Uworld/ Rx Journal pt.2

how to tell difference between cobalamin deficiency and thiamine deficiency

cobalamin deficiency (B12) causes subacute combined degeneration of dorsal columns (diminished vibratory sensation and gait ataxia) and corticospinal tracts. The degen of the CSTs causes a positive, upgoing babinski sign. Thiamine deficiency has a LOSS of reflexes so no babinski sign.

transplant rejection: hyperacute vs acute vs chronic vs GVHD

hyperacute (minutes, ischemia, type 2 HSR) vs acute (weeks, vasculitis, type 4 HSR) vs chronic (months, arteriosclerosis, type 2 AND 4 HSR) vs GVHD (systemic sx: jaundice, rash, diarrhea)

defective lipoprotein lipase or Apo C II

hyperchylomicronemia (hgih chylomicrons, and TG's)

hyperosmolar hyperglycemic state

hyperglycemia induced dehydration and increased serum osmo. seen in elderly type 2 diabetics with limited ability to drink (osmotic diuresis as well). glucose in blood >600. no acidosis. ketone production inhibited by presence of insulin. tx: aggressive IV fluids, insulin therapy.

tertiary hyperparathyroidism

hyperparathyroidism from CKD that persists after kidney transplant. tx: parathyroidectomy

hepatic overproduction of VLDL

hypertriglyceridemia (increased VLDL, TG's)

SIADH and tx

hyponatremia, inability to dilute urine, urine osmolal>plasma osmolal and urine sodium conc >40 in the setting of hyponatremia and tx is water restriction

ABG's assoc with pulmonary embolism

hypoxemia, hypocapnia, and increased pH secondary to hyperventilation and assoc with respiratory alkalosis.

anxiety secondary to a general medical disorder

i.e. hyperthyroidism causing anxiety for instance. can also be hypercortisolism, or hypoglycemia, etc. if they have medical sx, think of this (i.e. weight loss, palpitations, diarrhea, etc)

normoblast

immature RBC

antimetabolite drugs

immunosuppressants; interferes with the normal metabolic processes within cells (usually by combining with enzymes). (ex: azathioprine (prodrug), mycophenolate mofetil, basiliximab, sirolimus, tacrolimus, cyclosporin, glucocorticoids)

hypoglycemia after prolonged fasting with inappropriately low ketone bodies suggests

impaired beta oxidation. Medium chain acyl-CoA dehydrogenase deficiency is teh most common genetic defect in beta oxidation.

dubin johnson

impaired excretion of conjugated bilirubin

underlying cause of cystic fibrosis

impaired protein trafficking

patient has trauma to the face, and gets double vision. fracture of the inferior orbit bone.

impairment of the ocular muscles causing diplopia. caused by damge to V2 or entrapment of the inferior rectus muscle

manic episode

impulsivity, poor judgement, disregard for risks. (bipolar disorder)

gastrin, somatostatin, omeprazole

in a steady state, intragastric acidity (low pH) stimulates D cells in the gastric antrum to release somatostatin, which binds to G cells in the gastric antrum and inhibits gastrin release.

excess ammonia (i.e. in cirrhosis) will deplete which compound

in pts with cirrhosis, they get hyperammonemia. the urea cycle plays an integral role in converting amino acid byproducts (i.e. ammonia) into urea. Ammonia is shuttled to the liver via alanine, whose amino group is transferred to alpha-ketoglutarate to form glutamate, a precursor for the urea cycle. Therefore, excess ammonia will deplete alpha ketoglutarate.

central line placement

in the internal jugular vein, lateral to the common carotid. vagus nerve is posterior.

substantia nigra is located

in the midbrain just deep to the corticobulbar tract in the cerebral peduncle.

where do the majority of carcinoid GI tumors form?

in the midgut-derived small bowel, which begins at the distal duodenum and ends at the mid transverse colon, which includes the ileocecal junction. Carcinoid tumors of the small intestine secrete serotonin, which is usually metabolized by the liver and does not cause sx. However, when they metastasize to the liver, the bioactive amines can no longer be metabolized and enter the systemic circulation, causing diarrhea, abdominal cramps, GI tract bleeding, malabsorption, flushing bronchospasm, and right-sided heart valvular disease. carcinoid tumors most commonly present in the small intestine and the lung.

histo of irreparable damage/ later stages of cell injury

in untreated acute bowel disease, later stages of cell injury are characterized by organelle membrane damage, cytoskeletal dysfunction and nuclear changes, including pyknosis.

CGD is

inability of leukocytes to kill intracellular microorganisms due to lack of superoxide radicals aka NADPH oxidase.

competitive inhibitors on lineweaver burk plot

increase in Km and maintenance of Vmax.

severe burns over 35% of body, over the next week, the body will

increase its metabolic rate to keep the pt warm (bc the skin would usually insulate but now it cant)

ACE BATs Right handed

increased [acid, pCO2, exercise, 2,3 Bpg, altitude, temperature] cause right shift (increased O2 unloading to tissues)

hemochromatosis

increased intestinal iron absorption bc defective HFE (iron sensing) gene. triad: cirrhosis, diabetes, skin pigmentation (bronze diabetes); tx: deferasirox, deferiprone

multiple myeloma

increased production of IgG ! (M spike is spike in Ig light chains on electrophoresis)

moa of rifampin

inhibits bacterial RNA synthesis by binding to the beta subunit of DNA dependent RNA polymerase and consequently blocking transcription. It is indicated for the treatment of tuberculosis and causes bodily fluids to turn orange or red.

moa of TMP SMX

inhibits dihydrofolate reductase (TMP) and interferes with dihydropteroate synthetase (SMX)

chloramphenicol moa

inhibits the 50S ribosomal subunit.

digoxin increases intracellular calcium how?

inhibtis Na/K ATPase which inhibits the Na/Ca antiporter which increase Ca in the cell and leads to positive inotropic effect on heart.

if a bacteriophage (virus) is made to contain bacterial DNA instead of its normal virus DNA, it will be able to

inject its DNA into bacteria, like normal, but it cant produce progeny bacteriophages anymore bc it doesnt have its viral genome.

thoracentesis to avoid the lungs

insert needle at costodipahragmatic recess bnetween the 8th and 10th ribs at the midaxillary line

female athlete triad

insufficient caloric intake, amenorrhea, osteoporosis

phosphofructokinase-2 (PFK-2)/ fructose 2,6 bisphosphatase complex is regulated by

insulin and glucagon.

growth hormone is a diabetogenic agent leading to increased

insulin resistance and elevated fasting plasma glucose levels.

two most important pathophysiologic mechanisms for the development of type 2 diabetes mellitus

insulin resistance and progressive beta cell failure

high baseline plasma insulin level in the setting of normoglycemia during fasting is a sign of

insulin resistance in the peripheral tissues. (prediabetes heading to type 2 diabetes - which happens when enough beta cells die to the point where they can't compensate for the insulin resistance)

intellecteualization vs rationalization

intellectualization: excessive thinking to avoid painful emotions. rationalization: attempt to cover up unacceptable feelings by using excuses or justifications (i.e. if terminal pt said his diag was for the best bc he had done everything in life he wanted to)

where is the AV node

interatrial septum near the tricuspid orifice

axillary nerve: cord levels

C5, C6

huntington trinucleotide repeat

CAG (caudate loses ACh and GABA)

tx for somatic symptom disorder

CBT and SSRI's

where does the bladder lymph drain to

internal iliac

cremaster muscle is formed from the

internal oblique muscle. the cremaster muscle is responsible for reflexively pulling the testes superiorly into the scrotum to maintain optimal temperature for spermatogenesis.

interossei vs lumbricals

interossei: abduction and adduction of fingers; lumbricals: flexion of the hand at the MCP joints.

L5-S1 herniated disc sx

intervertebral discs herniate posterolaterally, due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament along the midline of the vertebrae. S1 nerve radiculopathy is assoc with decreased sensation of the posterior leg and lateral foot, diminished ankle-jerk reflex (S1/S2) and weakness of plantar flexion, toe flexion and inversion.

H pylori cancer

intestinal gastric adenocarcinoma and MALT lymphoma

first thing that buffers excess acid in the body

intracellular proteins

thyroid hormone signaling occurs via

intracellular receptors

primary cause of a primarily conjugated hyperbilirubinemia

intrahepatic or extrahepatic biliary obstruction;

tx for x linked agammaglobulinemia

intravenous immunoglobulin

4 hour old infant presents with bulging head and stiff muscles and arms and legs jerking. diagnosis?

intraventricular hemorrhage; neonatal intraventricular hemorrhage is classically seen in premature and low-birthweight infants. The bleeding originates in the germinal matrix. Neonates may have altered level of consciousness, bulging fontanelles, hypotension, seizures or coma.

after 6 months, a diet consisting of breast milk only, or intro of cow's milk before 1 year of age, puts a child at risk of

iron deficiency anemia (cows milk is low in iron). after 6 mo, most infants' iron stores have been depleted and thus require complementary foods containing iron

Km and Vmax

is the substrate concentration at which half of the enzyme in the sample is saturated. Therefore if you have a reversible competitive inhibitor it will increase the Km bc it take more substrate to saturate half of the enzyme in the sample! (but the Vmax wont change bc the same Vmax can eventually be achieved with more substrate). noncompetitive inhibitors decrease Vmax and have no effect on Km.

influenza virus can cause a secondary bacterial pneumonia bc

it affects tracheobronchial epithelium leading to destruction of alveoli and loss of cilia.

why should metoclopramide NOT be used in pts with parkinson disease

it can cause or exacerbate parkinsonian symptoms due to its antagonistic effect on dopamine receptors

malaria can cause hypoglycemia because

it can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands

how does the IVC traverse the diaphragm

it passes through the central tendon of the diaphragm

xerosis

itchy, dry, cracked skin (asteatotic dermatitis, aka winter itch). tx: use moisturizers after bathing

torsades is more common in which class III antiarrhythmic

its more common in sotalol use (less common in amiodarone)

explain why anesthetics like propofol have a rapid onset of action and rapid recovery

its readily redistributed; highly lipid soluble drugs can cross membranes readily at physiologic pH and are preferentially distributed to organs with high blood flow, like the brain. They are also redistributed rapidly to other tissues. This explains the rapid onset and short duration of action, respectively, of propofol.

high specific gravity of urine means

its very concentrated

turners syndrome coarctation is where

juxtaductal coarctation of the aorta (opposite the ductus arteriosis)

densely immunostaining cells adjacent to the renal glomerulus are

juxtaglomerular cells that produce renin

schistosomiasis

katayama fever, HSM, eosinophilia! travel hx to middle east, africa, south america. unsanitary fresh water.

epidermal cells belong to which class of proliferative activity?

labile cells (cells that multiply constantly throughout life)

metformin ADR

lactic acidosis is a life threatening condition that may affect those on metformin. (MUDPILES), risk factors for metformin-assoc lactic acidosis: AKI, hypoxemia, sepsis, alcohol abuse, liver failure, radiologic contrast media admin, myocardial infarction and shock. lactic acidosis can set in when someone has surgery and metformin is stopped for extended period. sx of lactic acidosis: abdominal discomfort, decreased appetite, diarrhea, kussmaul respirations, muscle pain, fatigue.

pulmonary embolism blood gas outcomes

leads to hyperventilation which leads to respiratory alkalosis (acute pulmonary emb)

ductus arteriosus is which aortic arch derivative

left 6th aortic arch

the mitral stenosis from rheumatic heart disease usually causes what change to the cardiac structure (i.e. what is enlarged)?

left atrium

left circumflex artery is coming off the

left coronary artery

CO toxicity has what shift in the oxygen hemoglobin dissoc curve

left shift; CO has 250X higher affinity for Hb than O2, so it decreases the O2 carrying capacity of Hb and causes left shift.

the thoracic duct receives all lymphatic drainage from the abdominal viscera and the lymph from this duct is sampled by the

left supraclavicular lymph node. enlargement of this node (virchow's node) may signify an occult abdominal malignancy.

patent ductus arteriosis

left to right shunt. aorta and pulmonary artery stay connected, aorta sends blood to pulmonary artery as well. they get PAH after a while. (eisenmenger syndrome)

kala azar or black disease is the grey discoloration of the skin of the hands, feet, abdomen and face.

leishmania donovani

Weil disease

leptospirosis, which is caused by leptospira interrogans, presents with flu like sx, myalgia (classically of the calves), jaundice and conjunctival suffusion (pink eye w/o the puss). Weil disease is a more severe form of leptospirosis and presents with the additional sx of renal failure and hepatitis.

30 amino acid alpha helical segment that consists of repeated leucine residues at every seventh position

leucine zipper (i.e. transcription factor); binds major groove of DNA. modifies gene expression by turning transcription on or off.

leukemoid reaction: what is it and how to tell it apart from CML

leukemoid reaction is just an increase in white blood cell count because of an infection (not cancer). diff btw it and CML is that in leukemoid reaction, leukocytes alkaline phosphatase (LAP) is high and in CML the LAP is low.

v fib tx

lidocaine (bc it decreases the abs refractory period)

correlation coefficienct

linear relationship of two variables. tells how they correlate (i.e. as one increases the other increases or decreases). it does NOT prove causation!

humoral immunity (B cells) is important in controlling extracellular pathogens. Cell-mediated immunity is key in destroying intracellular organisms such as

listeria monocytogenes

measles, varicella, mumps and rubella vaccines are all

live attenuated vaccines; vs Salk vaccine is an inactivated, killed poliovirus vaccine (can be given to immunocompromised kids)

decrease in blood oncotic pressure can come from

liver failure, or nephrotic syndrome

glut 2

liver, pancreatic Beta cells, renal tubular cells and small intestinal epithelial cells.

I cells

loacted in the duodenum and secrete cholecystokinin, which digests fat and protein.

bupivicaine

long acting amide based anesthetic capable of causing cardiac arrhythmias and hypotension.

NONsegmented virus in sketchy

long ticket roll

RNA hybridization technique causes mRNA to bind to DNA targets but the DNA has loops. why does it have loops

loops in the DNA bc the mRNA already underwent RNA splicing in which introns were removed. the DNA still has introns so those are the loops that have no binding pair

prader willi syndrome is caused by

loss of function of a gene inherited from the father. (i.e. a mutation in the paternal gene and genetic imprinting through DNA methylation). the idsease is characterized by intellectual disability, short stature, hyperphagia, obesity, and hypogonadism.

salivary flow rates: low flow = ; high flow =

low flow = low sodium/Cl, high K/HCO3; high flow = high sodium/Cl, low K/HCO3

lower p value means

lower alpha (type 1) error and therefore lower likelihood that we report a diff when there is none. therefore if p value is lower, we can report significant results with more confidence.

if pt has prominent right uvular deviation, which cranial nerve is damaged?

lower motor neuron of left CN X. the vagus nerve mediates motor innervation of the palatal arches and uvula. An LMN lesion in CN X would cause the uvula to deviate to the side contralateral to the lesion. this is bc CN X innervates the levator veli palatini which ELEVATES the soft palate and if damaged it will droop.

tx for IBS

lubiprostone (stool softener for constipation) (lubes up the colon, so ya poop keeps flowin)

lipid soluble substances are transported via the _ system

lymphatic. the lymphatic system bypasses the liver initially and thus avoids the first pass effect (or first pass metabolism). Fat soluble vit A is then ultimately stored in Ito cells in the liver

aspergillus fumagatus

mold with septate hyphae that branhc at V shaped 45 degree angles. causes aspergillomas (fungus balls). Clinical features of invasive aspergillosis include fever, chills, hemoptysis, shortness of breath, headaches and chest pain. AND aspergillus can infect pre-existing lung cavities from things like sarcoidosis.

tx for refractory depression or atypical depression

monoamine oxidase inhibitors are an older class of antidepressants; ppl on these should avoid tyramine in foods and wine, (cheese and wine) bc excess catecholamines can cause HTN crisis

moa of abciximab

monoclonal antibody against glycoprotein receptor IIb/IIIa on activated platelets, which prevents aggregation of platelets.

schizoaffective disorder

mood episode with concurrent active phase sx of schizophrenia + 2 or more weeks of delusions or hallucinations in the absence of prominent mood sx

anemia of chronic disease

most common cause of anemia in pts with SLE, and presents with normo or microcuytic aneia, with decreased reticulocyte counts.

pleomorphic adenomas

most common parotid tumor and contain multiple cell types, typically epithelial cells in a chondromyxoid stroma.

transitional cell carcinoma

most common tumor of the urinary tract system, and painless gross hematuria is the most common symptom. histo: shows an increased number of epithelial cell layers with abnormal cell maturation from basal to superficial layers.

asthma gross appearance of their lungs

mucoid exudate forming a cast of the airways; bronchial smooth muscle hypertrophy, hyperplasia of bronchial submucosal glands and goblet cells and charcot leyden crystals.

chronic bronchitis

mucus secreting gland hypertrophy and hyperplasia. smoking is risk factor.

ghon complex

multinucleated giant cells and epitheloid cells, assoc with lymphnode involvement. means you have TB. ghon complex consists of caseating granulomas with multinucleated giant cells and epitheloid cells surrounding an area of central necrosis.

mushrooms moa

muscarine toxin in mushrooms is like ipratropium (M3 muscarinic antagonists). vasodilation is mediated by an increased release of nitric oxide by endothelial cells activated by M3 receptors.

