Combo with "NBME 11 Notes" and 9 others
Antigenic variation of trypanosomes
"Programmed rearrangement"
Sudden withdrawal of what drug leads to life threatening symptoms?
***barbitals
Histidine makes what
--B6-->histamine
1-3 Atelectasis, pneumonia 3-5 UTI 5-7 Wound Walking
...
Light's criteria:
1) pleural protein/serum protein > 0.5 2) pleural LDH/serum LDH > 0.6 3) pleural fluid LDH > 2/3 upper limit of normal for serum LDH exudative effusions due to: ->infection, ->malignancy, ->pulmonary embolism, ->connective tissue disease, ->iatrogenic
What can cause increased BUN/cr ratio
1) prerenal 2) GI bleeding 3) steroid admin
signs of CLL. treatment
1. 60s/70s 2. painless lymphadenopathy 3. smear: smudge cells treatment: rituximab
Presentation of superior vena cava syndrome
1. headaches worse when leaving forward 2. JVD but no peripheral edema 3. Facial and upper extremity swelling 4. Collateral veins, conjunctival congestion
Superficial perineal pouch
1. ischiocavernosus muscle --> crus of the penis and clitoris 2. Bulbospongiosus = bulb of penis and build of vestibule 3. superficial transverse perineal muscle = related to the perineal body of both genders
Most effective way for aborting cluster headache
100% o2
What chromosome is beckwith wiedemann associated with
11
-Cause of renal cell carincoma. Risk factor?
2- napthylamine exposure
When can you begin heparin use after surgery
2-3 days
Goal INR in patients with prosthetic valves
2.5 to 3.5
pH in candidiasis
4-4.5. normal range.
Bedwetting is normal before what age
5
2 fold increase in creatinine sign of
50% reduction in GFR
Transudative fluid pH
7.4 to 7.55
Infants and children less than what age with first febrile UTI must get ultrasound
< 24 months
Patients who receive transfusion + hemolysis + fever + DIC within an hour =
Acute hemolytic transfusion reaction
What causes ventricular contraction rate in a patient in atrial fibrillation?
Atrial fibrillation occurs due to irregular, chaotic electrical activity within the atria Some of the atrial impulses are transmitted to the ventricles, but most are not. this is due to the AV nodal refractory period.
Treatment of afib with RVR
Beta blockers OR CCBs
EEG: sharp wave complexes =
CJD
Lithium induced Nephrogenic DI, where?
Collecting tubule
Tuberous Sclerosis Triad
Facial Angiofibromas Seizures Mental Retardation
Patient on seizure meds + megaloblastic anemia =
Folate deficieny due to phenytoin
27 year old man has solitary thyroid nodule that takes up iodine.. Most likely cause??
Follicular adenoma (too young for papillary carcinoma)
Switch sides for Picmonic Quiz
Good
What physical exam maneuvers help bring about an aortic regurgitation murmur?
Have the patient lean forward (brings the valve close to the chest wall) and at end expiration (listening during expiration often accentuates left-sided heart murmur)
Dendriform corneal ulcers =
Herpes zoster opthalmicus
Meniere's disease affects what part of the ear
INNER ear not middle ear
What second messenger increases ca2+
IP3
Abducens nerve palsy
Injury to abducens nerve -> paralysis of lateral rectus -> inability to abduct the affected eye Affected eye is fully adducted by the unopposed action of the medial rectus that is supplied by CN III
Treatment of histoplasmosis
Itraconazole
Adrenal insufficiency labs
Low ACTH, low cortisole, normal aldosterone
PAS + blast cells =
Lymphoblasts
What are the 2 most important factors for osteoclastic differentiation and where do these 2 factors come from?
M-CSF (macrophage colony-stimulating-factor) and RANK-L these both come from osteoblasts
1st pouch
Middle ear cavity, eustachian tube, mastoid air cells Tympanic membrane
Myotonic dystrophy characteristics
Muscle fiber atrophy: type 1 loss difficulty loosening ones grip CTG repeat: myotonia protein kinase cataracts in all patients frontal balding/gonadal atrophy
Does Carbon Monoxide affect the PaO2 and does it precepitate methemoglobinemia?
No and no. PaO2 remains normal (~95) Methemoglobin is formed when the Fe2+ (ferrous) in heme is oxidzed to Fe3+ (ferric iron). Methemoglobinemia results from drug exposures (dapsone, nitrates) as well as enzyme deficiencies and hemoglobinopathies.
Bronchiectasis and pneumothorax
No association
Chest tube placement with hydrothorax
Not recommended as pleural fluid will reaccumulate and large volume loss leads to electrolyte depletion
Treat oral candidiasis?
Nystatin
Chronic renal failure blood lab (pt,ptt...)
PT, PTT, PC= Normal BT= Increased uremia
-Secretin increase what?
Pancreatic bicarb
Diphtheria Rx
Passive immunization: Diphtheria antitoxin (greatest effect on prognosis) Antibiotic: Penicillin or erythromycin Active immunization: DPT vaccine
Who is likely to get babesiosis
Patients with functional asplenia/splenectomy
Symmetric circumferential narrowing of esophagus =
Peptic stricture
Site of T cells in splenic sinusoids
Periarterial lymphatic sheat
Eikenella corrodens in blood =
Periodontal infection
Cause of NAFLD
Peripheral insulin resistance --> increased lipolysis + uptake of fatty acids --> fatty acid oxication
Patient with vitiligo + atrophic glossitis + megaloblstic anemia =
Pernicious anemia
plasma osmolality and urine osmolality and urine sodium in SIADH
Plasma: hypoosmolality urine: high osmo (>200) urina na: high >30
What is unique to cardiac muscle actions potentials, and what channel mediates it?
Plateua, characterized by the opening of L-type dihydropyridine-sensitive Ca++ channels and the closure of some K+ channels thus, the membrane becoems highly permeable to Ca++ ions and minimally permeable to K+ ions
Oculomotor palsy from aneurysm?
Posterior Communicating Artery Anuerysm
2 risk factors for RDS
Prematurity and diabetic mothers
liver biopsy:extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts
Primary biliary cirrhosis
Episcleritis is associated with
RA and IBD
complications of prematurity
RIP BRE: RDS IVH: germinal matrix--> lat ventricle PDA Bronchopulmonary dysplasia Retinopathy of prematurity necrotizing Enterocolitis
retrovirus is what
RNA dependent-DNA polymerase
If untreated, hyperthryoidism can cause
Rapid bone loss
-Kidney venous PO2 is higher than others, why?
Ratio of oxygen consumption to blood flow is lower in kidney than in other organs
Management of simple renal cyst
Reassurance
Colon cancer presentation
Rectosigmoid>ascending>Descending Ascending: WIPE: exophytic mass, iron def. anemia, weight loss, vague pain Descending: CHIME: infiltrating mass, partial obstruction, colicky pain, hematochezia S.Bovis-endocarditis
Systolic-diastolic abdominal bruit =
Renal artery stenosis
Sickle cell
Renal papillary necrosis
thyroid: extensive stromal fibrosis extending beyond the thyroid capsule
Riedel's thyroiditis
Drug that act as D2 receptor agonist. what is drug?
Ropinirole
Treatment of OCD
SSRI like fluoxetine
Slight touch of skin eliciting severe pain =
Shingles
Cause of spitting up in babies
Shorter esophagus, decreased angle between stomach/esophagus, incomplete closure of LES, greater time spent supine
2nd Branchial arch
Smile, Nerve: VII Reichert's Cartilage: Stapes, Styloid process, lesser horn of hyoid, Stylohyoid ligament Muscles of facial expression, Stapedius, Stylohyoid, post. belly of digastric
Evaluation of aortic dissection without using CT
TEE
What does genomic imprinting refer to?
The phenomenon in which an offspring's genes are expressed in a parent-specific manner It occurs via an epigenetic process that alters phenotype of an organism independent of genetic code DNA methylation: mutes gene expression is important in imprinting
What is the cardiac auscultatory finding in atrial septal defect?
Wide splitting of S2 that does not vary with respiration.
Treatmetn of acute cholecystitis: surgery delayed or within 72 hrs
Within 72 hrs
Zanamavir MOA
Zanamivir MOA - inhibit virion release
adenocarcinoma
a malignant epithelial tumor with tubular, acinar, orpapillary growth patterns, and/or mucus production by the tumorcells.
systemic mastocytosis causes
abnormal proliferation of mast cells: increased histamine secretion
membranoproliferative glomerulonephritis causes nephritic or nephrotic syndrome
acc to u world: nephritic
complications of ventilation with high PEEP:
alveolar damage, tension pneumothorax ->sudden onset shortness of breath, ->hypotension, ->tachycardia, ->tracheal deviation ->unilateral absence of breath sounds.
Histological sign of diffuse alveolar damage
alveolar hyaline membrane
bupivicaina MOA
amide local anesthetic = decreased permeability of Na
Adults: pseudomonas?
amikacin/ceftazidime/cipro
most common brain tumors in adults
astrocytomas
alpha helix to beta sheets involves
breaking and reforming H-bonds
Arsenic poisoning Rx
chelating agents: dimercaprol, succimer, penicillamine
Treatment of endometrial hyperplasia WITHOUT atypia
cyclic progestins
cheyne stoke breathing
cylic breathing in which apnea is followed by gradually increasing tidal volumes and then gradually decreasing tidal volumes until next apneic period PaCO2 rise=apnea PaCO2 max-hyperventilation to overcompensate
What causes isolated systolic hypertension in elderly patients?
decrase in the compliance of the aorta and its proximal major branches
Cause of thrombocytopenia is wiskott-aldrich
decreased production
renal biopsy of DM
diffuse glomerulosclerosis
Hypochondriasis requires
disproportionate fear of serious illness
CREST achalsia
dysmotility and decreased LES pressure
hyochondriasis
fear of serious disease
Oral treatment of candida
fluconazole
receptor-mediated endocytosis occurs
forms clathrin-coated vesicles uptake of cholesterol mediated by LDL receptor
Pott's fracture
fracture dislocations of the ankle joint reason = forces eversion (abductioin) of the foot the deltoid ligament avulses the medial malleolus and after that fibula fractures at a higher level
Arterial supply of anterior abdominal wall
from: 1. femoral artery --> superficial circumflex arterty and superficial epigastric 2. internal thoracic --> musculophrenic and superior epigastric 3. external iliac --> inferior epigastric and deep circumflex
meckel's- what 2 tissue types
gastric + pancreatic
Insulin increases?
glucokinase activity
a weird complication of thoracentesis
hemothorax. intercostal arteries that course along underside of ribs result in bleeding that accumulates in pleural space
Cystocele
hernia of bladder- loss of bladder support in females by damage to the pelvic floor during childbirth It can result in protrusion of the bladder onto the anterior vaginal wall and loss of urine when a woman strains or coughs
achilles tendon reflex
herniation of L5/S1
pinpoint pupils, unconscious
heroin OD
Hyperestrinism in cirrhosis causes
higher binding of testosterone/ decreased ability of liver to metabolize estrogens spider angiomata (estrogen= vasodilatory) Men: gynecomastia, testicular atrophy, decreased body hair women: palmar erythema, soft skin, female hair distribution
sarcoid
hilar adenopathy and non-caseating granulomas. treat with steroids.
bevacizumab properties
humanized antibody inhibiting VEGF
ACE inhibitors ---bradykinin leading to increased vasodilation, permeability & pain
increase
NT defects markers
increased AFP and AChE Failed fusion
Cardiac Hypertrophy (Left atrial)
left atrial enlargement (hypertrophy) secondary to mitral valve failure, may compress on the esophagus and manifest as dysphagia (difficulty in swallowing) may be observed as a filling defect in the esophagus by barium swallow on lateral thoracic x-ray
Aspirin induced asthma is due to
leukotrienes
aspirin induced asthma mediated by? Treat with?
leukotrienes (montelukast, zirlukast)
high osmolarity in kidney means what
most concentrated (LOH)
What medication should be avoided in glaucoma
mydriatic agents like atropine
baby with bacterial infections; makes O2-; H2O2 but HOCl is decreased; what is she deficient in?
myeloperoxidase
Elevated PCWP + hypotension =
myocardial contusion
Greatest risk for death a few weeks after strep infection and PE that reveals pericardial friction rub and quiet heart sounds, but not pathogens
myocarditis
Cardiac tumor with scattered mesenchymal cells in an abundant extracellular matrix
myxoma
relative polycythemia
normal: RBC mass, O2 stat decrease plasma: dehydrated, excessive diuressis Hct>48F, 52M
Cyanide nitroprusside test is used for what
Cystinuria
Hexagonal crystals =
Cystinuria
PaO2/FiO2 value in ARDS
Decreased (<300)
Pain upper abdomen, refered to shoulder
Diaphram ulceration phrenic nerve
Management of increased BP with OCP use
Discontinue
Mechanism of niacin flushing
Drug-induced release of histamine and prostaglandins
What are bitot spots
Dry, silver-grey plaques on bulbar conjunctiva --> vitamin a deficiency
HSV + atopic dermatitis =
Eczema herpeticum
Mass on ovary + infertility =
Endometriosis
Dx perianal egg deposition
Enterobius vermicularis (pinworm)
Cause of endocarditis with UTIs
Enterococci faecalis
-High thyroid during pregnancy due to what?
Estrogen
Cause of baker's cyst
Excessive fluid production produced by inflamed synovium
metabolism of energy
per gram: pc4f9
AML cells stain for
peroxidase
CN 7-->12 pass through
posterior cranial fossa
Neuraminidase inhibitor mechanism of action
prevents release of virus from infected epithelial cells
Contraindication for raloxifene
prior DVT
colle's fracture
results from forced extension of the hand usually as a result of trying to ease a fall by outstretching the upper limb. distal fragment is displaced DORSALLY, dinner fork deformity, often ulnar styloid process is avulsed (broken off)
cardiomyopathy due to hemochromatosis can be reversed if caught early, however _______ cannot
sarcoid, scleroderma amyloidosis.
-Polio vaccine, what does it do?
Increase neutralizing antibodies in circulation
CHF patient has pleural effusions, pleural fluid: 80 glucose, 2 protein, 25 LDH, 500 nucleated cell ct. What is cause?
Increased hydrostatic pressure
Laryngeal neoplasm in a smoker
squamous cell
Hydronephrosis causes?
Increased tubular hydrostatic pressure from blockage
Acclimatization to high altitude
Increased ventilation: decreased PO2 and PCO2: Resp alk: inc pH Inc EPO: Inc Hct, Hb Inc 2,3 BPG: binds to Hb so the Hb releases more O2= increase unloading R shift Inc mitochondria Inc renal bicard excretion to compensate Resp Alk
What is primary polydipsia
Increased water intake that leads to dilute urine and hyponatremia
Obstructive lung volumes
Increased: TLC, FRC, RV RV/TLC= increased TLC/RV= decreased Decreased FEV1> dec. FVC FEV1/FVC: <80%
increased cholesterol (+ Tg)
statin + niacin or ezetimibe
Most common source of infection in Ludwig
Infected tooth
What is dacryocystitis
Infection of lacrimal sac
what is most commonly associated with splenic abscess
Infective endocarditis
Peripheral pulmonary cavities seen in HIV IV Drug users
Infective endocarditis due to Staph aureus
Broca's is which area
Inferior frontal
DNA polymerase I
synthesis 5'->3' and proofreads 5'->3 removes RNA primers(3oh groups)
How can macrophages reduce plaque stability?
Inflammatory macrophages in the intima may reduce plaque stability by secreting METALLOPROTEINASES, which degrade collagen.
Erectile dysfunction is caused by decreased
testosterone
Methotrexate anticancer effects?
Inhibition of Thymidilate Synthase
What organ is associated with max oxygen extraction from the blood?
the heart
Statistically define incidence:
the number of new cases of a disease per year divided by the total population at risk
What does not correlate well with the severity of Mitral Regurgitation?
Intensity of a holosytolic murmur that radiates to the axilla; it does not correlate well with regurgitatnt volume
Cerebellar dysfunction due to alcohol presents with what type of tremor
Intention
Trauma to the soft palate with a foregin body + stroke = cause
Internal carotid artery dissection
Stroke + vomiting + stuporous = what type of stroke
Intracranial bleeding
what is the treatment of choice for diabetic ketoacidosis?
Intravenous hydration with normal saline and insulin
HSP has an increased risk of what
Intussusception due to bowel wall edema and localized hemorrhage
Follicular cancer vs. adenoma
Invasion of capsule and blood vessels
What kinds of methods, invasive or noninvase, are used to assess the necessary parameters (O2 consumption, arteriovenous O2 difference) to determine cardiac output by Fick's principle?
Invasive methods
Most common cause of anemia in patient with OA
Iron deficiency
Treatment of vaginal foreign body in child
Irrigation with warmed fluid
What is incised to cut out renal cell carcinoma?
transversalis fascia
The patients treated with the new drug the duration of the outbreak was 1week, instead that the duration of the patients treated with the placebo was 2 week= what happens to prevelance?
It mean that the prevalence in the group treated with the new drug ↓ by half
What type of action does sumatriptan have on 5HT 1b/1d receptors
It works as an agonist
In what heart condition do we hear the Ken-Tuck-y murmur?
It's a classic S3, which may be normal in young patients and in well-trained athletes. In older adults, though, it's typically a sign of left ventricular failure So will have patients of exertional dyspnea and difficulty sleeping
Triple bubble sign =
Jejunal atresia
torsades de pointes diseases
Jervell and lange Nielsen syndrome(AR): also have congenital sensorineural deafness Romano-Ward syndrome (AD): no deafness
Where is the best place to harvest the great saphenous vein from, surgically?
Just inferolateral to the pubic tubercle
Term for fragmentation of nucleus during apoptosis
Karyorrhexis
What urine value seen in hyperemesis gravidarum
Ketonuria
What patients are at greatest risks of PDA?
Kids born prematurely Kids with cyanotic Heart Disease
What are the two major microtubular motor proteins? Which does anterograde axonal transport, which does retrograde axonal transport?
Kinesin, Dynein Kinesin: Anterograde Dynein: Retrograde`
Which microtubule associated protein aids in anterograde transport of intracellular vesicles and organelles? Which end of the microtubule do they go towards?
Kinesin. Towards the (+) rapidly growing end.
Cryptorchism
undescended testes (cyrptorchism) when the testes fail to descend into the scrotum. this normally occurs within 3 months after birth. The undescended testes may be found in the abdominal cavity or inguinal canal
Horner's syndrome is associated with what arm palsy
Klumpke palsy
long-chain-fatty-acids?
LCFA - peroxisomes
What genetic defect leads to formation of tendon xanthomas?
LDL receptor defect (NOT ApoC2
LDL/HDL in diabetics
LDL surface phospholipids are replaced by TGs in diabetics: subsequent removal of surface TGs in liver by hepatic liapse results in highly atherogenic small dense LDL serum HDL- low
Post MI complication
LV free wall rupture 3-7 days post (r/f: age>60, F, pre-HTN, abscent LV hypertrophy, first MI) mcc death: ventricular failure post infarct fibrinous pericarditis: 1-3 days (overlying necrotic segment of myocardium) previous MI: fibrosis of pericardium wks
Migratory arthralgias + monoarticular arthritis =
LYME disease
Dysarthria + clumsy hand stroke location
Lacunar stroke at basis pontis
Unilateral solid mass on ovaries during pregnancy, next step
Laparotomy/laparoscopy biopsy to rule out malignancy
-Surgical neck fracture, what is cutaneous problem?
Lateral aspect of arm lose sensation (axillary nerve)
Nystagmus + ptosis = stroke located where
Lateral medulla
So it's a biostats question and there's a lot of jargon about a new screening test and patient's surviving longer? What do you think about?
Lead-Time bias
structure that attaches to the cervical region and extends posteriorly
uterosacral ligament
quickest way to relieve pain in a mi
venodilation
prospective study
who will develop the disease?(already exposed) cohort
Positioning of patient with affected lung in the dependent position causes what
worsening of physiologic shunting
Pseudomonas infections
wound and burn patients Pneumonia (esp in CF) External otitis (swimmers ear) UTI Drug use and DM osteomyelitis hot tub folliculitis Malignant otitis externa
What are the 4 collagen subtypes, where is each found, and what are associated diseases with each?
(1) Dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue; osteogenesis imperfecta (2) cartilage, vitreous humor, nucleus pulposus (3) skin, lungs, intestines, blood vessels, bone marrow, lymphatics, granulation tissue Ehlers-Danlos Syndrome (types 3 and 4) (4) basement membranes Alpart Syndrome
How does ANP affect the following organs: (1) kidney? (2) adrenal gland? (3) blood vessels?
(1) Dilates the afferent arterioles, increasing GFR and urinary excretion of sodium and water (diuresis); also limits sodium reabsorption (in proximal tubule) and inhibits renin secretion (2) restricts aldosterone secretion --> increase in sodium and water excretion by the kidneys (3) relaxes vascular smooth mucles, producing vasodilation; also increases capillary permeability, leading to fluid extravasation to the interstitium and a decrease in circulating blood volume
What are 3 specific features that distinguish heart circulation from the blood flow provided to skeletal muscle and viscera? (this is a pretty vague question so if you don't get it, just be sure to read the 3 points on the back)
(1) Heart muscle is perfused during diastole and consumes approximately 5% of cardiac output (2) The myocardial oxygen requirement is very high [heart has a capillary density far exceeding that of skeletal muscle, and oxygen extraction from arterial blood is very effective within the heart: resting myocardium extracts 75% to 80% of oxygen from the blood, while myocardium at work extracts up to 90% of oxygen from the blood] (3) Coronary flow is regulated by local metabolic factors, including hypoxia and adenosine accumulation
What are the characteristic ECG findings of a patient in A-fib?
(1) absent P waves replaced with chaotic f (fibrillatory) waves (2) irregularly irregular R-R intervals (3) narrow QRS complexes
What are the ECG hallmarks of A-Fib?
(1) absent p-waves (2) irregularly spaced ventricular contractions (3) variable r-r intervals (showing (2))
alveolar ventilation (L/min)
(TV- Dead space vol) x Breaths/Min
tennis elbow
(lateral epicondylitis) repeated forceful flexion and extension of the wrist resulting strain attachment of the common extensor tendon and inflammation of periosteum of lateral epicondyle. pain over lateral epicondyle and radiates down posterior aspect of forearm. pain often felt when opening a door or lifting a glass origins of following muscles may be affected: extensor carpi radialis longus and brevis extensor digitorum extensor digiti minimi extensor carpi ulnaris
avulsion fractures of the hip bone and hamstring muscles
*muscles attached to ischial tuberosity = hamstring (biceps femoris, semitendinousus, semimembranosus) innervation: tibial nerve (except short head of biceps is common fibular)
use light's criteria to determine if pleural fluid is exudate or transudate. then determine if the fluid is complicated or uncomplicated. complicated fluid has
+ gram stain, + culture, ph < 7.2, glucose < 60 requires chest tube drainage ->unlikely to resolve spontaneously with antibiotic therapy. Can progress to empyema. infection (pneumonia) is a much more likely cause than pulmonary embolism.
Insensate, hypopigmented patch of skin, diagnosis?
Leprosy, skin biopsy
-Gastric band surgery, needs to pass through what?
Lesser omentum
Chalazion
Lid discomfort, hard, painless lid nodule
Organs drained by the celiac lymph node
Liver Stomach Spleen Pancreas Upper duodenum
Arg makes what
-->Creatine --+asp--> urea --BH4 (eNOS)-->NO
Next step in management of Hepatitis C patient
Liver biopsy to detemrine extent of disease and likelihood of response to treatment
What can induce theophylline toxicity
Liver disease, drugs like cipro/erythro/verapamil
Steroids and COPD
Long-term: inhaled; acute exacerbation: systemic
High yield path association for Parkinson's disease?
Loss of neurons in the substantia nigra
Osteomalacia lab findings
Low calcium, phosphate, high PTH
Treatment of PMR
Low-dose prednisone
Which type of AML is associated with many Auer Rods? What chromosomal translocation? What's it's "specific" differentiation / name? What do we treat it with?
M3 t(15;17) Acute promyelocytic leukemia all-trans retinoic acid
What disorder does the t(15;17) cause? Why is this special?
M3 type of AML, which is responsive to all-trans retinoic acid.
abduction of the upper limb
0-15 = abduction of the upper extremity is initiated by the supraspinatus muscle (supra scapular nerve) 15-110 = further abduction to the horizontal position is a function of the deltoid muscle (axillary nerve) 110-180 = raising the extremity above the horizontal position requires scapular rotation by action of the trapzeius (CN XI) and serratus anterior (long thoracic nerve)
RQ of 1, 0.8, 0.7
1 = carbs, 0.8 = proteins, 0.7 = fatty acids
Identify target of following: Alemtuzumab Bevacizumab Cetuximab
1. CD52 (used in CLL. "A*lym*tumab-chronic *lym*phocytic leukemia) 2. VEGF 3. EGFR (stage IV colorectal cancer)
Steps in bone healing post Fx:
1. Immediate reaction: inflammatory mediates, vasodilation, APR; Hematoma 2. Within 8 hrs increased cell division first in Periosteum (more prominent in kids= higher blood supply) 3. <7 days Mesenchymal stem cells proliferate 4. 2-3wks callus formation: fibroblast deposit collagen Periosteal callus: intramembranous ossification by proteoblasts intramedullary callus: at site of Fx/hematoma
Vulnerable brain regions due to hypoxia
1. Pyramidal cells of hippocampus 2. purkinje cells of cerebellum 3. pyramidal neurons of cerebral cortex(watershed infarcts(ACA-MCA)
sites of potential injury to major nerves in fractures of the humerus
1. axillary nerve and posterior humeral circumflex artery at the surgical neck 2. radial nerve and profunda brachii artery at midshaft, midshaft fracture affect origin of brachialis muscle 3. brachial artery and median nerve at the supracondylar region 4. ulnar nerve at the medial epicondyle
Portocaval shunts
1. extrahepatic portocaval shunt = splenic vein and left renal vein after removing the spleen 2. intrahepatic portocaval shunt = between portal vein and hepatic veins
granulomatous vasculitis vs leukoclastic vasculitis vs necrotizing vasculitis
1. leukoclastic: HSP. don't see granulomas here 2. granulomatous vascultitis: takayasu's, wegners, churg strauss. see granulomas here 3. necrotizing: polyarteritis nodosa. necrosis on path.
sound heard w/ high frequency at (1) vs low frequency at (2)
1. oval/round window base of cochlea 2. helicotrema: apex of cochlea
How long can we tolerate ischemia before it leads to irreversible heart damage?
30 minutes [due to myocardial stunning] after 30 minutes of total ischemia, the injury becomes irreversible
hCG starts secreting btw
6-11 days
Given abrupt onset of total myocardial ischemia, how long does it take to lose cardiomyocyte contractility?
60 seconds.
Colonoscopy screening guidelines for ulcerative colitis
8 years after diagnosis, then repeated every 1-2 years
apical lung tumors affect what nerves
8th cervical and 1st and 2nd thoracic spinal. symptoms in the ulnar districution on affected side. also can cause horner syndrome
schizophrenia time course
<1month brief psychotic disorder, usually stress 1-6 months: schizophreniform disorder >6 months schizophrenia
Rupture of the Achilles tendon/ Triceps surae muscle
= gastrocnemius (lateral and medial head), soleus muscles, and plantaris from avulsion or rupture of the calcaneal tendon and cannot plantar flex the foot
Epigenetics: Acetylating histones vs. Methylating cytosine and adenine?
A cetylating A ctivates DNA M ethylation M utes DNA
What is the classic cardiac auscultation finding in aortic stenosis?
A Harsh, crescendo-decrescendo systolic ejection murmur heard at the right sternal border
Receptor causing internal urethral sphincter contraction
A1
Diabetic, older, drug to prophlax
ACE-1 or ARBs decrease diabetic nephropathy onset
First line management for pseudotumor cerebri
ACETAZOLAMIDE +/- furosemide
Genetics of Myotonic muscular dystrophy
AD
When is radiation therapy helpful in bone mets of prostate cancer
AFTER orchiectomy
Vagal maneuvers affect which node
AV node
Dilated pupil with poor light response =
Acute angle closure glaucoma
Most common cause of viral conjunctivitis
Adenovirus
Virilization + normal testosterone + elevated DHEAS =
Adrenal source
When is paralytic ileus seen
After abdominal surgery but also retroperitoneal hemorrhage + vertebral fractures
When should screening for DM begin
Age 45 if no risk factors
What can reverse dilated cardiomyopathy
Alcohol cessation if due to alcohol
Gait instability + truncal ataxia + hypotonia + intention tremor =
Alcoholic cerebellar dysfunction
In a patient with relatively acute aortic regurgitation, what is the major hemodynamic adaptation that maintains cardiac output?
An increase in the left ventricular end diastolic volume (LVEDV) in association with ECCENTRIC left ventricular hypertrophy
perforated viscus
An organ with an abnormal opening can cause peritonitis
IL-receptor antagonist
Anakinra
Iron poisoning and acid/base status
Anion gap metabolic acidosis
R sternal border heart murmur
Aortic stenosis(syncope, angina, dyspnea)mcc= calcified aorta/bicuspid aortic valve flow murmur aortic valve sclerosis
What is the general pathophysiology of centroacinar emphysema?
Associated with chronic, heavy smoking predominantly involves intraalveolar release of proteases, especially elastase, from infiltrating neutrophils and from alveolar macrophages
Respiratory syncytial virus increases the risk for what
Asthma
Down syndrome + UMN findings =
Atlantoaxial instability
Rash in children where diaper area is spared
Atopic dermatitis
High yield path association for Huntington disease?
Atrophy of caudate nucleus
Increased total brainvolume =
Autism
Lambert-Eaton MG
Autoantibodies to presynaptic Ca2+ channel = proximal muscle weakness, improves with use
Complication of infectious mononucleosis
Autoimmune hemolytic anemia
Treatment of legionella
Azithro or levoflox
Treatment of catscratch
Azithromycin
-Mycoplasma. DOC?
Azithromycin (Macrolide)
Child with giardia and recurrent sinopulm infections =
B cell defect
Receptor causing increased myocardial contractility
B1
Receptor causing lipolysis
B1, B2
Megaloblastic anemia, increased methylmalonic acid and total homocysteine suggest a deficiency in
B12
rheumatic fever later effects occurs due to
Bacterial and human epitope homology: result from structural homology btw antigenic determinants(epitopes) on GAS and on human cardiac, cns and cutaneous tissue
Toxoplasmosis prophylaxis in HIV patients
Bactrim
Treatment of nocardia
Bactrim
Dysphagia work-up
Barium esophagram BEFORE endoscopy
Most beneficial therapy to reduce progression of diabetic nephropathy
Blood pressure control
R-shift
C-BEAT: taut Hb Inc CO2 Inc BPG Excercise Inc Acid/Altitude Inc temperature
Deficiency responsible for hereditary angioedema; ACEI are contraindicated
C1 esterase *inhibitor* deficiency
25 year old woman; bone pain for 9 years; bulky stools; fractures in feet; what are her serum Ca, P, Alk Phos & PTH?
Ca- Lo Phosphorus-lo (hi PTH) Alk Phos- HI (trying to get out Ca) PTH- hi (trying to increase PTH) She has a malabsortion issue- can't absorb fat soluble things- no VIt D
So, summarize the two important ways cardiac myocyte relaxation is accomplished.
