Step 1
What triggers asthma?
- Viral URIs - Allergens - Stress
What are the 2 forms of renal failure?
1) Acute: usually due to acute tubular necrosis 2) Chronic: usually caused by hypertension & diabetes
What are the primary findings in acromegaly?
1) Cause: excess GH in adults 2) Features: - Large tongue with deep furrows - Deep voice - Lg. hands & feet - Coarse facial features - Impaired glucose tolerance (insulin resistance)
What are the main functions of growth hormone (GH)?
1) Human growth and development 2) Stress response to starvation
What are the lab test results that indicate von Willebrand disease?
1) Increased Bleeding Time 2) Increased PTT
What structures are pierced in a lumbar puncture?
1) Skin/Superficial fascia 2) Ligaments (Supraspinous, interspinous, ligamentum flavum) 3) Epidural space 4) Dura mater 5) Subdural space 6) Arachnoid NOT PIA: Pia is not Pierced
What is uremia?
A clinical syndrome marked by increased BUN & creatinine & associated symptoms
Which drugs increase urine K+
All diuretics, except K+ sparing
What are the lab test results that indicate Hemophilia A or B?
All normal, except increased PTT
Where is a lumbar puncture taken?
Between L4 & L5 (Level of iliac crests)
Define Broca's aphasia.
Broca's Broken Boca: 1) Nonfluent aphasia with intact comprehension 2) Broca's area: infereior frontal gyrus
What is the pathology of Bronchiectasis?
Chronic necrotizing infection of bronchi leads to permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis
What is the most severe consequence of pulmonary hypertension?
Cor pulmonale & RV failure (JV distention, edema, hepatomegaly)
What factors are tested by PT?
Extrinsic factors: II, V, VII, & X
How does growth hormone (GH) respond to starvation?
GH is released in response to hypoglycemia & acts directly to REDUCE glucose uptake by cells & to increase lipolysis inorder to INCREASE blood sugar levels
What is the growth hormone (GH) response to pregnancy?
GH secretion decreases
What does it mean for a gas to be diffusion-limited?
Gas does not equilibrate by the time the blood reaches the end of the pulmonary capillary
What is the likely tumor at the epiphyseal end of the femur in a 30-year-old woman?
Giant cell: 1) Benign, primary bone tumor, aggressive 2) Radiography: double bubble or soap bubble sign 3) Histo: oval or spindle-shaped cells along with scattered multinucleated giant cells 4) Epidemiology: 20-40 year old, usually women
What is Ewing's sarcoma?
Going out for Ewings & onion rings! 1) Aggressive malignant bone tumor early met but responsive to chemo 2) Epidemiology: boys less than 15 years old 3) Histo: lamellated, "onion skin" periosteal reaction: uniform sheets of anaplastic, small blue cells 4) Gross: DIAPHYSIS of bones, pelvis, scapula, ribs 5) 11:22 translocation
Define "aphasia"
Higher-order inability to speak
What causes the visual disturbances often seen with acromegaly?
If the cause is a pituitary adenoma, this tumor can press on the optic chiasm
What does excess GH cause in adults? In children?
In adults: acromegaly In kids: gigantism
What is one chronic response to high-altitude induced hypoxia?
Increased hemocrit due to increased erythropoietin
How does acetazolamide work?
Inhibits carbonic anhydrase in the PCT (luminal/basolateral membrane & cytoplasm) - t/f decreases kidney reabsorption of bicarbonate in the proximal tubule & increases K+, Na+, & Cl- loss - ALKALINIZES Urine
What factors are tested by PTT?
Intrinsic: ALL, except VII
What are the pulmonary function findings in a case of COPD?
Obstructive Pattern: Increase in RV Decrease in FVC Decrease in FEV1 Decrease FVC Decrease FVC1/FVC ration (**) V/Q mismatch
What is the potential toxicity of acetazolamide?
PACE: - Potassion depletion (hypokalemia) - Acidosis (Hyperchloremic metabolic) due to excretion of HCO3 - Allergy (SULFA-based) - Ca nephrolithiasis - Encephalopathy in patients with hepatic cirrhosis due to decreased NH4+ excretion
What is the Tx for acromegaly?
Pituitary adenoma resection followed by octreotide administration
When is growth hormone (GH) normally increased?
Stress, exercise, & hypoglycemia
What are the clinical characteristics of Parkinson's?
TRAP 1) Tremor (At rest) 2) cogwheel Rigidity 3) Postural instability 4) Bradykinesia
What causes acromegaly?
Unsuppressed secretion of growth hormone (GH), usually due to a pituitary adenoma
Give the diffusion equation.
Vgas = A/T x Dk(P1-P2) A = area T = thickness Dk(P1-P2) = difference in partial pressures
What types of diseases present with tongue fasciculations?
degenerative neurological diseases (e.g. spinal muscular atrophy & amyotrophic lateral sclerosis)
What is the growth hormone (GH) response to obesity?
it's secretion is reduced
Define "dysarthria"
motor inability to speak
What is the most common benign bone tumor?
osteochondroma: it occurs in men less than 25 years old, in the metaphysis of long tubular bones
What type of muscle weakness is seen in Guillain-Barre syndrome and amyotrophic lateral sclerosis?
symmetrical
If the PT test is prolonged, what other test will automatically be abnormal?
the INR will be prolonged as well (that is, what is monitored in Warfarin Therapy
What does prolongation of all coagulation parameters indicate?
vWF deficiency or DIC
What are the dose-dependent effects of dopamine?
"DOPeDOse-dePendent Awards of MINE: - bronze (D1) at low doses = increased renal Perfusion - silver (B1) at intermediate = Positive inotropy - gold (Alpha1) at high doses = increased Peripheral resistance
What 4 components develop into the diaphragm?
"Several Parts Build the Diaphragm": - Septum transversum - Pleuroperitoneal folds - Body wall - Dorsal mesentery of the esophagus
What is the usual triad for adult normal pressure hydrocephaus (NPH)?
"Wet, wobbly, & wacky": excessive cerebrospinal fluid production, decreased absorption, or both 1) Incontinence 2) Gait difficulty (Magnetic: feet appear to stick to the floor) 3) Mental decline Rx: ventriuloperitoneal shunt Dx: MRI to rule out a mass lesion
What are the major toxins associated with TCC of the bladder?
"associated problems in your Pee SAC": - Phenacetin (painkiller) - Smoking - Aniline dyes - Cyclophosphamide S/S: painless hematuria (post 40 age patient)
How do subdural hematomas present on CT?
"crescent-shaped" density - bridging veins (between dura & arachnoid) rupture do to shearing forces
What is the MOA of Fenoldopam?
"one FELLOW of DOPAMine fires the D1-receptor" Gs -> increased cAMP -> PKA -> MLCK-Pi -> smooth muscle relaxation Vasodilation: - Renal, mesenteric, & coronary vascular beds - decreases arterial Bp - reflex sympathetic activation
What is Pamidrone used to treat?
(Bisphosphonate) Rx: Hypercalcemia
What characterizes the 2nd phase of Lyme disease?
(Borrelia burgdorferi via Ixodes tick) - Transient arthralgias - Bell's palsy - Atrioventricular nodal block - 2ndary annular rashes - Carditis
What are the risks of placenta previa?
(Placenta covers the cervical os): - Prior cesarean section - Multiparity - Advanced maternal age - Multiple gestations - Prior placenta previa
What does a P. aeruginosa ear infection present with?
(Swimmer's Ear) External or malignant otitis externa: ear pain & itchiness MOA: produces exotoxin A that ADP ribosylates elongation factor 2 & impairs host cell protein synthesis P. aerugoinoa: gram -, non-lactose-fermenting rod that forms blue-green colonies & has a fruity odor
What does Dracunculus medinensis cause?
(aka Guinea worm) - Cutaneous nodules & ulceration: resides in subcutaneous tissue & the tail of adult female can protrude to from a small ulcer (usually found on the Patient's lower limb)
Where is Necator americanus found (in the world)?
(aka hookworm) - Americas - sub-Saharan Africa - Southeast Asia
What cause a arcuate uterus?