KRAS

mutations in KRAS lead to colon, lung and pancreatic cancer

cardiac hypertrophy is characterized by an increased rate of

myosin mRNA synthesis (not mitotic rate bc its hyperTROPHY not hyperplasia)

Orexin

narcolepsy can result from loss of the neuropeptides orexin-A and orexin-B, which are produced in the lateral hypothalamus; these peptides promote wakefulness. Common sx: excessive daytime sleepiness, cataplexy, hallucinations and sleep paralysis.

specific test for mycoplasma pneumoniae infection

nasopharyngeal swab PCR

pyoderma gangrenosum

nasty ulcers that are extraintestinal manifestations of inflammatory bowel disease (i.e. crohns, UC, IBD). Tx: treat the underlying IBD with corticosteroids.

acute hepatitis infection

nausea, vomiting, jaundice, and lab values indicating transaminitis. sero markers confirm diag of acute HBV (s, c, and e antigens). acute HBV most commonly resutls in spontaneous viral clearance without liver failure, although chronic HBV can sometimes develop if the initial infection occurs in a very young pt or the pt is immunosuppressed.

where is the omental foramen/ epiploic foramen of winslow

near the pyloric sphincter on the lesser curvature of the stomach. the omental foramen is partly formed by the hepatoduodenal ligament.

budd chiari syndrome

nearly complete obstruction of blood flow by an acute clot in the hepatic veins or in the IVC, causing centrilobular congestion and necrosis in the liver. It can occur as a result of any hypercoagulable state, including antiphospholipid antibody syndrome and polycythemia vera.

nephroblastoma vs neuroblastoma

nephro: wilms tumor, beckwith wideman syndrome (big tongue, hypoglycemia, big baby (macrosomia), hemi-hypertrophy), from renal mesenchymal tissue (blastema), in the kidney; NEUROblastoma: most common solid tumor in kids, in adrenal medulla, increased VIP secretion, opsomyoclonus (dancing eyes, dancing feet), from neural crest cells.

a genetic defect in aquaporin 2 water channels will cause

nephrogenic diabetes insipidus

ADR of lithium

nephrogenic diabetes insipidus, tremor, hypothyroidism, and ebstein anomaly in the fetus.

calcineurin inhibitors (tacrolimus, cyclosporine) are common immunosuppressive agents used to prevent transplant rejection. ADR is

nephrotoxicity can occur from drug induced arteriolar vasoconstriction, which results in hypertension and a rise in serum BUN and Cr. Long term use can result in obliterative vasculopathy.

most common adverse effect of vinchristine

neurotoxicity (peripheral sensory neuropathy)

incidence

new cases/ (people at risk). people at risk has to subtract out ppl that already have the disease0

firstline tx for UTI in pregnancy

nitrofurantoin; also penicillin or first gen cephalosporin (cephalexin),

how does the 'jugular venous pulse wave tracing' change in a pt with atrial fibrillation?

no 'a' wave bc the atria are not contracting fully or regularly.

SCID

no IL-2. no T cells no thymus

tx for gram positive filamentous rod that causes pneumonia

nocardia - tx: TMP/SMX (sulfa based antibiotic)

generalized lymphadenopathy, weight loss, night sweats

non-hodgkin lymphoma; majority of cases are malignancies of B cells. Exceptions: T cell lymphoblastic leukemia/ lymphoma, mycosis fungoides, and sezary syndrome (which are T cell derived).

down syndrome is due to _ of meiosis _

nondisjunction during anaphase of meiosis I

epinephrine & phenoxybenzamine given together do what

nonselective alpha and beta adrenergic receptor agonist. phenoxybenzamine is a nonselective alpha antagonist. When theyre given together, a net decrease in blood pressure occurs as a result of unopposed beta 2 agonism by epinephrine (bc epinephrine is a beta 2 agonist at small doses)

congenital deficiency of dopamine beta hydroxylase will impair synthesis of

norepinephrine and epinephrine and lead to impaired sympathetic adrenergic activity (i.e. orthostatic hypotension)

what is the sodium level in ppl on loop diuretics

normal bc ADH kicks in to normalize sodium

HCM and/or LVH can cause exertional angina despite having

normal coronary arteries (i.e. no atherosclerosis)

moa of topical tretinoin for acne

normalizes follicular keratinization; its a vit A analog that binds intranuclear receptors, which then acts as a transcription factor. In patients with acne, retinoids decrease sebum production and increase cellular turnover and the shedding of cells from the stratum corneum. This reduces hyperkeratinization, opens blocked pores and prevents formation of microcomedones.

p53

normally: blocks the G1->S transition (holds cells in G1 phase) (its a tumor suppressor gene)

ehrlichia chaffeensis

obligate intracellular gram negative species of rickettsiales bacteria. tick vector (lone star). dogs are vector. sx: fevers, headaches, malaise, myalgias. Macular, maculopapular, and/or petechial rash may occur on the trunk, legs, arms or face. Blood may also show berry-like cytoplasmic inclusions in macrophages or monocyte. tx: doxycycline

x linked recessive disorders

oblivious female will often give her boys her x-Linked disorders

sampling bias

occurs if factors unrelated to the aim of the study distinguish the subjects from the rest of the population so that the results of the study cannot be generalized.

retroperitoneal hematomas

often bc of trauma. can go unnoticed until its bled so much that it compresses nearby structures (i.e. aorta, IVC, duodenum, pancreas, adrenal glands, kidneys, ureters, colon and nearby nerves - L2-L4 nerve roots of the femoral nerve

chronic myelogenous leukemia

older person, weight loss, lots of leukocytes, monocytes, basophils, etc, splenomegaly (BCR ABL enzyme), (9,22)

pt with severe burns, which drug do you give them to prophylactically prevent stress ulcers

omeprazole, these are called curling ulcers and they are stress ulcers assoc w severe burns. the loss of plasma volume results in mucosal ischemia and necrosis.

HTLV-1 (human T cell lymphotrophic virus)

oncogenic virus that causes adult T lymphocute leukemia, and is also respinsle for HTLV-1 assoc myelopathy, characterized by myelin destruction within the spinal cord and brain. It manifests with a gradual, unremitting course that includes lower extremity weakness, back pain, urinary incontinence, and eventual spastic paraplegia.

live attenuated/ oral vs killed/ inactivated vaccine

oral vaccine = live attenuated. killed = it cannot revert to a virulent form

joint space narrowing in the knee

osteoarthritis

lytic bone changes and periosteal elevation

osteomyelitis (infection of bone)

RB mutations pts are at risk for what cancers later in life

osteosarcoma and retinoblastoma

hereditary retinoblastoma at increased risk for

osteosarcoma later in life (compared to sporadic acquisition of the two mutations) in hereditary you inhereit one mutation and acquire another

defect in acid maltase, that primarily affects the heart in a 5 month old. has cardiomegaly sx (breathlessness, peripheral edema, fatigue, palpable liver)

pompe disease (type 2 glycogen storage disease)

pontine hemorrhages cause pinpoint pupils, loss of horizontal gaze, guadriparesis, decerebrate posturing, and rapidly evolving coma that culminates in death within hours.

pontine hemorrhage is one of the things that causes horner syndrome.

anterior/ posterior dislocations of the knee joint: what structure is most at risk for damage

popliteal artery bc its fixed to the back of the knee.

which veins are backed up in the portal hypertension that causes esophageal varices?

portal vein is backed up into the left gastric vein into the esophageal veins/ azygos veins.

child <15 months old displays what qualities

positive babinski (upgoing great toe with fanning of the other toes) (shows until 12 mo), stranger anxiety (begins at 7 mo), mature 'pincer' grasp and ability to stand (begins at 10 mo)

if you see eosinophil casts and they have renal problems following recent medication exposure

possibly acute interstitial nephritis

if radial and axillary nerve stuff is damaged, its a lesion at the

posterior cord of the brachial plexus

most common etiology of bilateral fetal hydronephrosis in boys

posterior urethral valves; caused by an embryological defect that leads to a persistent obstructing urogenital membrane at the junction of the bladder and urethra. (i.e. a membrane remnant)

molluscum contagiosum

pox virus (small pox, cow pox, molluscum contagiosum); histo: eosinophilic cytoplasmic inclusions (molluscum bodies).

Whipple disease

presence of numerous foamy macrophages in the lamina propria of the small intestine on histo. H&E stain shows vacuolated macrophages, which contain partially digested Tropheryma whipplei bacteria. sx: unintentional weight loss, joint pain, diarrhea.

non-classic congenital adrenal hyperplasia

presents during adolescence when androgen levels increase. Sx: in females includes primary amenorrhea, hirsutism, clitoromegaly, and delayed development of secondary sexual characteristics. pts with non-classic CAH can have up to 50% of normal 21-hydroxylase activity. They present later in life with milder sx.

VHL disease

presents with hemangiomas in the retina, medulla and cerebellum. its assoc with a greatly increased incidence of bilateral renal cell carcinoma.

zollinger ellison syndrome

presents with multiple gastric and duodenal ulcers, diarrhea, and epigastric pain. It is caused by a pancreatic gastrinoma, a gastrin-secreting tumor that induces parietal cells itn eh stomach to secrete acid. Gastrin is normally produced in the G cells of the stomach.

bronchiectasis

presents with purulent cough, hemoptysis, sx of infection, and rales and rhonci on auscultation. Assoc with hx of cystic fibrosis, given the stasis of mucus in the lungs, which can serve as a breeding ground for pathogens.

if pt has urine osmolality that gets up to 300-500 with water deprivation, and they have excessive water intake with polyuria, its

primary polydipsia/ psychogenic polydipsia

radiation exposure is the most important risk factor for

primary thyroid malignancy (i.e. papillary thyroid carcinoma)

pt has brown urine and has hyperlipidemia

prob on a statin drug inducing rhabdomyolysis.

glucosuria, phosphaturia, amino aciduria

problem with reabsorption at the PCT, therefore its Fanconi syndrome which has led to type 2 RTA

the regenerative nodules (i.e. spherical ndoules within the confines of fibrous septae) see in liver cirrhosis are composed of

proliferating hepatocytes

prostacyclin endothelin

prostacyclin: vasodilator; endothelin: vasoconstrictor

warfarin induced skin necrosis is a risk in pts with

protein C or S deficiency (some ppl have hereditary protein C deficiency) protein C is decreased early on in warfarin admin which is the risk factor here

psoriasis on histo

psoriasis (gross) is silver scaling plaques on felxural areas with pinpoint bleeding with scraping of the plaques. Histo: increased stratum spinosum and decreased stratum granulosum.

CML

pts with CML have marked leukocytosis and a peripheral blood smear showing myeloid cells in various stages of development. DIC is often a prequel to blast crisis and is seen in all types of leukemia.

pt is post-meno, on hormone replacement therapy and feeling good. what are her thyroid hormone levels like

pts with increased estrogen (i.e. hormone therapy) have increased thyroxine binding globulin (TBG) levels. these increased TBG levels lead to an overall increase in total T4/T3 in the setting of normal TSH and normal free T3/T4. called euthyroid hyperthyroxinemia.

severe pancreatitis

pts with severe pancreatitis are at an increased risk for developing acute respiraotry distress syndrome (ARDS). ARDS is assoc with decreased PaO2/FiO2 ratio, bilateral infiltrates on chest x ray study and NO clear signs of cardiac dysfunction (normal pulmonary capillary wedge pressure).

cardiac conduction velocity

purkinje>atria>ventricles>bundle of His>AV node

supinator muscle is innervated by

radial nerve (deep branch of the radial nerve)

Raloxifene vs tamoxifen

raloxifene (relax): SERM, estrogen agonist at bone, (inhibits osteoclasts) and anatagonist at breast and uterus. Tamoxifen: SERM with antagonist at breast, and agonist at uterus and bone (higher risk for endometrial cancer)

acetyl CoA carboxylase

rate limiting enzyme for fatty acid synthesis (acetyl CoA to malonyl CoA)

in viruses, they mix genomic segments with other segmented viruses via

reassortment; i.e. this is responsible for major antigenic shifts resp for pandemics of influenza A

tx for renal cell carcinoma

recombinant IL-2 (aldesleukin) promotes the proliferation, differentiation and recruitment of lymphoid cells. It is used to treat RCC, and is thought to promote immune-mediated antitumor effects.

cohort study

relative risk

"risk of influenza in those who received the vaccine relative to those who received placebo" is an example of a q asking for _

relative risk (RR)

reliability and validity

reliability = precision (reproducibility). validity = accuracy (trueness of measurements)

smaller vessels have greater

resistance

methicillin resistant staph vs sensitive (tx)

resistant: vancomycin; sensitive: penicillin

idiopathic pulmonary fibrosis

restrictive lung disease that results in collagen deposits and hypoxia; "honeycombing appearance on imaging". prolonged hypoxia leads to increased EPO and hematocrit.

obesity is assoc with what type of lung change on pft's

restrictive pattern, due to reduced chest wall compliance.

case control:

retrospective look for risk factors in two groups.

erythema marginatum

rheumatic heart disease

HLA DR4

rheumatoid arthritis, DM type 1, addison disease (4 walls in 1 rheum)

right vs left recurrent laryngeal nerve loops around:

right: loops around right subclavian artery; left: loops around aortic arch distal to ductus arteriosis.

relative risk is

risk of affected/ risk of placebo

4 day fever of 104 degrees then they get a rash when fever goes away

roseola (ro-SIX-ola, 6th disease), rash that spares the face

bursitis vs tendonitis

rotator cuff tear: painful arc, drop arm sign, weakness in external rotation. bursitis: tenderness over the greater trochanter. Difficulty in abduction may occur (above 70-100 degrees).; Adhesive capsulitis = active and passive ROM are decreased similarly. ; if normal passive ROM = tendonitis

malignant plasma cells in multiple myeloma, have abundant

rough endoplasmic reticulum so they can make the excess immunoglobulin.

kid with rash and postauricular lymphadenopathy, and has no vaccinations

rubella virus (measles)

in pts with impaired renal or hepatic function, how do you alter the loading and maintenance doses of their drugs?

same loading dose, lower maintenance dose

stage 1 vs 2 of schilling test

schilling test tests levels of intrinsic factor. stage 1: pts given B12 without intrinsic factor - if pernicious anemia: they do not absorb the B12 bc they dont have IF. stage 2: given B12 WITH intrinsic factor, and they absorb it.

DIC on peripheral smear

schistocytes (helmet cells)

calcifications in the bladder wall

schistosomiasis (parasite)

uremic platelet dysfunction

seen in the setting of renal insufficiency, where unfiltered uremic toxins cause poor platelet function. The condition is characterized by an increased bleeding time in the setting of a normal platelet count and normal PT/aPTT.

most common testicular tumor

seminoma (germ cell tumor) (fried egg cells)

sensorineural hearing loss vs conductive hearing loss in old ppl

sensorineural hearing loss (loss of hair cells - this is the more common form in old age); vs conductive hearing loss (otosclerosis)

catalase positive organisms

serratia marcescens, burkholderia cepacia, aspergillus fumigatus

SCID

severe combined immunodeficiency disease; sx:hx of failure to thirve, and recurrent infections with viruses, fungi, protozoa and parasites in a kid. also low lymphocyte count and absence of a thymus. a deficiency of adenosine deaminase can lead to SCID.

during an acute pain episode in sickle cell crisis, what is the O2 Hb dissoc curve

shifts to the right bc deoxygenated HbS forms polymer that has less affinity for oxygen.

AAA repair puts what part of GI at risk for ischemia

sigmoid colon bc its supplied by IMA which is commonly affected by AAA's and therefore can be affected despite collateral circ.