Calcium efflux, governed by the use of Ca2+-ATPase and Na+/Ca2+ exchange mechanisms
What do you do if you suspect child abuse? Ask the parents or call child protective services?
Call Child Protective Services immediately!
Pancreatic adenocarcinoma
Cancer of the head of the pancreas compresses the bile duct and results in obstructive type of jaundice! pain will be from sensory roots T5-9 dorsal root ganglia via celiac plexus and greater splanchnic nerve During surgery ablation of the sensory innervation that carries pain in this region may be performed by injection 50% ethanol around celiac artery. Type of jaundice NOT usually associated with fever, hepatitis also causes jaundice but is associated with fever
In trauma, hypotension + JVD + normal cardiac silhouette =
Cardiac tamponade
Neutropenia, giant granules in neutrophils, white hair, pale skin, blue irises, red pupils
Chediak Higashi (defect on phagolysosome fusion)
Cause of respiratory issues in ankylosing spondylitis
Chest wall motion restriction
Be sure to refer to FirstAid for the histological changes in the cells lining our airway. Here's a verbal description of the changes that we see from trachea to alveolus: (answer this first: What's the last feature to disappear as the epithelium changes along the respiratory tube?)
Cilia. Bronchi have a pseudostratified columnar ciliated epithelium with goblet cells and submucosal mucoserous glands and cartilage Bronchioles, terminal bronchioles, and respiratory bronchioles lack: goblet cells, glands, and cartilage By the level of the terminal bronchioles, the airway epithelium is CILIATED simple cuboidal. Epithelial cilia persist up to the end of the respiratory bronchioles
Testicular atrophy + gynecomastia + erectile dysfunction + low T3/T4 =
Cirrhosis
Infants with meningitis do not present with
Classic findings of headache or neck stickness. Normal range of motion!!!
Bilateral solid masses on both ovaries during pregnancy =
Classic luteoma of pregnancy
Psychologically speaking, what phenomenon is "white coat syndrome" associated with?
Classical Conditioning. In classical conditioning, a reflexive response normally elicited by an unconditioned stimulus becomes evocable by a second, formally neutral (conditioned) stimulus.
Treatment of treatment-resistant schizophrenia
Clozapine
When to CT scan a child with rhinosinusitis
Complications like periorbital edema, vision, or AMS
How does squatting improve the symptoms in a patient with Tetralogy of Fallot?
Compresses the femoral arterites, increases total peripheral resistance thereby decreasing the R --> L shunt and direction more blood from the RV to the lungs compression-->resistance-->pressure
Acute onset of pain + trauma + local tenderness in spine =
Compression fracture of vertebrae
Most important contributor to edema in CHF
Constriction of renal arterioles
Linear vesicules filled with coag negative staph
Contact dermatitis with staph epidermidis inside
Managmenet of bowel obstruction after x-rays show dilated bowel
Contrast studies to determine level of obstruction
Major source of estrogen in menopausal women
Conversion of adrenal androgens in adipose tissue
Function of superoxide dismutase?
Converts O2--->H202
Which live vaccine can be given to AIDS patients
MMR in CD4 > 200
-PPD skin test, predominance of what cell types?
Macrophages
Function of myeloperoxidase
Makes HOCl
Ruptured submucosal arteries of distal esophagus and proximal stomach =
Mallory Weiss tears
What disorder is the t(11;14) translocation associated with?
Mantle Cell Lymphoma
JVD + new onset RBBB =
Massive PE
Colon cancer + low BP + JVD + tachycardia =
Massive PE --> RV Dilation
Prevention of chlamydial conjunctivitis
Maternal prenatal testing/treatment
Is sublimation a mature or immature defense mechanism? How does it work?
Mature. Unacceptable drives are redirected toward completely acceptable targets. (Workout hard if you're angry)
Failure of both cleft lip and palate
Maxillary and nasal prominences
Renal HTN; how test to see if operation will reduce BP?
Measure the renal vein's outputs of renin
What's the most important thing to do when doing a workup of metabolic alkalosis?
Measure the urine chloride and ascertaining the patient's volume status.
Cause of recurrent intussusception in older children
Meckel's diverticulum
What is the general pattern of airway resistance in the lungs?
Medium and smalled sized bronchi greater than 2 mm in diameter (the first 10 generations of bronchi) account for the greatest summated frictional resistance to airflow in normal airways. The smallest bronchi and bronchioles have a larger total cross-sectional area, so they don't contribute much to total airway frictional resistance.
thyroid: nests of polyglonal cells w/ congo red+ deposits
Medullary carcinoma
Hepatitis B is associated with which renal disease
Membranous
2 day history of progressive confusion, fever, when he speaks, he enunciate clearly. Words uttered made no sense. Does not follow commands, what is diagnosis?
Meningococcal meningitis
Disc hyperemia = what poisoning
Methanol
Snowfield vision + acute pancreatitis = what poisoning
Methyl alcohol
what is otitis media with effusion
Middle ear effusion WITHOUT acute inflammation
Murmur of tetralogy of fallot
Midsystolic murmur heard loudest in the left 3rd intercostal space and associated with a thrill.
Excess cortisol results in what
Mineralocorticoid effects --> hypertension and hypokalemia
Hodgkin's lymphoma is associated with which nephrotic syndrome
Minimal change
What is one reason that lead intoxication causes hypochromic anemia?
Mitochondrial iron transport is important for Heme synthesis! It's inhibited by lead. So you don't make heme in your mitochondria and you get hypochromic anemia.
Left Axillary line holosytolic murmur
Mitral Regurg - Left Axillary line holosystolic murmur
What is the classic cardiac finding in Mitral Valve Prolapse?
Mitral Valve Prolapse classically results in a midsystolic click and mid-to-late systolic murmur
medial band-like calcification
Monckeberg's medial calcific sclerosis intima not involved
What cell lineage do osteoclasts come from?
Mononuclear Phagocytic cell lineage (same as macrophages)
What to do if a nonreactive NST
Most likely asleep, use vibroacoustic stimulation to try test again.
Treatment of proctocolitis in infant
Mother must eliminate dairy and soy from diet
Thrombolytics and central retinal artery occlusion
Must be delievered ARTERIALLY, not IV.
-What causes the contraction of skin after several weeks of healing?
Myofibroblast activity
Delayed relaxation upon contraction of hand muscles =
Myotonic muscular dystrophy
Heart tumors types and tissue morph
Myxoma: mesenchymal Rhabdomyomas: hamartoma (TSC)
pharynx->blood-> choroid plexus-> meninges
N. menengitids
What is the defect in Chronic Granulomatous disease? What is the pathophysiology?
NADPH Oxidase deficiency leads to the inability to kill intracellular organisms
Chronic granulomatous disease are deficient in --
NADPH oxidase
Mneumonic for phagolysosomal enzymes?
NaSty Myelo NADPH oxidase Superoxidae dismutase Myeloperoxidase
Important cause of patients with persistent, nonbloody, watery diarrhea
Cryptosporidium
NPH cause
DECREASED CSF ABSORPTION not production
When is the myocardium best perfused with blood? (this is a unique property of myocardium)
DIASTOLE The coronary circulation is unique in that only 10% of total perfusion through the myocardial capillaries of the left ventricle occurs during systole (contraction of the muscular left ventricle compresses the coronary arteries!) The great majority of blood flow through the vascular beds supplied by the coronary arteries to the LV occurs during diastole, when the blood vessels are not compressed by myocardial contraction
Associated with HLA-DR3
DM type I SLE Graves
What is DNA laddering indicative of?
DNA laddering is a sensitive indicator of apoptosis; during karyorrhexis, endonucleases cleave at internucleosomal regions, yielding 180-bp fragments.
Bicylclist with back program and erectile dysfunction, has back tenderness and hemorrhoids. What cause erectile dysfunction?
Damaged blood and nerve supply to erectile tissues
L-shift
Decrease acid= alkalosis dec 2,3 BPG decrease TEMp CO Inc EPO
-Long face, prominent ears, large testes, has 800 CGG repeat. What is the effect of the repeats on transcription of FMR1 mRNA?
Decrease transcription
How does hyperventilation lead to decreased ICP
Decreased CO2 leads to cerebral vasoconstriction
Polycythemia Vera
Decreased EPO Increased Plasma Volume, increased RBC mass myeloproliferative disorders
Okay, short version. What is pulsus pardoxus? A disease of what heart layer causes it?
Decreased systolic blood pressure during inspiration. Pericardial Disease.
LAD Type I
Deficiency in LFA-1 integrin (CD18); results in defective *tight adhesion* and *crawling*
Who is more likely to get acute bacterial parotitis
Dehydrated post-op patients and elderly
Definition of persistent complex bereavement disorder
Depressive symptoms focused on the loss of a loved one last at least a year
What dermatological layers are apocrine glands found at?
Dermis and subcutaneous fat
What is the pygmailion effect?
Describes researcher's beliefs in teh efficacy of treatment this can potentially affect outcome
Desmopressin vs. imipramine for enuresis
Desmopressin!
2nd pouch
Develops epi lining of palatine tonsil
-Anticough drug other than codeine?
Dextromethorphan
OCPs side effects other than hypercoag
Diabetes, hypertension, cholestasis/cholecystitis, increased triglycerides
Macrocytic anemia only + low retic count + congenital anomalies =
Diamond blackfan anemia
What physical exam finding do you get with pericardial effusoins
Difficulty palpating the point of maximal impulse
GI symptoms + vision changes + arrhythmias = what toxicity
Digoxin
Preseptal vs. orbital cellulitis, what sign is seen with orbital cellulitis
Diplopia, opthalmoplegia, pain with extraocular movements, proptosis
Management for IUFD
Discuss need for delivery and review options
Describe the pathogenesis and pathophysiology of Paget's Disease of the Bone.
Disease process starts with marked osteoclastic activation, followed by an increase in activity of bone forming cells osteoblasts. The net result is increased bone resorption and also formation of abnormal bone. A new collagen is laid down in a haphazard manner as compared to the normal, linear manner. The end product is a MOSAIC PATTERN of lamellar bone with irregular sections linked by CEMENT LINES which represent previous areas of bone resorption
-Sign of irreversible cell injury?
Disruption of plasma membrane
What is the consensus and professional standard regarding the receiving of gifts from patients?
Don't do it. It's unethical to accept individual gifts from patients, especially of signficant value. AMA doesn't have clear cut answer, but they recommend careful consideration be used. some general guidelines: -cash gifts should never be accepted (this includes gift certificates) -a gift should never influence treatment -no specific dollar value is given; but as a rule of thumb, it shouldn't be above patient's or physician's means -psychiatrist must be super careful even with small gifts -maintain consistency among all patients -if physician would be embarrassed or uncomfortable if his colleagues found out about the gift, don't accept it
C/I with levodopa
Dont take multivitamin or B6: increases peripheral metabolism of l-dopa and decreases it effectiveness
Treatment of restless leg syndrome targets what
Dopamine
Restless leg syndrome treatment
Dopamine agonists like pramipexole
4th pouch
Dorsal wing: develops into superior parathyroids fuse with follicular cells= thyroid
What cause of mental retardation is associated with t(8,21)? What disorder is further associated with this?
Down's Syndrome ALL "We ALL fall DOWN together."
Drug induced reactions vs. EBV and penicillin rash
Drug induced happens immediately; EBV and penicillin rash develops after 24 hours
Blebbing of the sarcolemma
Due to decreased sarcoplasmic ATP
What is the clinical picture of congestive heart failure? What is the super general pathophysiology?
Dyspnea, edema, and fatigue poor cardiac output
loss of what w/in the cell promotes metastasis and where are they located?
E cadherins: Ca2+ depen. adhesions proteins Adherens junction(zonula adherens aka intermediate junction) below TJ, forms belt connecting actin cytoskeletons of adjacent cells w/ Cadherins
Bloody diarrhea + fever + no risk factors/ingestions
E. coli
Most common cause of bloody diarrhea without fever =
E. coli
Most common risk factor for nasopharyngeal cancer
EBV
Sore throat + lymphadenopathy seen in which viral disease and not which
EBV, not CMV
In a patient with MI who develops a cold leg, next step in management
ECHO to rule out thrombus in left ventricle
Menkes syndrome
EDS type IX: mutation at ATP7a decreased activity of lysyl oxidase
EPO doping = ?
EPO will increase RBC's erythroid precursors
What is the classic murmur of aortic regurgitation?
Early diastolic, high-pitched and blowing decresendo murmur heard best at the left sternal border
Next best test for suspected adrenal insufficiency
Early morning cortisol, ACTH, and cosyntropin stimulation
In the heart, when do we see eccentric hypertrophy, and when do we see concentric hypertrophy?
Eccentric: with volume overload (e.g., in chamber dilation de to increased end diastolic volume Concentric: pressure overload (e.g., in aortic stenosis or systemic hypertension)
Before starting trastuzumab, what test and why
Echo because of increased risk of cardiotoxicity
Most common cause of viral meningitis
Echovirus and coxsackievirus
Malignant otitis externa seen in who
Elderly with poorly controlled diabetes
Patients with first degree AV block + prolonged QRS must have what? If normal QRS?
Electrophys testing. If normal, no further evaluation
Managmenet of penile fracture
Emergent urethral imaging with retrograde urethrogram
Biggest risk of tamoxifen
Endometrial cancer
Tamoxifen increases risk of
Endometrial cancer
-Bosentan, blockade of what?
Endothelin recepotrs
What protein do eosinophils release that help them kill parasites (helminths, e.g.)?
Eosinophils release major basic protein, a potent antihelminthic toxin that's capable of causing damage to epithelial and endothelial cells (as it does it atopic asthma)
Epidural hematoma
EpIdural looks like an Ellipse and has a lucId interval.
Jaundice, with blood regurgitation, elevated ALP (AST and ALT normal). What GI pathology?
Esophageal varices
What disorder is the t(11;33) translocation associated with?
Ewing's Sarcoma 11+22 = 33, Patrick EWING's number
Anterior drawer sign
Excessive anterior displacement= ACL ACL= ant/med Lateral femoral condyle to ant intercondylar area of tibia
Excisional vs. incisional biopsy
Excisional: cuts out whole lesion, incisional: just part of it
Need to reach involved vessels that feed leiomyoma, what is most direct course of catheter after entering femoral artery?
External iliac artery->internal iliac artery->uterine artery
cAMP receptors
FLAT CHAMP FSH LH ACTH TSH CRH hCG ADH (v2) MSH PTH CAlcitonin GHRH Glucagon
Next step in management if no breast development + amenorrhea
FSH measurement
GI embryo defects/causes
Failure of Rostral fold to close: sternal defect Failure of lateral fold to close: omphalocele, gastroschisis Failure of caudal fold to close: bladder exstrophy Duodenal atresia: failure of recanalization (Tri21) Jej, ileal, colonic atresia: vascular accident= occlusion (spiral) Abnormal rotation: cecum RUQ, intestinal obstruction with SMA
What is cricophyarngeal dysfunction
Failure of cricopharyngeus to relax during swallowing
Failure of what process leads due neural tube defects? What can be seen in the amniotic fluid due to leakage of fetal cebebrospinal fluid?
Failure of fusion of the neuropores. Alpha-fetoprotein and Acetylcholinesterase may appear in the amniotic fluid
Cleft lip cause?
Failure of maxillary and nasal prominences to fuse
Congenital marrow failure + poor growth + abnormal thumbs + hypopigmented areas =
Fanconi anemia
Failed fusion of paramesonephric ducts
Female genital structures malformed: uterus didelphys or bicornuate uterus Infertility, 2 vag,urether, uterus
Levels of ______ correlate with ESR; it promotes endothelial repair and is a coagulation factor
Fibrinogen
Hypertension + real bruit + symptoms of brain ischemia =
Fibromuscular dysplasia
New onset HTN in children + bruit at costovertebral angle =
Fibromuscular dysplasia
Multiple rib fractures over a contusion =
Flail chest
Which medication can develop extreme hypothermia
Fluphenazine by disrupting shivering mechanism
Schizophrenic with treatment noncompliance, next step in treatment
Fluphenazine depot
Why would we want to harvest the great saphenous vein?
For use in coronary bypass surgery
What is the RANK receptor/RANK-L interaction essential for?
Formation and Differentiation of osteoclasts. [2 most important factors for differentiation of osteoclasts: RANK-L and M-CSF]
Wide based gait + high plantar arches in a child =
Freidrich's ataxia
reducing sugar in urine
Fructokinase deficiency=fructosuria fructose--> hexokinase-> F-6-phosphate
-Cuase of bacteria vaginosis
Gardnerella vaginosis
What effect do the LAV and killed polio vaccine have in common?
Generation of CD8+ memory T cells
Which two nerves monitor the baroreceptors in the neck?
Glossopharyngeal nerve (IX) & Vagus nerve (X)
Bblocker antidote
Glucagon
Trendelenburg sign is caused by weakness of what muscle
Gluteus medius and minimus
Emergent plasmaparesis is required in what pulm-renal syndrome
Goodpasture's
Screening for PKU
Guthrie test
Managemetn of dyspepsia
H. pylori testing or empiric treatment. If alarm symptoms, then upper endoscopy
pharynx->lymphatics-> meninges
H.influenzae
HDL with age in woman?
HDL of a 25 year old vs. 55 year old, high in 25, low in 55 (estrogen)
hepatitis in pregant women causing fulminant hepatitis
HEV: unenveloped RNA virus
Down syndrome quad screen
HI is high. HCG and inhibin
Idiopathic thrombocytopenia--must rule out what
HIV and Hep C
HCTZ side effects
HYPERGLUT
STD: painful ulcer on cock culture: chocolate agar, small oxidase positive, gram negative bug w/ B-lactamase
Haemophilus ducreyi dx: DNA probe Rx: azithromycin, ceftriaxone
Benzos or haldol in elderly
Haldol! Do not use benzos, worsens confusion and metabolized slowly
Most common early side effects of levo/carbidopa
Hallucinations/dizziness/headache/agitation
Exercise program and herniated disc
Has not been proven beneficial for this type of pain
Who is at risk for developing herpetic whitlow
Health care workers who come in direct contact with infected orotracheal secretions
metastaic colon cancer spread MOA
Hematogenous spread of Liver Tumor from Colon via Portal Venous System
Prussian blue indicates the presence of
Hemosiderin
cystinuria
Hereditary(AR) renal tubular basic AA transport of cysteine, ornithine, lysine and arginine in PCT of kidneys cause kidney stones Dx: NaCN-nitroprusside test: detects sulfhydryl groups
HbA 60% HbS40%
Heterozygotes have the trait: protected from Sickle cell crises, aplastic crisis and sequestration crises Have hematuria protective against Malaria Normal peripheral smears, reticulate counts and MCHC values Will Sickle when sodium metabisulfite added
insulin resistence as environmental factor
High FFA: phosphorylate insulin R: induce TNFa, glucagon, glucocorticoids: decrease insulin secretion insulin resistence and beta cell dysfunction along w/ high FFA= lipotoxicity
Prevention of opthalmopathy exacerbation with radioactive iodine treatment of Graves
High dose corticosteroids
congenital HBV in neonate
High replication rate and High risk of chronic infection Mildly elevated lab markers no high lab markers cause liver is still immature and immature immune system
Croup management
Humidified O2 --> racemic epinephrine then intubation
What electrolyte abnormality can occur in patient who is immobile
Hypercalcemia
Proximal muscle weakness + low amplitude tremor =
Hyperthyroidism
Fibrates are used for what
Hypertriglyceridemia
What electrolyte abnormality caused by Cushing's
Hypokalemia and hypernatremia
Cortisol deficiency + hypothyroidism =
Hypopituitarism
ABG of atelectasis
Hypoxemia, hypocapnia, respiratory alkalosis
grades of astrocytoma
I and II: low grade. no necrosis, mitoses, or neovascularity III: anaplastic astrocytomas. increased mitoses IV: GBM. necrosis.
Receptor for binding Rhinovirus
ICAM (CD54)
Indirect inguinal hernia
INfants: failure of processus vaginalis to close(can form hydrocele) Goes through INternal(deep) inguinal ring(made of transversalis fasci), external (superficial) ring, INto scrotum lateral to inferior epigastic
next best step in patient with cryptococcal ifnfection
IV amphotericin + flucytosine BEFORE AIDS testing
Management of peritonsillar abscess
IV antibiotics and urgent drainage
Thyroglobulin levels
If low, factitious thyrotoxicosis. If elevated, thyroiditis.
When to use secretin stimulation test
If patient has non-diagnostic fasting gastrin levels
How does phenytoin cause folate deficiency
Impairs absorption of folic acid
What rotator cuff injury improves with lidocaine injection
Impingement not tear
ESR how it occurs
In injury neutrophils and macrophages release: TNFa. IL-1, IL-6 these mediate systemic inflammatory response and stimulate hepatic production of Acute phase reactants(fibrinogen, ferritin, CRP, serum amyloid A+P, complement) AP protetin bind microbes and fix complement Fibrinogen causes RBC to form stacks (rouleaux that sediment at a faster rate than do individual RBC)
Again, what are the serum calcium and PTH findings in primary osteoporosis?
In primary osteoporosis (osteoporosis not caused by a medical disorder), serum calcium, phosphorous, and PTH levels are typically normal.
subcutaneous olecranon bursitis- student's elbow
olecranon, to which the triceps tendon attaches distally, is easily palpated and separated from the skin only by the olecranon bursa, which allow the mobility of the overlying skin causing a friction subcutaneous olecranon bursitis
ANP function
opposite of aldosterone (inhibits renin)
-What is most useless tendon that can be used to fix others?
palmaris longus
What epithelial structure is compromised in patient's with Chron's?
Tight junctions
Women with Crohns disease has radio labeled laculose. She execrate more lactulose than normal subject. What inflammation associated changes in integrity of what epithelial structure?
Tight junctions (zona occludens)
Diagnosis of bacillary angiomatosis
Tissue biopsy
Common congenital heart abnormalities in pts with deletion *22q*11
ToF Truncus arteriosus (bonus: they also have low T cells, low PTH, low Ca++)
Treatment of local impetigo (2)
Topical mupirocin or oral erythro
Fleshy immobile mass on the midline = , treatment
Torus palatinus, no treatment unless symptomatic or interfering with speech/eating
Persistent pneumothorax and air leak after chest tube placement =
Tracheobronchial rupture
Gold standard for evaluating cervical incompetence
TransVAGINAL ultrasound
Regulatory protein able to dictate differentiation of progenitor cell
Transcription Factors
E coli has resistance. Carried by plasmid. What observation best support the hypothesis?
Transfer require cell to cell contact
Cyanosis + single loud second heart sound with no murmur =
Transposition of the great vessels
What is lerich syndrome
Triad of 1) hip/thigh/butt claudication 2) impotence 3) symmetric atrophy of LE due to ischemia
X-ray of chest. Where is the valve replacement
Tricuspid (show on the middle right behind sternum)
Left axis deviation + small/absent R waves =
Tricuspid valve atrexia
Treatment of tremor in parkinson's
Trihexylphenidyl an anticholinergic
Antibiotic cause of hyperkalemia and increased creanine
Trimethoprim/Bactrim by blocking channel and inhibiting secretion
non-destructive vegetation on mitral leaflets is similar to
Trousseau syndrome(migratory thrombophlebitis) because both are caused due to hypercoagulable state caused by endothelial injury normally due to cancer common in: pancreatic, colon, lung cancer produce thromboplastin-like substance
Enzyme required to degrade fibrinous pleuritis?
Trypsin
In the final stage of the healing process of myocardial infarction, what type of collagen is deposited?
Type I
What is unique about type II pneumocytes regarding alveolar injury?
Type II pneumocytes are unique in their ability to proliferate in response to injury
Anticoagulation in patients with severe renal insufficiency
UNFRACTIONATED HEPARIN
If maternal AFP is abnormal, what is the next step
Ultrasonogram
Presentaiton of pleural mesothelioma
Unilateral pleural abnormality with a large pleural effusion on CXR
Diagnostic study of choice in a patient with acute alkali ingestion
Upper GI endoscopy
Pronator drift is a sign of what
Upper motor neuron
Stain Drug effects
Upregulates LDL receptors
Evaluation of BPH after normal rectal exam
Urinalysis and serum cr
Most rapid and sensitive test to diagnose disseminated histoplasmosis
Urine or serum assay
Best treatment for PBC
Ursodeoxycholic acid
Pure sensory stroke location
VPL nucleus of the thalamus
Gradual onset of fatigue, fever, pain in muscle during past 3 weeks, lost 8 lbs, takes no medication, fever, BP 140/95, trunks and extremities has areas of raised, reticular, cyanotic discoloration consistent with lived reticularis. left foot drop. Has p-ANCA. what is diagnosis?
Vasculitis
Half life
Vd x 0.7/CL
Prophylaxis of cluster headache
Verapamil
What heart drug interacts with digoxin
Verapamil --> decreases renal clearance of digoxin
What type of drug, generally speaking, is Verapamil? I.e., what is it's mechanism of action?
Verapamil is a calcium channel blocker
Tingling and numbness of his hands. Has NHL. What medication cause this finding?
Vincristine
Most common predisposing factor for bacterial sinusitis
Viral URI
Visceral vs somatic pain
Visceral: poorly localized, somatic is specific
Bony prominences of costchondral junctions + genu varum in infant =
Vitamin D deficiency rickets
Doll-like face + thin extremities + protuberant abdomen =
Von Gierke's, glucose 6 phosphatase deficiency
Wiskott-Aldrich (WATER)
WAS gene (x-linked) Thrombocytopenic purpura Eczema Recurrent infections (bonus: risk of autoimmune disease and malignancy; labs show high IgE and IgA, fewer and smaller platelets)
Most effective intervention for hypertension
WEIGHT CONTROL
What compensatory mechanism can develop in the body to avoid edema in the context of cor pulmonale (right sided heart failure due to long standing pulmonary HTN)?
When the central venous pressure (CVP) is increased as in right heart failure, the interstitial fluid pressure rises due to an increase in net plasma filtration. As interstitial fluid pressure increases, compensatory increase in LYMPHATIC DRAINAGE allows for avoidance of edema.
So a patient presents with a stroke after a DVT was confirmed in his legs. You astutely recognize that since this is a stroke it must be from a paradoxical embolus, and begin to think "this gal must have an ASD, a common abnormal connection between the right heart and left heart that would let the embolus become paradoxical." Then, you confirm this on physical exam by hearing what?
Wide splitting of S2 that does not vary with respiration.
What is the syndromic name given to a condition in which an accessory AV conduction pathway is used [i.e., the AV node is bypassed and something else sets heart rhythm]?
Wolff-Parkinson-White syndrome
Treatment of nondisplaced scaphoid fractures
Wrist immobilization
Alport syndrome
XLR: Type IV collagen impaired (BM) nephritis, deafness, ocular disturbances Can't see, Can't pee, Can't hear me
What eye lesion is associated with PBC
Xanthelasma
Does infection with P. vivax show ring forms in a peripheral blood smear?
YES
injury to the gluteal region fractures of femoral neck
a common fracture in elderly women with osteoporosis is fracture of the femoral neck, causes shortness and lateral rotation of the lower limb fractures of the femoral neck often disrupt the blood supply to the head of the femur, at present time the best way in case of femoral neck fracture is hip replacement
scoliosis
a complex lateral deviation or torsion that is caused by poliomyelitis, a length discrepancy or hip disease
normal PCO2 along with ->silent lungs, ->cyanosis, ->altered sensorium
a severe asthma attack. PCO2 should be low ->b/c hyperventilation = respiratory alkalosis CO2 retention due to -> airway obstruction (air trapping) ->and/or respiratory muscle fatigue.
low glucose concentration in exudative effusions is due to high metabolic activity of leukocytes within the pleural fluid. ->pH < 7.2, ->glucose < 30 suggests: ->Glucose 30-50 suggests:
a) ->empyema ->rheumatic effusion. b) ->malignancy, ->lupus, ->esophageal rupture, ->tb.
thoracentesis location
above the 9th rib, midscapular line
Detached tumor cells have ability to adhere to basement membrane how
acquired ability due to increased expression of laminin and other adhesion molecules
essential tremor
action tremor: exacerbated by holding posture/limb position genetic predispotion: familial patients say that self medication w/ EtOH decreases tremor Rx: B-blockers, primidone
Cause of hyperglycemia in a type I diabetic
activation of hepatic adenylyl cyclase
careful cross-matching of blood prevents what
acute hemolytic reactions
laryngeal edema
acute-onset dyspnea. due to allergies, similar to asthma attack ->but with dysphagia
kid one day starvation, Vomiting, lethargy, hypoglycemic, low plasma ketones, hepatomegaly
acyl-coA dehydrogenase def. Also presents w/ Lactic acidosis inability to make ketones
endometrial gland w/in the myometrium
adenomyosis
Virulence factor of E. coli causing pyelonephritis
adhesins
patient with meningitis who does not want to be treated, next step in management
admit and isolate the patient and start treatment since it is highly contagious and can cause harm to others
Strabismus- CN III palsy
affects most of the extra ocular muscles Manifestations: ptosis, fully dilated pupil, eye is fully depressed and abducted ("down and out") due to unopposed actions of superior oblique and lateral rectus
csf finding in guillan barre
albuminocytologic dissociation. elevated protein content iwth a normal wbc count
lordosis
an exaggeration of the lumbar curvature that may be temporary and occurs as a result of pregnancy, spondylolisthesis or potbelly
kyphosis
an exaggeration of the thoracic curvature that may result in elderly persons as a result of osteoporosis
Ischiorectal abscess
an important surgical condition which results from spread of an infection through the external sphincter ani into the ischiorectal fossa, should be immediately drained by a wide cruciate incision through skin of the base of the fossa to avoid fistula formation Surgeon should avoid lateral wall of ischiorectal fossa because of Pudendal canal- with internal pudenal artery and pudendal nerve
thyroid: pleomorphic giant cell nest w/ occasional multinucleated cells
anaplastic thyroid carcinoma
inhibit aromatase
anastrozole, letrozole, exemestane
CO toxicity
anion gap metabolic acidosis/lactic acidosis. decreased delivery of O2 to tissues
Radial head subluxation ligament
annular ligament tear
loss of pulses over radial arteries that disappear with deep inspiration?
another form of pusus paradoxus
Epiploic (Winslow's foramen)
anteriorly: free border of the hepatoduodenal ligament, containing portal triad (DVA) posteriorly: IVC superiorly: caudate lobe of liver inferiorly: 1st part of duodenum
RhoGam
anti IgG against fetal RBC surface Rh antigens Fc R on phagocyte cells have greatest affinity for Fc fragments of IgG ab
What is the most common cause of palpitations?
anxiety. this was in there to remind you to THINK and not just "take the test"
Fatty bone marrow
aplastic anemia
carcinoid tumors (3 most common sites)
appendix, ileum, rectum (once mets outside GI tract = carcinoid syndrome)
What is ecthyma gangrenosum? Treatment?
associated with pseudomonas, immunocompromised. progress rapidly from a a small erythematous macule to larger, nontender nodules with necrosis. due to bac invasion through media and adventitia of blood vessels
Wow, simply put, describe atherosclerosis.
atherosclerosis is initiated by repetitive endothelial cell injury, which leads to a chronic inflammatory state in the underlying intima of large elastic arteries as well as large and medium-sized muscular arteries.
