii and it has glycoprotein in cell wall which is what PAS stains

Central and S America mucocutaneous: chronic mucocutaneous or cutaneous ulcers, can progress to lymph nodes and lungs culture: multiple blastoconidia Biopsy: cells covered in budding blastoconidia

Paracoccidioides brasiliensis (the 5 listed above and this one are all dimorphic fungi which means they grow as mold at 25-30C and as yeast at body temp 35-37C

virulence factor in Staph aureus

Protein A in the cell wall which binds to Fc region of immunoglobulins causes tracheitis (stridor, fever, resp distress)

blockage of fast Na channels can cause ___and ___prolongation. so a widened QRS interval or ventricular arrythmias are indicative for ___therapy?

QRS and QT sodium bicarbonate this can be caused by a tricyclic antidepressant overdose which blocks cardiac fast Na channels

normal dvmt until 5-`8months, followed by a loss of motor and language skills and the dvmt of stereotypic hand movements also see deceleration of head growth MECP2 gene mutations

Rett syndrome

a monoclonal Ab used in lymphoma therapy to target the CD20 surface immunoglobulin

Rituximab

a central line catheter is placed until the tip enters?? the cardinal veins gives rise to___? in the embryo, the common cardinal veins drain directly into?

SVC SVC sinus venosus

increased risk for Tb** impairs phagolysosome formation by M fibrotic NODULES in upper lobes the lung

Silicosis seen in sandblasters and silica miners

associated with gardening; often transmitted via thorn prick pustules, ulcers, and subcut nodules along the lymphatics culture 25C: branching hyphae biopsy: round or cigar shaped budding yeast

Sporothrix schenckii

which organisms most likely cause chronic granulomatous disease? what is this disease?

Staph aureus Burkholderia cepacia Serratia marcescens Nocardia Aspergillus (all are catalase +) impaired NADPH oxidase so now there is impaired intracellular killing by phagocytes catalase - organisms cannot destroy the hydrogen peroxide they produce

"several needle track marks on both arms" indicates IV drug users. ________can cause right sided endocarditis in IV drug users? what else can happen?

Staph aureus can cause perforations in heart valves, rupture chorda tendineae, and send septic emboli** to the lung (with right heart endocarditis) or to the brain and systemic circulation (with left heart endocarditis) septic emboli = "multiple lung opacities"

septic abortion is when there is infected retained products** of conception in the uterus. which organisms most likely cause? sx -tender uterus, dilated cervix, fever, chills, lower abd pain, bloody or purulent discharge

Staph aureus and E coli long term complications can be Asherman syndrome

lancet shaped gram + diplococci

Strep pna -causes lobar pna; most common cause of community acquired pna and secondary pna -it is bile soluble and cannot grow in presence of optochin -contains a polysaccharide capsule!!

beta hemolytic PYR negative CAMP + neonatal sepsis, PNA, meningitis, UTI

Streptococcus agalactiae

Which streptococcus causes subacute bacterial endocarditis? and what type of lesion is it associated with?

Streptococcus gallolyticus associated with GI lesions (COLON cancer) it is part of the the normal flora of the colon so bacteremia or endocarditis caused by this organism is associated with colon cancer -if found in the blood, need to be worked up for colonic malignancy with colonoscopy

beta hemolytic (complete hemolysis) PYR + bacitracin sensitive cellulitis, pharyngitis, erysipelas

Streptococcus progenies (GAS)

in primary biliary cirrhosis, what type of cell attack on the interlobular bile ducts??

T CELL ATTACK

no IL-12 means you can't differentiate into ____populations and therefore you can't synthesize ____ which is required for activation of macrophages

TH1; interferon gamma;

ulcerative colitis pathogenesis

TH2 cells which produce IL4,5,6 and 10

total lung capacity residuals volume forced vital capacity FEV1 diffusing capacity with aging?

TLC is unchanged bc decreased chest wall compliance and increased lung compliance counterbalances each other residual volume increases bc loss of elastic recoil forced vital capacity decreases bc RV increases FEV1 decreases diffusing capacity decreases

phosphorylation of serine and threonine residues of insulin receptor and insulin receptor substrate by serine kinase leads to insulin resistance. this type of phosphorylation can be induced by..? rephrasing what activates serine kinases?? these serine kinases phosphorylate serine residues on the insulin receptor and insulin receptor substates, which then prevents tyrosine from phosphorylating the substrate and now there is resistance to normal actions of insulin

TNF alpha, catecholamines, glucocorticoids, and glucagon ID 1326

Li Fraumeni syndrome is caused by an autosomal dominant mutation in the tumor suppressor gene _____

TP53

caseating granulomas are found in

Tb

how can yo tell the difference between a myasthenia gravis and cholinergic crisis?

Tension test (edrophonium -->a short acting AchE inhibitor) if sx improve-->MG if sx don't improve-->cholierngic crisis. too much AchE given so there is excessive stimulation of skeletal muscles which makes the muscle refractory to future impulses

immune response w lepromatous leprosy

Th2 mediated accumulation of acid fast bacilli w M dvp numerous, poorly demarcated plaques that are widespread across the body

during bacterial replication, if you see uracil associated with DNA fragments, what does that tell you?

This tells you that an RNA polymerase (primase) is used to make an RNA primer in order for DNA replication to occur. DNA polymerase uses the 3' hydroxyl end of RNA primer to initiate synthesis.

"polymorphic QRS complexes that change in amplitude and cycle length" during episodes and "QT prolongation" after the episodes

Torsades de pointes -a polymorphic ventricular tachy that is always associated with a prolonged QT interval!!!!

disease w abnormal dvmt of pharyngeal arch 1 AND 2

Treacher Collins syndrome

mnemonic to remember adverse effects of TCA's

Tri-C's -Convulsions -Coma -Cardiotoxicity = arrhythmia due to Na channel inhibition *confusion and hallucinations in elderly bc of anticholinergic side effects (nortriptyline better tolerated)

+ PAS diastase resistant granules small intestine mucosa contains enlarged, foamy macrophages packed with rod shaped bacilli

Tropheryma whippelii rare systemic illness involving intestine, joints, and CNS WHIPPLE DISEASE treat with abx

example of type 2 and type III hypersensitivity

Type II includes ABO blood group Type III includes immune complex, example=PSGN

xeroderma pigmentosum

UV rays lead to formation of thymine dimers defect in UV specfic endonuclease** nucleotide excision repair pathway is defective

what 2 substances predominately drive angiogenesis

VEGF and FGF vascular endothelial growth factor fibroblast growth factor

why does squatting help pts that have tetralogy of fallot?

VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy low systemic vascular resistance: pulmonary vascular resistance ratio squatting increases systemic vascular resistance bc it forces a higher proportion of right ventricular output to enter pulm circulation and oxygenate, which increases arterial oxygen concentration

physiologic dead space formula -it consists of both anatomic dead space of conducting airways and alveolar dead space (due to well ventilated but poorly perfused alveoli)

Vd = Vt * (PaCO2 - PeCO2/PaCO2) vd=physiologic dead space Vt=tidal volume arterial PCO2 and expired ari POC2 taco paco peco paco

comma shaped organism that can grow on high alkaline selective media; gram negative, oxidase + S shaped gram negative oxidase + ?

Vibrio cholerae Campylobacter jejuni

cerebellar hemangioblastomas + Angiomatosis + Renal cell carcinoma BILATERALLY + Pheochromocytomas

Von Hippel Lindau disease mnemonic is HARP deletion of VHL gene on chromosome 3, pVHL ubiquitinates hypoxia inducible factor 1a

sx of easy bruising, skin bleeding, mucosal bleeding like gingival bleeding, epistasis and menorrhagia and nose bleeds usually indicates since they were a child

Von Willebrand disease

bilateral hemorrhagic infarction of the adrenal glands

Waterhouse-Friderichsen syndrome -can be caused by bacterial meningitis due to Neisseria meningitidis =fever, NUCHAL RIGIDITY, AMS

which blot for protein

Western "WesP"

mutations in dystrophin gene

X Linked familiar dilated cardiomyopathy -also found in Duchenne and Becker muscular dystrophy -dystrophin stabilizes sarcolemma by linking component of cytoskeleton (actin) to transmembrane proteins connected to ECM

leuprolide

a GnRH analog, it increases LH so then causing an increase in testosterone however, after continuous use, it suppresses LH so decrease testosterone great for treating prostate cancer bc prostate cancer depends on androgens

if a patient has sparing of the forehead muscles, that means that his facial weakness is a result of

a central lesion affecting the corticobulublar tract and not due to direct damage of the facial nuclei/nerve

organophosphates (farmer) MOA

a cholinesterase inhibitor inhibits in both msucarinic and nicotinic cholinergic synapses

pulsus paradoxus

a drop in systolic blood pressure found in cardiac tamponade during INSPIRATION >10 mmHg drop in systolic pressure can see it in cardiac tamponade, severe asthma, COPD* , and constrictive pericarditis

side effect of olanzapine

a second generation anti psychotic metabolic effects like weight gain, dyslipidemia, hyperglycemia, increased risk for diabetes check fasting glucose and lipid profile

celecoxib

a selective COX2 inhibitor COX2 is unregulated by IL-1 and TNFalpha during inflammation. great for pt with GI problems bc COX1 helps with mucosal lining in GI. however it is bad for people with cardiac risk bc it increases COX1 which forms thromboxane-->platelet aggregation

how does aortic dissection dvp

a tear in the intima which leads to blood accumulation between the intima media, and the tear can extend

tests to determine specific causes of generalized malabsorption? for chronic pancreatitis to dx celiac disease to identify inflammatory bowel disease malabsorption due to giardia and crypto

abd imaging to identify thickening of bowel or structural disorders of the pancreas Endoscopy with jejunal biopsy colonoscopy stool inspection for ova and parasites

whenever you dont have apolipoprotein B which is needed to make chylomicrons and VLDL. now lipids cannot be transported in the blood so they accumulate in intestinal epithelium so you see enterocytes with a clear, foamy cytoplasm

abetalipoproteinemia

acanthocytes are typical of

abetalipoproteinemia cells with irregularly spaced surface projections that vary in length and width

internal hemorrhoids originate ____in the anal canal

above the dentate line external hemorrhoids originate below the dentate line

dvps on chronically exposed areas of hte skin. lesions are erythematous papules with a central scale and a rough "sandpaper" like texture. usually felt morethan seen in genetically predisposed individuals under influence of excessive sun exposure considered a premalignant lesion (less than 1% dvp into squamous cell carcinoma)

actinic keratoses

what causes granulomatous inflamm and formation of multiple abscesses and sinus tracts may discharge "sulfur granules" does it usually present as PNA?

actinomyces no

hyaline membranes lining alveolar ducts

acute respiratory distress syndrome (ARDS)

afferent and efferent limb of the carotid sinus reflex and how does this reflex get stimulated

afferent = HERING nerve (branch of the glossopharyngeal nerve) efferent = vagus nerve carotid sinus is located on internal carotid above bifurcation of common carotid it is stimulated with a tight collar on or pressure or massage, which stimulates baroreceptors -->increase parasympathetic output-->decrease BP bc of vasodilation-->decreased CO increased parasympathetic tone slows conduction through AV node and prolongs the AV node refractory period, which helps terminate paroxysmal SV tachy (VAGAL NERVES INNERVATE SA AND AV NODE)

corneal reflex

afferent is V1 ophthalmic and efferent is bilateral CN7

Good pasture syndrome antibodies? what do these antibodies cause?

agains alpha 3 chain of type IV collagen in the glomerular and alveolar basement membrane (anti -GBM Ab) the Ab cause injury to glomerular and alveolar BM, resulting in rapidly progressive glomerulonephritis and ALVEOLAR HEMORRHAGE linear IgG and C3 deposits** usually see crescent formation

sx of ADHD present before ?? and how long sx? and sx occur in how many settings?

age 12 >_6 months 2 settings

side effect of anti thyroid drugs? what should be obtained to confirm that diagnosis?

agranulocytosis which presents w sudden fever and sore throat obtain white blood cell count with differential from thoamides (propylthouracil, methimazole) which inhibit thyroid peroxidase m

tennis elbow which muscles involved and where

aka lateral epicondylitis seen in tennis players, backhand strikes transmit sudden extreme forces through the lateral epicondyle extensor carpi radialis brevis (ERCB) and extensor digitorum attach to lateral epicondyle and are involved with wrist extension angiofibroblastic tendinosis (excess fibroblasts and neovascularization) at its origin on lateral epicondyle

all benzodiazepines should not be used with

alcohol, barbiturates, neurotics, or 1st generation histamines *most common side effect of benzos is sedation

Mallory bodies, characterized by clumped, amorphous, eosinophilic intracytoplasmic inclusions made up of tangled intermediate filaments is seen in?

alcoholic steatohepatitis

eplerenone

aldosterone antagonist like spirno bc its a K sparing diuretic

alkaline phosphatase vs tartrate-resistant acid phosphatase, urinary hydroxyproline, urinary deoxypyridinoline

alk phos is a osteoblast marker, differentiate alk phosphor from liver vs bone w heat denaturation bc bone specific alk phosp easily denatured by heat (bone = boil) osteoclast activity markers, urinary deoxypyridinoline is most reliable

the difference between glyburide and glimepiride vs glipizide

all are sulfonyureas glyburide and glimepiride have higher incidence of hypoglycemia bc they are long acting glipizide is short acting

what lacks a peptidoglycan cell wall?? so how would you treat?

all organisms in Mycoplasma genus, including Ureaplasma, lack the wall so they are resistant to abx that attack cell wall like penicillin, cephalosporins, carbapenems, and vancomycin treat with anti ribosomal agents like tetracycline and macrolides

what are 2 drugs that can be used in tumor lysis syndrome to reduce the levels of uric acid

allopurinol (xanthine oxidase inhibitor) OR rasburicase (it is a urate oxidase enzyme that converts uric acid into allantoin, which is WAY MORE SOLUBLE

where are gastric ulcers usually located

along lesser curvature of the stomach along the transitional zone transitional zone = between gastric corpus (parietal cells here that secrete HCl and intrinsic factor) and the antrum (G cells the secrete gastrin) transition zone is perfect for H pylori

first line HTN meds in preggo

alpha 2 adrenergic agonist (Methyldopa) beta adrenergic antagonist (labetalol)

which 2 receptors causes a decrease in insulin secretion

alpha 2 adrenergic and somatostatin 2 receptors (beta 2 adrenergic receptors increase insulin secretion, even though EPI is sympathetic stimulation and would activate both alpha and beta, alpha has higher effect)

which receptors does nicotine stimulate?

alpha4 beta2 nicotine acetylcholine receptor in CNS

type IV collagen defect + lamellated and thinning and splitting of glomerular BM + sensory hearing loss + ocular disturbances + isolated hematuria

alport syndrome

difference in structure with bolus insulin (lisper, apart, glulisine)

altering of the amino acid structure at the C terminal of the insulin B chain can prevent polymerization and allow rapid absorption from the injection site (regular insulin forms dimers due to H bonding between the C termini of the B chains and can form hexameters in the presence of zinc ions)

the difference between bulimia and binge eating disorder

although both have recurrent episodes of binge eating, binge eating disorder HAS NO COMPENSATORY BEHAVIORS. bulimia has compensatory behaviors such as vomiting and exercise to prevent weight gain

problem with tamoxifen

although inhibits estrogen from binding to estrogen receptors which is used for adjuvant treatment of ER + breast cancers, it has estrogenic effect on uterus and can cause endometrial hyperplasia and cancer

what is the test done to confirm pulmonary embolism

although pulmonary angiography is gold standard, CT angiography is what you do bc cheaper you do a V/Q scan if they have a contrast allergy and you can't do CT angio

what does V/Q stand for? where is apex vs base of lungs?

alveolar ventilation and pulmonary blood flow apex is top and base is on bottom

rate zone 1 pressures in lung

alveolar>arterial>venous. arterial is low bc lung has to pump against gravity uphill. bc arterial pressure is lower than alveolar pressure, the pulm capillaries are collapsed and there is no blood flow (alveolar dead space) low pulm arterial pressure=ex hemorrhage high alveolar pressure=positive pressure ventilation

alterations in presenilin 1 and 2 associated w

alzheimers

what is a complication of using amioderone

amIODerone -made up of 40% iodine so it can cause hypothyroidism or hyperthyroidism so screen serum TSH before starting

female sx of prolactinoma

amenorrhea, an ovulation, and hypogonadism (bc prolactin blocks GnRH) and galactorrhea (bc of increased prolactin) hypogonadism aka LOW ESTROGEN causes accelerated bone loss and vaginal dryness , estrogen normally blocks osteoclast activity by blocking RANKL

if you suspect erythroblastosis fetalis, do amniocentesis to assess fetal hemolysis by measuring?

amniotic fluid bilirubin levels

What does the toxin of Bordetella pertussis do?

an AB exotoxin that ribosylzes G protein alpha subunits-->increased cAMP therefore increased insulin production therefore dysfunction lymphocytes and PMNs AND THEREFORE INCREASED SENSITIVITY TO HISTAMINE

which organs can be involved in Henoch Schonlein purport?

an IgA mediated hypersensitivity GI tract = upper and lower GI bleeding kidney = hematuria skin = palpable purpura on butt and LE joints** = migratory arthlarglias in large joints of the lower extremities (bc HS purpura is a vasculitits due to IgA immune complex deposition and then IgA Nephropathy aka Berger disease is when IgA deposits in the mesangium of the glomeruli!!!)

what is chronic granulomatous disease and what occurs as a result?

an X linked mutation in the NADPH oxidase so now this enzyme cannot produce ROS in the activated phagosomes. These ROS normally would activate granule proteases within the phagosome this leads to impaired intracellular killing by neutrophils and macrophages WHICH LEADS TO RECURRENT BACTERIAL AND FUNGAL INFECTIONS

Wolf parkinson white syndrome is due to

an accessory pathway that bypasses the AV node!!!! and directly connects the atria to the ventricles there is AV accessory pathway that bypasses the AV node

what is necessary for normal renal dvmt

ang II

how to calculate anion gap

anion gap = Na - (Chloride + bicarb)

what type of acid base disorder do you see in DKA? how to calculate compensation? ID1979

anion gap metabolic acidosis compensate by hyperventilating to get rid of CO2 so compensatory resp alkalosis if PaCO2 is above the expected range, then there is respiratory acidosis (use formula below to find out) PaCO2 = 1.5(serum HCO3-) +8 +-2

most common place for aorta to get damaged with MVC -also see a widened mediastinum on chest xray

aorta isthmus

head bobbing and bounding peripheral (femoral and carotid) pulses why does this happen

aortic regurgitation!!! you get an increase in LV end diastolic volume and the pt feels uncomfy feeling of heartbeat when lying on Left side -bc of a wide pulse pressure also hear a diatonic descrendo murmur

hyperplastic arterioscerosis is associated with what and what do you see histologically?

associated with malignant HTN; "onion skinning" of intimal smooth muscle cells

hereditary spherocytosis inheritance pattern

autosomal dominant

type of neuronal response? enlargement of cell body eccentric nucleus, nucleus displaced to periphery elarngment of nucleolus dispersion of nissl substance

axonal reaction loss of axon

which drugs do you not give with 6-mercaptopurine or azathioprine and why?

azathioprine metabolized into 6-MP these drugs are broken down into their inactive metabolites by xanthine oxidase. DO not give ALLOPURINOL OR FEBUXOSTAT with it bc they block xanthine oxidase which will increase toxicity

which medicine does allopurinol enhance effects

azathropine bc allopurinol blocks xanthine oxidase and you need this enzyme to break down azathropine. now azathropine converted to its active metabolite-->6 thioguanine aza has an immunosuppressive effect

what is derived from POMC (proopiomelanocortin)

beta endorphin (an endogenous opioid), ACTH, and MSH

what do glucocorticoids block in arachidonic acid pathway

blocks phospholipase A2, which converts membrane phospholipids to arachidonic acid

Total peripheral resistance will affect what?

both venous return and cardiac output increasing TPR will decrease the slope of both curves

what is a hallmark of chronic asthma?

bronchial hyperactivity

what do leukotrienes cause?

bronchoconstriction, mucus hypersecretion and mucosal edema -cause vasoconstriction (constrict smooth muscle of blood vessels, increased vascular permeability, broncoconstriction

side effects SSRIs

can be used for premature ejactulation so side effects include delayed ejaculation, anorgasmia, decreased libido

What is hematogenous bacterial spread

can cause acute pyelonephritis; seen in elderly, debilitated patients with weakened immune defenses and have potentially multiple infectious sources

what can happen if you injure prostate during prostactectomy?

can cause erectile dysfunction bc prostatic plexus supplies corpus cavernosa (CC) of penis, which facilitates penile erection the lesser and greater cavernous nerves arises from prostatic plexus and innervate CC and urethra

capsaicin MOA

causes a release and depletion of substance P which is involved in transmission of pain signals

what does an increase in pCO2 do to the cerebral vessels?

causes an INCREASE in cerebral blood flow bc CO2 is a cerebral vasodilator therefore, a decrease in PCO2 causes a decrease in cerebral perfusion.

how do cholingergics work with glaucoma

causes miosis which causes the iris to move further from the cornea. this widens the anterior chamber angle and allows for better outflow of the aqueous humor

you need caspases for? xanthine oxidase is involved in what cycle?

cellular apoptosis therefore no caspase will lead to cells resistant to apoptosis uric acid synthesis

elevated alk phosphatase suggests? when it is prolonged, the reduction in bile flow causes ?

cholestatic liver disease intestinal malabsorption of fats and fat soluble vitamins (A, D, E, K) which requires bile salts for digestion

inhibition of 7 alpha hydroxylase reduces the conversion of cholesterol to bile acids and increases the risk of

cholesterol stones

gustatory innervation (taste buds) of the anterior 2/3 of the tongue

chorda tympani branch of the facial nerve

a chronic productive cough, biopsy will show thickened bronchial walls, neutrophilic and lymphocyte infiltrates, mucus gland enlargement with increased number of goblet cells (increase mucus production< and patchy squamous metaplasia of bronchial mcusoa

chronic bronchitis

digital clubbing is associated wth

chronic diseases that cause hypoxia physical exam shows flattening of nail folds, skinniness of the nail and distal portion of the finger, drumstick appearance

nasal fractures or high force trauma to the mid face can result in loss of smell if olfactory nerves are torn from the __?

cirbiform plate in the ethmoid bone

decidualized endometrium with dilated, coiled, endometrial glands and vascularized edematous stroma and prominent serial arteries

consistent with luteal phase of menstrual cycle as progesterone prepares endometrium for implantation

where does positive selection occur

cortex of thymus

aging ___chest wall compliance and ____lung compliance

decreases , bc of stiffening from rib calcification and from increased thoracic curvature due to osteoporosis/arthritis increases , due to a loss of elastic recoil

if H pylori occupies the gastric antrum, then it leads to a depletion of what cells? and lead to what type of ulcer formation?

depletion of somatostatin producing cells so now gastrin is not inhibited by somatostatin duodenal ulcer

rapidly progressive glomerulonephritis (RPGN) -what is catch phrase to remember and what do you see with this condition?

"rapidly crescentic GN" -CRESCENTS PRESENT WHICH ARE COMPOSED OF FIBRIN AND MACROPHAGES so it is inflammatory debris LOCATED IN THE BOWMAN'S SPACE -

causes of a high A-a gradient

-R to L shunt -V/Q mismatch -impaired diffusion (interstitial lung disease) a R to L shunt occurs when venous blood bypasses lungs and enters arterial circulation, which decreases PaO2. increase in A-1 a L to R shunt is when blood from L heart goes to R heart. blood in L heart is Oxygenated so it doesn't lead to hypoxemia

describe what happens with a high altitude and what type of acid base disorder do you get ID 1980

-high altitude causes decreased PaO2 bc the partial pressure of O2 is less -the hypoxia triggers hyperventilation -hyperventilation causes decrease in CO2 levels = RESPIRATORY ALKALOSIS -in a couple of days, you will get renal compensation with a decrease in serum bicarb level with high altitude, you will see increase in 2,3 BPG

causes of a normal A-a gradient A=partial pressure oxygen in alveoli a=partial pressure of oxygen in arterial blood

-hypoventilation -low inspired fraction of oxygen (high altitude)

question iD 40 what is the difference in light microscopy changes after a MI? 0-4 hours vs 4-12 hours

0-4 hours = minimal change 4-12 hours = early coagulative necrosis

which arch four muscle of mastication -masseter, temporalis, lateral and medial pterygoid -TENSOR TYMPANI skeletal and cartilage derivative -maxilla and mandible

1

myotomes 1. shoulder/scapula elevation 2. shoulder abduction 3. elbow, flexion, wrist extension

1. C4 2. c5 3. c5, c6

to achieve pregnancy in women w/.. 1. normogonadotropic, normoprolactinemic, and euthyroid 2. hypogonadotropic, hypogonadal anovulation 3. Turner syndrome

1. Clomiphene citrate (bc it blocks the feedback inhibition of estrogen on hypothalamus so it enhances the release of gonadotropins) 2. Pulsative GnRH (stimulates ovulation in women with disordered hypothalamic GnRH secretion) 3. in vitro fertilization

1. proximal tubular cell ballooning and vacuolar degeneration; usually also see high anion metabolic acidosis 2. presence of oxalate crystals in the tubular lumen

1. acute tubular necrosis 2. ethylene glycol poisoning; ethylene glycol-->glycolic acid (toxic to renal tubules) + oxalic acid, which precipitates as calcium oxalate crystals

1. degeneration of Ach, cholingeric neurons 2. which neurotransmitter in SCZ and parkinson?

1. alzheimer dementia 2. dopamine -high doses w scz (tall dopey is skiing) -low doses w parkinsons (small dopey cant park his car)

K sparing diuretics 1. directly block the epithelium Na channels present in the apical membrane of principal cells in cortical collecting duct 2. competitively inhibit the aldosterone receptor, causing down regulation of the apical Na channels and basolateral Na/K pumps

1. amiloride and triamterene 2. Spironolactone and Eplerenone (preferred in pt with heart failure)

2 activities of amantadine

1. anti cholingeric 2. enhances the effects of endogenous dopamine

describe type IV hypersensitivity aka delayed

1. antigen gets picked up by a dendtritic cell 2. dendritic cell present antigen on MHC II class molecule to a CD4 T helper cell 3. T helper cell secretes interferon gamma 4. interferon gamma recruits macrophages 5. now you get monocytic infliltration of the area where the antigen was introduced

bilaterally enlarged kidneys with cysts in the renal cortex and medulla 1. associated with newborns presenting with Potter sequence, portal HTN, and congential helpatic fibrosis and hepatic cysts 2. associated with berry aneurysms, hepatic cysts, and mitral avavle prolase. may dvp HTN due to increased renin; in adults

1. autosomal recesive PKD 2. auto dominant PDK "cysts in the liver, brain kideny"

2 mechanisms bacteria can get penicillin resistance

1. bacteria get beta lactamases (penicillinase) so they destroy the beta lactam ring of penicillin -still effective against this includes carbapenems and nafcillin and methicillin 2. the bacteria modify the penicillin binding proteins in their peptidoglycan wall so that the abx cannot bind and interfere with cell wall synthesis -this is how MRSA works

1. increase the frequency of Cl channel opening 2. increase duration of Cl channel opening

1. benzo 2. barbiturates

During sexual intercourse, bacteria can be send up to bladder via short urethra of women. The bladder has 3 mechanisms for defense

1. bladder mucosa does not allow bacterial attachment (however, some bacteria have fimbraie which allow for bacterial attachment) 2. Urine is bacteriacidal bc it has high urea content and osmolality 3. urine flow washes bacteria downstream

all of the receptors TCAs target

1. block alpha 1 = vasodilation, orthostatic hypotension 2. Cardiac fast Na channels = arrhythmias 3. block Histamine receptors H1 = sedation, increased appetite 4. blocks muscarinic Ach receptors so anti cholingeric = tachy, urinary retention, dry mouth, flushing, decreased sweating, hyperthermia 5. blocks serotonin and NE uptake = anti depressant, sz, tremors

what are the 2 mechanisms that serotonin nihbitors prevent chemo induced vomiting

1. block vagus mediated n/v 2. block central serotonin receptors in the area postrema and nucleus tracts solitarius

myotomes 1. elbow extension, finger extension 2. wrist flexion, finger flexion 3. finger abduction

1. c7 2. c8 3. t1

1. precursor to vitamin A 2. precursor of pyrimidine

1. carotene 2. orotic acid

anterior communicating artery aneurysms typically compress the ____and cause ___ posterior communicating artery aneurysm causes compression of the ___, producing ___

1. central optic chiasm; bitemporal hemianopia 2. oculomotor nerve; ipsilateral myiadraiss, ptosis, and down and out deviation of eye

what is the first and second most common cause of ring enhancing lesions with mass effect in HIV?

1. cerebral toxoplasmosis 2. Primary central nervous system lymphoma

1. involuntary muscle activity that flows from one muscle group to another. mvmts may appear fragmented or jerky, and pt may display dancing gait. feature of huntigtons dz 2. cogwheel rigidity when you feel intermittent resistance with passive flexion/extension. also there is bradykinesia (slow mvmnt) 3. flinging of limbs on one side of body, occurs due to contralateral injury in or near sub thalamic nucleus

1. chorea 2. part of parkinson dz 3. hemiballism

physiologic defense against hypoglycemia

1. decrease insulin (decrease peripheral glucose utilization) 2. increase glucagon (increase hepatic gluconeogenesis and glycogenolysis) 3. increase EPI 4. increase cortisol and growth hormone (alters transcription of genes to conserve glucose)

1. lowets osmolarity in the nephron? 2. highest osmolarity in the nephron w/o ADH?

1. distal convoluted tubue 2. bottom of the loop of hence

1. what do urethral folds form in males vs females 2. what happens if the urethral folds dont fuse in males?

1. females-->dont fuse and form labia minora males-->fuse to form bottom of penis and penis raphe 2. hypospadias = opening at the bottom of penile shaft so urine leaks through there instead of through penis hypospadias in women = urethral opening into vaginal wall

1. filtration rate formula 2. net renal excretion rate formula

1. filtration rate = GFR*plasma concentration 2. exertion rate = filtration rate - tubular reabsorption rate

to prevent central venous catheter related infections

1. hand hygiene with alcohol sanitizer 2. barrier precautions during insertion such as mask, gloves, gown, sterile sheet drape 3. prepare insertion site w chlorhexidine antiseptic 4. use subclavian or internal jugular vein for insertion site bc femoral vein has a higher risk for infection 5. remove catheter when no longer needed topical ointments as well as switching out the catheter frequently does NOT help reduce infection rates

4 reasons that increase K excretion

1. high extracellular K levels stimulate Na/K to increase K secretion in tubular fluid 2. increased aldosterone bc that leads to Na retention and K excretion via Na/K pump 3. alkalosis (alkalosis is the cause of K excretion; alkalosis is when H and K IS BEING EXCRETED)you get alkalosis bc you are excreting H and K 4. increased fluid flow which washes away secreted K ID: 1554

sepsis and pulmonary infections are the 2 most common risk factors for developing Acute respiratory distress syndrome (ARDS). how does sepsis cause ARDS? in sepsis you will see hemodynamic instability

1. in sepsis, cytokines are released like TNF, IL-1, IL-6, and IL-8 to respond to infection 2. pulmonary epithelium gets activated 3. recruitment and extravasation of neutrophils into the lung tissue 4. causes an inflam response which damages capillaries and leak protein and fluid into the alveolar space**** 5. the alveoli getting filled with fluid causes its to dvp worsening hypoxia and resp failure

how does pulmonary HTN start

1. increased LV diastolic filling pressure 2. pulmonary venous congestion 3. increased pulmonary capillary and arterial pressures 4. endothelial damage and capillary leakage 5. decreased production of NO (vasodilator) and increased production of endothelin (vasoconstrictor) 6. remodeling with smooth muscle proliferation (hypertrophy) and collagen deposition

effects of nonselective beta adrenergic agonists such as isoproterenol

1. increases cardiac contractility (bc acts on beta 1 receptor) 2. decreased vascular resistance and mean arterial blood pressure (bc beta 2 receptors which causes vasodilation by relaxing vascular smooth muscle)

segment elevation in 1. leads II, III, and aVF 2. lead I and aVL 3. V1-4 and V5-6, I, aVL 4. V1-4 5. V3-4

1. inferior MI-->R coronary artery 2. lateral infarction-->Left circumflex 3. anterolateral MI-->Left main coronary artery 4. proximal occlusion of LAD 5. distal occlusion of LAD

1. loss of sensation at medial lower part of leg 2. loss of plantar flexion, inversion of foot, and decreased sensation at sole of foot

1. lesion in saphenous nerve, branch of femoral nerve 2. tibial nerve

what is the difference? both are cholinerastase inhibitors 1. tertiary amines = pheostigmine***, galantine, donepezil, rivastigmine 2. quaternary amines = neostigmine, edrophonium, pyridostigmine

1. lipophilic, non polar so they can easily cross BBB and reverse central and periphlera sx 2. hydrophilic, polarized, not cross BBB -reverse peripheral sx only

huntington disease 1. what is lost and gained (neurotransmitters) 2. how does neuronal cell death occur 3, which regions of the brain atrophy 4. some sx

1. low GABA, low Ach; high dopamine 2. glutamate excessively activates NMDA receptors which leads to increased Ca influx therefore cell death 3. caudate and putamen (lateral ventricles may appear large) 4. aggression, depression, chorea,

1. fall onto outstretched hand can cause dislocation of

1. lunate bone, scaphoid fracture, and distal radius fracture lunate more medial and articulates w radius scaphoid more lateral and articulates w radius

med suffix 1. mab 2. kept 3. nib

1. mab = monoclonal Ab (in their names the type of target and origin too) 2. cept = receptor molecule 3. nib = kinase inhibitor

how does the immune system respond to Mycobacterium Tb?

1. macrophages engulf bacteria and present it to native T helper cells 2. Macrophages secrete MACROPHAGE IL-12 which induces T helper cell--> CD4+ TH1 cells**** 3. now TH1 secretes INTERFERON GAMMA which activates more macrophages 4. those activated macrophages produce TNF ALPHA which recruit more monocytes and macrophages to the area 5. granuloma formed activated macrophages form langhan cells

with aerobic exercise 1. arterial O2, CO2, and pH 2. venous O2, CO2, and pH

1. maintained near normal resting values 2. bc exercising muscle extract additional O2, venous blood O2 is decreased, the venous blood CO2 is increased due to increased CO2 production and the venous blood pH is decreased

1. a legal determination. involves situations in which the treatment provided is below the accepted standard of practice and has resulted in injury or death to pt 2. a complication that cannot be prevented given the current state of medical knowledge (ex. allergic rxn to a medication in a pt w NKDA) 3. an unexpected occurrence involving death or serious physical or psychological injury (inpatient suicide, death of full term infant, retained object after surgery) that requires immediate investigation

1. malpractice 2. non-preventable adverse event 2. sentinel event

teratogenic medications 1. limb and craniofacial abnormalities, neural tube defects, abortion 2. renal dysgenesis, oligohydramnios 3. nasal hypoplasia, stippled (pinpoint calcification) of epiphysis

1. methotrexate 2. ACE inhibitors 3. warfarin ("dont wage WARfare on baby, keep it HEPpy with HEPARIN bc it doesn't cross placenta)

HOLOSYTOLIC MURMURS 1. Best heard at apex* and radiates to axilla 2. best heard at L 2-3 intercostal spaces and murmur increases with inspiration 3. best heard at L 3-4 intercostal spaces and murmur is usuall yloud and accompanied by a thrill

1. mitral regurg 2. tricuspid regurg 3. ventricular septal defect

1. where are melanocytes derived from? Melanoma is a malignancy of melanoctes. 2. how do melanocytes make skin pigmented?

1. neural crest cells 2. melanocytes take tyrosine-->make melanin in melanosomes-->keratinocytes take up the melanin

describe reabosroptions 1. inulin and mannitol 2. glucose, Na, and urea 3. PAH and creatinine

1. no tubular reabsorption or secretion so filtered amt = excreted Amt 2. net tubular reabsorption so excreted amt<< filtered amt 3. net tubular secretion so excreted amount >> filtered amount

the lac operon is regulated by 2 mechanisms. 1. negatively by binding the repressor protein to the ____ 2. positively by cAMP-CAP binding upstream from the ____

1. operator locus 2. promoter region

example of 1. killed bacteria vaccine 2. live attenuated vaccine 3. recombinant surface protein vaccine 4. inactivated toxin vaccine

1. oral cholera vaccine; poorer immunogneity than live attenuated vaccines and may require multiple inoculations or boosters 2. Tb and oral typhoid vaccines, most effective at inducing immunity bc the organisms are actively growing within the inoculated host 3. hepatitis B 4. diphtheria and tetanus

PCOS treatment 1. don't want to become preggo but you need to minimize endometrial proliferation, reduce androgenic sx 2. if they want to be preggo 3. to help minimize endometrial hyperplasia bc they directly inhibit the endometrium

1. oral contraceptive pills 2. clomiphene (or letrozole); selective estrogen receptor modulator, prevents feedback inhibition so you get increased LH and FSH 3. progestin only meds

teratogenic medications 1. neural tube defects, orofacial clefts, microcephaly, nail or digit hypolasia 2. ebstein anomaly (atrialized R ventricle), nephrogenic DI, hypoT 3. neural tube defects 4. microcephaly, thyme hypoplasia, small ears, hyrocephalus

1. phenytoin (antiepleptic) 2. lithium 3. valproate 4. isotretinoin

IL-2 functions

1. produced by helper T cells stimulates the growth, differentiation and survival of T lymphocytes, CD4 and CD8 cells 2. promotes B cell growth 3. activates NK cells and monocytes IL-2 used as immunotherapy for metastatic melanoma and renal cell carcinoma bc of increased activity of NK cells and T cells

which area of the brain affected depending on the clinical sx of a lacunar infarct 1. pure motor hemiparesis 2. pure sensory stroke 3. ataxia-hemiplegia snydrome 4. dysarthria-clumsy hand syndrome

1. psoteior limb of the internal capsule or basal pons 2. VPL and VPM of thalamus 3. poster limb of the internal capsule or basal pons 4. gene of the internal capsule or basal pons

1. what is recommended to give to pt for Ca stones who have been dx w hyperoxaluria as the cause of renal stone formation 2. which type of stones form only in association with upper UTI w urea splitting bacteria (Klesbiella, Proteus) 3. why does high Na diet increase risk of Ca stones

1. pyridoxine (vitamin B6) bc it decreases oxalate production so decreases rate of stone formation 2. struvite stones 3. Ca normally passively follows Na and water reabsorption. More Na intake leads to decreased Na reabsorption so less Ca reabsorption

1. responding in a manner opposite to one's actual feelings 2. attributing one's own feelings to others (attributing an unacceptable internal impulse to an external source) 3. transferring feelings to a more acceptable object

1. reaction formation 2. projection -- a man who wants to cheat on his wife accuses his wife of being unfaithful. a child angry of parents divorce thinks parents are angry at him 3. displacement

pathogenesis of stress related mucosal disease

1. shock, trauma, burns, sepsis-->hypotension/hypovolemia-->LOCAL ISCHEMIA-->decreased mucosal protection-->erosion and ulcer formation. CURLING'S ULCERS 2. intracranial disease/injury-->vagal stimulation-->increased H secretion-->erosion and ulcer formation. CUSHING ULCERS! ulcers can bleed

the most common causes of secondary pna (aka a virus knocks out mucociliary escalator which weakens the immune system and makes you increased risk to dvp 2 pna)

1. strep pna 2. staph aureus 3. H influenza

1. decreased urethral sphincter tone and urethral hyper mobility; leakage with coughing, lifting, sneezing 2. detrusor hyperactivity; sudden, overwhelming urge to urinate 3. impaired detrusor contractility, bladder outlet obstruction ; pt dvp involuntary and continuous urine leakage when pressure inside the full bladder >sphincters; incomplete emptying and persistent voluntary dribbling

1. stress incontinence; usually in women from external urethral sphincter trauma or pudendal nerve injury during childbirth 2. urge -loss of inhibitory CNS input to the bladder, due to frontal lobe and internal capsule infarcts, cause detrusor hyperreflexia 3. overflow

MOA 1. systemic progestins (combined BC, progestin implant) 2. locally acting progestins (progestin only pill, levonorgestrel IUD) 3. copper IUD

1. suppresses GnRH so no ovulation bc decreased FSH and LH 2. acts locally and thickens cervical mucus which prevents sperm from accessing uterus; pt still ovulates 3. releases copper ions which causes an inflam reaction which is toxic to sperm and prevents fertilization

abx contraindicated in preggo 1. tetracyclines 2. chloramphenicol 3. trimethoprim/sulfamethoxazole 4. aminoglycosides, salicylates, and cisplatin

1. teeth staining ("teethracyclines) 2. gray baby syndrome 3. neural tube defects (bc its a folic acid antagonist) 4. ototoxicity, vestibulotoxicity ('a mean guy' hit the baby in the car) CN8 damage

how does the vascular epithelium vasodilate with Ach, bradykinin, shear stress?