RSV

single stranded, non-segmented, negative sense enveloped RNA virus (most common cause of bronchiolitis in children <1 year of age)

which is NOT assoc with a pancoast tumor

small cell carcinoma

lambert eaton myasthenic syndrome is assoc with which lung cancer

small cell lung cancer

squamous cell carcinoma: major risk factor

smoking

lipid and membrane biosynthesis happen where

smooth endoplasmic reticulum

beta blockers decrease which ions

sodium and calcium (reducing the slop opf phase 4 and 0) decreases cAMP first. this is how they slow arrthythmias (AV nodal conduction is slowed)

as the rate of salivation increases, less

sodium is reabsorbed and less potassium is secreted. In this condition, salivary sodium will be increased while potassium will be decreased relative to normal salivary electrolyte levels. Normally: ductal cells reabsorb sodium and chloride and secrete potassium and bicarbonate. the final composition of saliva is normally hypotonic to plasma.

anticonvulsant meds like valproic acid can cause which birth defect

spina bifida occulta

most likely type of bone fracture in child abuse

spiral fracture; (caused by a twisting rotational force to the bone)

outcome of a ganglion cyst

spontaneous regression

pancoast tumors are most often

squamous cell carcinomas

renal amyloidosis

stains with congo red and demonstrates apple green birefringence under polarized light

bed bugs can cause infection with

staph aureus

strep pyogenes vs staph aureus on histo

staph aureus: cocci in clusters; pyogenes: cocci in chains

signaling cascade that leads to smooth muscle contraction

starts with influx of Ca from extracellular fluid, followed by binding of Ca to calmodulin (CaM) which forms a complex that then activates (phosphorylates) MLCK (myosin light chain kinase). MLCK phosphorylates the myosin light chains, which triggers the formation of the cross bridge and subsequent contraction.

erythema multiforme

stevens johnson syndrome

weibel palade bodies

store von willebrand factor and P-selectin (cell adhesion molecule) (involved with platelet stuff)

which layer of the epidermis does a benign nevus come from?

stratum basalis; nevus cells are derived from melanocytes, which are respinsible for producing melanin. They are distributed variably between the columnar cells of the stratum basalis.

migratory serpiginous perianal rash

strongyloides stercoralis. check stool for larvae

serpiginous rash, chronic cough, eosinophilia, pt is from southeast asia

strongyloidiasis is a parasitic infection that presents with chronic rash, cough and eosinophilia. Infection can be confirmed via microscopic examination of stool for rhabditiform larvae or via a serum ELISA test.

mutated gene that has same number of amino acids as that of the wild type gene.

substitution of one amino acid for another (i.e. a point mutation resulting in amino acid substitution aka a missense mutation).

tx for child with PSGN

supportive care only bc it will resolve on its own

pain with overhead motion of arms, and pain is worst with internal rotation of the shoulder. what muscle

supraspinatus (empty can test)

fever, maculopapular rash, and peripheral eosinophilia and acute onset of renal failure

sx of acute interstitial nephritis (following a recent medication exposure)

sx of and tx for beta blocker overdose

sx: cardiogenic shock, i.e. pale and cool extremities, bradycardia, hypotension. tx: glucagon

coccidiodes immitis

sx: dyspnea, cough, fever, unintentional weight loss, night sweats, and joint pain. Infection is seen in immunocompromised pts or the elderly and is in southwestern US. histo: sphere that is larger than a red blood cell and filled with endospores.

sweating is (symp/ parasymp)

sympathetic (but uses ACh aka muscarinic receptors)

androgen binding protein

synthesized by Sertoli (FSH) cells of the seminiferous epithelium and secreted into the seminiferous tubule lumen. ABP maintains the hgih local concentration of testerosterone necessary for normal sperm production and maturation. (i.e. without ABP you would have normal circulating testosterone levels but low testosterone in the seminiferous tubules)

patients with complement deficiencies (i.e. C1q, C4 and C2) are more likely to have

systemic lupus erythematosis bc they cant remove immune complexes.

fatigue, weight loss, migratory joint pains, female, joint inflammation, normocytic anemia, increased Cr, UA: blood and protein, spherocytes on periph smear

systemic lupus erythematosus with assoc normocytic anemia and glomerulonephritis

polyarteritis nodosa

systemic necrotizing vasculitis of small to medium sized arteries that spares the vasculature of the lungs. Transmural inflammation of the arteries with fibrinoid necrosis is seen on histo.

which portosystemic anastomoses are affected by portal hypertension

systemic vein: portal vein: consequence/sx --- esophageal veins:left gastric vein: esophageal varices; middle&inferior rectal veins:superior rectal vein: hemorrhoids; veins of the posterior abdominal wall: veins draining secondarily retroperitoneal structures: retroperitoneal bleed; superficial epigastric vein: paraumbilical veins: caput medusa

post-splenectomy: what type of RBCs will you see

target cells and howell jolly bodies bc of the loss of splenic macrophages

G CSF (filgrastim)

targets CD34+ cells (stem cells) to induce them to become granulocytes.

prosencephalon->telenceph and dienceph mesencephalon-> rhombencephalon->metencephalon and myelencephalon

telenceph: cerebrum and lateral ventricles (telemetry w your cerebrum); dienceph: thalamus and 3rd ventricle; (DieT) mesenceph: midbrain; metenceph: pons, cerebellum, upper 4th ventricle; (meet me at the pond, bella) myelenceph: medulla

jaw pain with granulomatous inflammation and multinucleated giant cells =

temporal arteritis. tx = prednisone

tension pneumothorax vs obstructive lesion of the mainstem bronchus

tension pneumo: trachea deviates AWAY from the pneumothorax; obstructive lesion: trachea deviates TOWARD obstructed side

DHR (dihydrorhodamine test)

test for chronic granulomatous disease (in CGD, it makes less green flouresence)

nitroblue tetrazolium test

test for chronic granulomatous disease (its negative in CGD).

a rapid increase in the secretion of what substance causes acne vulgaris in teens?

testosterone/ androgens

cyanosis that worsens with feeding, crying or exercise (infant).

tetralogy of Fallot. in older children, they squat to improve pulmonary blood flow

HR from RR interval

the R-R interval is seconds/beat. The inverse is beats per second and can be multiplied by 60 to get beats/min aka HR.

Receiver operating characteristic curves can be produced by plotting the sensitivity (true positive rate) against 1 - specificity (false positive rate). the area under the ROC curve represents

the accuracy of the test

the hepatoduodenal ligament contains

the common bile duct, the hepatic artery, and the hepatic portal vein. neoplasia in this area may disrupt the hepatobiliary system, resulting in jaundice.

st john's wort

the compounds in St johns wort inhibit neurotransmitter reuptake, which is amplified when taken in conjunction with an SSRI.

Hartnup disease

the defective transporter is expressed in both the urinary and GI tracts and results in loss of the neutral amino acids (i.e. tryptophan). Niacin deficiency, or pellagra, can develop as a result of reduced absorption of tryptophan, a precursor for niacin synthesis in the liver.

what is the continuation structure of the umbilical vein in the fetus' liver

the ductus venosus (dumps into the IVC)

globus sensation

the feeling of a lump in the throat without acompanying physical, endoscopic or radiologic findings of esopahgeal obstruction

umbilical vein and arteries are named in relation to

the fetus. I.e. the vein is supplying oxygenated blood TO the fetus and the arteries are delivering waste/ deoxygenated blood AWAY from the fetus.

the median nerve doe which lumbricals

the first and second lumbricals

phenylketonuria (PKU)

the genetic mutation that causes PKU results in the dysfunction of the enzyme phenylalanine hydroxylase and a subsequent increase in phenylketones. Tx: decrease phenylalanine in diet and increase tyrosine and thus prevent intellectual disability.

in a bimodal distribution

the mean is equal to the median and there are two modes

never event

the medical errors that should never happen. For an event to be classified this way, it should be serious, largely preventable and of concern to both the public and healthcare providers for public accountability (i.e. a sponge in the body cavity after a surgery)

which layer surrounding nerves in the PNS is the major permeability barrier between the blood and the nerve?

the perineurium

the increase in parathyroid hormone production in chronic kidney disease (secondary hyperparathyroidism) is caused by

the reduction in phosphate excretion.

if right hemidiaphragm is above left on an inspiratory chest x ray

the right phrenic nerve is damaged

Km is defined as

the substrate concentration at which half of the active sites are filled (i.e. Vmax/2)

pancoast tumor

the sympathetic nerve fibers of the inferior cervical or stellate ganglion may be compressed by pancoast tumors, leading to horner syndrome (unilateral ptosis, miosis, and anhidrosis). Pancoast tumors may cause hoarseness. In addition, a right sided pancoast tumor may cause SVC syndrome.

macrocytic anemia: folate deficiency: moa of tetrahydrofolate

the tetrahydrofolate form of folate functions as an intermediate in the "transfer of 1-carbon units", which is important for purine synthesis.

if the gallstones are radiopaque (i.e. white/ you can see them) on x ray film

they are pigmented gallstones, which are composed of unconjugated bilirubin. (cholesterol stones are radiolucent)

if pt is IV drug user and has negative PPD but has hemoptysis, fatigue, weight loss, and dry skin...

they might have HIV as well as TB and the HIV is preventing them from having a positive TB test, even though they have TB.

macrolides moa

they work by binding the 23S rRNA of the prokaryotic 50S ribosome, effectively blocking the translocation step of protein synthesis and are indicated as first line tx for M. pneumoniae. Methylation of the 23S rRNA in resistant bacteria diminishes the binding of macrolides.

maple syrup urine disease can be caused by what besides a deficiency in alpha ketoacid dehydrogenase (the enzyme that breaks down isoleucine, leucine and valine)

thiamine deficiency (B1RANCES) bc B1 is cofactor for that enzyme

systemic sclerosis: two types: diffuse cutaneous systemic sclerosis (extensive skin sclerosis) and limited cutaneous systemic sclerosis which presents with

thickening of the skin and hands and face leading to CREST syndrome. 60% of CREST syndrome pts have pulmonary arterial hypertension which is causes by hyperplasia of intimal smooth muscle layer of pulmonary arteries and subsequent increased pulmonary vascular resistance.

pt has fever jaundice and upper right quadrant pain

this is charcot triad and is therefore (ascending) cholangitis (infection of biliary tree usually due to obstruction that leads to stasis/ bacterial overgrowth).

cystathionine synthase deficiency

this is the enzyme that converts homocysteine to cystathionine to cysteine. it is a cause of homocysteinuria (kyphosis, intellectual disability, marfanoid, lens sublux down and in)

absence of thymic shadow in child, no tonsils, low T and B cell count, recurrent diarrhea and failure to thrive

this type of severe combined immunodeficiency (SCID) is characterized by lack of T and B lymphocytes and low Ig levels resulting from deficiency in adenosine deaminase.

abnormal grieving sx

thoughts of being better off dead (i.e. suicidal thoughts)

unstable angina is mediated by

thromboxane A2 (platelet aggregation -> incomplete occlusion -> ischemia ->pain in chest)

COX-1 synthesizes

thromboxane A2(TXA-2) from arachidonic acid. Therefore, aspirin and other COX-1 inhibitors reduce CV risk of platelet aggregation and clots via inhibiting this.

aspirin toxicity includes

tinnitus

drugs known to cause disulfiram like reactions when taken with alcohol

tolbutamide (long acting first gen sulfonylurea), metronidazole, griseofulvin, chloramphenicol, chlorpropamide, and some cephalosporins

submandibular lymphadenopathy, has squamous cell carcinoma in it. Where is the primary site of the cancer

tongue; bc most head and neck SCC's are from tobacco/ alc and they start in the mouth somewhere.

if kid has yellow skin but his eyes are nonicteric (and everything else is normal too) its

too much carotene in diet (i.e. its in carrots and it is a orange/ red pigment)

bacitracin

topical antibiotic that is highly effective against gram positive bacteria; it works by inhibiting bacterial wall synthesis. It is most commonly administered topically, rather than systemically, because of its harsh nephrotoxic effects.

quinidine (antiarrhythmic) ADR

torsades de pointes

tx for tourette syndrome and for intractable tourette's

tourette syndrome is cahracterized by rapid, recurrent, involuntary motor and vocal tics that persist for at least 1 year. tx: psychoeducation, behavioral therapy. for intractable tics: atypical (SGA) antipsychotics (risperidone) or high potency antipsychotics (Hal Tries to Fly High), or alpha 2 agonists, or tetrabenazine

outdoors; raised erythematous spots and streaks in the affected areas.

toxicodendron species exposure (poison ivy), causing a type IV HSR.

C diff is diag via

toxin assay

cellular differentiation is determined by the

transcription factors within an individual cell. All nucleated cells in humans possess the entire genome, but tissue specific transcription factors allow only for the expression of genes that are relevant for a particular cell type. Transcription factors can also induce cellular DE-DIFFERENTATION, causing terminally differentiated cells to revert to less specialized forms.

amaurosis fugax

transient loss of vision in one or both eyes, which can last from seconds to hours. It has been assoc with several etiologies but is due to underlying ischemia affecting the eye.

spermatocele

transilluminates. benign, cyst due to dilated epididymal duct or rete testis.

egg on a string heart

transposition of the great vessels

mast cell degran (histamine release) can be triggered by foreign antigens and

trauma

patau syndrome

trisomy 13; holoprosencephaly, cleft lip/ palate, microphthalmia (small eyes), cutis aplasia, inte dis, polydactyly, congenital heart disease, and rocker bottom feet. The first trimester screen combines the blood tests for PAPP-A and hCG, an ultrasound exam and screens for trisomy 13, trisomy 18 (edwards syndrome) and trisomy 21 (down syndrome).

edwards syndrome

trisomy 18, flexed fingers w overriding digits, narrow cranium with prominant occiput, and congenital heart anomalies (i.e. VSD)

whipple disease

tropheryma whipplei. sx: weight loss, diarrhea and arthralgias. intestinal biopsy reveals PAS staining macrophages in the lamina propria.

what do you find in stool samples of pts who have giardia lamblia

trophozoites.

developmental delay and multiple benign tumors in brain, eyes, skin and other organs

tuberous sclerosis

why is there hyponatremia in DKA

two reasons: serum sodium is decreased bc of the osmotic activity of glucose (serum sodium drops 1.6 for every 100 mg rise in blood glucose); and bc of the hyperglycemia induced osmotic diuresis which results in sodium and free water losses.

EDTA (ethylenediaminetetraacetic acid)

tx for lead poisoning

MG is a _ HSR

type 2 HSR

autoimmune hemolytic anemia is a

type 2 HSR (IgG to RBCs). spherocytosis, increased reticulocyte count, and a positive direct antiglobulin (coombs) test are suggestive of AIHA in pts with SLE

the type of ehlers danlos (stretchable skin) that causes ruptured berry aneurysms leading to subarachnoid hemorrhage

type III collagen gene mutation (vascular type of ehlers danlos syndrome)

poison ivy is which type of HSR

type IV HSR (CD4 T cells)

availability heuristic

type of cognitive bias where people rely upon immediate examples that come to their mind. In medicine, physicians can wrongfully apply this to pts if they do not properly asses each one

which amino acid can be synthesized by the body (and therefore is not essential) but can BECOME essential in a certain disease

tyrosine is made from phenylalanine normally. in PKU they dont have phenylalanine hydroxylase and cant make tyrosine (sx: int dis, seizures, musty body odor)

tyrosine kinase vs jak stat moa

tyrosine kinase: ligand binding causes formation of receptor dimers; jak stat: ligand binding causes translocation to nucleus

levodopa can cause autoimmune hemolytic anemia leading to an increase in

unconjugated (indirect) bilirubin

cancers in the upper two-thirds of the esophagus are most likely _ whereas cancers in the lower third are most likely _ evolved from _. antibodies against _ can be used to detect the latter

upper 2/3rds is squamous cell carcinoma and lower third is adenocarcinoma evolved from barrett esophagus. antibodies against cytokeratin can be used as an immunohistochemical stain to detect adenocarcinoma of the esophagus.

old person with urinary incontinence gait disturbance and dementia.

wet wacky and wobbly. normal pressure hydrocephalus. if severe, tx is ventriculoperitoneal shunt

most common moa of acute mesenteric ischemia for old ppl

when an artery (like SMA or IMA) is blocked by embolic events (i.e. arterial sided thrombus occluding vessels), acute mesenteric ischemia occurs. This presents with severe abdominal pain taht is out of proportion to physical findings. Atrial fibrillation and atherosclerotic disease are predisposing factors. Vs. Chronic mesenteric ischemia is due to atherosclerosis producing angina when ppl eat.

fishbone diagram

when sentinal events occur, such as mistakes that lead to the death of a pt, a root cause analysis is confucted in order to identify the mistake and prevent it from occurring again in the future. A fishbone diagram, which visualizes contributors to a never event, is a useful tool to help guide the root cause analysis.