LMN muscle signs
atrophy and fasiculations
uterosacral ligament
attaches to cervical region and extends posteriorly
large basophilic cells with vacuolated appearance =
atypical lymphocytes
What does the t(14;18) translocation cause? What disorder is it assocaited with?
bcl-2 activation Follicular Lymphoma
Volvulus
because of its extreme mobility, the jejunum, ileum and sigmoid colon sometimes rotates around its mesentery results in avascular necrosis may or may not correct itself spontaneously
unhappy triad- knee joint injuries
because the lateral side of the knee is struck more often, the tibial collateral ligament is most frequently torn (MCL), triad includes: tibial collateral ligament, medial meniscus, anterior cruciate ligament (MCL limits extension and abduction of leg at knee)
thyroid: sheets of uniform cells forming small follicles
benign follicular adenoma colloid containing microfollicles
Lumbar puncture/tap and epidural anesthesia
between L3/L4 to L5/4 in subarachnoid space (tap) or epidural space for anesthesia spinal cord may end as low as L2 in adults and dural sac ends at S2
Why are patients with CF chronically infected with pseudomonas
biofilm formation in the lower respiratory tract
hemothorax and pleural effusion have similar appearances on cxr:
blunting of costophrenic angle opacify the entire ipsilateral chest.
wegners vs goodpastures
both can see renal and pulm involvement, but wegners see upper airway and sinus symptoms
Esophageal peristalsis and lower esophageal sphincter tone in scleroderma
both decreased
thyroid: branching papillary structures w/ interspersed calcified bodies
branched calcified bodies= psammoma bodies papillary thyroid cancer
Right coronary artery (RCA)
branches: 1. anterior cardiac branches- supplies right atrium 2. Nodal branch- supplies SA and AV node 3. Marginal artery- supplies right ventricle 4. Posterior interventricular artery - supplies diaphragmatic (inferior) surface of both ventricles and posterior 1/3 of the IV septum
pleural effusion 2/2 to what malignancies
breast, lung
lung consolidation causes
bronchial breath sounds, ->(have a full exipratory phase) dullness to percussion, increased fremitus, bronchophony, egophony, whispered pectoriloquy.
Increased vagal stim to bronchi
bronchial smooth muscle contract ACh: increased work of breathing + increase airflow resistance: bronchoconstriction + mucus secretion tiotropium/ipratrium help counteract these:useful in COPD
chronic and recurrent cough with mucopurulent expectoration
bronchiectasis. recurrent infections ->producing cough ->responding to antibiotics. chronic bronchitis has non-purulent expectoration. Dx: ->high-resolution CT of chest
Simply put, how do beta-agonists treat asthma attacks?
by causing bronchial smooth muscle relaxation by increasing intracellular cAMP
blockage of the subclavian or axillary artery
bypassed by anastomoses between branches of thyrocervical and sub scapular arteries: transverse cervical, suprascapular, subscapular, circumflex scapular
What does the t(8;14) translocation cause? What disorder is it associated with?
c-myc overexpression Burkitt's Lymphoma
hereditary angioedema==
c1 esterase inhibitor deficiency; decreased C4
NO stimulates formation of what?
cGMP
Fracture of the fibular neck
can cause injury to common fibular (perineal) nerve, which winds laterally around the neck of the fibula results in paralysis of anterior and lateral compartments of the leg (dorsiflexors and evertors of the foot) causes foot drop
apical lung tumor in thoracic inlet
can compress cervical and thoracic nerve roots that contribute to the ulnar nerve causing pain, numbness, and weakness in ipsilateral arm. (look for radioopaque lesion in the apex)
IVDU tricuspid mass bilateral infiltrates
candida
in a steady resting state the respiratory quotient (RQ) near 1.0 suggests
carbs are the major nutrient being oxidized. when the ratio rises it's due to excess carbs. protein gives RQ of 0.8 fats gives 0.7
What are some simple maneuvers to treat PSVT?
carotid sinus massage and valsalva maneuver both of these increase cardiac parasympathetic tone the parasympathetic nervous system primarly functions to slow the heart rate by slowing conduction through the AV node
glucose transport across cell membrane? muscle/adipocyte
carrier mediated transport: facilitated diffusion
H202 is neutralized by --
catalase
blurring of vision that is worse at night, and a glare while driving, is usually due to
cataracts
M.pneumo and anemia
cause cold agglutination: cause hemolysis due to antigenic similarity btw antigen in cell membrane of M.pneumo and RBCs co when immune response tries to kill bacteria it also kills RBCs
Mechanism of resistance to vincristine, doxorubicin and dactinomycine...
cell export
micafungin/caspofungin MOA
cell wall inhibitor, blocks B-glucan synthesis
Characteristic triad of ataxia telangiectasia?
cerebellar ataxia, telangiectasias, increased risk of sinopulmonary infections
pharmacologic interventions for diabetic overflow incontinence
cholinergic agonists like bethanechol
in COPD you get
chronic hypoxemia -> pulmonary vasoconstriction -> pulmonary hypertension -> RV hypertrophy -> RV failure => hepatosplenomegaly/ascites/elevated JVP/peripheral edema
Treatment of malignant otitis externa =
cipro
AATAAA at 3' end encodes
cleavage and polyadenation
Everything has been normal for a woman but she cannot conceive, what should we give her next
clomiphene
Anencephaly failure of:
closure of the rostral(ANT) end of Neural tube no forebrain, open calvarium: frog-like Inc AFP, polyhydramnios assoc. w/ DM
Benign hypertrophy of prostate (BHP)
common in men after middle age. Prostate adenoma (benign hypertrophy) usually involves median lobe Common cause of urethral obstruction, leading to nocturia (need to void during night), dysuria (difficulty and/or pain during urination) and urgency (sudden desire to void) Prostate is examined for enlargement and tumors by DIGITAL RECTAL examination
External hemorrhoids
commonly associated with constipation, extended sitting and straining at the toilet, pregnancy and disorders that hinder venous rectum = dilated tributaries of the inferior rectal veins (IRV) below the pectinate line and are painful because the mucosa is supplied by afferent fibers of the inferior rectal nerves from internal pudendal
what is mediastinitis
complication of esopheageal rupture. see post procedure chest pain, hematemeis, sob. pleural effusions also. can lead to sepsis
Hepatomegaly + ascites + increased JVP =
constrictive pericarditis
Foregut
contents: esophagus, stomach, liver, pancreas, gallbladder artery = celiac artery innervation = (PS) vagus n (Sym) greater splanchnic nn T5-9 & celiac ganglion referred pain: epigastrium
function of NADPH oxidase
converts O2-->O2-
Thoracic Duct
conveys to the blood all lymph from lower limbs, pelvic cavity, abdominal cavity, left side of the thorax, left side of the head and neck, and left upper limb (3/4 of the body) Tributaries at root of the neck include left: jugular lymph trunk subclavian lymph trunk bronchomediastinal lymph trunk
overactive enzyme due to pro-carcinogens
cyto p450 microsomal monoxygenase
free ribosome synthesize
cytosol and cellular organelles
HBV hepatic damage is due to
cytotoxic T lymphocytes
How does I.V. hydration with normal saline and insulin help a person in diabetic ketoacidosis?
decrease in: serum glucose, osmolality, and potassium Increase in: serum bicarbonate sodium
in COPD, large lung volumes and diaphragmatic flattening make it more difficult to
decrease intrathoracic pressure during inhalation and thus increasing the work of breathing.
Beta2 agonists
decrease uterine tone
tension pneumothorax -> treat with needle thoracostomy emergently
decreased breath sounds, tachypnea, tracheal deviation.
lactic acidosis due to
decreased oxidative phosphyrlation
MPO deficiency
decreased production of bleach aka hydroxy-halide radicals = susceptibility to yeast infections
Directly decreased due to demyelination
decreased space constant(time constant) and decreased conduction velocity
pleural effusion/hemothorax
decreased tactile fremitus, decreased breath sounds, dullness to percussion
What is the Guthrie test
detects presence of phenylalanine products in urine for PKU
Cough suppressant treatment that does not cause constipation and has a low potential for substance abuse
dextromethorphan
cough suppressant without constipation and low addiction
dextrometorphan
complication of myocarditis
dilated cardiomyopathy
shoulder separation
dislocation of acromioclavicular joint, more severe if includes tear of coracoclavivular joint --> direct, forceful impact to shoulder or from fall on an outstretched arm
should dislocation
dislocation of glenohumeral joint, usually caused by excessive extension and lateral rotation of humerus, glenohumeral ligaments weaker inferiorly and describes as anterior or posterior (rare)
a fixed upper airway obstrution (such as laryngeal edema)
distinctive flow-volume loop: flow limitation with both -> inspiration (below the horizontal line) ->expiration (above the horizontal line). looks like an oval sideways.
if moderate to high suspicious of DVT if low suspicion (want to rule out)
do ultrasound before anti-coagulation. Do d-dimer. ->if negative = rule out clot. -> (high sensitivity. sn-out)
Atelectasis on xray
due to pleural space disease trachea deviation toward opacified lung w/ lung volume loss
claw hand
due to ulnar nerve at wrist, when attempting to straighten fingers, lumbricals 3&4 will not extend sensory deficits: medial forearm and digits 4&5
Direct (acquired) hernia
due to weakness of anterior abdominal wall, bowel with peritoneal covering pushed through transversals fascia to exit superficial ring medial to inferior epigastric artery to Hesselbach's triangle rare in women and most are bilateral
asbestosis is a pneumoconiosis and presents as
dyspnea, digital clubbing bibasilar end-inspiratory crackles. can develop cor pulmonale. CXR can show pleural plaques. will have decreased DLCO -> (interstitial lung disease)
aortic valve calcification is normally due to
dystrophic calcification= necrosis (cell injury and death)
causes of hypovolemic hypotonic hyponatremia
either renal or extrarenal losses of sodium and water. in extrarenal lossess see urine sodium < 10
When you hear the term "humoral hypercalcemia of malignancy" what does it sound like?
elevated serum calcium in the presence of cancer [so, patient has risk factors for types of cancer, and an elevated calcium, think this]
empathy vs support from dr
empathy has person story with it support just expresses concern and interest to the patient
causes of exudative pleural effusion:
empyema, malignancy, rheumatoid arthritis, esophageal rupture, pancreatitis, pulmonary infarction, tuberculosis. ->only tb is associated with a very high total protein, ->> 4g/dl.
Renal (Gerota) fascia
enclosing the perinephric fat is a membranous condensation of the extraperitoneal fascia, the renal fascia, Suprarenal glands are enclosed in this fascial compartment, separated from the kidneys by a thin septum
What cells characterize the late phase of atopic asthma? (3 types)
eosinophils basophils neutrophils
obstructive sleep apnea
episodes of short-term hypoxemia ->sensed by the kidneys ->stimulates erythropoietin production. ->drives creation of more RBCs =>polycythemia.
bppv treatment
epley maneuver
drugs that should be avoided with sumatriptan
ergot preps (also 5-HT agonists like suma) cuz this can cause prolong vasospastic reactions
estrogen does what to thyroid hormones
estrogen decreases catabolism of TBG: increase total T4 pool(bound and free t4) and total T3 but normal TSH seen in pregnancy, OCPs, HRT
Cause of carpal tunnel syndrome in pregnant woman
estrogen mediated depolymerization of ground susbtance --> interstitial edema
Treatment for absence seizures
ethosuximide or valproate
heroin intox
euphoria, resp, CNS depression, pupillary constriction, seizures
volume status in SIADH
euvolemic hyponatremia
What is the primary abnormality in Paget's disease of the bone?
excessive OSTEOCLASTIC bone resorption; osteoclasts in Paget's disease are typically very large and can have up to 100 nuclei bone turnover is markedly increased in Paget's disease, culminating in chaotic bone formation
So what is paget's disease of the bone caused by?
excessive osteoclastic resorption [childhood infection of osteoclasts by a paramyxovirus may be responsible]
Posterior drawer sign
excessive posterior displacement= PCL tear PCL= antlat medial femoral condyle to post intercondylar area of tibia
Why would mom have anti RH antibodies?
exposed to baby's blood
cleft palate formation due to
failure of fusion of the lateral palatine processes ,the nasal septum,and/or the median palatine process......formation of secondary palate
Cleft lip formation due to
failure of fusion of the maxillary and medial nasal process...formation of primary palate
tension pneumo on CXR.
faint white line (visceral pleura) near the midline ->beyond which no pulmonary vasculature or lung parenchymal markings are apparent. also usually - flattening of ipsilateral hemidiaphragm.
CCl4 to liver damage appearance
fatty change and hepatocyte necrosis due to free radical damage from the p450 system Lipid peroxidation: lipid degradation and H2O2 formation
cardiac catheterization
femoral artery is used, a long, slender catheter is inserted percutaneously and passed up the external iliac artery, common iliac artery, aorta, to left ventricle of the heart
Where do the adductors of the hip attach
femur and ischium
Drugs in weight lost assoc w/ pulm htn
fenfluramine, dexflenfluramine, phentermine
toxic shock syndrome toxin (TSST-1) is what
fever, V/D, muscle pain, erythroderma--> hypotension, multisystem dysfunction desqumation on palms and soles assoc. w/ tampons, nasal packing Superantigen: that MHCII on apc and variable region on Tcell(inc Il2), macrophages( IL1, TNF)
pain of appendicitis
first pain- referred around the umbilicus, visceral pain in the appendix is produced by distention of its lumen or spasm of its muscle afferent pain fibers enter the spinal cord at level of T10 segment, and a vague referred pain is felt in the region of the umbilicus If parietal peritoneum gets involved- pain shifts laterally to the Mc Burney's point where it is precise, sever, and localized (second pain)
median nerve runs btw
flexor digitorum superficialis and flexor digitorum profundus muscles
Pancreatic pseudocyst is
fluid sack lined by fibrous tissue and granulation tissue
antidote for benzos
flumazenil
Referred abdominal pain
foregut = epigastric region midgut = umbilical region hindgut = hypogastric region
fracture of anterior cranial fossa
fracture of the anterior cranial fossa - cribiform plate of the ethmoid bone, is suggested by anosmia, periorbital bruising and CSK leakage from nose (rhinorrhea)
correct serum Na too fast: from high-> low
from high to low your brain will blow: cerebral edema/herniation
correct serum Na too fast: low->high
from low to high your pons will die= CPM
most common cause of neprotic syndrome in adults
fsgs. even more increased in african americans and obses indivisuals
ectopy of cells
functionally normal cells/tissue found in an abnormal location due to embryonic maldevelopment
Micafungin targets
fungal cell wall
Hepatitis C has this genetic difference
genetic variation has led to hypervariable region of the envelope glycoprotein esp. prone to mutation: no proofreading 3'-->5' exonuclease activity built into virion-encoded RNA polymerase= make many errors Antigenic variation: So antigenic structure of HCV envelope proteins, production of AB lag behind new mutant strains of HCV= effective immunity against infection is not conferred High immunogenicity
gingival hyperplasia occurs...
gingival macrophages are exposed to PDGF it stimulates proliferation of gingival cells and alveolar bone
Defective protein if glucagon does not correct hypoglycemia in a strain of mice but epinephrine does
glucagon receptor
how do u make creatine
gly+arg+SAM
Most common cause of septic arthritis in young, sexually active patients
gonococcal
Muddy brown cast of ATN is a type of
granular cast
DNA polymerase III
has 5'->3' synthesis and proofreads 3'->5' if makes a mistake in synthesis; stops; rewinds 3->5 and fixes it high fidelity: preserve genetic code
carbon monoxide poisoning
headache, nausea, abdominal discomfort. pinkish-red skin hue diagnosis confirmed by ->carboxyhemoglobin levels.
carbon monoxide poisoning
headache, nausea, dizziness high hematocrit ->due to no unloading of oxygen, ->so body makes more red blood cells
Congenital diaphragmatic hernia
hernia of stomach through posterolateral defect in diaphragm called form of Bochadalek seen in infants and high mortality rate because of left lung hypoplasic
patellar tendon reflex
herniation of IV discs L2/3 or L3/4 afferent and efferent limbs of the arc are due to femoral nerve L2-L4 the patella ligament may be used for surgical repair of ACL
12 hours after birth baby begins sucking frantically and crying inconsolably, also overreacts to stimuli around him and has a marked startle response, symptoms resolve in 2-3 weeks, what was the mother using
heroin
a mutation in 50% of material mitochondrial DNA present in 100% of her children is explained by
heteroplasmy
mitochondrial inheritance expression
heteroplasmy = variable expression
Protein levels in an exudate
high (>2.9g/dL)
Arg and lysine are prominent in
histones
suspect lung cancer in smokers who present with
horner's syndrome. do a CXR
Resistance to cancer drugs
human multidrug resistance gene( MDRI): p-glycoprotein, transmembrane protein that function as an ATP-dependent efflux pump Normally in: intestine, RT epi cells, capillary endothelium (BBB)
onion-like concentric thickening of arteriolar walls
hyperplastic arteriosclerosis (SM)
interventricular septum hypertrophy
hypertrophic cardiomyopathy obstructs: mitral leaflet outflow tract
clubbing and sudden-onset joint arthropathy in a chronic smoker is suggestive of
hypertrophic osteoarthropathy. often associated with lung cancer, ->so do a CXR.
cause of ventricles to make ANP which is normally in atria
hypertrophy: volume overload normally ventricle make BNP
Electrolyte abnormality that is a bad prognostic factor in CHF
hyponatremia
What can cause cardiac tamponade?
hypothyroidism, physical trauma, pericarditis, iatrogenic trauma, myocardial rupture
Hunter's syndrome accumulation
iduronate sullfatase deficiency = heparan sulfate, dermatan sulfate (mild developmental delay, gargoylism, airway obstruction + aggression)
ileus vs bowl obstrection
ileus: both small and large bowel dilation sbo: don't see large bowel or rectum gas
CML treatment
imatinib. inhibits bcr-abl tyrosine kinase
Is reaction formation immature or mature defense mechanism? what is it?
immature, where unacceptable feeligns are IGNORED and the opposite sentiment is adopted (forced). man who's mad at his wife instead compliments her dress
Is splitting a mature or immature defense mechanism? what is it?
immature. frequently employed by patients with borderline personality disorder, everything is either "good or bad."
When does S3 heart sound happen?
immediately following S2 during phase of rapid passive ventricular filling
Limited healing in lateral collateral ligament tear
impaired blood supply
Phenomenon where you have a nuclear enzyme that transfers methyl group with SAm in DNA molecule
imprinting
Herniated IV disc
in lumbar or cervical regions at L4/L5 or L5/S1 or C6/C7 or C5/C6 (towards the ends) Symptoms include: history of back pain that may radiate down to the lower limb, usually after lifting something heavy usually compresses the nerve root one number below lower limb reflexes are decreased on the affected side
Branches of Celiac artery/trunk
in notebook
branches of IMA
in notebook
branches of SMA
in notebook
When do we most commonly (or typically for Step 1) hear an S3 ventricular gallop?
in patients with left ventricular systolic failure or restrictive cardiomyopathy
osteogenesis imperfect defect in bones
inability of bone matrix formation
Man has inflammation of esophagus after meals. What is most likely cause?
inappropriate relaxation of LES
pathophys of clubbing
increase megakaryocytes and platelet clumps: increased release of PDGF/VEGF increase fibrovascular proliferation, increased PGE2
klinefelters labs
increased LH/FSH, estradiol Decreased Testosterone, Sperm count
exudative effusions are caused by .... transudates are caused by ...
increased capillary permeability. increased hydrostatic or decreased oncotic pressure.
praziquantel MOA
increased cell membrane permeability
Oligomenorrhea
increased estrogen in adipose tissue
Crohn's disease and kidney stones, cause
increased oxalate absorption
muscle misuse
increased protein degradation not myosin activity
first dose hypotension or hyperkalemia w/ ACE inhibitor
increased risk with hypovolemic/hyponatremis due to thiazides or Loops diuretics hyperK: nonselective B-blocker
hypersensitivity pneumonitis
inflammation of lung parenchyma due to antigen exposure. acute episodes present with ->cough, ->breathlessness, ->fever ->malaise. chronic exposure can cause ->weight loss, ->clubbing, ->honeycombing of the lung.
crypitis
inflammation of the crypts of the intestines, for instance, of the anal sinuses can perforate the mucosa and lead to an ischioanal abscess
Pneumonia
inflammation of the lung, caused by an infection or chemical injury to the lungs: bacteria, virus, fungi symptoms: cough, chest pain, fever, and difficulty breathing chest xray: areas of opacity of the lung parenchyma and enlargement of bronchomediastinal lymph nodes
subacromial bursitis
inflammation of the subacromial bursa is often due to calcific supraspinatus tendinitis, causing a painful arc of abduction
What is adult still's disease
inflammatory disorder caused by recurrent high fevers, rash, and arthritis
Erythromycin mechanism
interferes with amino-acyl translocation
protective mechanism against C. dif
interstinal biomass: bacterial aerobes compete for nutrient and adhesion in gut with c.dif Rx: w/ antibiotics kills off normal bacteria leading to overgrowth of c.dif
causes of restrictive lung diseases
interstitial lung disease, neuromuscular disease, alveolar edema, pleural fibrosis chest wall abnormalities. ankylosing spondylitis. ->inflammation leads to fusion of the costovertebral joints ->resulting in restriction of chest wall motion. will have normal or increased FRC ->due to fixation of the chest wall in an inspiratory position.
Dx. Proglottids in stool
intertinal tapeworms: taenia solium, diphyllobothrium
ARDS
intrapulmonary shunting, hypoxia typically refractory to oxygen administration ->so give PEEP, not increased FiO2
Decreased MCV, red, swollen, tender tongue, angular stomatitis, spoon-shaped nails
iron deficiency
Portocaval anastomosis
is obstruction due to portal hypertension, blood can flow retrograde direction and pass through anastomoses to reach caval system, sites include: 1. esophageal veins 2. paraumbilical veins 3. rectal veins
global ischemic stroke aka
ischemic hypoxic encephalopathy
in pigment stones: dark what is released from hepatocytes
it implies there is a infection of the biliary tree: B-glucuronidase released by injured hepatocytes and bacteria
We can administer bevacizumab even though it is a foreign protein because
it is a humanized antibody
HBV helps HDV how
it must be coated by external coat antigen HBsAG so can only arise w/ coninfection of HBV or superinfection of chronic HBV carrier
initial treatment of torsades
iv magnesium sulfate, even if person has a normal mg level
tension pneumothorax
lack of breath sounds on one side, tracheal deviation to the opposite side. rapid development of hypotension ->high intrathoracic pressures ->decrease venous return = decrease preload. treatment ->large-bore needle in the 2nd intercostal space mid-clavicular line ->decompression = improves venous return.
Major risk with too much metformin consumption
lactic acidosis
Metformin SE
lactic acidosis
metformin overdose
lactic acidosis
Tx of hepatic encephalopathy
lactulose
treatment for hepatic encephalopathy
lactulose
reticulocyte
larger/bluer than mature RBC retains basophilic, reticular network or residual ribosomal RNA= blue wright-giemsa stain
facial nerve affected in what lesion
lateral pons. this is where the nucleus is
structures under inguinal ligament
lateral to medial: iliopsoas muscle, femoral nerve, femoral artery, femoral vein, femoral canal
adenocarcinoma of the lung
least association with smoking. But still most common type of lung cancer ->even in smokers. located peripherally consists of columnar cells growing along the septa. presents as a solitary nodule may be detected incidentally.
Atrial Septal Defect
less frequent than VSD results from failure of the foramen ovale after birth (failure of septum primum and septum secundum to fuse) postnatally- ASDs result in L to R shunting between right and left atrium, are non-cyanotic conditions
stable v tach management
loading dose of IV amiodarone
Abdominal aortic aneurysm
localized dilation of aorta typically just above bifurcation at L4 and crossed by 3rd part of duodenum pulsations of a large aneurysm can be detected to the left of the midline at the umbilical region acute rupture of an abdominal aortic aneurysm is associated with sever pain in abdomen or back
obesity hypoventilation syndrome (OHS)
long-term consequence of untreated obstructive sleep apnea. Ssx ->chronic hypercapnic/hypoxic respiratory failure, ->secondary erythrocytosis, ->pulmonary hypertension. will have respiratory acidosis, compensated by ->increased bicarbonate retention ->decreased chloride reabsoprtion
metabolic alkalosis with volume contraction
loop diuretic
Ischemia in cardiomyocytes what occurs
loss of atp rapidly deplete loss of contractility w/in 60 seconds w/in 30 mins total myocardial ischemia occurs due to complete loss of ATP->AMP->adenosine: irreversible (inability to vasodilate)
injury of tibia nerve in popliteal fossa
loss of plantar flexion of foot (mainly gastrocnernius and soles muscles) and weakened inversion (tibialis posterior muscle) causing calcaneovalgus (inability to stand on toes loss of sensation and paralysis of intrinsic muscles of the sole of the foot
diabetes lipid levels
low HDL, high TG, high free fatty acids
lung abscess looks like and is due to
lung parenchyma that result in necrosis of surronding tissue abscess cavity communicates w/ an air passage, semiliquid exudate with in partially drain, creates an air-containing cavity seen on XRAY destruction of parencyma is due to lysosomal enzymes by neutrophils and macrophages: serve to digest pathogens and debris
TB pleural exudate findings
lymphocytic leukocytosis, absence of frank purulence, glucose level that is mildly below serum glucose levels, protein >4g/dl
classic csf findings in herpes encephalitis
lymphocytic pleocytosis, increased protein, elevaed RBC, normal glucose. (RBC elevation due to hemorrhagic destruction of frontotemproal lobes.)
Pathologic ventricular hypertrophy is accompanied not only by morphologic changes, but by chanes in gene transcription patterns as well. When there is prolonged hemodynamic overload, there may be abnormal up-regulation or re-expression of fetal proteins fromboth atrial and ventricular myoctyes. What type of mRNA might ventricular myocytes express that is typically only expressed in atrial myocytes?
mRNA for natriuretic peptides. The main learning point is in the question stem here.
hartnup disease
malabsorption of TRY(N AAA) decreased Niacin DX: Neutral AA in urine rx: niacin
RA pressure > 10mmhg + systolic pressure >40mmhg are used to diagnose
massive PE. (Vs septic shock ->decreased RA pressure ->warm extremities)
matching variables in case-control studies is for what
matchin variables are those like age, race of the people of interest. so you find a control group with the same type of people in order to decrease Confounding bias for similar distribution
Cavernous hemangioma
mc benign liver tumor in patients 30-50 congenital malformations; cavernous, blood filled vascular spaces of variable sixe lined by single pi layer
imperforate anus
mc g/u malformation abnormal anorectal structures: absence of anal opening most often assoc w/ ururectal, urovesical or urovaginal fistulas malformation: renal agenesis, hyospadius, epispadias, bladder extrophy inability to pass meconium
Femoral hernia
mc- women protrude through femoral ring, medial to femoral vessels and inferior to inguinal ligament
negative skew
mean<median<mode
alpha thal minor vs minima
minim: (a,a)(a,-). no clinical or lab abnormalities minor: (a,a)(-,-) or (a,-)(a,-). typically asymptomatic but may have mild chronic anemia with microcytosis. hemoglobin H disease: (a,-)(-,-) severe alpha thal. only have approx 30% hemoglobin A
protein levels in TB pleural exudate
more than 4g/dL
lymphatic drainage of the breast
most lymph especially from lateral breast quadrants, drains to axillary lymph nodes, remaining lymph (mainly from medial breast quadrants) drains to the parasternal lymph nodes or to the opposite breast
behaviors shown by fragile x people
mr and autism spectrum, also seizures
Somatization disorder
multiple organ systems(4 pain, 2 gi, 1 sexual, 1 pseudoneuro) over a period of years, developing before 30 mc= F>M 2:1
Organophosphate toxicity Rx w/ atropine, patients still at risk for
muscle paralysis Atropine doesn't work on nicotinic R Pralidoxime works on restoring muscarinic and Nicotinic cholinesterase
-Levofloxacin resistance, how?
mutation of gene encoding topoisomerase II
symptoms of iron toxicity
nausea, vomiting, diarrhea initially. vomit and hiarrhea are typically hemorrhagic. later: lactic acidosis, hepatotoxi, organ failure
Optimal diagnostic cut point for results of test
need to include all of the "infected"
what receptors do ganglionic blockers bind?
nicotinic
Tx of fetal pulmonary hypertension
nitric oxide (monitor for methemoglobinemia)
hypopituitarism + mild increase in prolactin =
nonfunctioning adenoma
Infection with Staph Aureus, Serum electrophoresis show what pattern?
normal albumin. Elevated alpha, beta1, beta2. Low gamma.
inapproriate absolute
normal plasma, O2 stat Increased RBC mass RCC, HCC, hemanioblastoma, Wilms tumor, hydronephrosis ectopic EPO
most common adverse effect of inhaled corticosteroid therapy
oropharyngeal thrush (oral candidiasis)
cause of lumbar spinal stenosis
osteoarthritis of spine
Excess IL1 in elderly woman
osteoporosis
Diagnosis of patellofemoral syndrome
pain elicited by extending and compressing patella
Bilateral joint pain + loose bowels + acute onset
parvovirus B19
progression of ekg symptoms with hyperkalemia
peaked t waves--loss of p wave---widened qrs with sine wave pattern
location of bone that heals fracture
periosteum (includes osteoblasts)
features of distributive shock
peripheral vasodilation, decreased intravascular voume. this is essentially septic shock or anaphylaxis, or neural insufficiency
cutaneous skin lesions in increasing order
petechiae<purpura<ecchymoses(bruise)
variable expressivity
phenotype varies among individuals w/ same genotype 2 patients w/ NF1 may have varying disease severity
Interview: reflection
physician repeats what he has just been told: gives assurance that he has been listening and allows the patients to clarify any points that have been misunderstood
S. aureus
post-viral URI necrotizing pulmonary bronchopneumonia with multiple nodular infiltrates can cavitate -> cause small abscesses.
-Decreased amniotic fluid and normal size fetal kidney, bladder and ureter distended, what is the problem?
posterior urethral valves
Parasitic drug that increases the permeability of the cell membranes to calcium causing paralysis, dislodgement, and death
praziquantel
oxycephaly
premature closure of the coronal suture results in a high, tower-like cranium
most abused drugs and epidemic in US
prescription drugs; mostly opioid pain relievers
vulvar lesion in syphylis
primary-> chancre secondary-> comes back: chancre; also condylomata lata form tertiary: gummas: white rubbery lesion, indurated granulomatous lesions
invasion of basement membrane occurs due to
proteolytic enzymes: metalloproteinases and cathepsin D protease
Dx trophozoites and cyst in the stool
protozoal: giardia lamblia or entamoeba
Direct inguinal hernia
protrusion of abdominal contents through hesselbach triangle on anterior wall covered by external spermatic fascia(transversalis fascia) medial to inferior epigastric artery old people MD's don't LIe
Iliofemoral vein is what type of vein
proximal deep leg vein
pulmonary vs bronchial circulation
pulmonary circulation = larger percentage of CO (=CO vs. bronchial circ is much less of CO)
incidence of CF (AR disorder )in population is 1/40000 what are the chances of being a carrier?
q^2=1/400000.......q=1/200...... in a small population ......p=1 we can say p=1 bc it so close to 1(p+q=1, p=1-1/200=.995) hetero=2pq=2*1/200=1/100
stuff injured in middle humerus fractures
radial nerve in spiral groove
tumor lysis syndrome presents as
rapid cell turnover in lymphoma/leukemia patients hyperphosphatemia, hypocalcemia, hyperkalemia, and hyperuricemia decreased urine output, increased BUN + creatinine, peaked T-wave prevent: allopurinol/rasburicase
Ursodiol
reduces cholesterol absorption and can dissolve cholesterol gallstones
Two weeks after granular cast seen and none since then, we expect to see
regenerating tubular epithelium
Muscle fiber grouping post chronic peripheral neuropathy occurs because
reinnervation of muscle fiber by regenerating axons
age related changes w/ digoxin toxicity
renal clearance decreases
signs of atheroembolic renal disease following invasive vascular procedure
renal failure and to gangrene or livedo reticularis
Patent Ductus Arteriosus (PDA)
results from failure of the ductus arterioles to constrict and close after birth prostaglandin E and low oxygen tension sustain latency of the ductus arterioles in fetal period common in premature infants and in cases of maternal rubella infection L to R shunt increased pressure in pulmonary circulation and in non-cyanotic Treatment: surgical division and ligation imperative, in great danger in left recurrent nerve, injury results in hoarseness
Chromaffin cells of adrenal medulla
secretes 2 catecholamines: Epi and NE, which affect smooth muscle, cardiac muscle and glands in the same way as sympathetic stimulation Hypersecretion of catecholamines results in: tachycardia, sweating and high BP
Dull tympanic membrane without signs of infection =
serous otitis media
Constrictions of the esophagus
sites where ingested foreign bodies can lodge or where strictures may develop following ingestion of caustic fluids, common sites of esophageal carcinoma 1. C6 - where pharynx joins upper end 2. T4/5 - where aortic arch and left main bronchus cross its anterior surface 3. T10 where it passes through diaphragm into the stomach
RNA splice error
skipping of exons
lambert eaton can be associated with
small cell carcinoma of the lung. autoantibodies to presynaptic voltage gated calcium channels.