1. these stimuli activate endothelial receptors, leading to increased cytosolic Ca 2. Ca activates eNOS (endothelial nitric oxide synthase), which synthesizes ARGININE-->NITRIC OXIDE 3. NO diffuses into adjacent smooth muscle cells, activates guanylate cyclase, therefore increase formation of cyclic GMP 4. cyclic GMP activates protein kinase G which reduces cytosolic Ca levels and relaxes smooth muscles -can give arginine as a supplement to help with stable angina bc it causes vasodilation

treatment for pelvic inflamm disease?

1. third generation cephalosporin (like ceftriaxone)-->treats gonorrhea PLUS 2. azithromycin or doxycycline -->to treat chlamydia bc its not sensitive to beta lactase

overview of collagen synthesis

1. translation of mRNA to make collagen 2. pro collagen is hydroxylated and glycosylated (glucose and galactose added) 3. disulfide bond formation between C terminals of 3 alpha chains 4. triple helix assembly

T/F. 1. pulmonary capillary wedge pressure is reflective of venous pressure in the left heart (Left atrial pressure and left ventricular diastolic pressure) 2. SVC and RA pressure is the same 3. RV and pulmonary artery systolic pressure is the same but pulmonary artery diastolic pressure is higher bc of pulm vascular resistance and backwards transmission of left atrial pressure

1. true 2. true 3. true

1. what type of hypersensitivity is acute serum sickness? 2. other examples of this type of hypersensitivity? 3. what happens bc of deposition of IgG or IgM complement fixing Ab? 4. histo? 5. how can you get serum sickness

1. type 3. caused by tissue deposition of circulating immune complexes. 2. serum sickness, PSGN, lupus nephritis 3. localized consumption of complement -->decreased complement serum C3 levels!! (BC IMMUNE COMPLEXES ACTIVATE COMPLEMENT SYSTEM) 4. small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration** 5. from administration of monoclonal Ab (infliximab, rituximab), or nonhuman immunoglobulins (venom antitoxins), or w certain nonprotein drugs. YOUR BODY MISTAKES THE AB IN THE SERUM FOR A HARMFUL ANTIGEN sx: fever, pruritic skin rash, arthrlagias, low C3 and C4 complement levels

3 main groups of the body's veins in early embryonic dvmt? what happens to the,?

1. umbilical vein degenerates 2. vitelline veins form the portal system 3. cardinal veins form the constituents of the systemic venous circulation

path of degenerative arthritis

1. when you get older, your intervertebral disc denigrates and starts to protrude, (bc it is protruding you lose height) 2. losing height causes pressure and leads to formation of facet joint osteophytes and hypertrophy of ligamentum flavor 3. these compress nerve roots

how to tell the difference between 11 beta and 21 hydroxylase deficiency

11 beta has hyPERtension and hypokalemia bc there is an increase in weak mineralocorticoids (corticosterone) 21 beta - hypotension and hyperkalemia bc the deficiency is further up both have ambiguous genitalia in females

time frame after an ischemic stroke "red neurons" (eosinophilic cytoplasm, pyknotic nuclei, loss of Nissl substance)

12-24 hours

elevated amounts of ____in CSF is helpful in dx Creutzfeldt-Jakob disease, a neruogdenerative disease caused by prions

14-3-3 protein

what is translocated in follicular lymphoma

14:18 BCL2 which inhibits apoptosis

translocation in follicular lymphoma

14:18 which moves Bcl2 next to the IgG heavy chain enchancer element so you get increased bcl2 expression

all pts phenotypically female impaired synthesis of androgens, estrogen, and cortisol but mineralocorticoid production is in excess genetic males have ambiguous genitalia but genetic females appear phenotypically normal

17 alpha hydroxylase deficiency

golgi tendon organ innervated by ____. This axon contacts inhibitory interneurons in spinal cord, which then synapse with _____that innervate the same muscle. muscle spindle system vs golgi tendon system

1b sensory axon; alpha motor neuron muscle spindle system monitors and maintains muscle length while golgi tendon system monitors and maintains muscle force. golgi sensitive to increases in muscle tension but not with passive stretch (bc stretch takes place in muscle fiber and not tendon) when muscle exerts too much force, the GTO inhibits contraction of the muscle and causes sudden muscle relaxation

diphenhydramine (benadryl), promethazine, hydoxyzine

1st generation histamines cause sedation bc they easily penetrate the BBB and accumulate in CNS can cause CNS depression if used w benzos

what decreases Hb affinity for oxygen

2,3 BPG

doxycycline and neomycin both inhibit

30S ribosomal subunit

which arch superior laryngeal nerve CN10) right subclavian artery, arch of aorta CIRCOTHYROID MUSCLE!** thyroid cartilage

4 CRICOTHYROID IS NOT INNERVATED BY RECURRENT LARYGNEAL NERVE, IT CLOSES GLOTTIS

how many calories of energy are in 1 g of protein or carb how many calories of energy are in 1 g of ethanol how many calories are in 1 g of fat

4 calories 7 calories 9 calories

lisinopril

ACE inhibitor -good to give to diabetics with proteinuria ACE INHIBITORS ("-PRIL)

ramipril

ACE inhibitor so decrease AT II, aldosterone increase in renin, AT I, and bradykinin

what is the problem with TTP

ADAMTS13 doesnt work so it doesnt cleave vWF into smaller multimers so it causes thrombotic occlusion and more pro thrombosis

what type of deficiencies are patients with cystic fibrosis going to have

ADEK bc malabosprtion of fat soluble vitamin

in pt with cystic fibrosis, they have deficiencies in which vitamins WHENEVER YOU SEE PANCREATIC ENZYME THERAPY WITH RECURRENT RESP INFECTIONS, THINK CYSTIC FIBROSIS

ADEK bc they don't have pancreatic enzymes and those enzymes are necessary for absorption of nutrients in the gut you have fat malabsorption

urea and collecting duct

ADH increases water permeability in cortical and medullary collecting ducts cortical collecting duct impermeable to urea, but ADH activates urea transporters in medullary collecting duct, increasing urea reabsorption -->allows for max concentrated urine urea recirculates from inner medullary collecting duct-->medullary intersitium and think loop of henle, contributing to the osmotic gradient

what hormones does small cell carcinoma synthesize

ADH or ACTH so you might see SIADH

who the myosin head binds to an actin filament, a conformational change causes the myosin to pull the actin filament, leading to muscle contraction and ___ a new ATP molecule is then bound to the myosin head, causing release of the actin filament

ADP release release of the actin filament

tumor marker for hepatocellar carcinoma tumor marker for pancreatic cancer serum marker to monitor response to treatment in pts with colorectal cancer

AFP (alpha fetoprotein) CA19-9 CEA (carcinoembryonic antigen)-->can't be used to dx colon cancer but good for detecting residual disease and recurrence

if fetal neural tube defect is suspected, check amniotic fluid for___. high levels suggest neural tube closure defect like spina bifida and also for ventral wall defects like omphalocele, gastroschisis low levels of this suggest?

AFP which is alpha fetoprotein -trisomy 18 and 21 quadruple screen test at 15-18 weeks gestation

combined upper motor neuron and lower motor neuron lesions 1. damage to motor neurons of anterior horns (LMN) 2. demyelination of corticospinal tracts (UMN)

ALS, amyotrophic lateral sclerosis

which leukemia has DIC as a common presentation

AML

APL is a subtype of what leukemia and what is the translocation

AML 15:17 which is PML/RARA RARA=retinoic acid receptor alpa APL responds to all trans retinoic acid

side effects of ACE inhibitors

ANGIOEDEMA!** this is due to bradykinin accumulation ACE normally breaks down bradykinin bradykinin is a VASODILATOR that increases vascular permeability, causing angioedema. tongue, lip, or eyelid swelling and sometimes laryngeal edema and difficultly breathing

characterized by destruction of articular cartilage with resulting stiffness and fusion of axial joints the sacroiliac joints tender to palpation and the spine has decreased ROM SI joints-->erosion, sclerosis, narrowing, and fusion of the joint spaces** x rays shows scerlosis, ligamentous calcifications, and vertebral fusion (BAMBOO SPINE); no space b/n vertebral bodies

ANKLYOSING SPONDYLITIS

septate hyphae with dichotomous branching (V shaped branching)

Aspergillus fumigatus

the other most common presentation of nocardia asteroides asides from cavitary PNA is?

BRAIN ABSCESS

survives on steamed and fried rice where it produces a hat stable enterotoxin

Bacillus cereus

most prominent organisms isolated in intraabd infections (ex from a perforated appendicitis)

Bacteroides fragilis and E coli

mnemonic to remember P450 inducers

Barb's Funny Mom refuses greasy carb shakes phenobarbital phenytoin for funny Rifampin griseofulvin Carbamazepine Mom and shakes = chronic ETOH and St Johns wort

what causes cat scratch disease bacillary angiomatosis (in immuno pt, red purple papular skin lesions) and culture negative endocarditis??

Bartonella henselae

columnar cells that grow along pre existing bronchioles and alveoli; arise from Clara cells periphery presents w a pna like consolidation on x ray

Bronchioloalveolar carcinoma

acquired by drinking infected milk or by direct contact with infected sheep or goats

Brucella melitensis

occlusion of hepatic veins with a resulting increase in intrahepatic pressurew

Budd Chiari syndrome

diplopia, dysphagia, and dysphonia that dvps 12-36 hours s/p consumption

C botulinum toxin which inhibits Ach release from presnaptc nerve terminal, so prevents muscular contraction BOTH NICTONINC AND MUSCARINIC BLOCKADE so you see anti muscarianic effects and skeletal muscle weakness *high rate repetitive nerve stimulation improves the deficits bc rapid demoralization rate increases Ca concentration in the presynaptic nerve termaln and allows mobilization of additional Ach vesicles

what do you think whenever you see someone getting started on abx for whatever and then they develop watery diarrhea*** and they have leukocytosis? how does it cause damage??

C dif!!! toxin A (enterotoxin) = causes more inflam and fluid secretion Toxin B (cytotoxin) = more cytotoxic both toxins inactivate Rho regulatory proteins which are normally needed to maintain cytoskeletal structure. CYTOSKELETAL INTEGRITY IS DISRUPTED-->tight junctions disrupted and increased fluid secretion

the parietal pleura-->mediastinal and diaphragmatic is innervated by what?

C3,4,5 phrenic nerve

which complement components are inflamm anaphylotoxins that trigger histamine release from mast cells? which one is also involved in recruiting PMNs, monocytes, eos, and baso? which one is the least active?

C3a, C4a, C5a (triggers intense vasoconstriction, increased vascular permeability, and bronchospasm) C5a C4a

yeast with branching pseudohyphae that causes superficial (skin, esophagitis) or disseminated infection but not pna or brain abscess

CANDIDA

mnemonic to remember Wernicke? deficient in? when it progresses to korsakoff syndrome, what sx are irreversible?

CANO beer Confusion Ataxia Nystagmus OPthalmoplegia -thiamine B1 deficiency -memory loss, confabulations (impairment in memory and learning is permanent)

how to treat OCD

CBT and SSRI goal is to block reuptake of serotonin

a cell surface marker present on granulocytes. present on Reed Sternberg cells and is a cytologic marker useful in dx of Hodgkins lymphoma

CD15

low affinity Fc receptor found on surface of NK cells, neutrophils, and macrophages

CD16

tight adhesion and crawling is when neutrophils attach to the endothelium by binding ______ on ICAM-1 of endothelial cells

CD18 beta 2 integrins (Mac-1 and LFA-1)

where on the surface of B cells does EBV attach?

CD21 via their glycoprotein gp350

HIV viruses attach to their major target host cells ______primarily by binding of viral envelope glycoprotein ____and the coreceptor CCR5 or CXCR4

CD4 T cells; gp120

immune mechanisms against Giardia

CD4+ T helper cells and secretory IgA production** IgA binds to trophozoites and prevents their adherence in the upper small bowel. predisposition for this infection chronically = IgA deficiency, X linked agammaglobulinemia

asides from neutrophils, and macrophages being activated in COPD, what is another mediator of this disease?

CD8 T lymphocytes they secrete enzymes and proteases that cause and increase alveolar destruction and mucus hyper secretion found in chronic bronchitis

diffusely homogeneous, pale eosinophilic cytoplasm "ground glass" hepatocytes

CHRONIC HEPATITIS B INFECTION pathoma (acute hep <6 months) -acute hep presents with jaundice bc of mixed conjugated and unconjugated bilirubin -conjugated bilirubin is due to bile ducts being destroyed so some leaks out -dark urine bc of conjugated bilirubin is water soluble and filtered by kidney into urine elevated liver enzymes ALT>AST

presents with odynophagia (pain with swallowing), dysphagia (difficulty swallowing), fever, burning chest pain, linear and shallow ulcerations** in lower esophagus enlarged cells with baso or eosinophil intranuclear inclusion bodies**

CMV esophagitis can occur in immuno pts

what passes through foramen oval

CN V3 mandibular branch

what does accessory nerve innervate

CN XI, innervates SCM and trapezius muscles -nerve can be damaged with surgery to posterior triangle of neck which involves SCM, trapezius, and clavicle

which nerve courses between the posterior cerebral and superior cerebellar arteries so it is susceptible to injury from a compressive aneurysm from the posterior communicating artery

CN3

which nerves enter the orbit via the superior orbital fissure

CN3, CN5 V1, CN 4, CN 6, and superior ophthalmic vein

innervation of stylopharygneus muscle (elevates larynx during swallowing) afferent limb of gag reflex (sensory to upper pharynx) parotid gland secretion

CN9 glossopharyngeal

what do you want to give as an anti inflam that does not impair platelet aggregation

COX2 selective inhibitor like celecoxib COX2 is more expressed at sites of inflammation while cox1 plays a role in normal functioning tissues like platelets and GI tract

CREST syndrome vs systemic sclerosis

CREST has more pulmonary HTN and less pulm fibrosis and renal involvement CREST (associated with anti centromere Ab) SS (associated with anti-scl 70 Ab/anti-DNA topoisomerase I Ab) SS also has finger tip pitting*

anticentromere Ab found in majority of pts w

CREST snydrome Calcinosis Raynauds phenomenon Esophageal dysmotility Scerlodactyly Telangiectasias

which medications are used to inhibit mast cell degranulation? do they influence bronchial constriction directly? are they more or less effective than glucocorticoids?

CROMOLYN AND NEDOCROMIL no less effective, so this is why they are used as prophylaxis to prevent acute attacks instead of used to treat acute exacerbations

diagnostic test of choice for PE? unless they have renal insufficiency. why? then what test do you do?

CT angiography, which requires contrast administration bc with renal insufficiency (elevated creatinine), they have increased risk of contrast induced nephropathy so you should do a ventilation/perfusion scan

if you're target INR range is not where you want it to be while taking warfarin, what do you need to consider

CYP450 inducers bc it will increase the metabolism of warfarin and you will geta subtheraputic INR

ALA synthase is unregulated by ___and down regulated by ____

CYP450 inducers (most anti epileptics, griseofulvin, rifampin) heme and glucose

what is the best thing to give following a subarachnoid hemorrhage in order to prevent cerebral vascular spasm

Ca channel blockers Nimodipine

can be isolated from an infection resulting from perforation of the proximal bowel such as perforated peptic ulcer

Candida albicans

small oval yeast with narrow based budding

Candida albicans

germ tubes are specific for what? "budding yeast that forms germ tubes"

Candida albicans** specifically with albicans germ tubes aka true hyphae; these try hyphae occur when candid becomes in invasive it is commonly seen as a budding yeast or forming psuedohyphae

what type of breathing is seen in pts with CHF and what is it?

Cheyene-stroke breathing you have a apnea (no airflow) with a decreased tidal volume occurring at the same time (decreased thoracic/abd mvmt)

which cranial nerve does an uncal herniation usually compress

Cn3 so oculomotor nerve plays w a fixed dilated pupil

multinucleated spherules

Coccidiodes immitis infection (spherules packed with endospores)

thick walled spherules packed w endospores dimorphic fungus spherules larger than surrounding RBCs question ID 268 for pic

Coccidioides immitis

rapidly progressive dementia sharp waves on EEG***** increase in 14-3-3 protein in CSF spongiform cortex** caused by prions, beta pleated sheet resistant to proteases

Creutzfeldt Jakob disease

yeast with a polysaccharide capsule that can cause meningoencephalitits round oval cells with narrow based buds round or oval budding yeast can be seen on India Ink stain* can also identify a polysaccharide antigens in the CSF using latex agglutination

Crypto neoformans

associated with bird (pigeon) droppings; it grows abundantly in the soil

Cryptococcus neoformans

yeast with a thick capsule whenever stained with india ink, the capsule does not absorb the ink, resulting in a clear halo. most common manifestation is meningitis in immune pt

Crytococcus neoformans

think polysaccharide capsule that can be visualized w india ink staining culture on Sabouraud agar confirms the dx how to tx?

Crytopcoccus neoformans initial tx: amphotericin B and flucytosine long term maintenance therapy: FLuconazole

what metabolizes calcineurin inhibitors (ex. cyclosporine)? what type of juice inhibits this enzyme?

Cytochrome P450, specifically the CYP3A isoenzymes** grapefruit juice inhibits this enzyme

pneumonic for Manic episode

DIG FAST Distractibility Impulsitivity/indiscretion, risky behavior Grandiosity Flight of ideas/racing thoughts increased ACTIVITY/psychomotor agitation decreased need for SLEEP Talkativeness/pressured speech

what function is BRCA1 and 2 involved in

DNA repair they are tumor suppressor genes HER2 MUTATIONS ARE ACQUIRED NOT INHERITED

what is different about the nontypeable strain of H influenza?

DOES NOT PRODUCE A POLYSACCHARIDE CAPSULE and more than 90% of H influenza strains from otitis media are nontypeable -can also cause sinusitis and bronchitis (bc part of the normal upper respiratory tract)

what is surfactant made of? When does it start to rise dramatically?

DPPC, dipalmitoylphosphatidylcholine which is a type of lecithin. -<32 weeks, lecithin and sphinomyelin levels are about equal. after 33 weeks, lecithin levels rise. lecitin to sphinog ratio >1.9 inidcates mautral fetal lungs

chelating agent for iron overdoses or overload due to multiple blood transfusions

Deferoxamine

when neural crest cells fail to migrate into derivatives of 3rd pharyngeal pouch (inferior parathyroid and thymus) and 4th (superior parathyroid) bc of parathyroid and thymus hypoplasia, you get hypoCa and T cell deficiency -bc of hypoCa -Trousseau sign (inflation of blood pressure cuff leads to carpal spasm) -chvosktek sign

DiGeorge

what can you see in neutrophils with a leukemioid reaction

Doyle bodies, which are basophilic peripheral granules in neutrophils

most common in adolescents. sheets of uniform "fried egg" cells. hCG and LDH are tumor markers

Dysgerminoma

which virus is associated with burrkitt lymphoma

EBV

which virus is indented in primary central nervous system lymphoma? which cell origin is this lymphoma?

EBV B cell origin

doesnt ferment sorbitol and doesnt produce glucoronidase

EHEC in undercooked burgers SHIGA TOXIN inactivates ribosome units

characterized by apical displacement of tricuspid valve leaflets, decreased RV volume, and atrialization of the Right ventricle which drug can cause this if taken during preggo?

Ebstein anomaly lithium (used to treat bipolar disorders**)

the ciliary muscle is under parasympathetic control from the

Edinger Westphal nucleus/ciliary ganglion so inhibition by anti muscarinics will limit accommodation and cause blurring of vision for close objects

when pulmonary vascular resistance continues to increase and eventually causes a R to L shunt

Eisenmenger syndrome bc continued pressure in pulm arteries will cause pulm vascular sclerosis

increase in AFP. aggressive tumor in ovaries or testes. most common tumor in male infants. 50% have Schiller-Duval bodies (glomerulus like papillary structures with central vessel)

Endodermal sinus (yolk sac) tumor germ cell histologic type presents w abd pain due to ovarian torsion without virilization

riboflavin aka vitamin B2 is a precursor to which enzymes?

FMN = flavin mononucleotide FAD = flavin adenine dinucleotide riboflavin is P --> FMN with more P --> FAD FAD ACTS AS AN ELECTRON ACCEPTOR FOR SUCCINATE DEHYDROGENASE, which converts succinate into fumarate (In TCA cycle)

mutations in frataxin, a mitochondrial protein important in iron homeostasis and resp function. characterized by spinocerebellar degeneration and associated with hypertrophic cardiomyopathy

Friedrich ataxia

gait ataxia loss of position and proprioception kyphoscoliosis and foot abnormalities hypertrophic cardiomyopathy diabetes mellitus which repeats do you see?

Friedrich ataxia GAA repeats which decreases mitochondrial energy production and results in degeneration of tracts and nerves

How do humans acquire schistosomiasis and what happens??

From snails that infect freshwater. infect human skin-->travel to liver-->intestine (S. mansoni and S. japonicum) -CAUSE PERIPORTAL FIBROSIS infect human skin-->travel to urinary bladder (S. haematobium) -CAUSE ULCERATION/SCARRING OF BLADDER with both, get TH2 mediated rxn with Th2 cells, M2 macrophages, and eosinophils QUESTION ID 8541

retinoblastoma protei nei a regulator of the ___transition

G1 to S phase

bAclofen MOA

GABA B receptor agonist used to tx muscle spasticity

what accumulates in Tay sachs

GM2 ganglioside bc there is a beta-hexoaminidase A deficiency *cherry red spot, do NOT have hepatosplenomegaly while Niemann Pick disease do

where do spliceosomes remove introns

GU at 5' splice site and AG at 3' splice site

which cholesterol drug should you avoid in pts with gallbladder disease and why?

Gemfibrozil this drug blocks cholesterol 7 alpha hydroxylase, which decreases bile acid formation. decreased bile acid formation will decrease cholesterol solubility so it can precipitate and form gallstones this promotes cholesterol excretion

sex cord stromal neoplasms that secrete estrogen, along with inhibin. path findings include Call-Exner bodies with atypical granulosa cells and pink eosinophilic center containing coffee bean nuclei *granulosa cells arranged around collections of eosinophilic fluid*** -theca cells are plump with lipid contents

Granulosa cell tumor (sex cord tumor) bc increase estrogen-->post menopausal bleeding and endometrial hyperplasia granuloma cells=cuboidal, grow in cords or sheets, and form follicle structures

2 most common organisms that cause otitis media

H influenza and strep pna

what is epiglottis most commonly used by and what is its virulence factor?

H influenza type B polyribosylribitol phosphate (PRP) capsule

most common cause of acute epiglottis

H influenza type B, common in immunized and non immunized children but more common in non immunized children

gram negative coccobacillus that requires both X factor (hematin) and V factor (NAD+) to grow also has an antiphagocytic polysaccharide capsule, which allows it to spread hematogenously

H influenzae

ranitidine is a ___receptor antagonist that inhibits gastric acid secretion

H2

which 4 conditions do you see target cells in

HALT HbC Asplenia bc can't get rid of excess membrane Liver disease bc increased cholesterol in membrane Thalasemias target cell = increased surface area to volume

an interleukin that has anti inflame properties? produced by macrophages and TH2 cells

IL-10 inhibits Th1 cytokines (IL-2, IFN gamma) and inhibits MHC II expression so it limits production of pro inflam cytokines, like gamma interferon, IL2,3, TNF alpha)

what is secreted from TH1 cells

IL-2, interferon gamma, and lymphotoxin B macrophage is what produces IL-12 and IL-12 stimulates differentiation into the TH1 subset

what is secreted from TH2 cells

IL-4, IL-5, 10, and 13 IL-4 is released by other APC which facilitates differentiation into TH2 subset

what cytokine attracts eosinophils??

IL-5!!!!!!!!!!! also increases IgA production** (IL-4 promotes IgE Ab production by B cells)

which interleukin is dependent with multiple myeloma

IL-6!!!! (and Il-1) they activate osteoclasts

macrophages releases which cytokine that induces chemotaxis? this cytokine also triggers neutrophils to enter the site of infection via chemotaxis. and then it induces phagocytosis in neutrophils once they arrived

IL-8

how to tell the difference between the types of bleeding in von willibrand disease vs ITP

ITP is more episodic bleeding that is mucocutanous like petechiae, purpura, epistaxis, not chronic VW is chronic and has been occurring since childhood. frequent nose bleeds, heavy periods, bleeding from gingiva, nasal mucosa, GI tract and endometrium

initial treatment of status epilepticus (a single sz lasting greater than 5min or the occurrence of multiple discrete sz with incomplete recovery of consciousness between the episodes)

IV lorazepam and phenytoin

penetrating wound to the back to the immediate right of the vertebral bodies would strike

IVC bc IVC passes through the right side of the central tendon of the diaphragm at the level of T8

recurrent mucosal and resp infections and anaphylactic rxn after transfusion of blood products

IgA deficiency

people with intrinsic asthma will have normal ___ and ___levels?

IgE and skin test intrinsic asthma can be precipitated by pulm infections (especz viral), asa ingestion, cold air, inhaled irritants, stress, exercise question ID 663

what type of agglutination disease do yo get with SLE, CLL, and alpha methyldopa

IgG warm agglutinin disease

rheumatoid arthritis immune response

both TH1 and TH2 pathway activated 1. CD4 T helper cells activated** and promote inflam synovitis 2. CD4 cells also activate B cells to synthesize rheumatoid factor (IgM Ab specific for Fc component of IgG) both pathways form a pannus

renin and aldosterone levels w a pituitary amor (an ACTH secreting adenoma causing Cushings dz,

both are low bc it causes secondary HTN due to the mineralocorticoid activity of excess adrenal glucocorticoids

where do most saccular aneurysms arise from

branch points in circle of willis such as anterior and poster communicating and middle cerebral arteries

increased enterohepatic circulation of bilirubin in 2 week olds

breast milk jaundice beta glucoronidase is an enzyme in breast milk that deconjugate bilirubin. this causes increased absorption and therefore increased enterohepatic circulation of bilirubin

which blood vessel involved in subdural hematoma

bridging cortical veins

lamotrgigine levetiracetam topiramate valproic acid

broad spectrum tx for generalized sz (tonic clonic and myoclonic)

list dopamine agonists used to treat parkinson they directly stimulate dopamine receptors in the brain

bromocrytpine pramipexole, ropinirole promo can be used for hyperprolactinemia

mu opioid meds such as morphine do what?

cause contraction of smooth muscle cells (in sphincter of Oddi, and can lead to increased pressures in the common bile duct and the gallbladder -cause histamine release (leading to vasodilation of blood vessels and itching) -decrease parietal cell acid secretion -cause significant constipation by binding to mu receptors in the bowel and slowing gut motility -

clinical features and what is it caused by? Hemolytic uremic syndrome

caused by shiga toxin producing bacteria (E Coli O157:H7 or shigella) starts out with a bloody diarrhea illness then triad of microangiopathic hemolytic anemia w schizocytes + thrombocytopenia + acute kidney injury the toxin damages glomerular arterioles and capillaries, which leads to platelet activation and aggregation-->platelet consumption so thrombocytopenia RBCs go through damaged capillaries so you get anemia with schizocytes

what happens when you use nitrates with phosphodiesterase inhibitors? phosphodisterase inhibitor used in erectile dysfunction (tadalafil, sildenafil, vardenafil)

causes systemic hypotension bc they both increase intracellular cGMP which causes vascular smooth muscle relaxation

What does Ang II normally do to the arteriole? and which arteriole?

causes vasoconstriction of efferent arteriole; it also stimulates aldosterone secretion

what is the most common benign liver tumor and what does it look like?

cavernous hemangioma cavernous, blood filled vascular spaces lined by a single epithelial layer you don't want to biopsy bc it can case fatal hemorrhage

oculomotor paralysis due to injury to CN3,4, and 6 ptosis and myiadriasis bc of CN3 palsy involvement of maxillary and ophthalmic branches of CN5 -loss of upper facial sensation and afferent limb of corneal reflex eye protrusion and conjunctival swelling may also be presnt

cavernous sinus thrombosis -due to spread of infection to the cavernous sinus via the superior and inferior ophthalmic veins

duodenal biopsy reveals crypt hyperplasia, villous atrophy (atrophy of intestinal villi), and intraepithelial lymphocyte infiltration

celiac disease hypersensitivity to gluten, which is found in wheat, barley, and rye gliadin is a breakdown product of gluten and triggers immune mediated rxn

central vs peripheral vs pulmonary stretch receptors

central -located in medulla and stimulated by decreased pH in CSF. -and increase in PaCO2 --> although these receptors don't sense H in the blood bc H can't diffuse across BBB, CO2 can diffuse across and form H in the CSF peripheral -in the carotid and aortic bodies -sense arterial PaO2 -stimulated by hypoxemia pulmonary -regulate the duration of inspiration depending on degree of lung dissension (Hering Breur reflex) -located in myelinated and unmyelinated C fibers in lungs and airways

what is an apnea that is due to diminished respiratory drive from a neuro disorder? it is usually associated with a significant underlying chronic illness like CHF, cerebrovascular dz, renal insufficiency and is not mroe common in obesity

central sleep apnea

macular lesions impair what type of vision

central vision (scotoma)

what type of acinar emphysema are you likely to see with smoking?

centriacinar emphysema bc the smoke doesnt get all the way down to the alveoli

triad of ataxia telangiectasia and what mutation?

cerebellar ataxia, telangiectasis, and increased risk of sinopulmonary infections mutation of ATM gene which is responsible for DNA break repair *the immune deficiency primary manifests as IgA deficiency and predisposes to infections of the upper and lower airways (it predisposes to an increased risk of hematologic malignancies and causes an immune deficney of both cell mediated and humoral dysfunction)

classic, vs non classic in 21 hydroxylase deficiency will see an increase in 17 hydroxyprogesterone and testosterone levels

classic, salt wasting -girls with ambiguous genitalia -boys at 1-2weeks with failure to thrive, dehydration, hyperkalemia, hyponatremia classic, non salt wasting -girls with ambiguous genitalia -boys at 2-4yrs with early virilization non classic, delayed -premature signs of puberty -women with acne, hirsutism, menstrual irregularity

flank pain + hematuria + abd mass histo = nests of epithelial cells with abundant clear cytoplasm separated by branching vascular tissue

clear cell type renal cell carcinoma

long bone and pelvic fractures/orthopedic procedures with this triad -respiratory distress -neuro sx (altered mentation and sz) -petechial rash (head, neck, thorax, axilla)

clinical features of fat embolism syndrome

what acts on alpha 2 receptors in brain stem, resulting in reduced sympathetic outflow from CNS, which decreases peripheral vascular resistance, HR, and BP

clonidine

large spore forming anaerobic gram + rod catalase - coagulase - in food poisoning and gas gangrene double zone of beta hemolysis on blood agar

clostridium perfingens

what do you give for treatment resistant schizophrenia?? adverse side effects?

clozapine agranulocytosis so you must monitor absolute neutrophil count the most efficacy

info

clozapine is 2nd generation anti psychotic reserved for pt with treatment refractory scz doxepin is TCA that has anti cholinergic effects

cells that are non ciliated in the terminal bronchiole that also secrete protein and surfactant components and also help detoxify inhaled substances?

club cells

which cells are a regenerative source of ciliated cells in the bronchioles?

club cells (non ciliated secretory cells found in terminal portions of the bronchiole) club cells secrete secretory protein which protects against airway airway inflame and oxidative stress and they secrete surfactant proteins which prevent bronchiolar collapse ID: 478

how to separate Staphylococci

coagulase + = Staphylococcus aureus coagulase negative = S. epidermis, S. haemolyticus, S. sapro...etc

what enzyme is produced by Staph aureus

coagulase which activates prothrombin which converts fibrinogen to fibrin you get fibrin coating of the organism and resistance to phagocytosis

what type do of necrosis do you get with lethal tissue ischemia vs ischemia in the CNS?

coagulative necrosis liquefactive necrosis in the CNS -in coagulative necrosis, the tissue architecture is preserved bc digestive enzymes denature before they can significantly disrupt tissue integrity

blood pressure discrepancy AND pulse delay between the upper and lower extremities

coarctation of the aorta you can get cyanosis if the ductus arterioles remains open

associated congenital cardiac anomaly associated with ruptured cerebral aneurysm

coarctation of the aorta = aorta narrowing can be associated with berry aneurysms in the circle of willis (can rupture bc of HTN in branches of aortic arch next to coarct)

impaired judgment, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, chest pain*, sz*, mydriasis*, sudden cardiac death

cocaine intoxication tx: alpha blockers and benzodiazapenes; beta blockers not recommended

southwestern states (desert areas). Mold form is present in soil pulmonary form: flu like illness, cough, erythema nodosum disseminated form: affects skin, bones, lungs culture: forms hyphae biopsy forms thick walled spherules filled with endospores

cocidioides immitis causes San Joaquin Valley fever

long standing ulcerative colitis increases your risk for what type of cancer?

colorectal cancer colitis associated carcinoma associated with -early p53 mutation and LATE APC gene mutations -multifocal -higher grade

choledocholithiasis is due to gallstones in the

common bile duct, which leads to elevated ALP, GGT, direct bilirubin, and AST ALT

how do you get Giardia and what do you use to treat it

common cause of diarrhea in campers/hikers. get it from drinking contaminated water from an endemic area without first boiling it metronidazole

gastroduodenal artery comes from? and splits into ? peptic ulcers involving the poster duodenal bulb can erode into gastroduodenal artery and cause bleeding bc the gastrodudoenal artery courses behind the first part of duodenum

common hepatic artery into anterior superior pancreaticoduodenal artery and right gastroepiploic artery

the gastroduodenal artery arrises from the ___and one of its branches is _____

common hepatic artery right gastroepiploic

IVC is formed by? superior mesenteric vein joint the splenic vein to form?

common iliac veins at L4-5 portal vein

when there is no obstruction to CSF flow from ventricles toe the subarachnoid space but there is a problem with CSF absorption by the ARACHNOID GRANULATIONS**

communicating hydrocephalus so all ventricles are symmetrically enlarged usually caused by Tb meningitis or subarachnoid/intraventricular hemorrhage

flutamide spirnolactone cyproterone vs ketacozole

competitive testosterone receptor inhibitor prevents testosterone synthesis in leydig cells

other important chemotactic agents?

complement component C5a and IL-8 and 5-HETE (leukotriene precursor)

complete vs partial mole (these are hydatiform moles-most common type of gestational trophoblastic disease-->group of tumors characterized by abnormal trophoblastic proliferation)

complete -"bunch of grapes" bc of trophoblastic proliferation ; composed of multiple cystic edematous chorionic villi -"snowstorm pattern" -no fetus, no amniotic sac -p57 negative bc no maternal genome -larger uterus -46XX or XY (paternal origin) -SUPER HIGH HCG LEVELS-->which can stimulate ovarian growth and form theca lutein cysts -HCG acts like TSH to some receptors, high amts of N/V bc of high hCG levels -severe HTN w or w/o proteinuria<20wks!!! partial -fetal tissue present, -69XXX or XXY -p57+ bc maternal DNA present -normal uterine size and normal to high Hcg levels

the fovea is located in the macula which contains a lot of

cones each cone in the macula is synapses to a single ganglion cell ,that is why the visual acuity here is the greatest the neural fibers that transmit info from the macula go to a different area in the occipital visual cortex, that is why there is usually macular sparing w lesions to occitpial cortex

Romano-Ward syndrome and Jervell and Lange-Nielson syndrome is associated with?

congenital QT prolongation syndrome that results from mutations in the K channel and contributes to delayed cardiac action potential

lethargy constipation enlarged fontanella protruding tongue poor feeding umbilical hernia** non pitting edema, puffy face

congenital hypothyroidism -one of the most common causes of preventable intellectual disability -can be due to thyroid dysgenesis or iodine deficiency asx at birth bc of moms T4 YOU NEED T4 FOR NORMAL BRAIN DVMT AND MYELINATION DURING EARLY LIFE SO INFANTS AT RISK FOR IRREVERSIBLE INTELLECTUAL DISABILITY treat with levothyroxine

if a mom has rubella infection, what is likely to be passed on to baby?

congenital rubella syndrome -sensorineural deafness, cataracts, and cardiac malformations (patent ductus arteriosus) -noeonatal defects of head (microcephaly, mental retardation) so give people live attenuated vaccine

biliary atresia = obstruction of extra hepatic bile ducts presents with jaundice, dark urine, and acholic stools due to _________hyperbilirubinemia

conjugated (elevated direct bilirubin)

wet mount with epithelial cells and rare leukocytes

consistent with normal vaginal discharge

packed cells and whole blood contain what anti coagulaant? what is the problem with it?

contains citrate which can chelate Ca nad Mg which can cause hypoMg

damage to sub thalamic nucleus can result in .. (it modulates basal ganglia output)

contralateral hemiballism usually occurs in a setting of lacunar stroke

a lesion in the optic trace can produce ___homonymous hemianopia and a relative afferent pupillary defect (marcus gunn pupil) in the pupil ____to the tract lesion

contralateral; contralateral as the nasal portion of th retina contributes more input to the prectectal nucleus than the temporal portion (w the light reflex, the optic nerve-->optic chasm-->optic tract; the nasal fibers carry more input about the reflex so if there is a problem w the L optic tract, the R afferent pupil is defective bc no signal is getting there so it is not crossing to L optic tract)

increased pulmonary vascular resistance can cause

cor pulmonale (right heart failure due to pulmonary HTN)

what are the most common causes of enlarged coronary sinuses?

coronary sinus is responsible for venous drainage of myocardium and delivers DEoxygenated blood into RA. ANYTHING that causes right atrium to have increased pressure will result in an enlarged coronary sinus MOST COMMON CAUSE is due to pulmonary HTN!! which increases right sided heart pressure

cortex and medulla secretions

cortex -zona glomerulosa = aldosterone (outermost part of cortex) -zone fasciculata = cortisol -zone reticularis = androgens medulla -epi and norepinephrine (post ganglionic sympathetic neurons) they release epi and nepi in response to Ach released by preganglionic sympathetic neurons

a stab wound in the fourth intercostal space in the midaxillary line could strike what after passing through what??

could strike the left ventricle after passing through the left lung left ventricle composes the left lateral aspect of the heart

cystic mass in children filled with brownish yellow viscous fluid that resembles machine oil due to the presence of protein and cholesterol crystals. dystrophic calcification of cysts is highly characteristic* cysts are lined by stratified squamous epithelium w peripheral palisading and internal areas of lamellar "WET KERATIN" what is it and what is it derived from ?

craniopharyngioma rathke's pouch

tumors arising from epithelial remnants of Rathke's pouch (gives rise to anterior pituitary) (posterior pit arises from extension of hypothalamic neurons)

craniopharyngioma suprasellar mass composed of 1. solid-->tumor cells 2. liquid -->filled with machinery oil 3. CALCIFIED COMPONENT

full thickness inflammation with knife like fissures = TRANSMURAL INFLAMMATION anywhere from mouth to anus skip lesions terminal ileum most common site noncaseating granulomas** cobblestone mucosa, creeping fat and strictures ("string sign: on imaging, narrowing of intestinal lumen) ulcers can form then FISTULA FORMATION!! Bc of inflammation and necrosis of intestinal wall

crohn's disease

crohn's disease is ___mediated while ulcerative colitis is ___mediated

crown's disease is TH1 mediated bc you have non caseating granuloma formation!!! UC is Th2 mediated

a fungus has a polysaccharide capsule and the capsule appears red on mucicarmine stain and as a clear unstained zone with india ink

crypto neoformans

budding Yeast with a thick capsule that can be visualized on India ink staining

cryptococcus -causes meningitis in immuno pts****

a benign vascular tumor that is composed of unencapsulated aggregates of closely packed thin walled capillaries. they grow in proportion to the growth of the child and then they regress

cutaneous strawberry type capillary hemangioma

what type of channels are in photoreceptor and olfactory receptor neurons?

cyclic nucleotide gated channels (Like cAMP)

how to treat serotonin syndrome

cyproheptadine (5HT2 receptor antagonist)

recurrent resp infections + congenital absence of vas deferens** + digital clubbing** + obstruction of pancreatic ducts + no sperm!!*

cystic fibrosis bc CFTR mutations results in abnormal dvmt of Wollfian structures

What is a horseshoe kidney and what limits the ascent of the horshoe kidney?