WAGR syndrome

wilms tumor, aniridia, genital anomalies, retardation

wiskott aldrich syndrome

x linked recessive, recurrent pyogenic infections, thrombocytopenia, purpura, and eczema. (WATER: WA: thrombocytopenia, eczema, recurrent infections)

becker muscular dystrophy

x-linked recessive disorder, presents with muscular weakness between the ages of 5-15 years. Although most pts with duchenne muscular dystrophy die before the age of 30, the majority of pts with becker muscular dystrophy die btw the ages of 40 and 50, typically from heart failure or respiratory failure.

defect in correcting pyrimidine dimers

xeroderma pigmentosum

does sublingual nitroglycerin affect heart rate?

yes, the decrease in left ventricular volume causes a reflexive increase in heart rate (but still decreases O2 demand of heart)

at 8 weeks gestation, the fetus is still separate from the

yolk sac (it becomes the gut)

zafirlukast vs zileuton

zafirlukast: leukotriene receptor blocker (maintenance therapy for chronic asthma) (LTD4 receptor antagonist); zileuton: tx of chronic asthma, inihibits the 5 lipoxygenase pathway and blocks conversion of arachidonic acid to leukotrienes. (inhibits leukotriene production)

the test to screen for celiac disease

celiacs is an autoimmune disease caused by autoantibodues directed agiasnt gliadin, an epitope found in gluten. An IgA transglutaminase antibody assay is recommended as part of initial diagnostic work up. Endoscopic biopsy of the duodenal mucosa confirms the diagnosis.

transformation

cell takes up DNA from donor cell.

VEGF inihibitors (bevacizumab) can treat

wet macular degen, colon/lung/breast cancers

what is another way to express odds ratio besides (a/c)/(b/d) ?

(AxD)/(BxC)

antigenic shift vs drift

(Doktor drift): changes based on random mutation in HA or NA genes; (Night S_ift): reassortment of viral genome segments such as when segments of human flu A virus reassrot with swine flu A virus. Sudden shift is more deadly than gradual drift.

tx for prostate cancer

(for late stage): leuprolide and flutamide

IPEX

(immunodysregulation polyendocrinopathy enteropathy X-linked); mutation of FOXP3 gene which is a regulator for the Regulator T cell lineage. It leads to the dysfunction of regulatory T cells and the subsequent autoimmunity.

ToRCHeS infections

(toxo, rubella, CMV, HIV, Herpes, Syphilis)

moa of dantrolene

(tx for neuroleptic malignant syndrome) inhibits calcium release from the sarcoplasmic reticulum of skeletal muscle (i.e. inhibits the RyR/ ryanodine receptors)

BMI calculation

(weight in kg)/ (height in meters squared). (may need to multiply that answer by 10,000) 18.5 - 24.9 is normal

equation for filtration fraction

FF = GFR/RPF; RPF = RBF x (1 - Hct) therefore FF = GFR/ [RBF x (1 - Hct)]

mid face hypoplasia, shortening of limbs, head circumference in the 90th percentile, hands have space between the 3rd and 4th digits

FGFR3 gene mutation (achondroplasia)

obstructive lung disease PFT

FRC, RV and TLC are increased in obstructive (decreased in restrictive)

most common cause of hereditary aplastic anemia. inherited bone marrow failure syndrome in which cells are at increased susc to chromosomal breakage due to defects in DNA repair. It is characterized by pancytopenia, predisposition to malignancy and physical abnormalities including short stature, microcephaly, developmental delay and cafe au lait skin lesions.

Fanconi anemia

risk of exposure to aflatoxin is greater where? causing increased incidence of what

africa and asia (bc its assoc with grains and peanuts) and it carries aspergillus fumigatus infection

postpartum endometritis

C section is most important risk factor for this due to intro of mcirobial organisms into incised uterus. sx: fever, leukocytosis, uterine tenderness, and foul-smelling vaginal discharge (from bacterial vaginosis, etc)

AIDS infections: <200 CD4 <150 <100 <50

<200 CD4: p jiroveci (TMP SMX) <150: histoplasmosis (itraconazole) <100: toxoplasma (TMP SMX) <50: MAC (azithromycin)

major depressive disorder

>2 weeks

MDD with peripartum onset

>2 weeks of blues. tx with SSRI or CBT

x intercept of lineweaver burk plots is

-1/Km (bigger Km means the x intercept moves closer to zero)

chlorpropamide and tolbutamide

-amide = maid outfit on swan in sketchy. first generation sulfonylureas that can cause a disulfiram-like reaction when taken with ethanol. Patients typically present with vomiting, flushing and tachycardia.

pt has retinal hemorrhages and cotton wool spots and has low CD4 cell count

.cytomegalovirus retinitis. tx with ganciclovir, or foscarnet

homocystinuria results in intellectual disability, marfanoid habitus, and lens subluxation. Untreated homocysteinuria increases patient's risk for thromboembolic events in the third decade of life. the three types of homocystinuria are:

1. cystathionine synthase deficiency (this enzyme uses vitamin B6 as a cofactor), 2. decreased affinity of cystathionine synthase for pyridoxal phosphate and 3. methionine synthase deficiency (uses B12 as a cofactor)

intracerebral neoplasms can raise the intra-cranial pressure through two major mechanisms

1. disruption of the blood brain barrier and 2. obstruction of normal CSF flow. ; disruption of the BBB leads to vasogenic edema which causes the increased ICP.

NNH

1/AR; AR = [a/(a+b)]-[c/(c+d)] AR = attributable risk (difference in risk between exposed and unexposed groups)

accessory spleen

10% of ppl have another small spleen. after splenectomy, these ppl will still be able to process RBC's, etc

hypertension in CAH suggests

11 beta hydroxylase def or 17 alpha hydroxylase def

phase I vs II drug trials

1: tested in disease free volunteers for ADRs. 2: in pts with the disease

1/2 meat LOAF

1st and 2nd lumbricals, median nerve innervates them and the opponens pollicis, abductor pollicis brevis, and the flexor pollicis brevis

which congenital adrenal hyperplasia is similar to the effects of hypovolemic shock on renin?

21 hydroxylase deficiency

syncopal episodes are included in which CAH

21 hydroxylase deficiency bc they get hypotension due to lack of GC's and MC's. 11 beta hydroxylase def is hypertension (due to increased MC's)

alcohol withdrawal sx by time

3-36 hours: tremors, diaphoresis; 6-48 hours: withdrawal seizures; 12-48 hours: alcoholic hallucinosis; 48-96 hours: delirium tremens

DNA polymerase synthesizes DNA strands in a

5' to 3' direction, therefore new nucleotides are added only to the 3' hydroxyl end of the elongating strand (and it reads the template in a 3' to 5' direction)

DNA pol III

5' to 3' synthesis of complementary DNA (requires an RNA primer to initiate synthesis)

kid has stranger anxiety, able to roll over, hold a sitting position unassisted, pass toys from hand to hand and babble. how old?

6 months old (parents start observing (infant 0-12 mo); child rearing working (toddler, 12-36 mo); dont Forget, they're still Learning (preschool, 3-5 yr old)

drugs that reduce mortality in HF (i.e. prevent remodeling)

ACEI's, beta blockers, ARBs, aldosterone antag, hydralazine,

familial hypercholesterolemia

AD, defect in LDL receptor, high LDL, accel atherosclerosis

hypertriglyceridemia

AD, overprod of VLDL, increased TG's, pancreatitis

peutz-jeghers syndrome

AD, pigmented mucocutaneous macules and hamartomatous polyps in the GI tract. progressive growth can lead to malignant transformation.

peutz jeghers syndrome

AD, pigmented mucocutaneous macules and multiple hamartomatous polyps in the GI tract. hyperpigmented mouth, lips, hands and genitalia.

AML vs ALL on histo

AML: granules in cytoplasm, old person; ALL: kid, no granules in cytoplasm

hyperchylomicronemia

AR, defect in lipoprotein lipase or ApoC2, increased TG's, pancreatitis

dysbetalipoproteinemia

AR, defective ApoE, increased chylomicrons, premature atherosclerosis

strict vegan diet for years is at risk for

B12 deficiency

pt has tongue with glazed appearance (i.e. glossitis), megaloblastic anemia, and paresthesias. They are without a weird travel history or a restrictive diet so that means its prob _ caused by _

B12 deficiency caused by pernicious anemia

scleroderma

african american women, atrophy of smooth muscle of lower two thirds of the esophagus and incompetent lower esoph sphincter leading to reflux.

decreased LAP

CML

what type of liver dysfunction do azoles cause

CYP450 inhibition

how does isoniazid interact the cyp system

CYP450 inhibitor

aortic stenosis increases the

afterload on the heart

most significant risk factor for osteoarthritis

age; osteoarthritis is a chronic condition characterized by the progressive erosion of articular cartilage and is most common with advancing age.

fibrinolysis in DIC increases

D-dimer

which DNA polymerase removes the RNA primers and synthesizes new DNA in their place

DNA polymerase I

where do DNA vs RNA viruses replicate in relation to the cell architecture

DNA viruses (except for poxvirus) replicate in the nucleus. RNA viruses (except for orthomyxovirus and retrovirus) replicate in the cytoplasm.

how to diag small bowel obstruction on radiography

air-fluid levels

ARP and class I antiarrhythmic drugs

Different class I drugs can affect the absolute refractory period (ARP). A class IA drug will prolong the ARP because it increases the action potential (AP) duration. A class IB drug will decrease the AP and therefore decrease the ARP. A class IC drug will not change the ARP. Regardless of ARP action, all class I drugs decrease the slope of phase 0.

what substance can potentiate the effects of benzodiazapines

alcohol (leads to respiratory depression)

most common cause of UTI in young sexually active females

E Coli

cold agglutinin IgM mediated hemolytic anemia is caused by antibodies directed to RBCs and often follows infection with

EBV (epstein barr virus), mycoplasma pneumoniae, leukemia or HIV. pts present with anemia, painful gray or purple discoloration of the fingers exacerbated by cold exposure.

most appropriate method of diagnosing HIV infection

ELISA, followed by western blot

Eccrine vs Apocrine glands

Eccrine glands: secrete a watery solution and are stim by direct sympathetic innervation. these are thermoregulatory and used in marathon runners, for example. (most numerous on palms and soles). Apocrine glands: secrete oily, viscous fluid and are stimulated by catecholamines. these are in axillae, areolae, genitals, and anus.

renal tubular defects

F is first, the rest are in alphabetical order: fanconi syndrome (PCT: bicarb, phosphate, etc); Bartter syndrome (thick ascend loop: Na/K/Cl transport); Gitelman syndrome (DCT: Mg, K, Ca); Liddle syndrome (K, aldosterone, Na); Syndrome of apparent mineralocorticoid excess (K, aldosterone)

herniations

Examples: C7 nerve impingement = C6/C7 disc herniation; L5 nerve impingement = L4/L5 disc herniation; everything below T1: herniation hits the descending nerve (the one that traverses the intervertebral space) vs. above T1: herniation hits the nerve exiting that intervertebral level

turcot syndrome

FAP or Lynch syndrome PLUS malignant CNS tumor (i.e. medulloblastoma, glioma). (turcot = turban)

moa of G-CSF

G-CSF is a glycoprotein growth factor that stimulates immature neutrophils to differentiate in the bone marrow by binding a cytoplasmic receptor.

5-FU can cause _ if admin'd orally

GI ulceration if admin'd orally. therefore admin is rec to be IV

nonpolar hydrophobic amino acids

GLAMP TVIP

Ras

GTPase proto-oncogene. (active when bound to GTP).

glucagon acts via what receptors

Gs (GPCRs on hepatocytes)

histamine - alertness

H1 receptors are also located centrally, where they play a role in alertness and emesis

rash on kid that starts on trunk and spreads to face

HHV 6 (roseola)

PAIR

HLA B27: Psoriasis, Ankylosing spondylitis, irritable bowel syndrome, Reiter's syndrome

adenocarcinoma caused by microsatellite instability (mismatch repair defect)

HNPCC; hereditary nonpolyposis colorectal cancer. ppl get colorectal cancer and other cancers like endometrial, ovarian, urinary tract, small intestinal , stomach and biliary cancer.

fetal hemoglobin has what shift in the oxygen hemoglobin dissoc curve

HbF has higher affinity for O2 so its shifted left.

skeletal abnormalities, coarse facial features, corneal clouding and psychomotor retardation

I-cell disease. This is a defect in the ability of the golgi apparatus to send proteins to lysosomes via mannose 6 phosphate phosphorylation and consequently proteins are innapropriately sent to the extracellular space.

IBS vs IBD

IBD: (disease) includes Crohns and UC. IBS: does not cause inflammation/ damage to the bowel like IBD, sx include diarrhea AND constipation.

recurrent mycobacterial (acid fast pneumonia) infections in young child

IL-12 deficiency (bc assoc with macrophages)

ITP vs TTP

ITP: secondary to autoimmune, low platelets; TTP: schistocytes, high LDH, ADAMTS13

tx for direct hyperbilirubinemia from gall stones in common bile duct causing charcot triad (fever, jaundice) is

IV fluids and antibiotics

hepatic veins drain contents of the liver into the

IVC (ergo, IGF and somatomedins are secreted into circulation via the hepatic veins into the IVC)

IVC pressure in portal hypertension

IVC pressure is normal

tx for HBV

IVIG (IgG antibodies to help fight Hep B infection)

which virulence factor contributes to the ability of strep pneumo to colonize the lower lungs

IgA protease is the main colonizing factor of strep pneumo. strep pneumo's main virulence factor is its polysaccharide capsule.

multiple myeloma is assoc with overprodution of which immunoglobulin

IgG (its a monoclonal plasma cell cancer)

most common cause of death immediately after an MI is

an arrhythmia that leads to cardiac arrest (can occur anytime from right after MI to a few days later).

normal CSF and nonenhancing lesions on brain MRI (and CD4 less than 200)

JC virus

JC virus vs CMV

JC virus: PML rapid, multiple nonenhancing white matter T2 weighted hyperintensities. PCR is diag. CMV: enhancing PERIVENTRICULAR white matter lesions in cortical and subependymal regions. histo: giant cells with eosinophilic inclusions in cytoplasm and nucleus.

kaposi's sarcoma vs UC

Kaposi's sarcoma: endoscopy shows hemorrhagic nodules in the GI, and bleeding. UC: bloody stools, endoscopy shows erythematous, adematous, friable, and granular mucosa that begins at the anal verge an entends proximally. neutrophils accumulate in the crypt lumina

equation for loading dose

Ld = (Vd x Cpss)/bioavailability

pigmented nodules on the iris

Lisch nodules in neurofibromatosis type 1 (also has neurofibromas and cafe au lait spots)

glucocorticoids (i.e. cortisol) fxn on glucose

MAKE MORE glucose! (stimulates gluconeogenesis) (also causes body to release FFAs from adipose tissue, breakdown protein/ amino acids from muscle, and breakdown glycogen aka glycogenolysis) cortisol is active in times of STRESS to provide the body with energy

CO =

MAP/TPR or (rate of oxygen consumption)/(arterial oxygen - venous oxygen)

osteomyelitis from staph aureus from IV drug abuse is best evaluated with what type of imaging

MRI

if pO2 gets higher when going from SVC to right atrium there is probably

an atrial septal defect which is causing the right atrium and pulmonic artery to have higher pO2 than normal.

maple syrup urine disease: what sx?

MSUD is due to a defect in alpha ketoacid dehydrogenase, which causes an inability to degrade branched chain amino acids. If isoleucine, leucine, and valine are not eliminated for the diet, infants sustain severe brain damage and eventually die. Infants with this disorder have a characteristic sweet odor to their urine. Dystonia (uncontrolled movement) is another characteristic feature of MSUD.

tx for acetaminophen toxicity

N-acetylcysteine (acetaminophen toxicity sx: anorexia, nausea, vomiting, malaise, can cause hepatic failure)

what is the primary reducing equivalent used in the synthesis of steroids

NADPH, supplies reducing equivalents, generated by glucose 6 phosphate dehydrogenase in the oxidative portion of the pentose phosphate pathway.

firstline tx for acute low back pain

NSAIDs or acetaminophen; prolonged bed rest is assoc with longer duration of pain.

where do thiazides act

Na-Cl channel of the early DCT

sacroiliitis is assoc with what

PAIR (all of the seronegative spondyloarthropathies) i.e. HLA B27 positive ppl

HLA B27

PAIR (psoriatic arthritis, ankylosing spondylitis, IBD, Reactive arthritis

in areas of higher prevalence, the PPV is _ and the NPV is _

PPV is higher and the NPV is lower; increasing the prevalance will increase the likelihood that a positive test is positive and that a negative test may be a mistake.

tamoxifen

estrogen antagonist in the breast, making it effective adjuvant therapy against breast cancer; however it functions as an estrogen agonist in the uterus, increasing the risk of endometrial cancer.