There are 7 important risk factors for osteoporosis....
smoking menopause corticosteroid therapy physical inactivity caucasian race low total body weight alcohol use
In reversible hypoxic cell injury; swelling results from intracellular accumulation of --
sodium
6th branchial arch
speak; CN X (recurrent laryngeal branch) all intrinsic muscle of larynx besides cricothyroid
Relations of the spleen and left kidney
spleen follows the contour of 10th rib and extends from the superior pole of the left kidney to just posterior to the midaxillary line border between spleen and upper pole of the left kidney is 11th rib
Bisacodyl
stimulant laxative
bacteremia in scd pts most commonly caused by
strep pneumo in developed countries staph aureus in underdeveloped
Varicose Veins causes
stretch of venous valves causing them to fail Complications: painful thromboses, stasis dermatitis, skin ulcerations, poor wound healing, superficial infections
rotator cuff muscles - SITS
support the shoulder joint by forming a musculotendinous rotator cuff around it, reinforces joint on all sides except inferiorly, where dislocation is most likely supraspinatus, infraspinatus, teres minor, subscapularis
Cuboidal lung epithelial cells with dense lamellar bodies 1-2 u in diam
surfactant
granulomatous inflammation of media
temporal arteritis (carotids+temporal) or takayasu's arteritis(aortic arch) increased ESR in both
What is the major limiting factor for coronary blood flow?
the duration of diastole most of the blood supply to the heart occurs during diastole and the duration or length of diastole is a critical factor in determining coronary blood flow
pleiotropy
the production by a single gene of multiple phenotypic effects. The term is often used to refer to a single gene defect that is expressed as problems inmultiple systems of the body, such as in osteogenesis imperfecta, where thegene causes defects in several different systems that contain collagen
What is a 95% confidence interval?
the range of values in which one can be 95% confident that the true mean o the underlying population falls
in ventilated patients respiratory alkalosis can result from hyperventilation. if the tidal volume is appropriate (6 mg/kl of body weight)
the respiratory rate should be lowered. reducing the tidal volume can trigger increased ventilatory rate.
Where do all of our important baroreceptor nerves terminate? I.e., fibers from the aortic arch baroreceptors and the carotid sinus baroreceptors send their fibers to what brain structure?
the solitary nucleus of the medulla
treatment of familial dysbetalipoproteinemia
these peeps have high triglycerides. see striate palmar xanthomas. initial treatment is a fibri c acid derivative
Kidneys dimensions and position
they are extending from level of T12 to level of L3 , right kidney lying about 2-3 cm lower than the left one
managemnt of SBP
third gen, fluororoquinioleone, or extended spectrum penicillin
mallet or baseball finger
this deformity results from the DIP joint suddenly being forced into extreme flexion (hyper flexion) when, for example a baseball is miscaught or a finger is jammed into the base pad this avulse the attachment of the extensor digitorum tendon to the base of the distal phalanx, as a result, the person cannot extend the DIP joint
labs in DIC
thrombocytopenia, low fibrinogen, increased INR. signs of microangiopathic hemolytic anemia: high ldh, high retic count, high bili
4th-6th arches cartilages
thyroid, cricoid, artenoids, corniculate, cuneiform
What is the major physiological function of surfactant?
to decrease the surface tension of fluid layer lining the alveolar surface
avascular necrosis of femoral head
transcervical fracture disrupts blod supply to the head of the femur via reticular arteries (from medial circumflex femoral artery) and may cause avascular necrosis of the femoral head if blood supply through the ligament to the head is inadequate
quadrangular space
transmits axillary nerve and posterior circumflex humeral artery- inferior border of trees minor, surgical neck of the humerus, lateral border of long head of triceps brachia muscle, superior border of teres major
relative risk under/over 1
under one = decreased risk, over one = increased risk
what effect does recent gastric bypass surgery have on the gallbladder?
up to 40% chance of developing symptomatic gallstones cuz rapid wt loss increases concentration fo bile
tb cxr signs
upper lobe cavitary lesions and hilar adenopathy
staghorn calciulus bugs
urease-positive (Proteus, Staph, Klebsiella)
rx orotic aciduria
uridine inability to convert orotic acid to UMP
Winters formula for metabolic acidosi
used to evaluate respiratory compensation when there is metabolic acidosis PaCO2=(1.5 x HCO3-) +8 +/-2 PaCO2> predicted: concurrent respiratory acidosis PaCO2<predicted: concurrent resp alkalosis Inability to compensate indicates respiratory failure
injury to musculocutaneous nerve
usually results from lesions of lateral cord, greatly weakens flexion of elbow (brachial is and biceps) and supination of forearm (biceps) may be accompanied by anesthesia over lateral aspect of forearm
vascular vs alzheimer dementia
vascular has a faster progression
in a parapneumonic effusion, if the pH < 7.2
very high probability that fluid needs to be drained, ->it is an empyema. glucose < 60 is also an indication for this.
vincristine
vines that block formation of Mts
visceral vs somatic pain
visceral: more difficult to localize. like generalized brcrampy pain
vitamin def association with squamous metaplasia
vit a
injury to inferior gluteal nerve
weakened hip extension (gluteus maximus) most noticeable when climbing stairs or standing from a seated position Cause: posterior hip dislocation, surgery in this region
injury to sciatic nerve
weakened hip, extension and knee flexion footdrop- lack of dorsiflexion flail foot- lack of both dorsiflexion and plantar flexion cause of injury: caused by improperly placed gluteal injections but may result from posterior hip dislocation
plagiocephaly
when premature closure of the coronal or lambed suture occurs on one side only, the cranium is twisted and asymmetrical
retrospective
who developed the disease (exposed vs onexposed)?
distinguishing between alcohol withdrawal tremor and asterixis
with asterixis should see signs of liver cirrhosis like low albumin and elevated inr
Rupture of cruciate ligaments
with rupture of ACL, the tibia can be pulled forward excessively on the femur- exhibiting anterior drawer sign with PCL, tibia can be pushed backward excessively on the remus, exhibiting posterior drawer sign
How do we best auscultate an S3 gallop?
with the bell of the stethoscope at the ventricular apex
Can a competent patient refuse healthcare? Can a competent patient refuse knowledge of their potential health situation?
yes and yes
High yield path association for Alzheimer's disease?
Neurofibrillary tangles in the neocortex
Swollen, itchy eyes, runny nose, sneezing for past week. What history is important to establish diagnosis?
New pet in threshold (allergy)
Which of the two major metabolites that regulates coronary blood flow works more on large arteries and pre-arteriolar vessels of the heart?
Nitric Oxide
-AST and ALT high, no other risk factors except for fat and HTN with thiazide. Why high AST and ALT?
Nonalcoholic steatohepatitis
RNA polymerase III
Nuceloplasm: tRNA, 5s RNA, snRNA
Abnormalities of orbitofrontal cortex =
OCD
Treatment of chlamydial conjunctivitis
ORAL erythro
Octreotide vs. beta blockers for esophgeal varices
Octreotide for active bleeding, beta blockers for prophylaxis
Treatment of central retinal artery occlusion
Ocular massage and high-flow O2 admin
What is a common clinical picture of Paget's disease of the bone?
Older gentleman with pain and deformity in a bony area and hearing loss
Postterm pregnancies are associated with what amniotic fluid issue
Oligohydramnios
Traction apophysitis of the tibial tubercle
Osgood-schlatter
Neuraminidase inhibitors
Osteltamivir
Bone Markers
Osteoblast: bone specific ALP (heat denatures easily), Osteocalcin, osteoprogenin Osteoclasts: TRAP, urinary hydroxyproline, most= urinary deoxypyridinoline
What derm disease is associated with Hep C
PCT
What heart defect is classically heard with a Patent Ductus Arteriosus? Where do we best auscultate it?
PDA is associated with a continuous murmur best heard at the left infraclavicular region with maximal intensity at S2
Calcium/creatinine clearance ratio in primary hyperparathyroidism vs. familial hypercalciuric hypercalcemia
PHP: >0.02, FHH < 0.01
What is osteitis deformans
Paget disease of bone
Mosaic pattern of lamellar bone =
Paget's disease
Carpal tunnel C/F and assoc.
Parethesias in thumb index, middle finger, thenr atrophy Assoc: DM, acromegaly, RA, hypothyroidism Hemodialysis: amyloid B2 deposition: often bilateral
What is the most common paroxysmal tachycardia, and what is its common pathophysiology?
Paroxysmal supraventricular tachycardia (PSVT) PSVT typically results from a re-entrant impulse traveling through slowly and rapidly conducting segments of the AV node
What is levonorgestrel
Plan B
Best likelihood of survival of colorectal carcinoma?
Poorly differentiated carcinoma confined to mucosa
Precise vs Accuracy
Precision= reproducibility=Reliable Accuracy= trueness= Validity
Severe reflux + painless bloody stools in an infant =
Proctocolitis
Treatment of positive PPD test in HIV patient
Prophylaxis with isoniazid (and pyridoxine) for 9 months
Staghorn caliculus think
Proteus mirabilis
How, physiologically speaking, is cardiac relaxation achieved, which is best detected by a rapid decrease in cytoplasmic calcium levels?
Relaxation occurs subsequent to calcium efflux from the cytoplasm, which is accomplished through the use of : Calcium-ATPase and Na+/Ca2+ exchange mechanisms the Ca2+ ATP-ase pump uses active transport to sequester calcium in the sarcoplasmic reticulum and re-establish ion gradient the sarcolemmal Na+/Ca2+ transmembrane protein does not require ATP and acceps three Na+ ions in exchange for one intracellular Ca2+ ions
Nephrolithiasis
Renal calculi= solid concentrations formed in kidneys from dissolved urinary minerals Types: majority = calcium oxalate stones, followed by calcium phosphate stones Can lead to obstruction of the ureter
Flushing worse with hot drinks, heat, emotion =
Rosacea
Live, Alternate virus vaccines
Rotavirus Smallpox (vaccinia virus)
ToRCHEs infection associated with bilateral cataracts (and PDA)
Rubella virus
trauma wound-> CSF leakage-> meninges
S. aureus
Joint pain + photosensitivity
SLE
SIADH is seen wth which lung cancer
SMALL CELL
Neural crest origin
SO GAME SnAPP Schwann cells, Odontoblasts Ganglia(PNS), Aorticopulmonary septum, Melanocytes, Epi cells(chromaffin of AM) Skull bones, Arachnoid, Pia, Parafollicular cells of thyroid (C cells)
Antigenic variation bugs/viruses
Salmonella (2 flagellar variants) Borrelia (relapsing fever) Neisseria gonorrhoeae (pilus protein) Virus: influenza (major-shift-reassortment; minor-drift-rearrangement) Parasite: trypanosoma (programmed rearrangement)
Diffuse interstitial infiltrates in an african american woman =
Sarcoidosis
cochlea fluids filled w/
Scala vestibuli and tympani= perilymph scala media= endolymph
Ventricular septal rupture vs. papillary muscle rupture
Septal rupture: pansystolic murmur at LEFT STERNAL BORDER Papillary muscle rupture: pansystolic heard at APEX with radiation
Causes of urinary retention in a patient with mild urinary obstruction and herniated disk
Severe pain!
Side effects of tacrolimus aside from nephrotoxicity
Similar to cyclosporine + risk of diabetes, neurotoxicity; NO hirsutism or gingival hyperplasia
Management of fibrocystic disease after removing clear fliud
Since clear, just observation, no need to send fluid
At around what age is death seen as being final?
Six-year-olds typically understand the finality of death. Infants have no understanding, whereas preschool age children often think of deaths in reversible or metaphorical terms.
Stepwise approach to ascites treatment
Sodium/water restrict --> spironolactone --> loop --> paracentesis
Proctocolitis in infant is due to
Soy/Lactose intolerance
What is RQ
Steady state ratio of CO2 produced to O2 consumed
PMR vs. Steroid induce myopathy
Steroid induced myopathy has normal ESR and CK
Effect modification can be distinguished from confounding by
Stratified analysis
Most common cause of pneumonia in nursing home
Strep pneumo
Most common cause of acute bacterial rhinosinusitis
Strep pneumo, then H. flu, then Moraxella
Most common cause of sepsis in sickle cell
Strep. pneumo
What is a nonfibrin-specific fibrinolytic drug?
Streptokinase
Dx rhabditiform larvae in the stool
Strongyloides stercoralis
Intracranial calcifications that resemble a tramline =
Sturge Weber syndrome
Subdural hematoma
SuBdural is caused by Bridging vein rupture. The hemorrhage looks long and thin like a bridg
plexus in GI
Submucosal: meiSSners: Secretions muscularis externa, Myenteric nerve plexus(auerbach), Motility
Conversion disorder
Sudden loss of sensory or motor often due to acute stressor
Treatment with which agent can provide pain relief in a patient with severe, unilateral, throbbing headaches associated with nausea and exacerbated by loud noises?
Sumatriptan (NOT oxygen)
Wernicke's location
Superior temporal
What embryological layer is the anterior pituitary derived from?
Surface ectoderm
L sternal border murmur
Systolic: hypertrophic cardiomyopathy Diastolic: aortic regurg, pulmonic regurg
Quinidine like effects does what/ similar drug/ Rx
TCA's Torsades Rx: NaHCO3
Bipolar disease C/I
TCA's SSRI's/SNRI's can induce mania
DNA probe binding
TF: n-myc, c-Jun, c-Fus steroids thyroid proteins Vit D receptors Retinoid acid receptors
Nystatin treatment of candida
TOPICAL
excercise in muscle causes what to decrease
TPR: via sympathetic discharge the muscle release vasodilatory factors tho which increase blood flow to those organs of use: adenosine, NO, K+ ions, ATP, CO2, lactate
Treatment of Hepatitis B =
Tenofovir or entecavir
Subclavian line placement + absent breath sounds on right side + distended neck veins =
Tension pneumo
What regions of the body have apocrine glands?
The dermis and subcutaneous fat of the: breast areaolae, axillae, genital regions
How does carotid sinus massage help a person in PSVT recover?
The nerves innervating the carotid sinuses are constantly firing; when pressure at the carotid bodies increases, the number of impulses sent to the CNS also increases Carotid sinus massage increases carotid sinus baroreceptor firing (involving cranial nerve IX, not X like the aortic arch), thus increasing parasympathetic influence on the heart and vessles this ultimately prolongs the AV node refractory period which stops AV re-entrant tachycardias
When considering disease epidemiology, what is the latent period?
The time elapsed from initial exposure to clinically apparent disease
Bilateral cystic masses on ovaries during pregnancy =
Theca lutein cysts
Describe the net impact on Mean Arterial Pressure (MAP) of exercise on exercising muscle.
There is only a modest blood pressure increase! this is because of peripheral vasodilation to skeletal muscle within the muscle significantly decreases the total systemic vascular resistance.
What roles do leukotrienes (from mast cells, eosinophils, basophils, and other cells that infiltrate bonchilal mucosa in asthmatics) play in mediating asthma symptoms?
They cause bronchial constriction and hyperreactivity and also promote mucosal edema and mucus hypersecretion
How do zafirlukast and montelukast offer long-term control of atopic asthma?
They increase airway caliber and reduce mucosal inflammation by antagonizing the leukotriene receptors
Patient with abnormal gait + confusion + dilated puils =
Thiamine deficiency
Diagnosis of simple cyst
Thin walls, no solid component, no enhancement
What are the 3 most common causes of metabolic alkalosis?
(1) Loss of hydrogen ions from the body: e.g., vomiting and nasogastric suction may cause loss of hydrochloric acid; this causes serum chloride to decrease leadign to decrease in urinary cholirde (this would be SALINE-RESPONSIVE metabolic alkalosis) (2) Thiazide and Loop Diuretics: cause increase renal losses of Na, followed by excretion of Cl-; reabsorption of HCO3- increases to maintain electric neutrality in cells; this is CONTRACTION ALKALOSIS (3) Increased aldosterone secretion: seen in primary hyperaldosteronism (Conn Syndrome) and associated with metabolic alkalosis; aldosterone increases renal Na reabsorption and urinary lossess of K, Cl, and H with relative increase in HCO3- resulting from H losses; urinary Cl concentration is increased, but chloride doesn't correct it either (saline-resistant alkalosis)
What three things can patients with bulimia develop (hint: one isn't weight loss because bulimia doesn't work.)?
(1) bilateral partodi gland enlargement (2) erosion of tooth enamel* (3) irregular menses
Net excretion rate of substance
(filtration) - tubular reabsorption of substance
Kozak sequence in mRNA
(gcc)= gccRccAUGG; R is either adenine or guanine initiator of translation(mRNA binding to ribosomes) mutation in G switched to C particular position of B-globin in thalassemia intermedia
kid 10 yrs old vs 1 yr old with cyanosis+clubbing of lower extremities and not upper body
10: PDA 1: coarctation of aorta
Low blood solubility = slow or fast induction?
141) low blood solubility --> rapid induction, low potency
Max level of PEEP
15
Murmur heard when patient sits up, leans forward, and holds breath in full expiration
AR
Mallory weiss tears affect veins or arteries
ARTERIES
Which of the two major metabolites that regulates coronary blood flow works more on small coronary arterioles?
Adenosine
What are the two most important factors that metabolically autoregulate coronary blood flow?
Adenosine and Nitric Oxide (NO)
-Neutrophil chemotaxis and oxidative metabolism are defective due to increase activity of which enzymes?
Adenylyl cyclase
Treatment of pinworm
Albendazole or mabendazole
Use of sodium bicarb with TCA overdose
Alleviates cardiodepressant action on SODIUM channels
Ultrasound vs. amniocentesis in Down syndrome screening
Amnioecentesis after abnormal MSAFP/quad screen and ultrasound
Treatment of cat bites =
Amoxicillin and clavuluanate
Summarize the key facts of the S3 sound or S3 gallop.
An S3 sound is a low frequency sound that can be physiologic in younger individuals, but typically pathologic in older adults. In older adults, it results from left ventricular systolic failure or restrictive cardiomyopathy. The S3 sound can be accentuated by having the patient lie in the left lateral decubitus position and fully exhale.
Polygenetics is also in
Androgen alopecia ishemic heart disease schizophrenia epilepsy glaucoma htn malignancy DMII
Entamoeba causes what type of diarrhea
BLOODY
Exophytic purple skin masses + nodular, contrast-enhanced intrahepatic lesions of variable size =
Bartonella
What is the general histology of an eosinophil?
Bilobed nucleus packed with large granules of relatively uniform size and inclusions seen on EM
erythromycin MOA
Bind 50S, prevent release of uncharged tRNA after it has donated its amino acid (aka translocation)
Palivizumab
Blocks RSV F protein (only for high risk infants) [Pali*VI*zumab for *VI*rus]
Endocarditis: next best step
Blood cultures before antibiotics!!!
What blood vessel can be hurt in supracondylar fractures
Brachial
What is the unique convertase used by the alternative pathway?
C3bBb (aka C3 convertase)
Torsades de pointes drugs/causes
CAMP Class 13a RAT Chloroquine Antipsychotics (chlorpromazine, phenothiazide, ziprasidone) Macrolides Protease inhibitors Class 1a:disopyramide, quinidine, procainamide Class 3 (besides amiodirone):ibutilide, dofetilide, sotalol Ranalozine Antihistamines TCA's Jervell and lange-Nielsen syndrome
Mechanism of CFTR
CAMP mediated Cl secretion
Treatment of patients with a history of rheumatic fever
CONTINUOUS antibiotic prophylaxis with penicillin
What is the clinical picture consistent with a COPD patient?
COPD encompasses chronic bronchitis and emphysema; heavy smoking is the most common cause hallmark of any obstructive PFT profile is DECREASED FEV1/FVC ratio due to expiratory airflow obstruction Emphysema also tends to increase TLC and RV
secondary pneumothorax should be suspected in
COPD patients presenting with worsening of their respiratory symptoms is usually due to ->dilated alveolar blebs ->that rupture air into the pleural space. symptoms include ->acute onset of unilateral chest pain, ->shortness of breath, ->breath sounds markedly reduced on affected site ->chest is hyperresonant to percussion.
finger clubbing is not associated with
COPD. (suspect malignancy)
Which cyclooxygenase is an inducible enzyme that is normally undetectable in most tissues except during inflammation?
COX-2
diagnosis of fibromuscular dysplasia =
CT scan or duplex ultrasound
Reiters syndrome assoc w/ (CCSSB)
Campylobacter chlamydia shigella salmonella bartonella sacroilitis 20% of time
What is the characteristic finding via cardiac catheterization in a patient with mitral valve stenosis? I.e., if we see what value elevated while the other remains normal, when do we think "Mitral Valve Stenosis."
Cardiac Catheterization will reveal a LA end diastolic pressure (via pulmonary capillary wedge pressure) that is significantly greater than the LV end diastolic pressure (LVEDP). This abnormal pressure gradient implies increased resistance to flow between the LA and LV, i.e., mitral valve stenosis.
What would we expect in terms of cardiac output in a patient with chronic anemia?
Cardiac output increases in an effort to meet the metabolic demands of the tissues
Generally speaking, what is cardiac tamponade?
Cardiac tamponade is pressure on the heart muscle which occurs when the pericardial space fills up with fluid faster than the pericardial space can stretch
Treatment of unilateral cervical adenitis
Clinda + I&D
Treatment of endometritis
Clinda and gentamycin
Painless jaundice, dark urine and pale stool, CT has large poorly defined soft tissue density at head of pancreas. what causes jaundice?
Common bile duct obstruction
Immunosuppresant used for psoriasis, RA, and transplant rejection
Cyclosporin (binds to cyclophicin to inhibit calcineurin)
Nephrotoxicity + gum hypertrophy + tremor = what toxicity
Cyclosporine
Treatment of HELLP in women beyond 34 weeks
Delivery, do not need steroids
Why is hepatic infarct not common
Dual blood supply
Indirect (congenital) hernia
Due to fully or semi-patent processes vaginalis and most common. Hernia enters deep inguinal ring and protrudes into spermatic cord itself out through superficial inguinal ring, potentially reaching all the way to the testis/scrotum exits abdominal cavity lateral to the inferior epigastric artery (superficial space) most common on the right side
EPO abuse vs. steroid abuse
EPO: no gynecomastia; steroid abuse: gynecomastia
Treatment of spincter of oddi dysfunction
ERCP with sphincterotomy
Murmur in Marfan syndrome
Early diastolic murmur --> aortic regurg
How, immunologically speaking, are eosinophils recruited and activated?
Eosinophils are recruited and activated by IL-5, which is secreted by Th2 helper T-cells
Cause of spider angiomas
Estrogen causes dilation of arteriole and capillary network
Treatment of dysfunctional uterine bleeding
Estrogen treatment
What are the classic LFT findings in a patient with emphysema (either a-1-antitrypisin deficiency or centroacinar)?
FEV1/FVC: decreased (hallmark of obstructive lung disease) Total Lung Volume: Increased (air can't get out) Diffusing Capacity: decreased (due to destruction of alveoli and adjoining capillary beds)
How to reverse anticoagulation for emergent laparotomy
FFP
cAMP induce hormones
FLAT ChAMP FSH, LH, ACTH, TSH, CRH, hCG, ADH(V2), MSH, PTH, Calcitonin, Glucagon
Most common cause of megaloblastic anemia in chronic alcoholic
FOLATE deficiency NOT thiamine
moving from supine to sitting can increase
FRC by 20 - 35%. ->can help prevent post-op atelectasis.
How does uremia cause an anion gap metabolic acidosis
Fialure to excrete acids
increased TG
Fibrates + niacin
When treating an acute ST-elevation MI or ischemic stroke with fibrinolytics such as TPA, what may develop? Is it serious or benign?
Fibrinolytics may cause reperfusion arrhythmia on arterial re-opening, but these arrhythmias are usually benign. [Accerlerated idioventricular (AIVR) rhythm is a common reperfusion arrhythmia]
Indicated for treatment of neutropenia secondary to chemo
Filgastrim (GCSF)
Which anti-arrhythmic has use-dependence
Flecainide, effect on sodium channels increases as HR increases
The recurrent branch can be damaged by knife injury between the tendons of the _________ and _______.
Flexor carpi radialis Flexor digitorum superficialis
Renitoblastoma gene mutation allows the cell to move from _____ and enter ____
G1 phase S phase
FF=
GFR/RPF =normally=20%
Glycine makes what
Gly---B6+sucynl Coa-->Porphryin-> heme
cytosine deaminase pathway
Glycosylase: cleaves altered base leave an AP site Endonuclease cleave 5' end Lyase cleaves 3' end DNA polymerase and ligase then fill single nucleotide gaps
Androgen insensitivity syndrome, what to do with gonads
Gonadectomy AFTER puberty to avoid risk of testicular carcinoma
Abciximab
GpIIb/IIIa (prevents ischemic complications in pts undergoing *percutaneous coronary intervention*)
Rapidly progressive degenerative neurologic disease at Pacific Ocena island. Infected cells have RNA dependent DNA polymerase activity. What is the virus?
HIV
All patients with chronic hep C should receive what
Hep A and B vaccines
Vesicles and erosions on hands + elevations of transaminases =
Hep C, associated with cryoglobulinemia
enlarged hepatocytes containing glycogen and lipid deposits =
Hepatic adenomas
HyperIgM vs. agammaglobulinemia
HyperIgM: high levels of IgM, agammaglobulinemia: low levels of IgM
Female infant dies at 12 days. Autopsy shown, what is the infant most likely infected by?
Hyperbilirubinemia
Contraindication to succinylcholine and why
Hyperkalemia because it can cause more hyperkalemia
Most common non-neoplastic colon polyp
Hyperplastic
Baby gets GBS from a vaccinated mother, means mother only made one ab isotype
IgM
CML treatment
Imatinib. BCR-ABL 9:22
What do you think, immunologically speaking, when you see someone with recurrent Neisseria infections?
Inability to form the membrane attack (MAC) complex this is a common complement deficiency
in excercise increase in glucose occurs by
Increasing activity of phosphorylase kinase liver(Gq)/muscle(Gs)= increase Adenylate cylcase, inc cAMP= + protein kinase A= glycogen phosphorylase kinase activated
Crystal-induced nephropathy is a well known side effect of what HIV drug
Indinavir/protease Didanosine induced pancreatitis Abacavir hypersensitivity NRTIs lactic acidosis SJS NNRTIs nevirapine liver failure
Filtration rate of substance
Inulin Clearance x Plasma conc of substance
What medications can cause pseudotumor cerebri
Isoretinoin
The ratio of oxygen consumption to blood flow is _____ in the kidneys than in other organs
Lower
Organs drained by superior mesenteric L.N.
Lower duodenum Jejunum Ileum Colon to splenic flexure
-left eyelid drooping, weakness on right side. what is diagnosis?
Lower midbrain lesion (Weber syndrome)
Drainage of internal iliac L.N.
Lower rectum to anal canal (above pectinate), bladder, vagina (middle third), prostate
How show warfarin therapy be modify when a known P450 inhibitor such as TMP-SMX is prescribed to a patient?
Lower the dosage of warfarin
What is the ultimate action of ANP?
Lowers blood pressure through peripheral vasodilation, natriuresis, and diuresis.
Heterophile antibodies timeline
May be negative early in the illness
Does more or less blood return to the right heart during inspiration? Why?
More blood returns because during inspiration intrathoracic pressure drops, allowing more blood to return to the right heart
Sudden cardiac arrest after mechanical ventilation in patient with low neck veins, hypotension
Must replace volume first! Ventilation increased intrathoracic pressure --> decreased venous return --> circulatory collapse
Treatment of isolated duodenal hematoma
NG suction + parenteral nutrition
Carcinoid syndrome is associated with what deficiency
NIACIN
number needed to treat calc:
NNH= 1/Absolute risk ARR= Event rate(rx)- Event rate(placebo)
Ventilation type in acute exacerbation of COPD
NPPV
Mom thinks kids are lazy and fight with each other, she is poor and uses portable heater. kids have headache and dizzy. What is initial action?
Need to assess possibility of CO poisoning
Vit D issue in bone
Needed for osteoid mineralization Def: increased in unmineralized osteoid matrix accumulation around trabeculae (widening of osteoid seams)
What is the major protease of extracellular elastin degradation? What is the major serum inhibitor of this extracellular elastase?
Neutrophil Elastase (comes from neutrophils and macrophages) The major serum inhibitor of elastase is Alpha-1 Antitrypsin
When to use x-rays for sinusitis
Nevr, not sensitive enough. Use CT
Protein in CSF of MS patients
Normal total protein
Calcium restriction in hypercalciuric renal stones
Not advised
Surface Ectoderm origin
O Nile and AHE MAPS Olfactory epi Nails, Inner/Outer Ear, Lens, Epidermis Adenohypophysis(Anterior pituitary), Hair, Enamel of teeth Mammary glands, Anal canal(below), Parotid gland, Sweat gland
Difference between OSA and obesity hypoventilation syndrome
OSA: normal ABG; OHS: abnormal ABG
Decreased bone density with blurring and pseudofractures =
OSTEOMALACIA
Impaired osteoid matrix mineralization =
OSTEOMALACIA
Managmenet of hydrocele
Observe until 12 months, if not spontaneously resolved, remove surgically
What is erysipeloid and where is it found
Occupational disease affecting fingers and hands
So what does hypocapnia imply?
Ongoing alveolar hyperventilation
What is the classic cardiac finding of mitral stenosis again?
Opening snap followed by rumbling murmur.
Sweating, dilated pupils, piloerection ("cold turkey"), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea ("flu-like" symptoms). Treatment: long-term support, methadone, buprenorphine.
Opioid (e.g., heroin) withdrawal symptoms
What eye issues are seen in NF1
Optic glioma
Treatment of Amebic abscess
Oral metronidazole
If a child pressents with mental retardation, eczema, and a mousy, musty body odor, what disease are you thinking of?
