Uworld Journal (as of 6/5/19)

autosomal dominant polycystic kidney disease vs autosomal recessive polycystic kidney disease

"ADPKD: Intracranial berry aneurysms of the circle fo willis are often seen with this. When ruptured, they cause subarachnoid hemorrhage that presents with sudden onset of thunderclap headache. pts age 40-50 with enlarged kidneys, hypertension and renal failure. In newborns, kidneys are of normal size and cysts are too small to be detected. As the cysts enlarge, they compress the renal parenchyma and cause sx.

neprilysin

(i.e. sacubitril) drugs that inhbit neprilysin lead to increased levels of ANP and BNP and promote beneficial effects in heart failure. Neprilysin is also responsible for inactivating angiotensin II. Neprilysin is responsible for the breakdown of natriuretic peptides (BNP and ANP) and angiotensin II.

thyroid peroxidase

(TPO) catalyzes the oxidation of iodide to iodine, the iodination of thryoidglobulin tyrosine residues and the iodotyrosine coupling reaction that forms T3 and T4. Antibodies against TPO are present in >90% of patients with chronic lymphocytic (hashimoto) thyroiditis.

half life

(Vd x 0.7)/ CL - - - -steady state conc in 4-5 half lives

loading dose

(Vd x Cpss)/ [bioavailability fraction]

nystatin

(antifungal) binds ergosterol (same moa as amphotericin B) to form holes in the cell membrane ("Be NYCE to lab animals")

innervation to intrinsic interosseous muscles

(lumbricles, hyponerves) deep branch of ulnar nerve

portal hypertension

(as seen in alcoholic liver disease) produces splenomegaly by causing congestion of blood within the spleen, which produces expansion of the red pulp.

thromboangiitis obliterans

(buerger disease) segmental vasculitis extending into contiguous veins and nerves, raynaud phenomenon, young, smokers, asians, ischemic ulcerations in toes or fingers, histo: inflammatory intraluminal thrombi,

most common site for anal fissures that are painful

(due to hard stool and constipation) posterior midline distal to the dentate line bc there is decreased blood flow in this area.

Chlorpheniramine

(first gen H1 histamine receptor antagonist like diphenhydramine) - it shouldn't be used with benzos bc it causes sedation

smudge cells on peripheral smear

(flattened lymphocytes of B lymphocyte origin) seen commonly on smear of CLL or SLL. (chronic lymphocytic leukemia or small lymphocytic lymphoma). CLL/SLL originate from B cells (which normally produce antibodies in the humoral immune system).

ventral vs dorsal pancreatic bud

(foregut = pancreas); ventral pancreatic bud contributes to uncinate process and main pancreatic duct. The dorsal pancreatic bud alone becomes the body, tail, isthmus and accessory pancreatic duct. Both the ventral and dorsal buds contribute to pancreatic head.

besides hodgkin lymphoma, what else has an owl eye inclusion

(i.e. a clear halo), cytomegalovirus

common side effect of nondihydropyridine CCB's

(i.e. diltiazem and verapamil) constipation, bradycardia, AV conduction block (negative chronotropic effect) and worsening of heart failure in pts with reduced left ventricular function (negative inotropic effect)

Thioamides

(i.e. methimazole, propylthiouracil) decrease the formation of thyroid hormones via inhibition of thyroid peroxidase, the enzyme responsible for both iodine organification and coupling of iodotyrosines. Propylthiouracil also decreases the peripheral conversion of T4 to T3.

probability that a sperm donor is a carrier of an autosomal recessive allele

2pq (for rare autosomal recessive diseases, p=1) so 2q is the probability that the sperm donor is heterozygous.

men 1

3 P's: pituitary, parathyroid, and pancreas (gastrinoma - zollinger ellison) ; (the hyperparathyroidism causes hypercalcemia, constipation, and kidney stones).

phosphatidylcholine made at which week

36th week

how many calories come from protein, carbs and fat

4 calories per gram of protein or carbohydrate; and 9 Cal per gram of fat. i.e. 3000 Cal diet 900 of which is protein means 900/4 = 225 g/day of protein

normal A-a gradient (i.e. alveolar to arterial) in lungs

4-15 mmHg

turner syndrome

45, X; streak ovaries, amenorrhea, and infertility are the gynecological complications of Turner syndrome (TS). Pts with TS usually have short stature, webbed neck, shield chest, and low posterior hairline. Bicuspid aortic valve is the most common cardiac comorbidity. they get cystic hygromas (posterior neck mass)

klinefelter syndrome

47, XXY. Atrophied seminiferous tubules (low inhibin levels bc the seminiferous tubules contain the sertoli cells) and damaged leydig cells (low testosterone levels). They have no feedback inhibition from sertoli cells bc of their atrophy so they have high FSH and LH, which increase estrogen levels. small testes.

tricuspid

4th or 5th intercostal space at the left lower sternal border (where you auscultate for it)

sensation nerves on tongue

5 9 10 (sensation) (in that order from anterior)

which receptors are useful to block (antagonists) to alleviate chemotherapy induced vomiting?

5HT3 serotonergic and neurokinin 1 receptors

medicare covers

65 and older OR younger ppl with disabilities

taste nerves on tongue

7 9 10 (in that order from anterior)

technetium-99

99mTc-pertechnetate scan aka meckel scan. for uptake by herterotopic gastric mucosa.

ApoC II

Apo C II activates LPL to get triglycerides into VLDL (otherwise hyper TGs in blood)

Malabsorption of nutrients: what test to use?

Sudan III stain test for fat in the stool (normal is no fat in stool). Testing for fat is best for checking for malabsorption bc fat is usually first thing to be off.

silicosis

a pneumoconiosis characterized by dry cough, and shortness of breath, which slowly progresses over time. Risk factors: exposure to rock or minerals, such as sand and smoking. Pulmonary function tests are useful in categorizing this lung disease as restrictive rather than obstructive. When silicosis is present, chest x-rays will often reveal notable "eggshell" calcifications (nodular opacities that appear scattered thoruhgout the peripheral lymph nodes of the upper lobes of the lungs) in the upper lobes, a finding that helps to distinguish it from other pneumoconioses.

diffuse axonal injury

accumulation of transport proiteins (amyloid precursor, alpha synuclein) at the site of the injury.

acute angle closure (and open angle) glaucoma tx

acetazolamide (acts at proximal convoluted tubule

the immunity from hep B comes from

antibodies that are formed against the hepB Surface antigen. These antibodies bind the envelope of circulating virus and inhibit the viral entry

cyproheptadine

antidote for serotonin syndrome

reason for gonorrhea ability to evade host immunity

antigenic variability; they modify the pili to adhere to the mucosal epithelium.

Vinchristine

antineoplastic agent that acts by binding tubulin and inhibiting microtubule polymerization. A common adverse side effect is neuropathy (leading to areflexia)

adult T cell leukemia

assoc with HTLV-1, presents with short, aggressive course that includes hypercalcemia from lytic bone lesions, HSM, and cutaneous lesions. INfected T cells demonstrate a characteristic multilobulated nucleus

neurologic paraneoplastic syndromes (i.e. paraneoplastic cerebellar degeneration)

autoimmune phenomenon; assoc with small cell lung cancer as well as breast, ovarian, and uterine malignancy. Sx: dizziness, truncal and limb ataxia, dysarthria, and visual disturbances (diplopia). Its due to an immune response against tumor cells that cross reacts with purkinje neuron antigens, leading to acute onset rapid degeneration of the cerebellum. Anti Yo anti P/Q and Anti Hu are the most common antibodies in teh serum. (if you see cerebellar purkinje cell degen and theres a paraneoplastic tumor in the body think autoimmune is the etiology)

hashimoto thyroiditis

autoimmune; HYPOthyroidism; painless; positive TPO antibody; well developed germinal centers; Hurthle cells (eosinophilic epithelial cells)

familial adenomatous polyposis (FAP)

autosomal dominant disorder caused by germline mutation to the tumor suppressor gene adenomatous polyposis coli (APC gene). Patients with FAP develop hundred or thousands of colonic polyps (these polyps will develop into invasive cancer if not removed); lifetime risk of colon cancer is close to 100%.

essential fructosuria

benign disorder; fructokinase deficiency but hexokinase becomes primary pathway for converting fructose to fructose 6 phosphate

compound nevi

benign proliferations of melanocytes that involve both the dermis and epidermis. The lesions appear as slightly raised papules with uniform pigemntation and symmetrical sharp borders.

renal angiomyolipoma

benign tumor composed of blood vessels smooth muscle and fat. Bilateral ones are assoc with tuberous sclerosis, an autosomal dominant condition

isoproterenol

beta 1 and beta 2 agonist that causes increased myocardial contractility and decreased systemic vascular resistance (because beta 2 relaxes vascular smooth muscle)

Gonorrhea and ectopic pregnancy

beta HCG will be present; primary risk factor for EP is tubal scarring, and gonorrhea/ chlamydia are predisposing factors for this bc of pelvic inflammatory disease.

what do beta blockers do to the release of renin and how

beta blockers inhibit release of renin from renal juxtaglomerular cells through the antagonism of beta 1 receptors on these cells.

tx for essential tremor

beta blockers treat essential tremor. Propranolol, a nonselective beta blocker, is the most commonly used tx and prevents the interaction of epinephrine and NE with beta 1 and 2 to relieve the tremors. Inhibition of beta 2 in pts with airway disease can cause bronchocontriction.

drugs that have been shown to improve long term survival in pts with heart failure due to left ventricular systolic dysfunction

beta blockers, ACEI's, ARBs, and aldosterone antagonists.

marginal zone of the spleen

between the red and white pulp; contains macrophages and specialized B cells and is where APCs (antigen presenting cells) capture blood-borne antigens for recognition by lymphocytes.

loss of ciliated respiratory epithelial cells is assoc with which bacteria

bordatella pertussis (tractor cutting the grass in the middle of the road, tracheal toxin damages ciliated cells in the epithelium)

intraventricular hemorrhage with prematurity

born before 32 weeks, happens in first 5 postnatal days, hypotonia, decreased spontaneous movements, bulging anterior fontanelle, decerebrate posturing, seizures, and coma. The hemorrhage originates from the germinal matrix (in the subventricular zone from which neurons and glial cells migrate out during brain development).

presbyopia and skin wrinkles are related how

both age related changes that happen bc of structural proteins denaturing (i.e. loss of lens elasticity and loss of skin elasicity bc of collagen)

HbS and HbC

both from missense mutations. HbC is slower on gel; HbC: asympto, mild hemolytic anemia and splenomegaly

Secondary lactase deficiency

can occur after inflammatory (celiac disease) or infectious (giardiasis) processes damage the microvilli of the small intestines. Clinical presentation includes abdominal distension and cramping, flatulence and diarrhea.

hepatitis D

can only finish its replication cycle in the setting of coinfection with hepatitis B virus.

which STI's have no pain associated with their ulcers on the genitals?

chlamydia trachomatis (buboes), treponema (clean base), klebsiella (gram negative donovan bodies)

pt with fever, headache, and confusion is given penicillin and has reaction. Given a different antibiotic and gets better but has some anemia. What drug?

chloramphenicol

ADR of amphotercin B: it also binds...

cholesterol, causing toxicity to human tissues. The most important ADR's of it are nephrotoxicity, hypokalemia, and hypomagnesemia.

human chorionic gonadotropin

choriocarcinoma, germ cell tumor

wilms tumor aka nephroblastoma is what chromosome and what is the mnemonic

chrom 11, WAGR (wilms tumor, aniridia, GU malformation, and retardation)

causes of dilated cardiomyopathy

chronic alcohol abuse, beriberi (B1, thiamine def), coxsackie B, chronic cocaine use, chagas, doxorubicin toxicity

papillary thyroid carcinoma

cold thryoid nodule, previous radiation exposure (chemo), PTC is the most common form of thyroid cancer with an excellent prognosis. histo: "orphan annie" eye nuclei, nuclear grooves and pasmmoma bodies (extracellular, calcified, spherical bodies)

von willebrand factor normally binds to

collagen

post MI: 2 weeks-2 months

collagen deposition and scar formation

the principal site of uric acid precipitation is (in kidneys)

collecting ducts due to low urine pH

DCC

colon cancer; tumor suppressor gene

pts with diverticulitis should undergo which procedure after being stabilized

colonoscopy to rule out malignancy, especially if there is evidence of iron deficient anemia.

Epidermis layers:

come lets get sun burned (corneum, lucidum, granulosum, spinosum, basale) dorsum of hand does not have lucidum bc lucidum is in palms and soles)

asymptomatic left ventricular systolic dysfunction

common stage in the progression of heart failure. Neurohormonal mechanisms, including the sympathetic nervous system and renin-angiotensin-aldosterone system, help maintain the asytmptomatic period by increasing volume retention and peripheral resistance to maintain organ perfusion. Although these mechanisms are beneficial in the short term, they are ultimately deleterious, increasing hemodynamic stress and cardiac remodeling that eventually lead to decompensated heart failure.

rickets (kids)/ osteomalacia (adults)

deficiency of vitamin D

mosaicism

defined as the presence of multiple, genetically different cell lines within the body. It can result fom several processes, including chromosomal nondisjunction or a mutation during the first stages of embryonic development. Somatic mosaicism results in a mixture of normal and mutated somatic cells, often leading to a milder form of the disease.

tabes dorsalis

degeneration of the dorsal columns of the spinal cord and the dorsal roots. tertiary syphilis. sx: impaired proprioception and ataxia. caused by endarteritis obliterans of the microvasculature supplying the posterior columns and the dorsal root ganglia.

hypothyroid myopathy

delayed tendon reflexes (when knee reflex is elicited, the quad muscles contracts briskly but relaxation takes longer than normal)

varicose veins put people at high risk for what

edema, stasis dermatitis, skin ulcerations, poor wound healing, and infections.

efficacy vs potency

efficacy is a measure of the maximum pharmacodynamic effect achievable with a drug. Potency refers to the dose of drug that is required to produce a given effect (higher potency = lower ED50)

late onset cyanosis in 11 year old, continuous machine like murmur

eisenmenger syndrome (right to left shunt that started as left to right shunt) from a PDA (patent ductus arteriosis)

vibrio cholerae and enterotoxigenic e coli cause a purely toxin-mediated watery diarrhea. The toxins secreted modify

electrolyte handing by enterocytes but do not cause cell death, therefore no erythrocytes or leukocytes are noted on stool microscopy.

signs of MI

elevated CK, troponins, EKG abnormality, and persistant pain not alleviated with rest.

paranoid personality disorder

exhibits a lifelong pattern of pervasive suspicion and distrust. Unlike patients with psychotic disorders, they do not have fixed delusions and other psychotic sx.

which lipid lowering drug is assoc w gallstones

fibrates (gemfibrozil) bc it reduces cholesterol solubility and bile acid synthesis via inhibition of 7 alpha hydroxylase.

gower sign: what is the histo of the patients calf

fibrofatty muscle repplacement (pseudohypertrophy)

histo of a spleen from a pt with sickle cell disease

fibrosis and atrophy due to autosplenectomy. These pts are predisposed to infections with encapsulated bacterial organisms bc of this

holoprosencephaly mechanism

field defect (developmental field defect is from malformations secondary to embyronic disturbance - this one is incomplete division of the forebrain)

drug that decreases prostate volume

finasteride (5 alpha reductase inhibitor) ; alpha adrenergic antagonists like tamsulosin or terazosin will work acutely to relax and allow bladder outflow but they don't affect the prostate volume

the timeline of ischemic stroke repair in histo of brain

first 24 hours (red neurons); neutrophilis move in during the first 1-2 days; followed by microglia (3-7 days after event); foamy lipids accum from the breakdown of myelin;

edetate calcium disodium

first line treatment for lead poisoning; increases urinary excretion of lead.

deferoxamine

first line tx for iron overdose; it's a chelating agent that binds ferric irone to convert it to ferrioxamine which is excreted in urine

psoriasis tx

first line: topical corticosteroids and vitamin D analogs! Vit D analogs inhibit T cell and keratinocyute proliferation and stim keratinocyte differentiation.

acute gouty arthritis

first metatarsophalangeal joint; tenderness; needle shaped negatively birefringent crystals; 1st line: NSAIDs; 2nd line: colchicine

ulcers with undermining edges

flask shaped ulcers in entameoba histolytica

tx for giant cell arteritis

giant cell arteritis is assoc with IL-6 so tx is IL 6 inhibitor called tocilizumab

gilbert syndrome vs dubin johnson

gilbert: unconjugated, pts only have jaundice; dubin johnson: conjugated, pts only have jaundice

first objective sign of puberty in girls and boys

girls: breast bud development; boys: testicular enlargement

ischemic stroke: >2 weeks

glial scar formation (cystic area surrounded by dense glial fibers (from astrocytes) (>1 month)

pseudopallisading necrosis on histo

glioblastoma multiforme; shows areas of hemorrhage and necrosis on gross exam.

after irreversible neuronal damage (red nuerons; eosinophilic cytoplasm and basophilic nuclei) there is

gliosis/ astrocytosis forming a glial scar

rapidly progressive GN "crescents" consist of what?

glomerular parietal cells, lymphocytes, and macrophages, along with abundant fibrin deposition.

first sign of cellular damage is

hydropic change (cellular swelling) from ATP dependent Na K pump

vitamin C does what

hydroxylation of proline and lysine in procollagen.

aortic dissection

severe retrosternal pain that radiates to the back. From hypertension. Histo: cystic medial degeneration (necrosis), mucoid extracellular matrix with elastic tissue fragmentation and mucopolysaccharide.

proinsulin is cleaved where

in pancreatic beta cell secretory granules

chronic aortic stenosis + atrial fibrillation

in pts with chronic aortic stenosis and concentric left ventricular hypertrophy, atrial contraction contributes significantly to left ventricular filling. Loss of atrial contraction due to atrial fibrillation can reduce left ventricular preload and cardiac output sufficiently to cause systemic hypotension. decreased forward filling of the left ventricle can also result in backup of blood in the left atrium and pulmonary veins, leading to acute pulmonary edema.

parvovirus B19

in pts with sickle cel anemia and other chronic hemolytic disorders, the most common viral cause of an aplastic crisis is infection of ERYTHROID progenitor cells (erythrocytes) with parvovirus B19, a nonenveloped single-stranded DNA virus. It goes to the bone marrow and decreases the erythrocytes at the bone marrow.

varicella zoster virus

in the dorsal root ganglia (sensory neurons). Intranuclear inclusions in keratinocytes and multinucleated giant cells are on LM.

cortical follicles of the lymphnode

in the outer cortex and are a site for B lymphocyte proliferation.

haptan - penicillin

in the process of causing a type 2 HSR, such as penicllin induced autoimmune hemolytic anemia, penicillin is believed to act as a hapten, a molecule that cannot elicit an immune response on its own but can do so when protein is bound to it.

cystic fibrosis: sodium - what happens to it in the skin vs the lungs

in the skin: sodium is NOT reabsorbed so you lose sodium; in the lungs: sodium IS reabsorbed with water so you get dry, thick mucus in the lungs; so you get hyponatremia on hot summer days when you sweat a lot

hyperplastic ateriolosclerosis

in unilateral renal artery stenosis, the affected kidney is protected from high blood pressure by the narrowing of its renal artery and may suffer ischmeic damage. In contrast, the contralateral well-prefused kidney typically shows changes of hypertensive nephropathy (i.e. hyaline or hyperplastic arteriolosclerosis)

opioids can cause biliary colic bc of

smooth muscle contraction at the sphincter of Oddi.

colchicine moa

inhibits CYTOSKELETON; i.e. inhibits tubulin polymerization into microtubules and can be used for acute treatment and prphylaxis of gout. Side effects: nausea, abdominal pain and diarrhea.

foscarnet

inhibits dna pol in herpes and reverse transcriptase in HIV

biochem of lead toxicity

inhibtis ferrochelatase and delta aminolevulinic acid (ALA) dehydratase, resulting in anemia, ALA accumulatuon and elevated zinc protoporphyrin levels.

gastric bypass at the cardiac part of the stomach, where does the band pass thru to do this

lesser omentum

antiarrhythmic agent that binds rapidly depolarizing and ischemic ventricular myocardial fibers and has minimal effect on normal ventricular myocardium

lidocaine (binds inactivated Na channels and rapidly dissociates).

dicumarol

like coumadin aka warfarin which prolongs PT time

aldosterone escape

limits the hypernatremia and hypovolemia in hyperaldosteronism bc ANP causes fluid loss via kidneys and sodium excretion

EBV is double stranded DNA (linear or circular) virus

linear

moa of skeletal muscle's resistance to verapamil's effects

little dependence on extracellular calcium influx bc skeletal muscle calcium release by the sarcoplasmic reticulum is triggered by a mechanical interaction between L type and RyR calcium channels.

fulminant liver failure

liver makes all the clotting factors so they would be messed up

polycystic kidney disease will also show cysts in the

liver; mutation is PKD1 or PKD2

wchich pharmakodynamic principle is not affected by clearance

loading dose (=Css x Vd)

macula densa

located where the glomerulus touches the distal convoluted tubule

if mechanical/ prosthetic heart valve and anemia with helmet cells or burr cells think

mechanical trauma to the RBCs causing traumatic hemolysis

meckel's vs colonic diverticulosis

meckel's diverticula present in early childhood and are in the small intestines (and contains all 3 layers - mucosa, submucosa and muscularis layers). Colonic diverticula present in older people and are colon outpouchings (just mucosa and submucosa). Both can present with diverticulitis, pain, hematochezia (blood in the feces).

superior vena cava syndrome

mediastinal mass obstructing flow from SVC to heart causing facial swelling and edema

ventromedial nucleus (hypothalamus)

mediates satiety; destruction leads to hyperphagia

mediolateral episiotomy vs midline episiotomy

mediolateral: cut transverse perineal muscle; midline: cut perineal body

most common childhood tumors found int he cerebellar midline

medulloblastoma

medulloblastoma vs pilocytic astrocytoma

medulloblastoma: second most common brain neoplasms of childhood. Located in the cerebellum, often at the vermis, and has sheets of small, blue cells. Like other PNET tumors, medulobastomas are poorly differentiated and have a bad prognosis. PNETs on histo: (primitive neuroectodermal tumors) sheets of primitive cells, with many mitotic figures, deeply basophilic nuclei and scant cytoplasm (small, round, blue cells). These are aggressive tumors. Pilocytic astrocytomas are similar but have diff histo and good prognosis (rosenthal fibers).

hypersegmented neutrophils

megaloblastic anemia

turner syndrome (i.e. 45,X) occurs via what genetic process?

meiotic nondisjunction

Nevi that are enlarging rapidly

melanoma

BRAF

melanoma; protooncogene

cystic fibrosis:

membrane channel misfolding

korsakoff syndrome: permanent part

memory loss and confabulation

genetics for MEN 1 vs 2:

men 1: men1 gene; men2 A and B: RET gene (codes for tyrosine kinase)

phlegmasia alba dolens

painful white milk leg; acute rise in tissue pressure that impairs arterial inflow; caused by massive iliofemoral thrombosis

CYP450 inducers: most chronic alcoholics steal phen phen and never refuse greasy carbs

modafinil, chronic alcohol use, St john's wort, phenytoin, phenobarbital, nevirapine, rifampin, griseofulvin, carbamazapine

nuclear factor kappa B (NF - KB)

transcription factor with a role in immune response to infection. NF-KB is present in cytoplasm in a latent, inactive state bound to its inhibitor protein, IKB. Extracellular substance such as lipopolysaccharide can intitiate a signal cascade that results in the dstruction of IKB and translocation of free NF-KB to the nucleus.

TATA box

transcription initiation; promoter region that binds transcription factors and RNA polymerase II during the initiation of transcription. It is located approx 25 bases upstream from the beginning of the coding region.

amaurosis fugax

transient (<30 min) monocular loss of vision due to embolic occlusion of the ophthalmic artery.

CN IX sensory distribution

pain during swallowing and radiating toward the ear. it innervates stylopharyngeus muscle (derived from pharyngeal arch 3), which elevates the pharynx and larynx during swallowing and speaking.

pathogenesis of alcohol-induced hepatic steatosis

related to decrease in free fatty acid oxidation secondary to excess NADH production by the 2 major alcohol metabolism enzymes, alcohol dehydrogenase and aldehyde dehydrogenase

beta 2 agonism

relaxes vascular smooth muscle, leading to decreased vascular resistance and mean arterial blood pressure.

pulmonary artery catheterization: right ventricle pressure readings

right ventricle will go from 25 to 2

right coronary artery gives off marginal branches that supplies most of the right ventricle so therefore inferior wall MI is assoc with

right ventricular infarction

whole body cyanosis

right-to-left shunting in patients with large septal defects and tetralogy of Fallot

right vs left sided colon cancers

right: occult bleeding and sx of iron deficient anemia; left: infiltrate the intestinal wall and cause constipation and sx of intestinal obstruction

aspiration pneumonia

risk factor is dysphagia (sometimes happens in elderly people with dementia or hemiparesis). Dependent lung consolidation is seen in aspiration pneumonia.

focal segmental glomerulosclerosis

risk factor: african american

squamous cell carcinoma of the esophagus

risk factors: alcohol, smoking, foods containing N-nitroso; youll see keratin pearls on histo; assoc with mediastinal lymphadenopathy

tx for large B lymphocyte lymphoma

rituximab (recombinant anti-CD20 antibody). side effects: low blood pressure, bronchospasm, chills and decreased blood platelets, lymphocytes and neutrophils.

davenport diagrams DKA

DKA: metabolic acidosis bc DKA but kussmaul breathing = drop in PaCO2.

a fragment of nucleic acid, combined with a polymerase, a primer, and deoxyribonucleotides. the tube theyre in contains four bases that are flourescently labeled. run thru a capillary and laser detects flourescence.

DNA sequencing; determines the order of nitrogenous bases in a given segment of DNA. The process uses tagged dideoxynucleotides to randomly terminate growing strands of DNA and represent the sequence of nucleotides in the DNA fragment.

hep B genome replication process

DS dna -> + sense RNA template -> PARTIALLY DS dna progeny (reverse transcriptase)

subcutanous lipoatrophy or lipodystrophy and central fat deposition

Highly active antiretroviral therapy (HAART) for HIV is commonly associated with body fat redistribution. Subcutaneous lipoatrophy involving the face and extremities is associated with nucleoside reverse transcriptase inhibitors (especially stavudine and zidovudine) and protease inhibitors. Central fat accumulation in the trunk and viscera can occur with any HAART regimen.

how does the IgA protease allow N meningites to colonize the nasopharyngeal region

IgA protease and pili cleave immunoglobulin into Fab and Fc fragments

most important opsonins

IgG and C3b (opsonization is when host proteins bind foreign cell to promote phagocytosis)

what type of antibody is assoc with PSGN

IgG immune complex deposits

which types of Ig antibodies does the baby get from mom

IgG only

Ventral posterior Medial nucleus - M mnemonic

Makeup goes on the face (face sensation and taste from the trigeminal and gustatory pathways)

gamma carboxylation of glutamic acid

vitamin K is a necessary cofactor for the gamma carboxylation of clotting factors (II, VII, IX, and X) by epoxide reductase. Vitamin K is admin at birht to prevent hemorragic disease of the newborn.

chronic liver disease can cause a deficiency in

vitamin K-dependent clotting factors, leading to an increased prothrombin time. later, with disease progression, PTT time will be prolonged as well.

exclusively breast fed infants need supplementation with...

vitamins D (to prevent rickets) and K (to prevent hemorrhagic disease of the newborn)

VHL

von hippel lindau syndrome, renal cell cancer; tumor suppressor gene

mycoplasma pneumoniae

walking pneumonia; nonproductive cough; military recruits <30 y/o; chest x ray shows severe pneumonia even tho pt is relatively well appearing. It requires cholesterol supplementation to grow on artificial media.

VIPoma - causes verner morrison syndrome (WDHA)

watery diarrhea, hypokalemia, achlorhydria (absence of HCl in the gastric secretions)

post MI: 4-12 hours

wavy fibers with narrow myocytes, early coagulation necrosis, edema, hemorrhage

post MI: 10-14 days

well developed granulation tissue with neovascularization

davenport diagram

when acute, look at the pH to be Not compensated for yet.

transformation

when bacteria take up exogenous DNA fragments, integrate the DNA into its genome and express the encoded proteins. Through this method, nonvirulent strains of S penumo that do not have a capsule can make one. (gain virulence). (bacteria that have the innate capacity to do this are haemophilus, streptococcus, bacillus, and neisseria species). Does not alter the genome of the progeny virions however.

IgM can bind how many antigens

when its bound to B cells, its a monomer (binds 2 antigens), but when freely circulating in serum, its a pentamer and can bind 10 antigens

permissiveness

when one hormone allows another to exert its maximal effect (i.e. you give the oroginal hormone and then you give that same hormone with another one and the effect is greater).

lactic acidosis in septic shock

results from tissue hypoxia, which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis. Hepatic hypoperfusion also contributes to the buildup of lactic acid as the liver is the primary site of lactate clearance.

calcitriol

the active form of Vitamin D

C5b-C9 deficiency

these pts have recurrent infections by Neisseria species. They cannot form the membrane attack complex (MAC).

dihydrofolate reductase

trimethoprim, methotrexate and pyrimethamine inhibit this. Trimethoprim restrics bacterial growth through this process and works particularly well in conjunction with solfonamide, which inhibits an earlier step in the bacterial folic acid pathway.

Zollinger Ellison syndrome

"caused by gastrinomas located in the small intestine/ pancreas and presents with peptic ulcers (especially distal duodenal ulcers), heartburn, and diarrhea. Patients typically have elevated gastrin levels that rise in response to exogenous secretin administration. In contrast, secretin inhibits release of gastrin from normal gastric G cells.

cryptococcus neoformans

"common cause of meningoencephalitis (headache, vomiting, confusion, seizure) in pts with untreated AIDS. The yeast can be visualized in the CSF by india ink or silver stain. It is a round/ oval yeast with a thick polysacchariade capsule.

Statins

"common side effect: statin-induced myopathy (i.e. myalgia, elevated creatine kinase) is the most common complication of statin use.

c-anca vs p-anca

C-anca is in the cytoplasm of neutrophils; p-anca is PERINUCLEAR (i.e. right aqround the nucleus) of the neutrophils (theyre both in the cytoplasm)

tx for preventing recurrence of adenomatous polyps

COX2 inhibitors; adenomatous polyps contain dysplastic mucosa and are premalignant. Regular screening with timely excision of pilyps is effective for prevetnion of colon adenocarcinoma. Studyuies have linked increased activity of COX 2 to some forms of colon adenocarcinoma and suggest that regular aspirin use decreases adenomatous polyp formation.

pulsus paradoxus is defined by

a decrease in systolic blood pressure of >10 mmHg with inspiration.

mixed venous oxygen tension

a measure of the oxygen usage of tissues in the body; in cardiogenic shock you have decreased CO->decreased O2 delivery ->decreased SvO2 (mixed venous oxygen tension)

medication induced IgE-independent mast cell activation

a number of meds including opioids, radioconstrast agents and some antibiotics (i.e. vancomycin( can trigger IgE indpendent mast cell degranulation. Common sx include diffuse itching and pain, bronchospasms and localized swelling (urticaria).

what is the ONLY pediatric infectious disease/ illness in which aspirin is used?

Kawasaki's disease (fever of 5+ days).

most common cause of bronchiolitis (rhinorrhea, cough, fever, and decreased appetite) in infants and young children <5 years old is

RSV; patho: surface protein F, which causes nearby cells to merge and induces the characteristic syncytial appearance in pathology.

Ras - MAPK

Ras is active when boudn to GTP and inactive when boudn to GDP

75% of drug cleared is how many half lives

2

men 2A

2 P's: pheochromocytoma, parathyroid hyperplasia, medullary thyroid cancer

schizophreniform

2 or more sx of schizoprehnia for 1-6 months

acute rheumatic fever

2-4 weeks after group A step pharyngitis, molecular mimicry (attacks heart and brain) -> (acute) sydenham chorea (basal ganglia affected) (jerky involuntary movements), pancarditis, migratory arthritis; tx: penicillin

a decrease in which molecule/ substance is known to be associated with decreased sleep duration in elderly?

acetylcholine in the reticular formation induces REM sleep. Natural aging is assoc with lower levels of ACh and decreased sleep (REM and Overall) duration.

toxin B of clostridium difficile causes

actin depolymerization, disruption of the cytoskeleton integrity, leading to apoptosis and cell death.

pulmonary actinomycosis

actinomyces can be aspirated and shows lower lobe consolidation with air bronchograms. Look for dental stuff in addition to lung stuff.

which factor of melanoma is assoc with highest risk of mets

active vertical growth

most important predictor of success in the rehabiliation of surgery patients with fractures

activity level before the fracture

biotin (vitamin B7)

acts as a CO2 carrier on the surface of carboxylase enzymes and is an effential cofactor for numerous reactions, including the conversion of pyruvate to oxaloacetate and fatty acid metabolism. Excess ingestion of avidin, found in egg whites, has been associated with biotin deficiency. This condition presents with mental status changes, myaglias, anorexia, macular dermatitis, and lactic acidosis.

antidiuretic hormone

acts on the medullary segment of the collecting duct to increase urea and water reabsorption, allowing for the production of maximally concentrated urine.

abdominal aorta aneurysm is assoc with (risk factors)

age>60, smoking, HTN, male sex, family history; these lead to chronic transmural inflammation and extracellular matric degradation whithin the wall of the aorta. This leads to weakening and progressive expansion of the aortic wall, resulting in aneurysm formation, typically below the renal arteries.

moa of macrolides causing diarrhea

agonistic activity on motilin receptors

ADR of graves tx (i.e. antithryoid drugs (i.e. methimazole and propylthiouracil))

agranulocytosis (sx: fever, sore throat and throat ulcerations

ADRs to monitor with different SGAs (second gen antipsychotics)

agranulocytosis with clozapine; prolactinemia with risperidone, severe weight gain with olanzapine; hyperlipidemia with quetiapine.

dihydropterin reductase

aka BH4; deficiency in the enzyme phenylalanine hydroxylase leads to the buildup of phenylalanine and PKU. a more severe form, malignant PKU, occurs when BH4, a cofactor for phenylalanine hydroxylase, is absent.

homocysteine gets converted to

methionine

aminoglycosides - moa of resistance in some bacteria is

methylation of the aminoglycoside binding portion of the ribosome which inhibits the abiliuty of aminoglycoside to interfere with protein translation

vitamin B12 deficiency will have elevated levels of

methylmalonic acid and homocysteine levels

sickle cell anemia (mutation type)

missense mutation in 6th position of the beta chain of hemoglobin

irreversible myocardial cell injury is indicated by what histo/ structural changes

mitochondrial vacuolization

glioblastoma

most common primary cerebral neoplasm of adults that is typically located within the cerebral hemispheres and may cross the midline (butterfly glioma - across the corpus callosum). These tumors are highly malignant and grossly contain areas of necrosis and hemorrhage. sx: seizures, headache, memory loss and weakness

adenocarcinoma

most common primary lung cancer in the general population, women and nonsmokers. Epidermal growth factor receptor (EGFR) mutations and ALK gene rearrangement are seen more commonly in nonsmokers and thought to contribute to disease formation in this subgroup. Adenocarcinoma is typically located peripherally and may be assoc with clubbing or hypertrophic osteoarthropathy.