EKG: QT prolongation, ST depression, U waves, T wave inversions, peaked T waves

QT prolongation: hypocalcemia, ST depression: ischemic changes, U waves: hypokalemia, T wave inversions: (ischemia or recent MI), peaked T waves: hyperkalemia

histiocytosis X

RESPIRATORY SX, lytic bone lesions, HSM, lymphadenopathy

alteration in a gene that functions to transduce signals from the cell membrane to the nucleus by activating other molecules. predisposes ppl to malignancy

Ras is a GTP-binding, signal transducing oncoprotein. (part of the MAP kinase system). promotes mitogenesis.

Ras-MAPK pathway

Ras proteins are G proteins linked to receptor tyrosine kinases in the cell memb. Ras is an important G protein for intracellular transmission of signals from growth hormone. It has intrinsic GTPase activity which converts GTP to GDP, inactivating the protein's function. Mutations, such as KRAS, result in constitutive activation of Ras proteins and unrestricted growth. This is assoc with pancreatic cancer, among others. (KRAS is a GTPase)

which type of RNA is the most abundant in the body

Ribosomal RNA makes up a central part of the ribosome. As a result, rRNA is also the most abundant form of RNA in the human body, constituting about 80% of all RNA.

cord levels of pelvic splanchnics AND external anal sphincter

S2-S4 (pudendal nerve is anal sphincter, pelvic splanchnics is erections)

standard error of the mean and z score for 95% CI

SD/sqrt(sample size); 1.96 CI = mean +/- 1.96(SD/sqrt(sample size))

enterocytes contain which glucose transporter

SGLT-2 (sodium glucose cotransporter)

first line tx for social anxiety disorder

SSRI

pt with major depressive disorder presents with restlessness, tremors and excessive sweating. What drug was the pt put on?

SSRI's are first line for MDD. ADR is serotonin syndrome which is mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity.

kid with fever, sore throat and tonsillar exudates

STREP THROAT (streptococcal pharyngitis) - firstline tx is penicillin (beta lactam that blocks cell wall synthesis by inhibiting the PBP's cross linking)

treatment of non-typhoid salmonella mediated gastroenteritis with antibiotics in the absnece of bacteremia can

both prolong the symptomatic course of the disease and increase the risk of relapse. However, in S. typhi, antibiotics (flouroquinolones or ceftriaxone) are indicated.

fatty acid metabolism

Sytrate = Synthesis; CARnitine = CARnage of fatty acids (breakdown)

birbeck granules, found in langerhans cells which are a type of antigen presenting cell found only in the skin, activate which type of cell

T cell (CD4 helper T cell)

referred pain spinal cord segment for early appendicitis (when there is generalized peri-umbilicle pain)

T10 nerve distribution. belly butTEN. this is the point of referred pain in early appendicitis. (dermatome for umbilicus)

TE fistula

TE fistula with esopahgeal atresia manifests with choking, coughing, and an air bubble in the stomach on x ray. (air goes in when the infant breathes)

pt has acute renal failure, hypocalcemia, hyperphosphatemia, and metabolic acidosis. Pt also has cancer. what is the tx for these sx?

This is tumor lysis syndrome. Allopurinol, a xanthine oxidase inhibitor, often used to treat gout, can be used to prevent buildup of uric acid. this happens bc when ppl are treated for cancer, their tumor cells die at rapid pace and release purines and phosphate into bloodstream. purines form excess uric acid.

toxoplasmosis Gondii

ToRCHeS infections (toxo, rubella, CMV, HIV, Herpes, Syphilis) are those transmitted to a fetus transplacentally or during delivery. Congential toxo is caused by transplacental transmission of the parasite. Its thru mom touching cat feces or eating undercooked meat. neonate sx: chorioretinitis, hydrocephalus, and intracranial calcifications.

an increase in the amount of enzyme available in a system will do what to Vmax and Km

Vmax will increase and Km will stay the same

type 1 vs type 2 diabetes

Type 1: Absolute insulin deficiency (beta) cells in pancreas are destroyed. Autoimmune. Minimal or absent endogenous insulin. Thin. Issue with insulin production. Type 2 Diabetes: Issue with insulin attaching to receptors. obese ppl. normal insulin levels. Insulin resistance with an insulin secretory deficit

crohns vs UC. abscesses

UC has abscesses in colonic crypts but crohn's can have perianal abscesses (and fistulas). Crohns also have aphthous ulcers of the mouth and is most common in the terminal ileum. also UC has bloody diarrhea more often.

most common cause of URI

URI/common cold most common cause is: rhinovirus

horseshoe kidney (turner's) can lead to increased risk for

UTI's

split S1 sound: what is the first component

closure of the mitral valve

physiologic dead space

VD = VT x [(PaCO2 - PeCO2) / PaCO2] (peco2 is expired air CO2 pressure)

VACTERL

Vertebral anomalies Anal imperforate Cardiac anomalies TE fistula (E is in this also) Renal Limb defects

wiskott aldrich syndrome

WATER: wiskott aldrich, thrombocytopenia, eczema, recurrent infections

wolff parkinson white syndrome affect on ventricular filling

WPW is aberrant accessory pathway leading to decreased ventricular filling during diastole (bc the ventricle contracts earlier than it should bc the accessory pathway thru the bundle of kent - making it fill less during diastole)

SMA type 1

Werdnig-hoffman disease; autosomal recessive; destruction of the anterior horn cells. manifests with diffuse muscle strophy, hypotonia, fasciculations and decreased deep tendon reflexes. (in babies)

subclavian steal syndrome

When a narrowing or blockage occurs in the subclavian artery proximal to the vertebral artery, vascular demand from the ipsilateral upper extremity can cause blood to flow in a retrograde fashion. The blood flows down the vertebral artery to the distal subclavian artery; this is called the subclavian steal syndrome.

lesch nyhan syndrome

X linked recessive disorder caused by a deficiency in HGPRT, an enzyme in the purine salvage pathway. It results in accumulation of uric acid and is assoc with self-mutilation behaviors, intellectual disability, gout, and movement disorders (muscular hypotonia)

both hemophilia and duchenne muscular dystrophy are

X linked recessive disorders

which stain is used to diagnose TB

Ziehl - Neelson (aka Acid fast) stain

EPO is

a cytokine produced by interstitial oxygen sensing cells of the renal cortex.

irritable bowel syndrome

a diagnosis of exclusion (i.e. no abnormalities such as fecal occult blood, weight loss, abnormal endoscopy or colonoscopy) but pt has vague abdominal complaints (diarrhea, constipation). no pathologic changes are visible on a biopsy specimen. tx: lifetyle mod and dietary changes

MALT lymphoma is

a low grade clonal proliferation of extranodal B lymphocytes (a type of non-hodgkin lymphoma)

standard error

a measure of variability around the mean. the larger the sample size, the smaller the SE.

intussusception occurs when

a proximal segment of bowel telescopes into a distal segment, causing intermittent, colicky pain in young children who are otherwise healthy. A characteristic finding is "currant jelly" stool, which is composed of blood and mucous. If left untreated, venous and lymphatic congestion results in intestinal edema and can cause ischemia, perforation and peritonitis.

pts who have been restrained for a long period are at risk for

a pulmonary embolism (i.e. dyspnea and chest pain) due to venous stasis and thromboembolic disease that follows. tx: intravenous heparin)

locked in syndrome can be caused by

a stroke of the basilar artery (since its on top of the pons then the lesion would be at the pons, impeding horizontal eye movement as well bc abducens nucleus is at pons)

moa of toxic shock syndrome

a toxin that nonspecifically cross-links MHC II with T cell receptors

milrinone

he's one in a million (digoxin sketch); increases cardiac contractility (flexed bicep donkey); causes arteriolor dilation in heart failure, decreases cAMP breakdown; phosphodiesterase inhibitor

tx for third degree heart block (i.e. independent, regular P and QRS waves)

ablation of the AV node

"difference in risk attributable to the intervention as compared with a control" is asking for _

absolute risk reduction (ARR)

accidental vs intentional child injuries by parent

accidental: irregular margins and are asymmetric; intentional: regular margins and are symmetric

resident tells you to get informed consent from pt, what do you do

accompany the resident while the resident obtains signed consent

achalasia vs nutcracker esophagus

achalasia: esophageal motility disorder is the absence of esophageal peristalsis in the distal esophagus and incomplete relaxation of a hypertensive lower esophageal sphincter. Achalasia is caused by the degeneration of inhibitory ganglion cells in the mysenteric (auerbach) plexus. nutcracker: overactivity of esoph smooth muscle in respose to excitatory stimuli and typically presents with dysphagia or reflux sx. barium swallow demonstrates normal peristalsis without esophageal dilation but manometry shows high pressures in the distal esophagus.

compensatory neurohormonal mechanisms of CHF include

activation of RAAS, increased sympathetic output by the CNS, increased secretion of antidiuretic hormone. They do this bc CHF is the inability of the heart to maintain adequate cardiac output.

ethambutol ADR

active TB tx is RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol). Ethambutol toxicity can manifest with reduced visual acuity and red green color blindness, which are sx of optic neuritis.

contraindications to thrombolytic therapy

active bleeding, hx of intracranial bleeding, recent surgery, known bleeding diatheses (unusual susceptibility to hypocoagulability), or severe hypertension.

equalization of end-diastolic aortic and left ventricular pressures is characteristic of

acute aortic regurgitation bc the rise in left ventricular end-diastolic volume occurs too rapidly for left ventricular compensation to occur.

pulmonary edema as a result of heart failure on histo

acute build up of intra-alveolar transudative fluid and the presence of hemosiderin-laden macrophages, representing chronic fluid congestion within the lungs.

jaundice, elevated LFTs, diarrhea and the pt is on an antibiotic

acute cholestatic hepatitis secondary to macrolide toxicity

neurosyphilis

affects dorsal columns and the dorsal nerve roots. Pts present with decreased vibration and proprioception, sensory ataxia, pupillary abnormalities, neurogenic bladder disturbance, and shooting pains.

Km is INVERSE

affinity for substrate is LOW in HIGH Km and vice versa.

alcoholic hallucinosis vs delirium tremens

alcoholic hallucinosis: visual, auditory, tactile hallucinations 12-24 hours after consumption of the last alcoholic beverage. tx: benzos. differentiated from delirium tremens by the timing and severity. Delirium tremens: between 48-96 hours after the last alc drink and lasts 1-5 days. also get tachy, HTN, fever, agitation, lethargy, and diaphoresis. tx: benzos,

dark urine and dark connective tissue

alkaptonuria (def of homogentisic acid oxidase)

defic of homogentisate oxidase

alkaptonuria, leads to build up of homogentisic acid which causes blue black cartilage and skin, darkening of urine on exposure to air and osteoarthropathy

procarbazine

alkylating anti cancer drug, risk for hypertensive crisis bc tyramine bc inhibits MAO

tx for acute promyelocutic leukemia is _ and the moa of it is _

all-trans retinoic acid (ATRA), moa is to promote differentiation of immature cells

autogenic vs allogenic vs syngenic grafts

allo: most common, same species; syngenic: identical twin; auto: self-graft (no need for immunosuppresion)

ADR of etoposide

alopecia

(after) QISSes, (you get a) QIQ (out of) SIQ Super Qinky Sex

alpha1,2, beta1,2, M1-3, D1,2, H1,2, V1,2

moa for resistance to vancomycin (in enterococcus or any bacteria)

alteration in terminal amino acid (D ALA D ALA) of microorganism's cell wall component to D ALA D LAC

MRSA resistance moa

altered PBPs. although the main mech of resistance to beta lactam antibiotics is production of beta lactamase, MRSA has altered PBP2 (penicillin binding protein)

postoperative lung problem thats common

alveolar collapse/ atelectasis (pulmonary lucency on the side of the collapse)

pt takes a med for parkinsons and gets livedo reticularis (purple, lace-like discoloration of skin) and ataxia. whats the drug

amantadine

ventricular fibrillation tx

amiodarone

which CCB is best for woman about to get pregnant that has essential HTN

amlodipine has longer half life than nifedipine

entamoeba histolytica causes

amoebic colitis; which manifests with dysentery (bloody, mucus-containing diarrhea), abdominal pain, and weight loss. Its confirmed by detection of the organism or its antigen. It is common in tropical countries with poor sanitation.

tx for enterococcus (E. feacalis - nosocomial UTI)

ampicillin is used as first line for infections caused by susceptible strains of enterococcus including complicated UTIs, bacteremia, and endocarditis

what is the mech behind breast cancer

amplification (i..e overexpression) of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common

complete molar pregnancy is

an abnormal proliferation of cytotrophoblasts and syncytiotrophoblasts without fetal tissue. due to paternal imprinting, staining with p57 is negative. (a complete mole is distinguished from a partial mole by negative staining for p57). cytotrophoblasts and syncytiotrophoblasts are just placental precursor cells. the complete mole is derived entirely from the sperm.

clozapine is

an antipsychotic (second generation)

lac operon

an inducible set of genes that allows bacteria to use lactose as an energy source when glucose is not available. when glucose is present, the lac operon should not be active because cAMP levels are low. When cAMP is low, it does not bind to CAP (catabolite activator protein - which facilitates binding of RNA polymerase to the promoter) and thus transcription of genes involved in lactose metabolism is not activated. (summary: when glucose is low, cAMP creates CAP which activates lac operon to use lactose)

ITP (immune thrombocytopenic purpura) classically arises after

an upper respiratory tract infection

phase of meiosis that nondisjunction occurs at in down syndrome

anaphase I

normocytic anemia is either nonhemolytic or hemolytic in nature based on reticulocytes. in pts with SLE, anemia is usually secondary to

anemia of chronic disease (nonhemolytic) or autoimmune hemolytic anemia (AIHA)

low serum iron level, low total iron binding capacity (TIBC), and elevated ferritin level =

anemia of chronic disease. Tx is EPO

premenopausal nontender adnexal mass on left shows fluid filled cyst. This is due to

anovulation (i.e. when follicle doesnt rupture). its benign. simple adnexal cyst

what structure is at risk in a dissection surgery of the lower esophagus where it comes out of the right crus of the diaphragm

ant and post trunks of the vagus nerve

all 4 types of transfusion reactions are mediated by

antibodies (this includes ABO incompatibility reaction)

ADRs of tricyclic antidepressants

anticholinergic, antihistaminic, and alpha andrenergic antagonist effects. also affects cardiac conduction.

tx for tourette syndrome

antipsychotic (dopamine antagonist)

long term immunosuppressant therapy drug that is used after organ transplantation

azathioprine

tx of choice for chlamydia

azithromycin

most commonly injured site in traumatic aortic rupture

aortic isthmus (just distal to the left subclavian artery, right before the start of the desc aorta). This is bc the ligamentum arteriosum tethers the isthmus to the pulmonary trunk, rendering this locaiton relatively immobile and vulnerable to tearing during rapid deceleration.

transposition of the great vessels (right to left shunt)

aorticopulmonary septum fails to spiral during development, and the systemic and pulmonary circulations are completely separate, preventing proper oxygenation of systemic blood.