PKU
Aids patients with cortical/subcortical atrophy and secondary ventricular enlargement =
PML
What type of shoulder dislocation after seizure
POSTERIOR
What is the pathophysiology / pathology of tetralogy of Fallot (ToF)?
PROVe it (1) Pulmonary artery stenosis (2) RVH (3) Overriding aorta (overrides the VSD) (4) VSD
Decarease NE effect, decrease Phenylephrine effect, what drug is it?
Prazosin
What is the order of cardiac tissue conduction velocity from *fastest* to *slowest*?
Purkinje System Atrial Muscle Ventricular Muscle AV node
Managmenet of stress fractures of metatarsals
Rest + analgesia
prinzmetal angina causes
STEP-CT: ergonovine, cocaine, tobacco, TCA's, Propranolol, sumatriptan
Treatment of complex, thick rimmed empyema
Surgery!
primary lung focus-> blood->meninges
TB
Drainage of para-aortic L.N.
Testes Ovaries Kidneys Uterus
Transillumination and varicoceles/hydroceles
Varicoceles: None, Hydroceles: transilluminate
Drug for fat schizophrenic
Ziprasidone
suspensory ligament
connects ovaries to lateral pelvic wall, contains ovarian vessels
pneumothorax/COPD
decreased tactile fremitus, decreased breath sounds, hyperresonant to percussion
hypothalamic lateral area
hunger= inhibited by leptin destruction: anorexia
what is efavirenz? side effects?
non nucleoside reverse transcriptase inhibitor. causes CNS side effects like insomnia with vivd or bizarre dreams
glut+asp+gly
purines
nitric oxide
reduces pulmonary vascular resistance (watch for metglobinemia)
4th branchial arch
simply swallow: CN X(superior laryngeal branch) Muscles: pharyngeal constrictors, cricothyroid, levator veli palatini
treatment of kawasaki
single dose of IVIG along with aspirin to decrease incidence of coronary artery aneurysms
What diuretic for calcium stones?
thiazide
Side effects of cyclosporin aside from nephrotoxicity
"hyper" - everything. HTN, hyperlipidemia, hyperglycemia, tremor, *hirsutism (ewww)*, gingival hyperplasia
lipofuscin
"wear and tear" yellow-brown, finely granular perinuclear pigment that is product of free radical injury and lipid peroxidation common= heart and liver in aging, cachectic, malnourished patients
injury to radial nerve in the arm
"wrist drop" if injured in radial groove, only medial head of triceps is affected but extensors of forearm are paralyzed
Type IV Hypersensitivity: Delayed type: PPD
( 48 - 72 hrs), CD4 +TH1 cells mediate, Activate macrophages, causes inflammation, common in chronic intracellular inflammation.
How does the pathophysiology of aortic regurgitation explain the characteristic findings of these patients? And what are those findings again (2 major ones)?
(1) Bounding femoral pulses; (2) Carotid Pulsations with head-bobbing (de Musset sign) There is a large LVSV, a large regurgitant SV, and a large pulse pressure. Bounding femoeral and carotid pulses marked by abrupt distention and quick collapse ("water hammer" pulses) are the result of large pulse pressure the head bobbing is due to the transfer of mementum from htel arge left ventricular stroke volume to the head and neck
What are the two important formulae for cardiac output? What principle underlies the second?
(1) CO = Stroke Volume * Heart Rate (2) Oxygen Consumption / Arteriovenous O2 difference *the second formula is explained by Fick's principle; it states that the cardiac output is equal to the oxygen consupmtion by the tissues divided by Arteriovenous Oxygen difference
What are the 3 main causes of valvular aortic stenosis?
(1) Congenitally abnormal valve with calcification --e.g., a bicuspid aortic valve (2) a calcified normal valve (3) rheumatic heart disease N.B. rheumatic heart disease is most common cause worldwide, calcific aortic valve disease is more common in U.S.
In a patient with an isolated diastolic heart failure (due to smoking, perhaps), what would we expect to see regarding these three parameters: (1) LVEDP (2) LVEDV (3) LVEF
(1) Increased (2) Normal (3) Normal [Diastolic heart fialure is characterized by a decrease in ventricular diastolic compliance but normal ventricular contractile performance. As a result, LVEDP must be increased in order to achieve a normal LVEDV and stroke volume.]
What are some important precipitating factors for isolated episodes of a-fib?
(1) binge alcohol consumption ("holiday heart syndrome") (2) increased cardiac sympathetic tone (3) pericarditis
What 2 aspects of disease epidemiology can be related to latent period and how?
(1) disease pathogenesis: exposure and how long it takes for symptoms (2) exposure to risk modifiers (e.g., anti-oxidants)
Which nerve is more associated with the carotid sinus? How is it associated, and what is the name of the actual nerve / who is that nerve a branch of?
(1) glossopharyngeal nerve (2) AFferent fibers from the carotid sinus stretch receptors form a small carotid sinus nerve called HERING'S NERVE, which is a branch of the glossopharyngeal nerve
What is the classic triad (Beck's Triad) of cardiac tamponade?
(1) hypotension (2) distended neck veins (3) distant or muffled heart sounds
What are the adverse consequences of the body's adaptations to CHF? There are 3 major ones to keep in mind.
(1) increased afterload from excessive vasoconstriction (2) excess fluid retention (3) deleterious cardiac remodeling, which perpetuates a downward spiral of progressive cardiac deterioration
What are teh 2 major effects of Carbon Monoxide (CO) on oxygen delivery to tissues?
(1) it binds to hemoglobin with an affinity 250x that of Oxygen, reducing the number of heme binding sites available to oxygen (CO-bound hemoglobin is called CARBOXYHEMOGLOBIN). By decreasing the fraction of hemoglobin available for oxygen binding, CO decreases the oxygen content of blood. (2) CO poisoning causes a leftward shift of the hemoglobin dissociation curve, reflecting a decreased tendency for oxygen to unload in the tissues
What 2 physical examination maneuvers can help bring out an S3 more audibly?
(1) lying the patient in a left lateral decubitus position (2) ask the patient to exhale completely while in that position by decreasing the volume of the lungs and bringing heart closer to the chest wall
What is the characteristic triad of abnormalities corresponding to ventricular pre-excitation [due to Wolff-Parkinson-White syndrome]?
(1) shortened PR-interval (2) delta wave at the start of the QRS complex (3) widened QRS interval
Which two anatomical landmarks are important loctaions of barroreceptors that are especially important in blood pressure control?
(1) the carotid sinus [located just above the bifurcation of the common carotid artery] (2) the aortic arch
What three pathologies do we associate a holosytolic murmur with?
(1) tricuspid regurgitation (2) mitral regurgitation (3) ventricular septal defect
GFR
(Urine conc x urine flow)/ serum conc normally use creatinine or inulin
subacute ( 3-8 weeks) and chronic (> 8 weeks) cough.
1) postnasal drip 2) GERD 3) asthma cause 90% of cough w/ no pulmonary disease. if cough after URI ->most likely post nasal drip. Tx: ->1st gen anti-histamine: chlorpheniramine
Serum sickness like reaction can occur how many weeks after administration of drug
1-2 weeks
Branches of abdominal aorta and mesenteric ischemia
1. Celiac trunk- T12 2. SMA - L1 3. Renal arteries- L2 4. IMA - L3 5. Bifurcation at L4
Micturition reflex
1. PS fibers (pelvic splanchnic n) stimulated DETRUSOR M = contraction and involuntary relax internal sphincter 2. Somatic motor fibers (pudendal nerve) cause voluntary relaxation of external urethral sphincter inhibiting emptying: sympathetic fibers (sacral splanchnic nn) inhibit detrusor muscle and stimulate internal sphincter
lacunar strokes occur in
1. mc= lenticulostriate (basal ganglia) 2. internal capsule: pure motor stroke 3. thalamus: pure sensory stroke
signs in MRI suggestive of brain mets
1. multiple well circumscribed enhancing lesions usually at the grey-white junction 2. surrounded by large amounts of edema
Primary vs Secondary Tb
1.inhales aerosolized TB: deposits in lower lungs and phagocytosed by alveolar macrophages 2. proliferates in them until Th1 cells activate the macrophages 3. Walled off and eliminated if the area of necrosis is small enough(Ghon) If large: immunsuppressives or HIV can reactivate it and establish cavitary infection in upper lungs 4. Causes caseation and liquefactive necrosis
Once activated from 7-dehydrocholesterol to cholecalciferol by sunlight, how many hydroxylations must Vitamin D3 undergo to become active? Where do each of these occur?
2 the first is in the liver by cytochrome P450 25-hydroxylase [this step is NOT tightly regulated] the second is in the kidney, performed by 1-alpha hydroxylase
What is the best, most reliable way to quantify the severity of aortic regurgitation?
2D and Doppler Echocardiography
500 worker with bladder cancer, 200 without bladder cancer. Bladder cancer: 250 has exposure. No bladder cancer: 50 have exposure. What is odds ratio?
3.0 (OR= De * Hne / Dne * He) -De=disease exposed -Hne=healthy not exposed -Dne=disease not exposed -He=healthy exposed
Empiric treatment of infant > 28 days vs. < 28 days
>28 days: vanc and ceftriaxone, < 28 days: amp and gent/cefotaxime
What level of beta hcg must be for transabdominal ultrasound to reliably visualize gestational sacs
>6500
Receptor causing pilomotor contraction
A
A patient has deep venous thrombus and develops a stroke. What type of embolus is this? Why?
A Paradoxical embolus, because it originated in the venous system but crossed over into the arterial circulation (bypassing the lungs)
How is the reduced cardiac output in CHF initially detected? How does the body attempt to compensate?
A drop in blood pressure Compensatory neurohormonal stimulation that is directed at maintaining blood pressure and tissue perfusion Chiefly mediated through: (1)increased sympathetic nervous system activity, (2)stimulation of the renin-angiotensin-aldosterone pathway, (3) release of ADH
Summarize the cardiac findings in a patient with a tricuspid valve regurgitation.
A holosystolic murmur that increase in intensity on inspiration most likely represents tricuspid regurgitaiton.
What is the classic auscultatory finding of mitral regurgitation? What is the best physical exam finding indicator of the severity of mitral regurgitation?
A holosystolic murmur that radiates to the axilla. The presence of an audible S3; i.e., the best indicator of a high regurgitant volume indicating severe Mitral Regurgitation with left ventricular volume overload is the presence of a left ventricular S3 gallop
How do we differentiate a holosystolic murmur? I.e., how do we know if it's tricuspid valve regurgitation vs. mitral regurgitation vs. ventricular septal defect?
A tricuspid regurgitation murmur would be expected to increase in intensity during inspiraiton, while the other two would not
Receptor causing pupillary dilation
A1
SE of TCAs
A1 blockers (orthostatic hypotension) Muscarinic Blocker (like atropine)
liver biopsy: intracellular granules, reddish pink on PAS stain w/ periportal hepatocytes
A1AT deficiency unsecreted A1AT in periportal hepatocytes that resist digestion by diastase
Lysogeny specialized transduction bugs
ABCDE shigAlike toxin Botulinum toxin Cholera toxin Diphtheria toxin Erythrogenic toxin of S. Pyogens O antigen of Salmonella
supraspinatus
ABducts (super man initially)
Location of stroke that affects lower limbs more than upper limb
ACA
ehlers-danlos syndrome issue
AD or AR: or enzymes (hydroxylases or procollagen) Type 1 (joints) or 5 (joint and skin) collagen most common type IV EDS(AD): type 3 collagen impaired (vascular and organ rupture)
Paget's disease of the breast is a sign of what type of underlying breast cancer
ADENOcarcinoma
Diagnostic test in patient with solitary liver mass
AFP
When to do endoscopy in HIV patient with oral thrush and odynophagia
AFTER failing empiric therapy
When to do TIPS
AFTER trying conservative medical management
People with Down Syndrome are at an increased risk to develop what type of cancer?
ALL (we ALL fall DOWN together) Also increased risk of AML
Trisomy 21 associated with increased risk of which cancers?
ALL and AML
Treatment of lyme disease in children
AMOXICILLIN not doxy!
Enlarged liver + hepatomegaly + RA =
AMYLOIDOSIS
2 cGMP signalers
ANP, NO
cGMP
ANP, NO
transEsophageal echo see's
ANT: L atrium Post: descending aorta
Acute otitis media vs. otitis media with effusion
AOM: inflammation + acute eardrum inflammation!!
ARDS vs. pulmonary contusion
ARDS usually 24-48 hrs afterwards and bilateral lung involvement
There's a useful mnemonic for Ataxia Telangiectasia and the gene that's mutated. What is it?
ATM Ataxia Telangiectasia Mutated ATM gene is responsible for DNA break repair
Most effective parameter for estimating fetal weight =
Abdominal circumference
Managemetn of Beckwith Wiedemann
Abdominal ultrasound for monitoring of Wilm's/hepatoblastoma
Cause of lymphedema in Turner syndrome
Abnormal development of lymphatic system
What is the characteristic blood pressure of a patient with aortic regurgitation?
Abnormally large (wide) pulse pressure is caused by aortic regurgitation, and is responsible for many of the symptoms of Aortic Regurgitation
What is a major hemodynamic finding indicative of mitral regurgitation?
Abnormally prominent (regurgitant) left atrial V-wave during catheterization Left Atrial Pressure increases more than you would think towards the end / after systole
Which location in the mid scapular line is most appropriate for insertion of the needle used in thoracocentesis?
Above 9th rib at mid scapular line
what is a hordeolum
Abscess over the upper or lower eyelid
How does acetylcholine and adenosine influence cardiac pacemaker cells, particularly at Phase 4 (pacemaker potential)?
Ach and adenosine reduce the rate of spontaneous depolarization in cardiac pacemaker cells
acute ischemic injury = kidney findings?
Acute Tubular Necrosis - Muddy Brown Casts with epithelial cells
-diaper rash and swelling of hands and feet, face and lips are red, conjunctivae injected, bilateral cervical lymphadenopathy, S3 gallop no murmur, edema and erythema of hands and feet, what pathological process will be found?
Acute arteritis with aneurysm in coronary arteries (Kawasaki disease)
Fever + chest pain + leukocytosis + mediastinal widening on CXR after surgery =
Acute mediastinitis
Bridging necrosis of the liver =
Acute viral hepatitis
Adjustment disorder with depressive mood vs. major depressive disorder
Adjustment disorder with depressive mood does not meet all the criteria for major depressive disorder
erection and ejaculation
Afferent fibrous: dorsal n of penis or clitoris from pudendal nerve (DRG S2-S4) Erection: PS (S2-S4) from the pelvic splanchnic nerves dilate arteries supplying erectile bodies of the penis, allowing them to fill with blood. Somatic motor (S2-S4) fibrous from the pudendal nerves cause contraction of ischiocavernous and bulbospongiosus muscles to press the root of the penis and relax external urethral sphincter Ejaculation: Sympathetic fibers L1-L2 from the inferior hypogastric plexus (Sacral splanchnic nerves) cause contraction of smooth muscle of epididymis, ductus deferens, seminal vesicles and prostate; sympathetic nerve fibers stimulate internal urethral sphincter to prevent semen from entering bladder or urine entering prostatic urethra
Pregnant women and the flu
All women without contraindications should be vaccinated against flu, can occur ANY trimester.
Treatment of BPH
Alpha 1 blocker like doxazosin or tamsulosin
-Panic disorder, drug activates benzodiazepine binding sites on GABA. what is the drug?
Alprazolam
Here's a high yield overview of the histology of the lungs:
Alveolar surface is 95% covered by flat Type I pneumocytes Interspersed cuboidal type II pneumocytes are the source of pulmonary surfactant (stored in lamellar bodies) Type II pneumocytes are also the main cell type responsible for replacing the alveolar epithelium after alveolar injury
Anchovy paste =
Amebic abscess
Amikacin toxicity
Aminoglycoside --> acute renal failure
Difficulty concentrating, constipation, forgetful, weight gain = side effect of what heart medication
Amiodarone
Drainage of superficial inguinal L.N.
Anal canal (below pectinate line), skin below umbilicus (except popliteal territory)
What would we expect in anaphylaxis in terms of venous return and cardiac output?
Anaphylaxis causes widespread venous and arteriolar dilation along with increased capillary permeability and third-spacing of fluids this results in a serious drop in venous return cardiac contractility is also increased as the body attempts to maintain blood pressure
Elevated DHEAS is seen in what
Androgen producing adrenal tumors
Pancytopenia, like from leukemia can present as
Anemia: fatigue Leukopenia (opportunistic infections: candida, pneumo, perirectal infections) thrombocytopenia: gingival, retinal hemorrhages... hepatosplenomegaly/lymphadenopathy may or may not be present
Treatment of fibromuscular dysplasia +
Angioplasty + stent placement!!
Ataxia + hemiparesis stroke location
Anterior limb of internal capsule
Omalizumab
Anti-IgE (allergic asthma; blocks FcεRI
Natalizumab
Anti-alpha-4 integrin Indicated for MS, Chron's (prevents leukocyte adhesion; risk of PML in patients with JC virus)
Next best step in management of acute bacterial rhinosinusitis
Antibiotics
Treatment of cholangitis
Antibiotics, then ERCP if not responsive
Why is alloimmunizaiton from blood group of little concern
Antibodies to ABO antigens cause mild anemia or jaundice in newborns
-What best to classify N. meningitides into serogroup?
Antibodies to capsular polysaccharide
What is the mechanism and indication of Oxybutynin?
Anticholinergic; reduces bladder spasms Used to treat urge incontinence
Classic complement pathway begins with which components?
Antigen-antibody complexes + C1
What drugs are typically NOT used to treat asthma?
Antihistamines
What do you think when you hear a patient who has a heart murmur presenting with the following physical exam findings: Bounding femoral pulses, carotid pulsations accompanied by head-bobbing.
Aortic Regurgitation
Giant cell or temporal arteritis have what important complication other than blindness
Aortic aneurysms
Worsening heartbeat with lying down and turning to left =
Aortic regurg
Localized, shallow, painful ulcer with a gray base =
Aphthous stomatitis
If you're soaked with sweat, what types of glands are responsible for the distinctive smell of you?
Apocrine glands Initially odorless, but can become malodorous secondary to bacterial decomposition on the skin surface
The right lymphatic duct drains the right ____, right side of the ____ and the right side of the ____. The thoracic duct drains the rest of the body
Arm Chest Head (Thus, the thoracic duct drains the entire left side and the right leg)
Pain with thumbs down, shoulders up
Arm up Thumbs down sign... supraspinatus...
What is considered to be the main indicator of alveolar ventilation?
Arterial PaCO2 (inversely related to alveolar hyperventilation)
What's the relationship between high/low calcium and high/low phosphorous?
As a rule of thumb, if calcium levels are high, phosphorous levels are low, and vice versa
What does the Frank-Starling effect state?
As cardiac muscle is increasingly stretched (by venous return), the cardiac output increases (up to a limit). [This is essentially the same length-tension relationship that is seen in skeletal muscle]
How is the positive predictive value related to disease prevalence?
As the disease prevalence increases, the PPV also increases
Ammonia source in ammonioagenesis
Aspartate & GLUTAMINE donate NH4 ( amonia ) in renal ammoniaagenesis
Needed for tumor cells to divide
Aspartate--asp synthase--> aspargine
Mobile cavitary mass + hemoptysis =
Aspergilloma
Aspergillosis vs. PCP in immunocompromised ptaients
Aspergillosis is a solid mass where PCP is diffuse interstitial infiltrates
What medications can trigger bronchoconstriction in patients with asthma
Aspirin and beta blockers
Treatment of PVCs if asymptomatic vs. symptomatic
Asymptomatic: none Symptomatic: beta blockers
Lidocaine in ACS has an increased risk of
Asystole
A more concise look than above at the pathogenesis of atherosclerotic plaques (atheromas) please?
Atherosclerotic plaques (atheromas) develop like this: endothelial cell injury exposes subendothelial collagen. This promotes platelet adhesion, aggregation, and release of factos that promte migration of smooth muscle cells (SMCs) from the media into the intima, as well as SMC proliferation. 2 important factors are PDGF and TGF-beta, both released by platelets.
Where does Atrial Natriuretic Peptide (ANP) come from? In response to what?
Atrial Cardiomyocytes in response to atrial stretch, it is a signifier of volume expansion
Whenever you hear "irregularly irregular," you should think of the most common chronic arrhythmia, which is what?
Atrial Fibrillation
What classic heart defect would allow a DVT to become a paradoxical embolus leading to a stroke in a patient?
Atrial Septal Defect
What EKG finding is specific for digitalis toxicity
Atrial tachycardia with AV block
Organophosphate poisoning- first antidote
Atropine first/Pralidoxime second
Cause of serous otitis media in HIV
Auditory tube dysfunction due to obstructing lymphomas/lymphadenopathy
What is the characteristic histological finding of many forms of Acute Myelogenous Leukemia?
Auer Rods
Next step in management after first episode of IUFD
Autopsy of fetus and placenta
How is PKU inherited?
Autosomal Recessive
Diarrhea + leukopenia + hepatotoxicity = what toxicity
Azathioprine
Thiamine uses
B1: Transketolase, a-keto dehydrogenase, pyruvate dehydrogenase, branched-chain AA dehydrogenase
Receptor causing uterine relaxation
B2
Pyridoxine uses
B6: transamination (ALT,AST, a-ketoacetate) decarboxylation reactions (AA), glycogen phosphorylase
Biotin uses
B7:4 carboxylase enzymes: Gluconeogenesis: pyruvate carboxylase Fatty acid synthesis: Acetyl CoA carboxylase Odd-chain FA: Propionyl-CoA carboxylase 3-methylcrotonyl-CoA carboxylase
Most appropriate initial intervention for acute aortic dissection
BETA BLOCKADE. NOT hydralazine!! It increases shear stress on aorta!
What to do if nonreactive NST with vibroacoustic stimulation
BPP
GI bleeding can cause an increase in what ratio
BUN/creatinine
Firstline treatment for uncomplicated cystitis
Bactrim, nitrofurantoin, fosfomycin
How do arterial baroreceptors monitor systemic blood pressure?
Baroreceptors sense arterial wall stretch, which is an indicator of systemic pressure in arterial circulation. When stimulated by: (1) stretch: nerves innvervating those baroreceptors increase firing --> blood pressure decrease through peripheral vasodilation and decreased cardiac output (2) hypotension: decreased baroreceptor signaling --> releases inhibition of vasoconstrictor center and increases blood pressure
What is an important and easy equation to measure PaCO2?
Basal Metabolic Rate / alveolar ventilation
Which animal most warrants post-exposure rabies prophylaxis
Bat
-Hypersalivation, fever, confusion, right arm weakness, tingling, numbness. what animal?
Bat (rabies)
Collagen types:
Be So Totally Cool, Read Books I - Bone, Skin, Tendon (cornea, late wound repair-POST MI) II - Cartilage (including hyaline) III - Reticulin (skin, blood vessels, uterus, granulation) IV - Basement Membrane
Why do mitochondrial have their own tRNA?
Because they use non-standard genetic code
Duchene vs. Becker
Becker: after 5, no calf muscle hypertrophy
Screening in patients who recieved blood transfusions
Before 1992: Hep c, before 1986: Hep b
Treatment of acute dystonia
Benztropine or diphenhydramine (anticholinergic/antihistamine)
What is Berkson's bias?
Berkson's bias refers to selection bias created by selecting hospitalized patients as control group
First diagnostic step in the evaluation of severe vomiting during pregnancy
Beta HCG; if markedly elevated, ultrasonography to rule out bad causes of hyperemesis
Bradycardia + AV block + wheezing = what toxicity and treatment
Beta blocker treat with atropine
What are acute asthma exacerbations treated with?
Beta-adrenergic Agonists
How do beta-agonsists work? Why is this effective in acute asthma exacerbations?
Beta-agonists produce relaxation of bronchial smooth muscle by stimulating beta-2 receptors, which si a Gs protein-coupted receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations
Bicarb and chloride levels in obesity hypoventilation syndrome
Bicarb retention and decreased chloride
Initial drug of choice for symptomatic hypercalcemia of malignancy in outpatient setting
Bisphosphonate
Verrucous nodules that progress to microabscess = what fungal infection
Blastomycosis
How does hyperemia following reperfusion of an arterial vessel differ from hyperemia following reperfusion of muscle tissue?
Blood flow also increases during exercise. The more anaerobic metabolism you use and lactate build-up you have, the more hyperemia you need to clear out the waste products.
How do we relate blood flow and vessel radius?
Blood flow is directly related to the vessel radius raised to the fourth power. Resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power.
What ist he classic auscultatory findings in mitral regurigtation?
Blowing, holosystolic murmur heard best over the apex with radiation to the axilla
X-ray findings on cervical spondylosis
Bony spurs, sclerotic facet joints
BUN and Cr changes in pregenancy
Both are decreased!!
Proctocolitis vs. Meckel's
Both have painless bleeding, Meckel's not in neonates
Granuloma inguinale vs. syphilis
Both red base, but granuloma inguinale has no associated adenopathy.
Patient with bulbar palsies + constipation + hypotonia + no honey?
Botulism
Left coronary artery (LCA)
Branches: 1. anterior (descending) interventricular artery- most common place of MI descends in the anterior inter ventricular sulcus and provides branches to the anterior heart wall, anterior 2/3 of IV septum, bundle of HIS and apex of the heart 2. Circumflex artery - winds around the left margin of the heart in the atrioventricular groove to anastomose with the right coronary artery posteriorly- supplies left atrium and left ventricle
breastfeeding failure jaundice vs. breast milk jaundice
Breastfeeding failure: suboptimal breastfeeding, decreased bilirubin elimination
Bleed from which vessel results in a subdural hematoma?
Bridging cortical vein (NOT the superior sagittal sinus)
Afebrile + new onset blood tinged sputum + clear x-ray =
Bronchitis, observation and close follow-up
Most common cancer in patients with asbestos
Bronchogenic >> pleural mesothelioma
3 week old newborn brought to physician because recurrent vomiting after feeding. Eager to feed even after vomiting. Abdomen with 1-2 cm mobile mass in epigastrium to right of midline. If condition have lower threshold of liability in males than females, which relative have greatest risk to also develop this disorder?
Brother, if newborn is Female (??)
Buspirone vs. bupropion
Buspirone is an anti-anxiety, buspirone is for smoking cessation
Deficiency that increases susceptibility to type III hypersensitivity
C3 deficiency (this is because C3*a* [not C3b] aids in the clearance of immune complexes)
phrenic nerve
C3,4,5 runs in front of anterior scalene runs anterior to the root of the lung, where vagus runs posterior to root of lung innervates fibrous pericardium, mediastinal and diaphragmatic pleurae (sensory innervation), and the diaphragm for motor and its central tendon for sensory
What convertase is shared by the lectin and classical pathways?
C4b2b (aka C3 convertase)
What heart medication can cause peripheral edema
CCB like amlodipine
CD___ binds to Fc region of bound Ig, activating NK cell to perform antibody-dependent cell-mediated cytotoxicity
CD16
Markers of NK cells
CD16 (finds Fc of IgG) CD56
Regulatory T cells are identified by which markers?
CD3 CD4 CD25 (alpha chain of IL-2 receptor) FOX3P
Cells with CD40 and Cells with CD40L
CD40 present in T helper cells CD40 Ligand present in macrophages
Quantitative pilocarpine iontophoresis is used for
CF
Immune deficiency with abnormal dihydrorhodamine (flow cytometry) test
CGD (in addition to nitroblue tetrazolium dye reduction test)
AA with three titratable protons
CHAT GAL: Cysteine, Histidine, arginine, tyrosine, glutamic acid, aspartic acid, lysine
What is the pathophysiology of CHF in general terms?
CHF occurs when the heart is unable to pump sufficient amounts of blood to meet body's metabolic demands
Patients post PCI must receive what medication
CLOPIDOGREL
Atypical lymphocytes + negative heterophile =
CMV
Post BMT recipient with pneumonitis and colitis =
CMV
Eye symptoms in AIDS with CD4 < 50
CMV retinitis
Yellowish white patches of retinal opacification and hemorrhages in AIDS patient =
CMV retinitis
Painless, fluffy/granular retinal lesions near vessels =
CMV retinits
Negative monospot Differential
CMV, HHV-6, toxoplasmosis
Vertical diplopia CN
CN IV, trochlear: walking down the stairs
Theophylline toxicity
CNS stimulation, GI, and arrhythmias
cyt a/a3 blocked by
CO poisoning (requires oxygen)
Orbital cellulitis vs. cavernous sinus thrombosis
CST has abnormal fundoscopy (papilledema, tortuous retinal veins), orbital cellulitis has normal fundoscopic exam.
Treatment of splenic trauma in a patient who was unstbale but imprves with fluid administration
CT scan
the next step in investigation of a solitary pulmonary nodule detected on CXR
CT scan. if CT suspicious for malignancy or indeterminate -> biopsy or PET scan.
Most common cause of death in acromegaly
CV disease
What is the mechanism of Anemia in Hodgkin's lymphoma?
Cannot remove stored Fe from its stores!
Endocardial thickening due to dense fibrous deposits around tricuspid and pulmonary valves as well as pulm valve stenosis; L side normal
Carcinoid syndrome marker Urinary 5-hydroxyindoleacetic acid: metabolite of 5-HT; inactivated along with bradykinin by pulmonary MAO oxidase
Difference between case control and retrospective cohor
Case control: determines outcome then looks for associated risk factors. Retrospective cohort: finds risk factor exposure then determines outcomes
CMV receptor binding
Cellular integrins (LFA-1, MAC1...)
Retinal hemorrhages + cotton wool spots = what eye issue
Central retinal vein occlusion
What is an early BRAIN finding of Ataxia-Telangiectasia and how does it manifest itself?
Cerebellar atrophy manifests as ataxia in the first years of life.
Drug X is to design blocking HIV entry into cell. What is the appropriate target for Drug X?
Chemokine receptor (CCR4, CXCR5)
1st Branchial arch
Chew: Nerves: V2, V3 Cartilage: Meckel's Cartilage: Mandible, Malleus, incus, sphenoMandibular ligament Muscles: Mastication(Masseter, lat/Medial pterygoids, temporalis), Mylohyoid, ant. belly of digastric, tensor tympani, tensor veli palatini
Follicular conjunctivitis + neovascularization =
Chlamydia trachoma
Chloroquine, primaquine MOA
Chloroquie kills malaria/ Primaquine kills hypnozoites
Prophylaxis against malaria
Chloroquine or mefloquine for chloroquine resistant p. falciparum
Cyanosis aggravated by feeding, relieved by crying =
Choanal atresia
Bridging fibrosis of the liver =
Chronic active hepatitis
Recurrent upper abdominal pain + diarrhea + weight loss =
Chronic pancreatitis
Newborn that has meconium ileus will have what type of complication
Chronic rhinosinusitis from CF
When are vaccines administered: chronologic or gestational agein preterm
Chronologic
Central california, mild eosinophilia, patchy bronchopneumonia. Culture grow mold show in picture, what is problem?
Coccioides immitis
strong, slippery, bloody BM
Collagen types: I - strong II - slippery III - bloody IV - basement membrane
How could coronary arteriolar dilators worsen myocardial ischemia? What is this phenomenon called?
Collateral microvessels form adjacent pathways for blood flow to areas distal to an occluded vessel. Adenosine and dipyridamole are selective vasodilators of coronary vessels that can cause the phenomenon of CORONARY STEAL in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas I.e., coronary steal can lead to hypoperfusion and worsening of existing ischemia
Most common cause of thyroid nodule
Colloid
Organs drained by the inferior mesenteric L.M.