Essential thrombocythemia

myeloproliferative disorder characterized by increased platelets in the pheripheral blood and increased megakaryocytes in the bone marrow. Patients may be asymptomatic, or they may present with signs and sx of increased bleeding and/or thrombosis.

polycythemia vera

myeloproliferative disorder, uncontrolled erythrocyte production. Sx: aquagenic pruritis, facial plethora, (reddish complexion), and splenomegaly. Assoc with ulcers and arthritis bc of RBC turnover. Labs: increased erythrocytes, thrombocytosis, leukocytosis, and low erythropoetin levels. caused by abnormal janus kinase 2 (JAK2) and cytoplasmic (nonreceptor) tyrosine kinase. theres a mutation in JAK2 that causes constitutive activation.

key immune player in the formation of lung abscesses (cell)

neutrophil (releases cytotoxic granules that kill bacteria but also cause liquefication necrosis of tissue)

ischemic stroke: 24 - 72 hours

neutrophilic infiltration

erosive esophagitis

new onset odynophagia in the setting of chronic gastroesophageal reflux disease should raise suspicion for erosive esophagitis with esophageal ulcers. Diagnosis is made by upper endoscopy.

phenotypic mixing

no genetic exchange; coinfection of a host cell by 2 viral strains so it has proteins from one strain and unchanged parental genome of the other strain. Bc there is no change in the underlying viral genomes, the next gen of virions revert to their original unmixed phenotypes

nephrolithiasis

no temp, occasionally writhes in pain, cant get comfortable

shigella

non-motile, non-lactose fermenting organism that does not produce H2S when grown on triple sugar iron agar. Mucosal invasion of the M cells that overlie Peyer's patches is an essential pathogenic mechanism for Shigella infection. Shigella then escapes the phagosome and spreads laterally to other epithelial cells via actin polymerization.

neuromuscular blocking agents (anesthesia-related medications): which ones are myasthenia gravis patients more sensitive to?

nondepolarizing neuromuscular blockers (vecuronium, rocuronium) are the ones that MG pts are more sensitive to bc there are fewer receptors in MG. depolarizing neuromuscular blockers (succinylcholine) need LARGE doses/ amt of receptors bound to be a muscle relaxant so therefore since theres a low amt of receptors in MG, MG pts will be resistant to these effects bc the succinylcholine gets washed away before it can be a 'blocker'.

proliferative vs nonproliferative diabetic retinopathy

nonproliferative first: (early disease) thickening of the basement membrane, cotton wool spots and microaneurysms and dot-blot hemorrhages. Proliferative after (advanced disease): neovascularization of retinal vessels due to ischemia,

in the absence of an underlying metabolic disorder, a pt with calcium stones has what calcium levels

normocalcemia (bc of regulatory mechs), hypercalciuria

hemorragic mediastinitis, enlarged area of opacification between the lungs (mediastinal widening), bloody pleural effusions

bacillus anthracis, a gram positive rod with a protein capsule, whose spores are often transmitted from sheep or goat skin

two high risk consequences of coarctation of the aorta

bacterial endocarditis and cerebral hemorrhage

the reason its 2/3s for auto recessive that's not affected

bc if they were affected it would show that they had the auto recessive disease in the pedigree. Therefore the chances of them being a carrier is 2 out of 3 possibilities left.

why does erythroblastosis fetalis and hemolytic disease of the newborn occur in moms with type O blood, but not in moms with type A or B?

bc in type A and B blood, moms have IgM and it cant cross the placenta. In type O moms, they have IgG which does cross the placenta

spider angiomata are related to gynecomastia why?

because their both in alcohilism and both caused by overabundance of estrogen (liver cirrhosis)

fourth heart sound (S4)

before S1; atrial contraction as blood is forced into a stiff ventricle (from long standing hypertensive heart disease)

lentigo

benign linear melanocytic hyperplasia

acid base physio

bicarb and co2 ALWAYS go the same direction when compensation has occurred (in both metbaolic and respiratory)

what is the main way that you transport CO2 in the blood

bicarbonate! (second most common: carbaminohemoglobin)(third most common is CO2 dissolved in blood)

CA-125

biomarker for ovarian cancer

highest osmolarity in the nephron

bottom of the loop of henle (bc it's the most concetrated)

isoniazid (INH)

can be directly hepatotoxic, causing acute, mild hepatic dysfunction in 10%-20% of patients and frank hepatitis (fever, anorexia, and nausea, sometimes progressing to hepatic failure) in a small percentage of patients.

bacterial mRNA

can be polycistronic meaning that one mRNA codes for several proteins. An example of polycistronic mRNA is the bacterial lac operon, which codes for proteins necessary for lactose metabolism by E Col, the transcription and translation of these bacterial proteins is regulated by a single promoter, operater and set of regulatory elements.

gonorrhoeae triad

can be prevented with use of condoms; spreads thru bloodstream after GU infection. Leads to triad: polyarthralgia, tenosynovitis and dermatitis (or purulent arthritis)

mitochondrial inheritance

can have variable expressivity and incomplete penetrance therefore some members of children might not be affected in pedigree

Erythropoiesis stimulating agents (ESAs)

can improve anemia sx, avoiding the need for blood transfusions in chronic kidney disease and dialysis pts. However ESAs are assoc w increased risk for HTN and thromboembolic events.

case control vs cohort

case contrOl: odds ratio; cohoRt: relative risk

etanercept (TNFalpha inhibitor)

causes a drug-induced lupus like syndrome

ALS (amyotrophic lateral sclerosis)

causes both upper and lower motor neuron lesions. Loss of neurons of the anterior horns of the spinal cord (LMN lesion) causes muscle weakness and atrophy. Demyelination of the lateral corticospinal tract (UMN lesion) leads to spasticity and hyperreflexia.

aspergillus fumigatus

causes eosinophilia, bronchiectasis in ppl with history of asthma

carbon tetrachloride poisoning

causes free radical injury to the liver via the P450 oxidase system. This results in lipid peroxidation (lipid degradation and hydrogen peroxide formation). Causes fatty change and hepatocyte necrosis.

taenia solium

causes neurocysticercosis (cystic brain lesion); it's a pork tapeworm. Get it from eating poop of infected person (bc it has t solium eggs in it). Central and south america. Causes seizures, vignette: immigrant; risk factor: exposure to infected stool.

trazodone

causes priapism (persistent erection)

polymyositis

causes symmetric proximal muscle weakness. Muscle biopsy reveals inflammation, necrosis and regeneration of muscle fibers. Over-expression of MHC-1 class proteins on the sarcolemma leads to infiltration with CD8 T cells and myocyte damage.

mulberry like appearance

cavernous hemangioma

most common benign liver tumor

cavernous hemangioma (blood filled vascular spaces on histo)(don't biopsy bc it doesn't help and it just leads to fatal hemorrhage)

HLA DQ2 and DQ8

celiac disease

anti-gliadin/ anti-tTGA

celiac disease

blunting of intestinal villi and lymphocytic infiltration in the lamina propria on histo; watery diarrhea, erythematous vesicular rash

celiac sprue (celiac disease); autoimmune mediated intolerance to gliadin (wheat); dermatitis herpetiformis is a skin condition seen in 25% of pts with celiacs and appears as pruritic, vesicular rash on extremities.

mycoplasma has no

cell wall. Therefore theyre resistant to agents that target the cell wall (like penicillin and carbapenems). Tx them with tetracyclines or macrolides. (they include ureaplasma urealyticum)

low grade CIN

cells have not invaded past the lower one third of the cervical epithelium, these usually regress spontaneously

cherry red spot at fovea (center of macula) & acute painless monocular vision loss

central retinal artery occlusion

deferoxamine

chelating agent for iron overdoses or overload due to multiple blood transfusions. It facilitates iron's urinary excretion.

endometrioma

chocolate colored fluid inside an ovarian cyst

the duodenum secretes

cholecystokinin

donepazil

cholinesterase inhibitor; for alzheimers disease

markers for neuroendocrine tumors

chromogranin A and synaptophysin

pancreatic pseudocyst

common complication of acute pancreatitis. It is a collection of fluid rich in enzymes and inflammatory debris. Its walls consist of granulation tissue and fibrosis. Unlike true cysts, pseudocysts are not lined by epithelium.

congestive hepatopathy

common complication of right sided heart failure. Patchy hemorrhage and necrosis predominantly affect the centrilobular regions (zone 3) where hepatic congestion is most prominent. The centrilobular necrosis combined with relatively normal appearing periportal regions (zone 1), creates an overall heterogenous appearance sometimes referred to as "nutmeg liver".

hepatocellular carcinoma

common in HCV pts; fibrosis and worse cirrhosis, fatigue, variceal bleeding, jaundice, liver mass will show clusters of cells with pleomorphic, prominent nucleoli features.

postherpetic neuralgia

common with herpes zoster infections in which pt will have neuropathic pain in the affected region later on.

chi square

compares 2 categorical variables (qualitatitive)(i.e. two groups - one group of fibrinogen between 200-400, etc)

paroxysmal noctural hemoglobinuria

complement mediated hemolysis. Classic triad: hemolytic anemia (hemoglobinuria), pancytopenia, and thromobosis at atypical sites. Chronic hemolysis can cause iron deposition in the kidney (hemosiderosis). GPI (glycosylphosphatidylinositol) normally anchors CD55 and CD59 to the RBC membrane, inhibiting complement deposition. Absence of CD55 and CD59 allows MAC to form. all this is from a mutation in the PIGA gene.

compliance

compliance = delta V/ delta P ....volume and pressure

adult type coarctation of the aorta ppl are at increased risk for

congenital berry aneursyms and rupture of those which causes intracranial hemorrhage.

baby has: retinal lesions, hydrocephalus, jaundice and hepatosplenomegaly

congenital toxoplasmosis; this is why pregnant women should avoid raw or undercooked meat and cat poop.

adenovirus

conjunctivitis, sore throat, kids, crowded quarters,

theca externa does what

connective tissue capsule

dysfunction of motor or senosory systems without a physiologic cause, often following an acute stressor; normal DTRs and normal sensation.

conversion disorder

pegloticase or rasburicase moa

converts uric acid into more soluble metabolites (i.e. allantoin)

direct antiglobulin test

coombs test for ABO incompatability

penicillamine

copper chelator, tx for wilson disease

debranching enzyme deficiency

cori disease; hypoglycemia, hepatomegaly, hypotonia, inability to degrade alpha 1,6 glycosidic branch points in glycogen. Ketoacidosis.

left ventricular mural thrombus

dilated cardiomyopathy results from primary mycoardial dysfunction leading to eccentric remodeling of the left ventricle. Pts can develop left ventricular mural thormbus and are at risk for sudden cardiac death due to ventricular arrhthmia. Familial dilated cardiomypathy is tyically inhereited in an autosomal dominant pattern and most commonly results form truncating mutations of the TTN gene that codes for the sarcomere protein titin.

intrinsic acute renal failure

diminished renal reabsorptive capacity (i.e. lower urine osmolarity, higher urinary sodium, normal serum BUN/Cr)

pt has megaloblastic anemia (>100). What is causing this?

diminished synthesis of purines and pyrimidine bases in the synthesis of DNA due to deficiency of B12 of folate

tx for diptheria

diptheria antitoxin (preformed antibody admin to bind bacterial product aka the toxin) AND antibiotics (penicillin, erythromycin - to prevent more bacterial cell growth). The antitoxin will prevent the systemic complications of the infection in the pt

direct vs indirect bili

direct is conjugated and indirect is unconjugated

a single brain abscess (i.e. a solitary ring enhancing lesion) is caused by

direct spread of a contiguous infection. Temporal lobe abscess is usually a result of otitis media that has spread to the mastoid air cells. Frontal lobe abscess is usually due to ethmoid or frontal sinusitis.

heparin induced thrombocytopenia is tx with

direct thombin inhibitors like argatroban

indirect vs direct sympathomimetics

direct: (epinephrine, dopamine, NE) do not enter CNS as readily and are more selective bc they bind directly to postsynaptic receptor indirect: (cocaine, amphetamine, ephedrine) enter CNS, not as predictable

what skin condition is assoc with celiac disease

dermatitis herpetiformis (erythematous pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces. IgA antibodies against gliadin (gluten portion of wheat) or tissue transglutaminase complex in the intestine cross react with epidermal transglutaminase.

anti-Jo-1 autoantibody

dermatomositis manifests with muscle weakness, heliotrope rash (specific for this condition) and elevated muscle enzymes. Assoc w anti Jo1 antibody.

tx for severe bleeding in pts with von willebrand disease

desmopressin is a synthetic analog of ADH.it increases the release of vWF from storage sites and vWF is involved in both platelet aggregation and the utilization of factor VIII.

secondary vs tertiary prevention

detection of a disease at an early stage when a disease is easier to treat or cure. tertiary prevention: aimed at reducing complications or recurrence of or disability from, a pre-existing disease.

Southwestern blot

detects DNA bound proteins

western blotting

detects protein; proteins are seperated by gel elctrophoresis, then transferred to nitrocellulose membrane and probed with primary antibody specific for the protein of interest. The marked antibody goes on that.

ELISA

detects specific antigen or antibody. enzyme linked immunosorbent assay; measures the amt of protein in body fluids. (i.e. insulin levels)

axillary lymphnode dissection is a risk factor for the devel of chronic lymphedema in the ipsi arm and this predisposes to

devel of angiosarcoma (stewart treves syndrome)

hepatic abscess in developed vs undeveoped countries

developed: staph aureus; undeveloped: entamoeba histolytica

xeroderma pigmentosum

develops due to a defect in nucleotide excision repair via a UV specific ENDONUCLEASE (these pts are deficient in this endonuclease). Characterized by increased sensitivity to ultraviolet radiation and a high incidence of cutanous malignancy. Pts present with hyper or hypopigmented skin, telangiectasias, NEVI THAT ARE ENLARGING RAPIDLY = melanomas

hyaline artiolosclerosis is assoc with

diabetes (malignant hypertension causes fibrinoid necrosis and is a more acute thing - shows onion skinning on histo)

an individual with a point mutation affecting the gene responsible for neurophysin synthesis is most likely to suffer from

diabetes insipidus (neurophysins are carrier proteins for oxytocin and vasopressin)(Di is from insufficiency ADH release)

neuropathy in diabetes is caused by

diabetic microangiopathy which leads to nerve ischemia (endoneural arteriole hyalinization). Another pathogenetic factor is the accumulation of sorbitol, which leads to osmotic nerve injury. The symmetric peripheral neuropathy is common.

heroin withdrawal

diarrhea, dilated pupils, yawning, lacrimation

heart failure with preserved ejection fraction

diastolic dysfunction that occurs in the setting of prolonged systemic hypertension due to concentric left ventricular hypertrophy. Patients with longstanding hypertension have increased systemic vascular resistance. Can also be caused by: amyloidosis, sarcoidosis, and hemochromatosis.

low calcium diets - stones

dietary calcium binds oxalate in the gut to form unabsorbable calcium oxalate. Low calcium diets lead to increased absorption of free oxalate, which is then excreted in the urine; the resulting hyperoxaluria promotes the formation of caclium oxalate stones. Low calcium diets are therefore paradoxically assoc with increased risk fo stone formation.

thalassemias genetic

different mutations that encode the globin subunits of hemoglobin, this usually occurs due to a single base substitution that can form an abnormal splice site.

cirrhosis

diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous-lined parenchymal nodules. Chronic viral hepatitis (i.e. hepatitis B and C), alcohol, hemochromatosis, and nonalcoholic fatty liver disease are the most common causes of cirrhosis in the US.

acute cellular rejection of renal allograft is associated with

diffuse lymphocytic infiltration of the renal vasculature (endotheliitis), tubules, and interstitium.

syphilis

diffuse rash (palms and soles); lymphadenopathy; chancre; histo: proliferative endarteritis with a surrounding plasma cell infiltrate. Most syphilis sx are due to localized tissue ischemia resulting form endarteritis.

membranous glomerulopathy

diffuse thickening of the GBM; grnaular deposits of IgG and C3; spike and dome appearance on EM

arteries in lung segments

each lung segment is supplied by a tertiary bronchus and two arteries (one bronchial and one pulmonary), all of which run together in the center of the segments. Veins and lymphatics drain together along the edges of the segments.

major depressive disorder - sleeping pattern

early morning awakenings, terminal insomnia (once you wake up you can't get back to sleep), increased REM sleep time, decreased N3

cytokeratin positive staining means what

epithelial cell lineage

CIN is confined to what layer of skin

epithelial layer, if it invades past this its invasive carcinoma. cervical intraEPITHELIAL neoplasia...greater than 1/3 = high grade CIN

the presence of acute phase reactants increases the

erythrocyte sedimentation rate (a nonspecific marker for inflammation)

reason why women on birth control or pregnant women get gall stones

estrogen induced choleterol hypersecretion and progesterone induced gallbaldder hypomotility.

most common inherited cause of intellectual disability

fragile X syndrome (CGG trinucleotide repeat) Chin protruding and giant gonads - this geentic defect causes hypermethylation of the FMR1 gene.

what type of mutation is responsible for the CFTR mutaiton in cystic fibrosis

frameshift mutation

acute rejection of transplant

happens in first 6 months, perivascular and interstitial mononuclear cell infiltrates.

HLA DR5

hashimoto thyroiditis (also HLA DR3). DR5 pts are at aincreased risk fo developing pernicous anemia as well.

pes cavus

high plantar arch

heterophile antibody test

highly sens/spec for EBV infection. Sheep/ horse antigens mixed w EBV human blood makes agglutination.

alzheimer's disease: where does the brain atrophy first and most

hippocampus

coal workers pneumoconisosis

histo shows black, carbon laden macrophages (coal macules).

esophageal squamous cell carcinoma

histo: abundant eosinophilic cytoplasm and areas of keratinization (keratin pearls) and intercellular bridges. Patients typically present with progressive solid and eventually liquid dysphagia and weight loss. This is a malignancy with a poor prognosis.

berylliosis

histo: noncaseating epitheloid granulomas without obvious associated particles.

mitral regurgitation

holosystolic; radiation to the axilla; can happen bc of rheumatic heart disease

secretin

hormone released from the duodenum in response to acid and fat in the small intestine. The hormone increases pancreatic bicarbonate secretion and inhbits the release of gastrin from normal gastric G cells.

bone marrow biopsy for aplastic anemia/ idiopathic aplastic anemia

hypocellularity and an abundance of fat cells

beta thalassemia

hypochromic, microcytic anemia due to decreased beta globin chain synthesis. Unpaired alpha chains precipitate within red cells and cause membrane damage, leading to ineffective erythropoiesis and extravascular hemolysis.

moa of mallory weiss tears

increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining. (occur at the esophago gastric junction)

csf in herpes encephalitis

increased lymphocytes and erythrocytes

emphysema, which can present with dyspnea, prolonged expiratory time, pursed lip breathing, and barrel chest is a form of COPD. In pts with emphysema, _ destroys alveoli

increased protease activity in the lungs destroys alveoli, resulting in a decreased surface area for gas exchange.

things that prevent renal stones

increased urinary citrate concentration and high fluid intake

tx's to slow fibrosis

inhibit TGF-beta and other fibrogenic growth factors (PDGF, fibroblastic growth factor and VEGF).

tx for pyruvate dehydrogenase deficiency

ketogenic diet

parvovirus B19

kids get: slapped cheek that spreads down body; adults get: arthritis, joint pain

hemidesmosomes

link cells to basement membrane via integrins, the transmembrane anchor proteins. Autoantibodies to these proteins cause bullous pemphigoid and pemphigoid gestationis.

linoleic and alpha linoleic

linoleic (omega 6) and alpha linoleic (omega 3). These are the two essential fatty acids

major virulence factor of N meningitides

lipooligosaccharide in the outer membrane

contaminated foods with generalized rash, pregnant, fever, (outbreak)

listeria monocytogenes

proteins (including the acute phase reactants (CRP, IL6, Hepcidin) are made where (and the clotting factors)

liver

lower quadrantanopia vs upper

lower: parietal lesion; upper: occipital lesion

common anaerobic bacteria involved in a lung abscess

lung abscess is usually caused by aspiration of anaerobic oral bacteria such as peptostreptococcus, prevotella, bacteroides, and fusobacterium.

most common site of mets for an osteosarcoma

lung bc its hematogenous spread and its like a DVT going to the lungs first

#1 cause of death for men and women in america

lung cancer (from smoking)

RAS

lung cancer, colon cancer, pancreatic cancer (KRAS), renal cell cancer, bladder cancer (HRAS); protooncogene

right side: lung goes down to which rib and the liver?

lung: 8th; liver: 10th

placenta accreta

placenta is adherent to the myometrium. (instead of the norm of it being on the inner side of the endometrium)

preferred diagnostic imaging study for toxic megacolon from ulcerative colitis

plain abdominal x ray

pityriasis rosea

plaques in christmas tree pattern; herald plaque, resolves in 6-8 weeks

vWF functions in

platelet adhesion and as a protein carriers for factor VIII

pneumonitis vs pneumonia

pneumonitis: inflammation of the lungs, aspriation of gastric acid, presents hours after aspiration, no need for tx. Pneumonia: infection of the lungs, aspiration of microbes, presents days after aspiration, tx: clindamycin, or beta lactam

if you see free air under the diaphragm on CXR

pneumoperitoneum and this is due to perforation of a hollow abdominal viscus. i.e. perforated duodenal ulcer (or it can be from trauma, tumors, etc). Causes shoulder pain, peritonitis which can become sepsis and death.

tall people are at risk for (tall body habitus)

pneumothorax

sickle cell anemia genetics

point mutation that substitutes valine for glutamic acid in the 6th position of the beta globin chain of hemoglobin

polycystin

polycystic kidney

most common cause of hirsutism

polycystic ovary syndrome (tx: OCPs bc they decrease LH secretion which decreases andorgens)

woman with hirsutism, acne and is obese.

polycystic ovary syndrome, and the pathologic finding is the enlarged ovaries.

TE fistula is assoc with esophageal atresia which causes

polyhydramnios

cause of tamoxifen (estrogen receptor modulator for breast cancer tx) ineffectiveness in subset of patients

polymorphism of a cytochrome P450 enzyme

HIV replication cycle

polyprotein precursors encoded by the structural genes gag, pol, and env. Only the env gene polyprotein product (gp160) is glycosylated. Env is then cleaved in the golgi apparatus to form gp120 and gp41

major virulence factor of H influenzae

polyribosylribitol phosphate

acute intermittent porphyria hinders what enzyme in the synthesis of heme?

porphobilinogen deaminase

liver mets come from which circulation

portal circulation (blood from colon)

positive sense RNA viruses and negative sense RNA viruses

positive: infectious bc they can use host machinery to replicate. Negative: not infectious bc they need their own machinery (RNA dependent RNA polymerase) to be brought along to be able to replicate.

RNA i

post-transcriptional gene silencing

AV nodal artery comes off

posterior descending artery

inferior wall MI is what artery

posterior descending artery off of the right coronary artery (supplies the inferior side of the left ventricle which lays on the diaphragm

posterior displacement of the tibia when pressure is applied to the anterior tibua with the knee in the flexed position

posterior drawer test (this means there is a problem with the posterior cruciate ligament)

be careful pairing ACE inhibitors with

potassium sparing diuretics (spironolactone) because they both cause hyperkalemia.

anti-mitochondrial antibodies

primary biliary cholangitis manifests with fatigue, itching, hepatomegaly, late jaundice, and xanthomas. Most patients have elevated levels of antimitochondrial antibodies. Testing for these antibodies is specific and can aid in the diag.

what is increased in urine in pts with multiple myeloma

proteinuria (bence jones light chain proteins)

leser trelat sign

rapid onset of numerous seborrheic keratoses (tan, brown round lesion) is often assoc with internal malignancy (i.e. gastric adenocarcinoma)

mitochondrial myopathy

red ragged fibers

craniopharyngiomas are tumors that arise from

remnants of Rathke's pouch

ADR of cyclosporine

renal toxicity (its a drug used to inhibit IL2 in cancer pts to prevent T cell activation)

mycopbacterium tuburculosis

replicate inside macrophages during the initial infection

acute tx for variceal hemorrhage

requires rapid lowering of portal pressure via somatostatin and octreotide which inhibit the release of hormones that induce splanchnic vasodilation.

you can have metabolic and _ acidosis at the same time

respiratory

new/ immature RBCs are called

reticulocytes

slow waves determine the frequency of contractions of the GI tract. They are

rhythmic depolarizations and repolarizations of the smooth muscle cells within the muscularis propria of the stomach and intestines. They are enhanced in amplitude by parasympathetic nervous system stimulation and decreased by sympathetic nervous system stimulation.

inferior leads (II, III, and aVF) infarction is a block of which artery usually

right coronary artery (RCA) obstruction.

Nissl body

rough endoplasmic reticulum for the neurons

S-100 positive tumors

schwannoma and melanoma

FGAs vs SGAs (anti psychotics

second gen have less risk for extrapyramidal sx like acute dystonia

sudden infant death syndrome risk factor

second hand smoke

uricosuric

second line tx for gout bc they increase uric acid secretion but are therefore CI'd in pts with a hx of renal stones. Allopurinol is first line

which type of viruses are capable of genetic shifts through reassortment

segmented genome containing viruses (orthomyxovirus, rotavirus)

attrition bias is a form of

selection bias

case control study: how do you pick the control

selection of controls is intended to provide an accurate estimation of exposure frequency among the nondisease general population. Cases and controls should be selected based on DISEASE status, not exposure status.

recurrent pneumonia or upper respiratory infections are suggestive of immunodeficiency, of which _ is the most common

selective IgA deficiency; IgA prevents infection of the mucosal surfaces, and so deficiency can lead to GI infections such as giardiasis. Selective IgA deficiency also puts pts at risk for allergic reactions following blood transfusions or admin of IVIG.

osteoid osteoma

small, benign, bone-forming tumor that typically occurs in adolescent boys. Histopathology shows irregular patterns of woven bone lined by a single layer of benign-appearing osteoblasts.

vitamin A deficiency

squamous metaplasia of epithelia to keratinizing epithelium. Night blindness (nyctalopia); xerosis cutis - dry skin; corneal degeneration (keratomalacia); bitot spots (foamy appearance) on conjunctiva; immunosuppression. Can happen bc of cystic fibrosis bc pancreatic insufficiency and fat malabsorption.

cryptococcus staining

stains red on mucicarmine stain. Absence of stain on india ink. Shows yeast form on methanamine silver stain.

galactokinase deficiency (mild galactosemia) (first enzyme)

sx: cataracts, pseudotumor cerebri (galactitol accumulation);

milk alkali syndrome

sx: hypercalcemia (depression, constipation, weakness, fatigue - stones bones groans thrones psych overtones), metabolic alkalosis, and renal insufficiency. patients who overuse calcium carbonate for long periods may develop this syndrome. long term overuse of calcium carbonate can lead to rebound gastric acid hypersecretion as well.

smells burning rubber before seizure

temporal lobe epilepsy

most common form of headache, achy, pressure like pain, bilateral, associated with opericranial muscle tenderness, ppl can usually still do daily functions

tension headache

fibularis tertius vs brevis

tertius goes above/ anterior to the lateral malleolus; brevis is bigger muscle and has tendons posterior to lateral malleolus that affects lateral malleolus

reinke crystals

testicular tumors

inhibin inhibits FSH release while ___ inhibits LH release

testosterone

lowest and highest drug levels

the highest level of drug conc is 1/2 hour after IV or 1 hour after IM dosing. The lowest drug conc (trough) is the last 1/2 hour before the next dose.

uniparental disomy

the inheritance of two copies of a chromosome from one parent through nondisjunction.

if a tRNA is mischarged with an incorrect amino acid (and not corrected) then

the wrong amino acid with bc inserted into the polypeptide chain at the site where the old amino acid would have gone.

metalloproteinase and fibroblasts happen in what part of injury (wound healing)

their activity results in contracture

if the pH and the bicarb matches

then its metabolic

strongest recommendation for patients with alpha 1 antitrypsin deficiency is

to avoid second hand smoke bc exposure to some accelerates the deelopement of emphysema.

central diabetes insipidus moa (damage where)

to the hypothalamus bc if damage to posterior pituitary, the posterior pituitary will regenerate. ADH is made in the hypothalamus (paracentricular and supraoptic nuclei)

primaquine is added to chloroquine in tx of malaria bc

to tx infections with P vivax and P ovale to eradicate the intrahepatic stages (hypnozoites) of these malerial species which are responsible for relapses.

kids under 2 years old can get _ from antidiarrheal use

toxic megacolon

hepatitis A

transmission is fecal oral, and common in areas with overcrowding, or poor sanitation. Outbreaks from contaminated water or food and raw/ steamed shellfish is common in US. ; sx: fever, anorexia, vomiting, RUQ pain, jaundice, pruritis, dark colored urine and clay colored stool

drug for breast cancers that express ERBB2

trastuzumab (monoclonal antibody dependent cytotoxicity)

rifaximin

tx for hepatic encephalopathy; moa: decreases intraluminal ammonia production. Another tx is lactulose (increases conversion of ammonia to ammonium)

pancrelipase

tx for pancreatic insufficiency (i.e pancreative insifficiency is due to chornic pancreatitis, cystic fibrosis, obstructing cancer - causes malabsortion of fat and fat-soluble vitamins (ADEK) as well as vitamin B12. theres a decrease in duodenal pH (bicarb) and fecal elastase decrease). pacrelipase is a combo of lipase, protease, and amylase enzymes to correct the malabsorption.

HLA DR3 and DR5

type 1 diabetes mellitus

anaphylaxis and indoor allergen moa

type 1 hypersensitivity in which allergen cross-links antigen-specific IgE on the surface of mast cells and basophils. mast cells release histamine.

hereditary fructose intolerance

vomiting, hypoglycmeia, failure to thrive. Deficient in aldolase B.

hemophilia inheritance pattern

x linked recessive

Fabry disease

x linked recessive, alpha galactosidase A deficiency results in accumulation of globotriaosylceramide, sx: neuropathic pain, angiokeratomas, tenagiectasias, glomerular disease (proteinuria), cerebrovascular disease (TIA, stroke), cardiac disease (left ventricular hypertrophy). lipid storage disorder.

prevent recurrence of herpes

daily valcyclovir

polyethylene glycol

osmotic laxative

heberden nodes (DIP) and Bouchard nodes (PIP)

osteoarthritis

initial phase of Paget's

osteoclast activation

PTH activates osteoblasts which activate

osteoclasts thru RANK-L

BRCA mutations also increase risk for

ovarian cancer

theca cells and granulosa cells are located where

ovarian follicle

CA 125

ovarian tumor

call exner bodies

ovarian tumors

age <2 and they have bronchiolitis; this is most commonly

RSV (respiratory syncytial virus)

pt with fever, chills and muscle aches, was given penicillin for syphilis. What happened?

"Administration of Penicillin for Syphilis may lead to the Jarisch-Herxheimer reaction hours after treatment. Occurs due to lysis of spirochetes (so it can occur with Borrelia and Leptospirosis as well). The reaction is characterized by fever and chills.

indicators of cirrhosis

"increased aspratate aminotransferase and alanine aminotransferase are indicators of hepatocellular damage, and increased alkaline phosphatase and gamma glutamyl transpeptidase indicates biliary injury.

leukemia: bone marrow blasts: +TdT, + PAS material

"lymphoblast (B or T cell)

rotavirus

#1 cause of severe diarrhea in young children; causes self-limited childhood diarrhea in unvaccinated kids. It infects villous enterocytes in the duodenum and proximal jejunum and results in villous blunting, proliferation of secretory crypt cells and a loss of brush border enzymes; this results in watery diarrhea without fecal leukocytes.

False negatives

(1 - sensitivity) x (# of patients with the disease)

if calculating the probability that 3 different groups do NOT have something and they give u the probability that they do

(1-probability they do) x (1- probability group 2), etc

maintenance dose

(Cpss x CL)/ [bioavailability fraction] ; (Cpss = the steady state plasma concentration) - - the bioavailability fraction is 1 for drugs admin'd IV - - (maintenance dose is decreased in pts with renal or hepatic impairment)

horner syndrome

(PAM is horny); sympathetic denervation of the face; Ptosis, Anhidrosis, (absence of sweating), Miosis; assoc with lesions along the sympathetic chain.

PriVaTe TIM HALL never tyres (all the essential amino acids)

...never tyrosine

Bipolar type 1

1 or more manic episodes with OR WITHOUT a hypomanic or depressive episode. (if they have psychotic features, its bipolar type 1 with psychotic features)

regular insulin peaks in

2-4 hours

filtration fraction (FF)

FF = GFR/ RPF; RPF = renal plasma flow;

Heinz bodies

G6PD deficiency (denatured globin chains)

baclofen

GABA B agonist (decreases glutamate) muscle releaxant for MS, muscle spasticity

kaposi's sarcoma can spread to

GI tract. Usually lesions on skin. Reddish/ violet flat maculopapular lesions. Histo: spindle cells, neovascularization, and extravasated red blood cells.

filgrastim

GMCSF stimulator; for chemo and HIV pts to increase their neutrophil levels

splice sites

GT at 5' and AG at 3'

lateral femoral cutanous

L2-L3, sensory: anterior and lateral thigh

ketorolac

NSAIDs, can cause acute renal failure

factor 5 is

NAD/ nicotinamide (i.e. H influenza needs factor 5 and 10 to grow on chocolate agar)

medication that cuases impairment of ion channel function leading to an incident of syncope

QT prolongation; macrolides, antipsychotics, anti-emetics

acute ureterolithiasis shows what in urine sediment?

RBCs and crystals

uroshiol (poison ivy) causes reaction via what type of cells

T cells (CD8 and CD4); triggers a type IV hypersensitivity (mediated by T cells)

takotsubo cardiomyopathy

aka stress induced cardiomyopathy; characterized by hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the left ventricle, resulting in systolic dysfunction. The condition is likely caused by a surge of catecholamines in teh setting of physical or emotional stress. It usually affects postmenopausal women and resolves on its own within several weeks.

nonenveloped viruses are less susceptible to _ bc they have no lipid envelope to target

alcohol based disinfectants

good way to prevent intravascular catherter related infection

alcohol based hand scrub prior to beginning the procedure

biogenic amines

all the tyrosine derivatives

urachus is part of the

allantoic duct between the bladder and the umbilicus

peptostreptococcus and fusobacterium

anaerobic bacteria that are part of normal mouth flora. The presence of these organisms in a pt's lung lesion is highly suggestive of a developing lung abscess. Pt will foul smelling sputum (indicating anaerobes)

wide fixed splitting of the second heart sound (S2) is characteristic of

atrial septal defect (ASD)

ABL

chronic myeloid leukemia, acute lymphoblastic leukemia; protooncogene/ tumor promotor

eosinophilic granulomatosis with polyangiitis

churg strauss; small to medium vessel vasculitis, characterized by late onset asthma, rhinosinusitis, and eosinophilia. P-ANCA

patients weaning off of mechanical ventilation typically have weakened respiratory muscles and thereofre tend to breath at low tidal volumes to minimize the work of breathing. This caused an increase in

dead space ventilation. They compensate by increasing their respiratory rate so they can maintain their minute ventilation. You want them to breathe slower and deeper to be able to get off of the ventilator.

tx for rabies

inactivated/ killed vaccine

congenital long QT syndrome is

most often caused by genetic mutations in a K+ channel protein that contributes to the outward-rectifying potassium current. A decrease in the outward K+ current leads to prolongation of action potential duration and QT interval. This prolongation predisposes to the development of life-threatening ventricular arrhythmias (i.e. torsades de pointes) that can cuase palpitations, syncope, seizures or sudden cardiac death.

syphilis degeneration of vasa vasorum is

obliterative endarteritis with lymphocytes and plasma cells (obliterative in the vasa vasorum - i.e. arteries supplying the large blood vessels throughout the body - and the nerves)

intussusception

obstruction of the bowel most common among children younger than 5 years old. It presents with colicky abdominal pain and vomiting, which can indicate worsening of the obstruction. they also have palpable abdominal mass. nausea, fever, vomiting, tx: air enema (and diag)

c-myc

oncogene

type 1 diabetes mellitus and primary adrenal insufficiency

patients with type 1 diabetes mellitus are prone to developing other autoimmune endocrinopathies including hashimoto thryoiditis, graves' disease and primary adrenal insufficiency (addison's disease). Electrolyte abnormalities in patients with primary adrenal insufficiency include hyponatremia, hyperkalemia, hyperchloremia, and non-anion gap metabolic acidosis. this is due to decreased aldosterone.

number needed to harm (NNH)

...= 1/ absolute risk increase. Absolute risk increase is calculated by the adverse event rate in the control group by the adverse event rate in the experimental group. The NNH is the number of ppl who must be treated before 1 additional adverse event occurs.

calcium sensing receptors

G protein coupled receptors that regulate the secretion of parathyroid hormone in response to changes in circulating calcium levels. Familial hypocalciuric hypercalcemia is a benign autosomal dominant disorder caused by defective calcium sensing receptors in the parathyroid gland and kidneys.

memantine

NMDA receptor antagonist; for Alzheimers disease

pseudomonas aeruginosa tx

Pseudomonas is a mjor pathogen in burn patients. Only a few specific penicillins (i.e. ticaricillin and piperacillin) and cephalosporins (i.e. ceftazidime, cefepime) have activity against it. Certain aminoglycosides, fluoroquinolones (i.e. ciprofloxacin, levofloxacin) and carbapenems (i.e. imipenem, meropenem) are also effective.

HBeAg

a marker of viral replication and increased infectivity for hepatitis B.

Zidovudine (ZDT)

a nucleoside reverse transcriptase inhibitor used to prevent maternal to fetal transmission of HIV during labor (when the mother is not virally suppressed). It is a thymidine analogue that does not have the normal 3'-hydroxyl group found on thymidine. Because new nucleotides are added to growing DNA chains only at the 3'-hydroxyl group, the addition of ZDT into DNA results in chain termination.

DNA polymerases

all 3 prokaryotic DNA polymerases can remove mismatched nucleotides via their 3' to 5' exonuclease ("poroofreading") activity. Only DNA polymerase I has 5' to 3' exonuclease activity, which is used to remove the RNA primer synthesized by RNA primase.

cellular compartmentalization

allows multiple biochemical processes to occur simultaneously at maximum efficiency. Beta oxidation of fatty acids, the TCA cycle, and the carboxylation of pyruvate (gluconeogenesis) all occur within the mitochondria. The enzymes responsible for glycolysis, fatty acid synthesis and the pentose phosphate pathway (transketolase) reside in the cytosol.

narcolepsy

chronic sleep disorder cahracterized by excessive dauytime sleepiness, cataplexy (sudden loss of muscle tone that occurs in response to intense positive emotions), and REM sleep-related phenomena (i.e. hypnagogic/hypnopompic hallucinations, sleep paralysis).

transketolase

an enzyme of the pentose phosphate pathway that uses thiamine (vitamin B1) as a cofactor to shuttle 2 carbon fragments between sugar molecules.

hepatitis E

an unenveloped single stranded RNA virus spread thru the fecal oral route. The most concerning feature of hep E infection is the high mortality rate observed in infected pregnant women.

pregnant women and gastroesophageal reflux

elevated estrogen and progesterone levels relax the smooth muscle of the LES (lower esophageal sphincter) leading to decreased LES tone and reduced sensitivity to contractile stimuli.

CMV

mononucleosis-like illness

superior mesenteric artery syndrome

occurs when the transverse portion of the duodenum is entrapped between the SMA and aorta, causing sx of partial intestinal obstruction. Occurs when the aortomesenteric angle critically decreases, secondary to diminished mesenteric fat, pronounced lordosis or surgical correction of scoliosis.

#1 cause of gallstones via cholesterol lowering drug

fibrates (gemfibrozil)

drug tx for narcolepsy

modafinil (psychostimulant, amphetamine)

bethanechol

muscarinic agonist that treats urinary retention

measles/ rubeola infection, what vitamin helps/ cures it?

vitamin A

niacin

vitamin B3; elevates HDL, (most effective drug for this)

ascorbic acid is

vitamin C

osteioid is laid down by osteoblasts and _ mineralizes the bone

vitamin D

equation for the Flow of blood

"Flow (Q) = (P1-P2)/R ; but R = (viscosity x L)/ radius^4. So flow = (P1-P2 x r^4)/ (Viscosity x Length); OVERALL: blood flow is directly proportional to the vessel radius raised to the fourth power. Resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power. Example: if flow is decreased by a factor of 16, then the radius of the lumen has been reduced by: (r^4)/16 = r/2 so by 50%

clinical uses of K sparing diuretics

"Hyperaldosteronism

if patient is there with his family and you have bad news to give him and he says he doesn't want to know, what do you do

"I will not inform him of the results if that is his preference"

acute phase reactants

"IL 6, CRP, fibrinogen, ferritin , hepcidin, ceruloplasmin, haptoglobin, von willebrand factor, and complement. (these are all positive APRs - they rise in inflammation). Procalcitonin is a positive and negative APR in that it rises and falls (levels) in inflammation);

spherocytosis

"In spherocytosis, mean corpuscular hemoglobin concentration (MCHC) is increased due to mild dehydration of the red blood cell. Markers of hemolysis are often evident and include elevated lactate dehydrogenase, reticulocytosis and decreased haptoglobin.

PTT vs PT

"PTT: intrinsic coagulation system; Factors: 12, 11, 9, 8

multiple myeloma

"a plasma cell malignancy associated with purely radiolucent (osteolytic) bone lesions due to the stimulation of osteoclasts and the inhibition of osteoblasts. Myeloma cells stimulate osteoclast development by secreting RANK-ligand and destroying osteoprotegerin, which increases RANK activity and results in osteoclast differentiation.

porcelain gallbladder (thickened gallbladder wall with a rim of patchy calcification) is assoc with increased risk of

"adenocarcinoma of the gallbladder

sarcoidosis

"african americans, bilateral hilar adenopathy, noncaseating granulomas, erythema nodosum (nodules on skin), noncaseating granulomas,

Small cell lung cancer

"aka oat cell carcinoma; strong assoc w smoking, centrally located. Histo: small, round or oval cells with scant cytoplasm and large hyperchromatic (blue) nuclei; abundant mitoses are seen. Immuno stains: positive for neuroendocrine markers (chromogranin, synaptophysin, neural cell adhesion molecule (CD56)). assoc paraneoplastic syndromes: SIADH, Lambert Eaton, Cushing syndrome. pts will lose weight bc its a cancer.

Wilson disease

"associated with copper accumulation in the liver, brain and cornea. It commonly presents in childhood or adolescence with abonral liver function tests and/or neuropsychiatric sx. Psychiatric sx may predate other manifestations and include personality changes, depression, mania and/or psychosis.

immune thrombocytopenic purpura (ITP)

"autoimmune destruction of platelets by anti-platelet antibodies, (IgG against GPIIb/IIIa). Isolated thrombocytopenia (low platelets) and nothing else is usual. Tx: immunosuppression (corticosteroids), IVIG. Platelet level around 9,000.

sjogren syndrome

"autoimmune; inflammation of exocrine glands; labial glands show periductal lymphocytic infiltrates (focal lymphocytic sialadenitis), with germinal centers.