(aka septate uterus) Failure of resorption of the midline uterine septum
How does Brown-Sequard present?
(spinal cord hemisection) - ipsilateral loss of motor function & vibration/proprioception - contralateral loss of pain & temperature sensation
How does CNS lymphoma present on a scan
- 1(+) enhancing lesions surounded by enema = mass effect - PCR CSF for EBV
What is measure in the urease breath test?
- 13C-labeled CO2 - Px ingests 13C-labeled urea, which is hydrolyzed into 2 ammonia molecules & 1 CO2 by H. pylori
Describe the embryo origins of the ear structures.
- 1st branchial arch: incus & malleus - 1st branchial cleft: external auditory meatus - 1st branchial pouch: iddle ear cavity, Eustachian tubes, mastoid air cells - 2nd branchial arch: stapes - 2nd branchial cleft: temporary cervical sinus
What type of drug is Diphenhydramine?
- 1st generation H1-receptor antagonist - Rx: symptomatic relief of allergy symptoms or as a sleep aid
What type of drug is Loratadine?
- 2nd generation, H1-receptor antagonist - Rx: relieves allergy symptoms
What 2 sleep stages have been merged?
- 3 & 4 = N3 - 13% of total sleep
What is the normal vaginal pH?
- 3.8 - 4.5 - This is maintained by Lactobacilli species that secrete lactic acid & hydrogen peroxide
How does primary biliary cholangitis present? What is seen histologically?
- 40-50 year old female patient with pruritus with or without jaundice - Histo: granulomatous degeneration of the intrahepatic bile ducts - LAB: antimitochondiral antibodies are positive in >90% of Px
What is Ondansetron used for?
- 5-HT3 receptor antagonist - Used to treat refractory or severe nausea & vomiting
At what pH is bacterial vaginosis found?
- 5.0-6.0 (moderately elevated) - Dx: Add KOH to vaginal discharge = strong fishy or amine odor = WHIFF TEST
At what pH is a Trichomanos vaginalis infection found?
- 5.0-7.0
In what age group are fibroids found?
- <40 years old & can regress after menopaus - ~75% of these are asymptomatic
What is subacute sclerosing panencephalitis (SSPE)?
- A sequela of rubeola (measles virus) - Presents 7-10 years after initial infection - Demyelination of the CNS - 1st stage: dementia & personality changes (1 yr. duration) - 2nd stage: Severe myoclonus (3-12 months) - 3rd & 4th stage: Worsening dementia & deterioration of the ANS + decorticate rigidity or flaccidity - FATAL
What is the cause of von Hippel-Lindau disease?
- AD disease that results in a deletion of a tumor suppressor gene on Chromosome 3 - Features: cysts of kidney, pancrease, polycytemia, hemangioblastoma of cerebellum or retina
What chromosomal abnormality results in Li-Fraumeni syndrome?
- AD: Loss of p53 tumor suppressor on Chromosome 17p - Leaves patients at a significant rick for malignancy as children or young adults: osteosarcoma, soft-tissue sarcomas, early-onset breast cancers, adrenocortical tumors, leukemias
What paraneoplastic syndrome is associated with small cell lung carcinoma?
- ADH (SIADH) - ACTH (Cushing-like)
What is the MOA of the cholera toxin
- ADP ribosylation of the GTP-binding protein - Keeps adenylate cyclate in the active state & thereby increases chloride secretion
How is interstitial (or idiopathic) pulmonary fibrosis (IPF) characterized?
- Abnormal proliferation of mesenchymal cells, disruption of collagen structures, & impaired gas exchange - RIP within 5 years without lung transplant - X-ray: white lines in a netlike pattern at the lower part of the lungs
What are the symptoms of vitamin E deficiency?
- Absent tendon reflexes - Ataxia - Loss of position & vibration sense - Loss of pain sensations
What is the main action (& side effects) of hydrochlorothiazide?
- Action: Inhibit luminal Na & Cl entry to the DC tubule cells, Potassium-wasting - SE: hypokalemia, give potassium supplements
What is the MOA of Ephedrine?
- Activates alpha and beta receptors and stimulates CA release - A non-catecholamine (CA) agent
What happens after vasopressin binds to the V2 receptor?
- Activation of a Gs to activate adenylyl cyclase - Increased AMP then leads to the insertion of aquaporin proteins into the apical membrane of the collecting duct epithelium - mutations in the V2 receptor can cause diabetes insipidus
In what cancer will a pathologist be able to see Auer rods?
- Acute myelogenous leukemia - These are in myeloblast cytoplasm
How does a disseminated N. gonorrhoeae infection present?
- Acute onset of fever - Swelling of 2 joints - 75% of Px also have skin lesions on the extremities
Which 5 kidney diseases are nephrItic (hematuria, azotemia, RBC casts in urine, oliguria, hypertension, proteinuria)?
- Acute proststrep - Rapidly progressive (crescentic) - Diffuse proliferative (due to SLE) - Berger's (IgA glomerulopathy) - Alport's
What is the ABVD regimen?
- Adriamycin (aka doxorubicin: DNA intercalator; cardiotoxic) - Bleomycin (DNA strand breaker ) - Vinblastine - Dacarbazine Rx: Hodgkin's lymphoma
What is asthma characterized by?
- Airway hyperresponsiveness - Smooth muscel hypertrophy - Mucous plugging
What is the MOA of Cyclophosphamide?
- Alkylating agent: alkylates DNA (esp. at the N7 position of guanine) that results in interstrand linkages - This leads to DNA strand breaks & abnormal base pairing. - T/F Interferes with DNA replication
What face nervous modalities pass through the VPN of the thalamus?
- All sensory: light touch, proprioception, vibration, pain & temperature - Blood to this structure is supplied by the posterior cerebral artery
What are causes of interstitial nephritis?
- Allergic reaction to drugs (NSAIDS, diuretics, antibiotics) - Infections - Infiltrative process
What drugs should not be combined with cephalosporins (e.g. cefoxitin)?
- Aminoglycosides (Tobamycin, gentamicin, streptomycin). - The combination results in ATN which reduces GFR & increases serum creatinine. Can be reversed with discontinuation of the drugs
What type of drug is Ampicillin & what is it used for?
- Aminopenicillin - penicillnase-sensitive - combined with clavulanic acid to enhance spectrum - Rx: Gram + & Gram - : H. influenzae, E. coli, Listeria, Proteus, Salmonella, enterococci, Shigella - Tox: hypersensitivity & pseudomenbraneous colitis
What are the symptoms of HSV-1 encephalitis?
- Amnesia - Behavior changes (e.g. hypomania) - Kluver-Bucy syndrome (loss of anger/fear response + hypersexuality - Late: coma & death
What is a concealed abruption (of the placenta)?
- An abruptio placentae that occurs near the center of the placenta - Hematoma is hidden behind the placenta & there is no external bleeding
What is a left shift in the hemoglobin curve?
- An increase in hemoglobin's affinity for oxygen = less O2 unloading to tissue
What does the LAD artery (a branch of the left main coronary artery) supply?
- Anterior wall of both ventricles - Anterior 2/3 of the interventricular septum - AV bundle
What is Ondansetron used for?
- Antiemetic - 6-hydroxytryptamine-3 agonist that is centrally-acting
What is an ELISA test?
- Antigen-antibody hybridization: used to detect antigenic match in a patient's blood sample - Has a Patient's blood encountered a particular antigen? If positive: Px has a vaccination or exposure
What is the lab finding in a child with ITP (idiopathic thrombocytopenia purpura)?
- Antiplatelet antibodies - Thrombocytopenia - Blood smear: large platelets due to increased production
What symptoms/signs characterize serotonin syndrome?
- Anxiety - Diaphoresis - Tachycardia - Hypertension - Hyperthermia - Vomiting - Tremor - Hyperreflexia - Muscle rigidity
What value is found in a V/Q scan when there is a ventilatory obstuction to the lung?
- Approaches 0 - Airway obstruction leads to some perfusion, but no ventilation
What V/Q scan value indicates a physiologic dead space?