Inferior mesenteric artery prevents ascent. -when the kidneys are joined together at the lower poles. it is located anterior to aorta and posterior to inferior mesenteric artery. -kidneys are supposed to be at T12 to L3

produced by sertoli cells and is the physiologic inhibitor or FSH secretion what is LH concentration controlled by?

Inhibin B testosterone (LH stimulates the release of testosterone from Leydig cells of testes) (FSH stimulates release of inhibin B from the sertoli cells of testes) sertoli cells are present within the seminiferous tubules of testes

most common primary tumor in childhood. usually well circumscribed in children, most often found in posterior fossa like the cerebellum GFAP + (expressed in astrocytes); Rosenthal fibers* comprised of spindle cells with hair like glial processes that are associated with micro cysts

Juvenile pilocytic astrocytoma

congenital deficiency of GnRH

Kallman syndrome low LH, low FSH, low testosterone, also low estrogen bc decreased gonadotropins reduces aromatase activity defect in formation of olfactory bulb SO THEY CANT SMELL

what level does the superior mesenteric artery leave the aorta? if the SMA and aorta form an angle to less than 20 degrees instead of its normal 45 degrees, then what can get obstructed other than the left renal vein?

L1 transverse portion of the duodenum

ocular myasthenia gravis vs lambert eaton myasthenia syndrome

LEMS -hyporeflexia or areflexia -autonomic sx (dry mouth or impotence) -incremental response to repetitive stimulation

risk factors of aspiration

LOC or dysphagia such as alcoholism, drug overdose, SZ disorder*, prolonged anesthesia

virulence factor of Neisseria meningitides

LOS = lipxooligosaccharides LOS grows so much that it outgrows the surface area of the bacteria and begins blabbing off. the blebs is what leads to a massive inflammatory response

what are the CO2 levels in alveolar hyperventilation?

LOW CO2 levels aka hypocapnia.

diffusion capacity for carbon monoxide low or high for a pt with emphysema?

LOW bc in emphysema, the alveolar capillary surface area is decreased bc of idntraalveolar wall destruction

a hallucinogen visual hallucinations, euphoria

LSD intoxication

_____is a nonspecific finding for granulomatous conditions. They have multiple nuclei organized in the shape of a horseshoe

Laghans giant cells macrophages form these cells and the macrophages are activated by CD4+ Th1 lymphocytes

isolated idiopathic osteonecrosis of the hip

Legg Cavle Perthes disease

exposure to contaminated water patchy infiltrates (evidence of pna) high fever relative bradycardia neuro sx (confusion, ha) GI systems like WATERY diarrhea

Legionella pna

seen on silver stains and can culture organism on buffered charcoal yeast extract (BCYE) supplemented with L cysteine and iron so needs L cysteine to grow

Legionella pna

high fever, ha, confusion, watery diarrhea in a smoker* usually acquired from contaminated water **sputum gram stain shows many neutrophils but no bacteria and hyponatremia

Legionella pna (mycoplasma pna is also not detected on gram stain)

development of dystonia, choreoathetosis, self mutilation, and hyperuricemia in the first few years of life what disorder and what is deficient? what builds up as a result?

Lesch Nyhan syndrome HGPRT deficiency (hypoxanthine-guanine phosphoribosylatransferase) -hypoxanthine and guanine can't be converted back to IMP and GMP so there is an increased degradation of them to URIC ACID

the micro satellite instability pathway is characterized by mutations of DNA mismatch repair genes and is implicated in the dvmt of mutations in repair genes like MLH1 and MSH2)

Lynch syndrome aka hereditary nonpolyposis colorectal cancer

2 most important factors in osteoclast differentiation used to treat postmenopausal osteoporosis by working similar to OPG and binding to RANKL to stop interaction with RANK

M-CSF (macrophage colony stimulating factor) and RANK-L denosumab

Tranylcypromine,Phenelzine, Isocarboxazid, Selegiline

MAO inhibitors "MAO Takes Pride In Shanghai" Selegiline - selective MAO B inhibitor contraindicated with dextromethorpan to prevent serotonin syndrome USED FOR ANXIETY, ATYPICAL DEPRESSION**

what is zollinger ellison syndrome associated with

MEN1 (pancreatic tumors) MEN1 also associated with insulinomas, VIPomas, glucagonomas (pancreatic endocrine tumors) ZE syndrome is a gastrinoma!! (a tumor in the pancreas that produces gastrin)

both MEN2A and 2B are associated with RET oncogene mutation. which one is associated with marfanoid habitus?

MEN2B

with methlymalonic academia, acidic or basic? what is built up? glucose levels? ammonia levels?

METABOLIC ACIDOSIS bc of methylmalonic acid and propionic acid build up these organic acids also inhibit the urea cycle which leads to HYPERAMMONEMIA HYPOGLYCEMIA bc of increased metabolic rate this also leads to production of KETONES!! which furthers the anion gap metabolic acidosis

which infections trigger cold autoimmune hemolytic anemia

MMM so IgM "Cold weather is miserable" Mononucleosis Mycoplasma pna IgM titers usually begin to fall approximately 4 weeks after initial infection leading to a resolution of the hemolytic anemia

variable uterine dvmt-->bc uterus is hypo plastic or absent, pts cannot menstruate (primary amenorrhea) no upper vagina (short vagina) 46XX normal ovaries so it secretes estrogen normally so pts have regular dvmt of secondary sexual characteristics (breast, pubic hair)

Mullerian agenesis (Mayer Rokitansky Kuster Hausser syndrome)

infection with ____can result in cold agglutinin formation

Mycoplasma pna also more likely to cause tracheobronchitis instead of pna clinical presentation is mild compared to chest x ray

most common cause of atypical pna usually affects military recruits or college students living in a dorm complications include autoimmune hemolytic anemia (IgM against I antigen on RBCs cause cold hemolytic anemia)** they lack a cell wall so not visible on gram stain!!* ***need cholesterol to grow bc their cell membrane is composed of single cholesterol rich phospholipid bilayer

Mycoplasma pna chest x ray reveals that they are much worse than the clinical appearance

______is when there is chronic myocardial ischemia where both myocardial metabolism and function are reduced to match the reduction in coronary blood flow this prevents myocardial necrosis. these changes lead to what? How can you improve this?

Myocardial hibernation lead to decreased contractility and LV systolic dysfunction Coronary revascularization helps restore blood flow to hibernating myocardium which will improve contractility and LV function

you need vitamin B3 to form

NAD and NADP niacin deficiency = dermatitis, diarrhea, and dementia

neurofibromas optic nerve gliomas cafe au lait spots lisch nodules (pigmented nodules of the iris)

NF1 mutation in NF1 tumor suppressor gene on chromosome 17

what does NF1 and NF2 tumor suppressor gene code for

NF1 codes for neurofibromin NF2 codes for merlin

bilateral acoustic schwannomas juvenile cataracts meningiomas ependymomas

NF2 mutation in NF2 tumor suppressor gene on chromosome 22 NF2 affects 2 ears, 2 eyes, and 2 parts of the brain

which cells are responsible for the destruction of cells with decreased or absent MHC I clap proteins on their surfaces

NK cells -derived from lymphoid stem cells -contain perforins and produce holes in target cells and induce apoptosis

2 most important factors involved in coronary blood flow autoregulation

NO and adenosine (product of ATP metabolism)

what are the levels of Ca, P, and PTH in primary osteoporosis (not caused by a medical disorder?

NORMAL

how do you treat a pt with oropharyngeal candidiasis (oral thrush) s/p using oral or inhaled steroids for asthma?

NYASTATIN -administered as an oral agent, "swish and swallow"; not absorbed in GI tract; -oral thrush is a fungal infection caused by Candida fungi

which infections increase the risk of ectopic preggo

Neisseria gonorrhea or Chlamydia trachomatis bc they cause inflammation and damage to the fallopian tubes and cause cervicitis which progresses to pelvic inflam disease-->scarring of fallopian tubes->ectopic preggo and infertility Neisseria (gram negative diplococci) Chlaymidya (an intracellular gram negative bacterium)

hyperammonemia and elevated urinary orotic acid (can't eliminate ammonia-->episodes of vomiting, confusion, coma, tachypnea from cerebral edema from ammonia build up so hyperventilation and resp alkalosis

Ornithine transcarbamylase deficiency you need ornithine transcarbamylase (OTC) and carbamoyl phosphate to convert ornithine to citrulline when there isn't OTC, carbamoyl phosphate gets converted to orotic acid

tender, violaceous nodules typically located in the pulp of fingers and toes in infective endocarditis? What is its pathogenesis?

Osler nodes immune complex deposition in the skin

syndrome in which pt has severe recurrent nosebleeds and has pink spider like lesions on oral and nasal mucosa

Osler-Weber Rendu syndrome = hereditary hemorrhagic telangiectasia -with skin and mucosal membrane telangiectasias; mucosal involvemnt may affect lips, oropharynx, resp tract, GI tract, urinary tract -if telangiectasias rupture-->nose bleeds, GI bleeding, hematuria

Violence, impulsivity, psychomotor agitation, HORIZONTAL AND VERTICAL NYSTAGMUS, hallucinations, trauma is most common complication which drug and what receptor does it work on?

PCP N-methyl-D-aspartate receptor antagonist*

immobilization and recent surgery are risk factors for developing what?

PE bc immobilization causes venous stasis and recent surgery causes inflamm which causes a hyper coagulable state a risk of PE after an orthopedic procedure is as high as 50%

what does fructose 2,6 BP activate and what does it inhibit

PFK1 which is key enzyme in glycolysis inhibits FBPase-1 (which occurs in gluconeogesis)

what branches off of vertebral artery

PICA posterior inferior cerebellar artery

what is the gene that is mutated in paroxysmal nocturnal hemoglobinuria

PIGA gene so now you don have GPI anchor this anchor is needed to anchor CD55 and CD59 which are cell surface proteins that inactivate complement so now complement lyses RBCs

musty body odor, intellectual disability, gait or posture abnormality, eczema

PKU (phenylketonuria) mutation in phenylalanine hydroxylase which converts phenylalanine-->tyrosine don't give them artificial sweetener bc it has phenylalanine in it

E to A transition when listening to lungs indicates

PNA (usually happens when the lung fields are filled with liquid or a solid mass)

"bones, stones, abd groans, and psychic moans" also describe what you see on X-ray

PRIMARY HYPERPARATHYROIDISM -YOU WILL SEE HYPERCALCEMIA (pts will also be peeing out a lot of Ca) and HYPOPHOSPHATEMIA ***SALT AND PEPPER SKULL ***subperiosteal erosions in the phalanges of the hand ***osteolytic cysts in the long bones = osteitis fibrosa cystica

what is uremic platelet dysfunction characterized by? PT, aPTT, platelet count, and bleeding time

PT and aPTT and platelet count is all normal bleeding time is prolonged

no immunoglobulin or complement deposits on BM

Pauci Immune most pts have ANCA in their serum instead

what is the name of the rash in inflammatory breast cancer that is described as an erythematous rash that is often itchy

Peau d'orange itchy breast rash w skin texture changes analogous to an orange peel

normal glucose levels severe cardiomegaly, hypotonia, macroglossia glycogen accumulation in muscle and liver lysosomes deficiency in acid alpha glucosidase (acid maltase) -->normally breaks down glycogen in the acidic environment of lysosomes

Pompe disease

where does renal cell carcinoma like to mets

RCC likes to go to renal vein which increases risk for hematogenous spread to lungs* and bone

stool seen on vibrio cholerae? how does the toxin behave in cholerae? toxin action is similar to?

RICE WATER STOOL with no leukocytes or erthryocytes. this is bc the toxin toxin activates adenyl cyclase-->increase cAMP so increased Cl EFFLUX and DECREASE NA REABSORPTION-->watery diarrhea toxin does not damage or invade intestinal epithelium just like ETEC (enterotoxigenic E Coli)

the right brachiocephalic vein also drains the ..??

RIGHT LYMPHATIC DUCT which drains lymph from RUE, right face and right neck, right hemithorax, and RUQ (my notes= diaphragm, heart, right lung)

what type of shunt do you get with a PE?

RIGHT TO LEFT SHUNT a thrombosis in pull circulation leads to increased blood flow the remainder of the lung, causing a V/Q mismatch. the resulting ischemic injury also causes inflam, which leads to surfactant deficiency and atelectasis in the surrounding lung regions. this leads to a high volume of deoxygenated blood traversing poorly ventilated lung regions, leading to hypoxemia (R to L intrapulmonary shunting)

which RNA polymerase synthesizes ribosomal RNA

RNA polymerase I forms ribosomal components

which type of RNA makes mRNA , small nuclear RNA, and micro RNA

RNA polymerase II small nuclear RNA for mRNA splicing micro RNA for gene silencing via translation arrest or mRNA degradation

Renal plasma flow formula

RPF value is the same as PAH value -the plasma volume that flows through the kidney RPF = PAH clearance = urine PAH* urine flow rate/ plasma PAH

buzz words= fevers, night sweats, bloody cough, and weight loss

Tb this would be secondary Tb bc it arises with secondary activation of mycobacterium Tb. primary Tb is usually asx

Migratory thrombophlebitis aka _____should raise suspicion for____.

Trousseau syndrome cancer Hyper coagulability is a very common paraneoplastic syndrome seen most frequent in visceral adenocarcinomas of the pancreas, colon, and lung

an inherited PNS tumor syndrome where pts dvp neurofibromas, optic nerve gliomas, lisch nodules (pigmented nodules of the iris), and cafe au lait spots (hyperpigmented cutaneous macule)? "coast of California" border bc smooth border

Von Recklinghausen's disease (or neurofibromatosis type 1

What is Meckel's diverticulum

When the vitaline (omphalomesenteric duct) does not obliterate and toddlers get painless GI bleeding bc of ECTOPIC gastric mucosa -the vitelline duct connects yolk sac to the midgut lumen -not all of the vitaline duct closes. the part that stays open is close to the ileum -ectopic=functionall normal cells found in an abnormal location TRUE DIVERTICULUM so it contains all parts of intestinal wall-->mucosa, submucosa, muscularis

distended macrophages in the intestinal lamina propria

Whipple disease -malabsorptive diarrhea, weight loss, and joint pain

child with immune problem which shows as recurrent infections, decreased platelets and rash (eczema + thrombocytopenia, and combined B and T lymphocyte deficiency) ****

Wiskott Aldrich syndrome

inheritance pattern of G6PD deficiency

X linked recessive

deletion vs mutation of dystrophin dystrophin is a structural protein of muscle fibers

X linked recessive; skeletal muscle replaced by adipose tissue deletion = Duchenne muscular dystrophy mutation = Becker calf psuedohypertrophy weakness in proximal muscles so need to use hands to help stand up kyphoscoliosis bc of weakness of paraspinal muscles

what happens with secretin administration in Zollinger Ellison syndrome?

ZE syndrome is caused by a gastrin secreting tumor (gastrinoma) normally secretin releases bicarb and inhibits gastrin release but in this snydrome, secretin STIMULATES GASTRIN RELEASE FROM THE GASTRINOMA gastrin hyper secretion also causes parietal cell hyperplasia, and you get enlargement of gastric folds you see distal duedenal ulcers (proximal ulcers due to NSAIDS or H pylori)

RAS is activated when?

a growth factor ligand binds to a tyrosine kinase receptor which gets P and then that cause inactive RAS (GDP)-->active RAS (GTP)

how to test for essential fructosuria

a urine copper reduction test which tests the presence of reducing sugar (fructose, glucose and galactose are reducing sugars) a urine dipstick won't be + in the presence of galactose or fructose bc it uses glucose oxidase to test presence of urinary glucose

absolute vs relative erythrocytosis

absolute has an increase in Hct levels aka an increase in red cell mass relative has normal red cell mass. can be caused by diuretic therapy female Hct >48% and >52% in men

problem with preggo women with + group B strep

abx prophylaxis during labor and delivery bc infants can dip serious sepsis, pna, and meningitis strep agalactiae

the activity of pyruvate carboxylase is increased by? how does this increase gluconeogenesis?

acetyl CoA acetyl CoA stimulates pyruvate carboxylase (pyruvate-->oxaloacetate). then oxaloacetate is converted to PEP pyruvate cannot be immediately converted to PEP bc pyruvate kinase is one way

occurs 1-2 weeks after transplant it is bc of the recipient's reaction to the HLA of the graft *CD8 T cells** --> host T lymphocyte sensitization against graft (foreign) MHC antigens* characterized by a dense infiltrate of mononuclear cells immunosuppressants can treat

acute CELLULAR rejection-->mediated by host T cell...etc prevent w calcineurin inhibitors such as cyclosporine or tacrolimus. tx include corticosteroids in addition to maintenance therapy w calcineurin inhibitors (bad side effect is reduced renal blood flow and damage to renal endothelial and tubular cells, histo findings include arteriolar hyalinization and tubular vacuolization)

______glaucoma presents with very painful, red eye, sudden vision loss, halos around eyes, frontal ha, iced and mid dilated pupil

acute closure

hepatocyte necrosis, characterized by cellular swelling and cytoplasmic emptying "ballooning degeneration"

acute hepatitis

port wine colored urine abd pain neuro sx no photosensitivity

acute intermittent porphyria porphobilinogen deaminase deficiency elevation in porphobilinogen and ALA

when you see eosinophils in the urine*** drug induced hypersensitivity involving the INTERSTITIUM*** AND TUBULES causes include NSAIDs, penicillin, and diuretics ressolves w cessation of hte drug

acute intersitial nephritis sx resolve w stopping drug

acute pancreatitis and triglyceride levels and treatment

acute pancreatitis can be due to severe hypertriglyceridemia. This is bc pancreas releases pancreatic lipase to convert triglycerides to free fatty acids which have a toxic effect on pancreas fibrates are most effective to treat hypertriglcyeridemia bc it activates PPAR-alpha which increases the synthesis of lipoprotein lipase

diffuse damage to the alveolar capillary interface (diffuse alveolar damage); this causes leakage of protein rich fluid which leads to edema that combines w necroticc epithelial cells to form hyaline membranes in the aveoli

acute respiratory distress syndrome -white out on x ray -hypoxemia and cyanosis w resp distres **activation of neutrophils induces protease and free radical mediated damage of type I and type II pneumocytes -bc damage to type II, recovery may result in interstitial fibrosis occurs secondary due to a lot of disease processes, PANCREATITIS!***, sepsis, infection, shock,

migratory arthritis, new murmur, fever, + anti streptolycin O titer complications -mitral rega=rg, myocarditis, pancarditis

acute rheumatic fever develops 2-4 wks s/p strep grou A pharyngitis you have molecular mimicry so anti strep Ab attack cardiac and nuero antigens

acute/subacute -migratory arthritis -pancarditis (mitral regurg) -sydenham chorea chronic -mitral stenosis

acute rheumatic fever -treat strep pharyngitis with penicillin to prevent this from happening

sydenham chorea is a neuro manifestation of?

acute rheumatic fever!! -caused by a delayed onset autoimmune rxn involving anti strep Ab that cross react with the basal ganglia

glands or mucin most common tumor in nonsmokers and female smokers** peripheral hypertrophic osteoarthropathy; dermatomyositis or polymyositis; migratory thrombophlebitis (Trousseau syndrome)

adenocarcinoma

uniform symmetrical uterus involvement with dysmenorrhea, abnormal uterine bleeding, pelvic pain

adenomyosis (ectopic endometrial glands within the myometrium)

acts on A1 receptors on cardiac cells and activates K channels, which leads to conduction delay in AV node

adenosine

TSH glucagon PTH their hormone receptors use what type of messenger system>

adenylate cyclase second messenger system G protein coupled receptor activated-->GTP binds to alpha subunit-->adenylate cyclase activated-->ATP converted to cAMP-->protein kinase A activation***** TSH, LH, and FSH also use G protein coupled receptors

pheochromocytomas are what type of tumors that secrete what?

adrenal medullary tumors that secrete excessive catecholamines usually present w episodic headaches, tachycardia (sensed as palpitations), and increased sweating

what is nonbacterial thrombotic endocarditis (NBTE) associated with?

advanced malignancy characteristic of NBTE includes platelet rich thrombi (also seen with lupus, DIC, APP syndrome)

Potter sequence (aka??)

aka Oligohydramnios. It is caused by some sort of renal anomaly (usually bilateral renal agenesis-->absence of kidneys; can also be bc of polycytic kidney dz or posterior urethral valves; as a result, you have decreased formation of urine which is amniotic fluid. with decreased amniotic fluid, the fetus is squished bc the amniotic sac is smaller. this causes physical abnormalities. amniotic fluid is also needed to help develop the lung Pulmonary hypoplasia Oligohydramnios Twisted skin (wrinkles) Twisted face-->flat face Extremity deformities -->clubbed feet Renal agenesis

deficiency in homogentisic acid dioxynenase which breaks down homogentisate (from tyrosine) to maleylacetoacetate excess homogentisic acid causes pigmented deposits in CT ; blue black deposits apparent in sclera and ear cartage. deposits also occur in large joints and spine, causing ankylosis, motion restriction, and significant pain urine turns black when exposed to air bc of oxidation of homogentisic acid

alkaptonuria

What does the allantois connect and later in dvmpt when it turns into the urachus, what does the urachus connect?

allantois connects yolk sac to urogenital sinus and urachus connects yolk sac to the bladder

risk factors in americans vs asians for developing esophageal SCC? how does esophageal SCC present? what are these risk factors for?? = Barrett's esophagus, GERD

americans = smoking and drinking asians = eating foods with N-nitroso compounds presents with progressive dysphagia and weight loss; GI blood loss resulting in iron deficient anemia adenocarcinoma

prophylaxis for migraine ha

amitriptyline, beta blockers, topiramate, valproate******

amlodipine vs verapamil

amlodipine is a dihydropyridine calcium channel blocker so it is selective for vascular smooth muscle and doesn't affect the heart as much as verapamil

upper motor neuron involvement (hyperreflexia and spasticity) coupled with lower motor neuron involvement (atrophy and fasciculations)

amyotrophic lateral sclerosis

Class II MHC molecules are only displayed by

antigen presenting cells (dendritic cells, M, and B lymphocytes) ID 542 you need lysosomal acidification to occurring order for foreign antigen to be expressed on MHC II

What do you use acyclovir for to treat what? MOA?

antiviral to treat herpes simplex virus 1 and 2 and varicella zoster virus -nucleoside analogue, converted into acyclo-GTP in infected cells and that inhibits viral DNA poly

how do you worsen a murmur in hypertrophic cardiomyopathy

anything that decreases LV volume -diuretics -vasodilators (ex. dihydropyridine Ca channel blockers, nitro, ACE inhibitors) decrease systemic vascular resistance, leading to decreased after load and lower LV volumes

severe chest pain radiating to the back with differences in blood pressure measurements between arms

aortic dissection

"dissection flap in the ascending/descending aorta" indicates what? describe the classifications

aortic dissection (starts with an intimal tear) Stanford type A involves ascending aorta, usually originate in the sinotubular junction (affected to due increases in the rate of rise of pressure) Stanford type B involves descending aorta and originates close to the origin of the left subclavian artery*!

early diastolic descrendo murmu

aortic regurg inhaled amyl nitrates reduce murmur

blowing decrescendo murmur that begins immediately after aortic valve closure and heard best along 3-4th intercostal space while the pt is sitting up and leaning forward w breath held in end expiration

aortic regurg peak intensity of murmur is right after aortic valve closure when pressure gradient between LV and aorta is at its max

harsh ejection type systolic murmur best heard at the base of the heart with radiation to the carotid arteries (neck)

aortic stenosis

the most common complication of bicuspid aortic valve is?

aortic stenosis (dvps in 50s) bc the abnromal shaped valve increases hemodynamic stress which causes premature calcification and athersclerosis of the valve

pharyngeal arch innervation

arch 1: trigem CN5 arch 2: facial nerve CN7 arch 3: glossopharngyeal nerve CN9 arch 4 and 6: vagus nerve CN10

where is the chemoreceptor trigger zone (nausea and vomiting from chemotherapy is triggered here0

area postrema of the dorsal medulla near the 4th ventricle

composed of scattered cells with a mucopolysaccharide storm, abnormal blood vessels, and hemorrhaging

arial myxoma tumor -produce vascular endothelial growth factor which contributes to angiogenesis, hemorrhage (seen as hemosiderin deposition) -also produce lots of IL-6, so its frequently present with weight loss, fever...etc

wide and fixed splitting of S2 that does not change with respiration

arial septal defect with L to R shunt

what does the ansa cervicalis arise from? what does it innervate? how can it be injured?

arises from C1,2,3 nerve roots and innervates sternohyoid, sternothyroid, and omohyoid muscles of anterior neck penetrating trauma to neck above cricoid cartilage can injure this nerve

whenever there is maternal virilzation (ex hirsutism) bc of the transfer of excess androgens into the maternal circulation baby has high androgen levels w normal internal genitalia and ambiguous external

aromatase deficiency (converts androstenedione to estrone and testosterone to estradiol) w 21 hydroxylase deficiency, there is no maternal virilization

anastrozole, letrozole, exemestane are what type of inhibitors and used for what?

aromatase inhibitors so it prevents conversion of testosterone to estradiol this is good to slow the progression of ER + tumors in breast cancer bc estrogen is the main hormone driving the growth and dvmt of estrogen receptor + malignant breast tumors

what is a normal FEV/FVC ratio

around 80%

describe zone 2 in lung

arterial pressure>alveolar>venous pressure alveolar pressure is greater than venous pressure, the pulm capillaries are obsturcted near thevenous end of thecapillary bed. but when arterial pressure rises during systole, capillary pressure ecomes high enough to overcome the alveolar pressure so this is why blood flows in a pulsatile fashion

describe zone 3 in lung

arterial>venous>alveolar arterial and venous both greater than alveolar, so blood flows continuously through the pulm capillaries. when a person lies supine, the differrrences in lung perfusion are negated as gravity than affects the lung equally from apex to base.

Reye syndrome is seen in children mainly and is seen when

asa is given in the context of URI

pleural plaques, ferruginous bodies

asbestosis interstitial pattern more prominent in lower zones ferruginous bodies (fusiform rods with translucent asbestos center and an iron containing coating)

septate hyphae that branch at 45 degree angles it has a mold form only

aspegillus fumigates

"fungus ball"

aspergillus fumigatus septate hyphae that branch at 45 degree angles (V shaped branching)

bactericides, prevotella, fusobacterium, and peptostreptococcus how to treat?

aspiration pna -->seen in alcoholics so these organisms are aerobic bacteria in oropharynx treat w clindamycin which has most activity against oral anaerobes and covers aerobic gram + organisms binds to 50S ribosomal subunit in bacteria and disrupts protein synthesis (vancomycin only for gram +; metronidazole good for anaerobes)

where are ringed sideroblasts seen vs basophilic stippling and what is it associated with

associated w sideroblastic anemia and excess iron in the mitochondria seen in bone marrow!!! vs basophilic stippling which is seen in peripheral blood smear

Menetrier disease

associated with overproduction of TGF alpha TGF alpha is a potent stimulator of epithelial growth and is secreted by carcinomas, M, and epithelial cells

describe glutamate glutamine cycle in neurons

astrocytes take up glutamate in synapse to prevent excess neuronal excitation glutamate synthase in astrocytes combine glutamate with ammonia to form glutamine glutamine released by astrocytes and taken up into neuron glutamine-->glutamate in neuron so it can be a neurotransmitter

cells from tumors of glial origin stain + for GFAP. list the cells

astrocytes, oligodendrocytes, and ependymal cells

where does wasted ventilation occur

at apex of lung

where does tendon of biceps femoris attach

at styloid process of head of fibula

where does wasted perfusion occur

at the base of the lung

characterized by DNA hypersensitivity to ionizing radiation also have severe immunodeficiency with repeated sinupulmonary infections risk of cancer is increased bc of bad DNA repair

ataxia telangiectasia ataxia bc of cerebellar atrophy and oculocutaneous telangiectasia is another manifestation

what is the triad that occurs in normal pressure hydrocephalus in elderly patients

ataxic gait, urinary incontinence, and then dementia

diabetes mellitus High cholesterol** smoking tertiary syphilis are risk factors for what?

atherosclerosis which predisposes to aortic aneurysm formation tertiary syphilis results in spirochete endarteritis that affects the vasa vasorum within the adventitia of the ascending aorta, this weakens the aortic wall

reentry current the rotates around the tricuspid valve

atrial flutter P waves are replaced by regular rapid "flutter waves"

mid diastolic rumble best heart at the apex, positional dyspnea, and a large pedunculated mass in the left atrium

atrial myxoma

fixed splitting of second heart sound (S2)

atrial septal defect so L to R shunt bc LA has more pressure. so LA-->RA-->RV-->more pressure in pulmonary arteries

a complete AV canal defect is comprised of? It is the most common congenital cardiac anomaly associated with?

atrial septal defect, ventricular septal defect, and a common AV valve Down Syndrome THIS IS DUE TO FAILURE OF THE ENDOCARDIAL CUSHION TO FUSE WHICH RESULTS IN OSTIUM PRIMUM defects listed above

where does rabies attach to and how does it travel in body

attaches to the nicotinic Ach receptor at the neuromuscular junction RETROGRADE through peripheral nerves axons to the CNS

what type of cells do you see on a peripheral smear with mono

atypical CD8 T lymphocytes bc they are what respond to virally infected cells!!!

bupropion

atypical antidepressant inhibits NE an dopamine reuptake also used for smoking cessation contraindicated in anorexia or bulimia bc it decreases sz threshold

mood reactivity (experience improved mood with + events), reversed vegetative sx (hypersomnia, hyperphagia-->increased sleep and appetite), leaden paralysis

atypical depression use CBt and SSRI to tx. MAO are not first line

The best way to assess mitral stenosis

auscultating the duration between S2 (aortic and pulmonic valve closure) and opening snap. shorter interval=more severe obstruction bc left atrial pressure increases bc of the impaired mvmt of blood intro left ventricle. so higher pressure causes the valve to open more forcefully -will also hear diastolic rumbling murmur with presystolic accentuation due to left atrial contraction -normally wont hear an S3 or S4 unless a patient develops right sided heart failure bc of MS

tourette vs autism

autism has rhythmic and regular behaviors, don't have an urge, stop with distraction, and have an earlier age of onset tourette: comorbid with ADHD and OCD. -vocal and >1 motor tics (sudden intermittent, non rhythmic motor mvmts and vocalizations); tics are preceded by irresistible urges and followed by feelings of relief

what type of agonists do you treat COPD and asthma its and what is the mechanism?

beta 2 adrenergic agonists bc it relaxes bronchial smooth muscle beta 2 adrenergic receptor is G coupled receptor-->activates adenyl cyclase -->increased cAMP-->relaxation

what is secreted by the syncytiotrophoblast

beta HCG during the first trimester, rises to its highest level at the 9th week of gestation

what other receptor is highly expressed in hyperT?

beta adrenergic receptors so you give beta blockers to decrease sympathetic stimulation

what is helpful in pt w hypertrophic cardiomyopathy

beta blockers (metoprolol), nondihydropyridine Ca channel blockers (verapamil), and disopyramide reduce left ventricular outlet obstruction!!

what do you give pts with coronary artery disease and CHF along with HTN

beta blockers like metoprolol

what type of abx is penicillin and MOA?

beta lactam so it prevents formation of peptidoglycan cross links in bacterial cell walls

amoxicillin and cephalexin are what type of abx? do they get metabolized via the hepatic/liver?

beta lactams no

ingesting what can cause a change in elasticity of the aorta that mimics the myxomatous degeneration seen in pts with Marfan syndrome

beta- aminopropionitrile-->a chemical found in certain kinds of sweet peas it inhibits lysyl oxidase which helps cross link elastic and collagen fibers

where should thoracentesis be performed and why?

between 6 and 8th ribs at midclavicular line and ribs 8-10 along mid axillary line and ribs 10-12 along the paravertebral line bc the parietal pleura extends below visceral pleura if inserted higher, then there is a risk of lung injury

what do you see if there is incomplete upper lateral fusion of the paramesonephric ducts

bicornuate uterus characterized by an indentation in the center of the fundus

most common cardiac lesion seen in Turner syndrome

bicuspid aortic valve and coarctation of aorta

where does carotid body lie

bifurcation of common carotid artery (inferior to hyoid bone) contains O2, CO2, and H chemoreceptors

which cholesterol drug can lead to hypertriglceridemia

bile acid binding resins -cholestryramine, colestipol, colesevelam

ciguatoxin (exotic fish, Moray eel) and Batrachotoxin (South American frogs)

binds to Na channel and keep it open to cause persistent depolarization

tetrodotoxin (puffer fish) and saxitoxin (dinoflagellates in "red tide") MOA of these toxins?

binds to Na channels and inhibit Na influx and prevent action potential conduction

Prednisone binds with what to decrease the production of what

binds to glucocorticoid receptor to decrease the production of inflamm cytokines and adhesion proteins

diphenoxylate (also loperamide) MOA problem with high doses and what do you do?

binds to mu opiate receptors in GI tract AND SLOWS MOTILITY!!! helpful for diarrhea high doses produce morphine like effects/euphoria so you combine it with atropine (dry mouth, blurry vision, nausea)

opioid MOA in pre vs post synaptic neuron

binds to mu receptors on presynaptic neuron = closure of Ca channels so decreases excitatory neurotransmitter release post synaptic = opening of K channels therefore membrane hyperpolarzation

excess raw egg white consumption

biotin (vitamin B7) deficiency -can dvp macular dermatitis and metabolic acidosis

round test with broad based budding yes have thick doubly refractive walls

blastomyces dermatitis

nifedipine causes bronchodilation by

blocking Ca influx into bronchial smooth muscle cells

methylxanthines, like theophylline and aminophylline, cause bronchodilation by

blocking phosphodiesterase activity, thereby increasing the intracellular concentration of cAMP

abciximab eptifibatide tirofiban

blocks Gp2b/3a receptor directly from binding to fibrinogen

carbamazepine MOA

blocks Na channels **it inhibits neuronal high frequency firing by reducing the ability of Na channels to recover from inactivation

digoxin MOA

blocks Na/K exchanger in myocardial cells, increasing Na intracellularly which then increases Ca intracellularly bc of the Na/Ca exchanger so you get increased myocardial contractility

ezitimibe MOA

blocks cholesterol absorption so no intestinal absorption = decreased cholesterol stores in liver liver then compensates by increasing LDL receptor expression, which draws cholesterol out of circulation

clopidogrel, prasugrel, ticlopidine

blocks the ADP P2Y12 receptor on platelets this prevents this receptor from allowing Gp2b/3a receptor from being expressed on the surface

tetanospasmin (tetanus toxin) MOA

blocks the release of glycine and GABA which are inhibitory neurons travels retrograde through motor axons to spinal cord spastic paralysis

how is nitroglycerin used to treat stable angina pts

blood collects in venous system so cardiac workload is decreased, decreasing preload--------->decreasing ventricular wall stress and decrease in left ventricular end diastolic volume and pressure-->decreased myocardial O2 demand **lARGE VEINS MOST SUSCEPTIBLE TO THE EFFECT OF NITRO

what is most sensitive in dx vertebral osteomyelitis

blood cultures and MRI hematogenous spread is the most common way bacteria access the spine from distant infection, invasion from trauma or spinal procedures, or spread from adjacent soft tissue infection adult vertebral bone has rich vasculature

adverse side effect of carbamazapine

bone marrow suppression which may lead to anemia, agranulocytosis, and thrombocytopenia so complete blood cell counts should be monitored periodically)

pattern of unstable relationships, very impulsive, suicidal behavior, inappropriate or intense anger, splitting is a major defense mechanism, chronic feelings of emptiness, affective instability (marked mood reactivity)

borderline personality disorder

_____is a proteasome inhibitor used in the treatment of multiple myeloma and waldenstrom macroglobulinemia

bortezomib

what is used to treat pulmonary arterial HTN and how does it work?

bosentan it is an endothelin receptor antagonist that blocks the effects of endothelin (vasoconstrictor that also stimulates endothelial proliferation)

what is the difference between obstructive and restrictive lung diseases with FEV/FVC?

both FEV is reduced but it is more reduced in obstructive disease obstruction of airflow resulting in air trapping in the lungs vs restricted lung expansion which causes decreased lung volumes

recurrent respiratory infections with Pseudomonas (or Burkholderia cepacia-->non lactose fermenting gram neg rod), diarrhea, and failure to thrive suggests? what other complication is associated with this? how can you improve their condition?

cystic fibrosis pancreatic insufficiency give them pancreatic lipase supplementation; bc of the thick mucus, it is blocking their exocrine pancreas so they are unable to absorb nutrients well

cyanide inhibits ____in the mitochondria. this electron transport chain enzyme is needed for oxidative P, so inhibition results in severe lactic acidosis and death

cytochrome C oxidase giving inhaled nitrate causes Fe2+-->Fe3+ and cyanide binds to it which frees it from cytochrome C oxidase

is JAK2 an intrinsic receptor tyrosine kinase or non-receptor (cytoplasmic) ?

cytoplasmic it is in the cytoplasm it does not have intrinsic receptor kinase activity that P

how to treat neuroleptic malignant syndrome

dantrolene (skeletal muscle relaxant) -antagonizes the ryanodine receptors which inhibits Ca ion release from the SR of the skeletal muscle

damage to the brainstem at or below the level of the red nucleus (midbrain tegmenjtum, pons) usually causes

decerebrate extensor posturing unopposed vestibulospinal tract output

damage to neural structure above the red nucleus (cerebral hemisphere, internal capsule) typically results in

decorticate flexor posturing loss of descending inhibition of the red nucleus and subsequent hyperactivity of upper limb flexors

with regards to CO2, what is a way to reduce intracranial pressure?

decrease Co2 levels bc that will cause vasoconstriction and reduce cerebral blood volume

in celiac disease, when you aren't absorbing vitamin D, what happens?

decrease in both Ca and P absorption from GI. increase PTH (secondary hyperparathyroidism)

drugs that block sympathetic stimulation will do what to renin levels?

decrease renin levels beta blockers and clonidine

restrictive FVC TLC FEV/FVC ratio

decreased FVC decreased TLC FEV1/FVC ratio >80%; FEV increase bc FVC is decreased, lung compliance is decreased, and elastic recoil is increased

How does a patent ductus arteriosus close and what type of murmur do you hear if it doesn't close?

decreased PGE2 to close continuous "machinery like" murmur L-->R shunt that can cause left ventricular volume overload

bone density and relationship to BMI

decreased bone density with decreased BMI so increased risk for fractures

diagnosis for wilsons

decreased ceruloplasmin increased urinary copper excretion Kaiser flesicher rings increased copper content on liver biopsy

what happens to compliance whenever there is presence of fluid in the pulmonary insterstitium?

decreased compliance you have increased hydrostatic pressure in pulm circulation which causes transudation of fluid from pulm capillaries into the interstitium the presence of fluid in pulm insterstitium causes swelling, which increases resistance to mvmt which decreases lung compliance *so the negative pressure generating by inspiring is not enough to distend the lungs which results in poor gas exchange and SOB

how does surfactant work?