HER2

"breast cancer, ovarian cancer

chronic myelogenous leukemia

"cause is a translocation between chromosomes 9 and 22 (t9;22...philadelphia chromosome). the resulting oncogene is BCR-ABL (codes for constitutive tyrosine kinase activity). They will have dysregulated production of mature and maturing granulocytes (neutrophils, metamyelocytes, myelocytes, basophils) and splenomegaly. tx: imatinib or dasatinib (bcr abl tyrosine kinase inhibitors)

reactive arthritis (classic triad)

"classic triad is nongonococcal urethritis, conjunctivitis and arthritis. It is an HLA B27 assoc arthropathy that occurs within several weeks following a GU or enteric infection. It belongs to the group of seronegative spondyloarthropathies (including ankylosing spondylitis) and can cause sacroiliitis in about 20% of cases.

cyanide poisoning mech and tx

"cyanide inhibits complex IV (cytochrome C oxidase) leading to hypoxia unresponsive to supplemental O2 and increased anaerobic metabolism. Can lead to cherry red skin, seizures and coma. Sx: breath has bitter almond odor and CV collapse.

dihydropterin reductase deficiency

"disorders involving impaired tetrahydrobiopterin (BH4) levels, the most common being dihydropterin reducatase deficiency, account for 2% of phenyketonuria cases. BH4 is an important cofactor for both phenylalanine hydroxylase and tyrosine hydroxylase. Although phenylalanine levels can be corrected with dietary restriction, downstream deficiencies of dopamine, norepinephrine, epinephrine, and serotonin lead to progressive neurologic deterioration.

porphyria cutanea tarda (PCT)

"enzyme deficiencies of the early steps in porphyrin synthesis cause neuropsychiatric manifestations without photosensitivity, whereas late step derangments lead to photosensitivity. Photosensitivity manifests as vesicle and blister formation on sun-exposed areas as well as edema, pruritis, pain and erythema.

gauchers disease

"gausch he's such a bro. (crying), glucocerebroside, tissue paper appearance,

if someone has symptomatic coronary artery disease, next step in tx is:

"give them a statin. (regardless of baseline cholesterol levels).

systemic lupus erythematosis

"glomerulonephritis, photosensitive skin rash and arthralgias in a young woman. Antiphospholipid antibodies (these can cause false positive RPR and VDRL tests and aPTT prolongation). 30% of lupus pts have anti phospholipid antibodies and they are at risk for thromboembolism and recurrent pregnancy loss.

hand foot and mouth disease & herpangina

"hand foot mouth disease (oral and extremity ulcerations) and herpangina (oral ulcerations) are the most common manifestations of enteroviral infections. Myocarditis is a rare but serious complication of enterovirus that can lead to heart failure, dysrhythmia or acute circulatory collapse.

scabies (sarcoptes scabiei mite)

"highly contagious disease that presents with an intensely pruritic rash (usually worse at night) in the flexor surfaces of the wrist, lateral surfaces of the fingers and the finger webs. Patients usually have excoriations with small, crusted, red papules scattered around the affected areas. Diagnosis is confirmed by skin scrapings from excoriated lesions that show mites, ova, and feces under light microscopy.

acute respiratory distress syndrome (ARDS)

"injury of the pulmonary epithelium and/or endothelium and occurs due to sepsis or pneumonia. Cytokines recruits neutrophils to the lung tissue, which cause capillary damage and leakage of protein-rich fluid into the alveoli (during the exudative phase) - this leads to formation of hyaline membranes. Later cellular proliferation and collagen deposition occurs and in some patients, this leads to irreversible pulmonary fibrosis. (phases: exudative -> proliferative -> fibrotic).

deficiency of CD18

"leukocyte adhesion deficiency"; delayed umbilical cord separation; autosomal recessive, CD18 is necessary for formation of integrins which allow leukocyte adhesion to endothelial surfaces and migration to target tissues. Sx: lack of purulence due to absence of leukocytes in peripheral tissues. persistent leukocytosis (high WBC count)

hereditary hemochromatosis

"missense mutation in HFE gene, resulting in excessive intestinal iron absorption and organ damage (cirrhosis, diabetes mellitus, cardiomyopathy, arthropathy) due to iron accumulation within parenchymal tissues (GI doesn't get negative feedback from liver bc HFE is damaged so it keeps absorbing iron from lumen)

(treatment resistant) major depressive disorder with atypical features

"modd reactivity (mood improves in response to positive events), leaden paralysis (i.e. patients arms and legs feel extremely heavy), rejection sensitivity, increased sleep and appetite. Treatment resistant: failure of multople antidepressant agents.

minimal change disease

"most common childhood nephrotic syndrome. Increased glomerular capillary permeability causes massive protein (albumin) loss in urine. Hypoalbuminemia reduces plasma oncotic pressure which causes a fluid shift into the interstitial space, resulting in edema. Low oncotic pressure also triggers increased lipoprotein production in the liver (i.e. hyperlipidemia)

pilocytic astrocytoma

"most common type of brain tumor in children; sx: headaches and gait instability with a cerebellar lesion on MRI (has both cystic and solid components on MRI)

nephritic vs nephrotic:

"nephritic: (Inflammatory process), hematuria, edema, hypertension; RBC casts in urine, proteinuria,

medullary thyroid cancer on histo

"nests of polygonal cells with congo red positive deposits; it arises from parafollicular calcitonin secreting C cells. It has spindle shaped cells with extracellular amyloid deposits derived from calcitonin.

hepatic encephalopathy

"neurologic complciation of cirrhosis due to liver's inability to convert ammonia to urea. Leads to altered mental status, asterixis (rhythmic flapping of hands)

beta blockers and diabetics

"non-selective beta blockers exacerbate hypoglycemia and mask its adrenergic sx mediated by NE and epinephrine. For this reason, they should be used with caution in pts with diabetes mellitus. If beta blocker admin is necessary, give beta 1 antagonist instead. (this is bc epipnephrine stims hepatic glycogenolysis and gluconeogenesis in times when body needs glucose)

testicular cancer

"painless, solid scrotal mass is testicular cancer. Exam: solid, firm or fixed module in the tunica albuginea that is avoid in shape an painless to palpation. Testicular tumors do not transilluminate.

postpartum blues vs postpartum depression vs psychosis

"postpartum mood disturbances include postpartum blues, postpartum depression, and rarely postpartum psychosis. The most common disturbance is postpartum blues which is benign, self-limited condition that begins several days postpartum and resolves within 14 days without intervention.

an external stim applied to a cell increases the activity of several enzymes, inclduing dihydrofolate reductase and DNA polymerase. What precedes this effect

"retinoblastoma protein phosphorylation; G1 to S phase transition is whats referred to here bc DNA synthesis happens in the S phase of the cell cycle. Cells with damaged DNA are not allowed to enter the S phase. Retinoblastoma (Rb) protein is a regulator of the G1->S phase transition. Rb is inactivated via hyperphosphorylation via cyclin D, cyclin E and CDK 4,6. Inactivation of Rb allows G1->S phase transition. (hypophosphorylated Rb is active form that inhibits the transition)

ewing sarcoma

"second most common primary bone malignancy in young patients, often arises in long bones and causes progressive pain, swelling, and lytic bone lesions. However, histopathology reveals sheets of small, round cells separated by fibrous septae and patches of necrosis and high N:C ratio. hemorrhage; no osteoid or bone is produced.

rheumatoid arthritis

"small joints (PIP, MCP, MTP), spares distal joints (DIP). Fever weight loss, anemia. Cervical spine involvement: subluxation, cord compression. Anti-CCP antibodies, positive rheumatoid factor.

G6PD deficiency (glucose 6 phosphate dehydrogenase)

"sx: hemolytic anemia, dark urine (bc of RBC breakdown), weakness, scleral icterus,

half life drug elimination equation

"t1/2 = (0.7 x Vd)/ CL

acute promyelocytic leukemia

"the cytogenic defect t(15;17) is associated with acute promyelocytic leukemia (AMPL). A translocation involving the retinoic acid receptor alpha (RARA) gene from chromosome 17 and the promyelocytic leukemia (PML) gene on chromosome 15 leads to the formation of PML/RARA, a fusion gene whose product inhibits differentiation of myeloblasts and triggers the developement of APML.

severe combined immunodeficiency (SCID)

"the second most common cause of SCID is autosomal recessive deficiency of adenosine deaminase, an enzyme necessary for the elimination of excess adenosine within cells. Tx: retroviral vectors to infect pt stem cells with gene coding for adenosine deaminase.

transudative vs exudative

"transudative effusions are typically caused by alterations in hydrostatic or oncotic pressure (i.e. heart failure, cirrhosis, nephrotic syndrome), whereas exudative effusions typically result from inflammation and consequent increased vascular membrane permeability (i.e. infection, malignancy, rheumatologic disease). Exudative effusions are characterized by a high ratio of pleual fluid to serum total protein (>.5) or lactate dehydrogenase (>.6) or high absolute levels of lactate dehydrogenase.

chronic myeloproliferative disorders

(polycythemia vera, essential thrombocytosis, and primary myelofibrosis) often have a mutation in Janus kinase 2 (JAK2), a cytoplasmic tyrosine kinase. This results in constitutive tyrosine kinase activity, and in the cytokine independent activation of signal transducers and actiators of transcription (STAT) proteins (JAK STAT signaling pathway)

prostacyclin

(prostaglandin I2) is made from prostaglandin H2 by prostacyclin synthase in vascular endothelial cells. Once secreted, it inhibtis platelet aggregation and causes vasodilation to oppose the functions of thromboxane A2 and help maintain vascular homeostasis.

true positives

(sensitivity) x (# of patients with the disease)

pharyngeal/ branchial arches: 1 man Fuc*ed 2 strippers In 3 Great Styles (but dont tell) 4 Always remember to say that what happens in Vagus Recurs in Vagus

1 Man: 1st pharyngeal arch; Mandibular branch (V3), mm of mastication, & Meckel cartilage; Maxillary artery - F'd 2 Strippers: 2nd phar arch; facial nerve (CN VII); Stapes, stylohyoid, smiling mm); stapedial artery - In 3 great styles: 3rd phar arch; ICA artery; Glossopharyngeal nerve (CN IX), Stylopharyngeus muscle - 4 Always remember to say that what happens in Vagus: 4th phar arch; ARS: Aortic, right Subclavian arteries; That = Thyroid cartilage; Vagus nerve (CN X) - Recurs in Vagus: (6th Arch) recurrent/inferior laryngeal nerve (from vagus); everything else guess pharyngeal arch 6

1 liter is how many centimeters

1000 cm^3

time after injury if there is eosinophils and nuclear fragmentation in the brain histo

12-24 horus

spores can survive temp up to

120 C (248 F)

normal GFR

125

aortic arch derivatives

1: MAXillary artery; 2: Stapedial artery (Second); 3: Common carotid and internal Carotid (C is 3rd letter of alph); 4: aortic arch and right subclavian (4th arch = 4 limbs aka systemic); 6: pulmonary arteries and ductus arteriosus.

cartilage types

1: bONE 2: carTWOlage 3: vascular type of ehlers danloes (threE D) - blood vessels 4: type 4 under the floor (basement membrane)(goodpasture and alport)

diff btw degrees of burn (1-3)

1: epidermis, painful/erythematous NO blisters; 2: blisters, dermis, heals without scarring; 3: hypodermis, blisters, scars

type 1 vs 2 pnuemocytes

1: gas exchange, the majority of the alveoli. 2: secrete surfactant from lamellar bodies and serve as precursors to type 1's

effect on length of action potential (class 1 - sodium channel blocking - antarrhythmics

1A: prolonged; 1B: shortened; 1C: no change

sodium binding strenght for class 1 antiarrhythmics:

1C>1A>1B

men 2B

1P: medullary thyroid cancer, pheochromocytoma, marfanoid habitus

promoter regions are located

25 or 75 bases upstream from their assoc genes and function to intitiate transcription

HLA inheritance pattern

25% chance you'll be same as your sibling (mendelian genetics)

major depressive disorder

>2 weeks, has 5 of 9 sx, depressed mood, tx: CBT and SSRI's, (SIG E CAPS)

CD4 vs CD8 in graft rejection

CD8 is acute and CD4 is chronic

mechanism of injury in hep B to the liver

CD8 t cells respinse to viral antigens

most useful measure for assessing the degree of mitral valve stenosis

A2 to opening snap time interval

medicare A B C

A: hospital care, hospice; B: basic medical bills (doctor fees); C: Combo (paid by private Companies); D: drugs

9;22

ABL, philadelphia, BCR-ABL

right shift in hemoglobin O2 binding curve mnemonic

ACE Bats right handed: increased: Acid (i.e. H+) (so decreased pH) pCo2 Exercise 2,3 BPG high Altitude temperature

in addition to antihyperglycemic treatment, what other drug is good for diabetics' kidneys?

ACE inhibitors (bc it slows progression of diabetic nephropathy via decreasing glomerular filtration rate and pressure, which decreases albumin excretion and slows progression of renal failure.

give pts who had MI (who prob have heart failure with reduced ejection fraction):

ACEI, ARB, Beta blocker, neprilysin inhibitor-ARB (sacubitril), mineralocorticoid receptor antagonist (spironolactone) - all of these are first line in HRrEF bc they reduce cardiac remodeling which improves mortality.

RAAS activates

ADH (secretion of ADH)

mycobacterium avium complex infection is common in ppl with

AIDS (CD4 count <50)

ALT>AST vs AST>ALT

ALT>AST: acute viral hepatitis; AST>ALT: alcoholic hepatitis

neprilusin inhibitors (i.e. sacubitril) prevent degradation of

ANP and BNP which is helpfil in chronic heart failure bc BNP and ANP inhibit the RAAS system and cause the kidney excrete sodium and water and help decrease the load on the heart. They also vasodilate thru cGMP

protein C

ANTI-coagulant that degrades factors Va and VIIIa

aortic regurgitation

AR: AR due to aortic root dilation is heard at right upper sternal border. AR due to valvular pathology is heard at the left third intercostal space.

Absolute risk reduction

ARR = (event rate in control group) - (event rate in treatment group). However if they give you number of people in the treatment group that had events and the event rate in the treatment group and ask you how many people TOTAL were in the treatment group you will use: ERtx = (# of events in the tx arm)/(# of subjects in the tx arm) to calc the answer

ataxia telangiectasia vs xeroderma pigmentosa

AT: defect in ATM gene = failure to detect DNA damage (AR) -> cerebellar defects; XP: defective nucleotide excision repair -> skin cancer, light sensitivity

when tumor cell lines become resistant after exposure to anticancer drugs, they express a specific cell surface glycoprotein:

ATP-dependent transporter; the human multidrug resistance (MDR1) gene codes for P glycoprotein, a transmembrane ATP dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This protein can btoh reduce the influx of drugs into the cytosol and can increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.

a fib: what determines the ventricular contraction rate

AV node refractory period

if elderly pt is having trouble with activities of daily living (paying bills, navigating familiar areas) its

Alzheimers

White pulp of the spleen

B cells are found here. B cells are developed in the bone marrow and undergo antigen binding specificity mechanisms and class switching within lymph nodes.

uniform round, medium sized tumor cells with basophilic cytoplasm with a prolferation fraction > 99%

B cells in burkitts lymphoma (EBV)

familial pulmonary artery hypertension gene

BMPR2 gene; theres 2 steps to this: abnormal bmpr2 gene predisposes to smooth muscle cell proliferation and then an insult (infection, drugs) activates the disease process, resulting in vascular remodeling.

which tumor suppressor genes follow the two hit hypothesis

BRCA and APC (Familial adenomatous polyposis). They have heterozygous for one normal gene and then they get loss of one and over time loss of the other one. so you either: inherit one mutated gene and get a mutation of ther other or you get two mutations over time.

A-M beta blockers

Beta 1> beta 2 antagonist.

hemochromotosis

Bronze diabetes, glucose intolerance, cardiac involvement, ascites

cells most susceptible to ischemia in the brain

CA1 pyramidal neurons of the hippocampus, cerebellar Purkinje cells and the pyramidal neurons of the neocortex.

huntingtons disease

CAG repeats cause build up of huntington protein which damages GABAergic neurons in caudate nuclei (striatum)

stimulation of which T cells allows release of IFN gamma and increases the potency of macrophages to kill TB

CD4 T lymphocytes

IL 12 differentiates

CD4 into Th1 cells; Th1 cells secrete IFN gamma to activate macrophages

CD8 vs CD4 T cells (endogenous vs exogenous)

CD8 MHC I kill endogenous viruses, etc; CD4 MHC II kill exogenous bacteria, etc

CDK 4/6 inhibitors (i.e. palbociclib)

CDKs 4/6 regulate the movement of cells from G1->S phase. Cancers often have mutations that enhance the activity or downstream effects of CDK 4/6, which contribute to unregulated cellular growth. Inhibitors to CDK 4/6 can be used to treat certain forms of cancer. However, they can inhibit cellular replication in other rapidly dividing cells such as the hematologic cells in the bone marrow (i.e. neutropenia, anemia, or thrombocytopenia)

delta F508 mutations

CFTR (cystic fibrosis)

classical complement pathway can be intitiated using IgG or IgM binding to which region of the Fc fragment

CH2 component of the Fc fragment (above the macrophage binding site)

if it looks like mono but its got a negative heterophile antibodiy agglutination test (mono spot test), then its

CMV (can get it thru blood transfusions)

which kind of pneumonia are organ transplant recipients at risk for?

CMV-associated pneumonia

taste to posterior third of tongue

CN 9

cardiac output equation

CO = SV x HR ...or...CO = (rate of O2 consumption)/ (arteriovenous O2 content difference) .(this is called the fick principle)

GI bleeds from aspirin are bc of

COX 1 inhibition which results in impaired prostaglandin- dependent GI mucosal defense and decreased platelet aggregation.

acetaminophen acts on

COX 2 (pain reducer and fever reducer BUT it doesn't do anti inflammatory)

which antiarrythmic causes prolonged QRS duration

Class 1C

confounding

Confounding: when a percieved assoc between an exposure and an outcome is actually explained by a confounding variable assoc with both the exposure and the outcome. Used in Case control studies to pick matching variables that the cases and controls will be picked based on (i.e. race and age).

somatostatin is made in which cells

D cells of the pancreas

bleeding from venous puncture sites is

DIC

chronic pancreatitis

Diarrhea, weight loss, and epigastric calcifications in a patient with chronic alcoholism suggest chronic pancreatitis with resulting pancreatic exocrine insufficiency and malabsorption.

basophilic oval inclusions in mature neutrophils

Dohle bodies; granules in neutrophils (ribosomes bound to thr rough ER). Seen in toxic systemic illness such as during leukemoid reaction (i.e. benign leukocytosis which is >50,000) due to severe infection or tumor or acute hemolysis. Serum alkaline phosphatase will be normal or increased in leukemoid reaction but its usually low in chronic myelogenous leukemia.

E. Coli (and most gram negative) vs Neisseria

E. Coli: has LPS (causes sepsis - lipopolysaccharide); Neisseria: Lipooligosaccaride (LOS)

test to detect antibodies

ELISA

branchial (pharyngeal) pouches

Ear tonsils, bottom to top 1. ear 2 tonsils 3 dorsal (bottom for inferior parathryoids); ventral (to = thymus) 4: (top = superior parahtyroids)

ATP induced closure of the ATP sensitive _ channel in the pancreatic beta cells, leads to membrane depol and insulin release

K channels

bioavailability (F) graph and equation

F = (AUC oral x dose IV)/(AUC IV x dose oral) ....AUC = area under the curve. Bioavailability referes to the fraction of administered drug that reaches the systemic circulation in a chemically unchanged form.

sertoli cells

FSH secretion leads to production of androgen binding protein (maintains local levels of testosterone); secretes inhibin B which inhibits FSH secretion

mnemonic for genetics behind familial adenomatous polyposis (i..e which chromosome)

FiveAP (FAP) - chrom. 5

riboFlavin F's

Fumarate, FAD and FMN. Vit B2 (riboFlavin) is needed for succinate dehydrogenase (complex II) to convert succinate to fumarate. (FAD is a cofactor in that reaction). Without B2, the electron transport chain and the citric acid cycle don't work. B2 deficiency happens in alcoholics and the severely malnourished. sx: glossitis, cheilosis/ angular stomatitis ( inflammatory lesions at corners of mouth), eye changes (corneal neovascularization), and anemia.

giardiasis

GI illness transmitted via the fecal oral route, characterized by chronic and acute diarrhea with bulky, frothy stools as well as nausea and vomiting. Giardiasis is more common in the immunocompromised and those exposed to unfiltered water (and incidence is higher in men who have sex with men), and is considered a global disease. Tinidazole, nitazoxanide, and metronidazole are effective treatments.

streptococcus gallolyticus (formerly S bovis) endocarditis and bacteremia are assoc with

GI lesions (colon cancer) in 25% of cases. When S gallolyticus is cultured in the blood, workup for colonic malignancy with colonoscopy is essential.

endocrine hormones that use IP3 (phosphoinositide hydrolysis) pathway

GOAT HAG (GnRH, Oxytocin, ADH, TRH, Histamine, Angiotensin II, Gastrin

somatostatin, vasopressin, and calcitonin all act thru which type of signaling mechanism (others: adrenergic agonists, glucagons, ADH, LH, FSH, TSH , hCG, & PTH)

GPCRs on cell membranes.

dobutamine mechanism

Gs protein - adenylate cyclase activation

H pylori vs autoimmune gastritis

H pylori: antrum, gastric ulcers, causes MALT lymphoma (but u still have some parietal cells to make instrinsic factor so u don't get pernicious anemia); Autoimmune gastritis: corpus, increased gastrin, destroys ALL the parietal cells so you get pernicious anemia, and at risk for adenocarcinoma.

most common bacterial cause of pneumonia in COPD pts

H. influenza (leading viral cause is rhinovirus)

von hippel lindau disease is

HARP (hemangioblastomas, angiomatosis, renal cell carcinomas, pheochromocytomas

Hypertrophic cardiomyopathy - maneuvers

HCM involves interventricular septal hypertrophy that obstructs left ventricular (LV) outlfow and creates a systolic murmur that decreases in intensity with maneuvers that increase LV blood volume (i.e. hand grip, passive leg elevation). HCM is characterized by increased LV muscle mass with a small LV cavity, preserved ejection fraction, and impaired LV relaxation leading to diastolic dysfunction.

staining shows: 185 kD glycoprotein that spans the cell membrane and has tyrosine kinase activity in the intracellular domain.

HER2 oncogene encodes for a transmembrane glycoprotein with intrinsic tyrosine kinase activity and is a member of the family of epidermal growth factor receptors. Overexpression is poor prognosis and increased disease recurrence.

most common cause of febrile seizures in infants

HHV 6 (roseola infantum)

baby has oral thrush, interstitial pneumonia and severe lymphopenia during first year of life. Mom had

HIV (vertical transmission of HIV-1). This could have been prevented by the mom taking antiretroviral therapy (ART) meds during the pregnancy.

Abacavir

HIV NRTI (nucleoside reverse transcriptase inhbitor), strongly assoc with the HLA B 51:01 allele causing a type 4 hypersensitivity reaction.

most oropharyngeal carcinomas (tonsil, base of tongue) are caused by

HPV infection; HPV 16 and 18 are the ones that cause cancer. They overexpress the tumor suppressor gene p16.

koilocyte

HPV, "raisonoid" appearance, immature squamous cell. HPV: 1-4 = skin warts (verruca vulgaris); 6,11 = genital warts (condylomata acuminata) ; 16,18 = cervical, vaginal, vulvar & anal neoplasia. HPV is double stranded non-enveloped DNA virus. jHPV can cause intraepithelial neoplasia. koilocytes have dense, irregularyl staining cytoplasm and perinuclear halo like clearing.

pleomorphic gram negative coccobacilli = _ on which agar?

Haemophilus influenzae on chocolate agar

coarse facial features, autosomal recessive disease that affects protein tagging in the golgi complex. excess lysosomal enzyme secretion (which can be detected by blood tests) and the presence of prominent inclusion bodies and vacuoles in mesenchymal cells (i.e. fibroblasts) on EM. They also have elevated serum hydrolase.

I cell disease

when patient asks you to pray for them

I will keep you in my thoughts during your procedure

if friend asks you for prescription

I would like to help, but I am uncomfortable prescribing for someone I am not treating

I cell disease

I-cell disease (inclusion cell disease/mucolipidosis type II)—inherited lysosomal storage disorder; defect in N-acetylglucosaminyl-1-phosphotransferase → failure of the Golgi to phosphorylate mannose residues (forming mannose-6-phosphate) on glycoproteins → proteins are secreted extracellularly rather than delivered to lysosomes. Results in coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes. Often fatal in childhood.

Hot T-bone stEAK

IL 1 hot, IL 2 T cells, IL3 bone marrow, IL4 IgE, IL5 IgA, IL6 aKute phase proteins

pro inflammatory cytokines:

IL 1, IL 6, TNF alpha ; these stimulate the liver to release acute phase reactants (CRP and fibrinogen).

anti-inflammatory cytokines

IL 10, 4, and TGF beta

inflammatory cytokines

IL 17, 2 and IFN gamma and TNF alpha

which interleukin facilitates isotype switching

IL 4

in asthma, which interluekin is responsible for activating B cells to class swithc to IgE production which leads to mast cell priming?

IL 4 and IL 13

cyclosporin, tacrolimus (FK506), sirolimus (rapamycin) and basiliximab all target

IL-2 (inhibition)

decreased activity of n acetyltrasnferase results in diminished ability to metab which drugs

INH and sulfonamides

initial tx for status epilepticus

IV lorazepam and phenytoin

what type of immunoglobulin is found in breast milk

IgA (peyer patches also have IgA - they are lymphoid tissue found in the lamina propria and the submucosa of the small intestine. they play a role in GI immunity, as stimulated B cells leave them and diff into IgA secreting plasma cells.)

celiac disease is assoc with deficiency of

IgA deficiency (increased infections and anaphylaxis)

henoch schonlein purpura

IgA mediated type 3 hypersensitivity reaction with IgA and C3 deposition, in children that follows an upper respiratory infection. Joint pain, leukocytoclastic (inflammation of small vessels), abdominal pain, hematuria and LE purpura

transpeptidase is

a penicillin binding protein

"I Love Vermont MAPLE SYRUP from maple trees with BRANCHES"

Isoleucine, Leucine and Valine are branched chain amino acids that are present in the blood of maple syrup urine disease infants bc they cant break them down. sx: metabolic acidosis, intellectual disability, physical retardation, feeding difficulty, and urine with sweet odor, seizures, coma, death. tx: eliminate those AA's from diet.

i love vermont maple syrup from maple trees with Branches.

Isoleucine, Leucine, Valine, Maple syrup urine disease, Branched chain amino acids buildup

ETEC has

LT (heat labile) enterotoxin which is a cholera-like enterotoxin (eL agua de San Gabriel - labile is cAMP and stabile is cGMP)

S4 sound

LVH bc decreased left ventricular compliance and assoc w restrictive cardiomyopathy and LVH

coarctation of the aorta leads to what on ECG

Left axis deviation bc it creates increased LV overload that causes LV hypertrophy which causes the left axis deviation

Leukotriene B4

Leukotriene B4 is a potent chemotactic molecule for neutrophils. Selective loss of this would have no effect on platelets, mast cells, or endothelium - these are more responsive to changes in TXA2, complement/arachidonic acid, and PGI2, respectively.

if the upper limbs are affected more than the lower limbs =

MCA occlusion instead of the ACA (bc ACA affects the lower limbs more)

microcytosis/ hypochromia

MCV <80

edrophonium: if admin elicits improvement, means...; if it doesn't improve...

MG patient doesn't have enough so increase the pyridostigmine dosage; if it doesn't improve, it is cholinergic crisis (too much Ach), so temporarily discontinue their AChE inhibitors

structure of MHC class 1 vs 2

MHC class 1: has a heavy chain and a beta 2 microglobulin; MHC class 2: alpha and beta polypeptide chains

phenelzine

MOA inhibitor

NAVEL and SHAVE are mnemonics for the femoral triangle and the femoral sheath respectivily

NAVEL: nerve, artery, vein, empty space containing Lymphatics SHAVE: SHeath contains Artery, Vein and Empty space.

classes of antiarrhythmics

No Bad boy Keeps Clean (Sodium - 1) (Beta blockers - 2) (Potassium - 3) (Calcium - 4)

PAH and inulin

PAH = renal plasma flow (RPF); Inulin = GFR (bc inulin is neither reabsorbed or secreted)

periodic acid schiff stain

PASs the sugar (stains glycogen). Used to diag tropheryma whippelii (Whipple disease - gram pos org, cardiac, arthralgias, neurologic sx)

GTP is used by PEP carboxykinase to make

PEP (phosphoenolpyruvate); GTP is synthesized by succinyl-CoA synthetase during the conversion of succinyl-CoA to succinate in the citric acid cycle. During gluconeogenesis, PEP carboxykinase uses GTP to synthesize PEP from oxaloacetate.

IP3 DAG come after the ligand binds to G protein coupled receptor that activates what

PLC (phospholipase C)

if prevalence increases/decreases, the

PPV increases or the NPV decreases

IgA nephropathy vs PSGN

PSGN is 2-4 weeks after GBS infection (pyogenes); IgA nephropathy is concurrently with the infection or right after

halothane can cause fulminant hepatotoxicity and is used a lot in other countries for surgery. To distinguish this from acute viral hepatitis, check

PT time bc the liver makes clotting factors and 7 is the shortest half life.

PSaMMoma bodies

Papillary carcinoma of thyroid, Serous papillary cystadenocarcinoma of ovary, Meningioma, malignant Mesothelioma

congenital hypothyroidism (cretinism)

Patient has congenital hypothyroidism (cretinism). Findings: pot belly, pale, puffy-faced, umbilical hernia, macroglossia, hypotonia, poor brain development (MC cause of treatable mental retardation), large anterior fontanelles.

acute interstitial nephritis (P's)

Pee (diuretics), Pain free (NSAIDs), Penicillins and cephalosporins, PPI's, rifamPin (sx: fever, rash, acute renal failure, eosinophilia)

sciatica nerve root

S1 nerve root. Pain in posterior thigh and calf, and lateral foot.

Li fraumeni cancers

SBLA (Sarcoma, Breast, Leukemia, Adrenal gland)

raloxifene

SERM; estrogen agonist at bone (inhibits osteoclasts) and estrogen antagonist at the breast and uterus (reduced risk of breast and uterine cancer) - use for postmenopausal osteoporosis and prevention of breast cancer (like tamoxifen)

tamoxifen

SERM; estrogen antagonist at breast used in tx of estrogen recetpro positive breast cancer. Stimulator at endometrial tissue/ estrogenic effect on the uterus (agonist) and can cause ADR of endometrial hyperplasia and cancer.

cyp450 inhibitors

SICKFACES.COM when I Am drinking grapefruit juice (sodium valproate, isonaizid, cimetidine, ketoconazole, fluconozole, acute alcohol abuse, chloramphenicol, erythromycin/ clarithromycin, sulfonamides, ciprofloxacin, omeprazole, metronidazole, amiodarone, Grapefruit juice)

if pt should be compensating with respiratory and they are not its probably a metabolic acid/base disorder with a

SUPERIMPOSED respiratory acid/ base disorder.

type 3 hypersens reaction

antibdy against soluble antigen (floating in the blood)

what does calcitonin do?

TONES DOWN calcium! By opposing the action of PTH

T/F: wilson disease can present with parkinsonism because of copper damaging the basal ganglia (i.e. tremor, cerebellar ataxia)

TRUE

hCG has a structure similar to

TSH, pts with testicular germ cell tumors or gestational trophoblastic disease may develop very high serum hCG conc which can stim TSH receptors and causes paraneoplastic hyperthyroidism.

Th1 vs Th2 response cells

Th1 (IL2, IFN gamma and IL-12)(CD4 mediated); TH2: IL4, IL5, IL-10)

mesoderm vs endoderm vs ectoderm

The mesoderm, which is the middle layer between the other two, is responsible for the development of muscle, bone, and connective tissue (as well as the genitourinary tract). Therefore, any genes or processes involved with limb development will ultimately be controlled by the mesoderm. The ectoderm is responsible for the development of the outer portion of our bodies, including skin and sweat glands, and is further delineated into three portions: surface ectoderm, neural crest, and neuroectoderm.Surface ectoderm eventually becomes the epidermis and the anterior pituitary. Neural crest cells develop into melanocytes, the peripheral nervous system (dorsal root ganglia, etc.) and Schwann cells, among other structures. The neuroectoderm develops into the central nervous system, encompassing the brain, spinal cord, and retina. The endoderm is the embryologic derivative that forms the gut tube epithelium from the esophagus all the way to anal canal above the pectinate line. Other important organs derived from endoderm include the lungs, liver, gallbladder, and pancreas.

cox-2 inhibitors selectivelty decrease PGI2 levels leaving prothrombotic action of

TxA2 unopposed

hyperactive deep tendon reflexes is a

UMN lesion sign

jaw deviates to the side of the lesion of this nerve

V3 (mandibular branch of trigeminal)

key growth factors in tumor angiogenesis

VEGF and fibroblast growth factor. IL 1 and IFN gamma upreg VEGF

pulmonary embolism results in

VQ mismatch which causes hypoxemia and respiratory alkalosis (hypocapnia) due to hyperventilation. (serum bicarb will be normal)

tetralogy of Fallot

VSD, PS (pulmonary stenosis), OA (overriding aorta) and RVH (right ventricular hypertrophy)

marker for mesenchymal tissue (i.e. sarcomas)

Vimentin

cofactor (vitamin) necessary for conversion of glutamate to aspartate

Vitamin B6 (pyridoxine)

Vmax vs Km

Vmax: max enzymatic rate; Km: affinity for substrate (low Km means high affinity bc Km is an INVERSE measure of affinity) hexokinase has higher Km for glucose than glucokinase but a lower Vmax.

fall on outstretched hand

can cause dislocation of the lunate bone

rett syndrome inheritance pattern

X linked dominant (only females bc males die in utero)(neurodegen, hand wringing)

inheritance for G6PD deficicency

X linked recessive

lesch-Nyhan syndrome

X linked recessive; intellectual disability, self-mutilation, gout, disordered movement. lack of HGPRT (purine salvage pathway). results in accumulation of uric acid and poor utiliztion of folate and/or vit B12 which leads to megaloblastic anemia (hypersegmented neutrophils)

another name for acid fast stain

Ziehl Neelson

relative risk formula

[a/(a+b)]/[c/(c+d)]

pleural effusion

a collection of fluid between the visceral pleura that lines the lungs and the parietal pleura that lines the thoracic cavity. The fluid acts to insulate vibrations and sounds that originate in the airways of the lung; therefore, tactile fremitus and breath sounds are decreased over a pleural effusion. Dullness to percussion is also present

ehlers danlos syndrome

a disorder of collagen synthesis, leading to hyperextensible skin, hypermobile joints, and increased bleeding. Vascular EDS is a less common but more severe form of EDS that causes milder skin and joint manifestations and is associated with vascular (aneurysmal) and organ rupture. It is specifically caused by defective type 3 collagen.

nonbacterial thrombotic endocarditis (NBTE)(marantic endocarditis)

a form of noninfectious endocarditis characterized by valvular deposition of sterile platelet-rich thrombi. It likely results from valvular damage due to inflammatory cytokines in the setting of an underlying hypercoagulable state, and it is most commonly seen with advanced malignancy (especially mucinous adenocarcinoma) or systemic lupus erythematosus.

gallstone ileus causes air in the biliary tree because

a gallstone can enter the intestinal tract via a cholecystenteric fistula; this will reach the ileocecal valve and block the intestines, causing air to build up and enter the fistula which will push air into the biliary tree. Pts will present with sx of small bowel obstruction, and abdominal x ray shows gas within the gallbladder and biliary tree (pneumobilia). sx: distended, tympanic abdomen with high-pitched bowel sounds. the gallstone is lodged in the ileum.

tay sachs disease

a gang of 6 small jews will Sach you. GM2 ganglioside, hexosaminidase A (6), small = NO hepatomegaly

Meckel diverticulum and persistent vitelline duct

a meckel diverticulum presents with bloody bowel movements, usually in an otherwise healthy child, and is the result of a persistent omphalomesenteric (vitelline) duct. rule of 2's for meckel's diverticulum: 2 inches long, 2 feet from ileocecal valve, 2 types of ectopic tissue (most common gastric, also pancreatic), prepresenting bfore 2 years of age, 2 times more likely in males and present in 2% of the population.

in constrictive pericarditis, you have restricted ventricular filling, leading to low output and elevated JVP, pericardial knock, pulsus paradoxus, and

a paradoxical rise in JVP with inspiration (kussmaul sign)

precision vs accuracy

a precise tool is one that consistently provides similar or the same value when measuring a fixed quantity. An accurate tool is one that provides a measurement identical or similar to the actual value (as reflected in a gold standard measurement).

procalcitonin

a precursor of calcitonin; its an acute phase reactant that's both positive and negative. Positive bc its levels increase in bacterial toxins and fall with viral infections.

when a medical error occurs,

a root cause analysis should be performed to identify the causes of the medical error. A root cause analysis used medical records and participant interviews to identify the underlying problems that led to the medical error.

phenylephrine

a selective alpha 1 adrenergic reeptor agpnist that causes marked arterial vasoconstriction when administered IV. The result is an increase in systemic vascular resistance and blood pressure. The induced blood pressure increase elicits a baroreceptor mediated increase in vagal tone, which results in decreased stroke volume and a slowed heart rate. The pulse pressure defined as systolic pressure minus the diastolic, is decreased by phenyephrine bc of the reglex decrease in stroke volume and the increased afterload.

swiss cheese model

a single sharp end error is rarely enough to cause harm. Instead, such errors must penetrate through multiple incomplete layers of protection to cause a devastating result. This is best explained by the swiss cheese model (i.e. creating overlapping layers of protection).

conservative mutation

a type of missense mutation that still preserves the protein's function

e coli is indole positive

able to convert tryptophan to indole

cretinism

abnormal fetal brain devel bc of lack of thyroid hormone from mom (Leads to Cretinism. Findings in infant are the 6'P (Pot belly, Pale, Puffy face, Protruding umbilicus, Protuberant tongue, and Poor Brain development.)

aneuploidy

abnormal number of chromosomes as result of chromosomal nondisjunction during mitosis or meiosis

baby born while mom taking anti hypertensives, has oliguria, why?

abnormal renal development bc of ACE inhibitors or ARBs; bc Ang II is required for normal renal development.

pt with liver disease, neuro sx (gait problems, dysarthria, depression, personality changes) will have what other abnormality

abnormal slit lamp exam ( kayser flescher rings) - wilson disease

fibromuscular dysplasia

abnormal tissue growth within arterial walls, resulting in stenotic and tortuous arteries that can cause tissue ischemia and are prone to aneurysm formation. Path typically shows alternating fibromuscular webs and aneurysmal dilation with absent internal elastic lamina (string of beads appearance). Renovascular hypertension occurs due to renal artery stenosis and activation of the RAAS system

pure red cell aplasia

absence of erythroid precursors but preserved myeloid and megakaryocytic elements; marrow failure that has severe hypoplasia of marrow erythroid elements in the setting of normal granulopoeisis and thrombopoesis. Pure red cell aplasia is assoc with thymoma, lymphocytic leukemias, and parvovirus B19 infection.

vitiligo is

absence of melanocytes in the skin (loss of epidermal melanocytes)

side effect of 100% O2 tx for carbon monoxide poisoning

absorptive atelectasis

postoperative hypocalcemia

accidental removal of the parathyroid glands in surgery (so there is calcium excretion in the urine)

fasting pt, maintenance of the pt's blood glucose levels is facillitated by hepatic conversion of pyruvate into glucose. Which substance stimulates the first enzyme in this process

acetyl CoA stimulates pyruvate carboxylase; then PEP carboxylase is used to get pyruvate to PEP.

formation of a atherosclerotic plaque: where do the growth factors come from

activated macrophages, platelets and endothelial cells release growth factors (i.e. platelet derived growth factor) that stimulate recruitment of smooth muscle cells from the arterial wall media and their subsequent proliferation in the intima.

c-myc

activates transcription, overexpressed in burkitt lymphoma (EBV)

KRAS and EGFR

activating mutations of the KRAS gene lead to constitutive activation of the epidermal growth factor receptor (EGFR) pathway, promoting increased cell proliferation and growth. Tumors harboring these mutations are resistant to treatment with anti-EGFR drugs (cetuximab, panitumumab).

engorged pulmonary capillaries and intraavleolar acellular pink material that is more prominent at the bases

acute cardiogenic pulmonary edema results from increased pulmonary venous pressure from left sided heart failure. (maybe dilated cardiomyopathy). The alveolar capillaries become engorged with blood and there is a transudation of fluid plasma across the alveolar-capillary membrane, appearing as pink, acellular material within the alveoli.

pt with 4F's (i.e. fertile, fat, female, forty) with acute RUQ pain and elevated LFTs is probably

acute cholecystitis due to obstruction of hte biliary duct system at the level of the cystic duct. this causes wall thickening of the gallbladder (the thickening is a sign of inflammation)

over time ppl with hep B acute infection will produce antibodies to the HBeAG antigen, if they don't and the HBeAG persists, then they have an

acute infection that progressed to a highly infectious chronic hepatitis B

acute acalculous cholecystitis

acute inflammation of the gallbladder in the absence of gallstones. Occurs in critically ill patietns (sepsis, severe burns, trauma, immunosuppression) due to gallbladder stasis and ischemia. Sx: fever, RUQ pain and leukocytosis

acute intermittent porphyria

acute intermittent porphyria attacks are due to the accumulation of aminolevulinate (ALA) and porphobilinogen (PBG), resulting from inhereited PBG deaminase deficiency combined with ALA synthase induction (typically due to certain medications, alcohol use or a low-calorie diet). tx: Management with glucose or hemin/heme inhibits ALA synthase activity. reddish urine that darkens on exposure to light and air

elevated Cr with urinary EBC casts and eosinophilia

acute interstitial nephritis

penicillin allergy causes

acute interstitial nephritis. (also: rash, anaphylaxis, hemolytic anemia)

thrombocytopenia, anemia, leukocytosis, DIC =

acute myelogenous leukemia (AMPL - M3) t(15;17)

sudden cardiac death in otherwise healthy person

acute myocarditis from viral infection (coxsackie, adenvirus, influenza)

fat necrosis

acute pancreatitis, trauma (subcutaneous adipose tissue)

pancreatitis with subsequent respiratory failure is

acute respiratory distress syndrome (ARDS) from pancreas releasing large amounts of inflammatory cytokines and enzymes into circulation which leads to neutrophils in the pulmonary interstitium. During the initial phase, fibrin deposition causes the alveoli to become lined with waxy hyaline membranes.

acute stress disorder vs PTSD

acute stress disorder is more than 3 days but <1 month; PTSD is >1 month of sx.

epididymitis

acute testicular pain (posterior testicular tenderness), tenderness and pyuria. Caused by retrograde passage of prganisms from the urethra into the ejaculatory duct and vas deferens. Age determines: <35 = STI (gonorrhea, chlamuydia), >35 = gram negative bacteria from bladder outlet obstruction.

hemorrhage can lead to renal ischemia which causes

acute tubular necrosis

what type of kidney injury happens in rhabdomyolysis?