- Approaches infinity - There is a obstruction to perfusion (like a spontaneous pulmonary embolism) and perfusion is decreased
What is the pathogenesis of communicating hydrocephalus secondary to meningitis?
- Arachnoid granulations may become scarred & fail to resorb adequate CSF - CSF builds up in subarachnoid space & ventricles
What are the direct thrombin inhibitors & why aren't they 1st line therapy?
- Argatroban & Lepirudin - Effects are not readily reversible
What is the ABCD's of Wilson's
- Asterixis - Basal ganglia degeneration (parkinsonian symptoms) - Decreased Ceruloplasmin level - Cirrhosis, Corenal deposits in Descernet's membrane, Copper accumulation, hepatocellular Carcinoma, Choreaform movements - Dementia
What are the main causes of eosinophilia?
- Asthma - Neoplasms - Parasites - Collagen vascular diseases - Allergic processes
What are the signs of chronic vitamin A (retinol toxicity)?
- Ataxia - Alopeica - Headache - Fatigue - Bone & joint pain - Muscle pain - Visual disturbances - Hyperlipidemia - Hepatotoxicity - Dry mucous membranes - Lip Fissures
What ADHD medication is not a controlled substance?
- Atomoxetine - a selective norepinephrine reuptake inhibitor - it has no abuse potential
What 4 types of arrhythmia is cardioversion used to treat?
- Atrial flutter - Atrial fib - Ventricular tachycardia - Ventricular fib
Why are some B-blockers nephrotoxic?
- B/C they can induse rhabdomyolysis & T/F excretion of myoglobin by the kidneys. - Myoglobin is nephrotoxic = ATN
What causes the neurological problems associated with B12 deficiency?
- B12 is a cofactor for the conversion of methymalonyl coenzyme A to succinyl coenzyme A for the breakdown of odd-chained fatty acid. - Without B12, toxic byproducts damage Schwann cells in the PNS - Dx: methylmalonic acid (MMA) levels rise (even before B12 levels decrease) + megaloblastic anemia
What lab values indicate postrenal causes of renal failure (e.g. prostatic disease, urethral stones)?
- BUN:Cr ration of 15-20:1 - Low urine output
What lab values indicate a prerenal cause of renal failure?
- BUN:Cr ration of >20:1 - Fractional excretion of Na <1% - LOW URINE OUTPUT Cause: decreased blood flow to the kidneys -> Na conservation, increase in urea reaborbtion increases BUN
What causes a rapid-onset food poisoning with nonbloody diarrhea after eating reheated rice?
- Bacillus cereus exotoxin - S/S: nausea, vomiting, diarrhea - "food poisioning from Reheaded Rice (diarrhea)? Be Cerious!"
How does stage 2 Lyme disease present?
- Bell's palsy (LMN lesion of facial nerve) - New Heart block
What are Brenner tumors?
- Benign ovarian tumors composed of cells that resemble bladder transitional epithelium - Adenofibroma with epithelial component of nests of transitional cells
What antimuscarinics are used to treat Parkinsonian tremor?
- Benztropine - Biperiden - Orphenadrine - Procyclidine - Trihexyphenidyl
What are 2 qualitative platelet disorders that present with petechiae & purpura shortly after birth?
- Bernard-Soulier - Glanzmann's throbasthenia
What are the 4 main manifestations of NF2 (neurofibromatosis type 2)?
- Bilateral schwannoma (neoplasm at cerebellopontine angle (CN VII & VIII can be affected) - Eye lesions (juvenile cataracts) - Ependymomas - Meningiomas - NF2 - tmor-suppressor on Ch.22 that encodes a membrane cytoskeletal protein
How does GH act on tissue (i.e. via what kind of receptor)?
- Binds a tyrosine kinase associated receptor that then associates with a tyrosine kinase to add phosphates & increases intracellular signaling via the JAK/STAT pathway - Causes transcriptional modification of the progrowth pathways
How does hemophilia A present?
- Bleeding into a joint or retroperitoneal space - Lab: Elevated PTT (b/c of factor VIII deficiency)
What are the symptoms of atropine poisoning?
- Blind as a bat: mydriasis - Red as a beet: flushed skin - Mad as a hatter: delirium & disorientation - Hot as a hare: fever from inhibited sweat glands - Dry as a bone: lacrimal gland inhibition - no tears or saliva - Plugged Up: constipation & urinary retension
What is the presentation of giardiasis?
- Bloating - Flatulence - Foul-smelling, nonbloody, diarrhea - Light-colored fatty stools
What is the mechanism of action of ezetimibe?
- Blocks cholesterol absorption in the small intestine brush boarder - Usually dosed along with statins
What is the MOA of ethosuximide?
- Blocks low-threshold T-type Ca channels - Rx: absence seizures
What is the MOA of zileuton?
- Blocks the conversion of arachidonic acid to leukotrienes by inhibiting 5-lipoxygenase - Rx: asthma - SE: elevation of liver enzyme levels, sinusitis, nausea
What is the MOA of Propylthiouracil?
- Blocks thyroid hormone synthesis by partially inhibiting peripheral deiodination of thyroxine to triiodothyronine - Rx: hyperthyroidism or thyroid storm
What is the MOA of Allopurinol?
- Blocks xanthine oxidase & prevents formation of uric acid from purines - Rx: chronic gout or tumor lysis syndrome
What are the symptoms & history that indicate an infection iwth Entamoeba histolytica?
- Bloody mucoid diarrhea - Hepatic abscess (up alk phos with normal AST, ALT & bilirubin) - Recent travel to a developing country Rx: metronidazole
Besides generalized decrease in bone mass (osteopenia), what other abnormalities is Osteogenesis associated with?
- Blue Sclerae - Dental abnormalities - Progressive hearing loss
What is Bordet-Gengou (aka potato) agar or Regan-Lowe medium used to culture
- Bordetella pertussis (gram + rod: whooping cough) - Also collect with calcium alginate swabs
How does Ketoconazole or metyrapone inhibit ACTH effects?
- Both inhibit cytochrome P450 in the adrenal glands (& ketoconazole inhibits ACTH) - Can be used to treat SIADH from small cell lung cancer
What is Bronchiectasis associated with?
- Bronchial obstruction - CF - Poor ciliary motility - Kartagener's Syndrome - Development of Aspergillosis
What 2 chemotherapeutic agents can cause pulmonary fibrosis?
- Busulfan (CML Rx) - Bleomycin (testicular cancer & lymphoma Rx)
What trinucleotide repeat results in fragile X syndrome?
- CGG on the X chromosome = FMR1 RNA-binding protein gene - is the 2nd most common cause of inherited mental retardation (Down's is 1st)
What symtom is present with Creutzfeild-Jakob disease & missing in dementia with Lewy bodies?
- CJD is must rarer & presents with myoclonus - Electroencephalography shows burst suppression & periodic complexes
What trinucleotide repeat results in myotonic dystrophy?
- CTG on Chromosome 19 - Autosomal dominate disorder that presents late in childhood - Gait abnormalities, weakness of upper extremities (intrinsic hand & wrist extensors) - Atrophy of facial muscles resulting in characteristic facies
How is renal osteodystrophy treated?
- Ca - Phosphate binders - calcitriol (synthetic vitamin D3) supplimentation
What is the MOA of nondihydroperidines?
- Ca-channel blocker that prolongs the PR interval - Prolongs phase 0 & 2--slows the recovery of Ca-channels--especially in the AV nodal cells Rx: nodal arrhythmias
What are the manifestations NF1 (Neurofibromatosis type 1)?
- Cafe-au-lat spots - neurofibromas -iris hamartomas - optic pathway gliomas - pheochromocytoma - scoliosis (or other skeletal disorders) - UNILATERAL schwannomas)
What are the clinical signs of bulimia?
- Calluses/Scars on the dorsum of the hand (abrasion by teeth during induced gaggin) - Parotid enlargement - Erosion of tooth surfaces from enamel dissolution
What can cause SIADH?