Colon from splenic flexure to upper rectum
Colonic pseudoobstruction vs. paralytic ileus
Colonic pseudoobstruction only affects colon; paralytic ileus can affect both small and large bowels
Diagnostic test in patient with multiple liver masses
Colonoscopy
PSGN vs. IgA nephropathy
Complement levels low in PSGN; normal in IgA nephropathy
Staring spells + automatisms + post-ictal confusion =
Complex partial, NOT absence
Tender spine + hyperactive DTRs + extensor plantar response bilaterally =
Compression of spinal cord
What to do after high lead level in capillary fingerstick
Confirm with venous blood draw
Treatment of viral conjunctivitis
Cool compresses
What is the clinical term for RVH (with or without congestive right heart failure) caused by pulmonary hypertension?
Cor Pulmonale
What types of drugs could potentially worsen myocardial ischemia?
Coronary Arteriolar Dilators (e.g., Adenosine and Dipyridamole)
How does the heart myocardium normally support its own blood flow in coronary artery disease?
Coronary vessel occlusion can be bypassed by the natural existence and compensatory recruitment of collateral vessels that help support blood flow I.e., collateral circulation helps to alleviate ischemia and preserve myocardial function
Maintenance dose
Cp x CL/ bioavailability factor cp= steady state plasma conc. CL clearance IV drugs bio- 1 Decreased in renal or hepatic impairment
Where do craniopharyngyomas arise from?
Craniopharyngiomas are calcified cystic tumors that arise from remnants of Rathke's pouch (embryonic precuros of the anterior pituitary)
Hypertension + hyperglycemia + hypokalemia + headaches =
Cushing's syndrome
Tamoxifen and osteoporosis =
DECREASED RISK
Androgen producing adrenal tumors can be detected with
DHEAS
Deviation of mediastinum + elevated hemidiaphragm =
DIAPHRAGMATIC RUPTURE!!
needed in pcr
DNA template: region of DNA to be amplified Two primers: complementary to regions flanking the target DNA to be amplified DNA polymerase: replicate target DNA (Taq polymerase-temp sensitive wont denature) Deoxynucleotide triphosphates: to build the DNA
Dynein vs. Kinesin
DR AKA Dynein:retrograde (towards) anterograde Kinesin (away)
Mesoderm origin
DUMB COCKS BLAB b(V)eST Dura,Dermis, Urethra, Muscle, Bone (not teeth or skull) CT, Ovaries, CV structures, Kidney, Spleen Blood, Lymphatics, Adrenal Cortex, Bladder Vagina, Serous linings(pleura, peritoneum), Testicles
Tenderness, edema, redness over medial canthus =
Dacryocystitis
What is transiet hypogammaglobulinemia and when does it normalize
Decreased IgG, normal IgA, variable IgM. Normalize by 6-11 months
-What stimulate VEGF in tumor mass?
Decreased PO2
What lifestyle modifiation should be advised for ptaients with hypertension
Decreased alcohol intake
76 year old women with severe back pain for past 2 weeks. Taking prednisone for RA for 6 months and has HRT with estrogen for 15 years. X ray show vertebral fracture. Cuase?
Decreased bone formation due to inhibition of osteoblast differentiation
dietary recommendations for renal calculi (4)
Decreased protein, oxalate, sodium. Increased fluid, calcium
What is the biochemical problem in Lesch-Nyhan syndrome? (And, only if you got that right, what are the really cool symptoms of it?)
Defective purine catabolism, so buildup of purines. It's an X-linked recessive disorder with mutated HGPRT gene (hypoxanthine-guanine phosphoribosyltransferase, if you want to impress people). Now, if you got HGPRT and purine catabolism right, you can say: self-mutilating behavior on top of mental retardation, choreoathetoid (think Chorea) movements and spasticity.
Gene product of CMV cause translocation of nascent MHC I from endoplasmic reticulum into cytosol. What will occur regarding to MHC I?
Degradation by proteosome
Most common presentation of herpes simplex keratitis
Dendritic ulcer
Why deoxyHB can carry CO2 better than OxyHB?
DeoxyHB = better buffer
oogenesis
Diploid: Germ cell: 2n2c--> mitosis Oogonium: 2N2C--> mitosis 2 Prim oocyte: 2N4C--> meiosis I: arrested in prophase Now Haploid: 2 oocyte: 1N2C( + polar body) arrested in metaphase until fertilization--> meiosis II Ovum haploid: 1N1C
Fever + LLQ pain + inability to pass stool in an elderly patient
Diverticulitis
Mots common cause of lower GI bleeding in elderly patient
Diverticulosis NOT hemorrhoids
Voiding cystourethogram use in first febrile UTI
Do not need, first just do ultrasound
3rd pouch
Dorsal wings: inferior parathyroid Ventral wings: thymus 3rd pouch structure end up BELOW 4th pouch structures
Drainage of popliteal L.N.
Dorsolateral foot, posterior calf
HIV gene glycosylated
ENV gene is glycosylated to become gp160 and then proteolytically cleaved to become gp120 and gp41 by ER and golgi
noncompetitive antagonist
ENVY: E - efficacy decreases (curve goes down) N - non-competitive V - Vmax decreases Y - y-intercept (1/vmax)
High creatinine + constipation + increasing back pain, what is the cause of constipation
Electrolyte disturbance
Pancytopenia + macrocytosis =
Fanconi's anemia
Foamy macrophages and fat globules on breast biopsy =
Fat necrosis of breast
Reye's syndrome on histology
Fatty vacuolizaiton of hte liver
Biopsy of lung shows anapestic, biphasic neoplasm that express calretinin, cytokeratin but not carcinoembryonic antigen. What additional structure in lung tissue? -Work as insulation installer
Ferruginuous bodies (Asebetos!)
IP3 signalers
GGOAT GnRH GHRH Oxytoxin ADH (V1) TRH Histamine (H1) Angiotensin 2)
IP3
GGOAT HAG Gnrh, GHRH, Oxytocin, ADH(V1), TRH, Histamine, ATII, Gastrin
Which diabetes drug induces weight loss
GLP1-agonists
Endoderm origin
GTL PPALE GF Gallbladder, Thymus, Liver Pancreas, Parathyroid, Anal canal(above), Lung, Eustachial tube Gut epi, Follicular cells of thyroid
2 month old boy with failure to thrive and poor feeding. Jaundice, cataracts, hepatomegaly. Decreased glucose concentration. Urine has positive reaction to copper reduction test, negative reaction to glucose oxidase. Deficiency of what enzyme?
Galactose-1-phosphate uridultransferase (Classic galactossemia)
What intercellular connection connects osteocytes?
Gap Junctions this is so they can send signals to modulate activity of surface osteoblasts, thereby helping to regulate bony remodeling
Most common cause of hypothyroidism has what pathology?
Germinal centers, lymphocytic infiltrate;; hurthle cells (hash down hurtle)
Most significant risk factor for distal limb reduction defects in CVS
Gestational age
increased UC bilirubin
Gilbert syndrome
Globus hystericus
Globus sensation or "lump in the throat": 45% of pop emotional trigger: tear, tension, anger, and mental anguish multiple organic and function disorders assoc w/ it: GERD, upper esophageal spincter abnormalities, achalasia, psychiatric disorders, stress
Pernicious anemia is associated with
Glossitis, vitiligo, thyroid disease
-Adipocyte play important role in maintaining homeostasis when fasting. how?
Glucagon activate hormone sensitive lipase
Hypoglycemia + lactic acidosis + hyperuricemia + hyperlipidemia = what deficiency
Glucose 6 phosphatase deficiency, von gierke's
What type of ovarian tumor produces excess estrogen
Granulosa cell
Screening for patients with syphilis
HIV screening with ELISA
HPV E6
HPV E6 induces the degradation of p53. The E1 ubiquitin-activating enzyme activates ubiquitin (Ub), which is transferred by the E2 ubiquitin-conjugating enzyme to the E3 ubiquitin-protein ligase. HPV E6 binds to E6-AP, forming an E3 enzyme which specifically binds and ubiquitinates p53. The polyubiquitinated p53 is then degraded by the 26S proteasome complex
Trichloracetic acid used to treat
HPV genital warts
Serum sickness
HSR III fever, uriticaria, arthralgias, GN, lymphadenopathy 5-10 days after exposure to antigen fibrinoid necrosis and netrohil infiltration in arteries/small too Decreased IC containing IgG/IgM/C3... possible cause: TMP-SMX
Acute retinal necrosis =
HSV retinitis in immunocompromised
Mots comon side effects of EPO
HTN, headaches, flu-like symptoms!
Conn's syndrome issues
HTN, metabolic alkalosis, low plasma renin, hypokalemia (causes paresthesia/muscle weakness)
Men with purulent urethral discharge and dysuria. Found Gonorrhea, treated with ceftriaxone. Symptoms go away for 2 days, but discharge come back. Why?
Has infection with both N. gonorrhea and chlamydia
thyroid: mononuclear, parenchymal infiltration with well developed germinal centers
Hashimoto's thyroiditis Hurthle cells, normal ESR, Plasma cells
What types of defects in hematology, platelet or clotting factor, are more assocaited with hemarthroses? Which type is associated with small petechial lesions on the skin?
Hemarthroses: clotting factor defect / coagulopathy Small Petechial Lesions of the skin: platelet defects
Bruise green color
Heme oxygenase converts heme to biliverdin when cell lysis occurs
How does dehydration change hemoglobin, urea, and sodium plasma values?
Hemoconcentration Azotemia Contraction hypernatremia
Common complication with bronchiectasis =
Hemoptysis
Cause of hemophilic arthropathy
Hemosiderin deposition and fibrosis of the joint
Definition of fulminant hepatic failure
Hepatic encephalopathy that develops within 8 weeks of the onset of acute liver failure
Pegylated interferon + ribavirin treats what
Hepatitis C
-Withdrawal symptoms and yawn a lot, dilated pupil?
Heroin withdrawal
Erythema multiforme minor associated with what infection
Herpes simplex
Patient who presents with throbbing pain in finger + non-purulent vesicles =
Herpetic whitlow
Contraindication to rotavirus vaccine
History of intussusception
Cystic testicular mass that is transilluminated
Hydrocele
RUQ pain radiates to groin post invasic CIN surgery
Hydronephrosis: back up of urine dilation of renal pelvis and calyces (looks like ADPKD) mcc: BPH flattened tubular epi and interstitial fibrosis
Hyperaldosteronism effect on sodium, potassium, and acid
Hypernatremia, hypokalemia, metabolic alkalosis
Tumor lysis syndrome: phosphate and calcium levels
Hyperphosphate and hypocalcemia
Clubbing + onset joint arthropathy in a smoker =
Hypertrophic osteoarthropathy due to lung cancer
Chronic HTN, heavy heart?
Hypertrophy of heart
What electrolyte abnormality is associated with hyperactive DTRs
Hypocalcemia
Husband call to find out diagnosis for wife, what should you say?
I am sorry, but i cannot tell you anything about your wife's diagnosis without her permission
problem in brothers who die of mycobacterial infection
IFN-gamma receptor deficiency
Osteoporosis is associated with an increase in what cytokine
IL-1
cause of hypercalcemia in multiple myeloma
IL-1, TNF
Inhibits actions of activated T cells and Th1. Also secreted by regulatory T cells
IL-10
Oprelvekin
IL-11 Recombinant cytokine Indicatd for thrombocytopenias (as is thrombopoietin)
Recurrent severe mycobacterial diseases
INF-gamma receptor defect
Treatment of acute pain in patient with opioid addiction
IV morphine
Treatment of cellulitis with and without systemic signs
IV nafcillin/cefazolin; without: oral dicloxacillin
Treatment of acute organ rejection
IV steroids
What is the most compelling reason for newborn auditory screening program?
Identification and treatment of hearing loss before the age of 6 months will allow for better prognosis of speech and language development
When to use surgery for duodenal hematoma
If conservative methods fail
When to reassure for metatarsus adductus
If it can be overcorrected
When to use calcium infusion study in gastrinoma
If suspected gastrinoma despite negative secretin test
Management of hepatic adenomas
If symptomatic, must resect. If asymptomatic, discontinue OCPs, observe with imaging.
Blood cultures and lyme disease
If there is erythema migrans, no need for cultures.
Antibody isotype present in colostrum
IgA
What is the major immune deficiency of ataxia telangiectasia?
IgA deficiency, which predisposes to infections of the upper and lower airways (and other mucous membranes)
What type of deposits in bullous pemphigoid
IgG and C3
Is displacement a mature or immature defense mechanism? What is displacement?
Immature. A patient redirects emotions from the person or object that's causing the emotions (e.g., wife), but who it woudl be completely unacceptable to direct those emotions toward, to a more acceptable, but still inappropriate, person or object (e.g., a wall or a vase).
Is projection a mature or immature defense mechanism? What is it?
Immature. Unacceptable or personally disagreeable impulses are attributed to others; e.g., a student who wants to cheat on a test accuses his classmates of cheating. Or the gayness thing
Management of baby with BPP of 2 or less
Immediate delivery
Cause of pancytopenia in lupus
Immune mediated destruction
Screening for CD markers?
Immunohistochemistry
What properties of cardiac muscle make it a better target for calcium channel blockers such as verapamil?
In cardiac muscles, the L-type channel-RYR mechanical coupling mechanism DOES NOT EXST. In cardiac muscle, depolarization causes L-type calcium channels on the plasma membrane to open and allow influx of EXTRACELLULAR CALCIUM. This calcium then binds to and activates sarcoplasmic RyR-2 channels by a mechanism known as calcium-induced-calcium-release, which then allows calcium to move out of hte sarcoplasmic reticulum. [contraction then proceeds in a similar manner to that seen in skeletal muscle: Calcium binds to Troponin-C allowing actin and Myosin to bind, ATP bound to myosin is then hydrolyzed and contraction occurs]
What are early responses by our body makes to combat CHF? How do these cause further problems?
Inadequate visceral perfusion causes activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system Both the Sympathetic NS and the RAS system are meant to increase cardiac output, but their effect on the diseased heart is to cause an inappropriately high AFTERLOAD and CIRCULATING VOLUME this leads to progressive heart disease
Megestrol use
Increase appetite in patients with cancer
How does Zollinger-Ellison cause malabsorption
Increased acid inactivates enzymes
A mom brings in a 6 y.o. child who has had recurrent sinusitis. You're worried about CF, so you order a "sweat test" (chloride sweat test), but this comes back normal. You next order a "nasal transepithelial potential difference" test. Why would a patient with CF have a significantly more negative nasoepithelial surface?
Increased luminal SODIUM ABSORPTION. The CFTR normally SECRETES chloride ions into the lumen and has a tonic inhibitory effect on the opening of apical sodium channel (which abosrbds sodium into the cell) Impaired CFTR functioning directly reduces ductal epithelial chloride secretion and indirectly increases sodium absorption through lack of CFTR's inhibitory effect on the apical sodium channel. The result is dehydrated mucus and a widened, negative transepithelial potential difference
How does hyperventilation cause hypocalcemia
Increased pH increases levels of albumin-bound calcium --> hypocalcemia
2 sphincters of the urethra
Internal urethral sphincter is made of smooth muscles in the neck of the bladder and has sympathetic innervation External urethral sphincter has skeletal muscle fibers and surrounds the membranous part of the urethra, supplied by perineal branch of the pudendal nerve
In terms of vitamin D synthesis, where does sunlight exposure fall?
It catalyzes the first reaction in the chain of active vitamin D synthesis: 7-dehydrocholesterol --> cholecalciferol (vitamin D3)
Is the great saphenous vein located on the medial or lateral side of the foot?
It originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up the medial aspect of the leg and thigh. IT drains into the femoral vein within the region of the femoral triangle, a few centimeters inferolateral to the pubic tubercle
This is an important one: LEAD TIME BIAS. What is it?
Lead-time bias refers to apparent prolongation of survival after a SCREENING TEST without any real effect on prognosis
What condition do we associate an extra low-frequency heart sound at the end of diastole just before S1 (known as S4) with?
Left Ventricular hypertrophy... sounds like ba-dum BUM, ba-dum BUM, ba-dum BUM, etc. [may also occur in restrictive cardiomyopathy]
Lyme disease picture. The likely cause of this patient's infection is taxonomicaly and morphologically most similar to infection agent of which condition?
Letpospirosis (because this is also a spirochete)
-Treatment of precocious puberty
Leuperlide
Treatment of atrophic vaginitis
Local estrogen therapy
What is the most likely complication following resection of a pleomorphic adenoma of the parotid gland?
Local recurrence
Clubbing of fingers is due to
Lung disease: cancer, TB, CF, bronchiectasis, pulm HTN, empyema, HYPOXIA Heart disease: Cyanotic congenital heart disease(5T's) and bacterial endocarditis other: IBD, hyperthyroidism, malabsorption
Where does our body synthesize ACE? What does ACE stand for?
Lung endothelium Angiotensin-converting-enzyme (Ang I --> Ang II)
-HIV patient has dysarthria for 3 months, homonymous heminopia. Has enhancing lesion in cortex. Diagnosis?
Lymphoma
MCL
MCL limits extension and abduction of leg at knee attaches to medial epicondyle of femur and shaft of tibia and firmly attaches to medial meniscus
Maternal Diabetes complications
MD CaN POR fetal Macrosomia Deliver premature Cardiac: transient hypertrophic or transposition NT defects Polycythemia hypOcalcemia/transient hypOglycemia Respiratory distress
Differential for t-wave inversion
MI, myocarditis, old pericarditis, myocardial contusion, digoxin toxicity
What is the classic physical exam finding in mitral valve stenosis best heard over the apex of the heart?
MItral valve stenosis has a characteristic opening snap followed by a diastolic rumbling murmur.
Hypercalcemia in MM vs Sarcoid
MM = IL1 (osteoclast activating factor), Sarcoid = elevated 1,25 vit D
If you saw elastase in a healthy individual's bronchoalveolar lavage, what cell did it come from?
Macrophages. Macrophages and PMNs both make elastase, but this guy is healthy, so why would he have neutrophils in his lungs? We always have some dust cells in our lungs, so that's more likely.
What part of eye controls fine visual acuity
Macula
Grid lines that appear curved =
Macular degeneration
Measles vs. Rubella
Measles: more sevre, high fevers, coryza, darker rash. Rubella: conjunctivitis, coryza, koplik spots
Lyme disease vs. meningococcal disease meningitis
Meningococcal: purpura/petechiae. Lyme disease: later in course, erythema chronicus migrans. RMSF and meningitis: DOES NOT CAUSE!
What are the classic signs of phenylketonuria (PKU)?
Mental retardation, eczema, and a mousy, musty body odor.
provoke asthma and do what
Methacholine, histamine, exercise cold air inhalation (Leukotriene release) Meth: bronchoconstrict+increase airway secretions; decrease FEV1 by >20%
What additional microscopic finding is characteristic of malacoplakia?
Michael-Gutmann bodies, which are defective phagosomes that cannot degrade bacterial products
Lectin complement pathways begins with which components?
Microbial surfaces (e.g., mannose) + mannose-binding ligand (forms C1-like complex) + C4
In what condition do where hear a "snap" followed by a rumbling diastolic murmur, best heard over the cardiac apex?
Mitral Stenosis Opening snap results from abrupt halting of motion of the stenotic mitral valve leaflets during MITRAL VALVE OPENING (visualize where that is on a pressure-volume curve) [the point between isoblumetric relaxation and diastolic filling] the diastolic murmur is the result of turbulent blood flow through the stenotic mitral valve during LEFT ATRIAL CONTRACTION
Patient with hemoptysis + nocturnal cough + palpitations and irregular heart beats, cause
Mitral stenosis --> afib
10 year old boy, 46 XY in 15 cells and 69XXY in 5 cells, what is explanation of the finding?
Mosaicism
If a baby gets exposed to an unclean knife (...) and subsequently develops rigid paralysis, what is the diagnosis, where do we think this might happen, and how do we prevent it?
Neonatal Tetanus Developing Countries Maternal immunization with tetanus toxoid is the best way to prevent it an adeuately immunized mom will transfer IgG's across the placenta to the neonate
Receptor binding of Rabies
Nicotinic ACh receptor
Niemann Pick vs. Tay Sachs presentation and enzyme
Niemann Pick: sphingomyelinase and HSM; Tay Sach's: hexosaminidase, no HSM
-HTN and Raynauds disease, what antihypertensive drug will help both?
Nifedipine
How does nitric oxide act within vascular smooth muscle to affect vasodilation?
Nitric Oxide acts within smooth muscle with a soluble guanylate cyclase enzyme to INCREASE PRODUCTION OF CYCLIC GMP and CAUSE SMOOTH MUSCLE RELAXATION
treatment of pregnancy luteoma
No treatment, reassurance and follow-up
So, we should try to get lots of sunlight to catalyze the first step in vitamin D synthesis, right?
No, excess sunlight exposure shunts previtamin D3 to a pathway that forms inactive products this is a mechanism to prevent against excessive Vitamin D
Addison's disease's expected acid/base state
Non-anion gap metabolic acidosis
Drug Y at 1 um decrease potency but doesn't decrease Vmax, Drug Y at 10um decrease potency AND Vmax, Drug Y by itself has no effect, what is Drug Y to X
Noncompetitive antagonist
Afebrile + irritative voiding symptoms in a man + normal prostatic secretion =
Noninflammatory chronic prostatitis
Cancer in men with elevated HCG and AFP
Nonseminomatous germ cell tumors
Hyperaldosteronism labs
Normal NA: Inc Na retention but ANP inhibits reabsorptions so htn w/out significant edema or hypernatremia hypokalemia, metabolic acidosis(Increased HCO3, dec H)
Appropriate absolute polycythemia
Normal plasma volume Increased RBC mass Decrease SaO2 (<92 or PaO2<65) increased EPO Lung disease, CHD, high altitude, hypoxia
P bodies after transcription
Not all mRNA undergo translation these are distant foci found w/in eukaryotic cells that are involved in mRNA regulation and turnover; Role: translation repression, storage, mRNA decay, quality control
Positive toxoplasma serology means
Not much, common in normal subjects, not specific for toxoplasmosis
large Arteriovenous conc gradient for gas anesthetic
Not potency(MAC), influences rate of induction High solubility in tissue= High Vd = low blood saturation(due to peripheral tissues absorbing it)= Need more= blood saturation takes longer= Brain saturation is delayed= slower onset
meningococcal infection, virulence factor correltation w/ patients morbidity and mortality
Not the capsule Outer membrane Lipooligosaccharide: endotoxin causes sepsis by induction of systemic inflammatory response characterized by TNF-a, IL-1B, IL-6, IL-8 via interaction with toll-like R 4 Differs from LPS by lacking repeating O-antigen
RNA polymerase I
Nucleolus: make rRNA(28s,18s,5.8s) dark-basophilic
RNA polymerase II
Nucleoplasm: mRNA(largest)/hnRNA/som snRNA inhibited by amanita mushroom-hepatotoxic
What is the characteristic histology of a craniopharyngioma?
On light microscopy, cysts are lined by stratified squamous epithelium, possibly with Keratin perals. Cysts are usually filled iwth a yellow, viscous fluid that's rich in cholesterol crystals.
Sclerotic cortical lesion on imaging with central nidus of lucency =
Osteoid osteoma
Which bone lesion is relieved by NSAIDs
Osteoid osteoma
Amenorrhea secondary to intense exercise put a woman at risk of
Osteoporosis
Turner's syndrome have increased risk of what bone disease
Osteoporosis because of lower estrogen levels
Osteporosis vs. osteomalacia
Osteoporosis: adequate mineralization. Osteomalacia: abnormal mineralization!!
Most common cause of conductive hearing loss in young adults
Otosclerosis
Virilization + elevated testosterone + normal DHEAS in a woman =
Ovarian source
More specifically, what is the pathophysiology of centroacinar emphysema?
Oxidative injury to the respiratory bronchioles and activation of resident macrophages --> neutrophil infiltrate Neutrophils release NEUTROPHIL ELASTASE, proteinase 3, cathepsin G, and matrix metalloproteinases, as well as generating OXYGEN-FREE RADICALS The oxygen free radicals inhibit the antiprotease activity of alpha-1-antitrypsin the resultant net protease-antiprotease imbalance and oxidant-antioxidant imbalance destroys acinar walls
What is the mnemonic to help you remember the order of cardiac tissue conduction velocity?
P ark (purkinje's) AT (atria) VENT ura (ventricles) AV enue (AV node)
permissive vs additive vs synergistic means what
P: increases reactivity, acts like enzyme A: when combined effect of 2 drugs is equal to the sum of the effects expected from individual drugs s: when the combined effect exceeds the sum of the individual drug effects
RBF=
PAH clearance/(1-Hct) or (Renal Pa - Renal Pv)/ Renal Vascular resistance
RPF=
PAH clearance= (urinePAH x urine flow rate)/ plasmaPAH
Nephrogenic DI (PCT, DCT, CT)
PCT = always isotonic, DCT and CT = hypotonic because ADH acts here and action is blocked in DI
From a cardiac pathophysiology standpoint, summarize patent ductus arteriosus.
PDA is characterized by a continuous murmur heard best in the left infraclavicular region with maximal intensity at S2. A small PDA is often asymptomatic and detected incidentally during routine cardiac auscultation. It occurs most commonly in patients born prematurely and those with cyanotic congenital heart disease.
ARDS patients typically are given
PEEP and high FiO2 (80%ish) but then the ventilator settings should be adjusted to decrease FiO2 to nontoxic values ->slowly lower below 60%
test of the proximal and distal interphalangeal joints
PIP- FDS DID - FDP
Aspirin sensitivity syndrome is what type of reaction
PSEUDOallergic reaction due to mistbalance of prostaglandins and leukotrienes.
Decreased volume of hippocampus associated with
PTSD
Again, what's a useful equation for PaCO2?
PaCO2 = Basal Metabolic Rate / alveolar hyperventilation
criteria for long term O2 supplementation in COPD patients
PaO2 < 55, SaO2 < 88, hematocrit >55, or evidence of cor pulmonale. (shown to prolong survival)
After open carpal tunnel release operation, new numbness of right thenar eminence. Has shock like sensation radiating to affected area. Which nerve injury during operation?
Palmer cutaneous branch of median nerve
anchoring to inner aspect of plasma membrane at carboxy tail
Palmitoylation: process which FA are covalently anchored to plasma membrane cysteine residues thereby increasing the hydophobicity of protein
Epigastric pain that is improved by sitting up and leaning forward + pleural effusion =
Pancreatitis
Decreased amygdala and left temporal lobe associated with
Panic disorder
Transient vision loss with changes in head position =
Papilledema
The _________ is not well developed in patients with DiGeorge. The ________ usually enlarges in an extreme cellular immune response (e.g., viral infection
Paracortex
What happens to the parathyroid in MEN1
Parathyroid hyperPLASIA
___________ is when a physician makes decisions for patients instead of providing them with options and allowing them to then make an informed decision. It's old school.
Parentalism
Partial vs complete mole
Partial 1 egg two sperm 69XXY vs paternal complete 46XX 2 sperm no egg
What heart defect classically has a continueous murmur?
Patent Ductus Arteriosus
Describe the pathogenesis of atherosclerosis.
Pathogenesis of atherosclerosis is thought to begin with endothelial cell injury in the response-to-injury model, chronic endothelial cell injury may result from hypertension, hyperlipidemia, smoking, diabetes, homocysteine, toxins (alcohol), viruses, and/or immune reactions Such injury results in endothelial cell dysfunction and/or exposure of subendothelial collagen Endothelial cell dysfunction results in increased permeability as well as monocyte and lymphocyte adhesion and migration into the intima Endothelial cell denudation (fancy name for exposure of collagen) promotes platelet adhesion Growth factors produced by monocytes and platelets stimulate medial smooth muscle cell migration into and proliferion in the intima Increased endothelial cell permeability allows LDL cholesterol into the intima, where it is phagocytosed by the accumulating macrophages and SMCs to produce FOAM CELLS
Murmur + new conduction abnormality =
Perivalvular abscess
What are the 4 phases of a cardiac myocyte action potential?
Phase 0: rapid depolarization Phase 1: intial rapid repolarization Phase 2: plateua Phase 3: late rapid repolarization Phase 4: resting potential the action potential is associated with increased membrane permeability to Na+ and Ca++ and decreased permeability to K+
What is the t(9;22) Translocation also called? What is its associated disorder?
Philadelphia Chromosome bcr-abl gene product Associated with CML "Philadelphia CreaML cheese"
Diabetic patient with poor glycemic control, what is activated early when he goes exercising?
Phosphorylase kinase
Copious vaginal discharge that is malodorous, squamous cells, and rare PMNs =
Physiologic leukorrhea
What is more related to the likelihood of a plaque causing acute coronary syndrome: Plaque Size or Plaque Stability?
Plaque Stability
How to atherosclerotic plaques achieve max stability?
Plaque Stability depends significantly on mechanical strength o the fibrous cap.
What cell provides major proliferative stimuli for the cellular components of atherosclerotic plaques? How / what are these components?
Platelets release PDGR, which promotes migration of SMC from the media into the intima and their subsequent proliferation in the intima.
transmural inflammation w/ fibrinoid necrosis
Polyarteritis nodosa renal/visceral; NOT pulmonary immune complex
Where are the regional lymph nodes that drain the lateral side of the foot located?
Popliteal fossa
Unbalanced gait + trunk dystaxia = what
Posterior vermis syndrome
Pain + decreased visual acuity + hypopion after surgery =
Posteroperative endopthalmitis
Todd's paralysis, treatment?
Postictal paralysis, usually improves within 24 hrs
Cause of jaundice after a surgery with hypotension, blood loss, and massive blood replacement
Postop cholestasis
Prevention of uric acid stones
Potassium citrate to alkalinize the urine
What is amiloride
Potassium sparing diuretic
Pineal germinomas (3)
Precocious puberty: B-hCG production Obstructive hydrocephalus: aqueductal compression Parinaud syndrome: paralysis of upward gaze and convergence (compression of tectal area)
Prepatellar vs. anserine bursitis location
Prepatellar: directly over patella. Anserine: below the joine line of the knee
Difficulty hearing in a noisy-crowded environment =
Presbycusis
What is the pulmonary capillary wedge pressure and what does it indirectly measure?
Pressure in the pulmonary artey distal to the point of its occlusion by an inflated intravascular balloon. Since there's no significant blood flow towards the left atrium (LA) beyong this point of occlusion, the pressure at the tip of the "wedged" pulmonary artery catheter is an indirect measurement of LA Pressure.
Mullerian agenesis
Primary amenorrhea w/ fully developed secondary sexual characteristics: functional ovaries agenesis/hypoplasia of vagina and uterus; duplication of vagina, cervix, and uterus or unicornuate, bicornuate and septate uterus
What tremor drug can cause abdominal pain, confusion, headaches, hallucinatoins
Primidone --> causes AIP
What is the most common cause of mitral valve stenosis?
Prior rehumatic carditis
How is blood that will be used for transfusion typically stored? What electrolyte imbalance may develop in a patient who receives a massive blood transfusion? What symptoms will that electrolyte imbalance cause?
Prior to storage, whole blood is generally mied with solutions containing citrate anticoagulant. Packed cells derived from these whole blood collections also contain citrate Infused citrate can chelate serum calcium in the receiving person, causing hypocalcium The patient may experience paresthesias due to hypocalcemia.