decreases alveolar surface tension by creating a lipid rich monolayer that separates alveolar gas from the underlying aqueous fluid. it prevents atelectasis and end expiratory collapse and increases pulmonary compliance

valproate MOA and problem in preggo

decreases folic acid levels which increases risk of neural tube defects (meningocele, myelomeningocele) used to prevent migraines and treat epilepsy and bipolar disorder

leptin (large fat cells produce more leptin than small ones)

decreases food intake (appetite) -decreases neuropeptide Y production (appetite stimulant) -increases POMC production-->cleaved to form alpha melanocyte stimulating hormone (inhibits food intake)

area that has small basophilic granular chief cells that synthesize and secrete pepsinogen

deeper aspect of the gastric glands

whenever you see hypoglycemia and no acetoacetate detected and hypoketotic hypoglycemia AFTER A PERIOD OF FASTING

defect in beta oxidation of fatty acids in the mitochondria after a period of fasting defect in acyl CoA dehydrogenase so you can't generate acetyl CoA therefore you can't generate ketone bodies and can't use acetyl coA for citric acid cycle to get energy

familial chylomicronemia syndrome (type 1 hyperlipoporteinemia) deficiency? and what do you see an accumulation of? major manifestations?

defect in lipoprotein lipase and apoC-II so you see elevated chylomicrons ACUTE PANCREATITIS ERUPTIVE SKIN XANTHOMAS (yellow papule surrounded by erythema on extensor surfaces) LIPEMIA RETINALIS (milky retina)

fava beans

deficiency in glucose 6 phosphate dehydrogenase -cant make NADPH so now RBCs can't protect themselves against oxidative injury bc NAPDH is used to regenerate reduced glutathione which is an antioxidant -NAPDH is also needed to synthesis CHOLESTEROL, FATTY ACIDS**, AND STEROIDS (acute hemolytic anemia and jaundice)

succinylcholine what type of blocker?

depolarizing there is phase I and Phase II

what type of blockers initially induce an equal reduction but then go on to progressive reduction with train of four stimulation?

depolarizing NMJ blockers bc they block depolarization of the motor end plate, so initially you have equal reduction but then with time, you get progressive reduction bc Ach receptors become desensitized (since the motor end plate is not getting depolarized so there is no effect of Ach on the motor end plate)

where are neutral proteases like elastase derived from?

derived from infiltrating neutrophils and alveolar macrophages

autoimmune deposition of IgA at the tip of dermal papillae strong association w celiac disease

dermatitis herpetiformis

heliotrope rash Gottrons papules (raised erythmatous plaques overthe joints and bony prominences of the hands) muscle biopsy shows perimysial infiltrates

dermatomyositis

perimysial inflammation (CD4 T cells) with patchy ischemia and necrosis and perifasculicular atrophy and fibrosis

dermatomyositis

Gottron papule (over the joint of the fingers), heliotrope rash, symmetrical proximal muscle weakness (diff climbing stairs, combing hair), elevated muscle enzymes (creatine kinase, aldolase) what condition and what antibody?

dermatomyositis anti Jo1 (anti histidyl tRNA synthetase)

Griseofulvin is used to treat what type of fungal infections?

dermatophytoses -inhibits fungal cell mitosis during metaphase

medication used to treat HTN. side effects: peripheral edema and dizziness

dihydroperidine Ca channel blockers (amlodipine, nifidipine)

what is good to give to a pt that has bradycardia but you still need to treat their HTN?

dihydropyridines (nifidine) bc it has minimal effect on cardiac conduction -it can cause reflex tachy in response to peripheral vasodilation and therefore useful in HTN pt with brady

what do you think when you see recent viral infection and then dvmt of heart failure?

dilated cardiomyopathy caused by viral myocarditis eccentric hypertrophy (dilation of chambers) with systolic dysfunction

what type of amnesia with ketamine? MOA? toxicity?

dissociative amnesia (both analgesia and amnesia) NMDA receptor antagonist Emergence rxn possible w disorientation, hallucination, vivid dreams increase BP and HR

Alveolar macrophages are found where?

distal or past the terminal bronchioles (so they are in the respiratory bronchioles)

how to treat restless leg syndrome

dopamine agonists like pramipexole and ropinirole

which antagonists are the best to give for chemo induced emesis

dopamine, serotonin, or neurokinin 1 receptor antagonists

anti histone Ab

drug induced lupus procainamide, hydralazine, isoniazid SLOW ACETYLATORS

what can happen to cystic fibrosis patients with exercise

hyponatremia and hypochloremia due to excessive NaCl loss through the sweat. their sweat already has higher than normal concentrations of Na and Cl bc they can't reabsorb salt supplementation is recommended

what type of acid base disorder is pulmonary embolism associated with

hypoxemia and respiratory alkalosis hypoxemia causes hyperventilation so this increased ventilation causes more Co2 to be excreted

circulating IgG4 Ab to the phospholipase A2 receptor

idiopathic membranous nephropathy a transmembrane receptor found in high concentrations in glomerular podocytes

site of vitamin B12 and bile acid absorption

ileum

which nerve can be damaged during an appendectomy, it normally provides sensation to the suprapubic and gluteal regions

iliohypogastric nerve arises from L1 nerve root

infertility in Kartagener snydrome is due to

immotile sperm aka primary ciliary dyskinesia dynein arm defect -->abnormal ciliary motion and impaired mucociliary clearance

autosomal dominant pattern called essential tremor or familiar tremor it worsens while maintaining a posture like when holding an object a slowly progressive symmetric postural and or kinetic tremor that most commonly affects upper extremities what improves their sx and what is the first line treatment?

improves w alcohol consumption propanolol

red ragged muscle fibers are seen in what type of diseases? and why do they have this appearance?

in mitochondrial diseases bc abnormal mitochondria accumulate under the sarcolemma a male patient won't pass it on bc maternal inheritance only mitochondrial myopathies = myoclonic epilepsy, Leber optic neuropathy (blindness), and michodnrial encephalopathy w stroke like episodes and lactic acidosis

what is the most common cause of unilateral fetal hydronephrosis from OBSTRUCTION

inadequate canalization of uteropelvic junction, site between kidney and ureter if not detected in utero, newborns may present w abd mass reflecting an enlarged kidney vesicouretral reflux is when the vesicouretral junction does not completely close which then leads to dilation of ureter and renal pelvis

What is gastroschisis

inadequate enlargement of peritoneal cavity in utero. The viscera protrude through abd wall defefct next to umbilicus. Viscera not covered by peritoneum!!!!!-->bc the gut did retract into the body; the problem is that there is a weakness in the ventral body wall so it came back out -WHEN THE GUT HERNIATES THROUGH WEAKNESS IN ABD WALL.

relationship of estrogen to thyroid hormones

increase in estrogen activity increases thyroxine binding globulin levels (TBG) TBG binds to thyroid hormones when you increase TBG, you have a decrease in free T3 and T4 levels bc TBG binds to them you get a transient increase in thyroid hormone until TBG is saturated will thyroid hormone and free T4 and T3 levels are restored SO AN INCREASE IN TBG INCREASES TOTAL T4 (BOUND T4 + FREE T4) AND TOTAL T3 however, free thyroid levels normal, TSH in normal range

volume is related to venous return so excessive hydration will ___venous return and acute hemorrhage will ____venous return

increase; decrease

what is the level of mean corpuscular Hb concentration in spherocytosis

increased =MCH/MCV the volume is reduced bc spherocytes are small

haldane effect is increased oxygen therefore

increased Co2 and H unloading

COPD -RV -FRC (functional residual capacity) which is the volume of gas after normal expiration (RV + ERV) -TLC -FEV1 -FVC FEV1/FVC ratio

increased RV increased FRC increased TLC decreased decreased FEV1 decreased FVC decreased FEV/FVC ratio which is the hallmark*** bc there is expiratory airflow obstruction

what are the levels of 2,3 BPG in hypoxia

increased bc the higher 2,3 BPG levels allows erythrocytes to increase oxygen delivery in the peripheral tissues

what do you see with mastocytosis?

increased mast cell proliferation bc of mutation in KIT receptor tyrosine kinase -increased mast cell degranulation = increased histamine release = increased gastric acid secretion

with lactase deficiency, increase or decrease in stool PH stool osmolality breath hydrogen content

increased stool osmolality bc high amts of indigested lactose in bowel, which attracts excess water in bowel lumen-->osmotic diarrhea undigested lactose gets fermented by gut bacteria, so that acidified the stool (decreased stool pH) and H gas is also produced so increased breathe H content

someone in DKA, what happens in their adipose tissue?

increased triglyceride breakdown trig-->glycerol and fatty acids fatty acids get further broken down to ketone bodies and glycerol gets broken down to glucose

niacin MOA and side effects

increases HDL and inhibits VLDL secretion therefore lowers trig levels promotes flushing

ADH _____ urine osmolality in pts with central DI while with nephrogenic DI, ____ WHERE ARE POSTERIOR PITUITARY HORMONES SYNTHESIZED?

increases; no change IN THE PARAVENTRICULAR AND SUPRAOPTIC NUCLEI OF THE HYPOTHALAMUS posterior pit only releases hormones while anterior pituitary produces and releases hormones

what does incretin do and what other hormones act similarly?

incretin stimulates pancreatic insulin secretion in response to sugar containing meals; independent of increased blood glucose levels glucagon-like-peptide and gastric inhibitory peptide

the best way to prevent operation occurring on the wrong site

independent verification by 2 workers, usually the nurse and physician

Peptostreptococcus and Fusobacterium are anaerobic bacteria found in the normal mouth flora. if they are found in a lung lesion, what does that mean? (also found is prevotella and bactericides)

indicates the pt is developing a lung abscess. when the lung abscess involves, it forms a cavitary lesion with *AIR FLUID LEVEL ON IMAGING

what to you give to treat patent ductus arteriosus?

indomethacin or ibuprofen which are prostaglandin E2 inhibitors PGE2 keeps the ductus arteriosus open

the methacholine challenge test induces ... in pts with asthma, so it allows the demonstration of airway obstruction on spiro.

induces bronchoconstriction can also administer histamine too

what is the strongest risk factor for cervical dysplasia and carcinoma

infection with HPV type 16 or 18

splinter hemorrhages (on nails), Roth spots, Janeway lesions, and Osler nodes are seen in what?

infective endocarditis

when you see Janeway lesions and splinter hemorrhages (microemboli that deposit in palms and soles/nailbeds)

infective endocarditis microemboli from vegetations on the infected valve

large friable vegetations on the valve cusps along with destruction of the valve leaflets vs diffuse fibrous thickening and distortion of the mitral valve leaflets along w commissural fusion at the leaflet edges

infective endocarditis rheumatic fever ***there is DESTRUCTION IN THE VALVE LEAFLETS WITH INFECTIVE ENDOCARDITIS INSTEAD OF FIBROSIS LIKE IN RHEUMATIC FEVER

how does mono gain access into bloodstream

infects B lymphocytes by binding to CD21 receptor EBV = mono then CD8 T lymphocytes try to expand and kill the virus

what is a good landmark for surgeons to separate direct vs indirect hernias indirect hernias occur due to failure of the ____to obliterate, allowing abd contents to protrude through the _____

inferior epigastric vessels processus vaginalis; deep inguinal ring

lymphatic drainage of rectum proximal to dentate line vs distal to dentate line

inferior mesenteric and internal iliac lymph nodes for the rectum proximal to dentate line distal to dentate line = inguinal nodes

what is involved in breast if you see dimpling? if there is malignant spread of ductal carcinoma to lactiferous sinuses, what sx will you see?

infiltration of the suspensory ligaments (Cooper ligaments) in breast cancer nipple discharge and superficial nipple changes

how do you test pulsus paradoxus

inflate blood pressure cuff greater than systolic. the difference between systolic pressure at which KOROTKOFF SOUNDS become first audible during expiration AND at the pressure throughout which they are heard during all phases of respiration

which nerve exits the skull via the infraorbital foramen (just below the orbit) damage = numbness to upper cheek, upper lip, and upper gingiva

infraorbital nerve

what is an antimuscarinic agent that blocks M3 receptors in airway smooth muscle and mucosal glands, which provides short term relief of bronchoconstriction in allergic asthma?

inhaled ipratropium

MOA of thiazide diuretics. what is increased? what is decreased?

inhibit Na/Cl cotransporter in distal convoluted tubule raise serum Ca, uric acid, glucose, cholesterol, and trig levels decrease Na, K, and Mg levels

how do thiazide diuretics work hydrochlorothiaxide, chlorthalidone

inhibit NaCl cotransporter which cases Ca to be reabsorbed distally hypercalcemia and hypercalcuria (increase in Ca will suppress PTH)

how do antipyretics work like acetaminophen and ibuprofen

inhibit the synthesis of prostaglandin E2, which reduces the thermoregulatory set point in the hypothalamus

what does a metyrapone stimulation test do

inhibits 11 beta hydroxylase so no 11-deoxycortisol-->cortisol causes an increase in ACTH release 11-deoxycortisol gets converted to 17 hydroxycorticosteroids in the liver that accumulates in the urine

SGLT2 inhibitors MOA -Canaglifozin -Dapaglifozin

inhibits glucose and Na from being reabsorbed in the proximal tubule so it gets excreted in the urine **lots of urinary glucose loss -can get UTI bc of sugar in urine -monitor serum creatinine before giving bc this should be avoided in pt with renal impairment

tamoxifen (also raloxifene) tamoxifen used in breast cancer raloxifine used in post menopausal osteoporosis

inhibits the effects of estrogen on breast tissue and can reduce risk of gynecomastia acts as an estrogen antagonist in the breast and doesn't let estrogen bind

metformin inhibits

inhibits the mitochondrial enzymes needed for gluconeogenesis also increases insulin sensitivity

stages of acute tubular necrosis

initiation stage -ischemic injury to renal tubules bc of hemorrhage, acute MI, sepsis, surgery..etc maintenance stage -tubular damage is fully established and there is decreased urine output, fluid overload, increased BUN/creatinine, HYPERKalemia, anion gap metabolic acidosis recovery stage (diuresis) -**re-epithelization of tubules!!! -increase in urine output so high volume diuresis; decrease K, PO4, Mg, and Ca muddy brown casts

how to treat DKA

insulin and saline insulin allows cells to use glucose which decreases lipolysis and production of ketones. insulin also causes an intracellular shift of K, which decreases serum K level ID2073 *whenever you treat and get a decrease in ketones, this will result in increased serum bicarb (bc ketones are the main acid produced)

what happens when insulin binds to its receptor

insulin binds to receptor with intrinsic tyrosine activity 2. IRS-1 gets P and activated 3. IRS-1-->MAP kinase pathway 4. IRS-1 --.PI3K-->stimulates glycogen synthesis by activating protein phosphatase (which dephosphorylates/activates glycogen synthase)

abnormal fat deposition and excessive body weight are important contributors to

insulin resistance and dvmt of type 2 DM obesity lead to decreased numbers of insulin receptors**

what type of immune response do you get w tuberculoid leprosy

intact cell mediated response strong TH1 mediated response (IL-1, IFN gamma, IL-12), which leads to M activation that kill organisms this localized** inflamm damages the skin and cutaneous nerves, leading to HYPOIGMENTED well demarcated PLAQUES W DECREASED SENSATION

if a virus infects a cell, what does the cell release to induce synthesis of antiviral proteins that suppress viral replication and assembly?

inteferon alpha and beta

blood supply for internal vs external hemorrhoids

internal -superior rectal vein-->inferior mesenteric vein external -inferior rectal vein-->internal pudendal vein-->internal iliac veins internal have no somatic sensory innervation and can't cause pain. external are innervated by same nerves that cover perianal area and can be sensitive to pain

what is the external and internal urethral sphincter controlled by

internal = by smooth muscle control in ANS; sympathetic for contraction and para for relaxation external = under voluntary control w pelvic floor skeletal muscle (parasympathetic is going to cause detrusor muscle contraction and IUS relaxation)

patients w _____stroke commonly have pure motor weakness affecting the contralateral arm, leg, and lower face

internal capsule

what to ligate if someone is having a postpartum hemorrhage? number one cause?

internal iliac arteries (bilateral)-supplies pelvic organs do surgery if pt doesn't respond to uterine massage/uterotonic meds uterine atony -normally, the uterus contracts and constricts the spiral arteries to prevent excessive bleeding

lymph from the prostate drains where

internal iliac nodes

afferent limb of the cough reflex

internal laryngeal nerve (CN X) which carries sensation from the mucosa superior to the vocal cords it mediates sensation mainly from larynx and epiglottis, stimulation of these areas induces coughing, not gagging

which nerve is located overlying the piriform recess? what type of fibers does it contain?

internal laryngeal nerve (located in the thin layer of mucosa that overlies the piriform recess) -contains only sensory and autonomic fibers (carries sensation from the mucosa that is superior to the vocal cords) -branch of superior laryngeal nerve (CN X)

proliferation of papillary cells in a duct or cyst wall with a fibrovascular core and may contain foci or atypia

intraductal papilloma sx: -most common cause of bloody nipple discharge, unilateral, can be without breast masses or skin changes

if you have a low vitamin B12 level, that means you are deficient in ____ what happens to parietal cells in pernicious anemia?

intrinsic factor; can't absorb vitamin B12 from the terminal ileum CD4 immune mediated response against parietal cells so now parietal cells are not secreting HCl which stimulates gastrin secretion. parietal cell mass is also decreased bc being destroyed you also get a decrease in intrinsic factor bc parietal cells secrete intrinsic factor

TGF beta

involved in tissue regeneration and repair

golfers elbow

involves wrist flexors at their attachment on medial epicondyle =meidal epicondylitis

muscarinic antagonist that promotes bronchodilation and reduces mucus production

ipratropium

what other type of deficiency is common in restless leg syndrome

iron deficiency

what do you see in Plummer Vinson syndrome

iron deficiency anemia dysphagia due to esophageal web formation shiny red tongue bc of atrophy of lingual papillae koilonychia (spoon shaped nails!!)

type of neuronal response? shrinkage of cell body pyknosis of nucleus loss of nissle substance eosinophil cytoplasm

irreversible neuronal injury (red neuron)

muddy brown granular and epithelial cell casts

ischemic tubular necrosis

important landmarks for pudendal nerve block

ischial spine and sacrospinous ligament (from ischial spine to rectum) -if you miss pudendal nerve, you can hit internal pudendal artery and inferior gluteal artery and can lead to hematoma

what drug is used to treat Tb that can cause sideroblastic anemia? what does it inhibit?

isoniazid blocks pyridoxine phosphokinase, which normally converts B6 pyridoxine to its active form pyridoxal 5' phosphate you need B6 for ala synthase

what does riscocetin do and what does it test

it activates glycoprotein 1b receptors and makes them available to bind to vWF. decreased vWF causes poor platelet aggregation. when normal plasma is added that contains vWF, platelet aggregation occurs there is no platelet aggregation in vWF disease!

what is the problem with buprenorphine when used with other full opioid agonists

it acts as an opioid receptor antagonist in the presence of full opioid agonists so it can precipitate withdrawal** it is a partial opioid agonist that has low intrinsic activity (efficacy) for mu receptors but it can bind with high affinity (potency) and can prevent binding of other opioid medications

how does achondroplasia happen

it affects endochondral ossification, the process the makes long bones normally 1. mesenchymal cells -->chondrocytes which secrete cartilage matrix 2. chondrocytes continue to proliferate and for elongating cartilage template that becomes calcified and later invaded by osteoblasts, osteoclasts, and blood vessels 3. deposition of osteoid matrix over calcified cartilage matrix forms woven bone which then undergoes remodeling of compact bone with FGF, normally limits chondrocyte proliferation during endochondral ossification. w mutation, it is excessive inhibition of chodnrocte porlfieraton so you get bone shortening flat bones not affected bc thats intramembranous ossification. (mesenchymal cells-->osteoblasts-->osteoid matrix secretion without formation of cartilaginous bones)

what happens when you use glucocorticoids for a long time (like for an autoimmune dz)

it can produce clinical features of Cushings syndrome this can suppress HPA axis (suppresses ACTH secretion) which leads to bilateral atrophy of adrenal cortex whenever you stop glucocorticoids, can cause adrenal crisis

problem w anti cholinergic in the eye (ex atropine)

it causes mydriasis which narrows the anterior chamber angle and diminishes the outflow of aqueous humor bc cholingerics will normally constrict the pupil

how does aspergillus form a fungus ball?

it colonizes a previously existing old lung cavity (usually from Tb, emphysema, sarcoidosis)

what causes instability in a Hep C virus

it does not have proofreading 3-->5' exonuclease activity in its RNA Polymerase makes many errors during replication

how far does the parietal pleura extend compared to visceral pleura

it extends 2 ribs below the visceral pleura and the inferior margin of the lungs

how does inactivated/killed versions of influenza vaccine work?

it induces neutralizing antibodies against the hemagglutinin antigen

side effects of methotrexate

it inhibits the growth of rapidly dividing cells so side effects include problems with tissues that have rapid cell turnover oral and GI mucosa ulcerations, hepatotoxicity (LFT abnormal), pancytopenia (bone marrow suppression), and alopecia

what is rhogam

it is IgG Ab to the D antigen, so if D+ from fetus to mom, Ab coat the RBC and clear with Macrophages before an immune response occurs

gallstone ileus

it is a complication of gallstones-->form fistula between gallbladder and small intestine (usually duodenum) the gallstone usually gets stuck in the ileum bc that is the narrowest portion of the intestine might see air in the biliary tree and gallbladder bc of communication between intestine and gallbladder

mutation in left ventricular hypertrophy

it is a genetic disorder of the cardiac myocytes caused by mutations in one of several sarcomere genes encoding myocardial contractile proteins common mutations in genes for BETA MYOSIN HEAVY CHAIN and MYOSIN BINDING PROTEIN C

how does varencicline work?

it is a partial agonist of the nicotine receptor so it partially stimulates the receptor which helps reduce the sx of nicotine withdrawal bc its a partial agonist, it limits the downstream release of dopamine so there is less stimulation of the reward pathways

lipofuscin is a sign of what and what does it look like?

it is a sign of aging; composed of LIPID polymers and protein complexed phospolipids. -looks like yellow-brown granules perinuclear pigment. product of free radical injury and LIPID PEROXIDATION -seen in malnourished or cachectic patients

what happens to the intrapleural pressure w inhalation

it is already slightly negative at rest and w inhalation it becomes even more negative

sitagliptin is a DPP 4 inhibitor that increase beta cell insulin release. what is it dependent on?

it is glucose dependent so its effect diminishes as glucose levels become normal. it doesn't cause hypoglycemia

what is the problem with using theophylline? what happens?

it is metabolized by hepatic cytochrome oxidases, and these enzymes can be inhibited by concurrent illness (infection with fever) or other drugs like cimetidine, cipro, macrocodes, verapamil) -(i think its these drugs bc they probably get metabolized via THE LIVER!!!) serum concentration of theophylline gets raised and causes toxicity bc it has a narrow therapeutic index.

what is a Kussmaul sign and when do you see it

it is when JVP rises during inspiration. normally, JVP should drop with inspiration -this is bc the volume restricted right ventricle can't accommodate increase in venous return with inspiration in constrictive pericarditis

how do you get a neural tube defect during dvmt? what direction does fusion occur?

it is when the neural plate edges do not fuse around 4th week of dvmt from rostral to caudal so you get anencephaly if it doesn't close rostrally and spina bifida if it doesn't close caudally

what is the point of beta HCG?

it maintains the corpus luteum until the placenta can make estrogen and progesterone then the corpus lute degenerates and serum beta HCG decreases

prokaryotes can be polycistronic. what does that mean?

it means that one mRNA transcript contains the sequence for many proteins and can be translated into multiple proteins *a single mRNA codes for more than one protein example = bacterial lac operon which codes the proteins necessary for lactose metabolism by E Coli lac operon regulated by one operator, promoter

what is the problem with lupus anti coagulant test

it shows a false elevation of PTT test it interferes with the PTT test although anti phospholipid antibodies cause PTT prolongation, they actually produce a hyper coagulable state bc of activation of phospholipid dependent coagulation pathways !!!(******

what does the increase in estrogen help do right before delivery?

it up regulates gap junctions between individual myometrial smooth muscle cells which helps with increased communication and coordinations for labor contractions estrogen also increases expression of oxytocin receptors

the main presenting sx of primary biliary cirrhosis and what antibody?

itching anti mitochondrial antibody associated with Sjogren syndrome

you can obtain an amniocentesis to detect chromosomal abnormalities and metaobolic disorders via what type of analysis of fetal cellls?

karyotype analysis

hypertrophic scars in which excessive collagenous scar tissue deposited fibroblasts permanently extends beyond the margins of the original wound

keloids

what is a glucosaminoglycan in the extracellular matrix that may play a role in maintaining type I collagen organization in a number of tissues

keratan sulfate

the most involved organ in both primary and secondary amyloidosis

kidney amyloid deposits appear red/pink w Congo Red stating and have apple green birefringence under polarized light amyloid deposits in the mesangium, resulting in nephrotic syndrome

has the presence of a thick capsule (encapsulated) which is seen as a clear zone on gram stain and also causes the characteristic mucoid growth in culture

klesbiella

the hallmark is a thick mucoid blood tinged sputum (currant jelly sputum) and lung tissue necrosis with early abscess formation also classically affects alcoholics

klesbiella PNA usually gets colonized in oropharynx and then gets aspirated while sleeping bc you are supine and it affects upper lobe bc it causes tissue and early abscess formation, it produces blood tinged currant jelly sputum

most commonly causes aspiration or nosocomial pna in elderly pt and those that are alcoholics and diabetics; thick mucoid capsule with currant jelly sputum!**

klesbiella pna causes lobar pna

hypogonadism, long lower extremities, small firm testes, no sperm

klinefelter syndrome 47XXY destruction of seminiferous tubules/sertoli cell damage -->decreased inhibin levels-->increased FSH and LH (leydig cells are also dysfunctional so decreased testosterone) can dvp gynecomastia bc of increased aromatase activity (you get high estrogen levels bc of lots of gonadotropins)

what do you see in PAP smear in someone with HPV

koilocytes = immature squamous cell with dense, irregularly staining cytoplasm and perinuclear staining, resulting in a halo also has an enlarged pyknotic nucleus where the chromatin has condensed, giving it a raisin appearance

side effect of metformin

lactic acidosis so you don't want to give it to pts with renal insufficiency check serum creatinine levels before starting

what type of infarct involves the small penetrating arterioles

lacunar infarct that supply deep brain structures like basal ganglia and pons and subcortical white matter like internal capsule and corona radiate

lipohyalinosis and microatheromas are believes to be the primary cause of

lacunar infarcts uncontrolled HTN and diabetes are a major risk factor

proximal muscle weakness with gait alteration, difficulty rising from chair, difficulty climbing chairs cranial nerve involvement (usually oculobulbar), presents w diplopia, ptsosi, dysarthria, dysphagia dry mouth or impotence Ab directed against voltage gated Ca channels that participate in Ach release might have malignancy like lung SCC

lambert eaton myasthenic syndrome

a paraneoplastic order seen w lung cancer and muscle response increases on repetitive motor nerve stimulation

lambert eaton syndrome Ab against presynaptic Ca channels

length of acute stress disorder

lasts between 3 days and 1 month if more than 1 month = PTSD!! tx with CBT; pharmotherapy usually not indicated

anterolateral humeral vs anteromedial humeral fracture *supracondylar fractures that occur after hyperextension injuries

lateral = radial nerve injured -->wrist drop bc denervation of hand/finger extension and lose sensation over poster forearm and dorsolateral hand medial = median nerve and brachial artery injured -->pulseless hand; sensory loss over the first 3 digits and weakness in thumb flexion, flexion of 2/3digits, and wrist flexion/abdction

most fibers from the optic tract project to the ______, which then projects to the primary visual cortex of the occipital lobe via optic radiations

lateral geniculate body (located in thalamus)

indirect inguinal hernias are located where and why does it form? how is it different from direct? what type of population do you see indirect hernias with?

lateral to inferior epigastric vessels. bc of a patent processus vaginalis** (and internal inguinal ring doesn't close) direct don't pass through deep inguinal ring but only through superficial inguinal ring, so direct is only covered by the external spermatic fascia. indirect are covered by all 3 spermatic fascial layers male infants

ovarian vein thrombosis left vs right ovarian vein thrombosis can occur postpartum

left ovarian vein drains into left renal vein right ovarian vein drains into IVC so clot can go into IVC right is more common

what nerve can be impinged with left atrial enlargement

left recurrent laryngeal nerve can cause hoarseness

with frontal lobe, differences between left and right sided lesions?

left side = association with apathy and depression right side = associated w disinhibited behavior frontal lobe responsible for executive function and personality

HIV associated dementia what is the characteristic histopathologic finding?

microglial nodules, groups of activated M and microglial cells formed around small areas of necrosis that may fuse to form multinucleate giant cells involves inflammatory activation of microglial cells*

classic triad of iron overload

micronodular cirrhosis, DM, hyperpigmentation increased risk of hepatocellular carcinoma

how does urinary incontinence occur in elderly patient with normal pressure hydrocephalus

micturition reflex regulated by 3 centers 1. sacral micturition center: located at S2-4 level and responsible for bladder contraction via parasympathetics 2. pontine micturition center: in pontine reticular formation, it coordinates relaxation of external urethreal sphincter with bladder contraction during voiding 3. cerebral cortex: inhibits sacral micturition center ** w hydrocephalus, the cerebral cortex can no longer inhibit the sacral micturition center so you get uncontrolled micturition

what medications are recommended in addition to standard heart failure therapy (ACE inhibitors and beta blockers) THAT REALLY HELP IMPROVE PT SURVIVAL WITH CHF AND DECREASED EJECTION FRACTION

mineralocorticoid receptor antagonists -spirnolactone -eplerenone don't use in pt with hyperK and renal failure side effect=gynecomastia

formula for minute ventilation (the total volume of new air that enters the respiratory pathways per minute)

minute ventilation (L/min) = tidal volume (L)*breathes/minute

the loss of all or part of the X chromosome in Turner syndrome results in a missing??

missing SHOX gene which normally promotes long bone growth so these pts have short stature coarctation of aorta-->diminished femoral pulses bicuspid aortic valve streak ovaries, amenorrhea, infertility horseshoe kidney short stature narrow high arched palate low hairline webbed neck broad chest with widely spaced nipples -cystic hygroma and lymphedema can be 45X, 45X/46XX (somatic mosaicism) where the X chromosome is only missing in some cells bc nondisjunction was in mitosis instead of meiosis

what to think of when you see maternal inheritance?

mitochondrial diseases heteroplasmy is responsible for the clinical variability of mitochondrial diseases. mitochondria are randomly distributed between daughter cells so some contain more damaged vs normal mitochondria. this explains the variability in th severity of these disease

what is a sign of irreversible cell injury and why?

mitochondrial vacuolization bc it involves the mitochondria so it can't generate ATP via oxidative phosphorylation reversible injury however would be like mitochondrial swelling-->reversible injury IS CELLULAR SWELLING!!! so you get loss of microvilli, membrane blebbing, dissocation of ribosomes from rER so decreased protein synthesis PATHOMA CH1 -HALLMARK OF IRREVERSIBLE INJURY IS MEMBRANE DAMAGE** -this results in cytosolic enzymes leaking into serum (like troponin); Ca enters cell (normally kept in low concnetration in cytopplasm) -also get mitocochondrial damage which results in loss of electron transport chain (inner mitochondrial membrane) and release of cytochrome C from mitochondria into the cytosol which activates apoptosis -lysosomal membrane damage leads to hydrolytic enzymes leaking into cytosol, which are activated by Ca that leaked into cytosol too

holosystolic murmur at the apex that radiates to the axilla

mitral regurg

what causes an elevated pulmonary capillary wedge pressure

mitral stenosis

what also obstructs left ventricular outflow in hypertrophic cardiomyopathy

mitral valve leaflet

what is a common condition that predisposes to infective endocarditis in developed countries vs developing nations

mitral valve prolapse with regurg mitral valve is most affected by infective endocarditis developing nations= rheumatic heart disease (from strep pyogenes, usually get it after strep throat)GROUP A BETA HEMOLYTIC

what should you think when you see a patient with recurrent nose bleeds, ecchymosis, and very low platelets

most likely has ITP, an autoimmune destruction of platelets

accumulation of heparin sulfate and dermatan sulfate bc of L-iduronidase deficiency

mucopolysaccharidosis that leads to dysostkosis multiplex (enlarged skull, abnormally shaped ribs and vertebrae) and corneal clouding, which can cause blindness HURLER SNYDROME

what happens to the spleen with sickle cell disease

multiple infarctions will lead to its fibrosis and atrophy

an elderly pt w fatiguability (due to anemia) constipation (due to hyperCa) bone pain, most commonly in the back and ribs (bone lysis due to production of osteoclast activating factor by myeloma cells) elevated serum protein (monoclonal proteins) renal failure

multiple myeloma

normocytic anemia hypercalcemia bone lesions AL amyloid renal failure bone marrow infiltrated by plasma cells

multiple myeloma

romberg sign

negative with eyes closed means that it is cerebellar ataxia positive means there is a problem w proprioception, sensory ataxia due to problems in dorsal column or posterior nerves -->syphilis or vitamin b12 deficiency

rapidly progressive glomerulonephritis

nephritic syndrome (HTN, edema, renal failure, hematuria** and proteinuria crescent formation linear deposits of IgG, C3 on GBM

what is Creutzfeldt-Jakob disease caused by?

neurodegenerative disease caused by prions. prions cause abnormal folding of normal proteins so they aggregate and cant be degraded so apoptosis and neuronal loss occurs

a potentially fatal syndrome characterized by delirium, high fever, severe muscle rigidity, and autonomic instability

neuroleptic malignant syndrome Malignant FEVER Myoglobinuria Fever Encephalopathy Vitals unstable Elevated Enzymes (CK) Ridigity of muscles "lead pipe"

what is responsible for green colored pus

neutrophil myeloperoxidase bc its blue green heme pigmented molecule contained within the azurophilic granules of neutrophils and catalyzes production of hypochlrous acid from Cl and hydrogen peroxide

time frame after ischemic stroke neutrophilic infiltration vs macrophage, microglia infilatmaion and phagocytosis begin

neutrophilic infiltration at 24-72 hours the rest at 3-7 days

enflurane, isoflurane, sevoflurane, and desflurane

newer halogenated anesthetics that have less extensive hepatic metabolism but can still have liver toxicity hepatocellular necrosis

___is used to treat hyperlipidemia bc decrease LDL and trig and increase HDL side effects and why?

niacin cutaneous flushing, warmth and itching bc of prostaglandin release (E2 and D2) ASA inhibits PG synthesis so side effects can be reduced if you take ASA 30-60min before niacin administration

which medications are used to inhibit preterm labor? MOA?

nifedipine and terbutaline

nitrates and cGMP and phosphodiesterase

nitrates get converted to nitric oxide; nitric oxide increases cGMP phosphodiesterase breaks down cGMP cGMP leads to vascular smooth muscle relaxation

nitrates peripheral vascular capacitance LVEDP and volume preload LV systolic wall stress myocardial O2 demand systemic vascular resistance

nitrates primarily act on the venous system -venodilator increase peripheral venous capacitance decrease LVEDP decrease preload decrease stress decrease O2 demand decrease vascular resistance

does factor Xa inhibitors affect thrombin time

no

do yu see a lacunar infarct immediately on CT

no due to the small infarct size, after several weeks, these necrotic lesions turn into cavitary spaces filled wth CSF and surrounded by scar tissue called lacunas vs Charcot Bouchard anyuerms-->this involves the same penetrating arterioles but leads to intraparanchymal hemorrhage and you would see it on CT immediately; also caused by chronic HTN

benefit of ACE/ARBs inhibitors on the heart

no direct effect on heart conduction but they cause vasodilation-->reduces after load-->decreases contractile force needed to maintain CO, so this reduces myocardial oxygen demand

medical complications of anorexia nervosa

osteoporosis amenorrhea lanugo or hair loss enlarged parotid glands (if binge/purge type) hypotension, hypothermia, bradycardia cardiac atrophy, cardiomyopathy, arrhythmias

side effect of loop diuretics (furosemide, torsemide, bumetanide) when used in higher dosage, preexisting CKD, rapid IV administration, or when used in combo with ahminoglycosides, salicylatetes, cisplatin

ototoxicity!! (tinnitus, hearing impairment, vertigo, deafness) loop inhibit Na/K/2Cl symporter in ascending limb of loop of henle

what does the suspensory ligament contain (aka infundibulopelvic ligament) it is a fold of peritoneum that attaches the ovary to the pelvic wall when can it get occluded??

ovarian artery, veins, lymphatics and nerves needs to be ligated when removing ovary to prevent heavy bleeding the ureter is located close so it needs to be identified before surgery*like hysterectomy can get occluded in ovarian torsion, where he ovary rotates around this ligament and gets twisted, most likely due to the weight of a large adnexal mass -->ovarian ischemia

why is there primary amenorrhea in pts with Turner syndrome?

ovarian follicles are degenerated in utero (ovarian dysgenesis/ovarian failure) bc menstruation and breast dvmt are estrogen dependent, they don't occur bc ovaries are dysfunctional, they will have high LH and FSH levels

the left lateral geniculate body in the thalamus receives signals from the _____temporal retina and ____nasal retina

left; right left temporal hemiretina receives visual info from L nasal visual field so these fibers do not cross at optic chasm bc it is located laterally (temporal) the right nasal retina recipes visual info from the temporal visual field of the R eye, these fibers do cross at the optic chasm)

which gram negative bacilli causes pna generally following aerosolization from a contaminated water supply

legionella pna exposure to contaminated water, including recent travel (cruises/hotel visit) or hospital/nursing home stay contaminates natural bodies of water, municipal water supplies, and water based cooling systems

anterior cerebral artery supplies which part of the body more

legs think circle of willis and homunculus

smooth muscle neoplasms that arise in the myometrium of the uterus? which types cause excessive bleeding?? which one most common to see that exaggerate uterine irregularity more?

leiomyoma (aka fibroids) submucosal (just beneath endometrium) subserosal (beneath the uterine serosa), if its on the posterior uterus, can cause constipation

leptin and GnRH

leptin increase GnRH release

ipsilateral dysdiadochokinesia (impaired rapid alternating mvmts), limb dysmetria (overshoot or undershoot during targeted movements), and intention tremor (tremor during targeted movement)

lesion in ipsilateral cerebellar hemisphere

remnant of umbilical vein

ligamentum teres

first line medications for bipolar maintenance treatment

lithium, valproate, (quitiapine, a second generation anti psychotic; lamotrigine, carbemazapene) do not give anti depressant mono therapy!!! bc risk of causing a manic episode

furosemide

loop diuretic block Na/K/2Cl cotransporter and therefore increases urinary Ca excretion provide the max amt diuresis **on thick ascending limb of henle

what else do loop diuretics do and how does this interfere when you give a pt NSAIDs?

loop diuretics stimulate prostaglandin release which increase renal blood flow and increased GFR and enhanced drug delivery NSAIDs block PG release

what does vasoactive intestinal peptide do?

lose water, Na, K and Cl too much = hypokalemia, watery diarrhea, achlorhydria somatostatin inhibits (and gastric, glucagon, CCK)

what type of incontinence is seen in diabetic autonomic nueropathy

overflow incontinence cant sense a full bladder and have incomplete emptying. affects detrusor muscle innervation impaired destusor contractility or bladder outlet obstruciton

sx of injury to common peroneal nerve courses laterally around neck of fibula

loss of sensation of dorsum of foot (superficial, while deep involves sensory to first and second digits of toes) weakness in dorsiflexion (deep peroneal nerve), innervate anterior part of leg weakness in eversion (superficial peroneal nerve), innervate lateral part of leg FOOT DROP

levels of AFP and AchE levels in the amniotic fluid of down syndrome

low AFP and normal AchE

describe V/Q at apex of lungs

low V, low low Q = high V/Q

what happens to haptoglobin levels in intravascular hemolytic anemia

low bc it binds to free Hb that was released from hemolysis

what do you use to prevent TIA from happening and what are the side effects

low dose ASA inhibits COX-1 which prevents thromboxane A2 from being formed therefore impairs platelet aggregation -it also prevents prostaglandin formation which is needed for GI mucosal defense -side effect = GI bleeding

in X linked agammaglobulinemia, what is seen in peripheral blood and lymphoid tissue?