- Cancer: lymphoma, sarcoma, carcinoma of duodenum or pancreas - CNS: meningitis, brain abscess, trauma - Pulmonary: oat cell carcinoma, TB, pneumonia, abscess
WHat causes hypogonadism due to hypogonadotropic cuases?
- Cause: Impaired secretion of LH & FSH do to congenital GnRH deficiency - Characterized by low testosterone in the setting of low LH & FSH
How does progressive multifocal leukoencephalopathy present?
- Cause: JC virus - Altered mental status, motor deficits (hemiparesis or limb ataxia) - Visual symptoms: e.g. hemianopia
What is transcortical motor aphasia?
- Caused by damage to the watershed region between the anterior & middle cerebral arteries - Like Broca's aphasia, but with better repetition
What is transcoritcal sensory aphasia?
- Caused by damage to the watershed region between the middle & posterior cerebral arteries - Sounds like Wernicke's, but the Patient's repetition is better than spontaneous speech
How is Follicular lymphoma recognized histologically?
- Cellular attempt to recapitulate lymph node architecture by forming follicles - t(14:18) & over expression of antiapoptotic bcl-2 gene
How does Pasteurella infection present?
- Cellulitis, high fever, hepatosplenomegaly (septic arthritis in PEDs) - Route of infection: Dog or cat bite
What are the two types of diabetes insipidus (DI)
- Central (reduced ability to produce ADH) - Nephrogenic (lack renal response to ADH) & can be a rare toxicity of Lithium
What are the symptoms of vitamin B2 (riboflavin) deficiency?
- Cheilosis - Glossitis - Corneal vascularization - Seborrheic dermatitis
What is infliximab?
- Chimeric monoclonal antibody to tumor necrosis factor alpha - Rx: refractory Crohn's disease
What is the triad for Huntington's?
- Chorea (forceful, spastic involuntary movements of the limbs &/or facial muscles with gradual onset but become permanent) - Muscle rigidity - Dementia Cause: nucleotide repeat expansion on the short arm of Ch. 4
What is y-interferon used to treat?
- Chronic graulomatous disease - Produced by T lymphocytes & activated tumoricidal macrophages
List the SSRIs.
- Citalopram - Fluoxetine - Fluoxamine - Paroxetine - Sertraline
What 2 drugs prevent fibrinogen from binding to platelets during aggregation by irreversibly blocking the ADP receptors?
- Clopidogrel - Ticlopidine Rx: aucte coronary syndrome or prophylaxis after coronary stenting
What drugs commonly cause granulocytopenia (neutrophils, eosinophis, & basophils)?
- Clozapine - Ticlopidine - Sulfasalazine - Antithyroid drugs - Trimethoprim - Dapsone
What are the negative symptoms of schizophrenia?
- Cognitive disturbance (memory, orientation, consciousness) - Flat affect - Poor grooming & appetite - Social Withdrawel Rx: nontraditional/atypical antipsychotics to modulate central serotonergic activity & dopamine receptors.
What are the digoxin toxicities?
- Color vision disturbances (esp. yellow-green) - Nausea - Vomiting - Diarrhea - Arrhythmias
What causes uterus didelphys?
- Complete failure of fusion of the paramesonephric (Mullerian) ducts - Results in 2 seperate uterine cavities that each have a cervix & vagina
What is the function of zonula adherens?
- Components: actin filaments & E-cadherins - Connects cytoskeletal elements of neighboring cells - Below zonula occludens - Allows cells to create a functional unit
What is the ductus arteriosus & what is its function?
- Connection between the pulmonary artery & the aorta - Allows O2 blood from the placenta to bypass the fetal lungs & enter the systemic circulation - Open during gestation & closes with O2 increase @ birth & subsequent decrease in prostaglandins
What is sodium thosulfate used for?
- Convert cyanide into into thiocyanate via Rhodenase - Cyanide is a a metabolite of nitroprusside & can inhibit cytochrome oxidase
What does 11beta-hydroxylase assist in the formation of?
- Cortisol & corticosterone in the adrenal cortex - without this, biological males will be born with female external genitalia that will be virilized @ puberty
What are the clinical findings of asthma?
- Cough, wheezing, dyspnea - Tachypnea - Hypoxemia - Reduced I/E ratio - Pulsus paradoxus - Mucus plugging
What are the physical exam finding that indicate aortic stenosis?
- Crescendo-decrescendo systolic ejection murmur that radiates to the carotid - Weak peripheral pulse (pulsus parvus et tardus)
What is the course of the ureters in the female pelvis?
- Cross iliac artery anteriorly @ its bifurcation - Continues into the pelvis, where it passes posterior to the uterine artery "water under the bridge"
What is the difference in cough between croup & epiglottitis?
- Croup: barking (leads to inspiratory stridor) - Epiglottitis: stridor & hoarseness (leads to respiratory distress & can require surgery to establish an airway)
What would cause a penile urethra rupture?
- Crush Injury - Urine will flow into the deep fascia of Buck within the penis
What 2 important cystic infections are acid-fast staining?
- Cryptosporidium (water: fecal-oral): severe/mild, nonbloody diarrhea (severe = HIV Px) - Toxoplasma (raw meat or cat feces): brain abscesses in HIV Px & birth defects if congenital
What is the MOA of Dobutamine?
- DOes the BUTA of MINE excite the BeTA1 receptor of the heart? definately yes! - Selective B1-agonist - Cardiac stimulation (Gs-coupled = rise in cAMP) - Weak alpha1 & beta2 receptor agonism = vasoconstriction & vasodilation
What lab values indicate an intrarenal type of renal failure?
- Decline in GFR - BUN & Cr increase in proportion (RATIO REMAINS BELOW 15:1) - Faction of excreted Na >2% b/c the kidney is not effectively reaborbing Na = LOW URINE OUTPUT
How does imipramine change a patient's sleep pattern?
- Decrease in stage 4 or slow wave (delta: large & slow wave) sleep. - Stage 3 &4 is when disorders including night terrors, sleepwalking, and enuresis take place.
What causes TTP (thrombocytopenic purpura)?
- Defect in ADAMTS 13, metalloprotease respoonsible for cleaving high-molecular-weight, large vonWillebrand factor multimers - T/F platelets aggregate in the microcirculation & schistocytes are produced - Rx: plasma exchange
What is the pathogenesis & presentation of Ataxia-telangiectasia?
- Defect in DNA repair enzyme (Ch. 11q22-23 mutation) & IgA deficiency - Presentation: cerebellar problems (ataxia) & spider angiomas (telagiectasia) @ a young age - Also: impaired organ maturation, x-ray hypersensitivity, predisposition to malignancy
What genetic defect results in hereditary hemochromatosis?
- Defect in the gene that encodes the protein HFE (MHC locus on chromosome 6) - Result: increased dietary iron absoption & inability to excrete iron -> hepatic storage & liver makes more ferritin, which in turn saturates serum transferrin - Dx: increase in transferrin saturation
What foods can be contaminated with L. monocytogenes?
- Delicatessen meats & soft cheese - Gram + rod with tumbling motility
What are the side effects of Quinidine?
- Diarrhea - Cinchonism: tinnitus, vertigo, vision problems, & delirium
What is a common kidney complication of DIC & what is the Tx?
- Diffuse cortical necrosis due to generalized infarction of the cortices of both kidneys - Dialysis when the patient presents with AEIOU: A = Acidosis refractory to bicarb E = severe Electrolyte abnormalities (esp. K) refractory to meds I = intoxication with some drugs O = volume Overload refractory to diuretics U = Uremic symptoms (e.g. cardiac friction rub & altered mental status)
What type of goiter do Grave's patients have?
- Diffuse on palpation - High radionuclide uptake on thyroid scan
What type of goiter does a patient with a TSH-secreting pituitary tumor have?
- Diffuse on palpation - Low radionuclide uptake on thyroid scan
How does skeletal muscle respond to depolarization?
- Dihydropyridine receptor directly allows extracellular Ca influx & activates the ryanodine receptor - Ryanodine receptor mediates release of Ca from intracellular stores in the sarcoplasmic reticulum
What is the MOA of Norwalk virus infection?