Trauma patient who needs transfusion but whose wife says he is Jehovah's witness, what to do
Proceed with blood transfusion becaues of emergent situation and WITHOUT documentation
Mechanism for orthostatic hypotension in elderly
Progressively decreasing baroreceptor sensitivity
If you heard: amenorrhea, bitemporal hemianopsia, and enlargement of the pituitary gland on brain imaging, what would you be thinking?
Prolactinoma, the most common pituitary adenoma.
Glutamate makes what
Proline --B6--> GABA --> glutathione
DVT treatment + low platelets + prolonged aPTT vs. shortened aPTT
Prolonged PTT: heparin, shortened PTT: enoxaparin
Prostate tumors
Prostate cancer usually begins in posterior lobe and early stages are often asymptomatic and may be found during digital rectal examination. Prostatic malignancies tend to metastasize to vertebrae and brain because the prostatic venous plexus via sacral veins
Most common cause of malignant otitis externa
Pseutodmonas
What hip flexor is up in the abdomen near the appendix?
Psoas muscle
Treatment of adjustment disorder
Psychotherapy
What is pulsus paradoxus, and what disease do we associated it with?
Pulsus Paradoxus is defined by a decrease in systolic blood pressure of greater than 10 mmHg with inspiration, and is detected by inflating a blood pressure cuff above systolic pressure and then SLOWLY releasing it [just buzzword cap'd there] as the kuff is deflated, korotkoff sounds first become audbile during expiration and subsequently become audible during all phses of respiration Inspiration causes increase in systemic venous return... so normally, this results in expansion of right ventricle into the pericardial space with little impact on the left side of the heart in conditions that impair expansion into the pericardial space [PERICARDIAL DISEASE], the increased right ventricular volume pushes the interventricular septum to the left therefore, the left heart diastolic volume and stroke volume are reduced, resulting in decreased systemic blood pressure during inspiration and hence pulsus paradoxus
Thymic tumor or lymphocytic leukemias and hematology
Pure red cell aplasia: low reticulocytes, low Hb normal WBC, platelets inhibition of erythropoietic precursors and progenitors by IgG ab or cytotoxic T lymph Also assoc w/ B19: destroys proerythroblasts
Acid stricture + early satiety + nausea =
Pyloric stricture causing gastric outlet obstruction
What supplement is used in homocystinuria
Pyridoxine, a cofactor for homocystein --> cysteine
Pyromania vs. conduct disorder
Pyromania: only fire setting. Conduct disorders: other behavior issues
thyroid: mixed, cellular infiltration w/ occasional multinucleated giant cells
Quervain's thyroiditis or granulomatous thyroiditis possible viral infection increased ESR
Felty syndrome =
RA + neutropenia + splenomegaly
What type of insulin used for DKA
REGULAR insulin, NOT NPH
Infective endocarditis vs Rheumatic fever
RF: diffuse fibrous thickening and distortion of mitral valve leaflets + commissure fusion at leaflet edges, mitral valve orifice may be somewhat stenotic IE: larger, friable vegetation on valve cusps; destruction(rather then fibrosis) of valve leaflets
Diabetes + hyperkalemia + non gap metabolic acidosis =
RTA Type 4!!!
How does preeclampsia affect the liver
RUQ due to stretching of capsule
SCC of vagina > 2 cm are treated with
Radiation
Which hyperthyroid treatment can worsen graves' opthalmopathy
Radioactive iodine because destroyed thyroid cells release excess hormones
What happens if you give a beta blocker to pheochromocytoma
Rapid increase in BP
What must be true to equate odds ratio with relative risk
Rare disease
Justifying behaviors rather than the true reasons =
Rationalization
Most common complication of vesicoureteral reflux
Renal scarring, NOT bladder cancer
What major hormone comes from the renal juxtaglomerular cells, and what is its net effect on the vasculature?
Renin, which catalyzes angiotensinogen --> ang I angiotensin causes vasoconstriction, increased blood pressure, and aldosterone release
Patient with Beta HCG of 1000, no pregnancy seen on ultrasound, next step in management
Repeat HCG in 48 hours, intrauterine pregnancy seen with levels at least 1500-2000
What is the phenomenon of hibernating myocardium, and how does it explain why coronary artery bypass grafting is an effective treatment of a failing left ventricle?
Repetitive ischemia of cardiac myocytes or persistent hypoperfusion of myocytes can result in a chronic, but reversible, loss of contractile function that's HIBERNATION
Ophthalmoscopy reveals zones of whitened edematous retina following the distribution of retinal arterioles =
Retinal emboli
Association with malignant hypertension
Retinal hemorrhages, exudates, or papilledema
Most serious side effect of hydroxychloroquine
Retinopathy
Which neck space has highest risk of mediastinal involvement
Retropharyngeal space
Young woman with breast lump, next step in management
Return after menstrual period for rexamination, possible regression of mass
Fatty vacuolization of the liver =
Reye's syndrome
What is a very common cause of mitral regurgitation in developing countries? And what is the classic auscultatory finding for mitral regurgitation?
Rheumatic Heart Disease A blowing, holosystolic murmur heard best of the cardiac apex that radiates to the axilla
Indications of azathioprine (azathio-"purine") aside from transplant rejection *prophylaxis*
Rheumatoid Arthritis Chron's Glomerulonephritis Other autoimmune diseases!
Cause of mucormycosis
Rhizopus
To which side of the curve does 2,3-BPG shift the O2-hemoglobin dissociation curve?
Right
adherent biofilm: species
S. epidermis, Viridans, P. aeruginosa, Nontypable H influenzae
middle ear-> contigouous tissues-> meninges
S. pneumo
SHiNE SKiS
S. pneumoniae H. influenzae type B E. coli Salmonella spp. K. pneumoniae Group B S. treptococci
50 year old with BP 226/120; late diastolic sound with the bell at the apex
S4
patient in LLD position: heart sound precedes S1
S4: atrial sounds Due to increased atrial pressure against still LV wall
How to diagnose pancreatic ascites? Cause?
SAAG <1.1, total protein > 3 g, ascitic amylase > 1000. Chronic alcoholism
laryngeal carcinoma on vocal cord is what
SCC: smoking/alcohol/hpv
Neuroectodermal origin
SCOPEN CAiRO SC, CNS, Oligodendrocytes, Pineal gland, Ependymal cells, Neurohypophysis (Posterior pituitary) Choroid plexus, Astrocytes, Retina, Optic nerve
How do we calculate "Standard Error of the Mean"
SEM = SD / (square root: n [sample size])
Echinococcus is associated with what animal
SHEEP
Hyperglycemia + hypothermia in a burn patient =
SIRS, bacterial infection
SJS vs. erythema multiforme minor
SJS involves lesions in the mucosa. Erythema multiforme minor: not as many systemic symptoms
secreted from pancreas to inhibit trypsin
SPINK1: serine peptidase inhibitor Kazal type 1 inhibits trypsinogen molecules that become prematurely activated w/in pancrease
brachial plexus- posterior cord branches
STARS subscapular (upper) Thoracodorsal Axillary Radial Subscapular (lower)
Initial management of epidural spinal cord compression
STEROIDS + MRI
Wide excision or surgical excision of basal cell carcinoma
SURGICAL excision with 1-2 mm of clear margins
SVT vs. panic attack
SVT has no regular p waves, panic attack is sinus tach
steroids and acute exacerbation of COPD
SYSTEMIC steroids like methylprednisone
Mangaement of placenta previa in stable mother and term fetus
Scheduled c-section
Dx parasite eggs in stool
Schistosoma
keeping "schizo" straight
Schizoid<schizotypal(schizoid+oddthinking)<schizophrenic(greater odd thinking)<schizoaffective(schizophrenic psychotic symptoms+bipolar or depressive mood disorder)
Lateral ventricular enlargement = ?
Schizophrenia
Rarer symptom of HSP
Scrotal pain and swelling
Lung mass in a patient with Hodgkin lymphoma treated with chemo and radiation = most likely cause
Secondary malignancy
Absolute contraindication to buproprion
Seizures + anorexia/builima (electrolyte abnormalities that can precipitate seizures)
Parkinson's disease with history of major depressive disorder, treated with fluoxetine. What antiparkinsonian drug is contraindicated?
Selegiline (MAO Inhibitor)
Presbycusis is what type of hearing loss
Sensorineural
Temperature instability + poor feeding + lethargy + jaundice in a newborn =
Sepsis
Whistling noise during respiration following rhinoplasty =
Septal perforation from septal hematoma
High mixed venous oxygen saturation is related to what type of shock
Septic shock
What are the serum calcium and PTH findings in primary osteoporosis (this is important, so know it)?
Serum calcium and PTH are typically within the normal range.
Next step in management to evaluate gynecomastia and testicular atrophy
Serum prolactin levels
Why is chloride much lower in arterial blood than in venous blood?
Short answer: actions of carbonic anhydrase and chloride shift Longer answer: Hb is responsible for carrying 15% of our CO2 as carbamate and the rest of our CO2 is carried as bicarbonate ion within the RBCs. [CO2 enters RBCs and is converted by carbonic anhydrase to form carbonic acid and then HCO3- and H+] Many of the bicarbonate ions diffuse out of the RBC into the plasma; to maintain electrical neutrality chloride ions diffuse into RBCs to take their place This is called CHLORIDE SHIFT
What are some of the changes that characterize apoptosis?
Shrunken size Eosinophilic cytoplasm Pyknotic, fragmented nuclei
unfavorable lyonization
Since the boy has Duchennes, of a mother, it means the mother is a carrier. So one of the X chromosomes she carries has the DMD mutation. If the normal X chromosome becomes inactivated in her muscle cells (so-called "unfavorable lyonization"), she would display the phenotypical features of the disease
What can excessive stretching of the carotid sinus lead to?
Sinus bradyarrhythmia
Why does verapamil only exhibit a minimal effect on skeletal muscle?
Skeletal muscle does NOT require calcium to enter from the extracellular space to cause calcium release from within the cell. [review of skeletal muscle contraction: Calcium released from the sarcoplasmic reticulum binds to Troponic C allowing actin and myosin to bind. ATP bound to myosin is then hydrolyzed and contraction occurs]
How does the parasympathetic nervous system primarily function to slow the heart rate?
Slowing conduction through the AV node
Malabsorption syndrome associated with dysmotility disorder
Small intestinal bacterial overgrowth
Single most preventable cause of fetal growth restriction
Smoking
Strongest predictor of AAA expansion/rupture
Smoking
What cell types directly cause intimal changes and damage in the formation of atherosclerotic plaques?
Smooth Muscle cells The vascular reaction to endothelial and intimal injury is intimal hyperplasia and fibrosis, predominantly mediated by reactive smooth muscle cells that migrate from the media to the intima
So what do we think if we hear "heart failure with normal ejection fraction?"
Some kind of a diastolic heart failure.
What is the acidified glycerol test used for
Spherocytosis
What is the defect in Niemann-Pick disease? What causes that? What is the common macular finding?
Sphingolipid degradation is defective Caused by an autosomal recessive defect in sphingomyelinase Cherry Spot on the macula? Niemann Pick's or Tay Sach's.
Cauda equina syndrome affects what nerves
Spinal nerve roots
Palpable step-off in spine =
Spondylolisthesis
What initiates the alternative pathway
Spontaneous and microbial surfaces + C3
Again, how does squatting improve symptoms in Tetralogy of Fallot patients?
Squatting increases Systemic Vascular Resistance (Total Peripheral Resistance) and decreases R to L shunting, thereby increasing pulmonary blood flow. Squatting thus counteracts arterial desaturation during hypoxemic spells
Most common bug in unilateral cervical lymphadenitis
Staph aureus
Most common cause of CF related pneumonia in infants and young children =
Staph aureus
Most common cause of bacterial pneumonia in CHILDREN vs. adults with CF? Treatment?
Staph aureus, vanc
Pneumatoceles are seen with what bug
Staph. aureus
Patient with Hep C + biopsy showing fibrosis, next step in management
Start treatment
Diabetic patients age >40 should recieve what therapy
Statins regardless of baseline lipid levels
Who has denser bones, black ladies or white ladies?
Statistically, black females have higher bone density than white females
Hypokinesis of Posterior Left Ventricle?
Stenosis of the right coronary artery
50 year old with menopause symptoms. Has atrophic vaginal mucosa. Pap smear with increased paranasal epithelia cells with no dysplasia. Due to decrease production of what?
Steroid hormones by ovarian follicles
Abdominal succussion splash, what is it and what is it used for
Stethoscope over upper abdomen and rocking patient back and forth --> splash sound --> gastric outlet obstruction
Dental procedure, bug?
Strep Mitis - alpha hemolytic
-Cuase of PSGN?
Strep Pyogenes (Group A strep)
What are 3 three plasmin-activating, clot-busting drugs?
Streptokinase tPA Urokinase
PMNs make reactive oxygen species. Which enzyme protects the body from these highly reactive oxygen compounds
Superoxide dysmutase (NASty Myelo)
Most useful intervention to improve functional capacity in patients with PAD
Supervised graded exercise program
Paracentesis of urinary bladder
Suprapubic aspiration: urine can be removed from the bladder without penetrating the peritoneum by inserting a needle JUST ABOVE the pubic symphysis
3rd branchial arch
Swish swallow; CN IX Cartilage: styloPharngeus
Infections results in what type of growth restriction
Symmetric
Head to abdomen circumference ratio can be used to differentiate
Symmetric vs. asymmetric FGR
Use of transcutaneous pacing
Symptomatic bradycardia
What is the classic murmur of aortic stenosis?
Systolic ejection-type, crescendo-decrescendo murmur that starts after the first heart sound and typically ends before the A2 component of the second heart sound.
Candida infections require what --
T cells
-Invasive melanoma with regression. Why regression?
T lymphocyte mediated cytotoxicity
Capsular polysaccharides induce what type of response
T-cell independent B cells because polysaccharides cannot be presented to T-cells (only peptides can)
openings in diaphragm
T8/Caval = transmits IVC and terminal branches of right phrenic nerve T10/Esophageal = transmits esophagus, right and left vagus nerves, esophageal branches of left gastric vessels T12/Aortic = transmits descending aorta, thoracic duct, azygos vein
Tryptophan makes what
TRY----B6--> Niacin-> NAD+/NADP+ TRY---BH4--> Serotonin-->melatonin
Symptoms of menopause, must check what and why
TSH/FSH because similar presentation to hyperthyroidism
minute ventilation (L/min)
TV x breaths/min
Treatment of OSA: Nsaids or tylenol
TYLENOL/acetaminophen!!
Nephrotoxicity + tremor without gum hypertrophy = what toxicity
Tacrolimus
Immunosuppressant used for transplant rejection *prophylaxis*
Tacrolimus (bins to FK506-binding protein [FKBP] to inhibit calcineurin)
Lymphatic drainage of male viscera
Testis & epididymis = lumbar lymph nodes Scrotum = superficial inguinal nodes Penis - skin = superficial inguinal nodes glans- deep inguinal nodes body and roots - internal Prostate gland and bladder = internal iliac nodes Anal Canal (above = internal iliac, below = superficial inguinal nodes)
"*T*o *B*e *H*ealed *R*apidly"
Tetanus toxin Botulinum HBV Rabies (after-exposure passive immunity)
What drugs can cause esophagitis
Tetracyclines, aspirin, alendronate, KCl
Candida infection defense
Th cells: prevent superficial: caused in opportunistic infections Neutrophils prevent hematogenous spread and disseminated candidiasis: neutropenic patients disseminated cause: Rsided endocarditis, liver/kidney abcesses, candidemia
Hemi-sensory loss with severe dysesthesia (severe pain reaction with hypersensitivity) = stroke where
Thalamus
What does a paradoxical embolism usually indicate, generally speaking?
That there is some abnormal connection between the right and left heart, allowing the DVT to cross over from the venous system to arterial system bypassing the lungs.
[This is a friendly but stern reminder to learn what a JVP looks like on a graph... FirstAID.] What is the first peak on a JVP tracing? When is it notably absent?
The "a wave," which is generated by atrial contraction. This is notably absent in patients with atrial fibrillation.
Where does the bladder rupture causing leakage of urine into the peritoneum
The DOME
What aspect of Tetralogy of Fallot determines the degree of right-to-left intracardiac shunting and thus hypoxemic symptom severity?
The Degree of R.V. outflow tract obstruction, i.e., the degree of pulmonic stenosis PROVe *Pulmonary Stenosis* RVH Overriding Aorta VSD
What area of the heart is most prone to ischemia and myocardial infarction and why?
The Left Ventricular subendocardial myocardium, because the systolic reduction in coronary blood flow in this region is the greatest
What is a "positive predictive value" because you obviously don't know...
The PPV reflects the number of true positives divided by the number of subjects testing positive for a test
Summarize the key points of pulmonary capillary wedge pressures (PCWP) and how it helps us diagnose mitral valve stenosis.
The Pulmonary capillary wedge pressure (PCWP) measures LAEDP. Under normal conditions, the LAEDP is nearly equal to the LVEDP. Mitral stenosis eleveates the LAEDP and PCWP relative to the LVEDP.
What do the auscultatory findings of a patient with Left Ventricular Failure reflect?
The S3 sound of left heart failure is the result of increased left ventricular end-systolic pressure; i.e., it's not pumping enough blood out of the LV
What is the cause of humoral hypercalcemia of malignancy?
The hypercalcemia is caused by release of parathyroid hormone-related peptide (PTHrP) PTHrP acts like PTH, although the degree of hypercalcemia is generally higher with PTHrP than with primary hyperparathyroidism
So what is the best auscultatory indicator of the severity of mitral stenosis (MS)?
The length of the interval between S2 and the opening snap. The shorter the interval, the more severe the stenosis
What is the intensity of the Aortic Stenosis murmur proprotional to?
The magnitude of the left ventricle-to-aorta pressure gradient during systole [measured via catheter]
What does RQ reflect
The major fuel being oxidized.
Summarize an Aortic Regurgitation Murmur.
The murmur of AR is a diastolic decrescendo murmur, heard loudest in early diastole when the pressure gradient between the aorta and the left ventricle is maximal. The murmur of AR is typically best heard at the left sternal border with the patient leaning forward and at end expiration.
Where do we hear the class cardiac auscultation finding in aortic stenosis? [and what does it sound like]
The right sternal border harsh, crescendo-decrescendo systolic ejection murmur
How, in a physical sense, do we describe peripheral resistance in the total body circuit? What about circulation in an individual organ? What impact does that have on resistance and calculating resistance?
Total body circulation is best described as a parallel circuit, whereas circulation in an individual organ is often best described by a series arrangement Total body / parallel: 1 / TPR = 1/R1 + 1/R2 + 1/R3.... In an organ: TPR = R1+R2+R3.....
How does our body monitor total body iron?
Total body iron content is regulated through HEPCIDIN's effects on the absorption of dietary iron Hepcidin is an acute phase reactant synthesized mainly in the liver by hepatocytes
Fluid in abdominal cavity has specific gravity greater than 1.020, numerous leukocytes, cellular debris. what describe the fluid?
Transudate
What to do in patient with suspected ectopic pregnancy and quantitative beta HCG < 6500
Transvaginal ultrasound
What is susceptibility bias
Treatment regimen is selected for a patient based on severity of condition, without considering confounders
superior gluteal nerve injury
Trendelenburg sign: if the superior gluteal nerve on the right side is injured, the left pelvis falls downward when the patient raises the left foot off the ground Due to the paralysis of the gluteus medius and minims muscles, therefore can't pull the pelvis up and abduction of the thigh are lost Note*** side is contralateral to the nerve injury
Loading Dose
VD x Cp/ Bioavailability fraction
Watery diarrhea, hypokalemia, achlorhydria
VIPoma
How to monitor respiratory function in Guillain barre
VITAL CAPACITY
Most common cardiac abnormality in Edward's
VSD
Cough Reflex
Vagal
Treatment of meningitis in immunocompromised
Vanc + amp + cefepime
Vascular rings vs. laryngomalacia
Vascular rings do not improve when prone; laryngomalacia is improved when prone
neonates inject with this vitamin
Vit K: prevent hemorrhage have sterile intestines cant synthesize yet, also immature liver also Vit D: by 6 months can be deficient
Generally speaking, regarding blood flow through our vessels, the law of conservation of mass states that the total flow of mass into a contained system must be equal to the total outflow of mass from that system in a steady state. What equation helps us prove the following condition: to maintain a constant fluid flow througha tube with varying diametes, how are cross-sectional area and flow velocities related?
Volume in must equal volume out, right? Vol(in) = A1 * V1 ; Vol(out) = A2*V2 So any rearrangement of that equation holds true in a physiological system. A2 = A1*V1 / V2 for example, works. This applies for blood flow in the cardiovascular system.
What would we expect, in a normal patient, the relationship to be between LA and LV pressure during diastole?
We would expect them to be nearly equale (both <12) since the open mitral valve offers minimal resistance to flow between the 2 chambers
granulomatosis with polyangiits (wegener's) -> a form of granulomatous vasculitis. ->renal and pulmonary sx seen with both goodpasture's and wegener's ->but upper airway and sinus are only seen with
Wegener's can have systemic symptoms ->weight loss, ->anorexia, ->arthralgias. (churg-strauss has asthma and eosinophilia)
Genitourinary conditions associated with foamy macrophages
Xanthogranulomatous pyelonephrytis (has tumor like-growth) Malacoplakia (E. coli cystitis with ulcers/papules)
Would you see hyperpigmentation in an ACTH producing tumor? Why?
Yes. Melanocyte stimulating hormone (MSH) is a cleavage product of ACTH.
Outbreaks of influenza A can cause what post infection
after Fever, headache, myalgia, malaise usually improves 2-5 days post severely stricken develop 2ndry bacterial pneumo (fever, dyspnea, productive cough) normally old or IC Usually S. penumo, aureus, H. influenzae
Urine leaks
after a crushing blow or penetrating injury, spongy urethra commonly ruptures within the bulb of the penis and urine leaks into superficial perineal pouch, which keeps urine from passing into the thigh or anal triangle. After distending the scrotum and penis, urine can pass over the pubis into the anterior abdominal wall deep to the layer of superficial abdominal fascia
Glucose transport intestine
against concentration gradient via Na/glucose symporter Active transport and co-transport
first line interventions following an initial gout attack
alcohol cessation and weight loss
mc MRSA location in staff members
anterior nares: nasal colonization
sarcoid
anterior uveitis ->wbc in anterior chamber hilar adenopathy reticulonodular infiltrates
For in-patient community acquired pneumonia use For outpatient therapy use
anti-pneumococcal quinolones ->levofloxacin ->moxifloxacin azithromycin or doxycycline.
increased velocity across aortic valve is seen in
aortic stenosis
when u hear bicuspid valve
aortic stenosis in 60s
auscultation of heart valves
aortic valve = R 2 ICS pulmoary valve = L 2 ICS tricuspid valve = L 5 ICS mitral valve = L 5 ICS - midaxial
Bronchogenic Carcinoma
arises in the mucosa of the large bronchi, produces as persistent productive cough or hemoptysis, early metastasis to thoracic lymph nodes a tumor at the apex of the lung (pancoast tumor) may result in thoracic outlet syndrome May lead to: thoracic outlet syndrome, Horner syndrome, SVC syndrome, dysphagia, hoarseness, paralysis of diaphragm
pleural plaques on XR are seen in 50% of
asbestosis cases. helps to distinguish from other cases of pulmonary fibrosis. most common malignancy in asbestosis is *bronchogenic carcinoma* pleural mesothelioma can also occur ->but it has a lower incidence ->and occurs in the pleura, not in the lung fields.
Culdocentesis
aspiration of fluid from the "cup-de-sac of Douglas" (rectouterine pouch) by a needle puncture of the posterior vaginal fornix near the midline between the uterosacral ligaments because this structure is the lowest portion of the female peritoneal cavity, it can collect inflammatory fluid (pelvic abscess)
Dizziness & tinnitis- SE of what drug?
aspirin
AICA results in --
ataxic limb movements
Mesenteric ischemia
atherosclerosis causes ischmeia, which usually involves SMA and SI It primarily affects organs which locate far away from anastomoses with CA and IMA- blood supply to jejunum and ileum is most compromised typically occurs in people older than age 60 with history of smoking and high cholesterol level
Benzo vs. opioid overdose
benzo: lack of severe resp. depression and normal pupils
-Albuterol MOA?
beta 2 agonist->increase cAMP in smooth muscle
what meds must be withheld prior to cardiac stress testing
beta blockers, CCBs, nitrates
esophageal anastomosis
between left gastric artery --> esophageal arteries to azygous vein in wall of lower end of esophagus in portal hypertension, enlarge in wall of esophagus and later burst into lumen of the esophagus (esophageal varicose) resulting in hematemesis (VOMIT BLOOD)
Paraumbilical anastomosis
between paraumbilical veins (from portal vein) and superior and inferior epigastric veins in anterior abdominal wall around umbilicus in portal hypertension, this anastomosis gets enlarged and dilated veins form "kaput medussae" around umbilicus
Rectal anastomosis
between the superior rectal vein and inferior rectal vein (into internal iliac) from IVC chronic alcoholics commonly have this anastomosis dilate resulting in internal hemorrhoids and bleeding per anus from superior rectal vien
pulmonary edema on xray
bilateral luffy appearing finlitrate, not unilateral pulm opacification as in atelectasis
painless blood-tingued uring and hx of smoking in 55 YO
bladder cancer
Mechanism of Cocaine, TCA & amphetamines?
block NT reuptake
-NNRTI mechanism?
block replication of HIV genome in host cells
Molecular problem if trismus and opisthotonos
blockade of inhibitory NT release
What are korotkoff sounds?
blood pressure sounds
Toxicity of mycophenolate
bone MARROW suppression
blood supply of esophagus
branches off aorta
Diabetic neuropathy pain?
burning pain
Annular Pancreas
caused by malformation during the development of the pancreas before birth Occurs when ventral and dorsal pancreatic buds form a ring around the duodenum, thereby causing an obstruction of the duodenum and polyhydramnios symptoms: 1. feeding intolerance in newborns 2. fullness after eating 3. nausea and bile-stained vomiting half of cases are not diagnosed until symptoms occur in adulthood
lactase def what happens
causes osmotic diarrhea bacteria ferment it to form short chain FA and excess H= cause decrease in pH
trochlear nerve palsy
causes paralysis of the superior oblique and impair the ability to turn the affected eyeball infero-medially (pupil look superio-laterally) characteristic sign of trochlear nerve injury is diplopia (double vision) when looking down
-Histology of Type I DM pancreas?
cell necrosis with inflammatory infiltrate
features of apoptosis
cell shrinkage, eosinophilia, condensed cytoplasm, apoptotic bodies
arterial oxygen sat in central and peripheral cyanosis in babies
central: low arterial o2 sat peripheral: normal
Prominent ischial spines felt on pregnant PE during labor =
cephalopelvic disproportion
What are the major manifestations of Ataxia-telangiectasia?
cerebellar ataxia, oculocutaneous tenlangiectasias, repeated sinopulmonary infections, and an increased incidence of malignancy
Subacute sclerosing encephalitis cause from measles
certain type of measles virus that is missing an antigen (m protein) causes failure of the measles virus to be cleared by the immune system and allows persistence in CNS High titer of AB to measles are found but there are no Ab to M component of the virus
Cancer type and tumor antigen with high antibody titer
cervical cancer and HPV 16, E6 protein
Highest immunogenic tumor cell response
cervical cancer to HPV 16, E6 protein
compliance of heart=
change in V/ change in P
lithium toxicity: CF/Rx/CI
coarse tremors, fasicular twitching, agitation, ataxia, delirium rx: hemodialysis C/I: thiazide diuretics, ACE, NSAIDs
Deep perineal pouch
contains: 1. sphincter urethrae muscle 2. deep transverse perineal muscle 3. Bulbourethral (Cowper) glands (in male only) ducts perforate perineal membrane and enters bulbar urethra
Lesser omentum content and ligaments
content: 1. R & L gastric vessels 2. Connective and fat tissue and portal triad (bile duct, portal vein, proper hepatic artery) ligaments: 1. hepatogastric 2. hepatoduodenal (contains portal triad)
contents of cubital fossa
contents (lat to medial) = biceps brachii tendon, brachial artery, median nerve subcutaneos structures from lateral to medial = cephalic vein, median cubital vein (joins the 2), basilica vein sites of venipuncture= median cubital vein because not accompanied by nerves and overlies bicipital aponeurosis
hindgut
contents: 1/3 transverse colon, descending colon, rectum and sigmoid colon artery: IMA PS- pelvi splanchnic nerves S2-4 Symp- Lumbar splanchnic nerves L1-2 & inferior mesenteric ganglion referred pain: hypogastrium
midgut
contents: 2,3,4th parts of duodenum, jejunum, ilium, cecum, ascending colon, 2/3 of transverse colon artery: Superior mesenteric artery PS- vagus Symp- lesser splanchnic nn T10-11 & Superior mesenteric ganglion referred pain: umbilical
COPD can lead to
cor pulmonale. will have ->elevated JVP, ->hepatomegaly ->peripheral edema ->with clear lung sounds. loop diuretics are often used ->lower RV filling volumes ->reduce peripheral edema (in patients with COPD exacerbations). BUT loop diuretics can cause decreased CO in patients with cor pulmonale, ->leading to pre-renal azotemia (elevated BUN/Cr) and bicarbonate will go down secondary to a metabolic acidosis from uremia
exacerbates ischemic MI
coronary arterIOLAR dilation dipyridamole, adenosine exacerbates ischemic BF: coronary steal phenomenon
what effect of dipyridamole allows you to diagnose ischemic heart disease
coronary steal
vit d deficiency causes
decreased: Ca, phosphate increased PTH(causes osteomalacia) increased ALP
Lactulose
decreases NH3 production by bacteria and acts as a laxative for hepatic encephalopathy
Douglas (rectouterine) pouch
deeper point of peritoneal space in vertical position of the female body between rectum and cervix of uterus it is space of the pelvic abscess location
Function of catalase? (made by bacteria)
degrades H202
Function of glutathione peroxidase? (made by WBCs)
degrades H202
Axillary sheath
derived from the pre vertebral fascia, encloses the subclavian artery and brachial plexus as they emerge in the interval between the scalenus anterior and medius muscles (interscalenus space) Extends into the axilla
injury of obturator nerve
difficult adducting thigh, decreased sensation over upper medial thigh cause of injury: anterior hip dislocation, radical retropubic prostatectomia
Internal hemorrhoids
dilated tributaries of the superior rectal veins (SRV) ABOVE THE PECTINATE LINE and are not painful because the mucosa is supplied by visceral afferent fibers Frequently develop in chronic alcoholics bc cirrhosis and portal hypertension syndrome
Cholelithiasis (gallstones)
distal end of hepatopancreatic ampulla is the narrowest part of the biliary passages and is the common site for impaction of gallstones As a result of common hepatic, bile duct or hepatopancreatic ampulla- obstruction will cause jaundice gallstones in cystic duct do not cause jaundice, but produces biliary colic Fundus of gallbladder is in contact with transverse colon and body is in contact with duodenum therefore may ulcerate through GB and cause intestinal obstruction or passed naturally (transverse)
Aripruprazole and galactorrhea?
does not cause it bc it is a partial agonist
mastectomy
during, the long thoracic nerve may be lesioned causing winged scapula and weakness in abduction above 90 degrees intercostobrachial nerve may also be damaged during mastectomy, resulting in skin deficit of the medial arm
capillary hemangioma embryological origin
endothelial
Varicocele
enlargement of paminiform plexus that produces a wormlike scrotal mass and enlargement of the spermatic cord. May be reason of low sperm count usually on left side and may disappear in supine position May indicate kidney disease or may signal retroperitoneal malignancy obstructing the testicular vein
ab pain, nausea, vomiting after party, normal temp, low BP
enterotoxin ingestion (S. aureus, usually rapid onset in 1-8 hours)
Viral meningitis viruses
enteroviruses(coxsackie, echovirus, polio), HSV2/1, HIV, West nile virus, VZV
Tail of pancreas
enters splenorenal ligament to reach hilum of the spleen, only part that is intraperitoneal and may be removed during spleenectomy and resulting in type II diabetes because endocrine cells are here
Open pneumothorax pleura
entry of air into a pleural cavity causing lung collapse, due to stab wounds of the thoracic wall which pierce the parietal pleura so that the pleural cavity is open to the outside air via the lung or through the chest wall air moves freely through the wound during inspiration and expiration, during inspiration air enters chest wall and the mediastinum will shift toward other side and compresses the opposite lung during expiration, air exits the wound and the mediastinum moves back toward the affected side
What's the major factor in the development of centriacinar emphysema?
excess neutrophil elastase activity
Femoral hernia
exits through femoral ring inferolateral to the inguinal ligament through femoral canal where it presents subcutaneously
relieving extrahepatic and intrahepatic cholestasis pruritis
extra: stent intra: can try ursodeoxycholic acid
aspiration pneumonia
foul-smelling sputum caused by excessive alcohol intake. other risk factors ->altered consciousness, ->dysphagia, ->neurologic disorders, ->sedative procedures.
seminal vesicle secretions
fructose (bulbourethral gland/Cowper = mucous, prostate =acid phosphate and PSA )
Seminal vesicles secrete
fructose, glandins all the other stuff
trendelenburg gait
gluteus medius gait: hip drops down as ipsilateral foot lifted off the ground Injury: to CONTRalateral superior gluteal nerve or gluteus medius muscle (n: travels through greater sciatic foramen)
Bronchioles lack
goblet cells, glands and cartilage
N. gonorrhoeae have no vaccine due to
have pili that know to undergo antigenic variation at high frequency structural genes fro pilus proteins undergo recombination with each other to produce new antigenic type of pili
gestational trophoblastic disease
high hCG, nausea, vomiting, large uterus, associated with complete mole (male, male, no egg parts, 46 complete, 69 Partial)
exudate
high protein, cloudy, inflammatory (neutrophils), pH<7.4, low glucose malignancy, pneumonia, collagen vascular disease, trauma (increased vascular permeability)
pe heart pressures
high ra pressure (0-8 normal), rv high (normal 15-25/3-12), high pa pressure (normal 15-25/8-15)
dystonia, hyperkinetic movements, dimentia- disease & pathologic
huntingtons atrophy of caudate
homogenous acellular thickening of arteriolar walls
hyaline arteriolosclerosis
Adrenal crisis c/f
hypotensive, tachycardic, hypoglyemic w/ hx of adrenal insufficiency (vomiting, abd pain, weight loss, hyperpigmentation) rx. corticosteroids
in an acute COPD exacerbation alveolar hypoventilation leads to
hypoxia and hypercapnia. *avoid sedatives* ->can exacerbate alveolar hypoventilation, ->which can cause CO2 retention leading to ->lethargy, ->somnolence, ->seizures, ->coma, ->death.
acute pulmonary embolism
hypoxia and respiratory alkalosis.
most sensitive test for menopause
increased FSH(decreased estrogen negative feedback)
lobar pneumonia
increased tactile fremitus, bronchial breath sounds, dullness to percussion
solids in the lung make sounds travel faster so consolidation (lobar pneumonia) has
increased tactile fremitus. air or fluid outside the lung interrupts this transmission of sound. patients with consolidated lungs have bronchial breath sounds ->due to over-transmission of sound over the chest wall. (Vs breath sounds absent / diminished with ->pleural effusion, ->pneumothorax ->COPD)
mastitis
infection of the tissue of the breast that occurs most frequently during the time of breastfeeding causes pain, swelling, redness and increased temperature of breast
acute exacerbation of COPD treated with:
inhaled nebulized bronchodilators and systemic steroids.