low or absent B cells and pan-hypogammaglobulinemia (very low IgG, IgM, and IgA) so they are at increased risk for infection with encapsulated bacteria such as H influenza type B and strep pna

poliomyelitis is a purely ____disease

lower motor neuron

muscle fasciculations

lower motor neuron lesion also muscle atrophy, and loss of tendon reflexes

what is injured with sudden upward jerking of arm like grabbing tree branch from falling

lower trunk of the brachial plexus C8-T1

how can you tell the difference between pilocystic astrocytoma and medullobastoma on imaging since they both involve the cerebellum

pilocystic has both cystic and solid components to the tumor while medullobastoma is a solid lesion that can compress the 4th ventricle and cause hydrocephalus

examples and MOA of thiazolidediones

pioglitazone and rosiglitazone binds to PPAR-gamma, an intracellular nuclear receptor that 1. increases adiponectin production -->cytokine secreted by fat tissue that enhances insulin sensitivity and fatty acid oxidation 2. helps with glucose and lipid metabolism (increases GLUT4 so more glucose uptake) increase fatty acid uptake increase adiponectin production increase insulin sensitivity decrease TNF alpha production decrease leptin production **helps decrease insulin resistance

clopidogrel prevents? factor Xa inhibitor

platelet aggregation by inhibiting platelet adenosine diphosphate receptor (P2Y12) apixaban

_____is released by locally adherent platelets, dysfunctional endothelial cells, and infiltrating M which promotes migration of smooth muscle cells from the MEDIA to the INTIMA and increases SM cell proliferation Platelets also release ____which is chemotactic for smooth muscle cells and induces interstitial collagen production

platelet derived growth factor transforming growth factor beta

transmural inflammation with fibrinoid necrosis eventually helps with fibrosis and produces a string of pearls appearance

polyarteritis nodosa

a segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ. which vessels are typically spared?

polyarteritis nodosa pulmonary arteries -the inflammation can cause ischemia/infarction/hemorrhage -bead like aneurysm can form -cutaneous manifestations, including palpable purpura

necrotizing vasculititis, lung is spared presents with HTN (renal artery involved), abd pain w melon (mesenteric artery) **associated with Hep B Antigen

polyarterititis nodosa

which protein is altered in Alzheimers disease and what happens as a result?

polymorphisms in apolipoprotein E causes conformational change that alters lipid binding, inhibits neurite growth, and leads to accumulation of amyloid beta!!!!! amyloid beta is a peptide that aggregrates in the brain in pts with Alzh.

what occurs in more than half of its w temporal arteritis and is characterized by neck, torso, shoulder nd pelvic girlde pain and morning stiffness

polymyalgia rheumatica

pt >50yo subacute pain and stiffness in shoulder and hips, weight loss, fever, and malaise have elevated ESR

polymyalgia rhuematica

proximal muscle weakness and increased expression of MHC I which leads to presentation of CD8 T cells endomyseal inflammation and mononuclear infiltrate which Ab are associated?

polymyositis ANA and anti Jo-1 -elevated creatine kinase

what type of capsule does H infleunza have? and for which strain of H influenza?

polysaccharide capsule-->for the strain H influenza type B

problem with uroporphyrinogen decarboxylase enzyme photosensitivity that presents as vesicle and blister formation on sun exposed areas

porphyria cutanea tarda

which selection: thymus epithelial cells express MHC and T cells tested for binding to self MHC complexes via TCR

positive selection if their TCR is not specific for self MHC, then apoptosis

what is located posterior and anterior to the third part of the duodenum

posterior = aorta, IVC, L3 anterior = SMA

what type of infarction contralateral hemianopia due to infarction of the visual corte. macula usually spared bc MCA dual supply

posterior cerebral artery

what supples posteromedial papillary muscle of mitral valve and what supplies anterolateral papillary muscle?

posterior medial is supplied by the posterior descending artery (branch of right coronary artery) anterolateral supplied by LAD and left circumflex so this is why it is less likely to become ischemic following and MI bc it has dual blood supply

most common cause of bilateral fetal hydronephrosis

posterior urethral valves caused by an obstructive and persistent urogenital membrane at junction of bladder and urethra other congenital anomalies -bladder neck obstruction, meatal stenosis, urethral strictures

what happens in positive vs negative selection

postitive is to test strong MHC antigen binding and negative is to test for reactivity to self antigens

pharyngeal pouch 1, pharyngeal membrane, pharyngeal groove

pouch=epithelium of middle ear and auditory tube membrane=tympanic membrane groove=epithelium of external ear canal

with oogenesis, Meosis I is arrested in ___until___ Meiosis II is arrested in ____until ____

prOphase I until Ovulation (1 oocyte) 46 sister chromatids METaphase II until fertilization (2 oocytes) 23 sister chromatids

What is TdT a marker for

pre B and pre T cells aka -"blast" cells

seeing the presence of parallel chains "serpentine cords" in mycobacteria indicates the presence of what??

presence of cord factor which is composed of 2 mycolic acid to trehalose

what 2 combination of medications are good to treat cystic fibrosis?

lumacaftor and ivacaftor bc it helps restore CFTR proteins at cell surface and improves Cl transport (pumps Cl out and water follows, which allows secretions to be thinned out) -this combo is good for F508 homozygous mutations bc it improves FEV and decreases exacerbations

3 Ab in anti phospholipid syndrome

lupus anti coagulant anti cardiolipin beta 2 glycoprotein the 2nd 2 are specific anti phospholipid antibodies

stage 1: flu like sx and erythema chronicum migrant (ECM) 2: facial palsy and AV node block 3: asymmetric arthritis (usually a knee joint) and subacute encephalopathy

lyme disease caused by Borrelia burgdorferi treat w doxycycline or penicillin type abx (ceftriaxone) doxy for ECM and ceftriaxone for facial palsy to prevent progression

peau d'orange is seen in inflammatory breast cancer. what do the cancerous cells obstruct??

lymphatic drainage the cancer cells obstruct the lymphatic drainage after spreading to the dermal lymphatic spaces

what happens if alveolar macrophages are stimulated too much?

macrophages release cytokines which causes inflammation which then results in progressive interstitial lung fibrosis bc fibroblasts are stimulated to produce collagen

LaPlace's law

pressure = 2(tension)/radius so larger alveoli have lower pressure. without surfactant, air will flow from small to larger alveoli and small will collapse surfactant helps decrease the surface tension and prevent collapse of the smaller alveoli surfactant is stored and transported to the cell surface by lamellar bodies (organelles contains parallel stacks of membrane lamellae)

uncontrolled maternal hyperglycemia can cause fetal hyperinsulinemia which prevents what from happening?

prevents maturation of cortisol and production of surfactant proteins

placenta accreta is more likely to happen in someone that has had

previous C sections (scar tissue in uterus) when placenta adheres to myometrium

what are xanthelasmas associated with?

primary or secondary hyperlipidemia or dyslipidemia they are accumulations of macrophages that contain cholesterol and triglycerides -can also be associated w diabetics bc of insulin resistance promoting increased VLDL production

___presents with a single painless genital lesion (chancre) after an initial infection with Treponema palladium what happens if untreated?

primary syphilis untreated = infects dorsal root of spinal column and cause locomotor ataxia and general paresis

mechanism of Nephrotic syndrome

problem with podocytes on epithelial cells so you get loss of protein -frothy urine -edema everywhere -albumin is the main protein that is lost-->liver compensates by making more lipids -also lose antithrombin 3 so pt is in a hypercoagulable state

acromioclavicular joint subloxation

produces upward displacment of clavicle and results from downward blow on tip of shoulder (fracture of coracoid process is rare. see it in people with rifle activities

what happens after delivery with progesterone?

progesterone drops which allows prolactin to stimulate lactation

what do you expect to see in lab results with vWF disiease

prolonged bleeding time and prolonged PTT (bc factor 8 binds to vWF)

what time gets prolonged when you have a problem with platelet aggregation

prolonged bleeding time bc of impaired platelet function

plasma cells in MM are particularly susceptible to the effects of

proteasome inhibitors such as bortezomib

what recycles proteins and breaks down misfolded, damaged and cytotoxic proteins into their component building blocks for reuse in new proteins

proteasomes

what can make a patient even more hypercoagulable if you give them warfarin

protein C or S deficiency warfarin induced skin necrosis

what blocks the final pathway of gastric acid secretion from parietal cells? can also increase risk of osteoporotic fractures bc decrease Ca absorption (bc need acidic environment to absorb Ca)

proton pump inhibitors -omeprazole -lansoprazole

why does a direct hernia happen? classic presentation with who?

protrudes through Hesselbach's triangle. inguinal ligament inferiorly rectus abd medially inferior epigastric vessels laterally the transversalis fascia forms the floor of this triangle, so defects can lead to hernia older men bc due to acquired CT abnormalities or chronic abd wall injury

abd pain, diarrhea, leukocytosis, white yellow plaques with fibrin and inflam cells indicates? risk factors?? treatment? watery diarrhea caused by enterotoxin A and fibrin caused to cytoxin B

pseudomembrane colitis due to C dif recent abx (like Fluoroquinolones for bacterial PNA), hospitalization, PPI oral metronidazole or vancomycin OR FIDAXOMICIN USED FOR RECURRENT INFECTIONS

refers to elevated intracranial pressure in the absence of ventricular enlargement on imaging. this disorder claisscaly presents in young obese women, w ha, papilledema, and possible visual loss due to optic neuropathy

pseudotumor cerebri (idiopathic cranial HTN)

what did you treat ADHD with and what are the side effects?

psychostimulants = methylphenidate and amphetamines decreased appetite, insomnia, weight loss

describe cyclic breathing in CHF

pt with CHF have chronic hyperventilation with hypocapnia. when CO2 levels get too low, you get apnea in order to try to increase CO2 levels. then you get hyperventilation to try to decrease CO2 levels ID 8262

atherscerlosis of pulm trunk, smooth muscle hypertrophy of pulm arteries, intimal fibrosis **plexiform lesions are seen leads to RV hypertrophy and cor pulmonate presents w extertional dyspnea

pulm htn

medial hypertrophy (smooth muscle thickness), intimal fibrosis, and luminal narrowing and plexiform lesions

pulmonary HTN

which pathway is PRPP synthetase involved with (phosphoribosyl pyrophosphate synthetase)

purine synthesis

what to give to treat a patient w cerebral toxoplasmosis (multiple ring enchancing lesions in an HIV pt)

pyrimethamine and sulfadiazine

how can you differentiate sarcoidosis from other lung diseases and what technique do you do to make the diagnosis?

quantify CD4/CD8 ratio in bronchoalveolar lavage fluid!! (ratio >2:1) you will see increased accumulation of CD4+ cells bc that drives granuloma formation!!

sudden traction on the outstretched/extended and pronated arm of a child

radial head subluxation (nursemaid's elbow) the annular ligament is torn and displaced in this injury reduce by supinating forearm followed by fully flexing elbow

what is commonly injured in a spiral fracture of midshaft humerus

radial nerve from a torsion produced during a fall on an outstretched hand

what can you damage with a mid shaft humeral fracture

radial nerve injury and deep brachial artery (run along the posterior aspect of the humerus) radial nerve innervated forearm extensors (like triceps) and hand extensors at the wrist and extensors of the digits and brachioradialis and supinator muscles radial nerve aslo sensory innervation to the dorsal hand, forearm, and upper arm

fracture of the mid shaft humerus results in

radial nerve injury leading to paralysis of the hand and finger extensor muscles "wrist drop" with sensory loss over the poster forearm and dorsolateral hand

serotonin neurons are found in ___of brain stem

raphe nuclei RAP Sir Sir for serotonin and RAP for raphe nucleus

what can lead to osmotic demyelination of the axons in the central part of the pons

rapid overcorrection of hcornic hyponatremia in cn9,10,11 = pseudo bulbar palsy -so you see head and neck muscle weakness, dysphagia, and dysarthria corticospinal tracts are demlyeatited too so quadriplegia

HLA B27 spondyloarthropathy that can occur following infection with Chlamydia, Campylobacter, Salmonella, Shigella, Yersinia asymmetric oligoarthitis keratoderma blennorrhagicum, circinate balantis, conjunctivitis, urethritis

reactive arthritis -**doesnt represent disseminated infection, joint aspirates are sterile!!! it is a reactive not infectious arthritis caused by immune complexes involving bacterial antigens

if a pt has IgA deficiency and needs a blood transfusion, what do they need to receive?

receive blood products washed of residual plasma or from an IgA deficient donor they can get an anaphylactic reaction if they get transfused with a blood product containing IgA bc they have lots of IgE built up against IgA bc anaphylaxis is IgE mediated

endocarditis typically causes a _____murmur with valvular vegetations

regurg murmur typically see endocarditis with hx of prosthetic heart valves, valvular disease, IV drug use, immunosuppression, indwelling central venous catheters, or total parenteral nutrition

it is common to see mullerian tract anomalies with what other type of anomaly?

renal anomalies like unilateral renal genesis

hematuria + palpable mass + flank pain paraneoplastic syndrome** so it can release EPO, ACTH, PTHrP, or renin may present w left sided varicocele** loss of VHL (3p) tumor suppressor gene, which leads to increased IGF-1 (promotes growth) and increased HIF (transaction factor (increased VEGF and PDGF)

renal clear cell carcinoma EPO-can have elevated Hct

when you see flank pain, hematuria, elevated lactate dehydrogenase (cell necrosis), and a wedged shaped right kidney lesion on CT?? what is the most common cause of this? simultaneous dvmd of stroke, intestinal or foot ischemia and renal infarction should raise suspicion for?

renal infarction systemic thromboembolism -->which commonly occurs with A FIB embolic phenomena

presenting w gross hematuria + flank pain necrosis of renal papillae causes include -chronic analegesic abuse (ASA or long term phenacetin) -DM -sickle cell trait or disease** -severe acute pyelonephritis

renal papillary necrosis NSAIDs can inhibt renl blood flow by decreasing prostaglandin synthesis and vasoconstricting the afferent arterioles

sudden onset abd pain and flank pain hematuria left sided varicocele elevated lactate dehydrogenase

renal vein thrombosis, a complication of nephrotic syndrome elevated lactate dehydrogenase bc of renal infarction

hyperventilation causes _____, marked by an increased ___and a decreased ____

respiratory alkalosis; pH, pCO2

what type of lung disease is pulmonary fibrosis and what do you see on chest x ray

restrictive honey comb appearance

central obesity mimics ___lung disease ERV* FRC* FEV1 FVC TLC

restrictive reduction in both chest wall and lung compliance so to compensate they will have increased respiratory rates with reduced tidal volumes (rapid shallow breathing) ERV and FRC ar decreased!! others are mildly reduced

different heart sounds with restrictive vs constrictive pericarditis

restrictive= S3 sound bc you have reduced ventricular wall compliance bc ventricle reached elastic limit constrictive = pericardial knock sound (heard earlier in diastole than S3; constrictive reduces ventricular compliance VIA AN EXTERNAL FORCE such as thick fibrous tissue in the pericardial space

benzodiazapenes used for treating anxiety, insomnia, acute sz, OH withdrawal used temporarily while waiting until SSRI effect

short half life <6 hours -triazolam -oxazepam -midazolam intermediate 6-24 hours -alprazolam -lorazepam -temazepam long -diazepam -chlordiazepoxide -flurazepam

short and long term effects of glucocorticoids

short term -insomnia and hyperglycemia long term -weight gain, osteoporosis, muscle weakness

what does digoxin do to the QT interval

shortens QT interval slows conduction through AV node by augmenting vagal parasympathetic tone, and increases cardiac contractility by inhibiting Na/K ATPase it decreases AP duration

when perfusion exceeds ventilation

shunt like an airway obstruction =0

polymerization of Hb occurs in Hb

sickle cell anemia

when you see loss of fat from face, extremities, buttocks (called lipoatrophy) AND you see in increase in abd girth and buffalo hump (called central fat deposition)

side effect of highly active antiretroviral therapy is associated with central fat accumulation (in abd) lipoatrophy is associated wth nucleoside reverse transcriptase inhibitors (stavudine and zidovudine) and protease inhibitors

severe myopathy with elevations in serum creatine kinase

side effect of statins statins block HMG coA reductase. decreased cholesterol synthesis increases hepatic clearance of LDL by LDL receptors. once LDL particles are endocytosed, the receptors are returned for the cell surface for reuse-->RECEPTOR RECYCLING

involuntary head bobbing is a sign of

sign of a widened pulse pressure seen in aortic regurg

what does histone deacetylation do? explain what this does in huntington's disease

silences the genes necessary for neuron survival (abnormal huntington gene increased histone deacetylation) histone acetylation weakens the DNA histone bond and makes DNA segments more accessible for transcription

calcification of the rim of hilar nodes (eggshell calcification) and birefringent particles surrounded by fibrous tissue

silicosis

what is chronic mesenteric ischemia and what is it similar to>

similar to stable angina it is when there is diminished blood supply in the mesenteric arteries bc of atherosclerosis so you get a lot of pain a couple hours after a meal when blood is needed to digest sx = food aversion and weight loss

HPV is double stranded DNA HPV strains for -skin warts -genital warts -cervical, vaginal, vulvar, and anal neoplasia

skin = 1,4 genital= 6,11 neoplasia = 16, 18 (attributed to viral oncogene proteins E6 and E7 bc E6 blocks p53 and E7 blocks Rb) the only way to get cervical dysplasia/cancer is via HPV infection

most commonly affected organs in graft vs host disease

skin, liver and GI tract follows transplant of bone marrow or other lymphocyte rich tissues (liver, non irradiated blood) donor T cells migrate into host tissue and illicit immune response bc they think host is foreign

sleep hygiene vs stimulus control

sleep hygiene -maintain regular sleep schedule -avoid caffeine after lunch -avoid larger meals, alcohol, smoking near bedtime -exercise regularly but not before bedtime stimulus control -use bed only for sleep and sex; no reading, tv, eating -go to bed only when sleepy -leave bed when unable to sleep and go to another room -maintain a fixed wake up time, including weekends the point of stimulus control is to dissociate the bed from any stimulating activities that don't involve sleep

____is a syndrome that typically occurs 2-8 weeks after exposure to high risk drugs such as anti convulsants (phenytoin, carbamazepine), allopurinol, sulfonamides (sulfasalazine) and abx (minocycline, vancomycin)

drug reaction with eosinophil and systemic symptoms (DRESS syndrome) sx include fever, generalized lymphadenopathy, facial edema, and diffuse morbilliform rash

some side effects of vitamin A toxicity

dry skin, n/v, blurred vision, intracranial HTN*, and hepatosplenomegaly

small phallus with hypospadias to ambiguous or female type genitalia

due to 5 alpha reductase type 2 deficiency type 1 is present in skin post puberty they can't convert testosterone to DHT, so their internal genitalia dvps normally bc of testosterone but external genitalia don't bc no DHT when they reach puberty, you get an increase in type 1 5 alpha reductase so you get masculinization with male pattern muscle mass, voice deepening, penile and scrotal growth, and testicular descent

beat to beat variation in pulse amplitude

due to a change in systolic blood pressure and seen in pts with sever LV dysfunction

sx of epigastric pain worse at night and relieved by eating mucosal defect in first portion of duedenum

duodenal peptic ulcer disease -people with duodenal ulcers usually have H pylori infections H pylori typically found in the antrum

what do paramesonephric ducts form? remnant in opposite sex? what does the dvmt involve?

dvmt involves lateral/vertical fusion of paramesonephric ducts = mullerian ducts -gives rise to fallopian tubes, uterus, UPPER portion of vagina -in men, appendix testis

tumor lysis syndrome

dvps during chemotherapy w tumors that have a rapid cell turnover and sensitive to chemo large number of tumor cells are destroyed and lots of ions and uric acid** released and need to be filtered by kidney uric acid crystals can obstruct part of the nephron URIC ACID PRECIPITATES IN AN ACIDIC ENVIRONMENT AKA IN DISTAL TUBULE AND COLLECTING DUCT

how does congenital achalasia happen? what infection can cause achalasia?

dysfunction of the ganglion cells in myenteric plexus; dilated esophagus, absent peristalsis in smooth muscle portion of esophagus Trypanosoma cruzi

prolonged repetitive involuntary muscle contractions give common examples

dystonia, may result from impaired function of basal ganglia cervical dystonia=spasmodic torticollis blepharospasm: involuntary forcible closure of eyelids writers cramp: affects muscles of hands

straight short, non branching uniform endometrial glands and compact stroma

early proliferative phase of menstrual cycle (day 1-14, starts w menses and ends with ovulation)

ejection fraction in systolic vs diastolic heart failure

ejection fraction = stroke volume/total volume diastolic has NORMAL ejection fraction bc total volume is low and low stroke volume systolic has low ejection fraction bc lots of total volume but it can't pump so decreased stroke volume

beat to beat variation in QRS complex amplitude on ECG

electrical alterans -seen in a large pericardial effusion or cardiac tamponade bc of the swinging motion of the heart in the pericardial fluid

how can you tell that the neural tube didn't close based on certain labs?

elevated AFP and AchE; there is an opening between the neural tube and the amniotic cavity that allows their leakage into the amniotic cavity

screening and diagnostic tests for celiac disease

elevated Ab level of TISSUE TRANSGLUTAMINASE IGA bc this helps with gluten metabolism dx test = duodenal biopsy, which shows villus flattening and intraepithelial lymphocytes -bc duodenum and jejunum are exposed to highest concentrations of gliaden

chronic kidney disease and P and Ca levels

elevated P levels decreased Ca which causes elevated PTH bc decreased GFR so the clearance of P declines and the P binds to free serum Ca which results in hypoCa damaged kidneys also decreases 1,25 dihydroxyvtaiminD synthesis so you get decrease intestinal Ca and Ca resorption from bone

What does enalapril do to GFR?

enalapril is an ACE inhibitor, therefore it prevents the conversion of Ang I to Ang II. Ang II normally causes vasoconstriction of the efferent arteriole so enalapril will keep efferent arteriole vasodilated and as a result, decrease GFR decrease in GFR can cause dvmt of acute renal failure

trypanosoma cruzi causes what disease and destroys what?

endemic in central and south africa Chagas dz destroys myenteric plexus in esophagus, intestines, ureters-->achalasia, megacolon, and magureter

what are PCOS pts most at risk for and why

endometrial hyperplasia (action of estrogen on endometrium unopposed by progesterone) and adenocarcinoma (progesterone is normally released after ovulation/after LH surge to prepare endometrium for implantation, and convert endometrium from proliferative to secretory with PCOS, excess androgens prevents ovulation from occurring. no ovulation = no progesterone = lining is not shed (with PCOS, increased LH:FSH ratio so LH stimulates ovarian androgen production, then androstenedione converted to estrogen in fat cells)

entacapone and tolacpone MOA? what does it treat? toxicity?

entacapone = peripheral COMT inhibitor tolcapone = peripheral and central COMT inhibitor COMT is an enzyme that breaks down L dopa. (even with carbidopa, COMT limits L dopa benefit_ tolcapone associated w hepatotoxicity

which cells do carcinoid tumros arise from

enterochromaffin tumors of the intestinal mucosa

catalase negative gamma hemolytic (no hemolysis on agar) can grow in hypertonic 6.5% saline and bile infective endocarditis occur in older men who have undergone GU procedures

enterococci (formerly classified under Strepto) -enteroccocus faecalis and enterococcus faecium

what is the most common cause of viral meningitis in children?

enterovirus, particularly group B coxsackievirus

which esophageal disorder presents with dysphagia nd food impaction

eosinophilic esophagitis unresponsive to GERD therapy

what do you find in sputum in allergic asthma?

eosinophils and Charcot Lyden crystals (crystalloid bodies that contain eosinophil membrane protein) bc allergic asthma is a type I hypersensitivity

perivascular pseudorossettes most commonly found in 4th ventricle poor prognosis

ependymoma

activating mutations of the KRAS gene leads to constitutive activation of the _______, which promotes increased cell proliferation and growth

epidermal growth factor receptor (EGFR)

pharyngeal pouch 2 (membrane and groove obliterated)

epithelium of palatine tonsil crypts

what stimulates the production of erythrocytes in the bone marrow

erythropoietin in the kidneys

COPD causes hypoxia which stimulates what production by what?

erythropoietin production by the cortical cells in the KIDNEY

what does an env mutation allow HIV to do

escape the host neutralizing antibodies

what do you need to consider before giving a pt TNF alpha inhibitors? etanercept, infliximab, adalimumab etanercept functions as a decoy receptor for TNF alpha

evaluate for latent** Tb bc TNF alpha inhibitors impair cell mediated immunity TNF alpha is needed to sequester mycobacteria in granulomas so inhibitors promote reactivation of latent Tb and promote disseminated dz do a baseline Tb skin test or interferon gamma release assay used when methotrexate doesn't work for RA

whenever there is appearance of increased CSF on imaging but it is due to decreased brain tissue and neuronal atrophy (so it allows ventricles to expand while maintaining the normal pressure) ex alzheimers, adivanced HIV, Pick dz, Huntington disease ICP is normal

ex vacuo ventriculomegaly

sx of theophylline toxicity?

excessive CNS stimulation so tremor, insomnia, sEIZURES!!! GI disturbances, and CV changes like hypotension, tachy, and CARDIAC ARRYTHYMIAS**

the nigrostriatal degeneration in parkinsons disease results in ....

excessive excitation of the sub thalamic nucleus on the globus pallidus internus, which results in excessive inhibiton of the thalamus

second pharyngeal/aortic arch (associated nerve and derivative)

facial nerve (CN7) -aortic arch gives rise to stapedial artery which regresses in humans -pharyngeal arch gives rise to muscles of facial expression and ear and hyoid associated structures

rivaroxaban

factor Xa inhibitor

what are accessory nipples due to

failure of involution of the mammary ridge hyperpigmented, epidermal thickening, tender around menses, preggo, lactation

which ligament attaches the liver to the anterior body wall

falciform ligament derivative of embryonic ventral mesentery and contains the round ligament, the remnant of the fetal umbilical vein f

T/F. There are ciliated cells in the lining of alveolar ducts and sacs.

false

T/F. histamine antagonists are useful for treating allergic asthma for bronchoconstriction

false

T/F. hyaline cartilage is found in bronchioles

false

T/F. visceral pleura contains pain fibers

false

T/F. with an ABO compatibility, you get an anaphylactic rxn

false, reactions range from fever and chills to severe hemolysis and circulatory collapse

T/F. there are goblet cells in the alveoli

false. goblet cells found in bronchi and larger bronchi

Ca sensing receptors are G protein coupled receptors that regulate the secretion of PTH. high Ca inhibits PTH release what is an autosomal dominant disorder that is caused by a defective Ca receptor in PT gland and kidneys?

familia hypocalciuric hypercalcemia -you need higher levels of Ca to inhibit PTH -hypercalcemia -normal or mildly elevated PTH -reduced urinary excretion of Ca***

tendon xanthomas xanthelasmas accelerated coronary artery disease

familial hypercholesterolemia defects in LDL receptor or APOC-100 "DEFECTS IN LDL PARTICLE UPTAKE BY HEPATOCYTES" So there elevated LDL

1-3 days after a orthopedic surgery and pt presents with hypoxemia, tachypnea, petechial rash dyspnea

fat embolism syndrome -when fractured bone releases lipids into pulmonary vasculature

patient pays for each individual service

fee for service

genitalia of 21 hydroxylase deficiency

females have ambiguous genitalia males have normal genitalia, with salt wasting or precocious puberty occurring later elevated 17 hydroxyprogestone is dx

short palpebral fissures, smooth philtrum, and a thin vermillion border

fetal alcohol syndrome

pentad in thrombocytopenic thrombotic purpura (TTP) difference in coagulation studies compared to DIC

fever, neuro sx, renal failure, microangiopathic hemolytic anemia, and thrombocytopenia TTP has normal PT and aPTT

protein normally found in blood vessels (aortic media), periosteum, suspensory ligaments of the lens and acts as a scaffold for deposition of elastin

fibrillin 1

what type of drugs cause a reperfusion complex arrhythmia on arterial reopening

fibrinolytic like tPA, streptokinase, reteplase, tenecteplase

widespread MSK pain >3 months with fatigue and neuropsychiatric disturbances (poor sleep, depression, can't concentrate) involves abnormal central processing of painful stimuli gradual incremental aerobic exercise is proven to reduce pain and improve function; tricyclic antidepressants and serotonin NEPI reuptake inhibitors can also be considered

fibromyalgia

adhesion of the cells in the extracellular matrix involves integrin mediated binding to

fibronectin, collagen, and laminin LOCATED EXTRACELLULARLY

how to treat androgentic alopecia

finasteride a 5 alpha reductiase inhibitor which decreases conversion of testosterone to DHT follicular hair grwoth is strongly influenced by DHT

first vs second generation antipsychotics MOA

first generation -antagonism of dopamine 2 receptors ex. haloperidol second generation -less affinity for D2 receptors and additional serotonin 5Ht2 receptor antagonism

the juxtaglomerular apparatus is made up of macula densa cells and juxtaglomerular (JG) cells. what do they do and what is the response with renal hypo perfusion?

macula dense cells are located in distal tubule and monitor salt content and tubular flow rate info transmitted to JG cells which are located in the wall of the afferent arteriole. JG cells are modified smooth muscle cells that contain renin granules hypo perfusion causes JG cells to undergo hyperplasia from chronic stimulation of increasing renin secretion

what can you give to mother to prevent risk of cerebral palsy?

magnesium sulfate

reduced vitamin K activates which enzyme in order to activate coagulation factors 2,7,9, and 10

gamma glutamyl carboxylase

if you have elevated alkaline phosphatase, you need to check ____bc this enzyme is not found in bone disease

gamma glutamyl transpeptidase it wil help you decide if its a liver problem or a bone problem

gamma hemolytic gram + streptococci ? which one is PYR +, grows in bile, and 6.5% NaCl, and is seen after GU procedures; also cant convert nitrates to nitrites

gamma hemolysis = no hemolysis Enterococci and Streptococcus gallolyticus Enterococci

arises from astrocytes and typically located within the cerebral hemispheres ; areas of necrosis and hemorrhage may cross the corpus callosum

glioblastoma

what is good to use in asthma bc it is anti inflam so it inhibits the formation of inflam mediators like cytokines, PGs, leukotrienes and they reduce leukocyte extravasation and induce apoptosis of inflam cells it has the most effect on the inflammatory component of asthma!!!

glucocorticoids ex. fluticasone reduces airway inflammation**

how do you treat the opthalmopathy part of graves dz

glucocorticoids bc they reduce inflammation

how does cataracts form in hyperglycemia

glucose-->sorbitol via aldose reductase and sorbitol accumulates in the lens, causing influx of water, increasing osmotic pressure and injury -aldose reductase uses up NADPH!!! sorbitol-->fructose via sorbitol dehydrogenase

charges for sickle cell and HbC

glutamic acid is negatively charged valine is neutral lysine is positively charged

the tetanospasmin is the protein toxin of C tetani that travels by retrograde axonal transport into the CNS. it binds to ganglioside receptors on neuronal membranes and inhibits the release of ____and ___from ______

glycine and GABA inhibitory interneurons absence of inhibitory neurotransmitters causes sustained muscle contraction

cervical erythema/friability, purulent vaginal discharge, and a gram stain that shows gram negative diplococci

gonorrhea cervicitis

bacteria that usually cause UTIs

gram negatives (E coli, Klesbiella, Proteus) and Enteroccocus

characterized by bone marrow failure massive splenomegaly pancytopoenia dry tap of bone marrow TRAP+

hairy cell leukemia a B cell neoplasm

chronic inflammation with germinal centers and Hurthle cells (increased pinkness to the cytoplasm of cells)

hashimoto thyroiditis

what is the function of brown adipose tissue/tan fat tissue in neonates

heat production lots of mitochondria so thats why they are brown -also more O2 requirement than white adipose no ATP synthesized and energy dissapated as heat electron transport and phosphorlyation is uncoupled the protein thermogenin returns protons pumped out back to matrix

which enzyme gives green color in bruise

heme oxygenaase heme-->biliverdin

gold yellow hemosiderin granules in the cytoplasm

hemochromatosis, characterized by deposition of iron in the liver

pigmented gallstones are a complication of any ___anemia

hemolytic

what are the 2 hallmarks for dx of TTP

hemolytic anemia (MAHA) and thrombocytopenia

what should yo think of if you see deep tissue bleeding like bleeding into joints/muscles, GI bleeding, and hematuria

hemophilia with clotting factor deficiencies

mesna prevents what

hemorrhagic cystitis from taking clyclophosphamide or ifosfamide bc a metabolite is acrolein and mesna binds to it

what liver condition can regress with the discontinuation of oral contraceptives

hepatic adenomas

neuro complication of cirrhosis?? what can precipitate this complication? how do you treat?

hepatic encephalopathy bc the liver can't convert ammonia to urea (so ammonia crosses BBB and can cause AMS) DECREASED BUN bc ammonia can't be converted to urea by the failing liver -asterixis = rhythmic flapping of dorsiflexed hands -GI bleeding bc increased blood causes increased Hb breakdown which leads to nitrogen products in the gut***; excess protein intake is another trigger lactulose bc converts ammonia to ammonium rifaximin bc decreases intraluminal ammonia production

infection associated with fever, anorexia, n/v, RUQ pain, jaundice, dark colored urine (due to increased conjugated bilirubin levels), and acholic stool (lacks bilirubin pigment) hits = spotty necrosis with ballooning degernation (hepatocyte swelling with clear cytoplasm), mononuclear cell infiltrates

hepatitis A infection associated with recent travel

diagnostic test most specific for acute cholecytstis

hepatobiliary scan = a radio tracer is administered and you see it taken up by liver and excreted into bile. -if pt have a patent cystic duct, then you can see the tracer accumulate and concentrate -with acute or chronic cholecystasis, the GALLBLADDER WILL NOT BE VISUALIZED bc of obstruction ID 80 US is the preferred initial imaging test for dx. ONLY Suggestive when you see presence of "echogenic structures within the gallbladder" on US more specific findings to help dx= gallbladder wall thickening, pericholecystic fluid, + sonograph Murphys sign

you use inhaled anesthetics before doing surgery, such as halothane. (also enflurane, isoflurane, desflurane, sevoflurane). what do halogenated inhaled anesthetics cause?

hepatocellular pattern of liver injury -can cause fulminant hepatitis with 50% mortality rate liver appears shrunken on autopsy (histologically, centrilobular necrosis, inflamm of portal tracts-->makes it indistinguishable from viral hepatitis) labs!!! -elevated serum aminotransferase -prolonged prothrombin time bc of failure of liver to make factor VII

the portal triad (common bile duct, portal vein, and hepatic artery) run through which ligament?? the pringle maneuver is what?

hepatoduodenal ligament occlude portal triad to see where bleeding in RUQ is. if bleeding continues, then blood is either from IVC or hepatic veins

the lesser omentum is a double layer of peritoneum that extends from liver to the lesser curvature of the stomach and the beginning of duodenum. it is divided into?

hepatogastric and hepatodudenal ligaments

C1 inhibitor deficiency causes _____that can be triggered by transfusions. They have ___ but not urticaria or wheezing

hereditary angioedema angioedema

mutations in transthyretin gene

hereditary form of cardiac amyloidosis -amyloid deposition results in infiltrative cardiomyopathy

inherited disorder of blood vessels. blanching lesions on skin and mucous membranes recurrent nose bleeds skin discolorations AVMs GI bleeding hematuria

hereditary hemorrhagic telangiectasia (Osler weber rendu syndrome)

depressed mental status, miosis**, respiratory depression** an opioid exams shows constricted pupils, decreased bowel sounds, resp depression ID1288

heroin intoxication

Ohio and Mississippi River Valleys; Soil, bird, and bat droppings (chicken coops, caves) Pulmonary: similar to Tb (lung granuloma w calcifications) disseminated: lungs, spleen, liver Culture: branching hyphae biopsy: oval yeast cells within Macrophages

histoplasma capsulatum

injury to inferior thyroid artery is associated with what?

hoarseness bc it runs adjacent to the recurrent laryngeal nerve

Reed-sternberg cells, which are giant B cells with bilobed (owl eye) or multiple nuclei and prominent inclusion like nuclei pts have enlarged lymph nodes in neck or a mediastinal mass on chest x ray , with no involvement of other organ systems

hodgkin's lymphoma

pyridoxine (vitamin B6) can be used to treat ___, which is caused by a defect in vitamin B6 dependent cytathionine synthase

homocystinuria

adverse effects of tamoxifen/raloxifene (selective estrogen receptor modulators) Raloxifene = has estrogen activity on bone and prevents bone resorption tamoxifen = adjuvant treatment for breast cancer

hot flashes, VENOUS THROMBOEMBOLISM**, endometrial hyperplasia and carcinoma (tamoxifen only); raloxifine does not increase risk of endometrial cancer bc estrogen antagonist on uterus *medicines with estrogen agonist acitivty, including oral contraceptives and hormone replacement can cause HYPERCOAGULABLE STATE AKA THROMBOEMBOLISM

the HER2 oncogene codes for

human epidermal growth factor receptor with tyrosine kinase activity it activates epithelial growth and differentiation

acute cellular rejection vs acute humoral rejection

humoral = C4d deposition, neutrophilic infiltrate, necrotizing vasculitis cellular = lymphocytic interstitial infiltrate and endotheliitis

what is a glycosoamionglycan that contributes to water retention in the extraacellular matrix and determines the stiffness of the matrix

hyaluronic acid

what is the first line medication to treat essential hypertension

hydrochlorothiazide (diuretics) -blocks Na/Cl cotransporter in distal tubule so Na can't be reabsorbed -increases glucose, uric acid, and Ca so ITS NOT RECOMMENDED FOR DIABETIC PTS, GOUT PT, OR HYPERCALCEMIA PTS also decreases Na

improve cholesterol solubility by reducing the amount of cholesterol secreted into the bile and increasing biliary bile acid concentration. (good medical therapy for people who don't want to remove gallbladder)

hydrophilic bile acids you get cholesterol stones whenever there is too much cholesterol and not enough bile acids so you want to improve cholesterol solubility to dissolute the gallstone

cyanide poisoning presents with confusion, flushing, or a "cherry red" skin color, abd pain, and vomitnig how to treat?

hydroxycobalamin (vitamin B12 precursor)

to the affected side of pneumothorax, how does percussion sound

hyper resonant

to dx major depressive disorder vs persistent depressive disorder (dysthymia) in terms of length

major depressive disorder lasting >_2 weeks with 5/9 SIG E CAPS persistent = >2_ depressive sx lasting >_2 years!!

occurs within minutes of transplantation preformed Ab against ABO or HLA (Preformed Ab against graft in recipient's circulation) there is graft blood vessel spasm and diffuse intravascular coagulation, resulting in ischemia

hyperacute rejection

spider angiomata can occur with what type of states?

hyperestrogenic states, possibly due to estrogen's effects on arteriolar dilation you can see hyperestinism in liver cirrhosis and pts present with gynecomastia, testicular atrophy, decreased body hair and spider angiomata (increased testosterone binding, decreased free testosterone/estrogen production)

difference between hyper flexion injuries and hyperextension injuries in elbow

hyperextension (falling on outstretched hand) lead stop supracondylar humeral fractures hyper flexion (falling on flexed below)= common to see ulnar nerve injury bc it runs POSTERIOR to medial epicondyle -sensory loss over medial 1.5 digits and weakness on flexion of 4/5digits and wrist

relationship with H and K

hyperkalemic acidosis hypokalemic alkalosis

subperiosteal resorption with cystic degneration

hyperparathyroid bc increase osteoclasts **involves cortical bone you you get subperiosteal thinning

is Retinoblastoma protein inactive or active with hyperphosphorylation

hyperphosphorlyated Rb makes it inactive when it is inactive, it releases EF2 transcription factor which allows the cell to progress through the G1 to S phase checkpoint

high CD8+ count predominates in bronchoalveolar lavage fluid in pts with?