- Direct, noninvasive toxin-mediated damage of the microvilli of enterocytes - Disease course: gasteroenteritis (nausea, vomiting, diarrhead) that resolves within 12-24 hrs.
What is the classical presentation of Charcot-Marie-Tooth?
- Distal muscle (esp. calve) atrophy - Clumsiness Genetic disorder that affects peripheral nerves via mutations in various myelin genes
What is the most common invastive tumor of the breast?
- Ductal carcinoma - Histo: anastomosing sheets of pleomorphic cells - Most aggressive tumors overexpress HER2/neu
What are the clinical findings in Emphysema?
- Dyspnea - Decreased breath sounds - Tachycardia - Late-onset hypoxemia due to eventual loss of capillary beds (loss of alveolar walls) - Early-onset dyspnea
How do symptomatic vWD patients present?
- Easy bruising or bleeding - Prolonged bleeding - Menorrhagia (heavy menses)
What does mucosis fungoides initially present as?
- Eczematous, psoriatic-like rash - It is a cutaneous T-lymphocyte lymphoma
What is the electron & light microscopic picture for membranoproliferative glomerulonephritis (MPGN)?
- Electron: subendothelial "hump-like" immune deposits & mesangial interposition into the capillary wall - Light: tram-tracking of capillaries - Young Px (8-30 years old)
What are the classic lab findings for obstructive jaundice?
- Elevation in alk phosphatase & Direct bilirubin - Decreased Urine urobilnogen Light stools
How does CMV encephalitis show on a scan?
- Enhancing periventricular white matter lesions in cortical & subependymal regions - Histo: Giant cells with eosinophilic inclusions in cytoplasm & nucleus
What enzyme is most essential in activation of pancreatic enzymes in the duodenum?
- Enterokinase: activates trypsinogen to trypsin - This enzyme is normally embedded in the intestinal mucosa
What is the MOA of Epinephrine?
- Equally gives everybody a shot of adrenaline (alpha1, apha2, beta1, beta2 agonist): - vasoconstriction (a1) - vasodilation (b2) - cardiac stimulation (b1) - bronchoconstriction (b2) - decreased IOP (increased aqueous humor outflow: E for Efflux)
What is the pathophysiology of BPH (Benign Prostatic hyperplasia)
- Estradiol level increases with age - Sensitization of the prostate to the effects of dihydrotestosterone (DHT) - Porstatic cells grow
What is Osteitis fibrosa cystica and what causes it?
- Excessive bone resoption & fibrous replacement of the marrow leaving cystic spaces (brown tumors) - Increased PTH levels - Presentation: bone pain & fractures
How does exercise cause an increase in SV? Is there an increase in EDV or ESV?
- Exercise increases preload (EDV) - So,ESV is decreased to increase the cardiac ejection fraction (EDV-ESV)
What characterizes Paget's disease of bone & what lab values go along with it?
- Extensive remodeling of bone that drastically incrases bone mass (yet, with increased fracture risk). - Up risk for sarcomas - LAB: elevated/normal Ca, normal phosphate, elevated alk phosphate
What vessel supplies the region of external hemorrhoids?
- External hemorrhoids are below the pectinate line - Supplied by the inferior rectal artery (branch from the internal pudendal) & drained by the inferior rectal vein
What is the cellular failure in I-cell disease?
- Failure of the addition of mannose-6-phosphate by GIcNAc phosphotransferase on the GOLGI apparatus = no direction of enzymes to lysosomes & are excreted (e.g. hexoaminidase iduronate sulfatase, arylsufatase A) - S/S: skeletal abnormalities, restricted joint movement, coarse facial features, severe psychomotor impairment, death in 1st decade of life.
What embyrologic abnormality results in cleft palate?
- Failure of the fusion of the lateral palatine processes: difficult to create suction needed for proper feeding - Result: choking/coughing/aspiration + poor weight gain
What is the physical sign of LMN lesions?
- Fasciculations: twitching of the muscle as it loses innervation - Cause (in ALS: amylotrophic lateral sclerosis): release of acetylcholinesterase from the degenerating nerve terminal at the neuromuscular junction
What is the histological presentation of papillary thyroid carcinoma?
- Fingerlike projections of epithelium surrounded by a centeral fibrovascular core - Psammoma bodies (calcified spheres) - "Orphan Annie" nuclei & nuclei molding - Risk factor: prior history of radiation to the head & neck
How is endemic typhus (caused by Rickettsia typhi) spread?
- Fleas (oftn on rodents) - Sign: Centrifugal rash
What is the main feature of myasthenia gravis (MG)?
- Fluctuating weakness of certain voluntary muscles, particularly those innervated by the motor nuclei of the brain stem - Manifest during continued activity, quick restoration of power with rest & dramatic improvement in stregnth following admin of neostigmine
What will cause the superior bladder wall to rupture (dome rupture)?
- Forceful compression of a full bladder - Urine will flow into the peritoneal cavity
What will cause the anterior bladder wall to rupture?
- Fractured Pelvis - Urine wile flow into the retropubic space
What will cause a urethral rupture above the urogenital diaphragm (@ the junction of the prostatic & membranous urethra)?
- Fractured pelvis or improper catheter insertion - Urine will flow into the retropubic space
What are smudge cells and what do they indicate?
- Fragile lymphocytes (arrested between between pre-B & mature B cells) that are destroyed during slide prep - CLL: chronic lymphocytic leukemia
How does a Trichomonas (protozoa) infection of the vagina present?
- Frothy, foul-smelling discharge - Itching & burning on urination - Dx: Motile parasites on wet mount
What is the function of Gap junctions?
- Function: Cell communication - Structure: connexins with central channel
What organelle is the sperm's acrosome a development from?
- Golgi apparatus - Acrosome covers the anterior 2/3 of the nucleus & contains enzymes (e.g. hyaluronidase) that permit the sperm to penetrate the zona pellucida of the egg @ fertilization)
What does the activation of an adrenergic alpha-1 receptor elicit?
- Gq --> increased DAG/IP3/Ca2+ - Increased TPR & BP (vasoconstriction in A & V of superficial tissues) - Decreased Urination (Urinary SM contraction) - Mydriasis without cycloplegia (contraction of the Radial m. of the iris) - Ejaculation (Ductus deferens contraction)
What is the scope of Azithromycin and what are it's SEs?
- Gram + organisms - Allergic hepatitis & Thrombophlebitis
How does Haemophilus ducreyi present?
- Gram - - Chancroid: painful genital ulcer & inguinal lymphadenopathy
What is unique about Bacteroides fragilis?
- Gram - but without lipid A = NO ENDOTOXIN - anaerobic, Rx: metronidazole or clindamycin or surgical drainage for abscesses
What lab values indicate ALL in a child 3-7 years old?
- Greatly elevated ABC count (>20% blasts) - Neutropenia
What result on Hektoen enteric agar will show that the infection is Salmonella and not Shigella?
- Green with black centers = a colony of Salmonella (produces hydrogen sulfate) & are flagellated - Both will appear clear or white on MacConkey agar
What does a hydrops fetalis newborn look like?
- Gross hepatosplenomegaly & Ascities - Peripheral edema & purpura - Placenta is pale, thickened, & enlarged
What is the radiographic picture of Pneumocystis jiroveci pneumonia?
- Ground Glass = Diffuse Bilateral infiltrates - Absence of air bronchograms - No obliteration of the pulmonary vessels
Why do patients on repeated broad spectrum antibiotics develop spontaneous bleeds?
- Gut flora are wiped out & thus Vit. K is not produced & there is a deficiency in the Vit. K clotting factors: II, VII, IX, X, C & S. - VII is deficient 1st b/c it has the shortest 1/2 life & thus prothrombin time is prolonged 1st.
What is Omeprazole used for?
- HYPERsecretory states:Peptic ulcer, gastritis, esophageal reflux, ZE syndrome - Proton pump (H+/K+ATPase) of stomach parietal cells inhibitor - SE: headache, GI distrubances
What causes chancroid?