Valproic Acid MOA
inhibits HISTONE ACETYLASE - Histones were in DNA - transcription error
protease inhibitor MOA
inhibits cutting up of long enzyme chain into smaller pieces = no new viruses, lack mature core
lower brachial plexus (Klumpke paralysis)
injury to lower roots and trunk, when upper limb is suddenly pulled superiorly, stretching or tearing the inferior parts of the brachial plexus (C8 and T1 roots or inferior trunk) from: grabbing support during falling from height, birth injury or from TOS all intrinsic muscles of the hand supplied by the C8 and T1 roots of the lower trunk affected ulnar (claw hand) and median (ape hand) may include a horner syndrome
upper brachial palsy (Erb-Duchenne palsy)
injury to upper roots and trunk, usually from excessive increase in the angle between the neck and shoulder, C5-6 or superior trunk may occur as birth injury from forcefully pulling infant's head during difficult delivery in all cases, paralysis of the muscles of shoulder and arm supplied by C5 and C6 roots (axillary, supra scapular, musculocutaneous) = waiter's tip hand (adducted shoulder, medially rotated arm, extended elbow, loss of sensation in lateral aspect of the upper limb)
cerebellar hemisphere
intention tremor, limb ataxia, loss of balance, fall towards side of lesion
the A-a gradient is increased in
interstitial lung disease due to ->reduced diffusion capacity ->V/Q mismatch. CXR in idiopathic pulmonary fibrosis (IPF) ->airway fibrosis = "honeycomb" pattern, ->pulmonary vascular congestion - most evident in the hilum.
in a patient with rapid, ongoing, massive hemoptysis -> (>100-600ml in a 24-hour period)
intubate the patient ->to protect the airway and place the bleeding lung in the dependent position ->to preserve gas exchange in the non-bleeding lung. then give fluids and perform an emergent bedside bronchoscopy ->visualize the lesion ->and control the bleeding. i.e) intubate ---> fluids ---> bronchoscopy for bleeding control
theophylline OD:
like caffeine: abd pain, V/D, cardiac arrhythmias, seizures RX: adm charcoal (dec absorption) and cathartics (in elimina via GI tract); B-blockers for arrythmia, BZ/barbs most effective
arsenic poisoning/polyvinyl chloride (CD31)
liver angiosarcoma cd31= PECAM1: expressed on endothelial cells and functions for leukocyte migration through endothelium
MOA IKB
lkb --> NF-KB post phosphorylation for IL-1/IL-6 fever induction
Best diet for obese person wanting to avoid diabetes
low calorie
cat-scratch fever
low fever, lymphadenopathy, self limited bacillary angiomatosis, culture negative endocarditis Bartonella spp.
Vertigo + ear fullness + tinnitus + hearing loss = Meniere's disease Treatment of meniere's disease
low salt diet and lifestyle modifications
What is the characteristic cardiac finding on auscultation of ventricular septal defect?
low-pitched holosytolic murmur heard best at the left sternal border with accentuation during the hand-grip exercise the hand-grip maneuver accentuates it because of increased afterload, which results in an increase in the movement of blood from the left ventricle to the right ventricle across the VSD
Sliding hiatal hernia
mainly past middle age individuals when cardia of stomach enters into thorax through esophageal hiatus of diaphragm can damage vagal trunks as they pass through hiatus and resulting in hypo secretion of gastric juice
inhaled anti-muscarinic agents such as ipratropium
mainstay of symptom management in COPD.
failed fusion of urethral folds
males:hypospadias females: labia minor issue
bronchoalveolar lavage (BAL) is useful for
malignancy and opportunistic infections. >90% sensitive for PCP, but not as diagnostic in other lung diseases like ->sarcoid, ->interstitial pulmonary fibrosis, ->connective tissue diseases.
primary hyperthyroidism vs malignancy hypercalcemia
malignancy causes way more elevated calciums. like 14 or so.
Ear pain + ear drainage + granulation tissue =
malignant otitis externa
Granulation tissue + ear pain + itching =
malignant otitis externa
Carcinoma of the Breast
malignant tumors, usually adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the mammary gland lobules 1. it enlarges, attached to cooper's ligament (suspensory ligament) and produces shortening of the ligaments, causing depression or dimpling of the overlying skin
posterior gastric ulcer
may erode posterior wall of stomach into mental bursa (lesser peritoneal sac) and affect pancreas resulting in referred pain in back Erosion of splenic artery is very common in posterior gastric ulcers as well because the proximity of the the wall
imperforated hymen
mc obstructive lesions in female genital tract at birth vaginal secretions stimulated by mothers estrogen levels can cause mucoclopos(accum of mucus in vaginal canal) manifest to bulging introitus nothing until menarche: cyclic abd pain(hematocolpos(accum of blood in vag canal) distention of vagina: back pain and difficulties w/ defecation/urination (palpable anterior to rectum)
positive skew
mean>median>mode
golfer's elbow
medial epicondylitis- inflammation of the common flexor tendon of the wrist where it originates on the medial epicondyle of the humerus pronator teres flexor carpi radialis palmaris longus flexor carpi ulnaris
elbow ulnar nerve compression symptoms
medial forearm wekaness, weakness of intrinsic hand muscles, paresthesias in the fourth and fifth fingers
hand of benediction
median n at elbow when attempting to make a fist, index and middle fingers can't flex muscles paralyzed = lumbricals 1,2 and lateral half of FDP
ape hand
median n. typically after elbow, inability to abduct and oppose thumb muscles involved = abductor pollicis brevis and opponent pollicis
What are lamellar bodies in Type II pneumocytes?
membrane-bound intracellular inclusions composed of stacked layeres of cell membrane like material they contain phospholipids (dipalmitoyl phosphatidylcholine..... surfactant.)
nicotine and addiction: pathway
mesolimbic mesocortical tract: midbrain to cerebrocortical +limbic structures: increased release of DA in nucleus accumbens
CN2-6 pass through the --
middle cranial fossa
criteria for asthma
mild intermittent: ->daytime symptoms < 2/week, ->nighttime awakenings <2 month, ->no limit on daily activites ->treatment = PRN albulterol mild persistent: ->symptoms > 2 days/week but not daily, ->nighttime awakenings 3-4/month, ->minor limit on ADL ->treatment = prn albuterol + inhaled corticosteroid moderate persistent: ->daily symptoms, ->weekly nighttime awakenings, ->moderate limit on ADL ->FEV1 60-80% ->treatment: = daily inhaled corticosteroid or cromolyn/nedocromil or methylxanthine or antileukotriene severe persistent: ->Sx throughout the day, ->frequent nighttime awakenings, ->extremely limited ADLs, ->FEV1 <60% ->treatment = long acting beta-agonist + high-dose inhaled corticosteroids + systemic corticosteroid
aspirin intoxication causes
mixed ->respiratory alkalosis ->metabolic acidosis.
Viral hepatitis microscopy
mononuclear cell infiltrate, hepatocyte swelling and acidophilic bodies(apoptotic hepatocytes: Councilman bodies) Pseudoacini of dividing heptocyte and numerous mitotic figures: hepatocyte hyperplasia due to viral hepatitis attempt to regenerate cells lost due to viral damage
posterior hip dislocations
most common (anterior stopped by strong iliofemoral ligament) - a head on collision that causes the knee to strike the dashboard may dislocate the hip when the femoral head is forced out of the acetabulum the joint capsule ruptures inferiorly and posteriorly allowing the femoral head to pass through the femoral head to pass through the tear in the capsule (tearing of ishiofemoral lig.) and over the posterior margin of the acetabulum onto the lateral surface of the ilium, shortening and medial rotating the limb
Ankle sprains
most common ankle injuries, nearly always an inversion injury, involving twisting of the weight-bearing plantar flexed foot- the lateral ligament (anterior talofibular ligament) is injured because it is mush weaker than the medial ligament eversion sprains, the lateral malleolus of the fibula may be fractured
Plantar fascitis (calcaneal spur)
most common hind foot problem in runners, causes pain on the plantar surface of the foot and heel point tenderness is located at the proximal attachment of the plantar aponeurosis to the medial tubercle of the calcaneus and on the medial surface of this bone
VSD Ventricular Septal Defect
most common of the congenital heart defects, may be found in the membranous part of the ventricular septum and results from failure to fuse of the membranous portion with the muscular portion of the ventricular septum in this case, present left-to-right shunt (right ventricular hypertrophy and non-cyanotic) necessary surgery for large defects
Perinephric abscess
most infections of the perinephric space occur as a result of extension of an ascending urinary tract infection, commonly in association with nephrolithiasis or tuberculosis Typically descends down between 2 sheets of renal fascia along psoas major muscle. In case of abscess locates behind the psoas major muscle it descends down and may affect hip joint. If abscess spreads up it'll reach the diaphragm and irritate phrenic nerve. result = pain in shoulder
Chronic mesenteric ischemia presentation
most often caused by artherosclerotic narrowing of celiac trunk, SMA or IMA Epigastric or perumbilical abd pain 30-60 min post food intake atherosclerotic arteries are unable to dilate in response to increased BF during digestion and absoprtion of food Weight loss mc sign, patients avoid eating presents similarly to Stable Angina
Mitochondria differ from rest of cell
mtDNA-from oocyte; use a non standard genetic code stop codon-tryptophan double membrane and cristae
boxer's fracture
necks of the metacarpal bones are frequently fractures during fistfights typically fractures of 2nd and 3rd metacarpals are seen in professional boxers and fractures of 5th and 4th metacarpals are seen in unskilled fighters
Nerve supply of anterior abdominal wall
nerves and deep blood vessels lie in the neurovasculature plane between internal oblique and transverses muscles total of 7 nerves: lower 5 intercostal, 1 subcostal, L1 iliohypogastric and ilioinguinal L1 can be anesthetized by injecting 1 inch superior to ASIS
What is the most common congenital abnormality associated with the use of Sodium Valproate during pregnancy?
neural tube defects, e.g., meningocele because valproate inhibits intestinal folic acid absorption resulting in teratogenicity
Most common cause of foot drop
neuropathy, L5 radiculopathy
intercostal spaces
neurovasculature runs between the internal intercostal and innermost intercostal muscles in the costal groove arranged from superior to inferior as vein, artery, and nerve most vulnerable structures- intercostal nerve and posterior intercostal artery
Diagnosis of SBP made when
neutrophil count in ascitic fluid > 250 cells/uL
signet ring carcinoma
no glands, abundant mucin in cell give leather bottle stomach (linitis plastica) infiltrate large areas of stomach wall - LCIS
Does neuronal input typically have a strong impact on coronary circulation?
no. nervous input generally has very little effect on coronary blood flow (so NE, Ach, etc. doesn't have a lot to do with coronary flow... what does? adenosine for small arterioles, NO for larger vessels)
What are clara cells?
non-ciliated, secretory constituents of the terminal respiratory epithelium they secrete clara cell secretory protein (CCSP), which INHIBITS NEUTROPHIL RECRUITMENT and ACTIVATION as well as neutrophil-dependent mucin production
in patient with acute exacerbation of COPD refractory to oxygen, corticosteroids + bronchodilators, try
non-invasive positive pressure ventilation before you try to intubate and mechanically ventilate ->if the patient is not crashing.
Mild aminotransferse elevation and isoniazid, management
nothing, self-limited and will resolve
scaphoid fracture
occurs as a result of a fall onto the palm when the hand is abducted. pain occurs primarily on the lateral side of the wrist, especially during wrist extension and abduction deep tenderness will be present in the anatomical snuffbox the proximal fragment may undergo avascular necrosis because the blood supply is interrupted
Effect modification
ocurs when the effect of a main exposure on an outcome is modified by another variable smoker with drug vs smokers w/out drug have RR1.7 p=.01 nonsmoker w/ drug RR.<1 p=.68 smokers more suseptible to drug causing dvt to nonsmokers Not confounding: not smoking itself causing cause because compared smoking to nonsmoking
Aneurysm of the aorta of aortic or thoracic
of aortic arch: compresses left recurrent laryngeal nerve, leading to coughing hoarseness and paralysis of the vocal cord, may cause dysphagia, resulting from pressure on esophagus and dyspnea- resulting from pressure on the trachea, root of lung, or phrenic nerve of thoracic aorta: may compress and tug on the trachea with each cardiac systole so that the aneurysm can be felt by palpating the trachea at sternal notch
Inferior MI appearance and Rx
often due to RCA block-> supplies AV/SA node Usually assoc. w/ brady/ hypoTN Rx: atropine= incr HR/BP C/I: precipitates GLAUCOMA
Lymphatic drainage from the female viscera
ovary and uterine tubes = to lumbar lymph nodes uterus = lateral angle and trees ligament - superficial inguinal lymph nodes, funds and upper part of the body - lumbar lymph nodes, lower part of body- external iliac lymph nodes cervix- external & internal iliac Vagina Superior to hymen- to external and internal iliac inferior to hymen - to superficial inguinal nodes all external genitalia- superficial inguinal lymph nodes glans clitoris- deep inguinal
paralysis of the serratus anterior
owing to injury to long thoracic nerve, the medial aspect will move laterally and posteriorly from the thoracic wall, especially when the person leans on a hand or presses the upper limb against the wall =winged scapula cannot have complete abduction
Metabolic process impaired if rapid red fibers
oxidative phosphorylation
mitochondrial myopathies
oxidative phosphorylation disease
Gag gene
p24 capsid protein, p17-matrix,p7 virion core
PE blood finding
pH: >7.4 PaO2<80 paCO2<40 HCO3<24 (compensate)
1 COOH, 2 NH2+ changes at certain states pka: 2.2 carboxy, 9.2, 107
pH<2.2= +2 cause all have H+ attached (COOH, NH3+,NH3+) physio 7.4= +1 (COO-(-1), NH3+(+1), NH3+(+1)) pH 9.2-10.7= 0 (C00-(-1) NH2(0) NH3+(+1)) pH>10.2= -1 (COO-, NH2, NH2) protons dissociate from AA when solutions pH exceeds the pKa value assoc w/ each proton
hypersplenism in alcoholics causes
pancytopenia occurring in patients with an enlarged spleen. It is due to large numbers of cells being pooled and destroyed in the spleen's reticulo-endothelial system, and haemodilution because of an increased plasma volume
Diaphragm paralysis of half and ruptures
paralysis of half = results from injury or operative division of the phrenic nerve of same side, can be detected radiologically paradoxical movement: dome of diaphragm of injured side pushed superiorly by abdominal viscera during inspiration instead of descending
Nerve supply to parietal and visceral pleura
parietal = sensitive to general sensibilities (pain, temp, touch and pressure)- somatic sensory innervation --> costal pleura- intercostal nerves and mediastinal pleura - phrenic nerve, diaphragmatic pleura - phrenic nerve over the domes and lower 6 intercostal nerves around the periphery visceral pleura= sensitive to stretch but insensitive to general sensibilities- autonomic nerve supply from the pulmonary plexus
radial head subluxation ("nurse's maid elbow")
partial dislocation is common in children under 5, when radial head slips out of the annular ligament of radius
What is the result of insufficient surfactant (as seen in neonatal respiratory distress syndrome, or maybe a guy who doesn't have lamellar bodies in his type II pneumocytes)?
patchy atelectasis (collapse) of alveoli due to increased surface tension
emphysema
pathological diagnosis characterized by ->permanent and destructive enlargement of airspaces ->distal to the terminal bronchioles ->with loss of normal architecture. patients ->generally severe ->dyspneic (pink puffers) ->hyperinflation of chest, Signs ->decreased vascular markings, ->decreased DLCO (due to destruction of alveoli). panacinar emphysema ->alpha-1-antitrypsin deficiency. centriacinar ->COPD. (Vs chronic bronchitis ->DLCO normal ->clinical diagnosis - chronic productive cough for at least 3 months over 2 consecutive years)
Horner syndrome
penetrating injury to the neck, Pancoast tumor or thyroid carcinoma may cause horner syndrome by interrupting ascending preganglionic sympathetic fibers anywhere between their origin in the T1 segment (IML) of the spinal cord and their synapse in the superior cervical ganglion Includes: constriction of the pupil (mitosis), drooping of the superior eyelid (ptosis), redness and increased temperature of the skin (vasodilation), absence of sweating (anhydrosis)
Who is a tricky subset of a population who's NOT at risk to get a disease, statistically speaking?
people who already have the disease! population of 40 and 5 people have disease, population at risk is 35
Prostatectomy
performed through: suprapubic, perineal, or transurethrally Damage to nerves in capsule of prostate and around the urethra can cause impotence (erectile dysfunction) and/or urinary incontinence. Pelvic splanchnic nerves may be injured in case of intensive dissection of pelvic lymph nodes and as a result autonomic innervation of derivative of hind gut may be affected
Meckel's diverticulum
persistent portion of vitellointestinal duct, can be asymptomatic but occasionally becomes inflamed if it contains ectopic gastric, pancreatic, or endometrial tissue, which may produce ulceration located on ileum about 2 feet before the ileocecal junction and MSA supplies it occurs in 2% of patents diverticulitis, liberation, bleeding, perforation, and obstruction frequently mimcl symptoms of acute appendicitis
Tyrosine kinases do what
phosphorylate targets by taking a phosphate from ATP
partial beta agonists
pindolol, acebutolol (PAPA)
placenta accreta
placenta attahed to myometrium after birth = massive bleeding
Hair loss is a type of gene loss of..
polygenetics
CSF gram stain shows spore forming, gram+ bacilli, widening of mediastinum, what is the virulence factor that enable to avoid phagocytosis?
polyglutamic acid (Anthrax)
polymyositis vs polymyalgia rheumatica
polymyo: proximal muscle weakness. CPK and LDH elevated. polymyalgia rheumatica: proximal muscle tenderness. normal cpk.
pregnancy carpal tunnel pathology vs hypothyroid carpal pathology
pregnancy: excess fluid acumulation in carpal tunnel hypothyroid: matrix substances accumulate
Scaphocephaly
premature closure of sagittal suture, in which the anterior fontanelle is small or absent, results in a long, narrow, wedge-shaped cranium
presentation of juvenile myoclonic epilepsy
progression from absence seizures beginning around age 10 to myoclonic seizures around age 15. then tonic clonic seizures around age 16.
suprasellar mass, hormone excess?
prolactin
Salmonella post antibiotic?
prolonged fecal excretement post antibiotic
side effect of sotalol
prolonged qt
change of epi in terminal bronchi to respiratory bronchi
pseudostratified ciliated columnar to ciliated simple cuboidal resp: simple squamous and no CILIA
Airway pressure measured after inspiratory hold reflects what
pulmonary compliance
rare side effect of beta agnoists in pregnancy (these are the tocolytics)
pulmonary edema. cuz increased heart rate--low diastolic filling time--excess pregnancy volume--edema
v/q mismatch caused by:
pulmonary embolism, obstructive lung disease, atelectasis, pulmonary edema, pneumonia. shunt caused by intracardiac shunt (VSD). shunt doesnt get better with O2. ->n in shunt ->n in not better they both have increased A-a gradient. do not cause an increased A-a gradient: ->hypoventilation ->decreased inspired O2
amphetamine intox
pupillary dilation, diaphoresis, agitation, confusion
glut+ asp
pyrimidines
Chronic hemolysis + HSM + skin ulcers + pigmented gallstones =
pyruvate kinase deficiency
mammogram recs
q2yrs 50-75
Hirschsprung's Disease
rare congenital abnormality that results in intestinal obstruction (megacolon) because of congenital absents of postganglionic PS neurons inside the wall of large intestine commonly found in Down Syndrome children chief signs in newborn = failure to pass a meconium stool within 24-48 hrs after birth, reluctance to eat, bile-stained vomiting and abdominal distension treatment = removal of a ganglionic portion of colon
Most common cuase of death in patients with acute MI
reentrant ventricular arrhythmia (Vfib)
What is type grouping....
remember muscle has type I and II fibers (A 5 dollar word for cell)...normally type I and Type II arrange like Checkerboard" pattern of type I (Light) and II (Dark) fibers....but in type grouping Type I and type II muscle fibers are clustered in large groups (Type I together and Type II together )
Hydrocele
remnants of tunica vaginalis testis or other remnants of the processes vaginalis may form a hydrocele or hematocele In spermatic cord it sausage shaped structure that persists under gentle compression and doesn't get better in supine position In the scrotum - with transillumination, it produces a reddish glow, whereas light will not penetrate other scrotal masses such as a hematocele, solid tumor, or herniated bowel
Staghorn calculi
renal stone that develops in the renal pelvis and greater calicoes and in advanced stage resembles antlers of a stag Composed of magnesium ammonium phosphate, which forms in urine that has an abnormally high pH due to recurrent UTIs with microorganisms such as Proteus mirabilis
What is the most common cause of heart failure in developed countries?
repeated bouts of myocardial ischemia
drug overdose?
respiratory acidosis
severe asthma exacerbation will cause
respiratory acidosis due to ->air trapping ->CO2 retention.
obesity hypoventilation syndrome (pickwickian syndrome) ->severe obesity (BMI > 55) ->and alveolar hypoventilation during wakefulness ABG will reveal:
respiratory acidosis, hypercapnia hypoxemia. due to: ->decreased chest wall compliance.
Reccurent lobar hemmorrhages in elderly
result of cerebral amyloid angiopathy: when B-amyloid is deposited into arterial wall: weakens and predisposes to rupture Assoc w/ increased age, NOT to systemic amyloidosis MC presentation: recurrent hemorrhagic strokes (less severe) usually in cerebral hemispheres
smith's fracture
results from a fall or a blow on the dorsal aspect of the flexed wrist and produces a ventral angulation of the wrist, distal fragment of the radius is ANTERIORLY displaced
carpal tunnel syndrome
results from a lesion that reduces the size of the carpal tunnel, fluid retention, retention, dislocation of lunate bone medial nerve = most sensitive structure in the carpal tunnel and is most affected clinical manifestations: lateral 3.5 tingling palm sensation is not affected because superficial palmar cutaneous branch passes superficially to carpal tunnel apehand deformity- absent of opposition - 4 FDS, 4 FDP and 1 FPL
Coarctation of Aorta
results from congenital narrowing of the aorta distal to the offshoot of the left subclavian artery Cardinal clinical sign= higher BP in upper limbs compared to lower limbs results in intercostal arteries providing collateral circulation between internal thoracic artery and the thoracic aorta to provide blood supply to lower part of body
rubella vs roseola rash
roseola(hhv 6): high fever 3-5 days, then rash as fever subsides. rose colored macules and papules start on neck and trunk, then go to face and extremities rubella: erythematous macules and papules start on face and spread down to the body. rash adn fever are concurrent
LCL
rounded cord between lateral epicondyle of femur and head of fibula. Does not blend with joint capsule nor attach to lateral meniscus limits extension and adduction of leg at knee
hypothalamic ventromedial area
satiety: stimulated by leptin grow ventrally and medial= fat also become crazy, aggressive, bizarre behavior
RER ribosomes synthesize
secretory, membrane bound and lysosomal proteins
musculocutaneous nerve
sensation on lateral forearm, loss of elbow flexion
Nerve supply of the liver and gallbladder
sensory = right phrenic nerve, pain may radiate to shoulder PS = vagus n through celiac plexus and synapse at uxtramural plexuses in hilum of the liver symp = greater splanchnic n T5-9
fever, confusion, decreased food intake, and +cultures
sepsis. can cause ARDS. ->hypoxemia refractory to high inspired oxygen concentrations. ->often requires positive end-expiratory pressure (PEEP) via mechanical ventilation. ->try keep inspired O2 below 40%.
septic arthritis vs RA flare up
septic: monoarticular
calculation of saag
serum albumin-fluid albumin. If 2/2 portal hypertension, SAAG>1.1
Platelet activating factor causes what
severe bronchoconstriction, vasoconstriction, platelet aggregation w/ microthrombus formation works via Gq (PLC-IP3-Ca: promoting platelet activation) at low conc: vasodilator promote leukocyte adhesion to endothelium and diapedesis
asymptomatic thrombocytisosis due to
splenectomy. cuz one of the spleen's functions is to remove old platelets from circulation
oral leukoplakia can transform into--
squamous cell cancer
epidural abscess organisms
staph aureus. often mrsa
Monomorphous pink papules in the absence of comedones + steroid use =
steroid induced folliculitis
Medically speaking, how do we define palpitations? [I.e., not just a black woman saying "You give me heart palpitations."]
subjective sensation and awareness of one's own heart beating
characteristics of syncope due to arrythmias
sudden onset without prodrome.
massive pulmonary embolism leads to
syncope, right bundle branch block jugulovenous distension. right heart strain will progress to ->RV dysfunction, ->decreased CO, ->left pump failure, resulting in ->bradycardia. ->cardiogenic shock ->CNS effects (dilated pupils, unresponsive mental status)
What are 3 fibrin-specific throbolytic/fibrinolytic drugs?
tPA, reteplase, tenecteplase these act only on fibrin attached to recently formed clot without systemic activation
pulmonary contusion
tachypnea tachycardia, and hypoxia. will have decreased breath sounds on the affected side CXR ->patchy, irregular, alveolar infiltrate. ABG will show hypoxemia. (ARDS would be bilateral patchy alveolar infiltrates)
thyroid: Follicular hyperplasia with tall cells forming intrafollicular papillary projections
tall cell variant of papillary thyroid cancer older individuals= worse prognosis
What's the term for the tendency of a study population to affect an outcome due to the knowledge of being studied?
the Hawthorne Effect i.e., if a doc knows someone is monitoring how often he takes a sexual history, more likely to take lots of sexual histories
How can atrial fibrillation precipitate sudden heart failure?
the sudden loss of the contribution of normal atrial contraction to ventricular filling (loss of the atrial systolic kick) decreases LV preload (end diastolic volume)
Which nerve innervates the baroreceptors of the aortic arch?
the vagus nerve; fibers from the baroreceptors run within the vagus nerve (X)
How do natriuretic peptides (BNP and ANP) work?
they cause vasodilation, diuresis/natriuresis (as their name suggests...), and a decrease in blood pressure they counteract: endothelin sympathetic effects angiotensin II
transduate
transparent: low protein, low LDH, pH>7.4 due to CHF(inc HP), nephrotic syndrome(dec OP), hepatic cirrhosis
use lights criteria to determine if transudate or exudate. ph of 7.35 is consistent with
transudative pleural effusion.
cerebellar vermis damage
truncal ataxia, dysarthria (vermis is tree like)
where do u see turblulent airflow: rhonchi/wheeze secondary to airway obstruction
typically asthma/ bronchitis infant: RSV
Stomach ulcer vs erosion
ulcer: penetrates mucosal layer, extends into submucosal layer erosion: mucosal defects that doesn't penetrate muscularis mucosa
Median cervical cyst
usually presents as a painless midline mass on the anterior aspect of the neck just below the hyoid bone and moves during swallowing together with thyroid gland because of relation with pre tracheal layer of cervical fascia and infra hyoid muscles of the neck. Remnant of the thyroglossal canal Surgical excision must be done
Ristocetin Assay
vWF disease
DES exposure puts women at risk of
vaginal ADENO
SS disease in tissues
vasocclusive: bone ischemia: necrosis(staphylococcal salmenella osteomyelitis) splenic infarcts eventually lead to scarring, fibrosis and atrophy of spleen (autosplenectomy occur by late childhood: predispose to encapsulated organisms)
vit def causes infertility and decrease serum phospholipid
vit e
Most effective lifestyle intervention for reducing BP =
weight loss via DASH diet