APGAR

appearance (pink/blue), pulse (100), grimace (cry), activity, respiration

greater bioavailability means the drug has greater

area under the curve (i.e. overall greater drug exposure)

exemestane

aromatase converts testosterone to estradiol and androstenedione to estrone. exemestane forms an irreversible bond with aromatase, thereby inhibiting its activity, and is commonly used to treat hormone-responsive breast cancer in postmenopausal women.

tuberous sclerosis

ash leaf spots, shagreen patches, hamartomas in CNS, angiofibromas, mitral valve regurg, rhabdomyoma in heart, auto dom, mental retardation, renal angiomyolipoma, seizures. higher chance of autism.

aspirin overdose sx

aspirin overdose causes tinnitus, a combined metabolic acidosis and respiratory alkalosis will also develop.

samter's triad

aspirin sensitive asthma (triad of nasal polyps, asthma, and aspirin sensitivity)

dermatitis herpetiformis

assoc w celiac sprue and its a skin disorder with clustered vesicles often in a symmetric pattern.

peripheral artery disease and arterial atherosclerosis

atherosclerotic plaques are characterized by eccentric intimal thickening, with a fibrous cap, smooth muscle proliferation, local inflammatory infiltrate and a lipid filled core. Sx of peripheral artery atherosclerosis include exertional leg pain, dermal atrophy and arterial ulcers.

second line tx for pneumocystis jirovecii

atovaquone, primaquine-clindmycin, trimethoprim-dapsone, or pentamidine

ADRs of PPI's like omeprazole

atrophic gastritis secondary to hypergastrinemia, B12 deficiency, weakened bones, and increased risk of C difficile infection and pneumonia.

pt has diarrhea, weakness and watery eyes. works on a farm. tx is:

atropine bc they have organophosphate poisoning (DUMBBELSS sx). atropine is tx of choice (pralidoxime is adjunct therapy)

bullous pemphigoid location

autoantibodies bind lamina lucida, hemidesmosomes of basal keratinocytes at the epidermal-dermal junction

VHL disease is (genetics)

autosomal dominant

von willebrand disease (genetic inheritance pattern)

autosomal dominant

tuberous sclerosis

autosomal dominant disease; presents with a clinical syndrome including seizures, benign hamartomas, subependymal brain tubers, intellectual disability, renal angiomyolipomas, cardiac rhabdomyomas, astrocytomas, pulmonary lymphangioleiomyomatosis, and cutaneous manifestations (i.e. hypopigmented ash leaf spot, shagreen patch, and facial angiofibromas)

jervell and lange-nielsen syndrome

autosomal recessive condition caused by mutated voltage gated potassium channels. individuals commonly present with sensorineural deafness, a fam hx of sudden death, and a prolonged QT interval on ECG (>420 ms)

fanconi anemia

autosomal recessive disorder in which cells have increased susceptibility to chromosomal breakage when exposed to DNA cross-linking agents. Fanconi anemia is clinically characterized by progressive bone marrow failure (pancytopenia) and multiple congenital anomalies, including radial hypoplasia and thumb deformity. tx: bone marrow transplant [if pt has pancytopenia + skeletal abnormalities think fanconi anemia)

pyruvate kinase deficiency

autosomal recessive glycolytic disorder cahracterized by decreased ATP production in glycolysis resulting in a rigid RBC membrane. Changes to the RBC membrane manifest as extravascular hemolysis. Burr cells (echinocytes) are seen on periph smear.

bernard soulier disease

autosomal recessive inherited deficiency of the platelet membrane protein complex GP1b. Bernard soulier disease results in increased bleeding time without affecting PT or PTT. Giant platelets are a characteristic finding on a peripheral smear.

after completing a course of rituximab, what is a pt at risk for

bacterial infections (i.e. bacterial pneumonia) bc deficiency of B cells

tetanus moa

bacterial toxin mediated neuronal blockade (i.e. blocking inhibitory interneurons that would normally release GABA and glycine)

trimethoprim sulfamethoxazole treats MRSA as well. Its moa is

bactericidal agent that blocks nucleotide synthesis

transduction

bacteriophage

histo shows peripheral palisading nuclei and islands of tumor cells.

basal cell carcinoma (gross: pearly borders and fine telangiectasias)

base excision repair defect vs nucleotide excision repair defect

base excision repair: repairs DNA damage involving deamination, depurination and alkylation by ROS, radiation and alkylating agents. defect leads to leukemia and RCC.; nucleotide excision repair: xeroderma pigmentosum

why do ppl with longstanding diabetes get periods of prolonged hypoglycemia after injecting insulin?

bc destruction of pancreatic islets that contain beta cells (insulin secretion) and alpha cells (glucagon secretion)

venous drainage below pectinate

below pectinate is caval bc you have to enter the cave to get into the butt! (above is portal)

thoracic duct drains

below the diaphragm and LEFT thorax and upper limb into junction of left subclavian and internal jugular veins (rupture of thoracic duct can cause chylothorax). Most of the lymph in the body is drained via the thoracic duct. However, the lymph in the right chest, back, arm and neck and head are drained via the right lymphatic duct.

below dentate line and above it: what is the lymph drainage of cancer

below: superficial inguinal; above: superior rectal (then iliac)

tx for theophylline overdose

beta 1 antagonist (metoprolol)

which drug can mask the sx of hypoglycemia

beta blockers decrease HR, contractility and conduction thru the AV node. they can mask sx of hypoglycemia (diaphoresis and tachycardia) by decreasing heart rate.

how do propranolol and verapamil (non-DHPs) affect the pacemaker action potential (the funny current)

beta blockers increase the refractory period (phase 4) by slowing conduction. non-DHPs will effect phase 0 (bc thats the Ca dependent phase)

MS tx

beta interferon

Rhogam is given in order to

bind and remove the RhD antigens in pregnant moms so that they dont form an immune response (i.e. antibodies to RhD) against the antigen in the fetus' blood. given at 28 weeks and at delivery.

where does furosemide act?

binds and blocks the Na - K - 2Cl cotransport system in teh thick ascending limb of the loop of Henle

haptoglobin

binds free hemoglobin

schistosoma haematobium is assoc with which type of cancer?

bladder cancer (i.e. squamous cell carcinoma of the bladder) via long term irritation from the eggs of the trematode (schistosoma). histo: keratin pearls from the SCC

meckel diverticulum location in the GI

blind pouch coming out of ileum. (derived from vitelline duct)

Aminocaproic acid

blocks the conversion of plasminogen to plasmin and is used to reverse bleeding assoc with tPA. (put cap on paint bottle in sketchy)

yellow fever

body aches, high fever, dark vomit. histo: councilman bodies (eosinophilic globules indicative of hepatocytes)

bordatella pertussis and vibrio cholerae have same moa bc

bordatella pertussis disables Gi whereas vibrio cholerae activates Gs which both lead to increased levels of cAMP

borderline personality disorder vs histrionic

borderline: suicidal, efforts to avoid abandonment, impulsive; histrionic: excessive emotionality, attention seeking, sexually provacative behavior

ranitidine vs cimetidine

both are H2 blockers (-tidine = tye dye shirt kids); but ranitidine has less anti-androgenic effects (i.e. doesnt cause gynecomastia and impotence like cimetidine does). Both are used to treat peptic ulcers.

cyclothymic vs dysthymic

both for 2 years or more. cyclothymic: has hypomania (i.e. similar to manic but functional) AND mild depression. Dysthymic: no hypomania, just has mild depression

LTC4, D4 and E4 cause

bronchoconstriction (all except B4 lacrosse girls holding tightly to lacrosse sticks)

aspergillus on histo

broom-like structure on silver staining. TB pts are prone to aspergillomas in lung cavities

person who has CML and is being treated with chemotherapeutic drugs who has pulmonary symptoms. what drug is causing this ADR

busulfan

frameshift is due to insertion or deletion thats not evenly divisible

by 3, thereby disrupting the reading frame

granulomatosis with polyangiitis

c-ANCA, necrotizing granulomas (bull skull on sketchy path in sand trap), in lungs, assoc with necrotizing glomerulonephritis.

medullary thyroid cancer secretes

calcitonin (bc it originates from parafollicular cells (C cells))

NMDA (n methyl d aspartate) channel mediates flow of what ion?

calcium

calcium oxalate stones vs uric acid stones (radio-opaque vs lucent)

calcium oxalate = radiopaque; uric acid stones = radiolucent

fluoroquinolones should not be taken with

calcium, iron or magnesium as these will decrease absorption of the antibiotic

obstructive lesions of the mainstem bronchus

can cause atelectasis (collapse of the lung tissue) distal to the obstruction. This would be shown with complete opacification of lung on chest x ray with tracheal deviation toward the opacification.

where does cancer below the pectinate (dentate) line drain? (lymphnode)

cancer below the pectinate line (i.e. squamous cell carcinoma of the anus) drains to the superficial inguinal node.

myelin speeds the transmission of electrical impulses aka action potentials by insulating the axon and reducing axonal membrane _

capacitance (the ability of a system to store an electrical charge)

acetazolamide

carbonic anhydrase inhibitor that decreases secretion of H+ and increases secretion of HCO3-

episodic diarrhea, flushing, shortness of breath, chest tightness

carcinoid tumors in the bowel, (in the presence of liver metastasis). (malignant carcinoid syndrome), 90% of carcinoid tumors originate from the distal ileum or appendix (eembryological midgut). intestinal carcinoid tumors are often asymptomatic until metastasis to the liver occurs. this is bc the liver inactivates bioactive products secreted into the portal circulation.

which is more responsive to hypotension: carotid sinus baroreceptor or aortic arch baroreceptor

carotid sinus baroreceptor

adenomyosis

caused by the infiltration of endometrial (glandular) cells into the uterine myometrium. Women with adenomyosis present with menorrhagia, dysmenorrhea, and a diffusely enlarged, soft "boggy" uterus on exam.

naegleria fowleri

causes CNS amoebiasis; (brain eating amoeba); fresh water bodies like lakes and ponds. 3 forms: cyst, trophozoite (ameboid), and a biflagellate. Infection is via olfactory cell axons through the cribriform plate to the brain. causes meningitis like symptoms.

arteriovenous fistulas cause what to happen to the left ventricular pressure volume relationship and the heart

causes a rightward expansion and downward contraction of a pressure volume curve. it would cause an increase in preload and decrease in afterload, which causes an increase in cardiac output but would eventually cause high-output heart failure.

why does tumor lysis syndrome cause arrhythmias?

causes excess potassium and low calcium

acute adrenal insufficiency does what to glucose

causes hypoglycemia

busulfan toxicity

causes pulmonary fibrosis, hyperpigmentation, and myelosuppresion

midshaft humerus fracture damages radial nerve at spiral groove. what action is affected

causes wrist drop (i.e. can't do wrist extension). Elbow extension is intact bc the nerve fibers innervating the triceps leave the nerve before it enters the radial groove.

timeline of histo for post-MI

early coagulative necrosis appears 4 hours after an acute MI, with neutrophilic infiltration following at about 24 hours. Neutrophils are eventually replaced with macrophages >3 days after an MI, and contracted granulation tissue is evident within 1 week.

acetaminophen overdose causes what type of liver damage

centrilobular necrosis

cerebro- vs spino- vs vestibulo-cerebellum

cerebro: (aka neocerebellum) includes lateral hemispheres of cerebellum that fxn in motor planning and complex coordination. lesions here have dysdiadokokinesia and intention tremor. theyre laterally located and affect lateral limbs; Spino: (aka vermis) truncal ataxia (drunken sailor, wide based gait, nystagmus), vermis is centrally located and affects central body, degen assoc w alcohol use; Vestibulo-cerebellum: flocculonodular lobe, balance, maintaining posture, and eye movements. lesions: eyes cant follow/track objects.

cerebrum vs cerebellar lesion

cerebrum lesion = paralysis; cerebellar lesion = ataxia

trichomonas is not assoc with

cervical motion tenderness

if question is prerenal azotemia (i.e. heart failure, etc) and they give you BUN and Cr separate (values) you

check BUN/Cr ratio to see which is greater than or equal to 20

muscle weakness, cramps, myalgias and fatigue in a pt whose on loop diuretics

check electrolyte levels, bc this is hypokalemia. replenish to avoid respiratory depression and ventricular arrhythmias.

C5a is a

chemotactic factor for PMNs (neutrophils)

chlorpromazine, chlordiazepoxide, chlorpropamide

chlorpromazine: FGA (antipsychotic); chlordiazepoxide: benzo; chlorpropamide: (maid) sulfonylurea (first gen) for T2DM

what causes the pain after meals in pts with gallstones? (i.e. what substance is secreted that causes this pain)

cholecystokinin (bc it causes the gallbladder to contract and if these people have a stone obstructing the cystic duct, this causes pain). CCK is secreted bc of fatty acids, and amino acids.

Autosomal dominant polycystic kidney disease is what chromosome

chromosome 16

anti-HBc IgG can be present in

chronic Hep B infection and recovered pt who had prior infection with Hep B. if chronic infection, pt has HBsAg. pt who recovered has anti-HBs

negative dihydrorhodamine test

chronic granulomatous disease

Monday Disease

chronic industrial exposure to nitroglycerin can lead to nonatherosclerotic-related cardiac ischemia when exposure is abruptly stopped. Also known as monday disease, pts can experience reflex tachycardia, hypotension, flushing, and headaches.

smudge cells

chronic lymphocytic leukemia

alternative to firstline agents for uncomplicated UTI

ciprofloxacin

which substrate inhibits the rate limiting step of glycolysis

citrate inhibits phosphofructokinase, the enzyme that acts at the rate limiting step of carb metabolism in glycolysis

which enzyme inhibits the rate limiting enzyme of glycolysis and activates the rate limiting enzyme of fatty acid synthesis?

citrate is a key intermediate in the TCA cyle that inhibits phosphofructokinase. It also activated acetyl-CoA carboxylase, thus driving fatty acid synthesis.

tx for WPW

class 1A antiarrhthmics

galactose 1 phosphate uridyltransferase def

classic galactosemia

galactose 1 phosphate uridyltransferase deficiency

classic galactosemia. FTT, jaundice, hepatomegaly, int dis

the deltoid is attached to the inferior side of the

clavicle (at the distal end).

when a specific ion channel opens, the membrane potential will become

closer to that ion's equilibrium potential. sodium potassium pump is 3 sodium OUT and 2 potassium IN. this creates the concentration gradient thats used to generate action potentials. so if you have decreased sodium outside the cell, it messes up that concentration gradient.

on palpation of the injured area, a crackling sound is heard

clostridium perfringens (an obligate anaerobic rod that produces a phospholipase toxin, lecithinase (phospholipase/ alpha toxin) - this toxin causes cellulitis which leads to myonecrosis which causes the crepitus and hemolysis.

myelomeningocele caused by what developmental defective process

closure of the caudal neuropore

the most likely source for liver metastases is

colon (i.e. GI tumors)

pt with LOF of a protein that helps detect and correct base pair errors in microsatellites, short DNA sequences composed of repetitive stretches of nucleotides. this pt will develop what

colorectal carcinoma bc this is lynch syndrome. i.e. microsatellite instability occurs as a result of defective DNA mismatch repair and is the basis for lynch sydnrome (HNPCC).

leiomyomas

common, benign, uterine smooth muscle tumors that can result in endometrial venous dilation, which in turn can lead to heavy menstrual bleeding. Submucosal/ intracavitary fibroids are particularly assoc with anemia. Distortion of the intrauterine cavity can result in reproductive difficulties.

productive cough, chest pain, fever, malaise and lobar consolidation =

community acquired pneumonia; tx: macrolides bc its probably strep pneumo (most common)

blind vaginal pouch

complete androgen insensitivity syndrome (X linked, 46 XY, dude looks like a lady, no axillary/pubic hair) or mullerian agenesis (46XX, absent mullerian system, normal tanner stages)

spindle apparatus

complex structure that is essential for mitosis and meiosis. It involves microtubule polymerization at opposing centrosomes and microtubule capture by kinetochores located on each chromosome's centromere.

intrinsic factor moa

complexes with free vitmain B12 in the small intestine and then binds to receptors on the wall of the terminal ileum.

carcinoid tumors

composed of polygonal, eosinophilic cells that stain positive for neuropeptides such as chromogranin and synaptophysin. They typically arise in the GI tract or bronchus and can be assoc with dramatically elevated levels of vasoactive compounds, particularly serotonin, leading to carcinoid syndrome (episodic flushing and diarrhea).

unmyelinated nerve fibers

conduct action potentials more slowly. Among primary sensory (afferent) fibers, those resp for slow pain, heat sensation and olfaction are unmyeinated. Efferent neurons are all myelinated except the postganglionic autonomic neurons.

conjugation vs transformation vs transduction vs DNAse

conjugation: direct cell to cell interaction causing DNA passing. protected from extracellular environement bc of the conjugation pilus. transformation: when bacteria take up naked DNA from their environment (i.e from lysed cells) and incorp it into their genome. transduction: bacteriophage-mediated transfer of genetic info from one bacteria to another via the bacteriophage. DNAse: degrades DNA in the culture medium released by lysed bacteria, preventing transformation

kaposi sarcoma

consists of malignant proliferations of spindle cells and endothelial cells and can appear on the skin and in the lungs and GI tract. It is an AIDS-defining condition and is associated with human herpesvirus 8 infection. the lesions can appear in any organ, most commonly the lungs, GI tract, and biliary tree. 50% of pts have GI involvement which presents as mucosal bleeding leading to hematochezia, hematemasis and/or melena (black stools)

coagulase enables

conversion of fibrinogen to fibrin (formation of fibrin clots in cases of staph aureus leads to abscess formation).

kayser fleischer rings are deposits of copper in what part of the eye

cornea (descemet's membrane).

what does cortisol do to glucose

cortisol makes fat and muscle cells resistant to the action of insulin, and enhances the production of glucose by the liver.