- Haemophilus ducreyi - Painful genital ulcers
Where does Triatoma cruzi infect?
- Heart: myocarditis (ventricular dilation & congestive heart failure 2ndary to myocyte necrosis & fibrosis) - Nerve cells of the myenteric plexus: dysmotility of hollow organs (esophagus, colon, ureter) = acquired achalasia (distal 1/3) & mega-colon/ureter
What presents with Thrombocytopenia, hemolytic anemia with schistocytes, & uremia... & is a sequelae of a bacterial infection?
- Hemolytic-uremic syndrome - Shigella or Escherichia coli O157:H7 infection
What is Mesna disulfide used to prevent?
- Hemorrhagic cystitis associated with cyclophosphamide usage - MOA: reduced to mensa (a free thiol compound) that reacts with urotoxic products
What diseases is alpha-interferon used to treat?
- Hep B&C - Kaposi's sarcoma - Malignant melanoma - Certain leukemias
What enzyme is deficient in Tay-Sachs & how does the disease present?
- Hexosaminidase A - Loss of motor skills, increased startle reaction, macular pallor, CHERRY-RED spot on Macula - Dx: quantify hexosamidase level in isolated WBCs from flood - 1/25 carrier rate of this AR disease in Ashkenazi Jewish population
What is teh V/Q ratio at the apex of the lung?
- High - Low blood flow & only a slight decrease in ventilation
What is the vector for Borrelia recurrentis?
- Human louse: causes relapsing fever - Changes cell surface proteins (antigenic variation) to evade humoral immunity
What is the main SE of piperacilin?
- Hypersensitivity in 10% of patiensts - Effective against Klebsiella
What is the MOA of paclitaxel?
- Hyperstabilizes microtubules and directly prevent anaphase (M1 arrest) - Rx: ovarian & adjuvant to breast cancer
What lab results show elevated mineralocorticoids (along with a lack of other cortical steroids)?
- Hypertension - Hypokalemia - Female w/o sexual maturation 17alpha-Hydroxylase deficiency
What ECG finding indicate hypOkalemia? hyPERkalemia?
- Hypo: Flattened T wave & U wave - Hyper: Peak T waves & prolonged PR interval
How do patients with AIP (acute intermittent porphyria) present?
- Hyponatremia & recurrent episode of abdominal pain - RARELY: neuropsychiatric problems - attacks can be precipitated with barbiturates & starvations diets - NO Photoensitivity
What is the MOA of Isoproterenol?
- I am SO PRO for the beta TERRItory of PROpraNOLol a nonselective beta-blocker, although we are opposite in actions - Cardiac stimulation (B1 via Gs) - Vasodialtion (B2 via Gs in skeletal muscle) - Bronchodilation (B2 via Gs in broncial smooth muscle)
What is the DDx for the etiology of autoimmune hemolytic anemia?
- Idiopathic - Viral induced - SLE-induced - Lymphoma
What is the DOC for CML?
- Imatinib mesylate: inhibits the abnormal bcr-abl tyrosine kinase found in >90% of CML - Not a cure but restores normal blood cell counts & prevents progression to bast phase for several years
What is characteristic of dermatomyositis & what does it indicate?
- Immune-mediated disorder of skin & skeletal muscles: rash is violet discoloration of the upper eyelids with periorbital edema; gradual, symmetric muscle weakness of proximal muscles, sometimes dysphagia - Gottron's lesions: erythematous patches over knuckles, elbows, & knees - 6-45% of patients have underlying visceral cancer
How is growth hormone (GH) used in the Dx of acromegaly?
- In a healthy person, a glucose tolerance test should depress GH levels. - However, in acromegaly, the GH levels would not be affected
How can protaglandins be used to induce labor?
- In general, they activate dissolution of collagen bundles & increase the submucosal H2O content of the cervix - PGE = potentiates endogenous oxytocin (increases labor induction)
What does the inferior mesenteric artery become?
- In the rectum: superior rectal artery - Site of internal (painless) hemorrhoids)
How does Placenta accretia present & what are the risk factors??
- Incomplete separation of the placenta after delivery -> severe postpartum hemorrhage - RF: placenta previa, prior cesarean, prior intrauterine manipulation or surgery
How do fibrates reduce lipids?
- Increase lipoprotein lipase-mediated lipolysis & this removes triglycerides from the peripheral circulation - E.G. Gemfibrozil & fenofribrate
What is the hemodynamic picture for septic shock?
- Increased CO - Decreased SVR (Systemic Vascular Resistance) & PCWP (Pulmonary Capillary Wedge Pressure)
What hemodynamic picture indicates hypovolemic shock?
- Increased SVR - Decreased CO - Decreased PCWP (Pulmonary Capillary Wedge Pressure)
What hemodynamic picture is seen with cardiac shock?
- Increased SVR - Decreased Co - Increased PCWP (Pulmonary Capillary Wedge Pressure)
What CSF findings indicate bacterial meningitis?
- Increased protein - Decreased glucose
What is the MOA of diazepam?
- Increases the opening frequency of the Cl channel assocated with the y-aminobuteric acid (GABA) receptor: this inhibits further neuronal firing - Immediate onset of action when given IV
What is the MOA of thrombolytics?
- Indirect or direct assistance of the conversion of plasminogen to plasmin - plasmin cleaves thrombin & fibrin clots
What is the clinical use of Leuprolide?
- Infertility, prostate cancer, uterine fibroids - MOA: Gonadotropin-releasing hormone analog = dosage suppresses release of LH & downregulates the hypothalamic-pituitary-gonad axis - SE: gynecomastia, decreased libido, nausea, vomiting
How can dihydroperidine Ca-channel blockers (e.g. nifedipine) help to reduce hypertension?
- Inhibit Ca influx in the vascular smooth muscle cells - Decrease vascular tone
What is the MOA of Paclitaxel & other taxanes?
- Inhibit depolymerization of microtubles - Cell cycle arrest in mitosis Rx: breast cancer
What is the MOA of phytosterols?
- Inhibit the incorporation of cholesterol into micelles in the GI tract - Decreases the overall amount of cholesterol absorbed.
What is the MOA of Gemcitabine?
- Inhibits DNA polymerase & ribonucleotide reductase when phosphorylated intracellularly - It inhibits nucleotide synthesis by inhibiting the formation of deoxyribonucleotides
How does lactation prevent ovulation?
- Inhibits secretion of GnRH (Gonadotropin-releasing hormone) from the hypothalamus. - This inhibits secretion of LH and FSH from the anterior pituitary
What is the MOA of Etoposide?
- Inhibits topoisomerase II & t/f causes dsDNA breaks & interferes with cell division at the late-S to G2-phase
Describe the time bomb of acetaminophen tox?
- Initially: asymptomatic - 1st 24 hrs: nausea, vomiting, & malaise - 24-48 hrs: Right upper quadrant pain only - Day 3-4: jaundice & hepatic failure
What causes venous abnormalities that can lead to impotence?
- Insufficient relaxation of smooth muscle due to excessive adrenergic tone or damaged parasympathetic innervation - this can result in a leak into the dorsal & saphenous veins & results in venous outflow abnormality
What compounds work via a receptor tyrosine kinase (receptor has intrinsic tyrosine kinase activity that autophosphorylates tyrosine & progresses down the Ras/MAP kinase pathway)?
- Insulin - Growth factors: Endothelial growth factor, platelet-derived growth factor
What is Oprelvekin & what is it used for?
- Interleukin-11: throbopoietic growth factor - Combats thrombocytopenia
What is the MOA of Albendazole?
- Interrupts microtubule function - Rx: parasitic worms (e.g. hook & pin)
What are the 3 causes of microcytic, hypochromic RBCs (anemias)?
- Iron-deficiency anemia - Thalassemias - Lead poisoning
What is secretory diarrhea?
- Isotonic with plasma - Net intestinal fluid secretion - No abatement with fasting - Causes: viral or bacteria (Cholera)
Which stage of the cardiac cycle is prolonged in a patient with atrial stenosis?