hypersensitivity pneumonitis

progressive ha and n/v followed by confusion

hypertensive encephalopathy vs hypoxic encephalopathy which is due to global interruption of cerebral blood supply like due to a cardiac arrest

systolic ejection murmur that increases in intensity with standing

hypertrophic cardiomyopathy

more thickening of the ventricular septum compared to the left ventricular free wall (asymmetric septal hypertrophy)

hypertrophic cardiomyopathy -left ventricular outflow obstruction*

do you want to hyper or hyperventilate someone with cerebral edema?

hyperventilate bc it causes a decrease in pCO2 levels. decreased pCO2 levels means that there is less cerebral perfusion-->therefore lower cerebral blood flow, lower cerebral volume, AND lower intracranial pressure!!! hyperventilation = decreased pCO2 = arterial vasoconstriction

respiratory alkalosis is associated with____(2) while metabolic alkalosis is associated w____ while resp acidosis w/

hyperventilation-->panic attacks and PE repetitive vomiting COPD (although it is resp acidosis, bc its chronic, it will usually be compensated, if HCO3 <30 then it is acute resp acidosis, if HCO3 >30, then thats a chronic process)

asides from hyperCa, what are other side effects of thiazides

hypoKalemia and metabolic alkalosis they block Na/Cl transporters in distal convuluted tubule; this results in RAAS activation so high aldosterone leads to urinary excretion of K and H

side effect of PPIs

hypoMagnesemia and increased risk of osteoporosis

what is a risk factor in distal renal tubular acidosis for dvping kidney stones 2. risk factors for kidney stones (dietary intake) 3. what prevents a stone from forming

hypocitraturia 2. low fluid low calcium -bc if you ingest high amt of Ca, it binds to oxalate in food so decreased gut absorption and redued renal excretion of oxalate high oxalate (spinach, rhubarb) high protein high sodium high fructose 3. high levels of urinary CITRATE bc it binds and prevents pptation (binds to free ionized Ca)

what slows hemachromatosis in women? (too much iron in body bc of too much absorption and storage)

menstrual bleeding

Vimentin is an intermediate ligament found within cells of ______origin and is used to diagnose _____

mesenchymal; sarcomas;

list the 4 main dopaminergic pathways

mesocortical pathway mesolimbic pathway nigrostriatal pathway tuberoinfundibulnar pathway (inhibits prolactin secretion)

the spleen is derived from ___even though its blood supply is via ___derivative

mesoderm foregut (of endoderm)

what do inflammatory macrophages release in the intima that reduces the stability of an atherosclerotic plaque

metalloproteinases which breakdown ECM proteins and this reduces plaque stability

long acting oral opiate used for heroin detox or longer term maintenance therapy

methadone

what is a drug of choice for maintenance treatment of opioid abuse and how does it work?

methadone a full mu opioid receptor agonist!! a long half life, so it'll suppress cravings and withdrawal sx for >24hrs

colonization among hospital staff is a frequent cause of

methicillin resistant Staph aeurus. they can be asx but can pass this organism to their pts

which meds decrease formation of thyroid hormones via inhibition of thyroid peroxidase

methimazole propylthiouracil (also decreases peripheral conversion T4-->T3) enzyme responsible for iodine organification and coupling of iodotyrosines

narcoleptic pts have low levels of what in their CSF?

hypocretin 1 (orexin A) and hypocretin 2 (orexin B) they are produced in the lateral hypothalamus that function to promote wakefulness and inhibit REM sleep related phenomena bc people with narcolepsy have shortened REM sleep latency

which levels are elevated in vitamin B12 deficiency

methylmalonic acid and homocysteine

what type of anemia is caused by HUS

microangiopathic hemolytic anemia schizocytes

which nerve do you want to stimulate in obstructive sleep apnea and why?

hypoglossal nerve bc it causes the tongue to move forward slightly and increases the diameter of the oropharynx airway (it innervates the oropharyngeal muscles) OSA is due to neuromuscular weakness in the oropharynx

what causes an acquired QT prolongation

hypokalemia, hypoMg Class 1A and III antiarryhtmics (quinidine, sotalol) abx (macrolides, fluoroquinolone) methadone antipsychotics (haloperidol)

normally, what happens to the QRS duration during exercise? what does Flecainide do to QRS complex and how? what is flecainide good to be used for?

slightly reduced during exercise it is a class IC antiarrthymic that prolongs QRS duration bc it binds to Na channel in cardiac myocytes (phase 0 depolarization) -USE DEPENDENCE: Their Na blocking effects intensify as heart rate increases** used to treat SVT caused by A FIB

primary vascular site of action of vasoactive hypertensive drugs like nifedipine (Ca channel blocker) and prazosin (alpha 1 adrenergic blocker) what is responsive to NEPI and EPI and will either relax or contract? can also sense blood flow demand and will dilate in response to histamine, Low O2, elevated CO2 or decreased pH

small arteries and arterioles pre capillary sphincters

poorly differentiated small cells; arises from neuroendocrine cells: male smokers; Central may produce ectopic ADH (SIADH), coptic ACTH (Cushing syndrome); Lambery Eaton myasthenia syndrome (Ab dvp to Ca channels-->muscle weakness HIGH MITOTIC COUNT

small cell carcinoma

what is the most aggressive type of lung cancer and whats its origin

small cell carcinoma; neuroendocrine so the tumors will express neuroendocrine markers and contain neurosecretory granules in the cytoplasm -small cell carcinoma has rapid growth and distant mets

carcinoid tumors are most commonly associated where in the GI tract? they are malignant transformations of what cells?

small intestine, rectum, and appendix neuroendocrine cells

how does histoplasma capsulatum look on the microscope

small intracellular OVAL bodies located within MACROPHAGES

snRNPs are made up of? and needed for?

small nuclear RNA (made by RNA poly II) + specific proteins/Smith protein essential part of spliceosomes which remove introns to form pre-mRNA-->mature mRNA **lupus = anti smith Ab

what do all steroid producing cells contain

smooth ER bc it contains enzymes for steroid and phospholipid biosynthesis ex. ACTH stimulates cells in adrenal cortex to produce glucocorticoids, the cells that synthesize them contain glucocorticoids ex. the ovarian lutein cells that produce progesterone contain smooth Er but the endometrial cells on which progesterone acts do not

carpal tunnel is the space..? what does the ligament attach to? what structures do the carpal tunnel contain?

space b/n carpal bones and transverse carpal ligament (flexor retinaculum) hamate and pisiform on ulnar side and trapezium and scaphoid tuberosity on the radial side flexor digitorum profundus tendons, flexor digitorum superficialis tendons, flexor pollicis longus tendon, and the median nerve** median nerve causes weakness of thumb abduction and opposition and atrophy of thenar eminence!!***

lipid laden foam cells cherry red macular spot on retina hepatosplenomegaly (bc lipid laden foam cells accumulate in the liver and spleen) hypotonia and neuro degeneration

sphinomyelinase deficiency so you get an accumulation of sphingomyelin accumulation Niemann-Pick disease -common in Ashkenazi Jewish population

constant back pain, worse at night, and not responsive to position changes is consistent with

spinal mets other malignancies with propensity for bone mets = Lead Kettle = PB/KTL =breast, kidney, lung, thyroid

a condition caused by mutation in the survival motor neuron SMN1 gene which encodes a protein involved in assembly of snRNPs in lower motor neurons defective snRNP assembly results in imapreid spliceosome function and denigration of anterior hon cells -->infants have flaccid paralysis

spinal muscular atrophy

defective snRNPs results in defective ____function

spliceosome

toxicities of vitamin A? what is it used to treat? (it inhibits follicular epidermal keratinization, reduce size of sebum glands and production)

spontaneous abortions and fetal abnormalities, dry skin, pseudotumor cerebri, hepatic toxicity, blurred vision bc of teratogenity to fetus, CONTRAINDICATED IN PREGNANCY. if used, use 2 forms of contraception and take monthly preggo tests oral to treat severe cystic acne and all-trans retinoic acid to treat acute promyelocytic leukemia

what is a more specific test for asthma, sputum or serum eosinophil counts?

sputum bc eosinophilic infiltration of the bronchial mucosa is a common pathologic finding in allergic asthma -THE PRESENCE OF EOSINOPHILIA IS NOT A SENSITIVE OR SPECIFIC INDICATOR OF ASTHMA

histologically flattened polyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or "pearls" within or between cells, and intracellular bridging. arge hyper chromatic cells with bizarre nuclei and atypical mitoses are commonly observed

squamous cell carcinoma

pink keratin pearls or intercellular bridges most common tumor in male smokers* ; central may produce PTHrP (hypercalcemia)

squamous cell carcinoma

in the esophagus, smoking and alcohol use is an associated risk factor for developing? people with severe GERD are prone to Barretts esophagus. this is a major risk factor to dvping?

squamous cell carcinoma adenocarcinoma barretts = metaplastic condition where normal squamous epithelium is replaced by columnar

an atherosclerotic plaque that occludes greater than 75% of the cross sectional area of the coronary artery lumen will cause

stable angina sx

is tumor stage or grade the most important criteria for determining prognosis

stage! (extent of tumor expansion) grade refers to the degree of tumor differentiation like from well differentiated to anaplastic

stapedius is innervated by __which is a branch of ___

stapedius nerve; facial nerve the stapedius muscle stabilizes the stapes

grows in clusters; gram + catalase + coagulase + PYR-

staph aureus

usually colonizes intravenous catheters and prosthetic heart valves and orthopedic hardware, leading to bacteremia and sepssi

staph epidermis

the most effective lipid lowering drugs? how?

statins. HMG CoA reductase inhibitors!!

steroids and insulin relationship

steroids causes you to get insulin resistance so you will have more glucose built up in the body

erythema multiforme with oral mucosa/lip involvement and fever what is this severe form of this?

steven johnson syndrome -ususally occurs 1-3 s/p infection toxic epidermal necrolysis (charaterized by diffuse sloughing of skin, usually bc of adverse drug rxn)

how is the partial pressure of oxygen with CO poisonin

still normal. bc it reflects the oxygen content dissolved in the plasma CO decreases the oxygen carrying capacity and oxygen content of the blood

glucocorticoid effect in the liver? relationship to insulin?

stimulates LIVER gluconeogenesis and glycogenolysis -bc of more glucose availability, this increases liver protein synthesis -also opposes insulin net effect = hyperglycemia

how do androgens cause acne? (anabolic steroids like methyl testosterone) are androgens

stimulates follicular epidermal hyper proliferation and excessive sebum production

another function of FSH

stimulates release of inhibin B from sertoli cells in seminiferous tubules of testicles while LH stimulates testosterone from Leydig cells in interstitial of testicles FSH produces an androgen binding protein responsible for the high local testosterone concentration high local levels of FSH and testosterone are needed for spermatogenesis defect in FSH receptors prevents spermatogenesis and cause low inhibin B levels

group B strep catalase and coag - grows in chains colonies produce a narrow zone of beta hemolysis that enhances when plated perpendicular to S aureus (+CAMP test) causes newborn sepsis and meningitis

strep agalactiae

the most common organism causing community acquired pna? causes pna, particularly as a nosocomial infection or following influenza infection?

strep pna staph aureus both are gram +

what is the most common cause of bacterial meningitis in adults of all ages

strep pna -lancet shaped gram + cocci in pairs

2 most common organisms causing bacteriiemia in sickle cell patients

strep pna and H influenza

alpha hemolysis (partial green hemolysis) optochin-sensitive bile soluble*** PNA, meningitis, otitis media, sinusitis

streptococcus pna

port wine stain -->affects overlies the ophthalmic v1 and maxillary V2 regions of the face tram track calcifications unilateral mental retardation glaucoma GNAQ gene* Epilepsy

sturge weber syndrome

which zone in the process of T cell maturation has "double negative" , this is how T cells arrive at the thymus

sub scapular zone

where do you want to do deep brain stimulation with pt w parkinson disease

sub thalamic nucleus or globus pallidus internen in order to improve mobility thalami cortical inhibition

paraneoplastic syndrome associated w small cell uno cancer, breast, ovarian and uterine cancer immune response that cross reacts w Purkinje neuron antigens, leading to cerebellar degernation Anti Yo, Anti P/Q, and Hu are most common Ab

subacute cerebellar degeneration

painful thyroid onset following viral illness increase in erythrocyte sedimentation rate, C reactive protein **inflammatory lymphocytic infiltrate with macrophages and multinucleated giant cells

subacute granulomatous thyroiditis (De Quervain)

what is a rare complication of measles infection that occurs several years after apparent recovery from initial infeciton

subacute sclerosing panecephalitis

w MS, the MRI findings usually are white matters lesions scattered throughout the brain/spinal cord with a predlicatio for the _____regions

subcortical periventricular regions

what is commonly administered for rapid sequence intubation bc of its rapid onset? and its duration of action depends on its breakdown by___?

succinylcholine; cholinesterase

what promotes peptic ulcer healing by binding to the base of the mucosal ulcers and providing physical protection against gastric acid, but it doesn't inhibit gastric acid secretion

sucralfate

the reticulocyte index represents the reticulocyte percentage corrected for the degree of anemia. what does a low one mean?

suggests an inadequate bone marrow response and a lack of erythropoesis if its low, that means that there is an underproduction

meglitinides (repaglinide, nateglinide) are similar to what other diabetic medication?

sulfonyureas (glyburide) bc they they bind and close ATP dependent K channel, inducing depolarization and Ca influx, stimulating insulin release

most of the cutaneous lymph from the umbilicus down, including the external genitalia and anus (below the dentate line), drains where? what is the exception?

superficial inguinal nodes the glans penis and posterior calf drain into deep inguinal nodes

what control vertical gaze? what happens to damage to the dorsal midbrain in this region?

superior colliculus causes Parinaud syndrome-->upward gaze palsy, absent papillary light reflex, impaired convergence

which nerve for trendelenberg sign

superior gluteal nerve injury weakness in gluteus medius and minimus so you get a hip drop contra laterally patients lean to ipsilateral (affected) side to compensate for the hip drop (gluteus medium lurch)

the left renal vein can be compressed between ? this increased pressure can cause?

superior mesenteric artery and aorta "nutcracker effect" which can cause hematuria and flank pain increased pressure in the left gonadal vein results in valve leaflet failure and varices of the testicular pampiniform plexus (varicocele) -the left gonadal vein drains into the left renal vein -on the right side, the right gonadal vein drains directly into the IVC

trochlear nerve innervation, mvmt of that muscle, and what does the pt have difficulty with when its lesioned?

superior oblique causes eye to internally rotate and depress while adducted (down and in) when its lesioned, pt have vertical diplopia problems when the patient wants to look down and towards the nose such as reading up close, WALKING DOWN THE STAIRS* patients compensate by tucking the chin and tilting the head away from the affected eye

pharyngeal pouch 4

superior parathyroid glands, ultimobranchial body

where is wernicke area

superior temporal gyrus of temporal lobe

injury to the radial nerve as it passes through the ___may occur due to repetitive pronation and supination of the forearm, direct trauma, or subluxation of the radius -pt have weakness in finger and thumb extension ("finger drop)

supinator canal -if it was injury to radial nerve at axilla, there would be forearm, hand, and finger extensor muscle weakness (wrist drop and absent triceps reflex) and you would have sensory loss over posterior arm, forearm, and dorsolateral hand -if it was injury to radial nerve at the mid shaft humerus, you would get weakness of the hand and finger extensor muscles -the triceps would be spared -sensory loss over the posterior forearm and dorsolateral hand

a fracture to the surgical neck of the humerus may damage

the axillary nerve travels closely w the posterior circumflex artery the anterior and posterior circumflex humeral arteries are branches of the axillary artery

what does the body do when someone has an IgA deficiency?

the body forms IgE antibodies directed against IgA (anti IgA antibodies) serum IgA is low, IgG and IgM normal

what does FAS receptor activate

the extrinsic pathway of apoptosis (activates capsize 8 and 10 when then activate 3 and 6 and then apoptosis

does heme synthesis occur in the mitochondria?

the first step and the last 3 steps

how do you get excess copper in wilson disease?

the gene ATP7B normally takes copper and puts it in vesicles to be excreted into bile or binds it onto ceruloplasmin (extracellularcopper transport protein). w the mutation, copper builds up in liver and causes injury by making free radicals

which arteries perfuse the lesser curvature of the stomach?

the left and right gastric arteries they are frequently penetrated by gastric ulcers, leading to hemorrhage majority of gastric ulcers occur over the lesser curvature of the stomach

carboxyHb is represented by

the levels of CO bound Hb

where is hepcidin released from

the liver

which bile ducts are the problem in primary biliary cirrhosis and what do yo see?

the liver bile ducts!!! the rest of the bile ducts are normal autoimmune reaction with GRANULOMAS*** and lymphocytic infiltrate

hyperammoniemia in advanced liver failure occurs as a result of? excess ammonia in blood and therefore and neurons?

the liver's inability to metabolize nitrogenous waste products excess ammonia in blood crosses BBB, taken up by astrocytes, which causes increased glutamine production excess glutamine causes astrocyte swelling and impaired glutamine release glutamine can't be released to neurons to be converted into glutamate-->DISRUPTION OF EXCITATORY NEUROTRANSMISSION

describe the sweat content of cystic fibrosis patients

they dont have a functioning CFTR protein so CFTR cannot remove the sodium chloride. as a result, they have elevated sweat chloride and sodium levels another dx test to do is measuring nasal transepithelial potential difference

how does compensation with breathing occur in people with pulm fibrosis or pulmonary edema

they have reduced lung compliance so they will have a decreased tidal volume to compensate, you get increased respiratory rate

what happens to patients weeks to months later after an acute stroke to the dorsolateral thalamus

they present with contralateral hemisensory loss and then they develop excruciating pain on the side of their deficits (regular painless stimuli causes pain)

dilitiazem (nondihydropyridine Ca channel blocker) and metoprolol (beta 1 selective antagonist) have what in common?

they show the sinus node discharge rate and AV node conduction so they prolong PR interval but they don't affect the QT interval

pt with chronic alcoholism are usually deficient in ___?? it is a cofactor for which enzymes?

thiamine (B1) pyruvate dehydrogenase to convert pyruvate to acetyl CoA alpha ketoglutarate dehydrogenase which converts alpha KG -->succinyl CoA

chlorthalidone how does it increase glucose and cholesterol

thiazide diuretic. they decrease insulin secretion which raises blood glucose levels also increase LDL cholesterol and trig levels, possibly due to altered lipid metabolism from increased peripheral insulin resistance -hypokalemia bc compensatory rise in renin and aldosterone secretion due to decreased volume

presents w brief episodes of sudden and severe electric shock like or stabbing pain in the distribution of CN 5, particularly V2 and 3 pain is triggered by any stimulus to CN 5 like chewing, teeth brushing, shaving..etc what is it and how do you treat?

trigeminal neuralgia tx w carbamazepine

MOA of migraine headaches and what to give to tx

trigger afferents are activated which causes release of substance P and CGRP, which results in neurogenic inflammation due to vasodilator and plasma protein extravasation give triptans which are serotonin agonists that inhibit the release of vasoactive peptides and causes vasoconstriction

meiotic nondisjunction with maternal age >35. findings include dysmorphic face (micrognathia, low set ears), clenched hands with overlapping fingers, and hypertonia

trisomy 18 (47XX, +18)

T/F. Aspergillus fumigatus causes pulm disease in immno patients

true

T/F. inactivated viral vaccines do not infect host cells therefore they dont enter the MHC class I antigen processing pathway, which is needed to generate CD8 cell mediated immune response

true

T/F. nitroprusside decreases LV preload and after load, which allows adequate CO to be delivered at a lower LV end diastolic pressure

true

T/f. live attenuated vaccines strongly stimulate MHC class I antigen processign pathway and can generate cytotoxic CD8 T lymphocytes that can infect and kill cells

true

you can have anxiety due to a medical condition. t/f

true like hyperT, hypoglycemia, pheochromocytoma, hypercortisolism, and cardiac arrhythmia

T/F. mucous and serous glands are found from trachea to distal most bronchi and are not present within the bronchioles

true goblet cells are not found in terminal bronchioles, which are lined by club cells

t/f. in sickle cell, the aa substitution leads to the formation of a hydrophobic pocket on the beta global surface that interacts with a complementary non polar residue on another Hb molecule

true the hydrophobic interaction causes polymerization of the HbS molecules and erythrocyte sickling

lesions to the cerebellar vermis results in

truncal and gait ataxia, characterized by a wide based unsteady gate bc of lesions IN THE MEDIAL DESCENDING MOTOR SYSTEMS

what pancreatic enzyme activates enzymes in the duodenum

trypsinogen is released from pancreas to the duodenum and in duodenum, it is converted to trypsin by ENTEROPEPTIDASE so that trypsin can activate zymogens trypsinogen to trypsin via enterokinase so premature activation of trypsin destroys pancreas

a cause of hyperCa of malignancy is PTHrP (parathyroid hormone related protein) tumor types? mechanism? diagnostic?

tumor types -SCC -renal and bladder -breast and ovarian mechanism -PTH mimic diagnostic -low PTH -high PTHrP AKA HUMORAL HYPERCALCEMIA OF MALIGNANCY -->secretion of PTHrP (hyperCa with no bone lesions)

what is carcinoid heart disease caused by, how do you dx, and how do you treat?

tumors that cause excessive secretion of serotonin, which stimulates fibroblasts growth and fibrogenesis plaque like deposits of fibrous tissue on the right side endocardium, causes tricuspid regurg and right sided heart failure** dx with elevated 24 hour urinary 5-hydroxyindoleacetic acid treat with octreotide

which type of diabetes mellitus is associated with the HLA system (HLA DR3 and DR4) insulin is ____

type 1 anabolic so increases glycogen synthesis, protein synthesis, and lipogenesis (unopposed glucagon-->gluconeogenesis, glycogenolysis, lipolysis)

islet amyloid polypeptide (IAPP) deposits (islets are full of amyloid*****)

type 2 diabetes mellitus = YOU GET INSULIN RESISTANCE BC OF DECREASED NUMBERS OF INSULIN RECEPTORS!!*** (obesity leads to decreased...etc) strong genetic predisposition (more than type 1) vs type 1 = islet leukocytic infiltrate

what type of hypersensitivity is, "cell surface bound antibody bridging by antigen

type I ; you get cross linking***of the IgE when the antigen interacts with the IgE, which causes degranulation and release of chemical mediators, causing systemic vasodilation, increased vascular permeability, bronchoconstriction, and hemodynamic instability

islet leukocyte infiltration/autoimmune destruction of pancreatic beta cells the destruction occurs through cell mediated immunity

type I DM (DKA affects these pts)

what type of hypersensitivity is myasthenia gravis

type II IgG autoAb against nicotinic*** cholinergic receptors at NMJ

what type of hypersensitivty is "antibody dependent cell mediated cytotoxicity?

type II ; where IgM or IgG binds to antigens expressed on cel surface. these antibodies are recognized by Fc receptors on immune cells, triggering the release of perforn and granzymes that lead to cell lysis and death

which cells in the lung regenerate alveolar lining after an injury?

type II pneumocytes bc they are a precursor to type I pneumocytes which line the alveoli (squamous)

what type of hypersensitivity is "antibody-antigen complex deposition in the endothelium?

type III, ex. arthrus rxn, serum sickness

what type of hypersensitivity is "CD8+ lymphocyte mediated hypersensitivity

type IV

what syndrome predisposes to forming berry aneurysms?

type IV Ehler-Danlos Syndrome, which results in abnormalities of type III collagen

leukocytes with monocytic predominance leukocytes with neutrophilic predominance, typical of invading bacteria that cause dysentery or inflame diarrhea

typhoid fever caused by Salmonella typhi Shigella, Salmonella, C jejuni, EIEC

ligament most injured in throwers like baseball pitchers

ulnar collateral ligament due to intense valgus stress at the elbow

adduct the thumb

ulnar nerve

oxygenated blood flow from placenta

umbilical vein -->liver-->ductus venosus to bypass hepatic circulation--> IVC -->RA -->either RV -->pulmonary arteries-->ductus arteriosus-->descending aorta OR foramen ovale-->LA-->LV-->aorta

the most highly oxygenated blood in the fetus is carried by?? which drains into??

umbilical vein which empties into the IVC via ductus venosus

what does arginine make in the urea cycle

urea and ornithine tx arginine deficiency w low protein diet without arginine ; MILD TO NO HYPERAMMONIA, unlike other urea cycle disorders

what type of incontinence can you see with BPH

urge (bladder irritation from enlarged prostate) or overflow (urethral obstruction)

what does a midline epistomy cut through? what are these women at risk for if the laceration is severe? which muscle is cut during a mediolateral epistomy? which muscle forces blood into clit?

vertical incision from the posterior vaginal opening to the perineal body -risk for fecal incontinence due to external anal sphincter damage bc it inserts into perineal body -transverse perineal muscle -ischiocavernosus muscle

what do you see if there is lesions in inferior vermis and the flocculonodular lobe

vertigo and nystagmus vestibulocerebellum, which modulate balance and ocular movements via connections w the vestibular nuclei and MLF

is leukocyte alkaline phosphatase elevated or decreased in CML? what is the difference in benign neutrophilia?

very low bc of decreased activity in malignant neutrophils high in benign neutrophilia bc it is a luekemoid reaction and found in normal neutrophils

cortical scarring at upper and lower poles is characteristic of ____and is seen in ___

vesicouretral reflux; chronic pyelonephritis can cause secondary HTN

what nuclei have you damaged if there is nystagmus or vertigo?

vestibular nuclei

how does ASA irreversibly inhibit COX1 and 2

via acetylation

how is Cryptoccus neoformans transmitted

via soil contaminated by bird droppings like pigeons which is then inhaled into the alveoli of the lungs were it establishes an asx primary infection

how does parvovirus B19 attach to human erythroid cells

via the blood group P antigen

______produces the enterotoxin choleragen, which acts similarly to the heat labile toxin of ______. increases cAMP in intestinal mucosal cells, leading to increased secretion of Na, Cl and h2o

vibrio cholera (causes cholera) ETEC

viral vs bacterial meningitis in terms of -CSF cells -CSF glucose and protein

viral -lymphocytic predominance -glucose normal or slightly high -protein <150 bacteria -neutrophilic predominance -glucose <45 -protein >250

common cause of bacteremia s/p dental procedures

viridans streptococci bc they are normal inhabitants of the oral cavity

how does viridians streptococci eventually lead to endocarditis in pts with preexisting valve lesions

viridians produces dextran and then dextran allows viridians to adhere to FIBRIN and PLATELETS so if there is an affected valve, fibrin and platelets are deposited at sites of endothelial trauma and that allows for viridians to bind via dextran

alpha hemolysis (partial green hemolysis) optochin resistant bile Insoluble dental carries, SBE after dental work

viridians streptococci

gram + organisms capable of producing extracellular polysaccharides (dextran) using sucrose as a substrate

viridians streptococci

the presence of cord factor correlates with ____; mycobacteria that dont possess cord factor cannot___

virulence cannot cause disease the cord factor inactivates PMNs, damages mitochondria, induces TNF release

pie on th floor

visual info from upper retina-->parietal lobe-->cunneus gyrus

night blindness and thickened dry skin

vitamin A deficiency -need it for phototransduction and keratinocyte differentiation -you need bile acids to absorb fats. problems with the pancreas/gallbladder/intestine leads to malabsorption of fat soluble vitamins ADEK

cyanocobalamin

vitamin B12

what problems would you see w atrophic gastritis

vitamin B12 deficiency bad intrinsic factor production elevated methylmalonic acid levels hypoCl

which deficiency w wernicke

vitamin B1; thiamine

needed for hydroxylation of proline and lysine residues during collagen synthesis

vitamin C (ascorbic acid) -deficiency results in scurvy-->bone pain, easy bruising, poor wound healing. petechial hemorrhages, gingitivis, myalgias, subperiosteal hematoma*

what is a topical med used to treat psoariasis and MOA

vitamin D analogs (calcipotriene, calcitriol, tacalcitol they activate the vitamin D recepor, a nuclear transcription facotr that inhibts keratinocyte proliferation and stimulates keratinocyte differentiation

which vitamin would be affected with chronic renal failure

vitamin D bc you need to produce 1,25 dihydroxyvitamin D

increased deposition of unmineralized osteoid

vitamin D deficiency bc you need vitamin D to mineralize bone

what vitamin do you give babies? bc its not present in birth milk.

vitamin D to prevent Rickets vitamin K is also given after delivery via IM injection to prevent hemorrhagic disease

vitamin that functions as a scavenger of free radicals (antioxidant)

vitamin E

What type of deficiency? predisposes cell membranes, particularly neurons and erythrocytes to oxidative injury. associated with neuromuscular disease and hemolytic anemia** sx = loss of proprioception and vibratory sense; ataxia, hyporeflexia ID 1806

vitamin E deficiency

what needs to be given at birth in order to prevent intracranial, GI, cutaneous, umbilical, and surgical site bleeding?

vitamin K

what type of anesthetics are eliminated by the lungs

volatile inhaled like halothane

when do you see limb dysmetria (overshoot or undershoot during targeted movmvt)

w lesions affecting the cerebellar hemispheres due to involvement of the LATERAL DESCENDING MOTOR SYSTEMS like lateral corticospinal tract and rubrospinal tract

where are the watershed areas and whats the problem with them>

watershed area = splenic flexure and rectosigmoid junction (bc they lie between regions of perfusion of major arteries) more prone to ischemia during hypotensive states -->ischemic colitis splenic flexure = b/n SMA and IMA supply rectosigmoid = b/n sigmoid and superior rectal artery

subluxation of the radial head can injure the deep branch of the radial nerve during its passage through the supinator canal, leading to

weakness during finger and thumb extension "finger drop"

thiamine deficiency results in ?? which is characterized by encephalopathy, oculomotor dysfunction (horizontal nystagmus, bilateral abducens palsy), and postural and gait ataxia -ataxia, nystagmus, ophthalmoplegia, and anterograde amnesia

wernicke encephalopathy

single stranded RNA flavivirus transmitted by female mosquitos acute asymmetric flaccid paralysis with parkinsonian features

west nile virus

how can you cause wernicke encephalopathy in chronic alcoholics?

when you administer glucose also, with alcoholics, ethanol gets metabolized by alcohol dehydrogenase and aldehyde dehydrogenase, this consumes NAD+ so now you also don't have NAD+ for the citric acid cycle ethanol metabolized t acetyl CoA

what is a paradoxical embolism and what type of pts do you see it with

when you get a clot that starts off in venous system like DVT and and it crosses into arterial circulation and causes a stroke occurs in pt with patent foramen ovale, atrial septal defects, ventricular septal defect

thoracic outlet syndrome

when you get compression of the lower trunk of the brachial plexus as it passes through thoracic outlet most commonly occurs within scalene triangle, formed by anterior and middle scalene muscles and first rib sx: upper extremity numbness, tingling, weakness compression of subclavian vein = UE swelling compression of subclavian artery = extertional arm pain

what is a false/pseudoaneurysm?

whenever there is a hole in all 3 layers of the vessel and blood pools out. as a result, you get a hematoma that forms outside of the vascular wall which is surrounded by CT

how can you get gastric varices only in the fundus??

whenever there is a splenic vein thrombosis bc the short gastric veins drains the fundus of the stomach into the splenic vein

cardiac tamponade

whenever there is build up of fluid in the pericardium which puts pressure on the outside of the heart so the pressure obstructs blood flow decreased cardiac output therefore hypotension you get a decrease in systolic blood pressure >10 during inspiration!!**

how do you get black pigment stones

whenever there is excess bilirubin excreted, like with hemolytic anemia you get black stones when some of the excess conjugated bilirubin gets converted to unconjugated bilirubin by beta glucuronidase

what can occur in absence of neutrophil migration in relation with the umbilical cord?

whenever you get a leukocyte adhesion deficiency, you get a decrease in neutrophil cell surface adhesion proteins called beta -2 integrins. as as result, the PMNs are less adherent to the vascular endothelium and dont migrate towards the infected sites. -**The umbilical cord takes greater than 1 month to separate and the pt will have leukocytosis w neutrophilia** results from a defect in CD18 you need interns for leukocyte adhesions to endothelial surfaces and migration to peripheral tissue in resposen to infection/inflamm *impaired wound healing, recurrent skin and mucosal bacterial infections WITHOUT PURULENCE bc no luek in peripheral tissue you see persistent leukocytosis bc leukocytes can't migrate out of blood vessels

what disease can cause cystic degeneration of the putamen and globus pallid us (lentiform nucleus)

wilson's disease

how do you get a superficial candida infection if it is normally part of your normal flora?

with abx use, corticosteroid use, DM, HIV, and other immunpsuppressing illnesses -oral thrush, cutaneous candidiasis, vulvovaginitis

when do the lungs have the highest pulmonary vascular resistance

with decreased and increased lung volumes ID 1620 so functional residual capacity is where the resistance is the lowest

what is porcelain gallbladder associated with

with increased risk of adenocarcinoma of the gallbladder porcelain gallbladder -thickened calcified wall -bc of chronic cholecystitis

what type of hypersensitivity is "complement mediated cytotoxicity

with type II and III

monoclonal antibodies that block EGFR is only effective for tumors with...?

with wild type KRAS bc it will lead to reduced KRAS stimulation and decreased cell growth tumors with KRAS activating mutations are resistant to anti EGFR bc they have constitutive activation of a downstream signal that is independent of EGFR stimulation or blockade!!

femoral hernias are most common in ____and it is due to ___

women weakness in proximal femoral canal contents protrude through femoral ring inferior to inguinal ligament

who is at high risk of dvping myasthenia gravis

women in the post part period Ab against post synaptic Ach receptors; Ach stores become depleted s/o repetitive stimulation at neuromuscular junction

how does chronic renal allograft rejection present

worsening HTN, progressive rise in serum creatinine results in fibrous intimal thickening and scattered mononuclear infiltration of the surrounding tissues shrinking of renal parenchyma with tubular atrophy and interstitial fibrosis

what type of wrist movement does the ulnar nerve do

wrist flexion and wrist adduction ulnar claw deformity

a peroxisomal disease that is characterized by defective transport of very long chain fatty acids into peroxisomes

x linked adrenoleukodystrophy

do you see a high mitotic index indicated by a high Ki67 fraction in burkitt lymphoma

yes

can people with a Left MCA stroke get aphasia

yes expressive and receptive aphasia due to infarction of broca and wernicke area speech areas are located in dominant hemisphere, usually left

do TCAs have anti cholingeric properties

yes ; tachycardia, urinary retention, dry mouth Tri C's Convulsion Coma Cardiotoxicity

is having a breast cancer that has high estrogen or progesterone receptor activity good?

yes bc activation of these receptors are what the tumors need to grow so just give anti estrogen therapy

can vincristine have a neurotoxicity as a side effect

yes bc it inhibits microtubule formation, including in neuronal axons

do you get schizocytes in HUS

yes bc platelet consumption causes thrombocytopenia while the micro thrombi lead to erythrocytes damage (remember that endothelial damage causes increase platelet activation)

can scleroderma esophageal dysmotility lead to acid reflux?

yes bc you have esophageal smooth muscle atrophy so that decreases LES pressure and causes dysmotility which causes acid reflux and dysphagia

can administration of trimethoprim-sulfamethoxale cause GP6D deficiency

yes this is one way it can present

bc crohn's disease involves transmural inflammation, what is a problem with that

you can develop fistulas UC only imvoles the mucosa and submucosa inflamm

what happens if the processus vaginalis does not obliterate?

you get a connection between scrotum and peritoneal cavity (bc its open during dvmt so the testes can descend to scrotum) you get a HYDROCELE if the opening is small if opening is big, passage of abd contents

formation of fatty streaks in atherosclerosis

you get dvmt of intimal thickening and lipid accumulation 1. endothelial injury/irritant; LDL accumulation 2. monocyte adhesion. transformation of M into foam cells when it tries to devour LDL 3. foam cells release cytokine signaling 4. smooth muscle migrate out of smooth muscle layer into the plaque and they try to cover the plaque = fibrous plaque -smooth muscle also deposit Ca THERE ARE NO FIBROBLASTS IN A FATTY STREAK

what happens to CO2 and O2 levels with poor resp drive, upper airway obstruction, or resp muscle fatigue?

you get impaired alveolar ventilation so increased PCO2 and decreased O2 levels

how to treat congenital adrenal hyperplasia (21 hydroxylase deficiency) and why?

you give corticosteroids in order to suppress ACTH secretion increased ACTH secretion causes increased cortisol, but there is a defect in the enzyme so you end up making more testosterone bc cortisol production is blocked

how to treat thyrotoxicosis (severe hyperthyroid storm)

you have elevated HR, increased sensitivity to catecholamines so give BETA BLOCKERS which will decrease pt's HR and reduce peripheral conversion of T4-->T3 -propylthiouracil (also blocks thyroid peroxidase) -ipodate

3 things that contribute to thrombus dvmpt in A FIB

1. left atrial enlargement 2. stasis of blood due to ineffective atrial contraction 3. atrial inflammation and fibrosis which causes a procoagulant effect

3 problems that occur when the urachus is not obliterated correctly

1. stays patent = pt has straw colored urine coming out of the umbilicus 2. urachal sinus = when distal part of the urachus (closest to the umbilicus) doesnt close. as a result, get lots of recurrnet infections. pt has purulent discharge coming from umbilicus and periumbilical tendernss 3. urachal cyst = when central part of urachus doesnt close

6th pharyngeal/aortic arch (associated nerve and derivative)

CN 10, recurrent laryngeal branch of the vagus pharyngeal arch-->most muscles of the larynx aortic arch-->pulmonary arteries and ductus arteriosus

5th pharyngeal/aortic arch (associated nerve and derivative)

COMPLETELY OBLITERATED

What is the most common gene mutation found in pts with cystic fibrosis? (auto recessive disorder)

DELETION OF F508 (F=phenylalanine in the 508th aa) in the CFTR (cystic fibrosis transmembrane regulator) protein

Cornebacterium diptheriae. What does its toxin do and how does the pt present? what are complications?

DIPTHERIA TOXIN is an AB exotoxin which inhibits protein synthesis by ADP ribosylation of EF-2 (elongation factor); ribosylation is when a ribose residue is transferred from NAD to histidine on EF-2. diptheria prevents this from happening. as a result, EF-2 is inactivated, which is normally needed for peptide chain translocation on the ribosome during translation. toxin acts locally and causes resp cell necrosis with formation of fibrinous, coagulative exudates. IT COLONIZES THE RESP TRACT!! -endemic due to inadequate vaccination. sx: sore throat, fever, cervical adenopathy, pharyngeal exudates/COALESCING PSEUDOMEMBRANE complications: submucosal edema and pseudomembrane aspiration which can obstruct resp tract and cause SUFFOCATION -if toxin is absorbed systemically--->myocarditis/heart failure and neurotoxicity

DNA poly I vs DNA poly III

DNA poly III is the main poly for synthesizing DNA daughter strands while DNA poly I replaces RNA primers with DNA segments -BOTH have 3-->5' exonuclease activity to proofread and and fix mismatched nucleotides (so think of it like this-->they synthesis in 5 to 3 direction so the can go backwards to fix something that was mistmatched) ONLY DNA poly I has 5-->3' exonuclease activity to remove RNA primer and damaged segments (only this can go forward and degrade it in same direction it is synthesized)

which amino acid is best to help maximize acid excretion? how does this process work??

Glutamine renal ammoniagenesis; occurs in proximal tubule; glutamine absorbed and eventually makes NH4+ and bicarb (bicarb reabsorbed in blood). NH4+ secreted into tubular lumen to be excreted ID 11939

What type of toxin does Clostridium perfringens release? MOA of the toxin? what does it cause?

LECITHINASE (aka phospholipase C, C. perfringens alpha toxin) is the exotoxin released. -degrades membrane phospholipids such as lecithin which causes cell membrane destruction and death -causes gas gangrene -uses carbs for energy-->metabolize muscle tissue carbs which produces gas

neurocutaneous disorder with cutaneous facial angiomas and leptomeningeal angiomas. associated with mental retardation, seizures, hemiplegia, and skull radioopacitites = "tram track" calcifications

Sturge-weber syndrome = encephalotrigeminal angiomatosis

what is the vesicouretral reflux ?