myocarditis damages the cardiac myocytes, leading to signs of ventricular dysfunction, elevated cardiac enzyme levels, inflammatory infiltration, and myocardial necrosis. Although there are many causes of inflammation of the myocardium, one of the most common viral infections assoc with myocarditis is

coxsackievirus B

dilated cardiomyopathy causes systolic dysfunction of the heart, and results in CHF with sx that include an S3 heart sound and dyspnea. infectious agents leading to this are

coxsackievirus B and trypanosoma cruzii

how does crohns disease cause acute cholecystitis

crohns affects the terminal ileum, which decreases bile acid reabsorption and leads to increased formation of cholesterol stones due to decreased lipid emulsification. Gallstones can obstruct the gallbladder, causing acute cholecystitis, which presents with upper right quadrant pain.

if no time frame given in a stem, the study design is prob

cross sectional

physostigmine

crosses the blood brain barrier to treat anticholinergic toxicity in the CNS.

where are GI stem cells located

crypts of lieberkuhn

the proliferative phase of the menstrual cycle is controlled by

cyclin dependent kinases

B cells can present antigens to CD4 helper T cells which then release

cytokines to activate the B cell, causing it to become a plasma cell and release IgG (isotype switch) antibodies that recognize this antigen, marking those cells for degradation

heme synthesis occurs in both the

cytoplasm and the mitochondria. Mitochondria are involved in the first and final three steps of the pathway. However, the defective enzyme in PCT (porphyria cutanea tarda), uroporphyrinogen decarboxylase, is present in the cytoplasm.

preproinsulin is in the

cytosol (goes to RER where it becomes proinsulin)

what to do to reduce incidence of catheter related bloodstream infections

daily chlorhexidine bathing

which activity most recommended in diabetics (if blood glucose levels are already under control)

daily foot inspection

erb's palsy

damage to C5-C6; affects deltoid, supraspinatus, infraspinatus, and biceps brachii.

median episiotomy is at risk for _ if the incision is torn further

damage to external anal sphincter muscles

premature atherosclerosis and xanthomas (lipid deposits) in the skin and tendons

decreased LDL receptors due to familial hypercholesterolemia (most common inherited lipid disorder)

baby has coughing and choing and its worse during feedings, and it turns blue. there is gastric distension with tympanic sounds on PE. X ray shows gas in stomach.

esophageal atresia with distal tracheoesophageal fistula

female professional runner has focal midline tenderness over the lower thoracic spine after falling in shower.

decreased hypothalamic GnRH secretion due to chronic energy deficits from exercise or restricted caloric intake that suppresses the hypothalamic secretion of GnRH leading to early onset osteoporosis

alkaptonuria

def of homogentisic acid oxidase. results in deposition of homogentisic acid in cartilage (i.e. eyes and ears), kidneys, heart valves. homogentisic acid oxidase is in the tyrosine and phenylalanine pathway. have to limit dietary intake of these substances. (vs phenylketonuria where tyrosine becomes an essential amino acid due to lack of BH4 - tetrahydrobiopterin)

acute intermittent porphyria

def of porphobilinogen deaminase; sx: intermittent epidodes of abdominal pain with neuro manifestations following exposure to an offending med. urine during attacks will darken when exposed to sunlight. Skin photosensitivity is characteristically absent.

albinism gene

defective tyrosinase (cant make melanin)

von gierke disease

defic of glucose 6 phosphatase so all the glucose gets trapped inside cells and they get hypoglycemia.

which two enzymes are impaired in lead poisoning

delta-aminolevulinic acid dehydratase and ferrochelatase are disrupted. results in anemia, abdominal pain, encephalopathy, and peripheral neuropathy. Burton lines can be a sign of lead poisoning (blue lines along the gums).

delusional disorder vs schizotypal personality disorder

delusional disorder: persistant, false beliefs > 1 month without the presence of other psych sx. Functioning is intact apart from the impact of the delusion. Delusional pts are NORMAL besides their delusion (schizo is obviously weird all the time) Schizotypal: eccentric behavior and odd thoughts and perceptions. different than delusional disorder by the absence of clear delusions (i.e. persistant, false, fixed beliefs) (delusional ppl don't have the interpersonal awkwardness)

delusional disorder vs paranoid personality disorder

delusional: 1 month of fixed, false beliefs on ONE TOPIC. theyre otherwise normal Paranoid disorder: pervasive distrust of others (i.e. lots of topics).

the spider angiomas, palmar erythema, gynecomastia, testicular atrophy, Dupuytren's contractures and decreased body hair in alcoholics is from excess

estrogen

a hemangioma is

densely packed capillaries

4 D's of niacin deficiency

dermatitis, diarrhea, dementia, and death (excessive

in staphylococcal scalded skin syndrome, what structures in the skin are disrupted to cause the blisters?

desmosomes; the epidermis separates at the stratum granulosum as a result of binding of epidermolytic toxins A and B to desmoglein 1 (desmosomes) in this layer. results in positive nikolsky sign

drug to suppress the cough reflex

dextromethorphan

autoimmune hemolytic anemia

diagnosed by means of a positive direct coombs test result, which shows antibodies to the patient's red blood cells. It is assoc with elevated lactate dehydrogenase and indirect bilirubin levels and low haptoglobin levels.

S3 heart sound

diastolic (filling) heart sound caused by vibrations of the ventricular wall as it reaches its elastic limit during rapid filling in states of volume overload and/or ventricular enlargement. Maneuvers that increase preload, such as abrupt squatting, passive leg raising, and volume expansion, will accentuate the S3 heart sound.

which drug to give asthmatic that has arrhythmia? (i.e. cant give them a beta blocker)

diltiazem (non-dihydropyridine CCB) bc it has negative dromotropy

if eye is denervated in experiment, which drug would cause pupillary constriction

direct muscarinic cholinergic agonist (i.e. pilocarpine).

tx for HIT

direct thrombin inhibitor (argatroban, bivalrudin)

cromolyn sodium

directly binds to mast cells, etherby preventing their degranulation and release of histamine and leukotrienes. This treats the inflammation and bronchoconstriction of the airways that is characteristic of mild persistant asthma. Omalizumab (monoclonal antibody to IgE) is reserved for severe persistant asthma.

langerhans cell histiocytosis

disorder characterized by monoclonal proliferation of cells derived from myeloid progenitor cells which resemble the langerhans cells found in the dermis and mucosa. LCH often presents with nonspecific symptoms, inclduing fever, rash and bone swelling. On EM: birbeck granules may be seen within the cytoplasm of the aberrant cells. normal fxn of langerhans cells: phagocytosis of cell debris and pathogens

concussion sx are due to

disruption of axonal function

hepatic encephalopathy can be precipitated in severe liver disease pts with the use of

diuretics (i.e. hydrochlorothiazide) bc they cause hypokalemia, metbaolic alkalosis, azotemia, and hypovolemia.

abnormalities in color perception and visual acuity, fatigue, and cardiac depression are potential toxic effects of digoxin. They can be precipitated by hypokalemia, which may be caused by the use of certain _

diuretics (like furosemide)

hirschsprung disease aka congenital megacolon is assoc with

downs syndrome

negative dromotropy

dromotropy is the conduction speed at AV node

if pt develops parkinson-like sx after a long time of being on a certain drug for a chronic condition

drug induced parkinsonism from typical or atypical antipsychotics to treat schizoaffective disorder (or something like it). DIP can also be caused by GI prokinetics, CCBs, and antiepileptic drugs.

defective Apo E

dysbetalipoproteinemia (elevated chylomicrons and VLDL)

paget disease of the breast

eczematous lesions of the nipple or areola and characteristic large, halo-like cells on histo. Full-thickness biopsy that includes lactiferous ducts should always be done due to high suspicion of underlying ductal carcinoma.

a decrease in blood oncotic pressure (as in liver failure or nephrotic syndrome), an increase in capillary hydrostatic pressure (as in congenital heart failure), or a lymphatic obstruction can lead to

edema; Starling eqn: Net fluid flow = Kf [(Pc - Pi ) - ς (πc - πi)]. A positive net fluid flow indicates that fluid will move out of the capillary, and a negative net fluid flow indicates that fluid will move into the capillary.

what is elevated in molar pregnancy (hydatidiform mole) besides beta HCG

elevated beta HCG levels give rise to sx of hyperthyroidism bc of a shared alpha subunit. this type of pregnancy classically presents with triad of hyperemesis, vaginal bleeding, and hyperthyroidism.

pt has elevated gastrin and kidney stones, what else do they have

elevated prolactin bc this is MEN1 and they have pituitary problems, of which the most common is prolactinoma

pseudohypoparathyroidism

end organ resistance to parathyroid hormone due to defects in the PTH receptor and downstream signaling pathways. Pts have hypocalcemia and hyperphosphatemia despite elevated PTH levels. Albright hereditary osteodystrophy is a form of pseudohypoparathyroidism further assoc with short stature and short metacarpal and metatarsal bones. inherited from mom

treatment for hepatitis B

entecavir (or tenofovir) and interferon alpha

picornaviruses are

enteroviruses (and the most common cause of viral (aseptic) meningitis)

virus dies when heated, what outer structure does it have

envelope

histo of atopic dermatitis

epidermal thickening and hypertrophy along with lichenified plaques

sickle cell trait is most commonly assoc with which complication

episodic hematuria

periventricular intracranial calcifications on CT vs diffusely scattered intracranial calcifications

periventricular: CMV; diffusely scattered: toxoplasmosis gondii

internal ribosome entry site feature of mRNA

eukaryotic translation is initiated when the small ribosomal subunit binds the 5' cap of mRNA (facillitated by initiation factors) and scans for the AUG start codon within the Kozak consensus sequence. Internal ribosome entry is an alternative method used by apoptotic cells whereby a distinct nucelotide sequence (usually in the 5' untranslated region) allows translation to begin in the middle of mRNA. this happens during programmed cell death (apoptosis), the activation of caspases results in eIF degradation leading to interruption of translation. bc of this, the proteins needed for apoptosis are translated using this alternative method of internal ribosome entry.

right vs left renal vein

everything nearby on the left comes off the left renal vein (i.e. adrenal blood supply - left suprarenal vein, left gonadal vein). everything on right drains directly to the IVC.

palindromic sequence of DNA

example: TGTACA (bc the matching strand will be the same)

expel normal inspiration = _ , expel maximal inspiration = _

expel normal inspiration = inspriaotry capacity TV + IRV , expel maximal inspiration = vital capacity TV + IRV + ERV

action of gluteus maximus

extends and laterally rotates the thigh and aids in standing from a sitting position. pts with damage to the inferior gluteal nerve will also have difficulty ascending stairs and jumping

integral membrane proteins are anchored within the membrane via

extensive hydrophobic interactions between the amino acid side chains of the protein and the membrane's phospholipid tails

indirect coombs

external RBCs in maternal serum with external anti-IgG (direct would be fetal RBCs in anti-IgG serum)

intravenous injection puts fluid in what space (intra vs extra cellular fluid)

extra CELLular fluid.

angiokeratomas (black papules), acroparesthesia (intermittent periph paresthesias) and heat intol

fabry disease (accum of ceramide trihexoside) def of galactosidase A

middle cerebral artery provides blood flow to the motor and sensory cortex of the

face and the upper limbs

factor 8 vs vWF deficiency presentation

factor 8 (hemophilia A) deficiency: X linked, most common inherited coagulopathy, easy bruising, hemarthrosis and bleeding caused by oral injury. tx is factor 8 infusion. normal bleeding time ; vWF deficiency: increased bleeding time, ristocetin test shows no platelet aggregation,

defective proline hydroxylation leads to

failure of triple helix formation and stabilization by pro-alpha chains during collagen synthesis.

defective Apo B 100

familial hypercholesterolemia (high LDL, cholesterol), defective LDL receptors

aunt and cousin with breast cancer

family hx of breast cancer may have BRCA

ehlers danlos syndrome

faulty collagen synthesis; hypermobile joints is most common type. vascular type is mutation in type 3 collagen

polyarteritis nodosa

fibrinoid necrosis on histo, strong assoc w Hep B, segmental transmural necrotizing inflammation

common estrogen sensitive benign breast tumor in yoiung women. solitary, nontender, firm, well-demarcated, spherical, and mobile nodule corresponding to an encapsulated proliferation of stromal and ductal elements

fibroadenoma

on step, bleeding girls have _ and bleeding boys have _ (i..e increased bleeding time)

girls: vWF deficiency; boys: hemophilia

what drug is used as prevention/ prophylaxis for surgical site infections (i.e. before doing the surgery)

first and second gen cephalosporins (i.e. cefazolin) bc of their excellent activity against gram positive bacteria which are the most likely cause of surgical infections.

tolbutamide

first gen sulfonylurea for T2DM. disulfiram like reaction when taken w alcohol, (maid outfit on swan)

tx for hyperthyroidism

first give them beta blocker, then give them methimazole or propylthiouracil

thiosulfate

first line tx for cyanide poisoning

tx for SIADH

first line: conivaptan, tolvaptan. Second choice: demeclocycline

flu vs URI

flu: fever, muscle aches, dry cough; URI/ common cold (i.e. rhinovirus): rhinorrhea, headache, sneezing, sore throat, postnasal drip (mucus in back of nose)

addison disease tx

fludrocortisone (electrolyte imblance i.e. MC replacement) and dexamethasone (GC replacement)

collapsing glomerulopathy is a variant of

focal segmental glomerulosclerosis characteristic of HIV-assoc nephropathy

how to differentiate folate vs B12 deficiency

folate has NO neurologic sx

what are the arteries, respectively, that provide collateral circ in the hand (radial/ulnar) and the foot (dorsal/plantar)

foot: arcuate artery; hand: arteries of deep and superficial palmar arch

ADRs of interferon alpha

for young patients with chronic hepatitis B infection without cirrhosis, entecavir, tenofovir or pegylated interferon (IFN) may be used to tx. for pts who want to avoid long term treatment, interferon may be used. However, pts should know ADRs are cytopenia, neuropsychiatric sx, autoimmune disorders and ischemic sx.

excretion of what substance increases in acute tubular necrosis

fractional excretion of sodium increases from 1% to greater than 2% in ATN

what is the genetic mutation/ cause of duchenne muscular dystrophy

frameshift mutation (deletion in the dystrophin/ DMD gene).

Duchenne muscular dystrophy (genetics of it)

frameshift mutation caused by a deletion (i.e. frameshift deletions). X linked.

skin lesion with black base, transmitted by a tick, fever, fatigue

francisella tularensis (carried by rabbits or dermacenter tick, leads to ulceroglandular tularemia)

lactose is hydrolyzed to

galactose and glucose

sympathics will synapse at

ganglion. so preganglionic (second order) before synapsing at the stellate or cervical ganglion for instance (when they are outside of the T1-S2 range). When inside of that its prob postganglionic (third order) nerves getting compressed.

weight loss, early satiety, and abdominal pain

gastric adenocarcinoma (periumbilical nodule) (also a virchow node)

which hormone is increased in pernicious anemia

gastrin; pernicious anemia is due to autoimmune destruction of gastric mucosa. Prod of gastric acid is diminished leading to rise in gastrin release.

gaucher disease

gauche such a bro (crying); most common lysosomal storage disease. beta glucocerebrosidase deficiency and glucocerebroside accumulation. Clinical sx: splenomegaly leading to pancytopenia due to rapid splenic destruction of blood cells and skeletal destruction, which can lead to severe bone pain and avascular necrosis

SGLT1

glucose and galactose transporter that enables glucose and galactose absorption across the apical membrane of enterocytes. SGLT1 achieves glucose and galactose absorption by coupling to the sodium gradient, created by the basolateral sodium-potassium pump. Since SGLT1 is not involved in fructose absorption, inhibiting its function would not affect fructose.

protein modification happens in which organelle

golgi apparatus (through addition of oligosaccharides to proteins and lipids, tagging them for delivery to vesicles and lysosomes)

which two conditions both affect type IV collagen

goodpasture (IgG against alpha 3 type 4 collagen) and alports (hereditary connective tissue disease caused by inheritance of a defective form of type IV collagen.

in addition to bergers and PSGN, _ can present after an infection of the pulmonary system.

goodpasture syndrome (usually a virus) (hematuria and hemoptysis)

goodpasture syndrome causes what type of lung disorder

goodpasture syndrome has antibodies against the alpha 3 chain of type 4 collagen. pulm fxn tests show a RESTRICTIVE lung disease pattern with a decrease in FEV1 and FVC and a normal FEV1:FVC

whats a granulocyte; what is myelosupression?

granulocyte: neutrophil, basophil or eosinophil; myelosupression: granulocytes, platelets and RBCs mature in the bone marrow so these are suppressed (i.e. cyclophosphamide does this)

granulosa cell: vs theca

granulosa cel: FSH; theca: LH (in the follicle of the ovary)

group B strep vs group A strep

group B strep is agalactiae; group A strep is strep pyogenes

most common causes of meningitis in an infant/ newborns

group B streptococci, E. coli, and listeria.