- Isovolumetric contraction: it must overcome the resistance of the valve & open it - Sound: ejection click & cresendo-decrescendo murmur @ right sternal boarder that radiated to the neck
How does spironolactone cause gynocomastia, testicular atrophy, and decreased libido?
- It binds to steroid receptors outside the kidney - Its therapeutic effect is as an antagonist at the renal aldosterone receptor in the DC tubule - It is potassium-sparing
What is the action of methotrexate?
- It is a DNA and protein synthesis inhibitor - Folic acid antagonist: inhibits dihydrofolate reducatase during the S phase
What is the action of infliximab?
- It is a chimeric monoclonal antibody. It bings to soluble TNF-alpha (secreted by macrophages & found in high [] in Crohn's patients); a single infusion = clinical response in 65% of Px - Side Effects: Headache, GI distress, increased upper respiratory infections - Rx: Crohn's
What is the function of vonWillebrand factor?
- It is a protein that binds platelets to the endothelium during clot formation - Carries factor VIII
What is the MOA of Methotrexate?
- It is an analog of folic acid & inhibits dihydrofolate reducatase & thus prevents tetrahydrofolate regeneration (metabolically active folic acid - Therefore DNA, RNA, & protein synthesis is decreased
How is the kidney changed in hepatorenal syndrome?
- It is not. It remains of normal shape & size. - There change is only physiological: vasoconstriction in the vascular beds due to the activation of the renin-angiotensin system.
What gives Pseudomonas aeruginosa its blue-green color?
- It produces procyanin - Gram -, oxidase positive, lactose-fermenting - Virulence factor: exotoxin A (ADP riboxylates & inhibits eF2 in the host cell)
How does Clofibrate increase the risk of gallstones?
- It up regulates lipoprotein lipase (to increase triglyceride clearance from the bloodstream) but down regulates the rate of bile acid secretion. - Bile is supersaturated with cholesterol & this increases the risk for stones
What causes Kartagener's syndrome?
- Lack of dynein arms in the microtubles in cilia = immotile - immotile sperm - defective muco-ciliar ladder - situs invertus (reversed/mirrored major organs)
What are the clinical signs of Eisenmenger's syndrome?
- Late cyonosis (reversal of initial LtoR shunt) - Polycythemia - Clubbing - Pulmonary regurgitation (sometimes) - Holosystolic murmur
What measurement is used to estimate lung maturity?
- Lecithin:Sphingomyelin ratio - <2 = high rist for neonatal respiratory distress
Describe the source of blood to the stomach.
- Left Gastric (branch of the celiac) - Left gastroepiploic artery (branch of the splenic) - Right Gastric (branch of the common hepatic) - Right gastroepiploic (branch of gastroduodenal, a branch of celiac)
What anastomosis results in esophageal varices?
- Left gastric & Esophageal - Painless hematemesis
What are the clinical signs of a splenic infarct due to an embolism?
- Left upper quadrant abdominal pain - Left shoulder pain (Kehr's sign) - Nausea - Vomiting - History of embolic disorder
What does the ST segment represent?
- Legnth from the end of QRS to initial deflection of T wave - That is, the end of ventricular depolarization to the beginning of ventricular repolarization
What is a good drug to compliment methotrexate therapy?
- Leucovorin: it is folinic acid & helps to replinish the body's supply of folic acid. - T/F it inhibits the myelosuppressive effects of methotrexate
What drugs are analogues of gonadotropin-releasing hormone?
- Leuprolide - Goserelin MOA: decrease in FSH & LH -> decreased androgen & estrogen synthesis
What is the toxicity of valproic acid
- Liver & pancreatic toxicity along with neural tube defects if the patient is pregnant. - This drug is an antiepileptic
What is the MOA of unmetabolized tyramine?
- Loaded with beer, red wine, cheese, sausage & pickles, the TYRE of AMINE is squeezing out biogenic amines from a presynaptic vesicle of the adrenergic terminal - Sympathomimetic: NE release stimulant
How is Osteoarthritis characterized?
- Loss of cartilage elasticity - Eburnation: polished ivory-like appearance of bone - Cystic changes in the subchondral bone - Osteophyte formation at the perimeter of the articular surface
What is the hemodynamic picture of neurogenic shock?
- Loss of vasomotor tone - Decreased CO - Decreased PCWP (Pulmonary Capillary Wedge Pressure)
What is contraction alkalosis?
- Loss of volume without losing bicarbonate - E.G. Excessive diuresis with a loop diuretic; CF patient outside too long on a hot day
What is the leading theory about how vaccine use has increased the number of allergies/autoimmune diseases?
- Low stimulation of Th1 lymphocytes (b/c they are stimulated by bac/viruses) - This leads to an overproduction of Th2 lymphocytes and allergen-specific IgE
What urine values are characteristic of Nephrogenic or Central DI?
- Low urine specific gravity - High serum osmolality
What will a physician find upon physical exam of a spontaneous pneumothorax?
- Lung sound: decreased sound - Percussion: Hyperresonance b/c the space is filled with air instead of tissue. - Tactile fremitus: absent - Tracheal deviation: toward side of lesion (opposite for tension pneumothorax)
Besides the skin, in what organs is Kaposi's sarcoma also found?
- Lungs - GI - Biliary tree
What is the most common cause of meningitis in infants (0-3 months old)?
- Lysteria monocytogenes (gram positive rod) - E. coli (gram - rod) - Group B strep (gram + cocci)
Which strands of strep tend to cause poststreptococcal glomerulonephritis?
- M type - Autoimmune attack begins 2-6 wks. after skin infection & 1-3 weeks after pharyngitis
What is the MOA & use for Finasteride?
- MOA: Decreases conversion of testosterone to dihydrotestosterone - Rx: BPH hypertrophy
What is NADPH used for?
- Maintain a reduced pool of glutathione - Fatty acid & steroid synthesis - Cytochrome P450 system - Phagocytosis
What are the risk factors for Hodgkin's lymphoma?
- Male Gender - Age 15-40 or 50+ - EBV infection (history, not current) - Immunodeficiency/AIDS - Prolonged use of growth hormone
Where is Lactate dehydrogenase (LDH) found?
- Many tissues - Used as a marker for liver disease, MI, & hemolysis, but is not specific
What enzyme defect results in albinism?
- Melanocyte lack of tyrosinase: no conversion of tyrosine to melanin - Increased risk of squamous, basal cell, & malignant melanoma
What cells/tissues are derived from neural crest cells (part of the neuroectoderm)?
- Melanocytes - Odontoblasts - Pia & arachnoid mater - Schwann cells - Cells of the gangila - Parafollicular C cells of the thyroid - Chromaffin cells - Aorticopulmonary septum - Pharyngeal arch skeletal components - Neurocranium
How does class V "lupus" nephritis present histologically?
- Membranous nephropathy: diffuse thickening of the glomerular basement membrane due to immune complex deposition - Nephrotic: edema, proteinuria, hyperlipidemia - EM: sup epithelial deposits (spike & dome" - Immuno: granular
What are the classical symptoms of AngleMan's syndrome?
- Mental Retardation - Seizures - Ataxia - Inappropriate Laughter "Happy Puppets" - Deletion of q12 on the maternally derived chromosome 15
What are the classic symptoms of Prader-Willi?
- Mental retardation - Short stature - Hypotonia - Hyperphagia - Obesity - Small hands & feet - Hypogonadism Deletion of q12 on paternally derived chromosome 15
What are the finding in a patien with toxic aspirin ingestion?
- Metabolic Acidosis with Respiratory alkalosis or Acidosis with anion gap - Symptoms: coma, respiratory depression, cardiovascular collapse Asprin Tox: increase sensitivity of respiratory centers in the brain, uncouple oxidative phosphorylation, increase metabolism, inhibit Krebs cycle & platelet aggregation
What components of the CNS are derived from mesoderm?
- Microglia (like all macrophages) - Dura mater - Connective tissues: endo, peri, & epineuria
What action does Acetylcholine have at muscarinic receptors in the eye?