Vesico=bladder; if there is an anatomic abnormality or increased pressure in the bladder, that can send up pathogens in the bladder up the ureter and into kidneys, causing pyelonephritis. -almost always necessary to have with acute pyelonephritis

What organ synthesizes alpha-1 antitrypsin and what does it do?

alpha-1 antitrypsin is synthesized by the liver and it blocks neutrophil secreted elastase; as a result, alveloar wall is not degraded. it is a protease inhibitor

what is the difference between collagen and elastin in terms of synthesis?

both collagen and elastin have proline and lysine residues. however with elastin, THESE AA ARE NOT HYDROXYLATED. elastin does not have a lot of hydroxyproline and hydroxylysine!!*** collagen has a lot of hydroxyproline and hydroxylsine but not a lot of proline and lysine bc they are hydroxylated.

4th pharyngeal/aortic arch (associated nerve and derivative)

cranial nerve 10-->superior laryngeal branches of vagus nerve aortic arch-->left forms aortic arch (arch of aorta) and right forms subclavian arteries pharyngeal arch forms muscles of pharynx, soft palate, and a few laryngeal muscles

gyrase vs helicase

helicase= unwinds DNA but results in supercoiling so gyrase is a topoisomerase that helps relief that supercoiling

mechanism of nephritic syndrome

immune complex lodges in capillary and ilicits inflamm response. antibody meets with antigen and complexes white cells recruited. areas become inflammed and breakdown and allow RBCs to poor through openings and WBCs!! some protein also leak too. -will see blood in urine, hematuria -oliguria bc the glomulerus is damaged so free filtration cannot occur easily -HTN bc lack of filtration -granular casts -there is salt retention so you get HTN and periorbital edema bc the edema dvps around the loose CT, particularly around eye

Mycophenolate

inhibits inosine monophopshate dehydrogenase which normally increases proliferation of lymphocytes -get a decrease in B and T cell proliferation

atherosclerosis is the formation of atheromas in which layer? it is formed in response to chronic and repetitive endothelial injury

intima

how does verapamil work?

it blocks L-type Calcium channels which slows phase 4 and 0 depolarization; reducing conduction velocity in SA and AV nodes; THIS IS IN A PACEMAKER ACTION POTENTIAL. it slows spontaneous depolarization which is phase 4 -it slows the sinus rate and conduction through the AV node

significance of Bortezomib in in multiple myeloma

it blocks the 26S proteasome. therefore, it prevents pro-apoptotic factors from being degraded therefore it promotes apoptosis of neoplastic cells

what is finasteride?

it is a drug prescribed to pts who have bladder outlet obstruction bc of an enlarged prostate. it prevents testosterone from being converted to dihydrotestosterone in the prostate so it helps that gland shrink - it is a 5 alpha reductase inhibitor

what is elastin made up of and how is it synthesized?

it is a fibrous CT protein that provides elasticity. synthesis is similar to collagen. 1. tropoelastin is formed (large polypeptide precursor made of NONPOLAR AA--glycine, alanine, valine) 2. tropoelastin secreted into extracellular space and combines with microfibrils (fibrillin) 3. lysyl oxidase (which requires copper) deaminates lysine residues on tropoelastin 4. desmosine cross links are formed between neighboring elastin (gives elastin rubber like properties)

effects of phenylephrine on urinary retention

it is an alpha 1 agonist so it will stimulate the trigone and sphincter to contract; this will not alleviate but enhance urinary retention -instead, give an alpha 1 blocking drug

Sx of obstructed right brachiocephalic vein

right sided face and arm swelling and engorgment of subcutaneous veins on same side of neck -chronic cough SIMILAR TO SX SEEN IN SVC SYNDROME BUT SVC SYNDROME IS ON BOTH SIDES OF BODY

what changes on an ECG do you see with Wolff-Parkinson White syndrome and why is that?

shortened PR interval, delta wave, and widened QRS complex. -they have an accessory pathway-->bundle of Kent which is going to pre-excite the ventricles question ID 90

What happens when the CFTR gene is mutated?

the mutation causes abnormal protein folding and prevents glycosylation (impaired post translational processing) from occuring so now the protein is targeted to be degraded by a proteasome so it doesnt reach the cell surface. Now there is almost NO CFTR protein located on the APICAL* surface of exocrine ductal epithelial cells.

Hirschsprung disease vs Meconium ileus -asosciated with what disorder -typical level of obstruction -meconium consistency -"squirt sign" (forceful expulsion of stool after rectal exam)

Hirschsprung -Down syndrome -rectosigmoid -normal -positive Meconium ileus -Cystic fibrosis*** -ileum -inspissated ("dehydrated) -negative most deaths due to cystic fibrosis is pna, bronchiectasis, and for pulmonate most deaths in pt with Hirschrubng is due to enterocolitis (diarrhea, abd pain, distention, fever0

which blot for DNA

Southern

what is a good blotting technique to detect DNA mutations and how does this blotting technique work?

Southern blotting 1. extract DNA 2. use endonuclease to digest DNA fragments 3. use gel electrophoresis. larger fragments move slower and smaller fragments move faster 4. use a DNA probe to identify the target gene. the probe is a single strand DNA segment that is complementary to the target gene

scrapes from rose bushes

Sporothrix schenckii that cause sporotrichosis localized to the site of the wound or associated lymphatic channels

when you have sloughing of the skin due to exotoxin exfoliative A and B toxin of Staph aureus which reuslts in lysis and separation of the stratum granulosom (a superficial layer)

Staphyloccocal Scalded Skin Snydrome different from toxic epidermal necrolysis (TEN) bc this separation occurs at dermal-epidermal junction

right sided endocarditis commonly occurs in IV drug users and is typically caused by?*** they are at risk for dvping septic pulmonary emboli as a complication

Staphylococcus aureus

catalase negative gamma hemolysis grows in bile but not 6.5% NaCl PYR negative bacteremia/infectious endocarditis associated with colonic cancer

Streptococcus gallolyticus (Formerly known as strep bovid)

rhabditiform (non infectious) larva in the stool

Strongyloides stercoralis -penetrate skin--Lungs-->coughed up and swallowed-->intestine and lay eggs-->hatch into rhabdztofrom larva and excreted in stool can cause hyper infection if the rhabditiform larvae turn into filariform larva and re-infect the host by penetrating intestinal wall

what nerve exits the brainstem at the lateral aspect of the mid pons at the level of the middle cerebellar peduncles

trigem nerve

first pharyngeal/aortic arch (associated nerve and derivative)

trigem nerve (CN 5) -first aortic arch regresses almost completely. gives rise to a portion of maxillary artery

failure of neural crest cell migration in the gut causes a-ganglionic sigmoid colon/rectum. the affected bowels can't relax. can't pass meconium. presents with HUGE megacolon

Hirschsprung disease

a dimorphic fungi that is found as mold in the soil and is present in bird and bat droppings;

Histoplasma capsulatum

buzz words: patients reporting a hx of exploring caves (aka exposure to bats) or cleaning bird cages

Histoplasma capsulatum

small oval yeast forms within macrophages; smaller than surrounding RBCs

Histoplasma capsulatum

atrophy in caudate nucleus (and putamen)

Huntington disease

to treat depression or generalized anxiety disorder

SSRI or SNRI (first line tx)

what are side effects seen from using nitrates to treat chronic stable angina

HEADACHES, cutaneous FLUSHING, and hypotension, and lightheadedness -nitrates cause vasodilation, w decrease LV end diastolic volume and wall stress so it decreases myocardial oxygen demand and relief of angina sx so don't give it to pts with hypertrophic cardiomyopathy (due to increased outflow tract obstruction)and its with RV infarction (due to reduction in preload which impairs CO)

overexpression of what is associated with poorly differentiated and rapidly growing breast tumors

HER2

mutation in primary hemachromatosis

HFE protein that interacts with transferrin receptor to help sense changes in iron

which enzyme activates azathioprine, 6-MP to their active metabolites so that they can inhibit purine synthesis

HGPRT in the purine salvage pathway 6-MP added to PRPP so 6-MP gets incorporated and yo get decreased purine synthesis

diffuse large B cell lymphoma typically occurs patients with

HIV

compare HLA A,B,C,D with MHC I and II

HLA A, B, C -MHC I so cytotoxic T cells = CD8 T Cells -seronegative spondlyoparhtopathies aer HLA B27 -expressed by all nucleated cells and present endogenous antigens to CD* cytotoxic T cells HLA D -MHC II so TH2 pathway--B cells--Antibody disease -expressed by antigen presenting cells like M and dendritic cells, and present foreign antigens to CD4 helper T cells -**Rheumatoid arthritis, type I DM, and celiac disease

alpha 1 blockers such as doxazosin, prazosin, and terazosin are useful to treat both what?

HTN and benign prostatic hyperplasia block alpha 1 so they relax smooth muscle in arterial and venous wall (decreased peripheral vascular resistance) and relaxing smooth muscle in bladder neck and prostate so it decreases urinary obstruction side effects include orthostatic hypotension and vertigo

signs of primary hyperaldosteronism = Conn's syndrome

HTN, hypokalemia, metabolic alkalosis, and decreased plasma renin activity bc reabsorb Na and water and waste K and H

what are lab findings and sputum gram stain with legionella pna

HYPONATREMIA and sputum gram stain shows many Neutrophils but few or no organisms

why does Hep D need Hep B to infect?

Hep D is replication defective so it needs hepatitis B to to coat it with an external coat of hep B surface antigen so it can penetrate the hepatocyte (superinfection is worse than coinfection)

mild non progressive hyperglycemia that often worsens with preggo induced insulin resistance

MODY mutation in glucokinase gene normally 1. glucose enters beta cell via GLUT2 and converted to glucose 6 P by glucokinase 2. glucose 6 P metabolized by glycolysis and Krebs cycle to make ATP 3. ATP closes ATP sensitive K channels 4. depolarization causes Ca channels to open and influx which then causes insulin release mutations in glucokinase decreases beta cell metabolism of glucose, less ATP formation and therefore less insulin released

mutations in Lynch syndrome = hereditary nonpolyposis colon cancer

MSH2 and MLH1 genes (code for MutS and MutL homologues) caused by a DNA mismatch repair HIGH INCIDENCE OF COLON ADENOCARCINOMAS -also associated with endometrial, ovarian, and colorectal cancers family hx with high incidence of colon cancer

pneumonic for anion gap metabolic acidosis

MUDPILES Methanol Uremia DKA Propylene glycol/paraldehyde Isoniazid/Iron Lactic Acidosis Ethylene glycol (antifreeze) Salicylates (ASA) lactic acidosis-->overproduction of lactic acid so organs are hypo perfused, tissue oxygenation is impaired and oxidative phosphorylation is decreased which leads to buildup of NADH and shutting of pyruvate to lactate lactic acidosis results from tissue hypoxia, which impairs oxidative P and causes shunting of pyruvate to lactate

poor exercise tolerance, muscle cramps, and rhabdomyolysis due to a deficiency in muscle phosphorylase hallmark is a flat venous lactate curve with normal rise in ammonia levels during exercise

McArdle disease (type V glycogen storage disease) can't break down glycogen in muscle

fibrous dysplasia of the bone (multiple osteolytic appearing lesions in hips and pelvis) + endocrine abnormalities (precocious puberty) + cafe au lait spots fibrous dysplasia bc of increase porlfieraiton of fibroblast like cells, increase IL-6, and osteoclast activation

McCune Albright snydrome

broad ribbonlike hyphae with rare septations

Rhizopus

gastroenteritis associated with consumption of certain precooked foods, dairy products, custard, and mayo. more vomiting and abd cramps than diarrhea

S aureus

what happens with secretin whenever there is release of gastric acid into the duodenum? what is responsible for secretions of enzymes from pancreatic acinar cells? what is produced in the pancreas and stimulates intestinal water secretion, counteracts gastrin in the stomach, and promotes bicarb secretion for the pancreas?

S cells in the small intestine stimulate the pancreatic ductal cells to release Bicarb rich and Cl poor fluid CCK (also responsible for gallbladder contraction. VIP (vasoactive intestinal peptide)

saddle anesthesia and loss of the anocutanous reflex are due to damage of which nerve roots?

S2-4

S3 vs S4 sound

S3 is bc of rapid passive filling of ventricles in diastole. OCCURS AFTER S2 -normal under 40yo -mitral regurg, systolic failure** -heard after S2 S4 is sound of atrial contraction as blood is forced into a stiff ventricle -normal in older people -diastolic dysfunction like LVH -heard before S1

Pneumonic to remember retroperitoneal organs

SAD PUCKER Suprarenal (adrenal glands) Aorta and inferior vena cava Duodenum (except first part) Pancreas (head and body) Ureter and bladder Colon (ascending and descending) Kidneys Esophagus Rectum

intercellular bridges (connections b/n squamous epithelial cells) and keratin pearls

SCC

candidiasis, persistent diarrhea, failure to thrive with low or absent CD3+ T cells and hypogammaglobulinemia and thymic hypoplasia (bc of severe T cell deficiency) -absent T cells and hypogammaglobulinemia

SCID

what type of antibody is generated with live attenuated vaccine

SECRETORY IgA major antibody associated with mucosal immunity prevents bacterial and viral attachment to mucus membranes

what does mesoneprhic duct forms?

SEED seminal vesicles epididymis ejaculatory duct ductus deferens in females, remand is Gartner duct

Carbemazapine can cause?

SIADH

an example of a euvolemic hyponatremia? what can cause this?

SIADH paraneoplastic effect secondary to small cell carcinoma of the lung lots of ADH-->volume expansion-->decrease in aldosterone and increase in natriuretic peptides->more sodium loss + normalization of extracellular fluid volume

-what medication inhibits lymphocyte proliferation by blocking interluekin-2 signal transduction ??

SIROLIMUS -binds and forms a complex with FKBP which then blocks mTOR, which normally promotes cell growth and proliferation

glomerulonephritis, a photosensitive rash, and arthralgia indicates

SLE

SMV blockage could result in lower stomach varices but not upper, why?

SMV drains duodenum, pancreas, lower stomach

trypsin inhibitor that is secreted by pancreatic acinar cells

SPINK1 = serine peptidase inhibitor Kazal type 1 trypsin can also serve as its own inhibitor by cleaning active trypsin molecules

Fluoxetine, fluvoxamine, paroxetine, sertraline, escitalopram, citalopram

SSRI "FLUffy Flew SEmiconsciously and excitingly to a parvous city" -"PRAM" -"TINES" + sertraLINE and fluvoxamine

what does an arteriovenous fistula do to the LV pressure and LV volume? also how does it affect cardiac output and total peripheral resistance?

an AV fistula causes blood to go from arterial system to venous system. increased blood in venous system leads to increased blood flow back to the heart (increased venous return so increased LV volume) and therefore an increased cardiac output bc the preload is increasing. bc the blood is getting shunted to venous system, you get a decrease in total peripheral resistance therefore a decrease in LV pressure (decrease in afterload) CO = HR * SV MAP (mean arterial pressure) = CO * total peripheral resistance .... so CO = MAP/TPR you want to decrease TPR to increase CO if you increase TPR, then you decrease CO bc increased TPR causes blood to be retained on the arterial side of the circulation and it increases aortic pressure against which the heart must pump. so decreased CO therefore decreased venous return. if you decrease TPR, that lets blood flow move to the venous side so aortic pressure decreases so you get an increase in CO and increase in venous return.

what is theophylline and what is it used for?

an adenosine receptor antagonist and an indirect adrenergic agent with a narrow therapeutic index. used for alternative therapy for asthma and COPD bc it causes bronchodilation by increasing cAMP levels (similar to beta adrenergic agonists)

Nyastatin MOA? MOA is similar to what other medication? why is that medication not used to treat oral thrush?

an antifungal binds to ergosterol in the fungal cell membrane which creates pores that allows fungal cell contents to leak; -amphotericin B; administered IV; has too many TOXIC side effects to be used for simple mucotaneous infections

atrial septal defects can facilitate a paradoxical embolism when there is

an increase in right sided pressure such as straining during coughing or defecation

an elevated creatine kinase is suggestive of _____ common causes of elevated CK?

an underlying myopathy (bc of direct myocyte damage and leakage of muscle enzymes into circulation) -hypothyroid, inflam myopathies (polymyositis, dermatomyositis), statin induced

anaphylaxis and venous return

anaphylaxis causes widespread arterial and venous vasodilator along with increased capillary permeability so this will result in a DROP IN VENOUS RETURN cardiac contractility also increases in attempt to maintain BP

what is an effective treatment for postmenopausal women with breast cancer?

anastrozole bc it is an aromatase inhibitor that blocks estrogen production it decreases peripheral androgen aromatization in liver, muscle and fat (androstenedione-->estrone)

genetically male but have a female phenotype bc of resistance to testosterone. in adolescence, breast dvmt results from peripheral conversion of testosterone to estrogen, but axillary and pubic hair is absent*** primary amenorrhea bc no Mullerian structures

androgen insensitivity syndrome 46XY androgen receptor defect so free testosterone -->estrogen so you get boobs no penis or scrotum no uterus or ovaries

-low back pain that improves w exercise -limited chest expansion and spinal mobility bc of enthesitis (hypoventilation) -enthesitis: inflam at site of insertion of tendon into bone -acute anterior uveitis -stiffness and fusion of axial joints, mainly SI joint

ankylosing spondylitis -also get aortic insufficiency*

if CBT and nutritional rehabilitation doesn't work, what do you give to tx anorexia vs bulimia?

anorexia = olanzapine bulimia = SSRI, fluoxetine -increased salivary amylase -electrolyte abnormalities

1. pain along medial knee and well defined tenderness 4cm distal to the anteromedial joint margin of the knee. from obesity or overuse in athletes

anserine bursitis

function of anterior and poster hypothalamic nuclei

anterior = mediates heat dissipation so destruction leads to hyperthermia posterior = mediates heat conversation; destruction leads to hypothermia

korsakoff is associated with damage to?

anterior and dorsomedial thalamic nuclei

what type of infarction contralateral hemiplegia with lower limb more affected if bilateral occlusion, can cause significant behavioral problems, primitive reflexes, and urinary incontence

anterior cerebral artery

injury most common with externally rotated and abducted arm (like w throwing something)

anterior humerus dislocation often associated with axillary nerve injury, deltoid paralysis and loss of sensation of lateral shoulder bc axillary nerve innervates deltoid and teres minor

list 3 Ab found in SLE

anti Smith** (against snRPS) anti-dsDNA anti phospholipid

the PI3K/Akt/mTOR pathway is an intracellular signaling pathway important for

anti apoptosis cellular proliferation angiogenesis

atropine and scopolamine are ?

anti cholinergic (Ach muscarinic antagonists)

lamotrigine is an ___that blocks ______ side effects?

anti convulsant for partial and generalized sz that blocks Na channels Steven Johnson Syndrome or toxic epidermal necrolysis (TEN) cutaneous and mucosal lesions; histoogiclaly, lesions are characterized by epidermal necrosis and sub epidermal bulae

lupus ab

anti double stranded DNA and anti Smith (Ab directed against nuclear components) get formation of immune complexes that deposit and cause complement activation so active SLE HAS REDUCED COMPLEMENT LEVELS

cystinuria

auto recessive defective transportation of COLA so can't renally or intestinally absorb Cystine Ornithine Arginine Lysine *recurrent kidney stones; UA shows HEXAGONAL cystine crystals the other aa are soluble in urine so don't form kidney stones don't get aa deficiency bc they are absorbed as oligopeptides risk factors = presence of crystal nidus, urine pH <7, and urine supersaturation another screening test = sodium cyanide nitroprusside test which detects urinary cystine

PKHD1 gene mutation codes for fibrocystin (in epithelial cells of kidney and liver) auto recessive Rean insufficiency, nephromegaly, HTN Potter sequence dx: BILATERALLY ENLARGED ECHOGENIC KIDNEYS ON US

auto recessive polycystic kidney disease the oligohydramnios leads to potter sequence

anti smooth muscle Ab are seen in 2. anticardiolipin Ab are seen in

autoimmune hepatitis 2. antipospholipid Ab syndrome (w recurrent venous thrombosis or preggo loss)

what are 2 medications that can be used in multiple sclerosis to help decrease spasticity?

baclofen ( a GABA-B receptor) tizanidine ( alpha 2 adrenergic agonist)

thin, off white discharge with fishy odor no inflam lab findings? treatment

bacterial vaginosis (Gardnerella vaginalis-->anaerobic gram variable rods) Ph>4.5 ; clue cells ; positive whiff test (amine odor with KOH) metronidazole or clindamycin (no need to treat partner)

what type of studies do you want to avoid in pts with ulcerative colitis

barium contrast studies and colonoscopy bc of risk of perforation so plain abd x ray is preferred to show colonic dilation

taste from base of tongue vs taste from anterior 2/3 of tongue

base of tongue = CN IX facial nerve

low grade vs high grade CIN (cervical intraepithelial dysplasia)

based on epithelial involvement -atypical squamous cells CIN 1 low grade- involves <1/3 of epithelium CIN 2 -<2/3 of epithelium CIN3 2 and 3 = high grade

what type of infarction damages base of pons, which contains corticospinal and corticobulbar tracts, and maramedian tegmenjtum. so quadriplegia, facial weakness and dysarthria bc of bulbar dysfuctnion, and oculomotor deficits, horizontal gaze palsy

basilar artery occlusion

what is effective in the initial treatment of paroxysmal supraventricular tachycardia and what are the side effects

bc PSVT deals with automaticity in atria or AV node, adenosine blocks conduction through AV node by hyperpolarizing pacemaker cells which terminates reentry circuit flushing, hypotension, high grade AV block, bronchospasm ID898

why is it not good to use albuterol to reduce airway inflammation?

bc albuterol is a SHORT ACTING beta 2 adrenergic agonist so it will help with bronchodilation which is good to treat acute asthmatic episodes but it doesn't do anything with inflam (unlike glucocorticoids)

why is fructose metabolized really fast?

bc it bypasses PFK (Rate limiting enzyme in glycolysis) fructose --> fructose 1-phosphate

why does propofol have a rapid termination of drug action

bc it preferentially distributes to organs receiving high blood flow like the brain and then it is redistributed to rogans receiving less blood flow like fat and muscle tissue

why do you see basophilic stippling in lead poisoning

bc lead poisoning inhibits ferocheletase, ALA dehydratase and inhibits rRNA degradation so RBCs retain aggregation of rRNA

why are people with low body weights have secondary amenorrhea

bc low levels of leptin inhibits pulsatile GnRH, so decreased LH and FSH so decreased estrogen

LV pressure, volume in systolic dysfucntion

bc of decrease in contractility, you are going to get progressive chamber dilation with increased LV volume and pressure

why do kids under 12 months have babinski sign

bc of incomplete myelination of the corticospinal tracts

how can you tell it is T cell ALL

bc there is a mediastinal mass which can cause respiratory sx, dysphagia, or superior vena cava syndrome!! mass compresses esophagus which causes dysphagia, while compression f the trachea may lead to dyspnea and stridor

if you have already received the inactivated influenza vaccine and have been exposed to the live virus via natural infection, what happens?

bc you already had the vaccine, the antibodies prevent hemagglutinin from binding to sialylated receptors on the host cell membrane. the LIVE VIRUS NOW CANNOT ENTER THE CELL VIA ENDOCYTOSIS

where does an abd aortic aneurysm occur

below the renal arteries; chronic transmural inflammation ****

what are nevus (moles)

benign neoplasm of melanocytes; with hair; begins at dermal epidermal junction (junctional nevus) adn then extends into dermis. the junctional component gets lost resulting in an intradermal nevus

what are cutaneous neurofibromas in NF1 comprised of and what is their origin?

benign nerve sheath neoplasms comprised of Schwann cells, which are neural crest derived

how to treat extrapyramidal sx of acute dystonia and akathisia from first generation anti psychotics

benztropine, diphenhydramine

saccular aneurysms aka

berry aneurysms associated with ADPKD and Ehler Danlos syndrome

esmolol

beta 1 antagonist so it will decrease cardiac contractility

dobutamine acts on what receptors so it causes what

beta 1 receptor-->increases cAMP mainly increases cardiac contractility and a bit of heart rate-->increased CO and decreased LV filling pressures so its gonna increase myocardial O2 consumption

what is the best test to do to exclude the diagnosis of asthma? bc there are very few test to confirm/rule in diagnosis of asthma so you want to do what test to exclude asthma? this test is very sensitive but non specific measure

bronchial challenge testing bc it tests bronchial hyperreacitivity -give inhaled bronchoconstrictor and see if this produces 20% decline in FEV1 METHACHOLINE is commonly used bc it is a cholinergic muscarinic agonist which induces bronchial smooth muscle contraction and increases bronchial mucus production -so a negative test can help rule out asthma diagnosis

stones that are composed of calcium salts of unconjugated bilirubin that arise secondary to bacterial or helmith infections of the biliary tract. what does it result in?

brown pigment stones results in release of beta glucoronidase by injured hepatocytes and bacteria -it hydrolyzes bilirubin glucuronides and increase the amount of unconjugated bilirubin

autoantibodies to hemidesmosomes which link cells to BM via integrins

bulls pemphigoid and pemphigoid gestationis ORAL MUCOSA SPARED W BULLOUS PEMPHIGOID

healthcare organization receives a set amount per service, regardless of ultimate cost, to be divided among all providers and facilities involved

bundled payment

used for maintenance therapy for opioid withdrawal and detox

buprenorphine + naloxone buprenoprhine = partial agonist naloxone = antagonist

how is Coccidioides immitis transmitted and where do you find it

by spore inhalation and found in southwestern USA spores are formed by fragmentation of hyphae. once inside the lungs, the spores turn into spherules that contain endospores

what metabolizes simvastatin, lovastatin, atorvastatin? (except for pravastatin) what inhibits it?

by the liver cytochrome P-450 3A4 erythromycin and azithromycin inhibit P 450 3A4 combining statin and erythro can cause myopathy and rhabdomyolysis bc of increased level of statins

side effect of isonazid abx?

can cause peripheral neuropathy bc it is similar to pyridoxidine (vitamin B6) it causes an increased urinary excretion of vitamin B6 and it also

what happens when you accidentally puncture above the inguinal ligament during catheterization?

can cause retroperitoneal hemorrhage external iliac artery-->femoral artery once you pass inguinal ligament the external iliac artery is right below the peritoneum so puncture can result in retroperitoneal hemorrhage -->results in hypotension, bleeding can't be controlled with external compression

what is the problem with anti cardiolipin Ab

can give a false RPR and VDRL test which is for syphlis

what happens if pelvic inflam disease is not treated adequately?

can result in fallopian tube scarring-->leads to infertility can also cause ectopic pregnancy bc of untreated infection and tubal scarring

treatment for maple syrup urine disease

can't breakdown branched chain aa (leucine, isoleucine, and valine) lifelong restriction of those enzymes high dose thiamine bc thiamine is a coenzyme other cofactors = "Tender Loving Care for Nancy" Thiamine Lipase Coenzyme A FAD NAD

what happens with pyruvate dehydrogenase deficiency? how to treat?

can't convert pyruvate to acetyl CoA so pyruvate gets shunted to be converted to lactic acid ketogenic amino acids such as lysine and leucine bc they can provide energy in the form of acetyl CoA and ketogenic diet (high fat and low carb)l

pseudohyphae with leukocytes

candida vaginitis

an arrangment in which a payer pays a fixed predetermined fee to cover all the medical services required by a patient physicians receive a set amount per patient assigned to them per period of time, regardless of how much the patient uses the healthcare system, used by some HMOs restricts patient to a limited panel of providers WITHIN THE PLAN requiring referrals from a PCP prior to specialist consultations

capitation ID8456

acetazolamide can be used to relieve intracoular pressure in open angle and angle closure glaucoma (bc it decreases HCO3 and aquous humor formation)

carbonic anhydrase inhibitor -causes bicarb wasting (prevents bicarb absorption) so increases urine pH -systemic metabolic acidosis can worsen hypercalcuria by causing a compensatory release of CaPhosphate from the bone

endocardial thickening and fibrosis of the tricuspid and pulmonary valves is characteristic of? -flushing, watery diarrhea, and bronchospasm

carcinoid disease

wheezing, diarrhea, facial flushing, associated with tumor and mets and sometimes right sided valvular heart disease what do you use to treat and why?

carcinoid syndrome -the tumors secrete a lot of biologically active substances including serotonin use octreotide to treat bcc its an analogue of somatostatin which inhibits secretion of many hormones

well differentiated neuroendocrine cells-->chromogranin positive!!*** not significantly related to smoking central or peripheral; classically forms a polyp-like mass in the bronchus****

carcinoid tumor

you give EPI to treat what? (3)

cardiac arrest, severe asthma, anaphylaxis

function of the posterior limb of the internal capsule

carries corticospinal motor and somatic sensory fibers and visual and auditory fibers posterior limb separates the thalamus from the globus pallidus and putamen

primary Tb

caseating necrosis in LOWER LOBE of lung and hilar lymph nodes adenopathy which have fibrosis and calcification!! this is Ghon complex

what type of organisms are responsible for the recurrent infections in chronic granulomatous disease?

catalase + organisms bc they are able to destroy the hydrogen peroxide that their metabolic activity produces catalase - can't do that

what forms the striatum? what happens in Huntington disease?

caudate nucleus and putamen in huntignton disease, there is loss of cholinergic and GABA releasing neurons in the striatum

acoustic schwannomas are located at the ___and arise from cranial nerve 8. what other nerves can get compressed? what is the cell origin and histo stain

cerebellopontine angle can compress CN7 and result in facial muscle paralysis, loss of taste in anterior 2/3 tongue, decreased lacrimation, salvation, and hyperacusis (paralysis of stapedius) and can compress CN5 so loss of facial sensation (loss of the afferent limb of the cornea reflex) and paralysis of muscle of mastication Schwann cell origin; S100 +

what is the most common cause of spontaneous lobar/cortical hemorrhage ex. occipital, parietal, in the elderly

cerebral amyloid angiopathy

which area shows the most atrophy in Alzheimrs

cerebral cortex, especially the hippocampus!!

rheumatoid arthritis can affect ____spine. what can this cause? what is a problem with it?

cervical spine; causes joint destruction w vertebral subluxation the atlantoaxial joint is most commonly involved bc the atlas C1 has high degree of mobility compared to C2 ET intubation can worsen the subluxation and compress the spinal cord and vertebral arteries BC OF EXTENSION flaccid paralysis w decreased or absent reflexes -->spastic paralysis

what does this mean if you do a test and the neutrophils fail to turn blue following exposure to nitroblue tetrazolium?

characteristic of chronic granulomatous disease

how to treat wilsons disease

chelators like D-penicillamine, trientine or Zinc bc it interferes w copper aborption

ectopia of cerebellar tonsils associated with syringomyelia

chiari I malformation

herniation of low lying cerebellar vermis and tonsils through the foramen magnum with aqueduct stenosis -->hydrocephalus

chiari II malformation

AV malformations are the most common cause of intracranl hemorrhage in

children

separation anxiety disorder (sx must be present for how long in children vs adults?

children >_ 4 weeks in children adults >_ 6 months (greater than or equal to)

what are common causes of atypical community acquired pna and are not visible on gram stain and do not grow in conventional culture

chlamydia and mycoplasma pna

complications of varicose veins -->when you have increased intraluminal pressure or loss of vessel wall strength which causes venous dilation and failure of valves

chronic edema, stasis dermatitis, skin ulcerations, poor wound healing, infection no risk of PE bc this is in superificial instead of deep venous system

neutrophil function is impaired in ?

chronic granulomatous disease

patchy interstitial inflammation with subsequent fibrosis, tubular atrophy, papillary necrosis and scarring

chronic interstitial nephritis prolonged NSAID use cause this and ischemic papillary necrosis (bc NSAIDs decrease prostaglandin synthesis, causing constriction of medullary vasa recta)

what do you think of when you see fat malabsorption?

chronic pancreatitis bc not good enough secretion of digestive enzymes like lipase pancreatic head in close associated with second part of duodenum on CT

treats GERD and peptic ulcer disease by blocking parietal cell H2 receptors. therefore, it reduces gastric acid secretion in response to histamine or gastrin, but not from bagel stimulation

cimetidine also inhibits testosterone receptor

which 2 drugs inhibit the metabolism of warfarin, which can result in an increased PT/INR and bleeding risk which 2 abx?

cimetidine and amiodarone***** -pt with A Fib might be given both amiodarone and warfarin metronidazole and trimethoprim-sulfamethoxazole (end in "azalea" and these are P450 inhibitors)

diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous lined regenerative parencyhmal nodules

cirrhosis caused by Hep B and C, alcohol, hemochromatosis, portal HTN

quinidine procainamide disopyramide

class IA

lidocaine mexiletine

class IB antiarrhthymics Na channel blockers the weakest binding -dissociation from the channels occurs so rapidly that there is minimal cumulative effect over multiple cardiac cycles -usedto treat ischemic induced ventricular arryhtmias

which type of antiarrythmics do you give to inhibit ischemia induced ventricular arrhythmias and why? ID 900

class IB dugs like lidocaine they bind to Na channels in the inactivated state and rapidly dissociate ischemic myocardium has less negative resting membrane potential, which delays voltage dependent recovery of Na channels from the inactivated to the resting state. THIS ALLOWS CLASS IB DRUGS TO HAVE INCREASED BINDING

flecainide propafenone

class IC slowest to dissociate from channel so they have greater blockage at higher HR (high use dependence )

prolonged QT interval is seen with what meds and predisposes to what? QT represents ventricular depolarization and repolarization

class III antiarrhytmics sotalol has more of an effect than amioderone -dofetilide torsades de pointes

amioderone sotalol dofetilide

class III antiarryhtmics block K channels and prolong K phase 3 so it prolongs depolarization therefore total action potential duration sotalol used to treat A FIB, IT PROLONGS QT INTERVAL BC IT PROLONGS ACTION POTENTIAL DURATION

hydrocephalus, intracranial calcifications, and chorioretinitis (inflame of choroid and retina the can leave white/yellow cars on retina)

classic triad of congenital toxoplasmosis expected mothers need to avoid cat feces bc it can cause an in utero infection transmitted transplacentally

acute dystonic reaction is an example of side effect of what? like spasmodic torticollis, oculogyric crisis {a forced sustained elevation of the eyes in an upward position}, opisthotonus {arching of the back and head thrown backward}

first generation anti psychotic which block dopamine receptors D2 so increases cAMP in the nigrostriatal pathway! normally, the dopamine inhibitory effects are balanced with excitatory actions of muscarinic cholinergic neurons M1. when you inhibit dopamine, you get excess of cholinergic activity which gives you the extrapyramidal sx treat this side effect with M1 receptor antagonists like benztropine or diphenhydramine (anti histamine)

what are the medications of choice to treat the behavioral and psychotic manifestations of delirium

first generation anti psychotics (haloperidol)

what is edentate calcium disodium used for

first line treatment for lead poisoning, it increases urinary excretion of lead

Candida vaginitis is treated with ____, a fungistatic drug that inhibits ergosterol synthesis in the P450 system of fungi

fluconazole

main side effects of thiazolidinediones

fluid retention bc increase Na reabsorption, which can lead to water weight gain, peripheral edema, and decompensation of underlying CHF also causes adipose weight gain, bc of increased fat storage in adipocytes

1. to reverse benzodiazapene toxicity 2. what to give in the setting of acute opioid intoxication or overdose 3. to reverse warfarin

flumazenil (GABA receptor antagonist) 2. naltrexone (don't give to a pt w opioid withdrawal bc it will make is worse and cause sz) 3. vitamin K

3 features of carcinoid syndrome

flushing, watery diarrhea, bronchospasm

what type of deficiency is most common in alcoholism

folate acid deficiency!!!***** B12 deficiency is very possible too, however bc of the body's large B12 stores, this depletion would take place over a period of many years and not months. also the patient would have neuron sx like subacute combined degeneration with paresthesias, ataxia, and loss of proprioception

what type of deficiency can cause megaloblastic anemia

folic or B12 deficiency which impairs DNA synthesis

fluctuating lymphadenopathy waxing and waning clinical course presents with painless lymph node enlargement histo has cleaved and uncleared follicle center cells in a nodular pattern

follicular lymphoma

myxomatous degeneration (weakening of CT) with pooling of proteoglycans in media layer of large arteries is found in what and predisposes to what?

found in cystic medial degeneration and prediposes to dvmpt of aortic dissections and aortic aneurysms

what is medial degeneration characterized by?

fragmentation of elastic tissue (basket weave pattern). and the elastic and fibromuscular components of the tunica media gets separated and filled with amorphous ECM ID 462

what rapidly reverses warfarin's effects

fresh frozen plasma vitamin K requires time for clotting factor re-synthesis

speed of cardiac action potential conduction

from fastest to slowest -purkinje -atrial muscle -ventricular muscle -AV node "Park AT VENTure Avenue" speed of conduction slowest at AV node bc it allows ventricles to completely fill with blood during diastole

ulceration of a wound typically results

from inadequate vascularization during healing

how can you get arsenic poisoning? what do you use to treat? sx?

from ingesting pesticides/insecticides, contaminated water, pressure treated wood, glass making treat with DIMERCAPROL watery diarrhea, GARLIC odor on breath, QT prolongation arsenic impairs cellular respiration by inhibiting pyruvate dehydrogenase

where does the AV nodal artery arise from

from the dominant coronary artery

where do renal cell carcinomas originiate

from the epithelial cells of the proximal renal tubules clear cell carcinoma is the most common type; often golden yellow on macroscopic examination bc of high glycogen and lipid content

external hemorrhoids innervation

from the inferior rectal nerve, a branch of the pudendal nerve

ciliated mucosal epithelium extends..??

from trachea to RESPIRATORY bronchioles airway epithelium changes from psuedostratified ciliated columnar to ciliated simple cuboidal by the level of the terminal bronchioles

where are goblet cells found?

from trachea to larger bronchioles. NOT found in terminal bronchioles!!!

what can cause cataracts in galactosemia? which enzyme is responsible for the accumulation of it?

galactitol bc it is like sorbitol so it builds up in the lens of the eye galactokinase bc now can't convert galactose-->galactose 1-P so galactose gets covered to galactitol

how can you tell the difference between malignant cells in a lymph node or cells from reactive hyperplasia (in response to an antigenic stimulus)

malignant cells are going to be monoclonal, and it results from the unchecked proliferation of a single genetically unique cell from only one cell line for reactive hyperplasia, you get proliferation of MANY different cell types in the lymph node. each type of lymphocyte is responding to a different antigenic stimulus

what to think when there is muscle rigidity s/p surgical procedure

malignant hyperthermia (usually due to succinycholine or halothane)

which part of the brain most commonly undergoes necrosis n the setting of thiamine deficiency

mamillary body which is part of the Papez circuit ( na neural pathway of the limbic system involved in cortical control of emotions and memory)

general sensation from the anterior 2/3 of the tongue like touch, pain, pressure and temperature sensation

mandibular division of the trigem nerve

muscles of mastication, tensor tympani, innervation?

mandibular nerve of the trigem nerve (maxillary divison is mainly sensory)

osmotic diuretic to lower intracranial pressure to treat acute glaucoma; also used to manage cerebral edema and increased intracranial pressure

mannitol water moves from intersitital space into vascular space or tubular lumen (by increasing plasma or tubular fluid osmolality) BAD SIDE EFFECT = PULM EDEMA

what is the main principal anastomoses between the SMA and IMA

marginal artery of Drummond and sometimes the arch of Riolan (mesenteric meandering artery) both supply small and large intestine

what passes through foramen rotundum

maxillary division of trigem CN V2

fracture of the surgical neck of the humerus

may cause axillary nerve injury leading to paralysis of deltoid and teres minor muscle with sensory loss over the lateral upper arm

to see if a fetus has an adrenal disorder like CAH, you can use amniocentesis, which will analyze...