acute tubular necrosis (so you see brown, granular muddy casts)

the PCT and the thick ascending limb of the loop of henle are most commonly involved in

acute tubular necrosis bc of their high metabolic demand

ethylene glycol ingestion causes

acute tubular necrosis with vacuolar degeneration and ballooning of proximal tubular cells; causes calcium oxalate crystals to form in urine

jaundice, RUQ pain, nausea, elevated AST and ALT (ALT>AST) and total bilirubin

acute viral hepatitis. (ALT>AST)

acute vs chronic lung transplant rejection

acute: affects small blood vessels; chronic: affects small airways

drugs that can cause a crystal induced acute kidney injury

acyclovir, protease inhibitors, methotrexate, sulfonamides

adaptive vs innate immunity

adaptive: CD8 and CD4 T cells, & CD19 (B cells); Innate: NK cells (CD56)

kehr sign

adbominal process irritating phrenic nerve around diaphragm, refers pain to C3-C5 shoulder region (Kehr sign)

how do you make thyroid hormone

add tyrosine to iodine = monoiodotyrosine. need phenylalanine to make tyrosine; therefore a deficiency of phenylalanine will cause hypothyroidism

carboxylase

adds a carboxyl group to a substance

GERD, obesity, and tobacco use (chewing) are risk factors for what type of cancer

adenocarcinoma

barretts esophagus - which cancer

adenocarcinoma

villous adenoma

adenomatous polyps are either tubular, villous or tubulovillous, depending on their histologic appearance. Villous adenomas tend to be larger, sessile, and more severely dysplastic than tubular adenomas. Villous adenomas can cause a secretory diarrhea from increased mucin production; patients may develop hypoproteinemia and hypokalemia.

acyclovir nephrotoxicity

adequate hydration prevents renal side effects (i.e. crystalline nephropathy)

a normal bleeding time indicates

adequate platelet hemostatic function

dysgerminoma

adolescents, increased beta hCG, increased LDH, histo: fried egg cells

PSGN - worse in adult or kids

adults have worse long term recovery

chronic autoimmune gastritis

affects the fundus and body of the stomahc and is mediated by CD45 T cells reactive against gastric parietal cell components. Since these cells release intrinsic factor, vit B12 deficiency (pernicious anemia) often occurs.

prostaglandins constrict the

afferent arteriole

tricuspid regurg leads to

afterload decrease, preload increase, ejection fraction increase

IgA nephopathy

aka berger disease; glomerulonephritis, shortly after or concurrently with an upper respiratory tract infection. pts present with hematuria, RBC casts in the urine and mild proteinuria. IgA immune complex deposits are found in the mesangium on immunoflourescence.

aldosterone and spironolactone

aldosterone is a component of the renin-angiotensin-aldosterone system that acts on the principal and intercalated cells of the renal collecting tubules to cause resorption of sodium and water and loss of potassium and hydrogen ions. Aldosterone receptor antagonists (i.e. spironolactone, eplerenone) inhibit these effects.

conn syndrome

aldosterone producing adenoma; primary hyperaldosteronism. The hypertension, hypokalemia and metabolic alkalosis cause paresthesias and muscle weakness. Tx: K+ sparing diuretic (eplerenone, spironolactone); could also be due to bilateral nodular hyperplasia in the zona glomerulosa.

someone on prednisone for a long time will have what levels of CRH ACTH and cortisol

all low/ decreased (most common cause of adrenal insufficiency - steroid suppression) (in these pts, adrenal crisis can be precipitated by stressful situations (infections, surgery) if the glucocorticoids arent increased appropriately.

umbilical arteries and vein are derived from the

allantois

asthma, sinusitis, eosinophilia

allergic (eosinophilic) granulomatosis and angiitis is a vasculitis with pulmonary involvement. It is a small-vessel vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA).

to decrease pt's risk for kidney failure when undergoing chemotherapy, which drug do you give them?

allopurinol (it inhibits xanthine oxidase and is used to prevent tumor lysis associated urate nephropathy)

kid with chemotherapy has high uric acid levels, give him

allopurinol bc tumor lysis syndrome makes high uric acid levels and allopurinal prevents formation of uric acid

coronary autoregulation

allows coronary blood flow to be driven primarily by myocardial oxygen demand in spite of blood pressure. It is done thru alterations in vascular resistance via release of adenosine and nitric oxide in response to myocardial hypoxia.

marker to watch for recurrence of hepatocellular carcinoma (and to a lesser extent chronic hepatitis)

alpha fetoprotein levels will be increased

when a patient asks physician to date

always decline and say if would be unethical; only former patients are allowed to date physicians. It would be unethical to end the physican patient relationship just so they can date.

amniotic fluid embolism

amniotic fluid enters the maternal circulation. Causes hypoxia, shock, and DIC.

trophozoites in CSF =

amoebic encephalitis (naegleria fowleri)

tx for cryptococcus

amphotericin B first (frogs painted on the wall of the crypt) THEN long term fluconazole maintenance therapy

tx for aspiration pneumonia

ampicillin/sulbactam or amoxicillin/clavulinic acid (most aspiration pneumonia is caused by mixed anaerobic and facultatively anaerobic organisms)

kidney biopsy of pt with multiple myeloma shows

amyloidosis (fibrillary deposits in the mesangium and subendothelium that stain positive with Congo red )

calcineurin

an essential protein in the activation of interleukin 2, which promotes growth and differentiation of T cells. Immunosuppressants such as cyclosporin and tacrolimus work by inhibiting calcineurin activation.

estrogen effect on thyroid hormone production

an increase in estrogen activity, as seen in pregnancy or postemnopausal estrogen replacement therapy, increases the level of thyroxine-binding globulin. This leads to an increase in total thyroid hormone levels, but feedback control maintains normal levels of free (biologically active) thyroid hormone.

mannitol

an osmotic diuretic that works by increasing plasma or tubular fluid osmolality. Increased plasma and fluid osmolality causes extraction of water from the interstitial space into the vascular space or tubular lumen with subsequent diuresis. In the brain, water redistribution from the tissues into the plasma helps reduce edema and intracranial pressure in the setting of cerebral edema. One of the more severe toxicities of aggressive osmotic diuretics is pulmonary edema.

types of hypersensitivity reactions - ABCD

anaphylactic and atopic (type 1); antiBody-mediated (type 2); immune complex (type 3); Delayed (cell mediated, type 4); types 1,2,3 are antibody mediated.

what is almost always necessary for the development of acute pyelonephritis?

anatomic or functional vesicoureteral reflux

post MI: 1-3 days

coag necrosis (loss of nuclei) and prominent neutrophiic infiltrate

bleomycin

antineoplastic agent that binds to iron and oxygen molecules to create free radicals that cause DNA strand breaks. ADR: lung toxicity (pulmonary fibrosis). Patients develop dyspnea and nonproductive cough, and pulmonary function testing shows a restrictive pattern with reduced diffusion capacity for carbon monoxide (DLCO).

female pt on antipsychotics gets amenorrhea

antipsychotics block the release of dopamine which means that prolactin is disinhibited and they get hyperprolactinemia and prolactin inhibits the release of GnRH.

which adverse effect persists with levodopa carbidopa therapy of parkinsons

anxiety and agitation

CT scan of thorax shows line in the middle of the aorta ("septum")

aortic dissection from hypertension (this is the tunica inteima of the aorta). HTN is the most important risk factor of aortic dissection.

bicupsid valve leads to

aortic stenosis in 50's

calcific aortic valve disease

aortic stenosis most commonly results from age related calcific aortic valve disease. The early pathogenesis of CAVD closely mimics that of arterial atherosclerosis. In the later stages, fibroblasts differentiate into osteoblast like cells and deposit bone matrix, leading to progressive valvular calfication and stenosis.

aplastic crisis vs aplastic anemia (pancytopenia)

aplastic crisis: just low RBC precursors (parvovirus in sickle cell disease); aplastic anemia (pancytopenia): platelets, RBC precursors, and WBC's are low

apocrine vs eccrine

apocrine = sweat gland, apoptosis where they release some of their cytoplasm & its responsible for the body odor/ smell of sweat; eccrine: sweat gland but does not release its cytoplasm

DNA fragmentation is

apoptosis

NSAIDs block the prostaglandin synthesis which increases

arachadonic acid and leukotrienes (other side of the chart)

positive amino acids

arginine and lysine (in histones), and histidine

neuroblastoma

arises from neural crest cells of the adrenal medulla and presents with abdominal mass and elevated catecholamine breakdown products. Also sx include opsoclonus (eyes spazzing) and myoclonus which is paraneoplastic syndrome assoc with neuroblastoma

if mom experiences virilization during the pregnancy and the baby comes out with 46,XX but ambiguous genitalia and increased testosterone and androstenedione levels then the baby has a deficiency of

aromatase enzyme (i.e. aromatase deficiency is an autosomal recessive disorder) to convert testosterone to estradiol

most likely mechanism of death after person has had an MI

arrhythmia

dimercaprol

arsenic poisoning antidote

bruit over renal arteries

arterial narrowing (stenosis, atherosclerosis in the renal artery)

testicular torsion: vascular compromise: the gonodal arteries come from where? Vs the gonadal veins come from where?

arteries from aorta; LEFT vein from renal vein (right from IVC)

aspergillus fumigatus and TB

aspergillus can be an opportunistic infection in immunosuppressed (invasive pulmonary aspergillosis), can be colonizing (aspergilloma) when it forms a fungus ball within preexisitng lung cavity. Can cause lung hypersensitivity reaction in allergic bronchopulmonary aspergillosis in ppl with asthma

acute angle branching with septations

aspergillus fumigatus

which one irreversibly binds COX 1 and COX 2

aspirin (NSAIDs are reversible)

membranous nephropathy

assoc with IgG4 antibodies to the phospholipase A2 receptor, which might play a role in the development of the disease. Antibody titers are useful for diagnosis and correlate with disease activity. Also: oval fat bodies on UA, weight gain, edema, proteinuria

clonidine

assoc with drowsiness, lethargy, sedation, fatigue, depressed mood, rebound hypertension, hypotension, headache, and constipation. only prescribed to pts who cant use other meds or who have persistant HTN despite taking other first line meds

hepatic angiocarcinoma

assoc with exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride. Tumor cells express CD31, an endothelial cell marker part of the PECAM1 (platelet endothelial cell adhesion molecule) family of immunoglobulin proteins that are on surfaces of endothelial cells and function in leukocyte migration thru the endothelium.

xanthomas

assoc with hyperlipidemia, or lymphoproliferative malignancies. Lipid laden histiocytes in the dermis. 5 categories: eruptive (papules appear abruptly when plasma TG's and lipids increase); tuberous and tendinous (latter often present on achilles tendons and the extensor tendons of the fingers); plane (linear lesions in skin folds assoc with primary biliary cirrhosis); xanthelasma (soft eyelid or periorbital plaques with no assoc lipid abnorm in 50% of ppl). they have foamy cytoplasm.

schizophrenia moa

assoc with increased dopamine levels; it has been proposed that dysfuinction of the mesolimbic pathway is related to the positive sx (hallucinations, delusions, racing thoughts), whereas dysfunction of the mesocortical pathway is related t the negative sx (apathy, lack of emotion, poor social functioning)

primary biliary cirrhosis

assoc with sjogrens syndrome; severe pruritis (especially at night), elev alkaline phosphatase.

benign prostatic hyperplasia (BPH)

assoc with stromal and glandular growth in the periurethral and transitional zone of the prostate. The hyperplastic cells are supported by the formation of new blood vessels, which are friable and prone to bleeding. Therefore, BPH is often assoc with microscopic or gross hematuria.

intermittent respiratory sx in a pt with normal CXR, sputum eosinophils, and reduced FEV1 suggest

asthma

most common cause of pulsus paradoxus when its not constrictive pericarditis

asthma and COPD.

TGFA

astrocytoma, hepatocellular carcinoma; protooncogene

SIS

astrocytoma, osteosarcoma; protooncogene

group B strep prevention intrapartum

at 35 weeks gestation, give penicillin or ampicillin

livedo reticularis

atheroembolic disease

needle shaped cholesterol clefts in arterial lumen of kidney (i.e. cholesterol clefts in the arterial lumen)

atheroembolic disease (after surgery atheromas are disrupted/ vascular procedure due to mechanical dislodgement of atherosclerotic plaque and go to kidney - causes acute kidney injury). Other commonly involved organs are: skin (blue toe syndrome, livedo reticularis), GI tract (bleeding, infarction), and CNS (stroke, amaurosis fugax - i.e. a painless, temporary loss of vision)

lupus on renal and CV

atherosclerosis, libman sacks endocarditis (vegetations), renal: prolif GN, thickening of GBM with wire loop structures on light micro

renal infarcts can come from

atrial fibrillation (sx: flank pain, nausea, hypertension due to renin release from hypoxic tissue)

tx of vitamin B12 deficiency with cyanocobalamin aka B12)

atrophic gastritis can result in profound hypochlorhydria, inadequate intrinsic factor production, vitamin B12 deficiency and elevated methylmalonic acid levels. The reticulocyte count increases dramatically once vitamin B12 replacement therapy is initiated in an individual with perninous anemia. Hemoglobin and erythrocyte count levels rise more gradually and take up to 8 weeks to normalize.

tx for bradycardia from inferior wall MI

atropine; conduction impairment is common with acute inferior wall MI. Sinus bradycardia often occurs due to nodal ischemia and an increase in vagal tone triggered by infarction of myocardial tissue; the enhanced vagal tone can be counteracted by the anticholinergic effects of atropine.

myeloblasts have (acute myelogenous leukemia)

auer rods (intracytoplasmic granules) that stain for peroxidase. They replace marrow cells and cause anemia and neutropenia. (acute myelogenous leukemia)

acute myelogenous leukemia

auer rods, median age 65, blasts, pancytopenia, >20% myeloblasts in the bone marrow,

osler weber rendu syndrome (hereditary hemorrhagic telangiectasia)

auto dominant, telangiectasias to the skin and mucous membranes (pink spider-like lesions). Rupture can cause epistaxis, GI bleeding and hematuria.

myasthenia gravis moa

autoantibodies against the postsynaptic ACHr's cause fatigable skelatal muscle weakness as Ach stores within the presynaptic nerve terminal become progressively depleted with repetitive stimulation. Women in postpartum period are high risk for MG.

myotonic dystrophy

autosomal dominant disorder; muscle wasting, wide stepping gait, and bilateral cataracts. Caused by a CTG trinucleotide repeat and exhibits anticipation, whereby the number of CTG repeats can increase across generations and cause symptoms at younger ages. CTG = cataracts, toupee (early balding in men), gonadal atrophy

huntington disease

autosomal dominant neurodegen; chorea (involuntary, jerky, fidgety movements) and behavioral abnormalities (aggressiveness, depression). Characteristic neuroimaging = atrophy of the caudate nuclei which results in enlargement of the frontal horns of the lateral ventricles.

hypertension, gross hematuria after trauma, and numerous bilateral renal cysts at a young age is classic for

autosomal dominant polycystic kidney disease

neurofibromatosis type 1

autosomal dominant; cutenous neurofibromas, cafe-au-lait spots, and lisch nodules (pigmented hamartomas of the iris/eye). NF-1 gene stems from a mutation on chromosome 17 in a tumor suppressor gene(NF1) that normally regulates Ras signaling.

classic galactosemia (inheritance pattern)

autosomal recessive

sickle cell anemia inheritance pattern

autosomal recessive

refsum disease

autosomal recessive disorder of alpha oxidation, phytanic acid not metabolized to pristanic acid. Scaly skin, ataxia, cataracts/ night blindness, shortening of 4th toe, epiphyseal dysplasia. Tx: diet, plasmapheresis. - peroxisomes contain enzymes involved in very long chain fatty acid metabolism. Refsum disease is a peroxisomal disorder that affects myelin sheath formation, leading to neuro deficits.

jervell and lange nielsen syndrome

autosomal recessive disorder; profound bilateral sensorineural hearing loss and congenital long QT syndrome, which predisposes to ventricular arrhythmias and sudden cardiac death. This condition occurs secondary to mutations in genes that encode voltage-gated potassium channels.

inclusion cell (I cell) disease

autosomal recessive lysosomal storage disorder. Defect in the phosphorylation of mannose residues on lysosome bound proteins (in the golgi apparatus)

crigler najjar syundrome

autosomal recessive, lack of UGT enzyme; kernicterus.

bloom syndrome

autosomal recessive, mutation in BLM gene encoding helicase (unwinds double helix during DNA replication). Sx: growth retardation, facial anomalies, photosensitive skin rash, immunodeficiency

niemann pick disease

autosomal recessive; ashkenazi kews; sphingomyelinase deficiency (build up of sphingomyelin); hepatosplenomegaly, neurologic regression and a cherry red macular spot in infancy. (Pick your nose with your SPHINGER)

primary ciliary dyskinesia

autosomal recessive; half of pts have situs inversus; mutation to flagella and cilia proteins; sx: chronic sinusitis, bronchiectasis and infertility; if pt has triad (situs inversus, chronic sinusitis and bronchiectasis) they have Kartagener syndrome (therefore things like the dynein arms are likely to be dysfunctional)

chediak higashi syndrome

autosomal recssive disorder of neutrophil phagosome lysosome fusion that results in neurologic abnormalities, partial albinism, and an immunodeficiency caused by defective neutrophil function

avoidant

avoidance due to fears of criticism and rejection

neuronal damage: axonal reaction (regeneration)

axon transection; enlargement of the cell body; eccentrically placed nucleus; enlargement of the nucleolus; dispersion of the Nissl bodies

which vascular beds are the most susceptible to atherosclerotic burden/ plaque formation?

bends and branch points that encourage turbulent flow; i.e. the lower abdominal aorta and the coronary arteries.

struvite sontes: urease producing organisms (proteus, klebsiella)

big staghorn calculi, doesn't cause colic bc cant get to ureter. Kidneys excrete the uric acid so this is where it builds up. Hydrolysis of urea makes alkaline ammonia so the urine is alkaline

if pt is cushing syndrome (fat, striae, hypertension, hyperglycemia), they've prob been on glucocorticoids for a while, which means they will prob have

bilateral cortical atrophy of the adrenal glands

bile acid resins vs ezetimibe

bile acid resins: prevent reabsorption of bile acid resins (forcing

medical tx for cholesterol gallstones

bile acid supplement/ hydrophilic bile acids (ursodeoxycholic acid) improves cholesterol solunbility by reducing the amt of cholesterol secreted intot he bile and increasing biliary bile acid concentration

is the setting of gallstones, which two things are decreased?

bile acids and phosphatidylcholine

deficiency in bilirubin glucuronyl transferase

bilirubin glucuronyl transferase is a hepatic enzyme responsible for the conjugation of bilirubin with glucuronide, improving solubility for biliary excretion. A decrease in glucuronyl transferase results in unconjugated hyperbilirubinemia.

sirolimus

binds to immunophilin FK-506 binding proetin (FKBP) in cytoplasm forming complex that binds and inhbits mTOR. This leads to blockage of interleukin 2 signals and prevents cell cycle progression and lymphocyte progression

cyanide moa of toxicity

binds to the iron within cytochrome oxidase, interfering with the electron transport chain, and inhibiting cellular respiration. Cyanide poisoning is seen in household fires (sx: flushing, headache). A bitter almond like odor on the breath is a unique feature.

RBCs glycolysis sometimes generates no net ATP. This is bc of

bisphosphoglycerate mutase. They do this to make 2,3 BPG which causes RBCs to have less affinity for oxygen, enabling better oxygen delivery to the cells. Using mutase skips an ATP generating step of glycolysis.

dubin johnson syndrome

black liver, benign, defective hepatic excretion of bilirubin glucuronides; direct hyperbilirubinemia and jaundice. Liver appears black bc impaired excretion of epinephrine metabolites which appear as dense pigemnts within lysosomes.

most common cause of acute urinary retention is

bladder outlet obstruction (urethral compression) due to benign prostatic hyperplasia

bleb

blister filled with serous fluid. Can be a cause of spontanous pneumothorax.

four ways to block acid secretion from parietal cells

block H2 receptors (cimetidine), block CCKB receptors/ gastrin (atropine - vagal moa), block M3 receptors (atropine), PPI - blocks proton pump H+/K atpase proton pump (omeprazole); prostaglandins are inhibitory

rifamycins

block the action of the bacterial DNA dependent RNA polymerase, thereby inhibiting transcription. Resistance is acquired by modification of the rifampin binding site on the bacterial DNA dependent RNA polymerase. Common side effects include hepatotoxicity, blood dyscrasias, and harmless red-orange discoloration of body fluids.

ventricular ependymomas can

block the flow of CSF and cause increased ICP (headache, papilledema) due to obstructive (noncommunicating) hydrocephalus

moa of penicillin

blocks cell wall synthesis by inhibition of peptidoglycan cross linking

moa for sumatriptan

blocks postsynaptic serotonin receptors

mechanism of tetrodotoxin:

blocks voltage gated sodium channels in nerves inhibits passive transport of sodium

cause for iron deficient anemia in ilder men or postmenopausal women

blood loss in the GI tract (occult so they cant see it)

CPAP machine: what decreases

blood pressure bc increased thoracic pressure bc of CPAP air pressure compressing ICV which decreased preload which decreases blood pressure

reticulocytes on Wright Giemsa stain appear

bluish, because of retained basophilic, reticular (mesh like) network of residual ribosomal RNA.

ADR of carbamazapine

bone marrow suppression

meconium ileus is a specific finding in newborn for

cystic fibrosis

unfractionated heparin

both unfractionated heparin and LMWH can bind to antithrobin to increase its activity against Factor Xa. Only unfractionated heparin is able to bind to both antithrombin and thrombin to allow antithrombin to inactivate thrombin.

ACEI induced angioedema is mediated by

bradykinin accumulation

hereditary C1 esterase inhibitor deficiency

bradykinin mediated angioedema but presents early

which organs are more likely to suffer from embolic infarctions

brain and kidneys bc they are perfused at a higher rate

sildenafil is similar moa to bnp and anp how?

brain natriuretic peptide causes vasodilation just like sildenafil bc they both use cGMP increases to causes relaxation of vascilar smooth muscle and vasodilation

BRCA1 and 2

breast cancer and ovarian cancer; tumor suppressor gene; they code for DNA repair genes

tx for haloperidol overdose (neuroleptic malignant syndrome)

bromocriptine or dantrolene

ppl with asbestos exposure get what kind of cancer

bronchogenic carcinoma (of the bronchial epithelium) is the MOST COMMON malignancy assoc with asbestos exposure! Smoking and asbestos have a synergistic effect on this. Malignant mesothelioma is a RARE malignancy of the pleura that asbestos is the only known risk factor for.

ispilateral spastic paralysis (corticospinal tract injury), ipsi loss of tactile/vibratory/position sensation (dorsal columns) and contralateral loss of pain and temp (spinothalamic tract) below the level of the injury

brown sequard syndrome from hemisection of the spinal cord

undulating fevers (different at different times of day) and ate fresh cheese & person has a strong moldy odor

brucella melitensis

idiopathic intracranial hypertension (pseudotumor cerebri)

buildup of pressure compresses the optic nerves, causing bilateral optic disc edema (papilledema) (blurred disc margins on fundu). Presents in young obese women with daily headache (which worsens with valsalva), bilaterally symmetric papilledema, and transient visual distrubances.

bullous pemphigoid vs pemphigus vulgaris

bullous is supepidermal (between the dermis and the epidermis); vulgaris is between the LAYERS OF THE EPIDERMIS

tense, subepidermal blisters

bullous pemphigoid; antibodies against hemidesmosomes

c-myc

burkitt lymphoma (starry sky pattern on histo). t(8;14)

an aneurysm of the internal carotid artery can cause visual problems how?

by impinging laterally on the optic chiasm. Ipsilateral nasal hemianopia by damaging the uncrossed optic nerve fibers from the temporal portion of the retina

thymus: you can live without it as an adult because

by the time you hit puberty, your thymus has already made ALL of your t cells and they are long lived

burkitt lymphoma

c-MYC oncogene overexpression (responsible for transcription activation), tumor on jaw (african type),;t(8;14); starry sky appearance; EBV virus associated.

microarray

cDNA library with flourescent tags, flourescence occurs when the mRNA of the sample is bound to one of the cDNA in the chip

over time, granulomas will fibrose, and

calcify.

CREST syndrome

calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia; fingertip ulcers, [the esophageal part is due to fibrous replacement of the muscularis in the lower esophagus]

C cells in the thyroid produce what

calcitonin (parafollicular C cells) and they have sheets of cells in an amyloid stroma.

what is elevated in the serum of multiple myeloma pts

calcium bc of the pathologiuc fractures and lytic bone lesions. (hypercalcemia)

which drug to give to subarachnoid hemorrhage patients (after theyre stabilized)

calcium channel blockers bc it will prevent the cerebral vasospasm that usually happens 3-12 days after the subarachnoid hemorrhage

which drug do you avoid in pts with hypertrophic cardiomyopathy

calcium channel blockers; nitroglycerin; ACEI's and diuretics

arteriovenous shunts

can be congenital or acquired; acquired forms can result from medical interventions or penetrating injuries. AV shunts increase preload and decrease afterload by routing blood directly from the arterial system to the venous system, bypassing the arterioles. High-volume AV shunts can eventually result in high-ouput cardiac failure.

calcidiol

can be converted to calcitriol but is dependent on parathryoid hormone and so pts with hypoparathryoidism can have inadequate production of this.

tertiary syphilis

can result in thoracic aortic aneurysm. If the aneurysm compresses adjacent structures and dilates the aortic valve ring, a murmur and mediastinal widening might be present. The pathogenesis begins with vasa vasorum (vessels of the vessels) endarteritis and obliteration, resulting in inflammation, ischemia and weakening of the aortic adventitia. Fluorescent treponemal antibody absorption testing is specific for syphilis.

x linked adrenoleukodystrophy

cant transport very long chain fatty acids into peroxisomes

first line for trigeminal neuralgia

carbamazapine

elevated 5-HIAA levels means

carcinoid syndrome typically presents with episodic flushing, secretory diarrhea, and wheezing. It can lead to pathognomonic plaque-like deposits of fibrous tissue on the right sided endocardium, causing tricuspid regurgitation and right sided heart failure. Elevated 24-hour urinary 5-HIAA (hydroxyindoleacetic acid) can confirm the diagnosis.

5 HIAA

carcinoid tumor causing carcinoid syndrome (flushing, diarrhea, wheezing). Increased 5 HIAA in urine bc its breakdown product of 5HT bc carcinoid tumor secretes serotinin. Tx: octreotide

mitral stenosis

cardiac sounds: loud first heart sound, early diastolic opening snap after the second heart sound and a low pitched diastolic rumble best heard at the apex. Opening snap Is caused by the sudden opening of the mitral valve leaglets when the left ventricular pressure falls below the left atrial pressure at the beginning of diastole.

defective fibrillin in marfan syndrome predisposes pts to aortic dissection which leads to

cardiac tamponade which is low voltage QRS complexes with electrical alternans on an ECG (low voltage QRS complexes and oscillating QRS amplitudes)

beta 1 receptors are found in which tissue

cardiac, and renal juxtaglomeruluar cells(increase renin release) (beta 1 are NOT in vascular smooth muscle, only beta 2)

hypertrophic cardiomyopathy on histo

caripmyocyte hypertrophy with myofiber dissarray and increased interstitial fibrosis. The structural dissarray creates a substrate for ventricular arrhythmia.

the most highly oxygenated blood in the fetus is where

carried by the umbilical vein, which empties directly into the inferior vena cava via the ductus venosus.

Li-Fraumeni syndrome

casued by an autosomal dominant mutation in the tumor suppressor gene TP53. Leukemia, sarcomas, and tumors of the breast, brain and adrenal cortex are most common. If u see a lot of different cancers in one family.

burkholderia cepacia

catalase positive, gram negative,

polymyxins

cationic surfactants with detergent like activity against gram-negative organisms. They bind to and cause destruction of cell membranes. Major toxicities include neurotoxicity (numbness of the extremities, confusion, drowsiness, nystagmus, blurred vision), nephrotoxicity, facial flushing and anaphylactoid reactions.

subserosal leimyomas (fibroids)

cause irregular uterine enlargement, resulting in pelvic pressure. Fibroids arising from the posterior subserosal surface of the uterus can cause constipation due to pressure on the colon.

acute intermittent porphyria

caused by a deficiency of porphobilinogen deaminase, which causes accumulation of aminolevulinate and porphobilinogen. acute attacks of AIP (presenting with abdominal pain, red urine, and psych sx) can be precipitated by certain drugs and alcohol.

yellow fever

caused by a flavivirus and is characterized by headache, photophobia, musculoskeletal pain, and elevated transaminases with AST>ALT. Councilman bodies, eosinophilic degeneration and condensed nuclear chromatin, can be seen on liver biopsy.

acute allergic contact dermatitis

caused by a type IV (delayed) hypersenstivitiy reaction to an antigen on the skin surface. Gross findings include erythematous, papulovesicular, weeping lesions. Histo is characterized by spongiosis, an accumulation of edema fluid in the intercellular spaces of the epidermis. With chronic exposure, lesions become less edematous, with thickening of the stratum spinosum and stratum corneum.

hydroceles and indirect inguinal hernias

caused by an incomplete obliteration of the processus vaginalis. The resultant connection between the scrotum and abdominal cavity can allow for fluid leakage (hydrocele) or the passage of abdominal contents (indirect inguinal hernia)

oral thrush

caused by candida albicans infection and usually presents as white, plaque-like oropharyngeal lesions that are easily scraped off with a tongue depressor. Most cases arise in those who have disruptions to normal flora due to antibiotics or impairments in cell-mediated immunity from chemotherapy, inhaled corticosteroids or HIV. Young, otherwise healthy patients with thrush should be tested for HIV, particularly if they have HIV risk factors or other sx of the virus.

coronary steal with adenosine

caused by dilation of coronary arterioles nearby the atherosclerotic coronary vessel, diverting blood away from it (cilostazol can cause this as well)

acute cholecystitis

caused by gallstone obstruction of the cystic duct; test: it does Not show up on radionuclide biliary scan/ cholescintigraphy which means that the cystic duct is blocked.

anterior cord syndrome

caused by occlusion or hypoperfusion of the ventral spinal artery and results in bilateral deficits in pain and temperature sensation, voluntary motor control and autonomic motor control below the lesion. Dorsal columns are spared. can be caused by aortic aneursym repair.

marfan's on histo of aorta

cystic medial necrosis of the aortic root, leading to aortic dissection

tropheryma whippelii (whipple's disease)

caused by the gram positive actinomycete, tropheryma whippelii, Whipple disease is a rare systemic illness that involves the small intestine, joints, and central nervous system. Classic histo is small instestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules.

COPD (chronic obstructive pulmonary disease)

causes air trapping and hyperinflation; these patients breathe at higher baseline lung volumes (higher functional residual capacity). The absolute volume of air in the lungs that is not respired (residual volume) increases substantially, as does the fraction of air in the lungs that is not involved in respiration (residual volume/ total lung capacity ratio).

vitamin A deficiency

causes night blindness and hyperkeratosis. Deficiency of this fat-soluble vitamin can develop in patients with biliary disorders, exocrine pancreatic insufficiency or intestinal malabsorption. An example of a biliary disorder: primary biliary cholangitis in which there is a lack of bile to be able to absorb fats and fat soluble vitamins.

left sided heart failure

causes secondary pulmonary hypertension via elevated left sided diastolic filling pressures transmitting backward to the pulmonary veins, resulting in pulmonary venous congestion. Over time, pulmonary arterial remodeling (medial hypertrophy and intimal thickening with fibrosis) can occur, but not to the extent that occurs in (primary) PAH.

thiazide diuretics ADR

causes slight hypercalcemia by increasing the distal tubular reabsorption of calcium. This suppresses PTH.

central vs peripheral tolerance

central: T cells in the thymus will be removed if theyre reactive to self-antigen. peripheral: when a T cell engages an APC and doesnt receive the second of two signals (CD28-B7) then it is made refractory to future stimulation and is anergic.

3 phases of stimulation of acid secretion within the stomach

cephalic, gastric and intestinal. Cephalic: thought, smell, taste of food). Gastric: presence of gastrin stims histamine secretion and acid secretion - triggered by chemical stim of food and distension of the stomach. Intestinal: initiated when protein-containing food enters the duodenum, but this phase plays only a minor role in stimulating gastric acid secretion. intestinal influences mostly down-regulate gastric acid secretion after a meal via peptide YY on enterochromaffin-like cells.

person travels to south america (bolivia for example) and has fever now with swelling of an eye

chagas (trypanosoma cruzii); acute phase: trypomastigotes; from the triatomine bug. Eye swelling is from bug inoculating the conjunctiva while you sleep. Chronic chagas can lead to cardiomyopathy (HF, arrhythmias, ventricular aneurysm, etc).

reassortment

changes in genomic composition that occur when host cells are coinfected with 2 segmented viruses that exchnage whole genome segments. This process can cause sudden alterations in surface antigens of the viral progeny, as observed with the highly mutagenic influenza virus.

diverticulitis

characterized by inflammation of colonic diverticula. Pts have abdominal pain, nausea, vomiting and changes in bowel habits. Low grade fever and leukocytosis are common and physical examination may demonstrate a tender mass in the left lower quadrant. risk increases with age (>60 y/o usually)

ppl predisposed to getting giardiasis

children with IgA deficiency, X linked agammaglobulinemia and common variable immune deficiency (major defense against giardia is IgA)

high urinary cystine can cause what

cystine kidney stones (hexagonal)

obesity hypoventilation syndrome

chronic fatigue, dyspnea, difficulty concentrating, and evidence of hypoventilation (partial pressure of carbon dioxide >45 while awake). It is one of the important causes of hypoxemia with a normal alveolar to arterial oxygen gradient.

negative nitroblue tetrazolium dye reduction test

chronic granulomatous disease (X linked) lack of reduced NADPH oxidase activity.

black pigment gall stones are from

chronic hemolysis (sickle cell, spherocytosis) they have unconjugted bilirubin

hypertensive nephrosclerosis

chronic hypertension can result in hypertensive nephrosclerosis, which is characterized by compensatory medial hypertrophy and fibrointimal proliferation; endothelial damage from elevated systemic pressure also leads to hyaline arteriolosclerosis. The narrowed arteriolar lumens cause a progressive decrease in renal blood flow, resulting in flomerular ischemia and fibrosis (glomerulosclerosis).

erythropoietin signal transduction

chronic kidney disease is commonly assoc with normocytic anemia due to reduced production of EPO by the kidneys. EPO signal transduction is primarily mediated by the Janus Kinase 2/ signal transducers and activators of transcription (JAK2/STAT) pathway, which promotes erythrocyte precursor survival.

chronic lymphocytic leukemia

chronic lymphoproliferative disorder marked by progressive accumulation of mature B cells. Most patients are asymptomatic for years but eventually develop anemia, thrombocytopenia, and/or neutropenia. Diagnosis is made when complete blood count reveals dramatic leukocytosis, and flow cytometry shows a clonal population of leukocytes with typical B cell markers such as CD19, CD20 and CD23.

postprandial epigastric pain with assoc food aversion/ weight loss in the setting of generalized atherosclerosis

chronic mesenteric ischemia; atherosclerosis of the mesenteric arteries, resulting in diminished blood flow to the intestine after meals. This causes postprandial epigastric pain (intestinal agina) with assoc food aversion/ weight loss. Its pathogenesis is similar to angina pectoris in that both are due to pain from a lack of blood supply.

brown pigmented macrophages i.e. hemosiderin laden macrophages =

chronic passive lung congestion in the setting of heart failure (LV systolic dysfunction). Left sided heart failure leads to chronically elevated pulmonary venous and capillary pressures with resulting pulmonary edema and extravasation or red blood cells into the alveolar parenchyma. iron in these RBCs is stored as hemosiderin appearing as brown pigment on histopath.

ASD can result in

chronic pulmonary hypertension as a result of left to right intracardiac shunting. Eisenmenger syndrome is the late onset reversal of a left to right shunt due to pulmonary vascular sclerosis resulting from chornic pulmonary hypertension. Closure of the ASD surgically may be required to prevent irreversible pulmonary vascular sclerosis and a permanent eisenmenger syndrome

takayasu arteritis

chronic, large artery vasculitis that primarily involves the aorta and its branches. It presents with constitutional (fever, weight loss) and arterior-occlusive (claudication, blood pressure, discrepancies, pulse deficits) findings in patients age <40. Histo shows granulomatous inflammation of the vascular media. the arterial narrowing that it causes can lead to different blood pressures in different parts of the body. this is differnet from giant cell arteritis bc giant cell is >50 y/o and this is younger ppl (<40) and asian females.

if a herpes virus (VZV, etc) does not have a viral kinase then use which drug

cidofovir bc it doesn't need viral kinase, only the cellular kinase which all of them have.

timolol targets

ciliary epithelium; treats open angle glaucoma; if not treated, leads to progressive loss of peripheral vision; works by diminishing the secretion of aqueous humor by the ciliary epithelium.

liver fibrosis occurs when sinusoidal stellate cells are activated by cytokines and persistant activation of stellate cells leads to transformation of the normal extracellular matrix into

cirrhosis (widespread fibrosis and parenchymal nodules).

baby w lethargy, myotonia, vomiting, diarrhea, hepatomegaly, jaundice, and e. coli sepsis.

classic galactosemia (def of galactose 1 phosphate uridyltransferase). swtich to no galactose.

most common renal malignancy

clear cell carcinoma (arises from proximal tubular cells). Rounded or polygonal cells with abundant clear cytoplasm are seen on LM. Clear cells are generally those with a high glycogen or lipid content that dissolves during routine tissue preparation.

if pt has allergy to aspirin and needs it for coronary heart disease, give them

clopidogrel

atropine treats bradycardia but causes

closed angle glaucoma in susceptible individuals

layer of denuded epithelium, fibrin and inflammatory cells overlaying the mucosa in pt's GI with diarrhea sx. What bug

clostridium difficile

common spore forming pathogens

clostridium species and bacillus (i.e. anthracis)

clot in the artery vs clot in the vein

clot in the artery: embolectomy; vein(DVT): anti-coagulants (heparin, warfarin)

tx for treatment resistant schizophrenia

clozapine

corynebacterium diptheriae

clumped, gram positive bacteria with polar granules that stain deeply with aniline dyes .mild tonsilar erythema with exudates. Pathogenicity: impairment of protein synthesis.

neonatal vitamin K deficiency

common; its why we give neonates vitamin K; it can cause intracranial hemorrhage (increased head circumfrence, downward driven eyes); vit K def results in impaired clotting factor carboxylation. Newborns get it bc poor placental transfer of vitamin K and low content in breast milk.

medullary sinuses of the lymphondes

communicate with efferent lymphatics and contain reticular cells and macrophages.

adherins junctions and desmosomes

composed of cadherins and involved in intercellular adhesion. The cytoplasmic anchor of adherens junctions is the actin filament whereas the cytoplascmi anchor of desmosomes is the intermediate filament. Autoantibodies against desmoglein, a cadherin protein for desmosomes, are found in pemphigus vulgaris.

liddle syndrome and tx

constitutive activation of the epithelial sodium channel in the collecting tubules. leads to early hypertension characterized by low levels of renin and angiotensin, excess reabsorption of sodium and loss of reabsorption of potassium. Pts develop hypokalemia, and metabolic alkalosis. Tx: triamterene or amiloride (diuretic that inhibits ENaC).