peyer patches

gut lymphoid tissue, located primarily in the ileum. M cells in the peyer patches take up antigens from the intestines and present them to B cells, which then secrete IgA antibodies.

fragile X syndrome

happens in boys; CGG (Chin protruding, Giant Gonads) trinucleotide repeat, autism, int dis

cisplatin ADR

hearing loss

tx for hemolytic disease of the newborn vs tx for mom that's pregnant with baby with diff ABO blood type

hemolytic disease of newborn: (baby is born with high bilirubin, etc): tx is exchange transfusion with matched Rh-negative blood; if baby still in utero: give mom Rho (D) immune globulin IV (RhoGAM)

hep B vs C: outcomes

hep B: complete resolution; hep C: lifelong persistent infection

warfarin vs heparin: why does heparin not cross placental barrier

heparin is water soluble and warfarin is lipid soluble, therefore heparin does not cross placental barrier

prolonged oral contraceptive use can lead to

hepatic adenomas, which are benign and often regress after cessation of contraception use

hepatitis E is similar to hepatitis _ in its classification

hepatitis A; nonenveloped, single stranded RNA virus

hepadnavirus

hepatitis B virus is the only DNA hepatitis virus and therefore its called a hepadnavirus

hepatocellular carcinoma can be caused by

hepatitis B, hepatitis C, chronic alcoholism, and fatty liver disease. Pts with risk factors for these who present with RUQ pain and weight loss should raise suspicion for HCC.

brisk, painless rectal bleeding in a child (2 year old). caused by

heterotopic mucosa (i.e. meckel diverticulum from an incompletely obliterated omphalomesenteric duct (vitelline duct)). contains heterotopic gastric tissue that can ulcerate and cause brisk but painless lower GI bleeding.

in a newborn who fails to pass meconium within the first 24 hours of life,

hirschsprung disease is in the ddx. its also known as congenital megacolon, and is secondary to failure of neural crest cells to migrate to the distal colon.

clear corneas, coarse facial features, aggressive behavior, pearly skin lesions

hunter syndrome (def of iduronate 2 sulfatase).

the two histo features of hashimoto's in the thyroid

hurthle cells (eosinophilic metaplastic cells that line follicles) and lymphoid aggregates with germinal centers (it replaces thyroid parenchyma w lymphoid cells in this disease)

vitamin D

increases Ca and PO4 absorption from the intestines

tissue ischemia does what to electrolyte levels

increases extracellular potassium due to reduced fxn of the Na K ATPase and subsequent leakage of K+ from affected cells. ischemia also reduces extracellular Na Ca and HCO3. Cytoplasmic Ca accumulation is a hallmark of ischemic injury.

secretin

increases pancreatic bicarb secretion, decreases gastric acid secretion, and increases bile secretion. neutralizes gastric acid in duodenum allowing pancreatic enzymes to function

Il-12 is critical to the cell-mediated immune response. if pt is deficient in IL-12 you should give them _

individuals lacking IL-12 or its receptor are unable to mediate Th1 helper cell immune responses. For this reason, they cannot activate macrophages via interferon gamma to kill phagocytosed organisms and are suceptible to recurrent mycobacterial infections. Administration of interferon gamma bypasses the need for IL-12 and is helpful for these patients.

what is the cause of aspiration pneumonia in epileptics/ people prone to reduced consciousness?

individuals with reduced consciousness have an impaired cough reflex with incomplete glottic closure that predisposes to the development of aspiration pneumonia. Other risk factors for aspiration pneumonia include dysphagia, NG/ET tubes, upper GI tract disorders and prolonged vomiting.

treatment for acute lymphocytic leukemia is divided into 3 phases:

induction, consolidation and maintenance. induction: vinchristine, L-asparaginase and prednisone.

a posterior hip dislocation can injure the

inferior gluteal nerve which innervates the gluteus maximus.

vascular supply of the parathyroid glands

inferior thyroid arteries supplied by the thyrocervical trunk supplied by the subclavian artery

endometriosis (dysparenunia, chocolate cysts) leads to

infertility

anti-TNF alpha drugs

infliximab (monoclonal antibody to TNF alpha) and etanercept (a recombinant TNF receptor fusion protein)

teres minor vs infraspinatus: which is more commonly injured

infraspinatus. SItS muscles (supraspinatus, Infraspinatus, teres minor, and subscap)

moa of TCA's

inhibit NE and serotonin reuptake from the synaptic cleft.

azoles moa

inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol

antibody target of Hib vaccine

polyribosylribitol phosphate that comprises the type B capsule.

C diptheriae and strep pyogenes both acquire their virulence from

lysogenic conversion which is done via a bacteriophage that infects the bacteria and injects its genome.

firstline tx for mycoplasma pneumoniae

macrolides

if pt gets strep pyogenes and is allergic to penicillin, what drug to tx?

macrolides (azithro or clinda)

why do pts with sarcoidosis get hypercalcemia and hypercalciuria?

macrophage-mediated conversion of vitamin D to its active form.

goodpasture more common in

males (6:1)

multiple myeloma

malignancy in which malignant plasma cells secrete excessive quantities of immunoglobulin. resulting in renal failure, hypercalcemia, lytic bone lesions, and blood component deficiencies.

sudden appearance or rapid spread of acanthosis nigricans means

malignancy within the GI tract or lungs.

sublimation

mature; chanelling unacceptable desires into acceptable behavior

cells pile into small mounds in petri dish

means they are malignant bc normal cells only grow in single layer due to contact inhibition

pts with hodgkin lymphoma who have relapsed from ABVD treatment or cannot tolerate the ABVD regimen can be treated with the MOPP regimen:

mechlorethamine, oncovin (vinchristine), procarbazine, and prednisone.

tardive dyskinesia moa

med induced movement disorder due to prolonged exposure to dopamine-blocking agents which causes upregulation and supersensitivity of dopamine receptors.

femoral fractures causing osteonecrosis: which blood vessel

medial femoral circumflex artery

in a positively skewed distribution the mean is greater than the

median

1/2 meat LOAF

median nerve innervates these. OAF is oppenens pollicis, ABductor pollicis and flexor pollicis brevis. ADductor pollicis is innervated by the deep branch of the ulnar nerve

histo: increased levels of calcitonin in pt with cancer of neck

medullary thyroid carcinoma assoc with MEN2A and 2B (RET mutations)

firstline tx for UC

mesalamine or sulfasalazine (anti-inflammatory drugs)

severe lactic acidosis can occur due to surgical stress in patients who are diabetic and taking

metformin (you'll see an anion gap)

mecA positivity

methicillin resistant (MRSA) i.e. tx with vancomycin

thrombotic thrombocytopenic purpura

microangiopathic hemolytic anemia, thrombotic purpura, fever, renal failure, neurologic abnormalities (AMS).

absence of complement or immunoglobulin deposits on IF is seen with

minimal change disease (i.e. besides effacement, it looks normal)

blood transfusion reactions: within minutes, 1 hour, 1-6 hours, and within 6 hours

minutes: Type 1 HSR; 1 hour & 1-6 hours: type 2 HSR; within 6 hours: donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells.

adverse effect of phenoxybenzamine (long acting irreversible alpha antagonist)

miosis (pupillary constriction) - hard to see at night.

medication to prevent peptic ulcer disease that also is contraindicated in pregnancy

misoprostol (prostaglandin analog used in the prevention and treatment of NSAID-induced peptic ulcer disease (PUD). It also causes uterine contractions and therefore should not be used for the tx of PUD during pregnancy)

increase in left atrial pressure during systole

mitral regurgitation is assoc with holosystolic murmur that is heard at the cardiac apex.

acetyl CoA is an allosteric activator of a biotin dependent enzyme that catalyzes an irreversible step in gluconeogenesis. What is the product of this reaction in gluconeogenesis

oxaloacetate (i.e. pyruvate decarboxylase is the first irreversible enzyme in gluconeogenesis, and converts pyruvate to oxaloacetate)

shorter acting benzodiazepines

oxazepam, triazolam, and midazolam. these have a HIGH risk of causing dependency

pacinian corpuscles, meissner corpuscles, merkel discs, ruffini corpuscles and free nerve endings

pacinian corpuscles: vibration/pressure, meissner corpuscles: fine touch/position sense, merkel discs: pressure/deep touch, ruffini corpuscles: pressure/joint angle change and free nerve endings: A Delta plane is fast but a taxC is slow (Adelta fibers and C fibers) they both sense pain and temperature

the LATERAL spinothalamic tract controls

pain and temperature. LST is located LATERALLY

follicular lymphoma

painless lymphadenopathy, diffuse, bcl-2, non-hodkin lymphoma, t (14;18)

the vagus nerve innervates which muscle of the tongue

palatoglossus

electrolyte exchange of exocrine glands: pancreas vs salivary

pancreas: has HCO3 out and Cl in; salivary: low flow = high potassium excr, low sodium/ chloride excr...high flow = high sodium & bicarb excr, low potassium & chloride excr. ; ileal secretions: alkaline, high flow = bicarb and potassium

gallstones causing pancreatitis due to

pancreatic autolysis due to trypsin. trypsin is released by the pancreas and is first enzyme in the protein digestive enzyme cascade in the GI. inappropriate conversion of trypsinogen to trypsin causes autolysis and necrosis in pancreatitis

weight loss, painless jaundice and migratory thrombophlebitis are signs of

pancreatic cancer (trousseau syndrome)

orphan annie eye nuclei

papillary thyroid carcinoma

histo: grainy laminated calcifications in pt with nodule in anterior neck.

papillary thyroid carcinoma typically presents as a nodule in the anterior neck and may cause hoarseness bc of local compression. assoc with radiation exposure. has Psammoma bodies (grainy laminated calcifications), orphan annie eye nuclei, and nuclear grooves.

the upper optic radiations pass thru the

parietal lobe (the lower pass thru the temporal lobe)

fast to slow: cardiac tissue conduction velocity

park at ventura avenue; purkinje (fastest), atrial, ventricular, AV node (slowest)

slap cheek rash

parvovirus B19

acute interstitial nephritis: drugs that cause it

pee, pain free, penicillins, PPI's, rifamPin (diuretics, NSAIDs, penicillins/ cephalosporins, PPI's, rifampin) AIN can progress to hematuria by becoming renal papillary necrosis

hartnup disease

pellagra, caused by niacin (vit B3) deficiency, can be a result of insufficient dietary intake or a hereditary metabolic disease that leads to reduced renal tubular reabosrption of tryptophan (hartnup disease) the classic triad of pellagra is diarrhea, dermatitis, and dementia (the 3 D's of B3)

diffuse esophageal spasm (DES)

periodic uncoordinated, non-peristaltic contraction of the esophagus that leads to episodic substernal chest pain accompanied by dysphagia. It may mimic other etiologies of chest pain but can be differentiated by normal EKG and normal upper endoscopy findings. barium swallow would show a "corkscrew pattern".

intellectual disability, seizures, musty body odor

phenylketonuria

drugs with zero order elimination

phenytoin, ethanol and high dose aspirin

cardiolipin

phospholipid found in the inner mitochondrial membrane that is targetted in various immunologic conditions. Anticardiolipin antibodies are detected in syphilis, and their presence is considered a nonspecific marker of treponemal infection.

main bacterial factor resp for establishing infection in pts with N. gonorrhea

pili (they use it to establish infection)

lewy bodies

pink staining inclusions that are aggregates of the protein alpha synuclein seen in parkinson disease and lewy body dementia.

tx for pseudomonas

piperacillin/tazobactam, aztreonam, or a fluoroquinolone

which plasmodium species is the only one that has cerebral involvement

plasmodium falciparum

thromboxane A2 causes

platelet aggregation and vasoconstriction

enlarged spleen from portal hypertension backup from a cirrhotic liver will sequester increasing numbers of

platelets within the spleen, causing a low platelet count

pleiotropy vs allelic heterogeneity

pleiotropy: when a one mutation causes several phenotypic effects in the same person (i.e. marfans). allelic heterogeneity: different mutations in the same genetic locus cause similar phenotypes.

esophageal webs, iron deficiency anemia, atrophic glossitis

plummer vinson syndrome tx: iron supp and esophageal dialtion

pneumonia in an immunocompromised pt (AIDS) with dyspnea, fevers, weight loss and fatigue and CD4 of 110.

pneumocystis jirovecii. tx: TMP SMX; TMP SMX can also be used to prevent another infection in the future

polymyositis vs. dermatomyositis (both have anti jo)

poly: CD8 T cells, endomysial; dermato: CD4 T cells, gottron papules, perimysial, rash

primary myeloproliferative disorders

polycythemia vera: rbcs increased, wbcs increased, platelets increased; essential thrombocythemia: platelets increased, jak2 mutation; myelofibrosis: rbcs decreased, jak2 mutation, dry tap, dacrocytes; CML: decreased rbcs increased wbcs, increased platelets, philadelph chromo;

polygonal eosinophilic cells vs sheets of small blue cells

polygonal eosinophilic cells: carcinoid tumor; sheets of small blue cells: small cell lung cancer

morning stiffness in the shoulders and hips is a sx of

polymyalgia rheumatica, (assoc with giant cell arteritis) tx: prednisone

rhabdomyolysis UA

urine dipstick shows blood but UA shows absence of RBCs on microscopy.

what is implied or required under Good Samaritan laws

use of standard of care

schilling test

used to identify patients who have vitamin B12 deficiency because of a lack of instrinsic factor.

quinine

used to treat malaria caused by infection with plasmodium falciparum and can precipitate development of cardiac arrhythmias, such as torsades de pointes, a life threatening ventricular arrhythmia

shingles in what age

usually adults >50 y/o, but can happen in any age that has already had infection with the primary varicella zoster infection (chicken pox) (especially if it happened in first year of life).

variable expressivity vs mosaicism

v. expressivity: distinct genotype has varying phenotypic expressions. marfans can do this. mosaicism: multiple sets of genetic info found in Dad or Mom. Results in affected offspring without parent being affected.

recurrent laryngeal nerves branch off of

vagus nerves

painless masses in the scrotum that do NOT transilluminate

varicocele (enlarges w standing, regresses w laying down), testicular cancer (does not change in size with position).

angiogenesis is driven by two factors:

vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF). VEGF increases endothelial cell proliferation and leads to new capillary formation. FGF also leads to endothelial cell proliferation, but unlike VEGF, it is involved in additional processes such as hematopoiesis and wound healing.

which cells are directly responsible for the synthesis of the fibrous cap overlying the arterial atherosclerotic lesions

vascular smooth muscle cells are responsible for the secretion of matrix proteins, which ultimately form the fibrous cap of mature atheromas.

what will happen to vasopressin levels in nephrogenic diabetes insipidus

vasopressin levels are increased due to vasopressin resistance in the renal collecting ducts.

vinca alkaloids vs taxanes

vinca alkaloids: inhibit microtubule assembly. Taxanes: inhibit microtubule disassembly.

pediatric pt with tetany (intermittent muscular spasms), hypocalcemia, cardiac anomalies, recurrent viral/fungal infections

viral infections = T cell deficiency. that with hypocalcemia, means digeorge syndrome. which means that the pt will have underdeveloped paracortex in the lymph node secondary to thymic hypoplasia/ aplasia and consequent T lymphocyte deficiency.

which vitamin is stored in hepatic stellate cells in the space of Disse (in their cytoplasm)

vitamin A

eggs overingestion

vitamin A toxicity

cephalosporins long term use (and other broad spectrum antibiotics) can cause

vitamin K deficiency

vomiting leads to loss of _ and _ resulting in decreased ECF which activates the RAAS system. this causes what electrolyte exchanges to occur in the kidney

vomiting leads to loss of volume and protons. leads to increased Na absorption in exchange for K and H+ at the PCT. this contraction alkalosis is secondary to volume depletion and worsens the metabolic alkalosis that was already there from vomiting.

pheochromocytoma, hemangioblastomas, and renal cell carcinoma is

von hippel lindau syndrome

after thyroidectomy, pts must be treated with levothyroxine to prevent the sx of hypothyroidism which include

weight gain, cold intolerance, and fatigue. (i..e decreased lipolysis, and decreased gluconeogenesis - bc thyroid hormone stimulates gluconeogenesis)

alcoholic cerebellar degeneration vs wernicke korsakoff

wernicke korsakoff: confabulation, thiamine deficiency, mamillary bodies, horizontal nystagmus, ataxia. ; alcoholic cerebellar degeneration: long term alcohol use, cerebellar vermis degen, gait ataxia, truncal instability, rhythmic tremor of hands