measures 17 hydroxyprogesterone levels, gene linkage analysis involving HLA region of chromosome 6, or detect abnormal genes

flexion/opposition of the thumb

median nerve

which part of the hypothalamus nucleus is for mediating hunger vs mediating satiety

mediating hunger = lateral nucleus -destruction makes you anorexic (lateral injury makes you lean) mediating satiety = ventromedial nucleus -destruction makes you eating a lot (ventromedial injury makes you Very Massive)

what is one of the most modifiable risk factors for falls

medication review commonly associated w falls include antipsychotics, antidepressants, benzodiazapenes and Ca channel blocker-amlodipine, ibuprofen

medium chain triglycerides are restricted in ___deficiency, characterized by lethargy, sz, and hypoketotic hypoglycemia following a period of fasting

medium chain acyl CoA dehydrogenase deficiency

where in the thymus do they differentiate into CD4 or CD8 cells

medulla

where does negative selection occur

medulla of thymus

medullary carcinoma vs pheochromocytoma

medullary carcinoma is a malignant proliferation of parafollicular C cells-->secrete calcitonin -associated with MEN2A and 2B pheochromo.. -tumor of adrenal medulla -derived from chromaffin cells -tumors secrete EPI, NEPI, and dopamine, which can cause episodes of HTN -find catecholamines and metanephrines in urine TREAT WITH ALPHA THEN BETA BLOCKER -phenoxybenzamine then beta blocker to avoid HTN crisis

sheets or polygonal or SPINDLE SHAPED cells with extracellular amyloid deposits aka CONGO RED + DEPOSITS

medullary thyroid cancer the amyloid deposits are derived from calcitonin and stained with congo red mutations in RET protooncogene

elevated calcitonin + thyroid nodule what are you thinking?? what do you think when you see it associated with mucosal neuromas and marfanoid habitus (arm span>height)

medullary thyroid cancer bc it is parafollicular C cells so increase in calcitonin think of MEN2B -mutation in RET protoncogene, pheochromocytoma

most common malignant brain tumor in childhood involves cerebellum and can compress 4th ventricle leading to noncom hydrocephalus homer wright rosettes

medulloblastoma

most common malignant brain tumor in childhood and commonly involves cerebellum, often at vermis homer wright rosettes poorly differentiated and bad prognosis

medulloblastoma

schizoaffective disorder

meets criteria for schizophrenia + mood disorder (major depressive or bipolar) patient must have >2 weeks of psychotic sx without major mood episode so psychosis must occur in the absence of major mood episodes!!!

what sx do you see with vitamin B12 deficiency

megaloblastic anemia degeneration of dorsal columns so loss of proprioception/vibration, and lateral corticospinal tract so hyperreflexia, spastic muscle weakness

what happens to erythrocyte precursors when you start B12 therapy

megaloblastic to normoblastic you get more effective erythropoiesis therefore an increase in reticulocyte count

spike and dome appearance

membranous glomerulopathy SUBEPITHELIAL**

thick glomerular basement membrane due to immune complex deposition sub epithelial deposits with 'spike and dome' appearance associated with Hep B or C, solid tumors, SLE****, or drugs

membranous nephropathy

which adult brain tumor arises from arachnoid cells and is located external to the brain parenchyma

meningiomas

neoplastic proliferation of plasma cells so the plasma cells are overproducing 1. osteoclast activating factors-->punch out bone, bone pain, hyperCa 2. produce immunoglobulin-->elevated serum protein; M spike; increased risk of infection bc monoclonal plasma cells produce the exact same one Ab (lacks antigenic diversity) 3. light chain overproduction accumulation in urine (Bence Jones protein) goes to blood (deposits in tissue as amyloid) goes to kidney (renal failure)**

multiple myeloma (large eosinophilic casts composed of bence jones protein*)

Contraction of the detrusor muscle is stimulated by what? Which medication helps this?

muscarinic cholinergic agonists -BETHANECHOL -->to help improve bladder emptying s/p post surgery urinary retention

sx seen in primary aldosteronism due to hypokalemic alkalosis ____appear as well defined yellow tumors of the adrenal cortex and is functionally similar to the outermost layer of the adrenal cortex, which produces aldosterone

muscle weakness and paresthesias adrenocortical adenomas

what happens when HFE is mutated

mutation causes the complex to detect falsely low iron levels 1. the enterocytes increase expression of DMT1 which increases absorption of iron from the intestinal lumen 2. the liver decreases synthesis of hepcidin. this increases expression of ferroportin on enterocytes which increases iron secretion into the blood

hereditary hemochromatosis

mutation in HFE gene excessive intestinal iron absorption and accumulation in parenchymal tissues that result in end organ damage (cirrhosis, DM, cardiomyopathy, arthropathy) 1. increased expression of DMT1, so there is increased intestinal absorption from lumen 2. hepatocytes decreased hepcidin synthesis, which increases ferroportin expression and promotes iron secretion into circulation

what is the genetic mutation of ALS and how do you treat?

mutation of gene that codes for copper zinc superoxide dismutase (SOD1) treat with riluzole, which decreases glutamate release

Hartnup disease, mutation? pellagra like skin eruptions and cerebral ataxia how to dx? what to supplement?

mutations affecting neutral amino acid transporter tryptophan is a neutral aa which is a precursor to niacin, serotonin, and melatonin you need the conversion of tryptophan->niacin in order to make NAD+ ****** dx=lots of neutral aa in urine tx=niacin or NAD+ supplements

adenomatous polyps contain dysplastic mucosa and are premalignant. what mutations do they have? increased activity of what enzyme is found in colon adenocarcinoma? So how can you lower rate of colon adenoma/adenocarcinoma?

mutations in APC tumor suppressor gene, which regulates cell growth and adhesion. Needs an accumulation of mutations to progress to adenocarcinoma cyclooxyrgenase-2 (COX-2) regular ASA bc it inhibits COX

what mutations is associated with Crohn's disease

mutations in NOD2-->decreased activity of NF-KB protein -->reduced cytokine production NFKB is a proinflamm transcription factor so decreased production impairs the innate immune response of the intestinal mucosa (antimicrobial peptide synthesis, mucin secretion)

mutations in sickle cell anemia

mutations in the beta globin gene which leads to HbS production

an autoimmune disease that cause a decrease in the number of functional Ach receptors within the NMJ so threshold potential isn't reached and the muscle cells do not depolarize

myasthenia gravis

diplopia and ptosis that worsens towards the end of the day. weakens that also worsens along with fatiguable chewing and dysphagia what is it and how to tx?

myasthenia gravis pyridostigmine (long term AchE inhibitor)**

what are 2 constants that myelin depends on and how does it affect it

myelin increases the length constant and decrease the time constant, both of which improve axon speed

auer rods are deformed azurophilic granules found in the cytoplasm of myeloblasts that stain positive for ?

myeloperoxidase!!!!

achalasia is the failure of the LES to relax due to loss of

myenteric Auerbach plexus due to loss of postganglionic inhibitory neurons, which contain NO and VIP achalasia = absence of relaxation

what is a side effect of statins and what is another med that you can give with statins that will make the side effect worse>

myopathy and hepatitis -some pt will dip severe myopathy with elevations in creatine kinase and occasional rhabdomyolysis if you give it with vibrates* (GEMFIBROZIL), it will impair hepatic clearance of statins

5HT3 receptor antagonists are good to treat?

n/v caused by GI upset serotonin activates 5HT3 receptors

long acting opioid given IM or nasal spray to treat acute OD in an unconscious individual. also used for relapse prevention once detoxified

naltrexone use nalTREXone for the long TREX back to sobriety

where do pan coast tumors arise ? pan coast tumors normally compress the brachial plexus but it can cause horner syndrome if it compresses the cervical sympathetic ganglia

near the superior sulcus which si the groove produced by the subclavian artery

which selection: thymus epithelial cells and dendritic cells express self antigens and T cells are tested for binding to self antigens and MHC

negative selection

are neutrophils involved in any of the hypersensitivity rxns? their increased numbers in the blood indicates__? predominance of band forms during infection is also known as? what do corticosteroids do to neutrophils?

no. indicates infection, bc they are able to ingest and kill organisms by enzymatic and oxidative burst ways. left shift corticosteroids will increase neutrophil count; causes demargination of these cells-->previously attached to vessel wall; also decreases lymphocyte, monocyte, basophil, and eosinophil count

Zolpidem, Zaleplon, esZopiclone

non benzodiazepine hypnoitcs act at GABA receptor used for insomnia less dependence risk than benzos reverse with flumazenil "these ZZZs put you to sleep"

vecuronium pancuronium tubocurarine what type of blockers?

non depolarizing NMJ blockers they display a progressive reduction

Risk factors for osteoporosis fractures

non modifiable -advancing age -female sex -white, hispanic, asian -person or fhx fracture modifiable -decreased physical activity -low body weight -poor Ca or vitamin D intake -excessive OH or tobacco use -premature menopause -glucocorticoid use***-->increases osteoclast differentiation, decrease osteob, and decrease Ca absorption -meds that decrease Ca absorption or decrease estrogen levels** early post menopause involves cancellous bone which is important for vertebral column integrity (vertebral fractures). w advancing age, the cortical bone that makes up shafts of long bones becomes involve,d leading to hip fractures

carvedilol 2. doxazosin, prazosin, and terazosin

non selective beta and alpha adrenergic blocker used in pt with HTN and CHF 2. alpha 1 blockers good for HTN and BPH treatment but not used as mono therapy for HTN bc increased risk for CV events

which medications should be careful with diabetics bc of hypoglycemia?

non selective beta blockers (propranolol, timolol, nadolol) inhibit NEPI/EPI responses to hypoglycemia give selective beta1 antagonists bc minimal effects on glucose metabolism and adrenergic sx bc with hypoglycemia, epi limits glucose use and increases glyocgenolysis and gluconeogensis BETA BLOCKERS ENHANCE HYPOGLYCEMIA

pilocarpine

non selective muscarinic receptor agonist

acts on alpha 1 receptors which causes vasoconstriction and increase in systemic vascular resistance. also acts on beta 1 receptors weakly causing mild increase in cardiac contractility

norepinephrine

what neurotransmitters are involved in ADHD and therefore which meds to give?

norepinephrine and dopamine give stimulants, like methylphenidate** and amphetamines*, bc they increase release of NE and dopamine and block reuptake

how does an obstructed brachiocephalic vein happen?

obstruction from an apical lung tumor or an obstruction from a thrombus that formed due to a central venous catheter for being placed for a long time

how does a Mallory Weiss tear happen? (longitudinal mucosal tears at the esophagogastric squamocolumnar junction)

occur due to increased intraluminal and intraabd gastric pressure due to lots of BLOODY vomiting associated with alcoholics hiatal hernias strong predisposing factor CAUSES METABOLIC ALKALOSIS

you can still damage abd structures such as the LIVER by doing a thoracentesis where?

on the right if needle is inserted below the 9th rib at mid axillary line

clear cell carcinoma, the most common form of renal cell carcinoma originates? describe the clear cells

originates from proximal tubular epithelial cells and contains a lot of intracellular glycogen and lipids it appears clear bc tissue fixation and staining techniques dissolve glycogen and lipids, leaving clear spaces

orotic aciduria vs ornithine transcarbamylase deficiency

orotic acuduria = in de novo pyrimidine synthesis -defect in UMP synthase so can't convert orotic acid to UMP -build up of orotic acid ornithine transcarbamylase deficiency =in urea cycle -build up of orotic acid + HYPERAMMONIA

neuramidase from viruses cleaves sialic acid which allows for the release of influenza virions from infected cells. what acts as a sialic acid analogue that inhibits neuramidase? and as a result prevents the release of viruses

oseltamivir

focal pain and swelling at the tibia tuberosity in young adolescents caused by overuse injury of the quad muscle (esp jumping). patellar ligament connects to quad muscle and inserts at tibia tuberosity can get avulsion at site of tibia tuberosity

osgood schlauer disease an overuse injury of the secondary ossification center (apophysis) of the tibia tubercle

type I collagen deficiency resulting in bone fragility and frequent fractures, blue sclera (bc of deficient CT so you can see underlying vessels), and hearing loss, and small malformed teeth** type 1 collagen is major component of bones, teeth, ligaments, skin, sclera type 1 collagen is synthesized by?

osteogenesis imperfecta osteoblasts ; can't synthesize type I collagen by osteoblasts!!! type I collagen is the main collagen in osteoid** (organic portion of bone matrix) and allows bone to be somewhat flexible while still maintaining strength

dead bony trabeculae with empty lacunae and necrosis of surrounding adipocytes causes -sickle cell dz, glucocorticoids, vasculitis, alcoholism

osteonecrosis (avascular necrosis)

what type of kidney stone is most common with Crohn's disease and why

oxalate kidney stones in Crohn's, the terminal ileum is effected so now bile acids can't be reabsorbed normally anymore. you lose bile acids in the feces and now without bile acids, you can't absorb fats well. excess fats binds to Ca and the are excreted in feces. normally, Ca binds to oxalate so oxalate can get excreted. with Crohns, Ca binds to fats instead of oxalate so you get oxalate kidney stones bc oxalate absorption is increased URINARY OXALATE STONES!***

churg strauss syndrome (eosinophilic granulomatosis with polyangitis)

p ANCA (will find Ab against neutrophil myeloperoxidase) asthma and peripheral eosinophilia asymmetric multifocal neuropathy (mononeuritis multiplex) is particularly common due to the vasculitis affecting the epieneural vessels (wrist drop due to radial nerve involvement)

what type of acinar emphysema do you see with alpha 1 antitrypsin deficiency?

panacinar; you get excess protease activity

what happens when the ventral and dorsal pancreatic buds fail to fuse? where do the ducts drain?

pancreas divisor usually clinically silent dominant DORSAL duct of santorini opens into duodenum and drains majority of pancreas (so the accessory duct drains most of pancreas) smaller VENTRAL duct of wiring opens into the major papilla and drains the inferior/postieor portion of the head and uncinate process

recurrent unexpected panic attacks, concerned about additional attacks

panic disorder

overlapping nuclei containing finely dispersed chromatin, giving them ground glass appearance (orphan annie eyes) intranuclear inclusions and grooves Psammoma bodies (laminated Ca deposits)

papillary carcinoma exposure to ionizing radiation in childhood is a major risk factor

aplastic crisis is due to

paravovirus B19 infection non enveloped single stranded DNA virus

what are you worried about with gastrectomy?

parietal cells secrete intrinsic factor which is needed to absorb vitamin B12 in the ileum you need vitamin B12 supplementation FOREVER also get dumping syndrome so pts need to avoid large meals. with gastrectomy, you get accelerated emptying of hyperosmolar foods boluses-->bc normally the stomach serves as a reservoir for ingested food

autoantibodies against desmoglein, a cadherin protein for desomosomes b/n keratinocytes (stratum spinosum) presents as skin and oral mucosa bullae** Nikolsy sign = thin walled bullae that rupture easily

pemphigus vulgaris

2 ways bacteria spreads meningitis into CSF (N meningitides or Strep pna)

penetrate the cerebral capillary endothelium or the choroid plexus

people taking NSAIDS are at increased risk for ____so do ____when you suspect GI bleeding

peptic ulcer fecal occult blood testing

what increases more from apex to base?

perfusion increases way more than ventilation so that is why the V/Q ratio decreases from apex to base ventilation does increase from apex to base bc gravity stretches the lung downward from the apex, which is effectively fixed to the pleural cavity by the low intrapleural presssure during inspiration, a smaller amt of air is directed to the lung apex since the alveoli there are more distended and less complaint

progressive fatigue, lower extremity paresthesias, and megaloblastic anemia caused by destruction of?

pernicious anemia (can get atrophic gastritis) destruction of parietal cells. parietal cells secrete gastric acid and intrinsic factor you need IF to absorb vitamin B12 in the ileum parietal cells found in upper glandular layer

persistent lymphedema is associated with developing what type of cancer?

persistent lymphedema means chronic dilation of the lymphatic channels which prediposes pt to developing lymphangiosarcoma-->a malignant neoplasm of the endothelial lining of lymphatic vessels ID 470

sartorius muscle, gracilis, and semitendinosus inserts into

pes anserinus of the anteromedial tibia shaft near tibial tuberosity bursitis of res anserinus usually in runners and they have anteromedial pain

which enzymes need the conversion of BH4 (tetrahjydrobiopterin) -->BH2?

phenylalanine hydorxlyase to convert phenlyaaline to tyrosine tyrosine hydroxylase to convert tyrosine to DOPA tryptophan hydroxylase to convert tryptophan to h-hydroxytryptophan-->serotonin DOPA is a precursor for dopamine, NE, EPI SO YOU NEED BH4 TO MAKE TYROSINE, DOPAMINE, AND SEROTONIN

sudden onset headache, heart palpitations, sweating, HTN sx are episodic how to dx?

pheochromocytoma episodic bc of fluctuations in catecholamine synthesis by the tumor dx with elevated urianry and plasma catecholamines and metanephrines VHL gene--con hippel lindau RET gene--MEN2 NF1 gene--neurofibromatosis [

milrinone and inamrinone inhibit ____which leads to an increase in ____, which promotes _____and _____

phosodiesterase-3 (blocks conversion of cAMP to AMP) cAMP cardiac contractility (bc of increase Ca influx) AND systemic vasodilation (bc of increased cAMP in vascular smooth muscle cells)

when you have decreasead collagen fibril production and increased degradation of collagen and elastin in dermis nad increased collagen cross linking

photoaging

the presence of hemosiderin laden macrophages in the pulmonary alveoli indicate what? and it is usually the result of what?

result of left sided heart failure this indicates that there must have been some sort of hemorrhage in the lungs that caused macrophages to come in and digest RBCs. there must have been increased pulm capillary hydrostatic pressure which increases permeability of capillary wall. -this leads to extravasation of RBCs and alveolar hemorrhage. So macrophages come to phagocytose the RBCs

frontal bossing, craniotabes (ping pong ball skull-->softened skull bones), hypertrophy or the costochondral joints from cartilage overgrowth, and bowed legs in kids, widening and thickening of the wrists (epiphyseal plate widening and cupping)

rickets (vitamin D deficiency) RISK FACTOR INCLUDES EXCLUSIVE BREAST FEEDING bone will look like an excess of unmineralized osteoid matrix and epiphyseal growth plate cartilage **

a peritoneal recess found between the ascending colon and the abd wall

right paracolic gutter

right vs left sided colon cancers

right side (ex. ascending colon) -grows as masses -usually don't get intestinal obstruction bc ascending colon has bigger lumen -**iron deficiency anemia bc of blood loss -sx = anorexia, weight loss, malaise left side -infiltrates the intestinal wall and encircle the lumen, causing constipation and sx of intestinal obstruction (abd pain, dissension, n/v) -rectosigmoid involvement -->hematochezia

serum creatinine levels ___when GFR ____

rises when GFR decreases

how does uric acid stones form and what are risk factors

risk factors are pt with chronic diarrhea or pt that had colectomy -->reduced bicarb absorption from gut (bc this causes chronic metabolic acidosis) so the kidney compensates by excreting H and reabsorbing bicarb this lowers urinary pH (acidic urine) which increases the conversion of soluble rate salts into insoluble uric acid dehydration also a risk factor due to the production of concentrated urine ID 12081

problem w giving atropine in organophosphate toxicity and what else should you give

risk for muscle paralysis bc atropine only works on muscarininc receptors give PRALIDOXIME bc it is a cholinesterase reactivating agent that allows for degradation Ach and works on both muscarinic and nicotinic receptors

rituximab vs infliximab

rituximab = monoclonal Ab against CD20 infliximab = monoclonal Ab against TNF alpha id 8523

generalized lymphadenopathy, particularly post auricular and occipital, with a maculopapular rash that begins on the head and neck and spreads downward describes what infection? sequelae?

rubella most adult women with rubella dvp polyarthritis and polyarthralgia

what can happen 5-14 days after an anterior wall myocardial infarction (ST elevation in leads V2-5?

ruptured left ventricular free wall which leads to cardiac tamponade and hemoperricardium -HYPOTENSION AND SHOCK -the infarcted myocardium is weakened by necrosis, PMN and M infiltration..etc

high cellular areas (Antony A pattern) mixed with myxoid regions of low cellularity (Antoni B pattern) Antoni A areas have Verocay bodies S-100+ bc of neural crest origin most common site is at cerebellopontine angle at CN8

schwannoma ID 1304

what forms labioscrotal folds form

scrotum in males and labia majora in females

adenosine and dipyrimadole do what? how do these drugs worsen existing ischemia?

selective vasodilators of the coronary vessels coronary steal; whenever there is ischemia and you give a vasodilator, it is going to cause vasodilation of arteries in nonischemic regions, sp this will divert the blood flow from ischemic areas to non ischemic areas THE ARTERIES WITH ISCHEMIA ARE ALREADY MAXIMALLY DILATED -collateral circulation normally helps with alleviating ischemia

ivabradine does what to heart rate and cardiac contractility or relaxation

selectively inhibits funny Na channels, prolonging phase 4 (slow depolarization) which slows the SA node firing rate and decreases HR it does not effect cardiac contractility

what is an inhibitor of MAO-B that can prevent MPTP induced damage of dopaminergic neurons

selegiline used to delay the progression of parkinsons disease

neuritic plaques is the same thing as

senile plaques alzheimers -also associated wth beta amyloid deposits -neurofibrillary tangles (aggregates of phosphorylated Tau protein)

the long thoracic nerve innervates the ____and damage to this nerve causes a ___

serratus anterior winged scapula

list the layers the chest tube goes through when you do this for a pleural effusion at 5th intercostal space at mid axillary line

serratus anterior --> intercostals (external, internal, innermost) --> parietal pleura -->pleural cavity

large adnexal mass with increased androgens (hirsutism, clitoromegaly)

sertoli leydig cell ovarian tumor (sex cord stroma tumor) micro exam shows hollow or solid tubules lined by round sertoli cells and surrounded by a fibrous storm

neutrophil elastase is inhibited by___?? macrophage elastase is inhibited by___??

serum alpha 1 antitrypsin tissue inhibitors of metalloproteinases (TIMPs)

painful vesicular rash in a dermatome distribution a complication is postherpetic neuralgia which is persistent pain after resolution of lesions

shingles caused by reactivation of varicella zoster virus which causes herpes zoster (shingles) in light micro, it looks like intranuclear inclusions in keratinocytes and multinucleated giant cells**

what are the 2 branches of the splenic artery

short gastric and left gastroepiploic short gastric does not have anastaomeosis

PSGN treatment and lab results in PSGN (HYPERCELLULARITY IN THE LOBULES OF THE GLOMERULI BC OF LEUKOCYTIC INFILTRATION AND ENDOTHELIAL AND MESANGIAL CELL PROLIFERATION)

supportive 1. children rarely get renal failure 2. 25% of adults dvp rapidly progressive glmolerulonephritis**** PSGN sx -periorobital edema, HTN, cola colored urine labs!!**** -elevated antistrpetolysin titers (ASO) and elevated anti-DNase B titers, anti cationic proteinase (these are all anti strep Ab) - low C3 levels**** (bc of complement deposition in glomerulus)

what is the most common cause of adrenal insufficiency

suppression of hypothalamus pituitary adrenal access by long term glucocorticoid therapy low CRH, low ACTH, and low cortisol that will not rise in response to stressful situations (infections, surgery) glucortoicoids help maintain normal vascular tone by increase norepinephrine, renin, ang vasocontrsticion so no glucocorticoids = hypotension/shock

what type of injury can injure the brachial artery

supracondylar fractures

what embryologic derivative gives rise to the anterior pituitary

surface ectoderm anterior pituitary (Rathke's pouch)

irregular jerking moments involving face, arms and legs s/p a sore throat months ago

sydenham chorea -a HYPERkinetic extrapyramidal movement disorder

prostacyclin

synthesized from prostaglandin H2 causes platelet inhibition and vasodilation (opposite of TXA2) and increases vascular permeability secreted by vascular endothelial cells

posterior column involvement is seen with both

syphilis and vitamin B12 deficiency

whenever you have damage to the anterior white commissure so you have bilaterally loss of pain and temp in a cape like distribution destruction of the motor neurons in the ventral horns causes flaccid paralysis and atrophy of the intrinsic muscles of the hand

syringomyelia

what can chronic obstructive sleep apnea lead to?

systemic and pulm HTN with right sided heart failure

skin edema in the beginning and then cutaneous thickening, tightening, and induration. telangiectasias and cutaneous and subcut calcifications

systemic sclerosis

what type of dysfunction is it when you see a dilated left ventricle

systolic dysfunction bc can't pump so it doesn't squeeze as much blood out -can be caused by

phosphodiesterase 5 inhibitor that treats erectile dysfunction urinary analgesic that provides sx relief for dysuria during UTIs

tadalafil phenazopyridine

deficiency in Beta hexosaminidase A, which leads to GM2 accumulation in neurons

tay sachs also cherry red macular spot but no hepatosplenomegaly

______is a molecule linked to the peptidoglycan cell wall of gram + bacteria _____is a component of the outer cell envelope of gram negative bacteria

teichoic acid lipopolysaccharide

superficial blanching nests of distended capillaries

telangiectasias

where does herpes simplex virus type 1 encephalitis infect? which lobe? and how does it get there?

temporal lobe hemorrhage/edema on imaging primary oropharyngeal infection-->goes through olfactory tract-->olfactory cortex (temporal lobe) can also get wernicke receptive aphasia bc in temporal lobe and personality changes

what area is covered by ciliated cuboidal epithelium and club cells that help with mucociliary clearance?

terminal bronchiole

where does Crohns disease most commonly effect and wha type of cells are increased in activty

terminal ileum TH1 helper cells, which produce IL-2, interferon gamma and activate macrophages to synthesize TNF "cobblestone appearance and non-caveating granulomas

what is the most sensitive strategy for screening malabsorptive disorders and why?

test for fat malabsorption using a qualitative assay of stool with Sudan III Stain -fats are typically the most severely affected macronutrient in generalized malabsorption (lipids have the most complex digestive pathway)

limb defects (phocomelia, micromelia--"flipper limbs"

thalidomide "LIMB defects with the-limb-omide_

how does the PRP capsule in H influenza type B prevent it from being phagocytosed and lysed by complement?

the PRP capsule binds to factor H, and factor H degrades C3b

what is a good way to identify the appendix during surgery?

the Teniae coli (3 longitudinal bands/muscle) that travel on the outside of the colon and converge at root of appendix

what happen when there is cricophayngeal motor dysfunction?

the muscle contractions normally help propel the food to esophagus when it is impaired, the food gets obstructed at level of neck/start coughing (oropharyngeal dysphagia) this increases intraluminal pressure in oropharynx which can cause the food to herniate through a muscle weakness area in posterior pharynx and form ZENKER (FALSE) DIVERTICULUM pt dvp food halitosis/regurgitation/ and pulm aspiration can occur which leads to recurrent PNA

obstructive sleep apnea

the pharyngeal muscles relax and closes the airways. O2 declines and PCO2 rises until chemoreceptors in carotid body trigger arousal and pharyngeal tone returns obesity is a risk factor, morning headaches a common sx

what to NK1 receptor antagonists do like aprepitant and fosaprepitant

the prevent substance P release which helps prevent vomiting and delayed emesis associated with chemotherapy

What are the primary cell mediators in K regulation? what happens with hypokalemia and hyperpkalemia?

the principal cells and alpha intercalated cells located in the late distal tubule and collecting duct. w/ hypokalemia, K is reaborbed with H/K ATPase on apical side w/hyperkalemia, K is secreted through apical K channels.

what happens after fertilization in the fallopian tube?

the second meiotic division is completed and zygote is formed zygote travels through fallopian tubes and undergoes mitotic divisions and creates a morula (smaller cells) the morula goes to uterus 3-4 days after fertilization and becomes a blastocyst the blastocyst implants 6 days after fetilzation trophoblast (outer cells)-->cytotrophoblat and syncitiotrophoblast which secretes beta HCG, which signals to corpus luteum in ovary to keep making progesterone

pathology of centriacinar emphysema with smoking?

the smoke causes oxidative injury to the resp bronchioles-->alveolar macrophages activated->inflammation causes neutrophil recruitment; activated M and PMNs release proteases (like elastase) which degrade the ECM and generate free oxygen radicals which inhibit function of protease inhibitors like alpha 1 antitrypsin

what happens during testicular torsion

the spermatic cord gets twisted so the pampiniform plexus so now there is reduced venous outflow arterial flow initially preserved sx: pain, n/v, high riding testes, no cremastor reflex

which parts of the nephron are most susceptible to acute tubular necrosis

the straight portion of the proximal tubule and the thick ascending limb of the loop of henle susceptible to hypoxia bc they participate in active transport of ions (ATP consuming and have high O2 demand) presents wth increased serum Creatinine and BUN levels, normal BUN/Cr ratio, and oliguria

which portion of the left ventricle is most prone to ischemia and infarction?

the subendocardial region bc the systolic reduction in coronary blood flow is greatest in this region

which layer is involved in Hirschsprung disease

the submucosal layer-->the Meissner and myenteric (Auerbach) plexus are absent in the AFFECTED SEGMENT OF THE BOWEL WALL the submucosa of the narrowed area*** is the most superficial layer where the absence of ganglion cells can be seen

how does a patient with Crohn's disease develop gallstones

the terminal ileum is affected so you have decreased bile acid reabsorption this promotes cholesterol supersaturation of the bile

which type do we vaccinate against for H influenza?

the type B which is the one with a polysaccharide capsule (Hib vaccine)

what do these have in common -actinomyces israelii -pasteurella multocida -borrellia burgorferi

they all have a peptidoglycan wall pastur is gram - and known for causing wound infections following cat bites borrelia is disease causing spirochetes (lyme dz)

kinesin vs dynein

they are molecular motor proteins that help move cargo tworads opposite ends of microtubule Dynein = retrograde so to negative end (Negative Near Nucleus); retrograde axonal transport Kinesin = anterograde to positive end, away from nucleus (Positive near Periphery); helps move things in neuron down to axon terminal

fine dust particles like coal that reaches the respiratory bronchioles and alveoli gets cleared how?

they are phagocystosed by alveolar macrophages this activates macrophages which releases lots of cytokines and causes pulm inflammation growth factors are released which stimulate fibroblasts to proliferate and produce collagen this production results in the progressive interstitial lung fibrosis!****

chemoreceptor stimulation with COPD and what happens with administering O2

they are stimulated with hypoxemia in order to increase their minute ventilation so whenever you give a COPD pt oxygen, their minute ventilation decreases bc their chemoreceptors are not going to get stimulated with high levels of O2

how do bile acid binding resins work

they bind bile acids in the GI tract, so it interferes with their circulation and causes increased bile acid excretion this causes the liver to make new bile acids, from cholesterol that is stored in the liver. (bc bile acids are made from cholesterol breakdown) now LDL from circulation is being taken up by the liver to also make more bile acid so bile acid production and secretion is increased bc there is a decrease in cholesterol, this activates HMG CoA reductase to make more cholesterol this effect can be blocked by combining therapy with statins ex. cholestyramine

what is unique about spore forming bacteria? (BACILLUS AND CLOSTRIDIUM**)

they can survive boiling temps

what are neurophysins

they carry oxytocin and ADH after its made in the cell bodies of the paraventricular and supraoptic nuclei in the hypothalamus and then carries it to P pituitary can cause diabetes insipidus if there is a mutation

what do metalloproteinases do

they degrade collagen and other proteins in ECM important in wound healing bc it encourages myofibroblast accumulation at wound edges and scar tissue remodeling the myofibroblasts initiate wound contraction

whenever you can't decolorize with hydrochloric acid and alcohol after staining carbolfuchsin

this is an acid fast stain and is used to detect mycobacterium and some nocardia bc they have mycelolic acid present in their cell walls 1. use aniline dye (carbolfuchsin) which is a red color and it binds with mycelia acids in bacterial cell wall 2. then treat with HCl and alcohol; the alcohol dissolves the outer cell membranes but bc there is mycelia acid, it prevents decolorization 3. add methylene blue to be taken up by decolorized bacteria so red = mycobacteria bc of the acid fast carbolfuchsin stain and blue= non acid fast bacteria

whenever you see normal anaerobic bacteria (part of normal mouth flora) found in a lung abscess/lesion, what does that tell you?

this means that oropharyngeal aspiration most likely occurred

innervation and function of latismus dorsi

thoracodorsal nerve (c6-8 nerve roots) extension, adduction, internal rotation of humerus inserts at humerus so repsosnbileq for forceful mvmvt of humerus injured w movement that require forceful downward mvmt of humerus-->throwing, climbing, shining a tennis racket overhead

lower extermity vascular insufficiency seen with heavy smokers vasculitis in medium and small sized arteries, tibial and radial arteries

thromboangiitis obliterans (Buerger's disease) ID451 also see raynauds

what type of sign is seen with epiglottis?

thumbprint sign and it causes inspiratory stridor f

what are the 3 things that red cell aplasia is associated wth

thymoma lymphocytic leukemia parvovirus B19 infection

what do pts with myasthenia gravis have

thymoma or thymic hyperplasia

pharyngeal pouch 3

thymus, inferior parathyroid glands

methimazole, propylthiouracil

thyroperoxidase inhibitors used to treat hyperT

how can a placental abruption cause DIC?

tissue factor is release from placenta into maternal circulation -->intravascular coag cascade activated -->lots of micro thrombi -->platelet consumption and coagulation factor consumption -->bleeding

y-interferon function (IFN-y)

to activate macrophages, therefore helps promote adaptive immunity against intracellular pathogens -also promotes Th1 differentiation -produced by activated T cells and natural killer cells

desmopressin can be used to treat what blood disorders

to increase factor 8 and vWF so hemophilia A and Von Willebrand Disease

IL-3 fucntion

to promote growth and differentiation of bone marrow stem cells

lymph from the upper third of hte rectum drains where

to the inferior mesenteric lymph nodes

where does the lungs and mediastinum deviate to with a tension pneumothorax?

to the opposite side of the chest

what is colchicine used to treat and MOA

to treat gout (first line treatment is NSAIDs-->indomethacin but contraindicated with ulcers) inhibits micro tubular polymerization in neutrophils (binds to tubulin protein that normally helps form microtubules, now can't be used for functions like CHEMOTAXIS, PHAGOCYTOSIS, AND DEGRANULATION (like neutrophil mitosis and chemotaxis!****) -**bc it blocks micro tubular assembly in pmns, that reduces phagocytosis and transport of MSU crystals also blocks formation of leukotriene B4 side effects: n/d/abd pain (inhibits tubulin polymerization into microtubules)

_____is an anticonvulsant used to treat epilepsy in children and adults

topiramate

what type of bone does osteoporosis involve

trabecular = spongy = cancellous bones most common fractures at dorsolumbar vertebral bodies and head of femur bc lots of trabecular trabecular thinning

a ______ is used to assess the degree of paralysis induced by a neuromuscular junction blocking agent

train of four stimulation

sickle cell trait vs disease in terms of erythrocyte count

trait has normal count while disease has elevated with a normal mean corpuscular volume

patient projects feelings about formative or other important persons onto physician ex. psychiatrist is seen as parent

transference

elderly pt presenting w gross hematuria a hx of smoking or occupational exposure to rubber, plastic, aromatic amine containing dyes,textiles, or leather increases risk describe 2 pathways that is can arise

transitional urothelial cell carcinoma usually arises in the bladder 1. flat - dvp high grade flat tumor then invades, associated w early p53 tumors 2. papillary - dvp low grade-->high grade papillary tumor -->invades. not associated w p53

what to treat drug induced parkinsonism with

treat with benztropine , trihexyphenidyl (anti cholinergic)

what do you treat acute intermittent porphyria with and why

treat with hemin and glucose bc they block ALA synthase even though the enzyme that is deficient is porphobilinogen deaminase, you want to block ALA synthase bc this is the rate limiting step of the rxn

wet mount with leukocytes and pear shaped organisms

trichomonas vaginitis

thin, yellow green malodorous frothy discharge vaginal inflammation lab findings? treatment?

trichomoniasis (trichomonas vaginalis) pH>4.5 ; motile, flagellated trichomonads metronidazole; treat sexual partner

what type of incontinence does multiple sclerosis cause/

urge. causes varying degrees of demyelination, inflam, and gloss in the CNS. so you lose CNS inhibition ofdestrusor contraction (uninhibited bladder contraction) spinal cord lesions above sacral region cause a loss of higher center control of micturition and lead to detrusor hyperreflexia upper motor neuron lesion THE BLADDER DOES NOT DISTEND OR RELAX PROPERLY DUE TO LOSS OF DESCENDING INHIBITORY CONTROL FROM UMN as the disease progresses, the bladder can become atonic and dilated leading to overflow incontinence

gross painless hematuria in an older adult should be considered a sign of ____until proven otherwise

urinary tract cancer (urethelial or renal cell carcinoma) until proven otherwise

how to remember Maple Syrup urine disease

urine smells like burnt sugar "I Love Vermont Maple Syrup Branches" can't break down isoleucine, leucine and valine bc they are branched aa

how to calculate GFR? how to calculate RPF?

use the inulin or creatinine clearance bc they are freely filtered at glomerulus (neither are reabsorbed RPF = use para-aminohippuric acid clearance (PAH)

What are class IV antiarythmics used to prevent? examples?

used to prevent recurrent nodal tachyarryhtmias such as PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA -also used for HTN, angina pectoris, and supraventricular arrhythmias (atrial flutter, A FIB, paroxysmal supraventricular tachycardia) -verapamil and diltiazem (nondihydroperidine calcium channel blockers)

what should you avoid when you take metronidazole?

used to treat trichomonas vaginitis and bacterial vaginosis metro acts like disulfiram so it blocks acetaldehyde dehydrogenase causing an accumulation of acetaldehyde

presentation of Nocardia asteroides?

usually seen in immunocompromised pts. it affects lungs, brain, or skin. cavitary infiltrates in the lung can be mistaken for Mycobacterium Tb.

weakening of ___contributes to uterine and vaginal apical prolapse injury to ____results in urethral hyper mobility

uterosacral ligaments levator ani muscles (bc they hold the bladder and urethra in the appropriate anatomical position)

connects posterior aspect of uterus to anterior part of sacrum broad ligament made up of ?

uterosacral ligaments that hold uterus in anteverted and retroverted position -->loss contributes to uterine prolapse in cha cha mesosalpinx, mesovarium, mesometrium

how to treat paroxysmal supra ventricular tachy

vagal stimulation like carotid sinus massage or valsalva maneuver you want to increase refractory period in AV node to prevent reentry circuit valsalva maneuver -->when you exhale against a closed glottis (bear down like a bowel moment while holding your breathe)

female children exposed to diethylstilbestrol during pregnancy are like to dvp?

vaginal adenosis -normally, therer is replacement of vaginal squamous with glandular columnar epithelium. so vaginal adenosis is the persistence of columnar epithelium in the upper vagina precursor of clear cell adenocarcinoma of the vagina

general sensation and gustatory innervation to posterior area of the tongue

vagus nerve

propionyl CoA is converted to methylmalonyl CoA. the catabolism of what leads to the formation of propionyl CoA?

valine isoleucine threonine methionine

what happens with the RAAS system when you take valsartan and hydrochlorothiazide?

valsartan = Ang II receptor blocker blocks RAAS pathway so feedbacks to increase serum renin levels decrease volume leads to decreased renal blood flow which activates RAAS and increases renin levels

what is a drug that reduces nicotine cravings while decreasing pleasurable effects of cigarettes and other tobacco products?

varenicline

rest and nighttime chest pain associated with transient ST elevation

variant (Prinzmetal) angina -this is when the coronary arteries spasm and it leads to a brief myocardial ischemia -treat with vasodilator therapy like nitrates and calcium channel blockers -this type of angina is also triggered with smoking, cocaine/amphetamines/triptans(dihydroergotamine)

what invades the dorsal root sensory ganglia, so reactivation from the dorsal root ganglia causes herpes zoster

varicella zoster virus

described as "bag of worms" and it is the distension of veins in the spermatic cord

varicocele

intestinal atresias are due to ? features of apple peel atresia?

vascular occlusion aka ischemia occurs when SMA is obstructed -distal segment of ileum spirals around ileocolic vessels -blind end pouch on distal duedenum -no ileum or jejunum

what do carcinoid tumors release

vasoacrtive substances like serotonin, PGs, and bradykinin

what does CO2 do to cerebral vasculature?

vasodilates therefore increasing cerebral blood flow

what is in common with all of these? amlodipine morphine phentolamine