NK cells

contain the cell surface marker CD16, which is an Fc receptor that recognizes IgG bound to foreign pathogens. Release of perforin and granzymes on binding to CD16 helps destroy pathogen-infected cells.

hemoglobin S

contains valine in place of glutamic acid at the sixth amino acid position of the beta globin chain. This promotes hydrophobic interaction among Hb molecules and results in HbS polymerization and erythrocyte sickling.

patent ductus arteriosus

continuous machine like murmur, located in the sixth aortic arch, can produce a continuous machine like murmur. Indomethacin is used to close a PDA and prostaglandins are used to keep a PDA open.

left vs right heart dominance (circulation)

coronary dominance is determined by the coronary artery that supplies blood to the posterior descending artery (PDA). Right: PDA comes form right coronary artery; Left: PDA comes from left circumflex artery

adrenal cortex vs medulla

cortex: GFR (salt sugar sex); medulla: catecholamines (epinephrine, norepinephrine -- this is where pheochromocytomas are, these are neurochromaffin cells that are positive for synaptophysin, chromogranin, and neuron specific enolase)

UMN lesions affect any part of the pyramidal motor system, i.e.

corticospinal tracts of the spinal cord, the medulla, pons, and midbrain, the INTERNAL CAPSULE; and the precentral gyrus (primary motor cortex)

moa of zenker diverticulum

cricopharyngeal motor dysfunction; diminished relaxation of cricopharyngeal muscles during swallowing results in increased intraluminal pressure in the oropharynx. This may eventually cause the mucosa to herniate through a zone of muscle weakness in the posterior hypopharynx, forming a zenker (false) diverticulum, which presents in elderly patients with oropharyngeal dysphagia, halitosis, regurgitation and recurrent aspiration.

easy bruising after partial bowel resection bc of Crohns

crohn disease with ileal resection or extensive ileal involvement can cause bile acid malabsorption, which may lead to impaired absorption of fat soluble vitamins (ADEK). Vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (i.e. hemarthrosis) after minor trauma, and prolonged bleeding after surgery.

cross sectional study vs others

cross sectional is just prevalance of disease at one point in time. Theres no control group.

the only fungus that has a polysaccarhide capsule

cryptococcus

cryptococcus vs west nile virus

cryptococcus is bird droppings in immuno-compromised (AIDS) and west nile is mosquitos from birds.

cryptosporidium vs cryptococcus

cryptosporidium: parasite that is on modified acid fast stain, causes diarrhea, basophilic cysts lining the intestine, happens in immunocompromised; cryptococcus: fungi

protease inhibitors (-navir), are assoc with what ADR

crystal induced nephropathy, whcih presents with weakness, nausea, flank pain, dark urine.

vibrio vulnificus

curved gram negative in salt water, infects wounds, or thru oysters, ppl with liver disease or iron overload are at high risk of severe fulminant infection (sepsis, necrotizing fascitis).

major side effect of nitroprusside tx

cyanide poisoning (sx: bright red venous blood) (tx for the cyanide poisoning: hydroxycobalamin, sodium nitrite or sulfur donors (sodium thiosulfate).

tx for serotonin syndrome

cyproheptadine

common cause of colitis in patients with advanced AIDS

cytomegalovirus; it's the second most common CMV reactivation disease in this population (CMV retinitis is the most common). Patients with CMV colitis often have abdominal pain, fever, diarrhea and weight loss. Colonoscopy usually shows erythema, erosions and ulcerations; colonic biopsy typically reveals large cells with prominent basophilic intranuclear inclusions.

imprinting

cytosine methylation used in imprinting where diff alleles from diff parents are inactivated via methylation so that only one allele is expressed.

common accidental injury during hysterectomy surgery

damage to the ureters(due to its close proximity to the uterine structures)

drugs that cause hemolysis in ppl with G6PD deficiency

dapsone, and pegloticase (converts uric acid into allantoin)

decorticate posturing vs decerebrate

decorticate: hands are at your cor (flexed); decerebrate is worse; damage at the pons or below causes decerebrate because decorticate is above the red nucleus (pons) and decorticate is below the red nucleus

statins (decrease/increase) hepatic cholesterol synthesis

decrease (HMG coa reducatase inhibitors)

thrombotic thrombocytopenic purpura

decreased ADAMTS13 level. Results from impaired function of the von willebrand factor cleaving protease ADAMTS13, resulting in uncleaved vWF multimers that are signifcantly more prothrombotic and cause diffuse microvascular thrombosis, microangiopathic hemolytic anemia, and thrombocytopenia. normal PT/PTT time but increased bleeding time. anemia.

PSGN

decreased C3; most common cause of nephritic syndrome in kids

common side effects of ACE inhibitors besides cough

decreased GFR (leading to increase in Cr), hyperkalemia, angioedema.

cannabis/ marijuana withdrawal

decreased appetite, depressed mood

bernard soulier disease

decreased glycoprotein Ib

left sided heart failure is common from Mi affecting the left ventricle. The other effect of this is

decreased lung compliance bc of accumulation of edema (restricts inspiratory expansion)

glanzmann thrombasthenia

decreased platelet aggregation and decreased coagulation. platelet disorder caused by decreased glycoproteins IIb/IIIa

idiopathic thrombocytopenic purpura

decreased platelet count secondary to an autoimmune anti-GpIIb/IIIa antibodies, which lead to peripheral platelet destruction. Although abciximab is derived from an antibody to GpIIb/IIIa, it is composed of Fab fragments, which act as receptor antagonists and do not lead to destruction of platelets.

on off phenomenon of levodopa

decreased therapeutic window for levodopa due to nigrostriatal degeneration which causes unpredictable fluctuations in motor function (i.e. drug response is unpredictable)

valsalva moa

decreases preload which accentuates/increases murmurs like mitral valve prolapse and HCM. Phase 1 increases preload and phase 2 decreases preload. has to do with increase in thoracic pressure as you bear down, cutting off flow of IVC and this increases flow to heart (phase 1) initially, then decreases it (phase 2).

decreasing what would lead to increased ratio of forward flow volume to regurgitant flow volume

decreasing systemic vascular resistance

artery injured by midshaft fracture of the humerus 9inability to extend wrist as result)

deep brachial artery (runs with radial nerve)

VHL disease

defect in VHL gene on chromosome 3 and confers an increased risk for development of hemangioblastomas, renal cysts, renal cell carcinoma, and pheochromocytoma. Hemangioblastomas are highly vascular tumors composed of foamy cells.

lynch syndrome (HNPCC): genetics

defective mismatch repair; autosomal dominant MSH2 and MLH1; leads to occurrence of colonic adenocarcinomas at a young age (age <50) along with a predispostion for extraintestinal malignancies.

defective process in achondroplasia

defective production of hyaline cartilage models (osteoblasts secrete osteoid over this to form bone - this is endochondral ossification)

DiGeorge syndrome

deletion of chromosome 22q11.2; CATCH (cardiac defects (tet of fallot, truncus arteriosus, interupted aortic arch), abnormal facies, Thymic hypoplasia (t cell deficiency), Cleft palate, Hypocalcemia/ hypoparathyroidism (hypocalcemia)

alcohol withdrawal

delirium, anxiety, seizures

isoniazid inhibits B6 leading to B6 deficiency. B6 is a cofactor for

delta aminolevulinate synthase, the enzyme that catalyzes the rate limiting step of heme synthesis. Inhibition of this step results in sideroblastic anemia (excess iron in mitochondria - ringed sideroblasts)

deyelinating neuropathies vs axonal neuropathies

demyelinating neuropathies: caused by damage to the myelin sheath. Loss of insulation results in delayed (or blocked) nerve conduction velocity. Axonal neuropathies: caused by damage to the nerve axon. Loss of axon fibers results in reduced signal amplitude.

dihydropyridines vs nondihydropyridines

dihydropyridines (-dipines): act only at vascular smooth muscle and cause peripheral vasodilation; non-dihydropyridines: act at cardiac muscle (verapamil) and cardiac muscle/ vascular smooth muscle (diltiazem).

leber hereditary optic neuropathy (LHON)

disease of painless, subacute visual loss due to mutations in mitochondrial DNA, which is transmitted exclusively thru the mother. A strong family hx of adult-onset blindness as well as manifestations of extraocular sx such as movement disorders, cardiac arrhythmias, and multiple sclerosis-like sx should raise suspicion for LHON.

post MI: 3-7 days

disintegration of dead neutrophils and myofibers; macrophage infiltration at border areas

cystic fibrosis does what to pancreatic ducts

distension and obstruction of pancreatic ducts;

left lower quadrant pain

divertiulitis

calculating drug concentration (mg/L)

divide the (initial drug dose (mg)) by the (volume of distribution (L))

E Coli EHEC O157:H7

does NOT produce glucuronidase and does NOT ferment sorbitol on sorbitol-containing MacConkey agar. MOA of toxin: inactivates ribosomal subunits. It's a shiga-like toxin (binds 60S subunit of ribosomes and inhibits translation).

common peroneal nerve

dorsiflexion, numbness of the calf and dorsal foot)

side effect of loop diuretics

dose related hearing loss (gong in sketchy roller coaster)

small low set ears, flat facial profile, upslanting palepbral fissures, protruding tongue and abnormal space between the first and second toes

down syndrome. They are at high risk for acute lymphocytic leukemia and acute myelogenous leukemia

drugs that tx BPH and hypertension

doxazosin, prazosin, and terazosin (alpha 1 blockers

Fas receptor Fas ligand

drives programmed cell death via CD8 T cells mediated in the extrinsic pathway. Cancer cells splice out (alternative splicing) the exon that codes for the transmembrane domain of the Fas receptor.

what do you monitor when a person is on clozapine

drug of choice for treatment resistant schizophrenia; due to potential for agranulocytosis, weekly bloodwork is required to monitor the white blood cell count (absolute neutrophil count) of these patients.

cromolyn and nedocromil

drugs. Mast cell stabilizing agents that inhibit mast cell degranulation (i.e. vesicle release from the mast cell) independent of the triggering stimulus. They are less effective than inhaled glucocorticoids and are considered second line tx for allergic rhinitis and bronchial asthma.

chronic mucocutaneous candidiasis

due to a rare dfecet in T cells that impairs an individuals ability to defend against candida species. Patients with this condition have recurrent oral thrush and vaginal yeast infections.

charcot bouchard aneurysm rupture

due to chronic hypertension and causes hemorrhage in deep brain structures (basal ganglia, cerebellar nuclei). Deep intraparenchymal hemorrhage is most commonly caused by hypertensive vasculopathy of the small penetrating branches of the cerebreal arteries (charcot bouchard aneurysm rupture). This is in contract to rupture of saccular aneurysms, which typically cause subarachnoid hemorrhage. sx of charcot: progressive neuro deficits (vs saccular is sudden severe headache)

abnormal bleeding in patients with uremia due to renal failure

due to qualitative platelet disorder from the uremic toxins impairing platelet aggregation and adhesion resulting in prolonged bleeding time but normal everything else (PT, PTT, platelet count).

secretin

duodenal S cells secrete secretin in response to increasing H+ concetrations. Secretin increases pancreatic bicarbonate secretion. The chloride content of pancreatic secretions decreases in proportion to bicarbonate concentration increases.

downs are at risk for which GI complication

duodenal atresia (double bubble sign)

ulcers refractory to PPIs or ulcers distal to the duodenum/ duodenal bulb

duodenal neoplasm (zollinger-ellison syndrome)

h pyrlori infection, where do you get the ulcers

duodenum

iron is absorbed where

duodenum and proximal jejunum

FSH and estrogen and OCPs

during the follicular phase of the normal menstrual cycle, follicle-stimulating hormone (FSH) stimulates follicular maturation and the release of estrogen, which at peak concentrations, causes the ovulation-inducing luteinizing hormone (LH) surge. Oral contraceptives contain exogenous estrogen and progesterone that feed back to negatively inhibit endogenous GnRH release, thereby decreasing FSH concentrations. Without FSH, follicular-phase estrogen concentrations do not increase to the level required for the mid cycle LH surge.

common aeroallergens that trigger asthma

dust mites, cockroaches, pet dander, mold and pollen (and exercise and cold air0

plummer vinson syndrome

dysphagia, (esophageal web formation), iron deficiency anemia (koilonychia (spoon shaped nails) and a shiny red tongue. Tx: iron supplementation

bulbar

dysphonia, difficulty chewing

silicosis

dyspnea and productive cough occurring years after inhalational exposure to crystalline silica. Histo: birefringent silicate particles within dense, whorled collagenous nodules surrounded by dust laden macrophages. Radiogrpahy: numerous small rounded nodules predominant in the upper lobes; calcification of the rim of hilar nodes (eggshell calcification) may also be seen.

e. coli vs salmonella

e. coli: no fever, stains green on hektoen agar; salmonella: fever, produces hydrogen sulfide (stains BLACK on hektoen agar)

lyme disease

early disseminated lyme disease can have cardiac involvement (Lyme carditis) that most commonly manifests with varying degrees of AV conduction block. Patients may be asymptomatic, but those with complete AV conduction block are likely to have dyspnea, lightheadedness or syncope.

liver cyst on US, RUQ pain, vomiting, interaction with dogs or sheep, with eosinophilia

echinococcus granulosis (they make tapeworm cysts in liver); tx: albendazole

alpha 1 antitrypsin deficiency leads to

emphysema (panacinar) which is obstructive bc it has air trapping (fricken RV needs increased TLC but its hard w COPD), and this means lower FEV/FVC ratio and TLC is increased and DLCO is decreased.

phosphatidylcholine

emulsifies fats; released by the gallbladder

if you see sickle cells on the smear, and its an infection, its

encapsulated organism like strep pneumo

homeobox genes

encode DNA binding transcription factors that play an important role in the segmental organization of the embryo along the cranio-caudal axis.

HIV 2

endemic to west africa; lower viral loads, less risk of transmission, slower progression to AIDS; suspect this when HIV tests are positive on screening but negative on HIV 1 RNA and western blot

pancreas embyro (beta cells as well)

endoderm (like gallbladder, etc)

dyspareunia and abnormal menstrual bleeding and infertility

endometriosis (ectopic endometrium)

pathogenesis of atherosclerosis

endothelial cell injury - from HTN smoking hyperliidemia, and diabetes - exposure of subendothelial collagen - monocyte and lymphocyte adhesion and migration into the intima - promotes platelet adhesion - grwoth factors produced stim medial smooth muscle cell migration into the intima - increased vascular perm allows LDL into intima where its phagocytosed by macrophages and SMCs to make lipid laden foam cells (fatty streak) - fibrous cap with intermixed SMCs (fibrofatty atheroma)

tx for pulmonary artery htn

endothelin antagonists (bosentan, ambrisentan)

amantadine moa

enhances the effect of endogenous dopamine (by increasing its synthesis/ release and inhibiting its uptake) ADR: anticholinergic (dry mouth, unsteady gait, etc), and reddish-blue rash. its a weak NMDA receptor antagonist.

CMV esophageal histo shows

enlarged cells with intranuclear inclusions

life cycle of west nile

enveloped RNA virus that replicates in birds and is passed to mosquitos (Cluex)

CMV

enveloped double stranded linear DNA virus that is latent in mononuclear cells. It is seen histologically as large cells wiht intranuclear inclusions ("owl's eyes") and is a common cause of pneumonia in immunocompromised patients, especially those 1-4 months post-transplant.

what does IL 5 do in asthma

eosinophil recruitment

what type of HSR do eosinophils employ

eosinophils are recruited by the immune system to help fight parasitic infections. Their main function is to destroy parasites via antibody-dependent cell-mediated cytotoxicity (HSR type 2) and the associated release of cytotoxic proteins (i.e. major basic protein).

moa of cord compression from prostate cancer

epidural aggregates of neoplastic cells

gram negative sepsis can cause schistocytes because

excess fibrin strands exert shearing forces on circulating RBCs, resulting in schistocytes. The coagulation cascade is activated by bacterial endotoxins, leading to firbin dposition and consumption of coag factors and platelets with bleeding.

Rickets

excess of unmineralized osteoid matrix and epiphyseal cartilage due to vitamin D deficiency. Clinical manifestations include frontal bossing, craniotabes, costochondral junction deformity ("rachitic rosary") and bowed legs.

keloid

excessive collagen formation during the remodeling phase of wound healing (hypertrophic scar).

tx for chronic kidney disease (old person with long standing diabetes and nephropathy and anemia)

exogenous EPO (which will cause the red blood cells to differentiate and mature...i.e. it will cause an increase in progenitor cell differentiation)

HPV and cervical intraepithelial neoplasia (CIN): (squamous abnormality) what do you see on histo

expansion of immature basal cells to the epithelial surface (bc it starts at the basement membrane and grows up to the surface) basement membrane breach signifies invasive disease

which nerve is commonly injured during thyroidectomy

external branch of the superior laryngeal nerve is at risk of injury during thyroidectomy due to its proximity to the superior thyroid artery and vein. This nerve innervates the cricothyroid muscle. Causes a hoarse voice.

cryptocordism is fixed by pulling the testicle thru a physio opening in which structure

external oblique muscle aponeurosis

the presence of \erythroid precursors in organs such as the liver and spleen is indivative of

extramedullary hematopoiesis. This is most frequently caused by severe chronic hemolytic anemias, such as beta-thalassemia.

hyperacusis

facial nerve (stapedius nerve off of facial)

tumor in the parotid gland; what nerve is it going to compress and what will that cause

facial nerve causing facial droop on that side

gap junctions

facilitate communication and coordination between cells and play an important role in labor contractions. Connecvins are proteins that assemble into gap kunctions and their density increases in the uterus before delivery in response to rising estrogen levels.

what type of transport is glucose transport across plasma membrane of adipocytes

facilitated diffusion (carrier mediated transport); (does not require energy but still requires transport protein)

failure o the PT time to correct with vit K supplementation indicates

factor 7 deficiency whch is often due to underlying liver disease.

hirschprung disease

failure of neural crest cells to migrate to the rectum (failure to pass meconium)

congenital diaphragmatic hernia

failure of the pleuroperitoneal canal to close completely, leading to protrusion of the abdominal viscera into the chest. Pulmonary hypoplasia is the most common cause of death in these pts but pulmonary (artery) hypertension may also be seen.

FTT caused by psychosocial

failure to thrive is usually caused by psychosocial stuff when others can be ruled out (malabsorption, etc). infant's growth curve begins to fall, weight is the first to be affected, followed by height and then head circumference.

truncating mutations (nonsense usually) affecting the TTN gene (titin sarcomere protein) are the most common cause of

familial DCM (dilated cardiomyopathy)

bimodal distribution of speed of INH metabolism is bc

fast and slow acetylators

social anxiety disorder

fear of scrutiny in social situations, and can result in marked social-occupational impairment. Preferred tx: SSRI or SNRI; marked anxiety about 1 or more social situations of for >6 months.

drug to decrease serum triglycerides

fenofibrate

ferrous sulfate overdose: effect on bicarb

ferrous sulfate is an acid; binds bicarb and makes it low. Deferoximine is tx

down syndrome

flat facial profile, epicanthal folds, upslanting palpebral fissures, protruding tongue, and small ears. 50% have heart defects (complete AV canal defect - ASD, VSD AND a common AV valve - is the most common cardiac congenital anomaly with downs syndrome)

lactose intolerance

flatulence, crampy abdominal pain and watery diarrhea after dairy product consumption. It can be acquired by inflammatory/ infectious conditions that injure the mucosal brush border of the small intestine where lactase is expressed. Studies can show increased breath hydrogen content, reduced stool pH (bc the breakdown of lactose in the lumen is acidic), and elevated stool osmolality.

femoral nerve

flex the thigh and extend the knee

tibial nerve

flexion of foot

median nerve courses thru

flexor digitorum superficialis and flexor digitorum profundus muscles

FISH

fluorescence in situ hybirdiation; can identify specific chromosomal translocations, duplications, or deletions using a single stranded , complementary DNA segment that is tagged with a radiotracer. FISH is rapid, highly sensitive, and specific, and can be used on tissues with low mitotic rates. However, the targeted chromosomal abnormality must be somewhat large in order to be identified.

rosacea

flushing in response to heat and alcohol, papules and pustules

chronic long term management of asthma (drug)

fluticasone (corticosteroid)

phenytoin ADR besides gingival hyperplasia

folate deficiency leading to megaloblastic anemia (waitress spilling salad in the air)

pts with sickle cell disease or other hemolytic anemias have increased _ requirements

folic acid (due to increased erythrocyte turnover)

methotrexate

folic acid antagonist

14;18

follicular lymphoma; overexpression of apoptosis inhibitor protein BCL 2

tibial nerve sensory area and motor function

foot plantar flexion and inversion and toe flexion; sensory: on the sole of the foot (bottom of the foot)

TPR (total peripheral resistance)

for a group of vessels in parallel is equal to one divided by the sum of the inverse values for resistance of each of the contributing vessels as follows: 1/TPR = 1/R1 + 1/R2 + 1/R3 + ... 1/Rn. Total body circulation can be best decribed as a parallel circuit, whereas circulation in an individual organ is often best described by a series arrangement.

V3 nerve (mandibular) of trigeminal

foramen ovale; senstation to jaw area and motor to muscles of mastication including the masseter, medial and lateral pterygoids and the temporalis muscles.

FVC, FEV1 for COPD

forced expiratory volume and forced vital capacity are both decreased.

foscarnet side effects

foscarnet is used to tx ganciclovir resistant CMV infections. Side effects: chelates calcium, and causes hypomagnesemia which can promote seizures.

myxomatous changes with pooling of proteoglycans in the media layers of large arteries like the aorta

found in cystic medial degeneration, which predisposes to the development of aortic dissections and aortic aneurysms. Medial degeneration is frequently seen in younger individuals with Marfan syndrome.

genetics of duchenne muscular dystrophy

frameshift mutation that causes a truncating mutation leading to inability to produce functional dystrophin bc premature stop codon (vs BMD: in-frame mutation that produces somewhat functional dystrophin)

substance that will reverse warfarin's effects the fastest

fresh frozen plasma

chest pain that gets better with leaning forward

friction rub (acute pericarditis)

parietal cell

fried egg cell on histo

granulomatous inflammation of the media happens in what disease

giant cell arteritis (tx: prednisone)

chronic granulomatous disease

from a genetic defect in NADPH oxidase. Normally NADPH oxidase participates in the killing of microbes within neutrophil and macrophage phagolysosomes. Patients with CGD develop recurrent bacterial and fungal infections that are predominantly caused by 5 catalase positive organisms: staph aureus, burkholderia cepacia, serratia marcescens, nocardia and aspergillus. this is bc bacteria that are catalase positive can kill their own hydrogen peroxide. but catalase negative bacteria will build up hydrogen peroxide and even ppl with no NADPH oxidase (superoxide production impaired) can kill them.

sperm get their energy from where

fructose

_ is one fo the rate determining enzymes in renal gluconeogenesis

fructose 1,6 bisphosphatase

desmosomes anchor cells to each other. whereas hemidesmosomes

function to anchor the cell to the underlying basement membrane.

diuretic for ppl with chronic renal failure

furosemide

amniotic fluid with increased acetylcholinesterase means

fusion of the edges of the neural plate (this and alpha fetoprotein leak out indicating spina bifida or anencephaly)

shigella moa

gains access to GI mucosa by invading microfold (M) cells in ileal peyer pathces thru endocytosis.

lead poisoning hinders what enzyme in the synthesis of heme?

gamma aminolevulinic dehydratase AND ferrochelatase

tx for BTK deficiency (i.e. x linked agammaglobulinemia(

gamma globulin injections

the reduced (active) form of vitamin K is a cofactor for

gamma glutamyl carboxylase

x linked siderblastic anemia hinders what enzyme in the synthesis of heme?

gamma-aminolevulinic acid synthase

how to differentiate between hepatic or bony origin of high alkaline phosphatase/ what test to do next when you get high alkaline phosphatase back

gamma-glutamyl transpeptidase (GGTP) (its in liver and biliary epithelia but not in bone

fenestrae

gaps between endothelial cells that allow for paracellular transport. Swollen fenestrae in renal glomerular capillary endothelial cells are implicated in preeclampsia (presents with new onset HTN and proteinuria or end organ dysfunction at >20 weeks gestation).

perfusion limited vs diffusion limited

gas exchange between the alveoli and pulmonary capillary blood depends on both perfusion and diffusion. The exchange of O2 and CO2 in a normal individual at rest is perfusion limited so alveolar and capillary partial pressure are equal. Situations in which O2 exchange becomes diffusion limited (i.e. emphysema, pulmonary fibrosis) causes a large gradient between alveolar and capillary PO2; PCO2 is less affected due to the greater diffusing capacity of CO2.

hyperplasia of branched tubular submucosal glands containing alkaline secretions which causes abdominal discomfort

gastric acid is neutralized by bicarbonate from the submucosal glands of the duodenum (Brunner glands) and from pancreatic duct secretions. Chronic overproduction of gastric acid can lead to hyperplasia of the submucosal glands.

h. pylori: which site of the GI demonstrates the highest amount of H pylori when infected

gastric antrum

which artery runs behind the duodenal bulb (common target for ulcerations that cause bleeding)

gastroduodenal artery

gastroesophageal reflux disease (silent GERD type)

gastroesophageal reflux disease is caused primarily by gastroesophageal junction incompetence and can be associated with extraesohageal sx (i.e. nocturnal cough) in the absence of heartburn. Acidic gastri contents irritate the esophageal mucosa, leading to characteristic histologic findings that include basal zone hyperplasia, elongation of the lamina propria papillae and scattered eosinophils.

osteoporosis, avascular necrosis of the femoral head, bone crises, hepatosplenomegaly

gaucher disease, AR, pancytopenia

inactivated (killed or component) viral vaccines moa

generate a humoral response against extracellular viral antigens, preventing viral entry into the cell. (i.e. against the viral HA) vs live attenuated: kills virally infected cells with cell-mediated in addition to provoidung humoral immunity

which part of the lymphnode makes immunoglobulins

germinal center

overdose no beta blockers tx is

glucagon bc it increases heart rate and contractility independent of adrenergic receptors. Glucagon activates G protein coupled receptors on cardiac myocytes, causing activation of adenylate cyclase and raising intracellular cAMP. The result is calcium release from intracellular stores and increased sinoatrial node firing.

rapid relief of symptoms of RA

glucocorticoid (prednisone) or NSAIDs

mutations in what gene lead to a state in which higher glucose levels are required to stimulate insulin secretion and are a cause of maturity onset diabetes of the young

glucokinase

steroids promote hyperglycemia by stimulating

gluconeogenesis

insulin sensitive transport proteins vs insulin independent

glucose transport protein (GLUT)-4 is an insulin-sensitive glucose transporter expressed in skeletal muscle cells and adipocytes. In the absence of insulin, it is sequestered in the cytoplasm. However, as insulin concentrations rise, the receptors translocate to the plasma membrane, facilitating glucose transport into the cell. Other tissues have GLUT transporters that are independent of insulin (i.e. renal tubular cells, etc)

excitatory amino acid

glutamate

glycogen synthesis is activated by dephosphorylation (activation) of

glycogen synthase (via protein phosphatase)

how do you make glucose in a fasting state

glycogenolysis and gluconeogenesis (alanine from breakdown of protein to make glucose - alternate pathway)

carcinoembyonic antigen

glycoprotein involved in cell adhesion. CEA levels are increased in colon cancer. Its associated with a worse prognosis. Its also a marker of colorectal cancer recurrence.

hyaluronic acid

glycosaminoglycan for water retention in the ECM and determiens the stiffness of the ECM

keratin sulfate is

glycosaminoglycan in the ECM that maintains type 1 collagen fibril organization

if high synovial leukocyte count in knee pain, its

gonorrhea

cyclosporine is assoc with

gout in the post transplantation period due to decreased uric acid secretion

what allows ppl to avoid MI when they have atherosclerotic plaques (naturally)?

gradually developing myocardial ischemia encourages the formation and maturation of collateral vessels and is most likely to occur in the setting of a slow-growing, stable atherosclerotic plaque. An unstable atherosclerotic plaque (i.e. that with active inflammation, a lipid rich core and or a thin fibrous cap) is more likely to rupture, resulting in the abrupt onset of ischemia/ infarction that precludes the development of viable collateral vessels.

bone marrow transplant pts are at high risk for:

graft versuss host disease, in which alloreactive donor T lymphocytes recognize recpient as foreign and mount an immune response.

APL (acute promyelocytic leukemia)

granules in promyelocytes contain strong procoagulant substances and if these cells are disrupted, the granules pour out into the blood and can cause DIC.

fungal infections in the lungs will form

granulomas

reaction to a foreign body in the skin can result in _ on histo

granulomas

giant cell arteritis

granulomatous inflammation of the media with fgragmentation of the internal elastic lamina of medium and small branches of the carotid artery. Tx: immediate glucocorticoid therapy

androgens synthesized in the ovaries are converted estradiol in which cell type?

granulosa cells (they contain aromatase)

reactive (atypical) lymphocytes like CD8 T cells or NK cells contain

granzymes (enter the cytoplasm in the infected cell's membrane) and perforin (create holes in the infected cells membrane)

anti-TSH receptor antibodies

graves disease

most common cause of meningitis in infants 0-3 months old

group B strep, E coli, and listeria monocytogenes. if the infant is preterm and low birth weight, they are at high risk for listeria monocytogenes bc of their increased exposure to hospital personnel. (it's also lymphocyte predominant on CSF analysis - i.e. listeria is).

defect in the ankyrin gene

hereditary spherocytosis

cocaine effects

hallucinations, paranoid (psychotic sx), euphoria, and agitation. Tachycardia. Mydriasis.

haloperidol vs levodopa vs bromocriptine

haloperidol: dopamine antagonist; levodopa: synthetic dopamine; bromocriptine: D2 dopamine agonist

best way to avoid spreading infection in hospital setting (for providers)

hand hygeine (washing hands, etc) after contact with patients.

reperfusion injury

happens after thrombi are removed; it occurs secondary to oxygen free radical generation, mitochondrial damage and inflammation. Creatinine kinase increases bc it leaks out of the damaged cells

crohns disease

has noncaseating granulomas, fistulas and (serpiginous) abscesses (perianal disease is common - i.e. skin tags and fissures); patchy inflammation throughout the entire GI tract. Skip lesions, cobblestoning of the mucosa, bowel wall thickening, and creeping fat.

anti-thyroglobulin/anti-microsomal antibodies/antithyroid peroxidase antibodies

hashimoto's thyroiditis (histo shows lymphocytic infiltration with well-developed germinal centers and Hurthle cells.

cox 2 inhibitors

have anti-inflammatory effects without the side effects of bleeding and GI ulceration assoc with non-selective COX inhibitors. Selective COX 2 inhibitors do not impair platelet function because platelets predominantly express cox 1

factor 10 is

hematin/ hemin (i.e. H influenza needs this and 5 to grow on choclate agar)

when a bruise becomes greenish in color, which enzyme does this

heme oxygenase (converts heme to biliverdin)

bullous pemphigoid

hemidesmosomes, along the basement membrane of the dermal - epidermal junction. Forms tense, subepidermal blisters.

testosterone increases

hemoglobin

sickle cell disease

hemoglobin S aggregates in the deoxygenated state. Sickling occurs under anoxic conditions, i.e. low pH, and high 2,3 BPG.

the 3 variables that affect the total content of blood are

hemoglobin concentration, oxygen saturation of hemoglobin (SaO2) and the partial pressure of oxygen dissolved in blood (PaO2). Anemia is characterized by decreased hemoglobin concentration in the setting of normal SaO2 and PaO2.

emicizumab

hemophilia A is an X linked disorder assoc with a deficiency of factor VIII. Emicizumab, a bispecific monoclonal antibody, mimics the activity of factor VIII by binding to both factor Ixa and factor X, bringing them into close proximity to allow for factor X activation.

bleeding after a dental procedure, is prob _ and tx is _

hemophilia and a general tx to stop the bleeding immediately is thrombin (factor II)

hemophilia A and B

hemophilia is an X linked recessive coagulopathy that presents with intramuscular hemorrhage, hemarthroses, and delayed bleeding after procedures. Lab results show partial thromboplastin time (PTT) prolongation; other tests of hemostatic function are generally normal.

hep B on histo

hep B infection causes the hepatocellular cytoplasm to fill with hepatitis B surface antigen. These inclusions are highlyh pecific for hepatitis B infection and have a finely granular, pale eosinophilic, ground-glass appearance.

window period of hepatitis

hep B; the period between disappearance of HBsAg and appearance of HBsAb. IgM anti-HBc (core antibody) is the only marker of Hep B infeciton during the window period and indicates an acute infection.

tx for thromboembolic disease in pregnancy

heparins (i.e. LMWH: enoxaparin, dalteparin). Patients transitioned to unfractionated heparin when they give birth.

IV drug abuse - tricuspid valve insufficiency leads to

hepatic congestion (prominent systolic pulsation of the liver)

why does hepatitis C virus genome vary so much from virus to virus

hepatitis c lacks 3' -> 5' exonuclease activity which means its RNA is prone to frequent mutations. Its envelope glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation.

councilman bodies:

hepatitis induced apoptosis of liver cells (eosinophilic round bodies); degraded by cytotoxic T cells

diabetes, hyperpigmentation, cirrhosis, and/or cardiomegaly

hereditary hemochromatosis

abdominal distention, hyperactive bowel sounds, and tenderness on palpation = bowel obstruction caused by abdominal tumor. cancer hx in close relatives + young pt =

hereditary nonpolyposis colon cancer (lynch syndrome); AD; two hit hypoth; defective 'mismatch repair'

pigmented gallsontes and aplstic crises from parvoviruys B19 infection are complications of what

hereditary spherocytosis resulting from red cell cytoskeleton abnormalities, in the proteins spectrin and ankyrin. Hemolytic anemia, jaundice and splenomegaly.

virus that flares and remits in a cyclical fashion

herpes

erythema multiforme is usually assoc with

herpes simplex virus

hetero vs euchromatin

heterochromatin: condensed chromatin composed of heavily methylated DNA in tight association with deacetylated histones. Euchromatin: loose chromatin w high level of transcriptional activity

sixsteine

hexagonal crystals with cysteinuria

cystine nephrolithiasis

hexagonal stones on microscopy; from defective dibasic amino acid transport; decreased reabsorption of cysteine from the urine; sodium cyanide nitroprusside test can be used to detect excess cystine in the urine

characteristics that trap drugs in the plasma compartment resulting in a low Vd (3-5 L)

hgih molecular weight, high plasma protein binding, high charge, and hydrophilicity.

metabolic alkalosis: how to diag the cause

high arterial blood pH, HCO3- and pCO2. Vomiting/ nasogastric suctioning and thiazide/loop diuretic use cause volume and CL- depletion, resuting in metabolic alkalosis that is saline-responsive. In contrast, hyperaldosteronism leads to metabolic alkalosis that is saline-unresponsive. Determining the patient's volume status and measuring the urinary chloride concentration can help to identify the cause of metabolic alkalosis.

picture of outpouchings of intestine (with assoc pain), what caused this?

high dietary intake of fat and red meat

sheehan syndrome

high estrogen levels during pregnancy cause enlargement of the pituitary gland without a proportional increase in blood supply. Peripartum hypotension can cause ischmeic necrosis of the pituitary leading to panhypopituitarism (sheehan syndrome). Patients commonly develop failure of lactation due to deficiency of prolactin.

aflatoxin

high levels of dietary aflatoxin exposure (grain, peanuts) is assoc with G:C -> T:A transversion in codon 249 of the p53 gene, a mutation that increases the risk of developing hepatocellular carcinoma.

thryoidectomy

high rate of injury to the parathyroid glands

fetal hemoglobin has a _ affintiy for oxygen

higher (left shift in the o2-hb curve)

airway resistance in lungs:

highest in the medium sized bronchi bc of the total cross sectional area of all the airways at that level. It gets lower as you get lower in the lungs after that.

CCK (cholecystokinin)

hormone responsible for gallbladder contraction. Made in the duodenum and jejunum in response to fatty acids and amino acids.

risk factor for clostridium difficile colitis

hospitalization, recent antibiotics, PPI

positive sense RNA viruses use

host cell RNA polymerase.

pool water bacteria

hot tub folliculitis is a superfiical and self-limited pseudomonas aeruginosa infection of the hair follicles that tends to occur in minor outbreaks following exposure to a pool or spa in which the chemicals have not been maintained at appropriate concentrations. Pseudomonas are gram negative, oxidase positive, nonlactose fermenting, motile rods that produce green pigment.

paracortex of the lymphnode

houses T cells (mature ones).

medulla of the lymphnode

houses the cords and the sinuses. Cords contain B cells and plasma cells.

high fever followed by a rash in a kid <2 years old

human herpesvirus 6 (HHV 6) "roseola infantum". The MOST common cause of febrile seizures. Tx: supportive.

hypercalcemia of malignancy

humoral hypercalcemia of malignancy is the most common cause of hypercalcemia in patients with malignancy and is due to secretion of parathyroid hormone related peptide (PTHrP) by malignant cells.

first line tx for essential hypertension in the gen population

hydrochlorothiazide

invasive cervical carcinoma is assoc with

hydronephrosis bc it spreads from the uterus to the bladder

septic shock

hyper- or hypothermia; initial disturbance is peripheral vasodilation leading to decreased systemic vascular resistance, decreased entral venous pressure and decreased pulmonary capillary wedge pressure. A compensatory increase in sympathetic drive causes an increase in cardiac output; the resulting high flow rates lead to incomplete oxygen extraction in the tissues, resulting in high mixed venous oxygen saturation.

organ rejection

hyperacute, acute or chronic; acute cellular rejection occurs within weeks of transplantation due to the sensitization of host T lymphocytes against donor MHC (HLA) antigens. This causes a mononuclear (lymphocytic) infiltrate on histo and graft dysfunction. Prevention is attempted with calcineurin inhibitors and tx includes systemic corticosteroids.

if person has diabetes type 1 they have no insulin so they have (_kalemia)

hyperkalemia, bc insulin forces potassium into cells

chronic headaches and low libido

hyperprolactinemia (males or females)

skin hyperpigmentation

hypersecretion of ACTH (primary adrenal insufficiency - addisons disease)(or a corticotroph adenoma)

hypercortisolism

hypertension, central obesity, musclular weakness, ecchymoses, and hyperglycemia.

fibrinoid necrosis

hypertension, vasculitis

acute pancreatitis can be caused by

hypertriglyceridemia (>100 triglycerides) bc the TGs damage the pancreatic acinar cells

bile acid resins (cholestyramine, colestipol, colesevelam) can cause (ADR)

hypertriglyceridemia bc they bind bile acids and prevent recycling of them so the liver makes more cholesterol which makes more VLDL which contains triglycerides.

the most common cause of gastric outlet obstruction in infants (with nonbilious vomiting)

hypertrophic pyloric stenosis

cor pulmonale

hypertrophy and/or dilation of the right ventricle

hypospadias moa vs epispadias

hypo: defect in the urogenital folds that form the penile urethra and ventral shaft of the penis in the male and the labia minora in females. (failure of fusion). epi: defect in formation of the genital tubercle

narcolepsy with cataplexy (loss of motor tone triggered by emotion); which compound is low/ abnormal in these pt's CSF?

hypocretin 1 (orexin A) and hypocretin 2 (orexin B) which are makde in lateral hypothal. They are neuropeptides that promote wakefulness and inhibit REM.

aluminum hydroxide overdose

hypophosphatemia, hypokalemia

opioids cause hypo or hypertension

hypotension bc histamine release

what determines therostatic set point

hypothalamus

pt is missing hair on the lateral third of their eyebrows

hypothyroidism

amiodarone can cause (ADR)

hypothyroidism and hyperthyroidism

most common adverse effects of long term lithium therapy

hypothyroidism and nephrogenic diabetes insipidus

acute onset left sided heart failure presents with

hypoxemic respiratory failure and the subjective sensation of SOB. Elevated left ventricular diastolic filling pressures lead to the transudation of fluid into the pulmonary interstitium. This causes areas of V/Q mismatch and shunt and an overall decrease in lung compliance.

cutaneous small vessel vasculitis that's assoc with medication

i.e. penicillins and cephalosporins); sx: palpable purpura in the lower extremities, perivascular inflammation of small blood vessels with fibrinoid necrosis and neutrophils and fragmented neutrophilic nuclei (leukocytoclastic vasculitis)

negri bodies

iNtEGRIty; round eosinophilic inclusions in the cytoplasm of pyramidal hippocampal neurons and cerebellar purkinje cells in patients infected with the rabies virus.

bell's palsy

idiopathic paresis of the facial nerve. Facial nerve does motor to facial mm, PS to lacrimal, submandibular and sublingual salivary glands, SSA for taste at anterior 2/3 of the tongue, somatic afferents for pinna and external auditory canal. Sx: unilateral facial paralysis, decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior 2/3 of the tongue.

candida

if oral and new: nystatin if minor infection: fluconazole if major infection: amphotericin B if resistant: caspofungin

anxiety caused by a medical condition

if pt has prominent physical findings on examination (i.e. unintentional weight loss, tachycardia, moist skin, tremor, frightened stare, restlessness), this could be hyperthyroidism or something.

cushing syndrome: diag the cause: high dose dexamethasone suppression test:

if suppressed ACTH levels: pituitary adenoma; if ACTH and cortisol levels unchanged: ectopic ACTH production; if the ACTH levels were suppressed before the test: adrenal adenoma, adrenal malignancy, exogenous glucocorticoid intake; in NORMAL ppl: low dose dexamethasone will suppress ACTH production (that's the initial test for cushings then you gotta figure out where its coming from)

folate deficiency

if you add thymidine to a folate deficient medium, it will stop cells from undergoing apoptosis. Folate deficiency inhibits the synthesis of nucleic acids, particularly the formation of dTMP (deoxythymidine monophosphate). This leads to defective DNA synthesis that causes increased apoptosis of hemopoietic cells and megaloblastic anemia. Thymidine supplementation bypasses this enzyme and can reduce erythroid cell apoptosis.

surgery risk factors for pulmonary embolus

immobilization (venous stasis) and inflammation induces a hypercoagulable state. Fat embolus would be accompanied by a skin rash and neuro findings (confusion).

multiple sclerosis

immune mediated disorder of the central nervous system characterized by focal demyelination (plaques). Histo: plaques contain foci of perivenular inflammatory infiltrates made up primarily of autoreactive T lymphocytes and macrophages. Patchy demyelination occurs followed by astrocyte hyperplasia (glial scarring).

low platelet count, easy bruising or bleeding through skin or mucous membranes, platelets are abnormally large on blood smear bc of increased platelet production, more megakaryocytes in the the marrow.

immune thrombocytopenic purpura; caused by autoantibodies against platelet antigens, where the speen phagocytoses the platelets ia macrogphages; can also be caused by drugs (acetaminophen, TMP/SMX, quinine, heparin, vancomycin). Tx: steroids.

Acyl CoA dehydrogenase deficiency

impaired beta oxidation of fatty acids causes hypoglycemia after prolonged fasting and insufficient levels of ketone bodies. Acyl-CoA dehydrogenase catalyzes the first step in the beta oxidation pathwya and is the most commonly deficiency enzyme.

ectopic pregnancy

implantation outside of the uterus. Uterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but no embryonic or trophoblastic tissue (i.e. no villi)

hyroxylation of proline and lysine is improtnat for what and happens where

important for collagen synthesis and they need vitamin C, and it happens in the rough ER

snRNPs

improtant components of the spliceosome, a molecule that removes introns from pre-mRNA during processing within the nucleus. Disorder assoc w this: spinal muscular atrophy, caused by SMN1 gene mutation.

tubular fluid concetration of para aminohipuric acid (PAH) is lowest where

in Bowman's space

cough reflex

in by X and out by X

chagas vs acute rheumatic fever

in chagas youll see the trypanosomes in the heart muscle; interstitial myocardial granulomas (aschoff bodies) are found in carditis due to acute rheumatic fever, which develops after an untreated group A streptococcal pharyngeal infection. Aschoff bodies contain plump macrophages with abundant cytoplasm and central, slender ribbons of chromatin (anitschkow or caterpillar cells)

peri-infarction pericarditis

in contrast to angina, the chest pain of pericarditis is sharp and pleuritic and may be exacerbated by swallowing or coughing. Peri-infarction pericarditis (PIP) occurs between 2-4 days following a transmural myocardial infarction. PIP is an inflammatory reaction to cardiac muscle necrosis that occurs in teh adjacent pericardium.

acute arsenic poisoning

in insecticide. (attempted suicide). Impairs cellular respiration and presents with abdominal pain, vomiting, diarrhea, hypotension and a garlic odor on the breath. Insecticides and contaminated water are common sources of arsenic. Dimercaprol is the chelating tx of choice.

Becker muscular dystrophy

in-frame deletion, manifests with muscle weakness, and/or cardiac disease beginning in adolescence. It is caused by DMD (dystrophin) mutations, such as in-frame deletions and the resulting dystrophin protein retains some residual function.

phenylketonuria (PKU)

inability to convert phylalanine to tyrosine by the phenylalanine hydroxylase system, making tyrosine an essential amino acid in these patients. Classic clinical features of untreated PKU include intellectual disability, seizures, light pigmentation and a musty odor

kid with Downs has large reducible midline abdominal protrusion covered by skin that is more pronounced when he cries. What is the cause?

incomplete closure of the umbilical ring. i.e. umbilical hernia; usually would close and form the linea alba.

sulfonylureas (glyburide and glimepiride)

increase insulin secretion by pancreatic beta cells independent of blood glucose concentration. These meds have a high incidence of hypoglycemia, especially in the elderly.

endodermal sinus (yolk sac)

increased AFP, aggressive, schiller dival bodies resemble glomeruli

exercise test

increased HR and CO but arterial blood gas will show normal partial pressures of arterial oxygen and carbon dixoide

inhibition of BCL 2 protein will lead to

increased activation of caspases on abnormal cells in the setting of chronic lymphocytic leukemia. BCL 2 is an anti-apoptotic protein on the mitochondrial membrane. Tx with a BCL 2 inhibitor causes cancer cell death by promoting cytochrome c release from the mitchondria which activates caspases.

sertoli leydig tumor

increased androgens (hirsutism, clitoromegaly) (in females)

nicotine withdrawal

increased appetite, irritability

normal aging: CV changes

increased basal systolic blood pressure

ADRs of volatile anesthetics (i.e. -fluranes)

increased cerebral blood flow (increased ICP), myocardial depression, hypotension, respiratory depression and decreased renal function

11;14

increased cyclin D1; mantle cell lymphoma

moa for increased gfr in early diabetes

increased glucose filtered load caused increased filtered/ resorbed sodium in the prox tubule and that means macula densa at the DCT senses low sodium and constricts the efferent arteriole and dilates the afferent arteriole (tubuloglomerular autoregulation system)

homocysteinuria

increased homocystine in urine, osteoporosis, marfanoid, ocular changes (down and in lens subluxation), cardiovascular (thrombosis and atherosclerosis), kYphosis (HOMOCYstinuria mnemonic). Supplement with pyridoxine (vit B6) and cysteine; genetics: pleiotropy

celiac disease

increased intestinal intraepithelial lymphocytes

beta agonists used for asthma, cause smooth muscle relaxation via what moa

increased intracellular cAMP

things that increase likelihood of renal stones

increased urinary concentrations of calcium, oxalate, and uric acid

niacin

increases HDL

g alpha s

increases cAMP and PKA

effects of desmopressin therapy

increases factor VIII and endothelial secretion of vWF to stop bleeding (for hemophilia A and type 1 vWF disease). In central DI and nocturnal enuresis, it binds to V2 receptors in collecting duct to increase aquaporin channels and increase water reabsorption and decrease urine output.

exercise does what to venous blood mean O2 content

increases it

NE action on the heart

increases venous return to the heart, leading to an increase in stroke volume. This results in a reflex decrease in heart rate; this is known as the reflex bradycardia effect of NE. (this is physiologic)

incretin

incretin is a GI hormones made by the gut mucosa that stims pancreatic insulin secretion in response to sugar containing meals. Two hormones with incretin effects are GLP-1 and GIP (glucose dependent insulinotropic peptide). Incretin is only released following oral ingestion of sugars/ glucose, not IV admin.

ecchymoses

indicates a deep hemorrhage (hematoma) due to bony fracture, ligamentous rupture or muscular injury. They do not blanch under pressure.

hairy cell leukemia

indolent B cell neoplasm found in middle aged men and has bone marrow failure and infiltration into the reticuloendothelial system, causing massive splenomegaly. Other sx: dry tap and presence of lymphocytes with cytioplasmic projections.

in pts with undiagnosed pheochromocytoma, induction of anesthesia can

induce catecholamine surge leading to HTN crisis and a fib

ristocetin

induces platelet aggregation normally; abnormal test: vWF deficiency

perinatal hepatitis B infection

infants born to HBeAg-positive mothers have a high risk of acquiring perinatal hep B virus (HBV) infection. Infected neonates have high levels of HBV replication (high HBeAg and high viral load) and are at high risk for chornic infection btu are usually asymptomatic or have only mildy elevated liver function tests.

medial medullary syndrome

infarct of the anterior spinal artery. the syndrome is characteried by weakness of the contralateral body, ipsilateral tongue deviation, and contralateral loss of proprioception and vibratory sense below the face.

HSV 1 (primary herpes simplex virus type 1)

infection in children causes gingivostomatitis (vesicular lesions on the lips and hard palate). HSV 1 and other herpesviruses are double-stranded, enveloped DNA viruses.

cavernous sinus thrombosis

infection of the medial face, sinuses (ethmoidal or sphenoidal) or teeth may spread through the valveless facial venous system into the cavernous sinus, resulting in cavernous sinus thrombosis. Pts present with headache, fever, proptosis, and ipsilateral deficits in cranial nerves III, IV, VI, and V (opthalmic and maxillary branches).

giardia lamblia moa

infects the small intestine, causing loss of brush border enzymes and resulting diarrhea, gas and bloating. has trophozoites. lactase is one of the brush border enzymes that is lost causing secondary lactose intolerance.

blood supply to internal hemorrhoids

inferior mesenteric vein tributaries (they drain into the superior rectal vein which then drains into the inferior mesenteric vein).

great saphenous vein location

inferolateral to the pubic tubercle

acne vulgaris

inflammatory disorder of pilosebaceous follicles. Contributing factors include hyperkeratinization and obstruction of follicles; sebaceous gland enlargement with increased secretion of sebum; colonization and proliferation in the gland by Propionibacterium (cutibacterium) acnes; and follicular and perifollicular inflammation.

psoas abscess

inguinal mass; pain with extension of the hip

defective interferon gamma signaling - tuberculosis

inherited defects involving the interferon-gamma signaling pathway result in disseminated mycobacterial disease in infancy or early childhood. Patients require lifelong treatment with antimycobacterial agents.

abetalipoproteinemia

inherited inability to synthesize apolipoprotein B, an important component of chylomicrons and very low density lipoprotein. Lipids absorbed by the small intestine cannot be transported into the blood and accumulate in the intestinal epithelium, resulting in enterocytes with clear or foamy cytoplasm.

pyruvate dehydrogenase complex deficiency

inherited inborn error of metabolism causing lactic acidosis and neurologic defects. Patients are unable to convert pyruvate to acetyl-CoA, resulting in a shunting of pyruvate to lactic acid. In these patients, metabolism of exclusively ketogenic amino acids (lysine, leucine) can provide energy in the form of acetyl-CoA without increasing lactate production.

beta lactam drugs (cephalosporins, penicillin, etc)

inhibit cell wall synthesis via inhibition of cell-wall synthesis via inhibition of bacterial transpeptidase

aminoglycosides - moa

inhibit mRNA genetic code reading and protein synthesis by binding to the prokarytic 30S ribosomal subunit (causes genetic code misreading)

sulfonylureas

inhibit the ATP sensitive potassium channel on the pancreatic beta cell membrane, inducing depolarization and L type calcium channel opening

moa of vinchristine and colchicine

inhibition of polymerization of microtubules (vs taxanes stabilize them)

glutamic acid is a precursor for

inhibitor neurotransmitter GABA.

most significant risk factor for cervical intraepithelial neoplasia III (carcinoma in situ)

lack of barrier contraceptives (i.e. condoms).

ghon complex

initial area of infection (lower lobe, ipsilateral hilar lymphnode). Ghon complex is these two initial sites of primary tuberculosis infection. Over time, these sites become calcified and fibrosed and can be visualized on gross pathology and radiographic imaging (Ranke complex). apical cavitary lesions = secondary TB (reactivation)

stages of acute tubular necrosis

initiation (2 days, tubular injury); maintenance stage (3 weeks, increased Cr, met acidosis); recovery phase (months, restored Cr, but electrolyte wasting)

both the CAAT box and the TATA box promote

initiation of transcription they bindn RNA pol 2

supracondylar humeral fracture with anterolateral displacement leads to

injury of radial nerve and wrist drop

3rd degree heart block tx

insertion of transvenous pacemaker

benzodiazapines withdrawal

insomnia, seizures

high waist circumfrence (metabolic syndrome) is suggestive of increased _ resistance

insulin

advanced chronic kidney disease and diabetes mellitus

insulin is cleared by the kidneys and liver. In advanced chronic kidney disease, pts w diabetes mellitus have decreased renal clearance of insulin which can lead to symptomatic hypoglycemia if exogenous insulin dosease are not adjusted based on the change in renal function.

positive response to candida antigens (skin test) means

intact T cell function

hydrophobic amino acids and transmembrane domains

integral membrane proteins contain transmemrane domains composed of alpha helices with hydrophobic amino acid residues (i.e. alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine). These transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane.

phthirus pubis (pubic louse)(crabs)

intense pruritis; tx: permethrin (topical)

stimulants (cocaine, amphetamine) withdrawal

intense psychomotor retardation, severe depression ("crash"), increased appetite, vivid dreams

path from neck bruit to retinal artery (embolus)

internal carotid artery, ophthalmic artery, retinal artery

the ureter runs (anterior or posterior) to: internal iliac artery and gonadal blood vessels

internal iliac artery: anterior; gonadal blood vessels: posterior

asbestosis

interstitial pattern of involvement most prominent in lower zones of lungs. Pleural plaques. Histo: ferruginous bodies featuring fusiform rods with a translucent asbestos center and a golden brown iron coating.

2 forms of gastric adenocarcinoma

intestinal type forms a solid mass that projects into the stomach lumen and is composed of glandular-forming cuboidal or columnar cells. In contrast, diffuse carcinoma (linitis plastica) infiltrates the stomach wall and displays signet-ring cells on light microscopy.

vitamin A overuse

intracranial hypertension, skin changes and hepatosplenomegaly

tx for severe hypoglycemia with loss of consciousness

intramuscular glucagon (nonmedical setting); IV dextrose (medical setting)

tx for diabetic ketoacidosis

intravenous normal saline and insulin. This increases serum bicarbonate and sodium and decrease serum glucose, osmolality and potassium.

inulin vs PAH

inulin is not reabsorbed or secreted (just like mannitol); PAH and creatinine are secreted at the PCT.

if a cervical intraepithelial neoplasia breaches the basement membrane, it's NOT CIN anymore, it is then called

invasive carcinoma

ST elevation myocardial infraction

involves transmural (full thickness) infarction of the myocardial wall and usually results from acute atherosclerotic plaque rupture with the development of overlying thrombus that fully occludes the coronary artery lumen. It classically presents with sudden onset substernal chest pain that is not releived by rest of short acting nitrates. ECG demonstrates ST elevation in the affected leads with subsequent development of Q waves. if just 80% occlusion only = angina.

transient myocardial ischemia causes myocardial cells to increase in size. This is due to accumulation of which ion

ion pump failure due to ATP deficiency during cardiac ischemia causes intracellular accumulation of Na and Ca. The increased intracellular solute concentration draws free water into the cell, causing the cellular and mitochondrial swelling that is observed histologically.

oculomotor nerve gets impinged by which artery in the circle of willis

ipsilateral posterior communicating artery aneurysms. (PCA)

iron fist bro

iron absorbed at the duodenum, folate at the jejunum, and B12 at the ileum

most common cause of microcytic, hypochromic anemia

iron deficiency (especially in an older patient) can be caused by a nutritional deficiency in iron or chronic bleeding

kid OD's on grandmas pills: vomiting bright red blood and has hypotension and tachycardia. nausea.

iron toxicity can cause GI bleeding and fatal hypovolemic shock. Tx of acute iron toxicity is IV deferoxamine and volume resuscitation.

coagulative necrosis

irreversible ischmeic injury outside the CNS

moa of omeprazole or pantoprazole

irreversibly inhibit the hydrogen potassium ATPase on parietal cells, decreasing gastric acid secretion

primase

is a DNA dependent RNA polymerase that incorporates short RNA primers into replicating DNA

mech of vanco resistance in VRE

is a substitution of D lactate in the place of D alanine during the process of peptidoglycan cell wall synthesis. This prevents the binding of vancomycin to its usual D alanyl D alanine binding site in the cell wall.

erythema multiforme

is a target-shaped, inflammatory skin lesion that typically arises in the setting of infection, particularly with herpes simplex virus or mycoplasma pneumoniae. It is caused by the deposition of infectious antigens in keratinocytes, leading to a strong cell-mediated (i.e. cytotoxic T cell) immune response.

erythrocytosis

is defined as a hematocrit level >52%in men and > 48% in women. Measurement of red blood cell mass is necessary to dstinguish absolute from relative erythrocytosis. A normal red blood cell mass indicates plasma volume contraction as the cause of polycythemia. absolute erythrocytosis is true increase in RBC mass but relative erythrocytosis is decrease in the plasma volume.

Flow cytometry

is often used in the diagnosis of leukemia. Laser-based test that evaluates surface markers (i.e. CD5).

most common cause of DIC in pregnancy

is release of tissue factor (thromboplastin) from an injured placenta(i.e. placental abruption) into the maternal circulation

neuronal damage: acute neuronal injury

ischemia leading to cell death. Shrinkage of cell body, pyknosis of nucleus, loss of nissl bodies, eosinophilic cytoplasm (red neuron) (i.e. if its lacking nissl bodies, its irreversible)

if pt has surgery and has muddy brown casts its

ischemic tubular necrosis/ acute tubular necrosis from blood loss from the surgery

acute ethanol intoxication can lead to hypoglycemia and gap (lactic) acidosis because

it causes an elevated NADH:NAD+ ratio, which favors the conversion of pyruvate to lactate and limits available pyruvate for gluconeogenesis.

SIADH causes hyponatremia bc

it causes large volume and ANP causes excretion of sodium and water thru the kidneys

increasing population/ number of people in a study decreases which type of error

it decreases type 2 error (beta)

ethanol inhibits gluconeogenesis bc

it increases the NADH (and depletes NAD+). NAD+ is required for gluconeogensis, and conversion of malate to oxaloacetate.

bioavailability fraction

its 1 for drugs admin'd intravenously

pt is given penicillin and within hours they get acute inflammatory reaction. What is this

jarisch herxheimer reaction is an acute inflammatory reaciton that occurs within hours of treatment for spirochetal (syphilis) infections. The rapid lysis of spirochetes releases inflammatory bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias. (i.e. bacteria parts into circulation) tx: self limited and doesnt need intervention

horseshoe kidney

keeps anomalous origins of multiple renal arteries to each kidney bc as the kidney ascends embryologically, it gets blood from external iliac, and then gets to higher up and sheds those normally, but with horseshoe it stops at IMA and keeps them

TMP/SMX can cause _ in neonate/ during pregnancy to baby

kernicterus bc it binds to albumin, displacing bilirubin which causes hyperbilirubinemia leading to cerebral toxicity (basal ganglia toxicity via deposition there) in the baby.

tet spell - squatting

kids squat to increase systemic vascular resistance to divert more blood thru the stenotic pulmonary artery to the lungs to be oxygenated.

initial management of septic shock - intravenous admin of what

lactated ringer solution (i.e. isotonic crystalloid); intial management requires rapid fluid resuscitation to replace intravascular volume and restore adequate end organ perfusion. This is best accomplished with intravenous boluses of isotonic crytalloid in the form of 0.9% (normal) saline or lactated ringer solution because these solutions remain int he extracellular space.

lactose fermentation on Macconkey agar

lactose fermenters appear pink and non-lactose fermenters appear white

fibronectins

large glycoproteins made by fibroblasts. They bind integrins, matrix collagen and glycosaminoglycans, serving as a mediator of cell adhesion and migration. Differential expression of integrins is a part of malignant behavior in tumors (including melanoma)

nitrates act where

large veins (reduced venous return to the heart bc increased venous capacitance) (reduced preload) which decreases left ventricular wall stress and oxygen demand to relieve anginal sx

apoE4

late onset familial alzheimer is assoc with apoE4 genotype

don't PICA a horse that can't eat

lateral medullary syndrome (wallenberg syndrome) (hoarsness, dyphagia, PICA occlusion, nucleus ambiguus, CN 9, 10, 11, decreased pain/temp loss c/l, ipsi horners, ipsi ataxia & dysmetria.

single muscle that opens the jaw

lateral pterygoid (V3 nerve)

lateral lowers m's munch

lateral pterygoid is opening of jaw; rest are closing (chewing)

indirect inguinal hernia

lateral to inferior epigastric vessels and superior to the inguinal ligament

test detects stuff earlier but says treatment has longer survival; what bias

lead time bias

cardiac amyloidosis

leading cause of restrictive cardiomyopathy. It is characterized by amyloid infiltration of the myocardial wall, which leads to decreased ventricular compliance, an S4 heart sound and sx of diastolic cardiac dysfunction.

carotid sinus massage

leads to an increase in parasympathetic tone causing temporary inhibition of sinoatrial node activity, slowing of conduction through the AV node, and prolongation of the AV node refractory period. It is a useful vagal maneuver for termination of paroxysmal supraventricular tachycardia.

turcot syndrome

leads to colorectal as well as brain cancers. It is an autosomal dominant condition that commonly presents with a family history of colorectal cancer and brain malignancies

coronary atherosclerosis

leads to plaque formation that causes downstream myocardial ischemia. Individuals with this present with stable angina, which is characterized by stable, exertional, squeezing chest pain that resolves with rest or nitrates.

clostridium perfringens

lecithinase, also known as alpha toxin, is the main toxin produced by clostridium perfringens. Its function is to degrade lecithin, a component of cellular phospholipid membranes, leading to membrane destruction, cell death, and widespread necrosis and hemolysis.

right gonadal vs left gonadal veins

left = drains to left renal vein; right = drains to IVC

which veins anastomose to give rise to the esophageal veins (the esophageal veins that bleed in esophageal varices)

left and right gastric veins

neurapraxia

left atrial enlargement can sometimes cause left recurrent laryngeal nerve impingement (causing hoarseness). Neurapraxia resulting in left vocal cord paresis and hoarseness may result.

the posterior surface is mostly formed by the ___ and therefore enlargement of this space due to stenosis or regurgitation can compress the mid-esophagus causing cardiovascular dysphagia

left atrium

acute diverticulitis

left lower quadrant pain, in >60 year old patients

machine like murmur

left to right shunting, small PDA. (large PDA will go right to left).

confusion, diarrhea, fever, cough, hyponatremia

legionella pneumophila is a facultative intracellular gram-negative bacillus that can cause a systemic infection.

cutaneous leishmaniasis

leishmania species are obligate intracellular protozoa that mature in macrophages and can be identified on biopsy by the presence of intracellular, round-oval amastigotes with rod-shaped kinetoplasts. They are transmitted to humans by infected sand flies and cause the clinical syndrome of cutaneous leishmaniasis, characterized by a chronic, pinkish papule that evolves into a nodule or plaque.

fat cells produce

leptin; the more fat cells, the more leptin produced.

schizotypal personality disorder

magical beliefs

moa of amiodarone

longer effective refractory period due to the blocking of voltage gated slow potassium channels. blocking potassium channels prolongs phase 3 myocardial action potential (rapid repolarization) which in turn prolongs the effective refractory period. Amiodarone is an agent that uses this mech, and is linked to pulmonary fibrosis, hepatotoxicity, and hypothyroidism/hyperthyroidism.

anemia of chronic disease

looks like iron deficiency anemia; but the total iron binding capacity is low (bc in iron deficiency anemia, you have a lot of iron capacity - transferrin)

most potent diuretics and are first line for rapid relief of sx from acute decompensated heart failure (i.e. fluid/ edema)

loop diuretics (furosemide)

why do MS pts get urge incontinence?

loss of central nervous system inhibition of detrusor contraction in the bladder.

if tx with antibiotics and then get diarrhea, and prolonged PT time its probably

loss of gut bacteria that normally make vitamin K

facial nerve paralysis

loss of the corneal reflex (efferent limb) due to denervation of the orbicularis oculi muscle. Paralysis of the stapedius muscle may lead to increased sensitivity to sound (hyperacusis). Decreased lacrimation, salivation, and loss of taste in the anterior two thirds of the tongue.

mitral stenosis

loud first heart sound (S1), early diastolic sound (opening snap) followed by a mid-daistolic murmur from turbulent flow across the mitral valve.

chronic CHF leads to

low cardiac output, and the kidneys activate the RAAS system bc of poor prefusion which causes dilution of the serum sodium due to ADH (vasopressin) secretion and edema. Osmoreceptors in the hypothalamus are the primary way that ADH (vasopressin) is regulated and secreted.

dopamine - hemodynamic effects

low dose dopamine infusion stimulates D1 receptors in the renal and mesentreric vaculature resulting in vasodilation and increased blood flow to these sites. Increasing doses of dopamine stimulate Beta 1 and Alpha 1 receptors, resulting in increased cardiac output and elevated systemic vascular resistance. At the higher end of the dose range, the increase in afterload can result in decreased cardiac output.

anorexic hormone levels

low everything (GnRH, LH, FSH, and estrogen)

S3 sound

low frequency sound after S2 that is assoc with increased ventricular end-systolic volume. S3 is usually mitral regurg and systolic heart failure (dilated cardiomyopathy)

prophylactic anticoagulation drug given to hospitalized patients/ surgery patients

low molecular weight heparin

x linked agammaglobulinemia

low or absent circulating CD19 and CD20 positive B cells and pan-hypogammaglobulinemia; absence of opsonizing and neutralizing antibodies causes patients to have increased susceptability to pyogenic bacteria, enteroviruses and giardia lamblia.

low vs high potency first gen anti psychotics

low potency: chlorpromazine and thioridazine; hihg potency: haloperidol and fluphenazine

nitric oxide has a ___ blood gas partition coefficient

low; its poorly soluble in blood; so it has a low coefficient and a RAPID onset of action

chylothorax

lymph in the pleural cavity bc of disruption or obstruction of the thoracic duct

peua de orange

lymphatic obstruction; inflammatory breast cancer

granulocyts vs lymphocytes

lymphocytes: adaptive immune response (B, T, and NK cells); granulocytes: neutrophils, basophils, or eosinophils (innate immune system)

lynch syndrome vs familial adenomatous polyposis

lynch: (HNPCC) AD, colorectal cancers & others (GI, urinary and female reproductive tracts); FAP: AD, colorectal cancer, but no other cancers

which amino acid used for desmosome cross linking

lysine

liquefactive necrosis in the brain mediated by

lysosomes

fidaxomicin

macrolide antibiotic that inhibits RNA polymerase. It is bactericidal against C difficile. It has a narrow spectum of activity with a lesser effect on normal colonic flora than oral vancomycin (the other tx for C diff).

cell types involved in granuloma formation

macrophage, T cell IL 12 -> Th1 -> IL 17 and TNF alpha and IFN gamma,

ischemic stroke: 3-7 days

macrophage/microglia infiltration and phagocytosis begins

histoplasma capsulatum proliferates in

macrophages

elastase is in

macrophages and neutrophils

macrophages - athersclerotic plaques

macrophages destabilize thin cap fibroatheromas by infiltrating the atheroma and contributing to the breakdown of extracellular matric proteins (i.e. collagen) by secreting metalloproteinases. This causes ongoing intimal inflammation which destabilizes the mechanical integrity of the plaque resulting in plaque rupture and consequent acute coronary syndrome.

cd14

macrophages marker (monocyte macrophage)

pharyngeal infection with strep pyogenes causes

macrophages to produce IL 1 (fever) (increases the hypothalamic set point temperature).

cholesteatomas

made by accumulation of squmaous cell debris that form pearly mass behind the tympanic membrane

chronic rejection of transplants

major problem in lung transplant recipients; affects the small airways, causing bronchiolitis obliterans (obstructive lung disease - reduced FEV1). It is characterized by lymphocytic inflammation, fibrosis and ultimately destruction of the bronchioles.

leydig

make testosterone in response to LH. (testosterone feedback inhibits LH)

nonsense mutation

makes a premature stop codon

if no sertoli cells but there is leydig cells, what do you get

male external genitalia and female/male internal repro organs (this is bc testosterone does internal organs BUT testosterone is peripherally converted to DHT which does external organs)

choriocarcinoma

malignant form of gestational trophoblastic disease composed of anaplastic cytotrophoblasts and syncytiotrophoblasts without villi. It often presents as dyspnea/ hemoptysis due to pulmonary metastasis from hematogenous spread.

inhibited beta oxidation of fatty acids is probably because of an increase in

malonyl CoA (bc malonyl CoA inhibits carnitine acyltransferase, so the carnitine carrier in the mitochondria doesn't work so beta oxidation of FFAs doesn't work

general sensation to the anterior 2/3 of the tongue is which nerve

mandibular division of the trigeminal nerve. (v3)

lobar pneumonia

marked by cytokine-mediated accumulation of neutrophils and proteinaceous material in the alveoli (leakage of protein rich fluids into the alveolar airspaces). Over several days, the proteinaceous material becomes fibrinous, neutrophils are replaced by macrophages and macrophages digest the fibrinous exudate, thereby restoring normal lung histology.

keratin

marker of epithelial cell origin

the trisomies that survive birth (13, 18, 21) have what genetic defect

maternal nondisjunction due to advanced maternal age.

aortic arch derivatives

maxillary stapedial common carotid and internal carotid aortic arch and right subclavian artery pulmonary arteries and ductus arteriosus

middle meningeal artery branches from where

maxillary artery

ANOVA and t tests compare the

means between groups. T test compares 2 groups; ANOVA compares >2 groups

tdt

means cells are lymphoblasts

epiploic

means connecting the stomach to the omentum (i.e. the peritoneal fold over the intestines). Gastroepiploic arteries are therefore on the inferior side of the stomach bc that's the side next to the intestines.

subacute sclerosing panencephalitis

measles; shows hemagglutinin; pt will have high titers of measles antibodies even though they recovered from measles already

correlation coefficient

measure of strength and direction of a linear relationship between 2 quantitative variables

the Hib vaccine will protect a child against what?

meningitis; the H infulenza type B vaccine induces anticapsular antibodies that facilitate complement mediated phagocytosis of the bacterium. The vaccination series has drastically reduced the incidence of invasive disease caused by Hib (meningtitis, epiglottitis)

moa of mesna

mesna counteracts the serious potential side effect of cyclophosphamide-mediated hemorrhagic cystitis. It combats this complication by binding to acrolein, a urotoxic metabolite of cyclophosphamide.

the oocyte is arrested in which stage of meiosis immediately prior to fertilization

metaphase of meosis 2

polygonal cells with abundant clear cytoplasm

metastatic clear cell carcinoma, the most common subtype of renal cell carcinoma.

metformin - lactic acidosis

metformin inhbits gluconeogenesis, resulting in the buildup of substrate molecules. Decreased formation of pyruvate results in excess buildup of its precursor, lactate, which increases the risk of lactic acidosis. This risk is increased in those with renal fysfunction bc they cant clear it as well.

diabetic drug that causes kidney damage

metformin. it inhibits hepatic gluconeogenesis. high anion gap metabolic acidosis in the setting of high serum creatinine levels is characteristic of lactic acidosis due to metformin toxicity.

methylene blue

methemoglobinemia may occur as an adverse effect of oxidizing agents such as dapsone. Patients with methemoglobinemia carry a large amount of oxidized iron (ferric Fe3+) instead of reduced iron (ferrous Fe2+). Fe3+ does not bind oxygen effectively. Methylene blue increases the conversion of Fe3+ back to Fe2+, increasing hemoglobin oxygen content and overall oxygen delivery to body tissues.

amino acid essential for synthesis of surfactant

methionine

tx for diabetic gastroparesis

metoclopramide (prokinetic medication, antiemetic)

pt with amebic abscess (fever, abdominal pain, liver mass on US) (bloody mucoid diarrhea, recent travel to developing country) tx is what?

metronidazole

tx for bacterial vaginosis

metronidazole or clindamycin

shigella and E coli cause what type of anemia

microangiopathic hemolytic anemia (small blood vessel factors cause RBCs to lyse)

hookworm infections cause

microcytic anemia (hanging iron in sketchy)

alpha thalassemia

microcytic, hypochromic anemia with minimal anisocytosis (when its mild). severe: death in utero (hydrops fetalis), this does not happen in beta thalassemia. has target cells as well.

increased activity of a specific intracelluarl enzyme that causes pts to be susceptible to benzopyrene induced lung cancer

microsomal monooxygenase enzyme overactivity (i.e. cytochrome P450 monooxygenase). Procarcinogens need to be activatred by cytochrome P450 oxidase system. Individual susceptibility depends on the activyt of these enzymes.

reye's syndrome

microvesicular hepatic steatosis and encephalopathy from aspirin during viral infection

seated thoracentesis placement

mid-clavicular: 6-8 ribs; midaxillary is 8-10 ribs and posterior/ paravertebral line is 10-12 ribs

primary biliary cholangitis (PBC)

middle aged woman with generalized pruritis and signs of vitamin A deficiency; common autoimmune disease characterized by destruction of small bile ducts in the liver.

the most potassium permeability in the membrane depol graph of of the action potential is the

middle of the down slope

which parameter best correlates with the potency of an inhaled anesthetic

minimal alveolar concentration; it's the concentration of the anesthetic in the alveoli that renders 50% of ppl unresponsive to pain (ED50). Potency is inversely proportional to the MAC: the lower the MAC, the more potent the anesthetic.

work of breathing

minimized in patients with increased elastic resistance (i.e. pulmonary fibrosis) when their respiratory rate is high and tidal volume is low (fast, shallow breaths). In contrast, patients with disease that increase airflow resistance (i.e. asthma, COPD) breathe at a lower respiratory rate and higher tidal volume (slow, deep breaths) to minimize the work of breathing.

leber hereditary optic neuropathy inheritance pattern

mitochondrial (progressive bilateral optic neuropathy leading to blindness)

MELAS

mitochondrial encephalopathy lactic acidosis and stroke like episodes (neuro findings with lactic acidosis)

rheumatic fever is assoc with

mitral stenosis; can cause atrial enlargement -> atrial fibrillation -> mural thromboses. These thrombi can dislodge and cause an embolic stroke

subacute infective endocarditis with an embolic stroke

mitral valve prolapse with regurgitation is the most common predisposing condition for native valve infective endocarditis (IE) in developed nations. Rheumatic heart disease remains a frequent cause of IE in developing nations. Turbulent flow predisposes them to fibrin and platelet clots that cause emboli.

opening snap followed by a diastolic rumbling murmur that's best heard over the apex of the heart

mitral valve stensosi

trastuzumab - heart toxicity

monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) to encourage apoptosis. HER2 normally helps preserve cardiomyocyte function, so trastuzumab causes decrease in myocardial contractility wihtout cardiomyocyte destruction of myocardial fibrosis.

omalizumab

monoclonal antibody that does IgE binding (at the Fc portion) of mast cells to prevent them from being sensitized and degranulated. Thereby preventing the inflammation in asthma from occuring (i.e. prevents release of histamine and leukotrienes)

strong evidence of malignancy in abnormal lymph node architecture

monoclonal lymphocytic proliferation (monoclonal T cell receptor gene rearrangements

the intestine can absorb which type of sugars without processing first?

monosaccharides can be absorbed by the intestinal wall without first being processed (i.e. like the polysaccarides); this means that D-xylose, for instance, is not affected by exocrine pancreatic insufficiency and can be used to differentiate between pancreatic vs mucosal causes of malabsorption.

tx for bipolar disorder

mood stabilizers (lithium, valproic acid, carbamazapine, lamotrigine) or atypical antipsychotics (second gen)

besides meitoic nondisjunction, what can happen with the genetic inheritance of downs

mosaicism (some (not all) of the cells have an extra copy of chrom 21)

TP53

most cancers, Li Fraumeni syndrome; tumor suppressor gene

colon adenocarcinoma

most common GI malignancy; right sided lesions: more likely to bleed and cause iron deficiency; left sided lesions: present with obstructing sx (altered bowel habits, constipation, abdominal distention, nausea and vomiting)

familial hypercholesterolemia

most common autosomal dominant disorders. Result of LDL receptor gene mutation, underexpression of LDL recepotors. Leads to accelerated atherosclerosis and early coronary artery disease.

echinococcus granulosus

most common cause of hydatid cysts. Spilling of cyst contents can cause anaphylactic shock. Surgical manipulation should be performed with caution.

cytomegalovirus

most common cause of ocular disease in patients with untreated AIDS who have CD4 counts <50. diagnosis is made by fundoscopy, which typically reveals yellow-white, fluffy retinal lesions near the retinal vessels with associated hemorrhage. Tx with ganciclovir is required to prevent blindness.

candida albicans

most common cause of oppotunistic mycosis, can affect any organ and cause generalized candidemia. Yeasts and pseudohyphae on LM and a postiive germ tube test are diag of candida infection.

cerebral amyloid angiopathy

most common cause of spontaneous lobar hemorrhage, particularly in the elderly. Most common sites of hemorrhage include the occipital and parietal lobes

porphyria cutanea tarda (PCT)

most common form of cutanea; uroporphyringoen decarboxylaton

follicular lymphoma

most common indolent non-hodgkin lymphoma in adults. B cell origin, and presents with waxing and waning lymphadenopathy. T(14,18) and has overexpression of bcl-2 oncogene (has antiapoptotic effects).

acute lymphoblastic leukemia

most common malignancy of childhood. B cell ALL is responsible for approx 70 -80% of all cases of ALL whereas T cell ALL accounts for 15-17% of all cases of ALL. T cell ALL oftenpresents as a MEDIASTINAL mass that can cause respiratory sx, DYSPHAGIA, or superior vena cava syndrome.

serous cystadenocarcinoma

most common ovarian cancer, bilateral, histo: psammoma

osteosarcoma

most common primary bone malignancy in children and young adults. It occurs most frequently at the metaphyses of long bones and presents with local pain and swelling. Most cases are assoc with sporadic or inherited mutations in RB1 (hereditary retinoblastoma) and TP53 (Li-fraumeni syndrome)

teratomas

most common subtype of germ cell tumor. Ovarian teratomas occur most frequently in females age 10-30. They are divided into mature (cell lines of >1 germ layer, commonly including hair, teeth and skin) and immature types.

fibrinous pericarditis

most common type of pericarditis and is characterized by pericardial inflammation with a serous, fibrin-containing exudate in the pericardial space. Pleuritic chest pain and a triphasic friction rub are frequently seen. Common causes include viral infection, myocardial infarction, uremia, and rheumatologic disease (i.e. systemic lupus erythematosus, rheumatoid arthritis)

clear cell carcinoma

most common type of renal cell carcinoma and originates from the epithelial cells of the proximal renal tubules. Gross path shows a sphere like mass of golden yellow cells (high lipid content) with areas of necrotic cells and focal hemorrhage;

papillary thyroid cancer

most common type of thyroid cancer. Histo: large cells with ground glass nuclei (Orphan annie eye - nuclei containing finely dispered chromatin) and intranuclear inclusions or grooves. Psammoma bodies

which effect of cholinergic toxicity (poisoning from pesticides, etc) persists after giving atropine and wghy

muscle weakness/paralysis and fasciculations because its nicotinic and the others are muscarinic

zinc finger is

most commonly identified DNA binding domain in humans; only intraellular receptors located in the cytoplasm or the nucleus can act directly as transcription factors. They typically bind lipid soluble hormones. Examples of these are steroids (aldosterone, cortisol, estrogen), thyroid hormone, and fat soluble vitamin receptors.

fibromyalgia

most commonly in women age 20-55, sx: diffuse musculosketal pain, fatigue, and neuropsychiatric distrurbances. Abnormal central processing of painful stimuli. Tx: aerobic exercise helps to improve pain and function.

acute compartment syndrome

most commoon site for ACS is the anterior compartment of the leg, which includes the foot extensor muscles, anterior tibial artery and the deep peroneal (fibular) nerve. Injury to the deep peroneal nerve causes decreased sensation between the first and second toes, decreased dorsiflexion of the foot, foot drop and claw foot.

infective endocarditis

most likely cause of fever, fatigue and new onset cardiac murmur is IE. Diffuse, prolfierative glomerulonephritis secondary to circulating immune complex deposition may complicate IE and can result in acute renal insufficiency

rat poison

most rat poisons have warfarin (brodifacoum) in them. So if vignette says they ingested rat poison, think warfarin with vitamin K depletion and tx them with fresh frozen plasma. Their sx will be coagulopathy first since warfarin inhibits II, VII, IX and X and C and S but the 2,7, 9, and 10 take 48 hours to be inhibited whereas the C is immediate (and protein C is a natural anticoagulant). so you see coagulation first then bleeding.

achalasia

motility disorder caused by reduced numbers of inhibitory ganglion cells in the esophageal wall, which creates an imbalance favoring excitatory ganglion cells. Esophageal manometry in achalasia shows decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relaxation at the lower esophageal sphincter.

right angle branching of hyphae

mucormycosis (rhizopus, mucor and absidia)

fever facial pain and black eschar in the nose

mucormycosis (rhizopus, mucor)

patho of chronic bronchitis

mucous gland hypertrophy and hyperplasia, chronic inflammatory infiltrate including CD8+ lymphocytes and monocytes, squamous cell metaplasia and fibrosis. This process of disproportionate gland proliferation can be quantified by the Reid Index, which is the ratio of submucosal gland thickness to epithelium and cartilage thickness.

reid index

mucous glands/ submucosa + lamina propria; higher values correlate with increased duration and severity of chronic bronchitis. (smokers)

cardiac tamponade triad:

muffled heart sounds, jugular venous distention and hypotension. (and pulsus paradoxus: fall in systolic BP >10 mmHg on inspiration)

random pedigree =

multifactorial

MEN 2B

multiple endocrine neoplasia type 2B is characterized by medullary thyroid cancer, pheochromocytomas, mucosal neuromas (painless nodules on lips and tongue), and marfanoid habitus (joint laxity).

rouleaux formation of RBCs

multiple myeloma (also have numerous plasma cells with clock face chromatin and intracytoplasmic inclusions containing immunoglobulin.

clock face chromatin & radiolucent bone lesions & waxy laminated casts on UA

multiple myeloma (waxy casts from light chain cast nephropathy)

if bone marrow shows lots of plasma cells with basophilic cytoplasm its

multiple myeloma.

internuclear ophthalmoplegia and optic neuritis happen in

multiple sclerosis bc of demyelination. Internuclear ophthalmoplegia: the affected eye (ipsilateral to the MLF lesion) is unable to adduct and the contralateral eye abducts with nystagmus.

polyarteritis nodosa

multisystem vasculitis characterized by episodic ischemic sx in various organs with sparing of the lungs. Histo: segmental, transmural inflammation with fibrinoid necrosis. PAN is commonly assoc with hepatitis B. bead like aneurysm formation especially in the mesenteric circulation. can get livedo reticularis and palpable purpura.

hypertrophic cardiomyopathy caused by

mutations affecting structural proteins of the cardiac sarcomere; autosomal dominant mutations affecting the cardiac sarcomere genes (cardiac beta myosin heavy chain gene and myosin binding protein C gene) are responsible for the majority of cases

sporadic and hereditary (assoc with von hippel lindau disease) renal cell carcinomas are assoc with

mutations in VHL gene on chromosome 3p; VHL is a tumor suppressor gene

HIV pol gene

mutations in this gene are responsible for acquired resistance to reverse transcriptase inhibitors, protease inhibitors and integrase strand transfer inhibitors. Mutations of the env gene enable escape from host-neutralizing antibodies.

caseous necrosis

mycobacterial, fungal infections (cheeselike)

serpentine cords

mycobacterium tuberculosis; it surrounds TB and prevents its destruction by macrophages; it also drives the formation of macrophages

cold agglutinins

mycoplasma pneumoniae binds an oligosaccharide on the respiratory epithelium that is also present on erythrocytes, leading to the generation of cross-reacting IgM antibodies (cold agglutinins). Patients with M pneumo infections often develop mild, transiet hemolytic anemia that resolves as IgM antibody titers decline (6-8 weeks after infection begins).

leukemia: bone marrow blasts: peroxidase positive granules (Auer rods)

myeloblast (i.e. granulocytes - PMN's, Eosinophils, basophils)

marker for myeloid cells (i.e. AML)

myeloperoxidase

primary myelofibrosis

myeloproliferative disorder assoc with clonal expansion of megakaryocytes. Bone marrow fibrosis accounts for most of the major manifestations including HSM, cytopenias, and blood smear evidence of dacrocytes. Bone marrow aspiration is usually dry, but bone marrow biopsy will show marked fibrosis with occasional clusters of atypical megakaryocytes.

post MI: 12-24 hours

myocyte hypereosinophilia with pyknotic (shrunken nuclei); coag necrosis, marginal contraction band necrosis.

positive blood on urine dipstick in the absence of red blood cells on microscopy suggests

myoglobinuria (from rhabdomyolysis)

drugs that inhibit P450 will increase _ ADR of statins

myopathy

fibrates combined with statins increase the risk for

myopathy

mcardle disease or glycogen storage disease type 5

myophosphorylase deficiency causes failure of muscle glycogenolysis, resulting in decreased exercise tolerance and myoglobinuria during exercise.

nitrates moa

myosin dephosphorylation leading to relexation of large veins

the most common cardiac neoplasm

myxomas (gelatinous mass; mucopolysaccarhide ground substance) can embolize. With myxomas, you'll heart a mid diastolic murmur (tumor plop) that results from the motion of the tumor mass obstructing the mitral valve orifice.

optics: temporal side of visual field and nasal

nasal crosses; temporal stays the same side

glucagonoma

necrolytic migratory erythema (blistering erythematous plaques with central clearing) affecting the groin, face and extremities. & hyperglycemia

conjugate vaccine

needs a protein AND a polysaccarrhide component (to allow for T cell activation which allows for cell mediated immunity and memory) (CD4)

negative vs positive pressure room

negative pressure: airborne protection from transmitting airborne disease, they pump air in and force it out so it doesnt passively leak out into hospital area; positive pressure room is just a normal room

triad of polyarthritis, vesiculopustular skin rash, and tenosynovitis

neisseria gonorrhoeae. Also get septic arthritis in young, sexually active adult

mesothelioma

neoplasm arising from the pleura. Strongly assoc with asbestos exposure and presents with dyspnea, cough, and chest pain. Unilateral pleural thickening or plaque formation is seen on imaging; pleural effusions are also common and may be hemorrhagic. Histopathology reveals tumor cells with numerous long, slender microvilli and abundant tonofilaments.

chondrosarcoma

neoplastic chondrocytes in a hyaline cartilage matrix, usually with small calcifications

net excretion rate of a substance

net excr rate of sub a = (inulin clearance)(plasma conc of substance A) - (tubular reabsorption of substance A)

melanoma comes from which embyrological derivative

neural crest

schwannoma

neural crest cell origin; cerebellopontine angle (CN VIII) is most common location; sx: tinnutis, vertigo and hearing loss

how to diff b12 vs folate deficiency

neuro sx only seen in b12 deficiency

most common extracranial solid neoplasm in children

neuroblastoma

MYC

neuroblastoma (NMYC); small cell lung cancer (LMYC); protooncogene

NF1

neuroblastoma , neurofibromatosis type 1, sarcoma; tumor suppressor gene

small cell carcinoma of the lung is the most aggressive type of lung cancer and is of what tissue origin

neuroendocrine; therefore on biopsy you'll see neural cell adhesion molecules, neuron-specific enolase, chromogranin and synaptophysin.. because these are neuroendocrine markers. Risks: smoking; assoc with this: lambert eaton syndrome

most common clinical manifestations of vitamin E deficiency

neuromuscular disease (spincerebellar ataxia, polyneuropathy) and hemolytic anemia.

sciatic nerve:

neuropathy can happen from hip fracture. Causes deficits in sciatic nerve, peroneal nerve, and tibial nerve

botulinum toxin

neurotoxin. Prevents release of Ach from presynaptic nerve terminals. Causes both muscarinic and nicotinic blockage. Autonomic sx (pupils dilated, dry mouth) and skeletal muscle weakness (diplopia, dyphagia, resp depression).

nonpurulent vs purulent cellulitis

nonpurulent: beta hemolytic strep; purulent cellulitis: staph aureus

flutamide

nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors (causes impaired androgen-receptor interaction). It is used in combo with long acting gonodotropin releasing hormone agonists for the treatment of prostate cancer.

pressure inside the aorta

normal is 120/80; in aortic regurg its 160/ 60. normal pressure in the LV: 120/10.

small bowel mucosa in ppl with primary lactase deficiency is

normal on histo

electrolyte levels in conn syndrome

normal sodium (bc aldosterone escape bc of ANP), low potassium and high bicarb (bc H+ excretion w K, leads to more bicarb production)

c-Jun and c-Fos

nuclear transcription factors that directly bind DNA via a leucine zipper motif and they are protooncogenes

first event in pathogenesis of acute appendicitis

obstruction of the lumen of the appendix via fecaliths, hyperplastic lymphoid follicles, foreign bodies or tumors.

obtruction of a mainstem bronchus (i.e. just one lung), can prevent ventilation of an entire lung, leading to

obstructive atelectasis (as the O2 trapped in the lung gets dissolved into the blood), and complete lung collapse, causing the trachea to deviate TOWARDS the SIDE OF THE COLLAPSED LUNG. CXR: unilateral pulmonary opacification and deviation of the mediastinum toward the opacified lung.

flow volume loops

obstructive lung disease: scooped out expiratory pattern (reduced expiratory flow rates);

opioid seeking patietn

obtain confirmation of the patients prescription history

acute bacterial parotitis

occurs more in elderly post-op pts who are intubated or dehydrated. Staph aureus is most common bacterial cause. Has elevated serum amylase (with normal serum lipase level- which tells u its not pancreatitis).

HPV 16 and 18 lead to inhibition of _ and _ by E6 and E7 respectively

p53 and Rb tumor suppressors

main measure of association in a case control study

odds ratio

corticosteroids inhibit the down regulation

of beta 2 receptors (which is why you add LABA always to SABA) which is why you always add corticosteroids to beta 2 agonist asthma tx

diabetic mononeuropathy

often involves CN III. It is caused by central ischemia, which affects the somatic fibers but spares the peripheral parasympathetic fibers. Sx: ptosis and a down and out gaze and normal accomodation reflexes.

diverticulitis

often manifests with left lower quadrant abdominal pain and is usually caused by blockage of a diverticulum. The characteristic hito finding of diverticulosis and diverticulitis is attenuated muscularis propria (thinner) (creating a false diverticulum)

adenocarcinoma of the lung

often metastasizes to bone. Histo shows neoplastic glands lined with mucin-producing cells. Most common pulmonary malignancy, histo: invasive glandular cells with eccentrically placed nuclei. Imagin: discrete mass or pneumonia like consilodation at the periphery of the lung.

oligodendrocytes vs schwann cells

oligodendrocytes: CNS (many axons at once); schwann cells: PNS (one axon at a time)

kozak consensus sequence

on eukaryotic mRNA and is defined by: (gcc)gccRccAUGG, in which R is either adenine or guanine. This sequence helps initiate translation at the methionine start codon (AUG). For prokaryotes it's the shine delgarno sequence (AGGAGGU) upstream of the AUG start site.

the AV node is located

on the endocardial surface of the right atrium, near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus.

necrotizing enterocolitis

one of the most common GI emergencies in newborns; bacrterial invasion and ischemic necrosis of the bowel wall (pneumatosis intestinalis (air in the bowel wall) is confirmatory

diphenoxylate

opioid agonist, antidiarrheal drug that binds mu opiate receptors in the gut to slow motility. Overuse can lead to euphoria and physical dependence. To discourage abuse, diphenoxylate is combined with atropine wihcih induced adverse effects if taken in high doses. moa: slows motility of the GI.

dextropmethorphan

opioid that causes constipation

right homonymous hemianopia

optic tract lesion; cant see the right side of both eye fields can also have afferent pupillary defect (marcus gunn pupil) in the pupil contralateral to the optic tract lesion.

vancomycin vs metronidazole for c diff

oral vancomycin is first line (metronidazole is second line)

ornithine transcarbamylase deficiency

orotic aciduria, hyperammonemia; deficient enzyme: ornithine transcarbamylase; this deficiency interferes with the body's process of eliminating ammonia.

orotic aciduria

orotic aciduria, megaloblastic anemia; deficient enzyme: UMP synthase; these patients will benefit from supplemenation with Uridine (bc these pts have defective UMP synthase aka uridine 5' monophosphate) (Uridine will then be converted to UDP)

ortolani vs barlow

ortolani: hip already Out of socket so you Open legs/ abduct to push it back it; Barlow: suspicion of hip instability, so you adduct and see if you can Break/ dislocate hip.

the peptidoglycan cell wall of gram positive (big layer) and gram negative (little bit of it) organisms gives them the ability to surivive

osmotic changes/ stress

granulosa cell tumors

ovarian tumor, postmenopausal women, sex cord stromal tumors, the cells in these are called Call-Exner bodies (gland like with pink eosinophilic center and coffee bean nuclei), unilateral, secretes estrogen, endometrial hyperplasia. Increased inhibin, increased estrogen

krukenberg tumors

ovaries are a common site for metastases from adenocarcinomas of the alimentary tract, especially from the stomach. These tumors, known as krukenberg tumors, are often bilateral and characterized histologically by overproduction of mucus.

endometriosis commonly affects the

ovary; the uterine mucosa is covered by endometrium, and abnormal implantation of endometrial glands/ stroma is referred to as endometriosis. The ovary is covered by a simple cuboidal epithelium involved in surface repair of defects from ovulation. Endometriosis commonly affects the ovary and results in infertility.

tricyclic antidepressants

overdose can cause fatal cardiac arrhythmias and refractory hypotension due to inhibition of fast sodium channels in cardiac myocytes.

osgood schlatter disease

overuse injury of the secondary ossfiication center (apophysis) of the tibial tubercle

irreversible step in gluconeogenesis

oxaloacetate to phosphoenolpyruvate (catalyzed bny PEP carboxykinase)

fatty acid oxifdation vs synthesis location

oxidation: mitochondria; synthesis: cytosol

transition from adenoma to carcinoma: which gene is inactivated

p53 (KRAS is activated to make it an adenoma in the first place)

locus ceruleus

paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle and functions as the principal site for norepinephrine synthesis in the brain. It projects to virtually all parts of the CNS and helps control mood, arousal (RAS), sleep wake states, cognition and autonomic function.

absent P waves

palpitations refer to a subjective sensation/ awareness of the heartbeat due to rapid arrhythmias or forceful ventricular contractions. Atrial fibrillation is the most common cause of an irregularly irregular rhythm and is detected on ECG by an absence of organized P waves and varying R-R intervals.

painless obstructive jaundice, and weight loss, and courvoisier sign (painless palpable gallbladder in a jaundiced patient), migratory thrombophlebitis

pancreatic adenocarcinoma; smoking is the most important environmental risk factor for pancreatic cancer. Others are: advanced age, chronic pancreatitis, and genetics (peutz jeghers syndrome)

most common GI manifestation of cystic fibrosis is

pancreatic insufficiency (pancreatic duct obstruction and distension due to viscous mucus leading to fibrosis) (present from birth) - leads to ADEK deficiency

VIPoma

pancreatic islet cell tumor that hypersecretes vasoactive intestinal peptide, which increases intestinal chloride loss into the stool and causes excess losses of the accompanying water, sodium and potassium. VIP also inhibits gastric acid secretion. Somatostatin inhibits the secretion of VIP and is used to treat the sx of VIPoma.

CA 19-9

pancreatic tumor

PSaMMoma bodies

papillary thyroid, serous ovary, meningioma, and mesothelioma

parenteral vaccines

parental = IV; parental vaccines are not good at eliciting an IgA response, which means theyre not good for gut mucosal infections like V cholerae.

parenteral vs enteral

parenteral: anywhere besides the mouth/ alimentary canal (i.e. admin into a vein); enteral: by mouth/ using the alimentary canal.

mumps

parotitis and severe testicular pain

idiopathic pulmonary fibrosis

patchy interstitial inflammation intermixed with areas of dense fibrosis and normal lung, focal fibroblastic proliferation, and a honeycomb pattern most prominent in the periphery. Repetitive injury and disordered healing are implicated as potential causes; lung injury results in the focal loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes. digital clubbing.

differential clubbing (i.e. toe cyanosis but not finger) and cyanosis without blood pressure or pulse discrepancy

patent ductus arteriosis complicated by eisenmenger syndrome (reversal of shunt flow from left to right, to right-to-left.

continuous murmur in the left infraclavicular region with maximal intensity at S2

patent ductus arteriosis.

wide splitting of S2 that does not change with respiration

patent foramen ovale or ASD (transient shunt reversal during periods of coughing or straining)

baby with pee coming out umbilicus

patent urachus (failure of the urachus to obliterate). Urachus is part of the allantoic duct that connect the bladder and umbilicus. Allantois becomes the urachus in the baby. in adults this becomes the mediAN umbilical ligament

anitschkow cells

pathognomnic for rheumatic heart disease (activated macrophages that are part of Aschoff bodies).

membranous segment of the posterior urethra in men is the weakest point and prone to damage in

pelvic fracture

you cant get DOME if your FLACCID penis is VULGAR

pemphigus vulgaris is flaccid bullae and erosions of the skin and mucosal membranes. Autoantibodies against desmosomes.

flaccid bullae, desquamations, and oral ulcerations

pemphigus vulgaris; bullous impetigo; staph aureus; exfoliative toxin A; targets desmoglein 1 and 3 in superficial epidermis (bc big bullae are deeper and not flaccid); desmoglein is a cadherin component of desmosomes

lupus pts can have (heart stuff)

pericarditis

aortic dissection can extend into the

pericardium, causing tamponade with reduced cardiac output and shock

menopause

permanent cessation of menses for 12 months (usually happens at 51) ; elevated serum FSH level confirms the diagnosis. (bc estrogen usually inhibits ant pit from releasing FSH.

zellweger syndrome

peroxisome defect - cant digest very long chain fatty acids.

wallerian degeneration of axons: what will you see 6 months later

persistant myelin debris (can persist for years); suppresses axonal growth and astrocytes also make glial scar that forms a barrier to axon regeneraton. Astrocytes = CNS; Schwann cells = PNS

Obsessive compulsive disorder

persistent, unwanted thoughts (obsessions) and repetitive, time-consuming rituals (compulsions) that the individual feels driven to perform to alleviate anxiety or prevent a feared event (i.e. someone breaking into their house).

bordatella pertussis

pertussis should be considered in any adult who has not had updated vaccination boosters. The clinical presentation is a praoxysmal cough lasting >2 weeks that is associated with post-tussive emesis or inspiratory whoop after a severe coughing episode.

friedreich ataxia

pes cavus, degeneration of the spinocerebellar tracts, dorsal column and dorsal root ganglia. Kyphoscoliosis, heart disease (HCM),

what is responsible for the conversion of C. Diptheriae from nontoxigenic to toxigenic

phage conversion permitting exotoxin production (bacteriophage)

post MI: 7-10 days

phagocytosis of dead cells by macrophages; beginning granulation tissue

daptomycin

pharoah's chicken (police DePt); tx for gram positive organisms; moa: glycopeptide polymerization (the drug is inactivated by pulmonary surfactant)

train of four stimulation pattern for succinycholine

phase 1: constant depol; phase 2: fading depol

PCP

phencyclidine; sx: nystagmus, violence, hallucinogen

Cortisol increases the conversion of NE to epinephrine in the adrenal medulla by increasing the expression of _

phenylethanolamine-N-methyltransferase (PNMT)

musty body odor

phenylketonuria; tx: phenylalanine-free diet

dipalmitoyl lecithin

phosphatidylcholine (lecithin) levels increase as surfactant is produced; sphingomyelin remains constant. Surfactant production begins at 28 weeks. Phosphatidylcholine (lecithin) is the major component of surfactant (made by the type 2 pneumocytes).

myosin light chain dephosph vs phosph

phosphoryation = contraction; dephosphorylation = relaxation

what causes wrinkles

photoaging is a product of excess exposure to ultraviolet A wavelengths and is characterized by epidermal atrophy with flattening of rete ridges. In addition, there is decreased collagen fibril production and increased degradation of collagen and elastin in the dermis. there is increased crosslinking of collagen with deposition of collagen breakdown products.

the diaphragmatic and mediastinal pleura pain fibers are in the

phrenic nerve (C3-C5). The rest of the pain fibers for the rest of the parietal pleura is the intercostal nerves.

interscalene (brachial plexus) nerve block is danger to what nerve

phrenic nerve roots (C3-C5) bc they pass thru theere

beta endorphin and ACTH

physiologic modulation of pain; beta endorphin is one endogenous opioid peptide that is derived from proopiomelanocortin (POMC). POMC is a polypeptide precursor that oges thru enzymatic cleavage and modification to produce not only beta-endorphins but also ACTH and MSH. The fact that beta endorphin and ACTH are derived from the same precursor suggests that there may be a close physiological relatinshup between the stress axis and the opioid system.

tx for anticholinergic overdose/ toxicity

physostigmine (can reverse both the CNS and PNS sx of anticholnergic toxicity - the other -stigmine's can only do PNS)

Niemann pick disease

pick your big nose with your sphinger, sphingomyelin, big = hepatomegaly

What muscle passes through the greater sciatic foramen

piriformis muscle

malassezia globosa

pityriasis versicolor (tinea versicolor) is a superficial skin infection caused by malassezia species. It causes erythematous, hyper- or hypopigmented macules and patches. Malassezia forms spores and hyphae, producing the characteristic "spaghetti and meatballs" appearance on KOH preparation light microscopy.

ph vs pka

pka is a unique measure of a substance of when it will either be in acid form or basic form. If pH > pka the substance will be in basic form. If pH< pka the substance will be in acidic form

profuse bleeding/ postpartum hemorrhage can result from

placenta accreta (placenta in the muscularis layer of the uterus and therefore it doesn't get entirely evacuated after birth of child and causes continued bleeding). Prior uterine surgery can impair decidualization, resulting in myometrial invasion by villous tissue and a placenta that is abnoramlly adherent to the myometrium (placenta accreta).

thrombotic thrombocytopenic purpura

platelet disorder due to a deficiency of ADAMTS 13 (a von willebrand factor metalloprotease). typically occurs in pts who have a pentad of fever, microangiopathic hemolytic anemia, thrombocytopenia, renal disease, and neurologic sx.

wallenberg syndrome

posterior inferior cerebellar artery occlusion causes lateral medullary (wallenberg) syndrome, characterized by vertigo/ nystagmus, ipsilateral cerebellar signs, loss of pain/ temperature sensation in the ipsilateral face and contralateral body, bulbar weakness and ipsilateral Horner syndrome. This condition can occur in the setting of cervical spine trauma with dissection of the vertebral artery.

Postpartum hemorrhage

postpartum hemorrhage is an obstetrical emergency. Bilateral ligation of the internal iliac artery can decrease uterine blood flow and control postpartum hemorrhage that is unresponsive to medical management (i.e. uterine massage, uterotonic medications).

class 3 antiarrhythmics act via what ion

potassium. They block potassium channels and inhibit outward potassium currents during phase 3 of the cardiac action potential, prolonging repolarization and total action potential duration.

released phosphate binds to free calcium and

precipitates in soft tissues

predictable drug reactions vs nonpredictable

predictable is stuff like gastritis assoc with naproxen (COX inhibitors); nonpredictable includes: exaggerated, idiosyncratic (unpredictable), immunologic (drug allergy), and pseudoallergic drug reaction.

active form of prednisone

prednisolone

preeclampsia vs eclampsia

preeclampsia: proteinuria, hypertension and end organ damage. Eclampsia is all those plus seizures (grand mal).

schizoid

prefers to be a loner; detached, unemotional; persistent pattern of social detachment, preference for solitary activities, and constricted range of affect in social interactions.

pregnancy and thyroid binding globulin

pregnacy upregulates thyroid binding globulin (this is normal) so pregnant women have increased TOTAL T3 and TOTAL T4, and normal FREE T4 and T3.

anterior knee pain - which bursa

prepatellar bursitis (from repetitive or prolonged kneeling)

patients with severe mitral regurgitation: what is the best indicator of the severity of their disease

presence of audible S3 (rapid filling of the ventricles), due to a large volume of regurgitant flow reentering the ventricle during mid-diastole.

adenomyosis

presence of endometrial glandular tissue within the myometrium. Menorrhagia and dysmenorrhea are common presenting symptoms. Patients have a uniformly enlarged uterus with normal-appearing endometrial tissue on biopsy.

periarticular lymphatic sheath (ALS)

present in the spleen

familial chylomicronemia syndrome

presents in childhood with recurrent episodes of acute pancreatitis. Patients with this disorder are not usually at increased risk for premature coronary artery disease. Eruptive skin xanthomas may be present in hypertriglyceridemia but tendon xanthomas and xanthelasmas are primarily seen with hypercholesterolemia.

digoxin toxicity

presents with cardiac arrhythmias and nonspecific gastrointestinal (nausea, vomiting), neurological (confusion, weakness), and visual symptoms (color vision alterations). Elevated potassium is another sign of digoxin toxicity is caused by inhiition of Na-K-ATPase pumps. causes increased vagal tone (causing slowing of conduction through the AV node).

digoxin toxicity

presents with nonspecific GI (i.e. anorexia, nausea, vomiting) and neuro (fatugue, confusion, weakness) sx. Changes in color vision are a more specific but rarer finding. Life threatening ventricular arrhythmias are the most serious complication.

central retinal artery occlusion

presents with sudden, painless and permanent monocular blindness. Fundoscopic: pale retina and "cherry-red" macula. Central retinal artery comes from ophthalmic artery which comes from internal carotid artery. Athero and thrombo-emboli can cause this.

catheter IV assoc infections - how to decrease these

prevention: placement of catheter by a specialized IV team, antiseptic techniques, and prompt removal once no longer needed

moa of vancomycin

prevents cell wall synthesis by binding D ala D ala moieties

what type of cancer is an immunosuppressed pt going to get. The mass have cells containing EBV genome.

primary CNS lymphoma. These arise from B cells and are universally assoc with EBV. They are high grade tumors with a poor prognosis. Most commonly assoc with AIDS. The most common subtype if the diffuse large B cell lymphoma. These cells are usually positive for CD20 and CD79a.

lacunar infarcts in the brain: primary cause and what they are

primary cause: lipohyalinosis and microatheromas; they happen bc of hypertension or diabetes and cause liquefactive necrosis in the brain; they are ischemic infarcts involving deep brain structures (basal ganglia, pons) and subcortical white matter (internal capsule, corona radiata). can also be due to hypertensive arteriolar sclerosis (hardening of the vessel wall), which predisposes to thrombotic vessel occlusion.

second most common cause of ring enhancing lesions on MRI of brain

primary central nervous system lymphoma (PCNSL). It's a diffuse, large-cell non-hodgkin lymphoma of B cell origin. Has positive EBV in CSF. T cells (downey cells) are not usually in the brain unless its in AIDS associated T cell lymphoma where they get EBV, not this condition.

x linked (bruton) agammaglobuinemia; due to the absence of B cells _ and _ will not form within lymph nodes

primary lymphoid follicles and germinal centers

pneumothorax

primary spontaneous pneumothorax occurs in patients without preexisting pulmonary disease when a large change in the alveolar or intrapleural pressure results in a break in the visceral (i.e. ruptured superficial bleb) pleura and air trapping between the pleural spaces.

CI's for OCP

prior stroke, hx of estrogen dependent tumor, female 35 or older who smokes, hyper TG's, liver disease, pregnancy

effective reporting system

privacy of whistleblowers; resports from broad range of personnel; reports shared in timely fashion; structure for reviewing and taking action

type 1 error (alpha error)

prob of saying there is a difference between groups when there isnt one

type 2 error (beta error)

prob of saying there is no difference between groups when there is one

IgA protease

produced by neisseria meningitidis, gonorrhea, strep pneumo and H influenza. It cleaves IgA. IgA would normally prevent pili of bacteria and other surface antigens from binding/ adhering to the mucosa (i.e. prevents their penetration of the gut mucosa).

h pylori testing

produces the enzyme urease, which splits urea into CO2 and ammonia and neutralizes the acidic gastric pH. If there is alkalinization bc of the ammonia formation, this is confirmatory.

mifepristone

progesterone antagonist (works for abortion bc progesterone is necessary for implantation and maintenance of pregnancy - used with misoprostol to terminate first trimester pregnancies), and glucocorticoid antagonist

kid whose parents are getting a divorce thinks that they are mad at him when they are really not. This is...

projection (because he is projecting his feelings on to the parents (i.e. he's mad at them).

iatrogenic cushing syndrome

prolonged administration of glucocorticoids. Can lead to osteonecrosis. Both cushings and SLE can increase risk for atherosclerosis and acute coronary events.

why give tetanus vaccine with HiB vaccine?

promotes t cell dependent immune response

inactivation of anti-oncogenes eliminates

proofreading/ oversight of the cell cycle

prostacyclin, thromboxane/ endothelin, and nitric oxide: what do they do to the lung vasculature

prostacyclin: vasodilation; thromboxane/ endothelin: vasoconstriction; nitric oxide: vasodilation

misoprostol

prostaglandin E1 agonist

loop diuretics like furosemide will cause

prostaglandin release (which increases renal blood flow leading to increased GFR and enhanced drug delivery.

which area/type of cancer is the one that most often metastasizes to bone

prostate

antidote for unfractionated heparin

protamine

drug used for heparin reversal

protamine

warfarin induced skin necrosis is from what

protein C activity

transthyretin (TTR) deposition

protein made in the liver, carries thyroxine and retinol, if mutated causes amyloid protein that deposits in the myocardium causing infitrative cardiomyopathy (a restrictive cardiomyopathy that is a form of HFpEF (heart failure with preserved ejection fraction))

which two bugs cause staghorn calculi

proteus and klebsiella (bc theyre both urease positive so they convert urea to ammonia which alkalizes the urine and precipitates magnesium ammonium phosphate crystals aka staghorn calculi).

RET

proto-oncogene. Medullary thyroid cancer, pheochromocytoma

haldane and bohr effects: RBCs will unload what in the presence of increased oxygen?

protons and CO2

KRAS

protooncogene

myotonic dystrophy

proximal muscle weakness and delayed muscle relaxation

if pt takes longer to come out of succinylcholine anethesia it is caused by what

pseudocholinesterase deficiency

ecthyma gangrenosum

pseudomonas aeruginosa (black spots on body/ skin patches with necrotic centers and ulcerations)

malignant otitis externa

pseudomonas is the most common cause of MOE, which is a serious infeciton fo the ear in elderly diabetic patients. MOE presents with exquisite ear pain and drainage, and granulation tissue is often seen within the ear canal.

mucinous cystadenocarcinoma

pseudomyxoma peritonei, mucin-producing epithelial cells

main muscle used for getting up from a seated position

psoas major (hip flexors)

hyperkeratosis, parakeratosis, epidermal hyperplasia, and dilated capillaries in the dermal papillae

psoriasis

psychogenic polydipsia vs DI

psychogenic polydipsia: vasopressin doesn't change the urine osmo & serum sodium is low; central DI: large increase in urine osmo w vasopressin admin; nephrogenic DI: mild increase in urine osmo w vasopressin admin

schizophreniform

psychotic sx >1 month but less than 6 months (schizophrenia)

drug induced lupus (isonaizid)

pts who are slow acetylators are predisposed to drug induced lupus bc INH (and procainamide, and hydralazine) are metabilized via phase 2 acetylation in the liver, so therefore they have increased drug concentrations and get DILE.

tx for PCOS (polycystic ovary syndrome)

pts who desire fertility can be tx with clomiphene (estrogen receptor modulator that decreases negative feedback inhibition on the hypothalamus by circulating estrogen, thereby increasing gonadotropin production).

alcoholic with lung abscesses and fever

pts with alcoholism are at increased risk for lung abscess due to the aspiration of oral flora during periods of unconscousness. Usually bacterioides fragilis and tx is clindamycin

gilbert syndrome

pts with no apparent liver disease who have mild unconjugated hyperbiirubinemia that appears provoked by one of the classic triggers.

common complication of systemic sclerosis

pulmonary arterial hypertension, resutling from proliferation of T cells with release of cytokines (TGF beta) and consequent progressive thickening and occlusion of the small and medium sized pulmonary arteries/ arterioles. Patients typically have progressive dyspnea and a loud pulmonic component of S2 and may develop signs of right-sided heart failure (i.e. hepatomegaly, peripheral edema).

pts with rheumatoid arthritis get what kind of lung disease

pulmonary fibrosis from the RA itself and form the tx (methotrexate, cyclophosphamide and sulfasalazine)

congenital diaphragmatic hernia can lead to

pulmonary hypoplasia (oligohydramnios can also cause pulmonary hypoplasia)

atrial fibrillation: most common site of ectopic foci

pulmonary veins in the left atrium.

widening splitting of S2

pulmonic stenosis, pulmonary HTN

forceful postprandial nonbilious vomiting in the first 2 months of life

pyloric stenosis

thiamine is a cofactor for what

pyruvate dehydrogenase (pyruvate->acetyl CoA) & alpha ketoglutarate dehydrogenase complex (alpha ketoglutarate -> succinyl CoA)

if person is in metabolic acidosis from lactic acidosis, the enzyme that is faulty is prob

pyruvate dehydrogenase bc this shuttles it over to lactate dehydrogenase

drools and has painful throat spasms after camping; what's the entry receptor for this infection

rabies virus (rhabdovirus) enters thru muscle acetylcholine receptors

brachioradialis is innervated by and its action is...

radial nerve and flexion of the forearm at the elbow.

radiculopathy for back pain

radiates to leg; positive straight leg raise test

graves vs postpartum thyroiditis

radioiodine uptake is high in graves but not in postpartum. Like hashimoto's (chronic lymphocytic thyroiditis) the 3 stages are: hyperthyroid (releases bc they lyse the cells) then euthyroid then hypothryoid

third heart sound (S3)

rapid passive filling of ventricles in diastole (after S2)

non-hodgkin lymphoma

rapidly progressive mass, lymphadenopathy, splenomegaly, B sx (night sweats, weight loss). Dx: lymph node biopsy (large atypical B cells with high nuclear cytoplasmic ratio); EBV can be assoc with NHL bc its known to cause burkitt's lymphoma which is a type of NHL.

ehlers danlos syndrome

rare hereditary disorders that have defective collagen synthesis. Can be caused by procollagen peptidase deficiency, which results in impaired cleavage of terminal propeptides in the extracellular space (N terminal propeptide removal). Patients often have joint laxity, hyperextensible skin, and tissue fragility due to the formation of soluble collagen that does not properly crosslink.

glucose 6 phosphate dehydrogenase

rate limiting enzyme in the pentose phosphate pathway (glucose 6 phosphate to ribulose 5 phosphate), the mahor source of cellular NADPH. This molecule is necessary for reducing glutathione and for biosynthesis of cholesterol, fatty acids, and steroids.

ischemic stroke: 1-2 weeks

reactive gliosis & vascular proliferation around the necrotic area (liquefactive necrosis (1wk - 1 mo)

chronic neuronal injury

reactive gliosis (ALS, parkinsons) - progressive disease

downey cell

reactive, atypical T lymphocyte (EBV) that functions to destroy virally infected B lymphocytes

biggest risk factor for suicide besides previous attempt and access to guns

recent diagnosis of chronic illness

vertebral osteomyelitis

recent infection, intravenous drug abuse or immune compromise; fevers and night sweats

mast cells are activated via

receptor aggregation; the high affinity IgE receptor (FcERI) is found on the surface of mast cells and basophils and normally binds the Fc portion of circulating IgE antibodies. Cross-linking of multiple membrane bound IgE antibodies by a multivalent antigen results in aggregation of the FcERI receptors, causing degranulation and the release of preformed mediators (i.e. histamine, tryptase) that intiate an allergic response.

intermittent explosive disorder

recurrent episodes of explosive verbal or physical aggression. The aggressive behaviors are impulsive and grossly out of proportion to the provocation.

IgA nephropathy

recurrent hematuria that occurs spontaneously or within 5-7 days of an URI. Unlike PSGN, IgA has normal complement levels

hyperparathyroidism can cause

recurrent kidney stones, and they have hypercalcemia and hypophosphatemia.

cystic fibrosis

recurrent respiratory infections with pseudomonas aeuruginosa, diarrhea and failure to thrive, causes steatorrhea and FTT due to malabsorption secondary to pancreatic insufficiency, which can be corrected by pancreatic enzyme supplementation.

red pulp vs white pulp

red = red blood cells; white = white blood cells

ischemic stroke: 12 - 24 hours

red neurons (loss of nissl substance)

moa of niacin

reduced VLDL and hepatic triglyceride synthesis

dihydrorhodamine test (new test) vs nitroblue tetrazolium dye reduction test

reduced flourescence = chronic granulomatous disease or tetrazolium: negative

surfactant moa

reduces the surface tension by disrupting the hydrogen bonds between molecules of water, thereby preventing small alveoli from collapsing. It is made of mostly lecithin (phosphatidylcholine).

how does combined hormonal oral contraceptive work?

reduction of serum gonadotropin levels (i.e. suppresses GnRH and pituitary gonadotropin secretion inhibiting ovulation)

recombination

refers to the gene exchange that occurs through the crossing over of 2 double stranded DNA molecules. Reassortment describes the mixing of genome segments in segmented viruses that infect the same host cell.

lac operon

regulated by two distinct mech: negatively by binding of the repressor protein to the operator locus and positively by cAMP-CAP binding upstream from the promoter region. Constitutive expression of the structural genes of the lac operon occurs with mutations that impair the binding of the repressor protein (Lac I) to its regulatory sequence in the operator region.

releasing factor

releases ribosome when it hits a stop codon

spondyloarthropathy

relieved with exercise; HLA B27; young men, prolonged morning stiffness

osteoarthritis

relieved with rest

protein kinase A

responsible for the intracellular effects of the G protein mediated adenylate cyclase second messenger system. Hormone receptors that use this system include the TSH, glucagon, and PTH receptors.

familial retinoblastoma

result of mutations of each of the two Rb genes (two hits). These pts have an increased risk of secondary tumors, especially osteosarcomas, later in life.

diabetic gastroparesis

results from the destruction of enteric neurons due to chronic hyperglycemia, leading to impaired relaxation and disordered and ineffective peristalsis. This causes delayed gastric emptying, which presents as postprandial fullness, regurgitation of undigested food, nausea and vomiting.

shaken baby/ abuse

retinal hemorrhages; subdural hemorrage (tearing of bridging veins)

wet age-related macular degeneration

retinal neovascularization due to increased vascular endothelial growht factor (VEGF) levels. Patients typically have acute vision loss and metamorphopsia with funduscopy showing a grayish-green subretinal membrane and/or subretinal hemorrhage. Tx: moking cessation and VEGF inhibitor therapy (ranibizumab, bevacizumab).

RB

retinoblastoma, osteosarcoma, other cancers; tumor suppressor gene

tetanus path of infection

retrograde (wound, motor neurons, spinal cord interneurons

cannulation above the inguinal ligament into the femoral artery increases the risk of

retroperitoneal hemorrhage. They usually do it below the inguinal ligament to avoid this risk.

sadpucker mnemonic

retroperitoneal organs. Suprarenal (adrenal) glands, aorta, and IVC, duodenum (not 1st part), pancreas (body and head), ureters and bladder, colon (asc and desc), kidneys, esophagus, rectum (mid-distal)

hand wringing

rett syndrome (return to baby - always girls; X chromosome; ataxia and seizures)

what distinguishes cervical malignancy from low grade dysplasia (from HPV)?

reversibility of changes (low grade dysplasia in HPV often spontaneously regresses) (high grade dysplasia often goes to cancer)

asthma

reversible airway obstructon by mucous plugs, shortness of breath and wheezing. Sputum pf patients with asthma contains eosinophils, charcot leyden crystals and curschmann spirals.

squamous metaplasia is a

reversible, adaptive response to chronic irritation, such as smoking. The normal columnar epithelium is replaced by squamous epithelium, which is more resistant to irritation but has reduced mucociliary clearance. Metaplasia also occurs with Barrett esophagus, in which esophageal squamous epithelium is replaced by columnar epithelium in response to chronic acid exposure.

strongyloides stercoralis - findings in the stool

rhabditiform larvae in the stool

IgM anti-IgG autoantibodies

rheumatoid arthritis

implantable pacemakers can lead to

right heart failure via tricuspid valve regurgitation (bc the pacemaker goes thru the tricuspid valve)

high altitude sickness

right shift in the hemoglobin dissociation curve; hypoxemia leads to hyperventilation and respiratory alkalosis. This causes the sx (headache, fatigue, lightheadedness). The kidneys respond by creating a compensatory metabolic acidosis (decreased HCO3- reabsorption and H+ secretion) and by increasing erythropoietin secretion.

two syndromes that cause QT prolongation due to mutations in K channel

romano ward syndrome and jervell & lange-nielsen syndrome

anterior wall MI can lead to

rupture of the left ventricular free wall, which usually occurs within the first 5-14 days after an MI. Rupture leads to hemopericardium and cardiac tamponade, causing profound hypotension and shock with rapid progression to pulseless electrical activity and death.

most common fetal neoplasm

sacrococcygeal teratoma; and its the most common extragonadal germ cell tumor in infants and children. usually benign.

#1 cause of osteomyelitis in pts with sickle cell anemia

salmonella typhi (bones of fishhead and sickle in hand of seagull)

celiac sprue

same as celiac disease

biopsy of the bladder shows eggs, person is from sudan, has hematuria, what is it and what predisposed the pt to it?

schistosomiasis; contaminated water exposure (snails)

schizoid vs avoidant personality disorder

schizoid: social withdrawal, no close relationships, pts are viewed as reclusive, and emotionally cold. Avoidant: DESIRE companionship/ relationships, fear of rejection keeps them form socializing, feelings of inadequacy,

acoustic neuroma

schwann cell derived tumors that arise from the vestibular portion of the vestibulocochlear nerve and are located at the cerebellopontine angle (between the cerebellum and lateral pons). Patients usually present with unilateral sensorineural hearing loss and tinnitus.

koebner phenomenon

scratching spreads it (psoriasis)

colchicine

second line agent for treating acute gouty arthritis. It inhibits tubulin polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis and emigration to sites inflamed by tissue deposition of monosodium urate crystals. Gastrointestinal mucosal function is also impaired by microtubule disruption, leading to diarrhea and less commonly nausea, vomiting, and abdominal pain.

11 beta hydroxylase deficiency

second most common cause of congenital adrenal hyperplasia after 21 hydroxylase deficiency. Typically results in excessive adrenal androgen and mineralocorticoid (11 deoxycorticosterone) production. Genetically female infants are born with ambiguous genitalia and affected individuals develop HTN and hypokalemia early in life.

PBG deaminase deficiency

see with acute intermittent porphyria (classically presenting with abdominal pain and neuropsychiatric manifestations).

numbness and paresthesias

sensory disturbance. Can come from a partial (focal) seizure originating in the cortical region (i.e. the postcentral gyrus - primary somatosensory cortex)

kernicterus moa

serious neonatal illness and preterm status are assoc with marked reductions in bilirubin-binding capacity and affinity and an increased risk of kernicterus. Kernicterus is caused by increased unconjugated bilirubin crossing the blood-brain barrier. Albumin binds bilirubin in serum. Decreased levels of albumin prevent complexing and transport to the liver, increasing the risk of kernicterus. (i.e. increased enterohepatic circulation of bilirubin)

raphe nuclei

serotonin releasing neurons in the CNS are located here. This is where SSRI's and TCA's act.

how do you monitor kidney function when using amphotericin B

serum potassium and magnesium levels

liquefactive necrosis

severe bacterial infections (gangrene), CNS infarcts; mediated by digestion by hydrolytic enzymes, the infarcted CNS tissue is replaced by cystic astroglial scar.

lower extremity cyanosis

severe coarctation of the aorta

severe bacterial and viral infections in infancy; chronic diarrhea; mucocutaneous candidiasis

severe combined immunodeficiency (absent T cells and hypogammaglobulinemia. Thymic shadow is not there

rabies

severe encephalitis, hydrophobia; infects the synaptic motor endplate and goes retrograde; negative sense RNA; helical

pituitary apoplexy

severe headache, bitemporal hemianopsia (optic chiasm), ophthalmoplegia (CN III), hemodynamic instability and altered sensorium. Panhypopituitarism (acute and chronic), severe hypotension (central adrenal failure), coma and death.

herpetic gingivostomatitis

severe vesicular or ulcerative disease following primary infection with herpes simplex virus 1. involves gingiva, tongue, palate, and pharynx with sx: fever, malaise. Reactivation of a latent herpes infection in the trigeminal ganglia generally results in just mild perioral vesicles.

pleuritic chest pain

sharp, localized, often severe pain that is exacerbated by coughing, breathing or changing position. Results from inflammation of the pleura. The visceral pleura (covers the lungs) does not have pain fibers. Parietal pleura (forms the outer boundary of the pleural space - divided into costal pleura, mediastinal pleura, diaphragmatic pleura and cervical pleura).

esmolol is

short acting beta blocker (class II antiarrhythmic)

migratory thrombophlebitis

should raise suspicion for cancer. Hypercoag is common paraneoplastic syndrome seen in visceral adenocarcinomas of the pancreas, colon and lung. Bc the tumors make a thromboplastin like substance. Migratory superficial thrombophlebitis, known as trousseau syndrome, is assoc with cancer.

howell jolly bodies

sickle cell disease (nuclear remnants in RBCs as a result of splenic dysfunction)

common causes of avascular necrosis

sickle cell disease, glucocorticoid therapy, and alcoholism

in order for a protein to get into the ER or the nucleus, you have to put _ on the N terminus on the protein

signaling sequence (an amino acid sequence)

GLP1 agonists ADRs

significant weight loss, and pancreatitis; it functions to delay gastric emptying leading to a feeling of satiety longer.

silicosis

silica particles impair macrophage function and this increases risk of TB infection

frameshift mutation

single base deletion leading to alteration in the reading frame

silent mutation

single base substitution that doesn't change anything.

missense mutations

single base substitution that results in placement of an incorrect amino acid in a protein sequence.

Dengue fever

single stranded RNA viruses with 4 different seroptypes. Primary (first) infection can be asymptomatic or cause a self-limited disease in most adults. Secondary infection is due to infection with a different viral serotype and usually causes more severe illness.

appendicitis

singular event, with acute periumbilical or right lower quadrant pain and tenderness

during exercise, total systemic vascular resistance decreases because

skeletal muscles get up to 85% of cardiac output and their vasodilation decreases the total system vascula resistance (despite increased cardiac output and splanchnic vasoconstriction)

blowing/ harsh holosystolic murmur at left sternal border with no symptoms (at birth or around that time)

small VSD

giardia causes (gross)

small bowel inflammation and villous atrophy

lambert eaton is assoc with (cancer)

small cell carcinoma of the lung

chromogranin and synaptophysin stain

small cell carcinoma of the lung (assoc w lambert eaton)

small kidney (unilateral) and hypertension, hyperlipidemia, coronary artery disease,

small kidney is from oxygen and nutrient deprivation from renal artery stenosis

wallerian degeneration causes skeletal muscle atrophy which on histo appears as

small muscle fibers with decreased cross sectional area, which are angulated or triangular.

histoplasma capsulatum on histology

small ovoid bodies on histology.

5 alpha reductase deficiency

small phallus and hypospadias are common

legionella pneumophila

smokers, diarrhea, hyponatremia, doesn't show up on gram stain, tx: fluoroquinolones, macrolides

biggest risk factor of renal cell carcinoma

smoking

risk factor for urothelial cancer of the bladder

smoking

strongest risk factor for squamous cell carcinoma of the larynx aka laryngeal cancer in the vocal cords

smoking

risk factors for urothelial (transitional cell) bladder cancer

smoking, occupational exposure (rubber, plastics, aromatic amine-containing dyes, textiles or leather)

pathogenesis of centriacinar emphysema

smoking; neutrophils & macrophages release proteases (i.e. elastase, cathepsins, and matrix metalloproteinases). This leads to the irreversible airspace dilation distal to the terminal bronchioles.

if renal artery stenosis in one kidney, the other one will increase excretion of what?

sodium bc it senses the increased blood pressure

treatment for TCA overdose

sodium bicarb

when saline is applied to the nasal mucosa, the increase _ absorption in pts with _ causes a more negative nasal transepithelial potential difference, which can be used to diagnose _

sodium, cystic fibrosis

first phase in pacemaker action potential (funny channels)

sodium-mediated (phase 4 is first) then phase 0 which is calcium then phase 3 which is potassium

somatic symptom disorder vs illness anxiety disorder

somatic symptom = several physical complaints that persist for more than 6 mo, but medical work up is normal illness anxiety disorder = no symptoms but they are worried about GETTING an illness so they get tested all the time

non-small cell lung carcinoma

some pts have a chromosomal rearrangement that creates a fusion gene between EML 4 and ALK which results in constitutive active tyrosine kinase that causes malignancy.

conversion of glucose to what, causes diabetic blindness

sorbitol (builds up)

acanthocyte

spiked cell membrane (spur cell)

potassium sparing diuretics (k STAys)

spironolactone& eplerenone = aldosterone receptor inhibitors ; triamterine & amiloride = Na channel blockers at the collecting duct

what are the two areas of the GI that are especially susceptible to ischemia (i.e. watershed areas)

splenic flexure and the rectosigmoid junction (bc they lie between regions of perfusion of major arteries)

gastric varices (of the short gastric veins in the fundus of the stomach) can be caused by increased pressure in which vascular structure?

splenic vein

prion disease on histo

spongiform degeneration of the gray matter with vacuolization of neurons, gliosis, and cyst formation.

Sentral (squamous and small cell); the S's (i.e. both are) are paraneoplastic. Squamous is:.. and small is:...

squamous (PTHrp); small cell (SIADH and ACTH)

actinic keratoses can develop into

squamous cell carcinoma; you're more likely to have just one squamous cell carcinoma

HER1:

squamous cell lung cancer; protooncogene

Myocardial hibernation

state of chronic myocardial ischemia in which myocardial metabolism and function are reduced to match a concomitant reduction in coronary blood flow due to stenosis. Hibernating myocardium refers to the presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization.

most effective lipid lowering drug for prevention of cardiovascular events

statins

sustained tonic clonic seizures...what is this and whats the treatment

status epilepticus and benzodiazpines

s4 heart sound

stiff ventricle walls - hypertrophy of the ventricles, abnormal filling causes turbulent flow which makes the s4 sound (before s1)

transforming growth factor beta

stimulates connective tissue synthesis and remodeling of the ECM. If overexpressed you get too much collagenous scar tissue (keloid)

APC/ Beta catenin

stomach cancer, colon cancer, pancreatic cancer, familial adenomatous polyposis (FAP); tumor suppressor gene

lamellar bodies of type II pneumocytes

store and release pulmonary surfactant into the fluid layer lining the inner surfaces of alveoli. Deficiency in these will cause alveolar atelectasis, as seen in neonatal respiratory distress syndrome.

urine in the scrotum from trauma

straddle injury causing injury to the bulbous urethra. sx: inability to void, blood in the urethral meatus, and scrotal swelling. confirmation with retrograde urethrogram.

which bacteria has an increased zone of hemolysis when plated with staph aureas

strep agalactiae

urinary incontinence in normal pressure hydrocephalus is caused by

stretching of descending cortical fibers (in the paraventricular arrea). This leads to loss of cortical inhibition on the sacral micturition center causing urge incontenence

which area do you sample to diag hirschprung disease

submucosal (meissner) and myenteric (auerbach) autonomic plexi are absent in the affected segment of the bowel in hirschsprung disease (the narrow part). The submucosa of the narrow part is the most superficial layer that has the absence of ganglion cells.

damage to what neural structure can cause hemiballismus

subthalamic nucleus

nephrotic syndrome is a hypercoagulable state.

suddent onset abdominal or flank pain, hematuria and left-sided varicoceles suggest renal vein thrombosis, a well-known complication of nephrotic syndrome. Loss of anticoagulant factors, especially antithrombin III, is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome.

if somebody has low glucose like they took too much exogenous insulin BUT their C peptide levels are normal...think __

sulfonylurea use!! (it promotes release of endogenous insulin)

average is calculated:

sum of the values (i.e. total number of UTI's) divided by the total number of values (i.e. number of people in the study)

which lymphnodes get drainage from the cutaneous areas below the umbilicus (and the external genitalia and the anus below the dentate line)

superficial inguinal nodes (exceptions: glans penis (para-aortic nodes) and posterior calf (popliteal nodes)

malrotation of the gut - bilious emesis - which artery gets pinched by the ligament of treitz

superior mesenteric artery

sphenoethmoid recess is

superior to the superior concha

superoxide dismutase vs NADPH oxidase

superoxide dismutase: neutralizes reactive oxygen species preventing cell injury. During post ischemic reperfusion, oxidative stress is high and ROS production exceeds the neutralizing capability of antioxidants, leading to cell death. ; NAPDH oxidase: catalyzes the reduction of molecular oxygen to superoxide free radicals, aiding in bacterial destruction by phagocytic cells. deficiency leads to chronic granulomatous disease in whcih those affected are unable to destroy catalase postiive organisms. ; AND just NADPH is involved in G6PD deficiency (without G6PD you cant make NADPH to help protect against oxidation

V/Q mismatch in COPD

supplementl oxygen admin in patients with COPD can lead to increased CO2 retention (oxygen induced hypercapnia), resulting in confusion and depressed consciousness. The major cause is reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli.

TNF alpha

suppresses appetite and increases basal metabolic rate which leads to cachexia.

mechanism of omeprazole

suppresses the H/K ATPase primary active transporterwhich leads to an increase in the pH of the gastric lumen

which hypothalamix nucleus controls circadian rhythm

suprachiasmatic nucleus

craniopharyngiomas are

suprasellar cystic masses (from rathke's pouch); found in children and composed of calcified cysts containing cholesterol crystals. Rathke's pouch is an embryonic precursor of the anterior pituitary

HIV associated dementia

suspected in patients with AIDS who have progressive cognitive decline. Histo: microglial nodules (groups of activated microglia/ macrophages around small areas of necrosis) and multinucleated giant cells.

warm reactive autoimmune hemolytic anemia (AIHA)

sx: anemia, hemolysis (jaundice), increased reticulocyte count and positive warm agglutinin test. A peripheral blood smear may demonstrate spherocytes. Corticosteroids are first line initial treatment.

thoracic aortic aneurysm

sx: chest or back pain, can compress structures and cause dysphagia, hoarseness, cough or dyspnea.

galactose 1 phosphate transferase deficiency (classic galactosemia/ severe galactosemia) (second enzyme)

sx: jaundice, vomiting, e coli sepsis, cataract, hemolytic anemia; cessation of breast feeding and switching to soy milk based formula is recommended.

to avoid bleeding during oophorectomy, clamp what?

the suspensory ligament of the ovary (houses the ovarian blood vessels)

muscle phosphorylase kinase

synchronization of glycogen degradation with skeletal mscle contraction occurs due to release of sarcoplasmic calcium following neuromuscular stimulation. Increased intracellular calcium causes activation of phosphorylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis.

theca interna does what

synthesis of androgens

methionine is a precursor for

synthesis of cysteine, carnitine, taurine and lecithin.

glucocorticoids are catabolic, but theu also cause increased hepatic

synthesis of gluconeogenic and glucogenic proteins to increase glucose availability. They also peripherally antagonize insulin, which causes the hyperglycemia.

desmopressin

synthetic analog of vasopressin (ADH). It increases vWF release from endothelial cells, which is tx for ppl with von willebrand disease.

cardiolipin

syphilis, lupus, anti-phospholipid syndrome

diminished pinprick and temp sensation across the upper back, shoulders and arms is what condition and is assoc with a lesion where

syringomyelia; lesion is at ventral white commissure. Leads to bilateral loss of pain and temp sensation that is limited to the affected levels (arms and hands). Destruction of the motor neurons in the ventral horns (due to extension of the syrinx) causes flaccid paralysis and atrophy of the intrinsic muscles of the hand.

tx for dermatomyositis

systemic glucocorticoids

CD3

t lymphocyte marker

the two immediate sx of marijuana intoxication

tachycardia and conjunctival injection

calculating incidence

take the previous "cases" of disease OUT of the total popilation when calculating the incidence

mallory weiss tear

tear in the gastric mucosa near the gastroesophageal junction. It typically results from repetitive forceful vomiting, which can also cause metabolic alkalosis.

patient has second thoughts about participating in a research study what do you tell them

tell them they can change their mind about participating

minute ventilation

tidal volume x respiratory rate

microbial infection of keratinized structures in a flower petal shape

tinea corporis

blood gas partition coefficient

term used to tell you the solubility of a gas in blood. If its high, the gas is highly soluble in blood (and therefore has a slower onset of action). And vice versa. If something has a high coefficient, it will have a slow rise in the partial pressure of anesthetic in arterial blood. this is because its DISSOLVED in the blood and DOESNT contribute to the partial pressure of anesthetic in the arterial blood (think coke can CO2 thats dissolved in coke before opening can)

romberg test

test of proprioception used to distinguish sensory (dorsal column/ peripheral nerves) from cerebellar ataxia. When eyes are open = cerebellar. When eyes are closed = sensory ataxia/ problem with posterior column or peripheral nerves (could be caused by tabes dorsalis/ syphilis or vitamin B12).

frontal lobe is tested by

testing abstraction (asking about the similarities between two related objects)

candida skin test

testing for anergy; T cell mediated. Type 4 hypersens reaction; evident 24-48 hours after exposure.

tx for h pyrlori

tetracyclines and metronidazole

pharyngeal arch: speech muscles

the 6th pharyngeal arch gives rise to the intrinsic muscles of the larynx responsible for speech except the cricothyroid, which is derived from the 4th pharyngeal arch.

mTOR pathway

the PI3K/Akt/mTOR pathway is an intracellular signaling pathway important for anti-apoptosis, cellular proliferation and angiogenesis. Mutations in growth factor receptors, Akt, mTOR or PTEN that enhance the activity of this pathway contribute to cancer pathogenesis.

HIV and CCR5

the T cell chemokine receptor, CCR5 is a coreceptor that enables the HIV virus to enter cells. Blockade of CCR5 by chemokine receptor antagonists prevents viral entry into host cells.

arteriovenous concetration gradient for anesthetics

the arteriovenous concetration gradient is the difference between the concentration of a gas anesthetic in arterial and venous blood. The solubility of the anesthetic in the peripheral tissues is a major factor in determining the size of the arteriovenous gradient. If tissue solubility is high, a large amount of anesthetic is taken up from arterial blood, which results in low venous concetration. As a restul, saturation of the blood requires further absorption of anesthetic in order to replace that which is absorbed by the peripheral tissues. because blood saturation takes longer, brain saturation is also delayed and onset of action is slower.

the deltoid is innervated by

the axillary nerve

as blood moves from the lungs to the left atrium, there is a slight drop in PO2 because

the blood supplying the bronchi is mixed in with the oxygenated blood at that point

the most important expected physiologic response to combat hypovolemia in a patient's body

the body must retain sodium so it uses renin from the juxtaglomerular cells, i.e. the RAAS mechanism. Juxtaglomerular cells are located in the wall of the afferent arteriole.

what is the most deoxygenated blood in the body?

the cardiac venous blood in the coronary sinus, before it reaches the right atrium

axonal reaction

the changes in the body of a neuron after the axon has been severed are called axonal reaction. This process reflects an increased protein synthesis that facilitates axon repair. Enlarged, rounded cells with peripherally located nuclei and dispersed finely granular Nissl substance are seen.

syringomyelia

the combination of fixed segmental loss of upper extremity pain and temperature sensations, upper extremity lower motor neurons signs, and/or lower extremity upper motor neuron signs in the setting of scoliosis suggests syringomyelia. Lower extrimty stuff: loss of position and vibration senses in the feet due to involvement of the posterior columns. scoliosis can occur due to paresis of paravertebral muscles.

common cardinal veins

the common cardinal veins of the developing embryo drain directly into the sinus venosus. These cardinal veins ultimately give rise to the superior vena cava and other constituents of the systemic venous circulation.

proximal tubule concentrations of solutes

the concentrations of PAH, creatinine, inulin and urea increase as fluid runs along the proximal tubule, while the concentrations of bicarbonate, glucose and amino acids decrease (bc they get absorbed into plasma)

ventral pancreatic primordium

the dorsal pancreatic bud forms the majority of pancreatic tissue (body, tail and most of the head). The ventral pancreatic bud is a precursor of the uncinate process, inferior/ posterior portion of the head, and major pancreatic duct (of Wirsung). Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. In this condition, the pancreatic ductal systems remain separate, with the accessory duct draining the majority of the pancreas.

CT of esophagus

the esophagus is located between the trachea and the vertebral bodies in the superior thorax. It is typically collapsed with no visible lymen on CT images of the chest.

left pyriform recess surgery, which nerve is at risk/ what might this affect

the internal laryngeal nerve mediates the afferent limb of the cough reflex above the vocal cords. Foreign bodies (i.e. chicken or fish bones) can become lodged in the piriform recess and may cause damage to the nerve, impairing the cough reflex.

microfilaments and integrin

the intracellulaar domains of integrins interact with microfilaments (actin) and intermediate filaments (keratin) but the extracellular domains of integrins do not.

IGF-1 is made where

the liver

place on the immunoglobulin that complement attaches

the middle

poststreptococcal glomerulonephritis

the most common cause of nephritic syndrome in children, occuring 2-4 weeks after a streptococcal infection (i.e. impetigo, cellulitis, pharyngitis). It is caused by a type 3 (immune complex mediated) hypersensitivity reaction from nephritogenic strains of group A beta hemolytic strep.

von willebrand disease

the most common inherited coagulation disorder. Decreased vWF impairs platelet adhesion bc vWF is necessary to stabilize factor III in the coagulation cascade.

osteosarcoma

the most common primary bone tumor in children and young adults and typically arises near the metaphyses of long bones. Patients usually have slowly worsening pain and soft tissue swelling. X ray typically reveals a lytic bone lesions and biopsy classically shows pleomorphic, spindle shaped tumor cells that generate osteoid and thin trabeculae of neoplastic bone.

aortic stenosis - murmur intensity

the murmur of AS is a systolic ejection-type, crescendo-decrescendo murmur that starts after the first heart sound and ends before the A2 component of the second heart sound. The intensity of the murmur is proportional to the magnitude of the left ventricle to aorta pressure gradient during systole.

hepatopancreatic ampulla connects

the pancreas to the duodenum (ampulla of vater)

lipofuscin

the product of lipid peroxidation, accumulating in aging cells (especially in patients with malnutrition and cachexia)

anaphylaxis

the result of widespread mast cell and basophil degranulation and the relase of preformed inflammatory mediators, inclduing histamine and tryptase. Tryptase is relatively specific to mast cells and can be used as a marker for mast cell activation.

coronary sinus communicates freely with

the right atrium; therefore increased pressures in the right heart will affect the coronary sinus as well (i.e. pulmonary hypertension)

elastin fibers in the lung allow it to stretch. What contributes to this property of elastin?

the rubber-like properties of elastin are due to high content of nonpolar (hydrophobic) amino acids and extensive cross-linking between elastin monomers facilitated by lysyl oxidase. Patients with alpha-1 antitrypsin deficiency can develop early-onset, lower lobe-predominant emphysema due to excessive alveolar elastin degradation.

subarachnoid villi =

the same thing as the arachnoid granulations

lymphoblastic and lymphocytic

the same thing. lymphoblastic might be earlier form.

fatty streaks can occur as early as

the second decade of life (lipid laden macrophages - foam cells - in the intima that progress to plaques)_

adenomatous polyps

the size of adenomatous polyps determines their malignant potential. Adenomas <1cm are unlikely to undergo malignant transformation, whereas those >4cm are very likely to progress to adenocarcinoma. KRAS protooncogene mutation facilitates the growth of adenomas by causing uncontrolled cell proliferation.

korotkoff sounds

the sounds you hear when taking blood pressure (when its deflated), normal sounds

which artery do you ligate in thyroid surgery

the superior thyroid artery coming off the external carotid artery

why do ppl with crohns get gallstones easier

the terminal ileum is most commonly affected in crohns and so they don't reabsorb bile acids which means that there is less bile acids in the gallbladder to mix with the cholesterol and therefore the ratio of cholesterol to bile acids increases causing gallstones.

cachexia and ubiquitin

the ubiquitin-proteasome pathway mediates targeted protein degradation, which allows for rapid disposal of unneeded intracellular proteins. In cancer-related cachexia, high levels of pro-inflammatory cytokines lead to increased ubiquitination of sarcomeric muscle proteins, which in turn leads to extensive skeletal muscle loss.

ecological study

the unit of analysis in ecological studies is populations rather than individuals.

metanephric mesoderm vs ureteric bud

the ureteric bud gives rise to: collecting system of kidney including the collecting tubules, and ducts, major and minor calyces, renal pelvis, and the ureters. The metanephric mesoderm (blastema) gives rise to the glomeruli, bowman's space, proximal tubules, the loop of henle and distal convoluted tubules.

theophylline intoxication

theophylline is a methyl xanthine and its related to caffeine. Intoxication = seizures and tachyarrhythmias. Tx for seizures: beta blockers, benzos and barbiturates.

ring enhacing lesions on MRI of HIV pt =

toxoplasmosis

nail bed cells (dermal glomus bodies) do what?

thermoregulatory functions (modified smooth muscle cells)(shunts away blood from the skin surface in cold temps)

high altitude alkalosis: kidneys bicarb

they excrete bicarb to normalize pH

body dysmorphic disorder

they have a preoccupation with perceived defects in physical appearance.

cretinism

they have elevated levels of thryoid stimulating hormone bc mom has thyroid disease and her IgG antibodies attack the fetus's thyroid OR mom thyroid hormone replacement can block endogenous getal thryoid hormone synthesis.

anorexics get stress fractures bc

they have hypogonadal state which leads to estrogen deficiency which causes osteoporosis.

what do the pancreatic islets look like in type 2 diabetes

they have pancreatic islet amyloid deposition

schizoaffective disorder

they have sx of both schizophrenia and a mood disorder (mania, and/or depression). definition: periods of schizophrenia sx WITHOUT mood disorders for >2 weeks, followed by periods of schizophrenia sx WITH mood disorder sx (mania, depression) tx: mood stabilizers and antipsychotic medications

pt has a mutation in the KIT receptor tyrosine kinase (i.e. they have large clusters of mast cells that are positive for KIT (CD 117)) and hypotension, flushing, pruritis (diffuse itching after hot showers), what do they have and what does it cause

they have systemic mastocytosis and it causes gastric hypersecretion of gastric acid by parietal cells bc of the histamine release from the increased mast cells

HPV: viral proteins E6 and E7

they inhibit the cell cycle regulatory proteins p53 and Rb respectively. Allows unchecked proliferation.

how do SGLT2 inhibitors cause hypotension/ decrease blood pressure

they inhibit the reabsorption of glucose at the proximal convoluted tubule, which leads to urinary glucose loss and an osmotic diuresis which lowers blood pressure. Excess urinary glucose also leads to increased risk for genitourinary tract infections via candida.

GLAM VIP

theyre fabulous so they like to stay inside (hydrophobic) Glycine, Leucine, alanine, methionine, valine, isoleucine, proline

give hydrochlorothiazide to diabetes insipidus bc

theyre peeing out lots of water (hyponatremic urine) and they keep drinking water, so theyre body is hypernatremic and you want to increase the electrolytes they pee out so they can be isonatremic so you give them HCTZ so that they pee out electrolytes (not furosemide bc HCTZ spares calcium)

wernicke's: glucose thiamine infusion, when?

thiamine first then glucose.

what is the thing that obstructs blood flow in an HCM pt

thickened interventricular septum and the mitral valve leaflet (anterior leaflet)

effacement

thinning

agar that contains vancomycin, colistin, nystatin, and trimethoprim

this is a thayer martin agar meant to exclude everything else and grow Neisseria species.

adverse effect of roux en Y gastric bypass:

this procedure ligates the jejunum to a small piece seperated from the stomach. Which makes a pouch attached to the duodenum and the duodenum attaches lower on the jejunum now. It allows for small intestinal bacterial overgrowth which overproduces vitamin K and folate causing nausea and discomfort.

why don't direct Xa inhibitors affect thrombin time?

thrombin time: they put in thrombin in a tube with blood and the other stuff and see if it prolongs bleeding time. But since direct Xa inhibitors affect the conversion of prothrombin to thrombin, and there is already thrombin in there, it doesn't prolong thrombin time but it prolongs PT and PTT time

virchow's triad

thrombosis risk is markedly increased during pregnancy and puerperium due to virchow's triad: stasis, increase in factors VII, VIII and X and vWF and fibrinogen, and endothelial damage due to infection or trauma.

microangiopathic hemolytic anemia (MAHA), thrombocytopenia, neurologic and renal abnormalities, and fever. This is the classic pentad of

thrombotic thrombocytopenic purpura. these pts have large multimers of von willbrand factor bc there is a deficiency of the metalloprotease that breaks down ultralarge vWF multimers. This metalloprotease is ADAMTS13

RNA contains uracil; DNA contains

thymidine

3rd pharygneal pouch

thymus and inferior parathyroid glands arise from this.

tyrosine is a precursor for

thyroxine, dopamine, epinephrine, norepinephrine and melanin

urticaria

transient hypersensitivity disorder characterized by pruritic erythematous plaques that arise suddenly and resolve over hours. They are most often caused by IgE mediated degraulation of mast cells, leading to increased permability of the microvascultature with edema of the superficial dermis. causes dermal edema.

which enzyme converts fructose 6 phosphate to ribose 5 phosphate

transketolase

synaptophysin

transmembrane glycoprotein found in the presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells.

left circumflex artery occlusion

transmural ischemia of lateral wall of the left ventricle, with ST elevations mainly in V5 and V6 and possibly also in I and aVL.

Congenital toxoplasmosis

transplacental infection (acquired in utero). Its classic triad includes hydrocephalus, intracranial calcifications and chorioretinitis (white yellow chorioretinal lesions). Expecting mothers should avoid cat feces to help prevent exposure to toxoplasma.

mast cells activated by

trauma IgE, or C3a C5a (anaphylatoxin)

tertiary prevention

treating an established condition with the goal of minimizing its progression or complications

adenosine side effect

treats paroxysmal supraventricular tachycardia. ADR: flushing, chest burning, hypotension and high grade AV block

Mccune-Albright syndrome

triad of fibrous dysplasia of the bone, endocrine abnormalities, and café au lait spots. The condition results from an activating mutation in the G protein/CAMP/adenylate cyclase signaling pathway.

dormant virus

trigeminal ganglion: HSV 1; varicella zoster: dorsal root ganglia; HSV 2: sacral ganglia; EBV: B cells; HIV: T cells

decompensated heart failure

triggers neuroendocrine mechs like RAAS and sympathetics to vasoconstrict and volume retention which puts more stress on the heart.

microcephaly, microphthalmia, polydactyly, hypotonia, and heart defects are

trisomy 13 (patau syndrome)

M protein (virulence factor for strep pyogenes) shares structural homology with

tropomyosin and myosin. Its function is to inhibit phagocytosis. This is why we get rheumatic carditis.

skeltal muscle: calcium binds

troponin to pull tropomyosin away from the binding sites so actin can bind to myosin.

T/F: secretin paradoxically stimulates gastrin release from gastrinomas due to abnormal adenylate cyclase activation. (it will inhibit gastric release from normal gastric G cells)

true

meckels diverticulum

true diverticulum (all 3 layers), 2 feet prox to the ileocecal valve; results from failure of omphalomesenteric (vitelline) duct to obliterate at 7th week of devel

serotonin is made from

tryptophan

Mycobacterium leprae: tuberculoid vs lepromatous leprosy clinical presentations

tuberculoid is Th1 response (positive PPD) vs lepromatous is Th2 response (negative PPD)

seizures, intellectual disability, facial angiofibromas and cardiac rhabdomyomas (autosomal dominant), ash leaf spots, shagreen patches

tuberous sclerosis

CA19-9 & CEA

tumor markers assoc with pancreatic adenocarcinoma (used for eval of response to therapy and monitoring recurrnece but no diagnosis)

e-cadherin in tumors

tumors down-regulate e-cadherin which is the thing that enables cells to stick together, this means the tumor can invade the basement membrane and the tumor cells don't stick together so they can disseminate and metastasize

pancoast tumor

tumors located in the lung apex (superior sulcus). Invasion of surrounding structures can lead to ipsilateral Horner syndrome, rib destruction, atrophy of hand muscles and pain in the distribution of C8, T1, and T2 nerve roots.

moa of terbinafine

tx for dermatophytosis. It inhibtis synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase

asthma is which hypersen reaciton

type 1 hypersensitivity reaction

acute hemolytic transfusion reaction

type 2 hypers reaction, antibody against surface antigens activates MAC complex C5-9

serum sickness

type 3 hypersensitivity rxn to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes. Cinical findings include fever, pruritic skin rash, arthralgias and low serum C3 and C4 complement levels.

erythema nodosum and the PPD test are which type of hypersensitivity reaction

type IV HSR

if the baby or anyone needs blood, give

type O, Rh negative

absence seizures

type of generalized epilepsy. "brief staring spells with momentary loss of awareness followed by an abrupt return to fill conscousness". EEG: 3 Hz spike wave. Tx: ethosuxamide

influenza epidemics

typically caused by reassortment of the RNA segments coding for hemagglutinin or neuraminidase proteins (major antigenic shifts). This process can occur between human and animal strains of influenza A virus in avian or swine hosts.

insulin receptor is

tyrosine kinase

flexor digitorum profundus split innervation

ulnar half of this muscle flexes the DIPs of the 4th and 5th digits (C8) and median nerve does the others

wrist adduction is which nerve

ulnar nerve

lactate dehydrogenase deficiency

under anaerobic conditions, NADH transfers electrons to pyruvate to form lactate and regenerate NAD+. NAD+ is required to convert glyceraldehyde 3 phosphate to 1-3-bisphosphoglycerate in glycolysis.

Campylobacter jejuni: you can get this from

undercooked poultry and fecal-oral route from domestic animals (dogs)

campylobacter

undercooked poultry, and contact with domesticated animals (dogs). Bloody diarrhea

anaplastic tumors

undifferentiated; bear no resemblance to their tissue of origin. Composed of pleomorphic cells with large, hyperchromatic nuclei that grow in a disorganized fashion. Anaplastic tumors may also contain numerous, abnormal mitoses and giant tumor cells.

the _ feature of the genetic code describes a common language for almost all organisms to translate nucleotide sequences of NDA and RNA into amino acid sequences of proteins.

universal

yersinia

unpasteurized milk (dirty milk bottle), cold temperatures (ice on outside window)

viable sperm after vasectomry

up to 3 months at least 20 ejaculations

fixed, dilated pupils: which part of CNS is affected

upper midbrain contains neural structures (i.e. optic nerve, pretectal nuclei, edinger-westphal nuclei, oculomotor nerve) that mediate the direct and consensual pupillary light reflex.

enhancer and silencer sequences of genes can be located

upstream, downstream or within introns of the gene

gross painless hematuria in an older adult =

urinary tract cancer (urothelial or renal cell carcinoma) until proven otherwise.

renal stones

urine supersaturation is the main mechanism underlying all types of renal stones. Low fluid intake increases the concentration of stone-forming agents, thereby promoting stone formation. All patients with nephrolithiasis should be advised to maintain adequate fluid intake (i.e. drink plenty of water daily).

porphyria cutanea tarda hinders what enzyme in the synthesis of heme?

uroporphyrinogen decarboxylase

pt with low literacy, what do you do

use alternate learning methods like visual aids/ resources to educate the patients

splenorenal shunt

used for esophageal varices ( to decrease the pressure at them)

PTT

used for monitoring unfractionated heparin

two sample t test

used to compare the means of 2 groups of subjects

99mTc pertechnetate (technetium) scintigraphic scanning

used to confirm a meckel diverticulum. the arterial supply for mechel diverticulum comes from the SMA (superior mesenteric artery) as it supplies the midgut and meckels is failure of the developing midgut (obliteration of the vitelline duct).

APACHE II scoring system

used to predict the mortality of patients admitted to the ICU. One common indication for admission to the ICU is acute pancreatitis; however, it (APCHE) does not differentiate between sterile and infected necrosis.

ELISA

used to quantify antibodies or antigens in a fluid.

acromegaly

usually due to a pituitary somatotroph adenoma. MSK manifestations: bony hypertrophy (frontal bossing), and osteoarthritis. Left ventricular hypertrophy is often common in acromegaly and may progress to heart failure.

spindle shaped smooth muscle cells with varying degrees of atypia. increased mitotic rate and areas of necrosis. if pt has abnormal vaginal bleeding, its

uterine leiomyosarcoma

von willebrand factor deficiency

vWF binds to GP 1b receptors; labs: normal platelet count and an abnormal ristocetin cofactor assay. When there isnt VWF, there is poor platelet agglutination in the presence of ristocetin.

predisposing factor for infective endocarditis

valvular abnormalities (rheumatic heart disease, mitral valve prolapse, prosthetic valves, congenital heart disease) and conditions that promote bacteremia/ fungemia (IV drug use, dental procedures).

gardner syndrome

variant of FAP. has occurrance of colorectal polyposis, osteomas, bone and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium and dental abnormalities.

cowdry type A inclusion bodies

varicella zoster, CMV, HSV

kawasaki disease

vasculitis of medium sized arteries that presents with persistant fever for 5 days or more, bilateral conjunctivitis, cervical lymphadenopathy, and mucocutanous involvement. Coronary artery aneursyms are a serious complication. Asian ethnicity. strawberry tongue (mucositis/ fissured lips)

neurophysins

vasopressin and oxytocin both secreted from the posterior pituitary. (paraventricluar and supraoptic nuclei). Neurophysins are invlved in the postranslational processing and stabilization of oxytocin and vasopressin within neurosecretory vesicles.

most common complication of aneurysmal subarachnoud hemorrhage is

vasospasm which occurs 3-12 days after the initial insult and can cause delayed cerebral ischemia (i.e. sudden change in mental stutus, new focal neuro deficits). The CT scan remains unchanged (unlike with rebleeding)

what is the initiating step in the pathogenesis of rheumatic heart disease

vegetations are caused by bacterial colonization and growth on a sterile fibrin-platelet nidus that forms on the damaged/ disrupted endothelial surface of the valvular apparatus.

BNP is secreted from the

ventricular myocardium

harsh, blowing holosystolic murmur best heard at the left sternal border and is the most common congenital cardiac anomaly

ventricular septal defect

tetralogy of fallot

ventricular septal defect, overriding aorta, right ventricular outlfow tract obstruction and right ventricular hypertrophy.

holosystolic murmur over the lower left sternal border

ventricular septal defect.

ventral posterior lateral nucleus of thalamus (VPPPL mnemonic)

vibration, pain, pressure, proprioception, and light touch. (i.e. PCML and spinothalamic tracts is where it gets its info)

path histo: greatest risk of malignant transformation in colonic polyp histo

villous adenomatous polyp or a serrated polyp. Threse are the two types that have malignant potential. Increasing polyp size is the most important risk factor for cancer.

subacute granulomatous thyroiditis aka de quervain thyroiditis

viral illness; painful; HYPERthyroid sx; giant cells (multinucleated)

most common cause of acute pericarditis

viral infection (causes pericardial effusion and diffuse ST elevation on ECG)

vitamin B12 deficiency

vit B12 is an essential cofactor in the recycling of 5-methyl-tetrahydrofolate to tetrahydrofolate, which is required for amino acid, purine, and thymidine synthesis. Deficiency primarily affects hematopoietic cell materuation and is marked by increased nuclear-cytoplasmic ratio, elading to macrocytic red blood cells and hypersegmented neutrophils; increased apoptosis often also leads to anemia and mild thrombocytopenia/ leukopenia.

pleiotropy

where multiple phenotypic manifestations result from a single genetic mutation. Most syndromic genetic illnesses exhibit pleiotropy (like homocysteinuria)

epistasis

where the allele of one gene affects the phenotypic expression of alleses in another gene

pituitary adenoma

white discharge from nipples

ehrlichia chafeensis

white tailed deer tick, (lone star tick); spreads to mononuclear cells. Causes lymphopenia. Looks like mulberry shpaed intraleukocytic inclusions (morulae). Tx: doxycycline.

unvaccinated kid that has cough followed by vomiting

whooping cough; bordatella pertussis

lipophilic drug metabolism

will have delayed distribution to poorly vascularized peripheral compartments such as skeletal muscle, bone, and fat. Organs with huge blood flow will get it first (brain, liver, kidneys, and lungs)

Deficiency of ALA synthase

will result in a decrease in formation of all porphyrins. Will lead to a decrease in heme synthesis and concurrent hypochromic, microcytic anemia. Pyridoxal phosphate (vitamin B6) is the cofactor required for activity of ALA synthase; therefore, pyridoxine deficiency can result in mycrocytic hypochromic anemia.

WT1

wilms tumor

wilms tumor vs neuroblastoma

wilms tumors: in kidney, gene at 11p13; most common renal tumor in children neuroblastoma: adrenal medulla derived from neural crest cells; from mutation in N-myc (children get secretory diarrhea from paraneoplastic prod of VIP)

kayser fleischer rings are indicative of _ which can cause atrophy where?

wilson's disease which can cause atrophy in the basal ganglia

spinal metastasis

worse at night

treatment of a vit B12 deficiency with folate alone can

worsen the neurologic dysfunction

fragile X syndrome

x linked disorder; most common cause of inherited intellectual disability. The patho involves unstable expansion of trinucleotide repeats (CGG) in the fragile X mental retardation 1 (FMR1) gene. Sx: dysmorphic facial features (large jaw, protruding ears, long face) and macroorchidism.

tender lymphnodes with staining that resembles closed safety pin

yersinia pestis, gram negative coccobacillus. Buboes. Get it from rodents (flea bites)

zero vs first order kinetics

zero: same AMOUNT of drug is metabolized/ glucuronidated per unit time; first: same PROPORTION of drug is metabolized/glucuronidated per unit time

metalloproteinases

zinc-containing enzymes that degrade the extracellular matrix. They participate in normal tissue remodeling and in tumor invasion through the basement membrane and connective tissue.