- Miosis (pupil constriction) - Ciliary muscle contraction (accommodation) NB: atropine (a muscarinic agonist) has the oppose effect: mydriasis & cyloplegia. Physostigmine restores the parasympathtic response in atropine poisoning
What is the pathogenesis of Leber's hereditary optic neuropathy?
- Mitochondrial mutation that causes degeneration of the optic nerve with rapid loss of central vision, leading to a permanent central scotoma - Males are more affectwith & symptoms usually start in the 3rd decade
What drug is used to treat narcolepsy daytime sleepiness>
- Modafinil: increases monoamines in the brain somehow (MOA unknown) - Safer than amphetamines & methylphenidate
What is the action of COX-2 inhibitors?
- Modulate vascular & bronchial tone - DO NOT modify vascular permeability or platelet aggregation (NSAIDs change platelet aggregation)
What are the characteristics of Waldenstrom's macroglobulinemia?
- Monoclonal IgM - Epistaxis - Bleeding Gums
What is the MOA of abciximab
- Monoclonal antibody against the glycoprotein IIb/IIIa receptor on the surface of platelets - It impairs platelet aggregation Rx: acute coronary syndrome
What is Infliximab used for?
- Monoclonal antibody to tumor necrosis factor alpha - Crohn's & a 2nd line for UC
What can IgM cold agglutinin immune hemolytic anemia occur concuurently with?
- Mononucleosis - Mycoplasma pneumoniae - Lymphoid neoplasm (chronic anemia only)
What type of structures result when a fertilized oocyte divides between days 4 & 8?
- Monozygotic twins - Monochorinoic placenta - Diamniontic
What is the symtomatic course of Rabies virus infection?
- Months after infection: convulsions, parasthesias, & difficulty swallowing solids/liquids due to spasticity of pharynx muscles - Cognitive effects: manic episodes & altered mental status - Death after flaccid paralysis sets in
What type of goiter do patients with toxic hyperthyroidism present with?
- Multinodular on palpation - High radionuclide uptake on thyroid scan
How does PML (Ptrogressive mutifocal leukoencephalopathy) present?
- Multiple nonenhancing T2-hyperintense lesions - Histology: nuclear inclusions in oligodendrocytes
What are condyloma acuminata?
- Multiple, white, hyperkeratoic peduculated verrucase clusterd in the perianal region - Caused by HPV type 6&11
What is the typical presentation of a Becker's (BMD) patient?
- Muscle weakness &/or cardiac disease a mid adolescence - Cause: an in-frame deletion in the dystrophin gene: partially functional protein is produced (vs. DMD = out of frame that results in truncated or absent dystrophin)
What causes PNH (paroxysmal nocturnal hemoglobinuria)?
- Mutated PIG-A gene - Abnormal synthesis of surface phospholipids that anchor inhibitors of complement activation on all cell lines (WBCs, RBCs, platelets) - Deficiency of DAF (decay-accelerating factor) in the compliment cascade
How does Addison's result in diffuse integumentary hyperpigmentation?
- NO ACTH secretion feedback inhibition from cortisol - T/F the POMC gene (which codes for ACTH & melanocyte-stimulating hormone) is upregulated
How does C5 radiculopathy present?
- Neck & shoulder pain - Numbness of the skin on the lateral arm - Weakness to shoulder abduction/external rotation & elbow flexion/supination - Diminished biceps reflex
What side effect is shared by Demeclocycline & lithium?
- Nephrogenic diabetes insipidus: these drugs inhibit the kidneys' response to ADH. - DDx: Exogenous ADH administration or a hold on fluids will not improve symptoms.
What are the toxicities of cisplatin?
- Nephrotoxicity & acoustic nerve damage - It is a cell cycle nonspecific drug that alkylates DNA (cross-links and inhibits DNA synthesis)
What does an elevated AFP in amniotic fluid possibly indicate?
- Neural tube defects (spina bifida, meningocele, menigomyelocele) & AFP is leaking out into the amniotic fluid - Folate Deficiency in 1st 4 weeks of pregnancy or drugs such as valproate & carbamazepine
What are the symptoms of Conn's syndrome (primary hyperaldosteronism)? What is the treatment?
- New-onset hypertension - Alkalosis & hypokalemia (can manifest as muscle weakness or paralysis) - Low plasma renin Rx: Aldosterone antagonist (e.g. spironolactone)
What are the characteristic symptoms of Hodgkin's lymphoma?
- Night sweats, fever, & weight loss - Also, mediastinal lymphadenopathy - Histo: Reed-Sternberg cells: cells with large, "owl eye" binucleate cells, and reactive lymphocytes
Why are nitrates used to treat cyanide poisoning?
- Nitrates can increase the amount of Methemoglobin - Methemoglobin: the iron in hemoglobin is oxidized to Fe3+ & has an increased affinity for cyanide. - Then this can be treated with methylene blue
What is the definitive test for chronic granulomatous disease?
- Nitroblue tetrazolium dyn reduction: negative result
How does a goiter on a patient with primary hyperthyroidism due to destructive throiditis, iodine excess or excess thyroid hormone appear?
- Nodular on palpation - Low radionuclide uptake
How does Giant Cell arteritis present histologically?
- Nodular thickening that reduces the size of the lumen - Granulomatous inflammation with mononuclear & giant cells - Fragmentation of the internal elastic membrane
What lab values indicate Paget's disease of the bone?
- Normal Ca & PO4- - Elevated Alk Phos (significantly elevated)
At what pH is vulvovaginal candidiasis found?
- Normal vaginal pH range (<4.5) - On Gram Stain: Hyphe & bastospores
Where is Schistosoma hematobium endemic? What does it cause?
- North Africa & Middle East (parasitic flatworm) - Infection via snails; enters bladder can cause squamous cell carcinoma of the bladder - Rx: Praziquantel
What innervates the obturator externus>
- Obturator nerve - Laterally rotates the thigh
What do plasma cells look like?
- Off-center nuclei - Clock-face chromatin distribution
What drugs for GERD inhibit the CYP450 system?
- PPIs (e.g. omeprazole) - Cimentidine (antihistamine)
How does C7 radiculopathy present?
- Pain & numbness extending to the hand & index & middle finger - Weakness to elbow & wrist extension - Diminished triceps relex
How does C6 radiculopathy present?
- Pain & numbness of the lateral arm, forearm & hand (1st & 2nd digits) - Weakness to shoulder abduction/external rotation & elbow flexion/supination - Diminished biceps reflex
How does T1 radiculopathy present?
- Pain & numbness of the medial forearm - Weakness to thumb flexion/abduction & finger abduction/adduction
How does C8 radiculopathy present?
- Pain & numbness of the medial forearm & hand (4th & 5th digits) - Weakness to wrist extension & finger extension/abduction/adduction
What is an ERCP "double-duct" sign?
- Pancreatic tumor obstruction of both the common bile duct & main pancreatic duct - Seen on a radiographic visualization of the pancreatic duct & bilary tree
What paraneoplastic syndromes are associated with renal cell carcinoma?
- Parathyroid hormone-related peptide - Erythropoietin
What is the typical profile of a patient that suffers from Prizmetal's (variant) angina?
- Patient is young - Pain is NOT prompted by activity - Pain relieved by sublingual nitroglycerin - Normal ECG Cause: coronary vasospasm
What is Nizatidine used for?
- Peptic ulcer, gastritis, mild GERD - Reversible histamine-2 blocker
What tissues of the nervous system are derived from neural crest cells?
- Peripheral ganglia - Afferent sensory nerves (dorsal root) - Schwann cells
What gene fusion is characteristic in Chronic myelogenous leukemia (CML)?
- Philadelphia chromosome - t(9:22): BCR-ABL fusion protein
What is the DOC for Entaerobius vermicularis infection
- Pinworm: transmitted in food contaminated with eggs -> intetinal infection & anal pruritus - Dx: tape on anus to catch noctural worms - DOC: mebendazole
What are teh 2 main causes of Diabetes insipidus?
- Pituitary dysfunction - Failure of kidneys to respond to ADH
What does Thromboxane A2 cause?
- Platelet aggregation & vasoconstriction - Inhibited by aspirin
What conditions go along with APKD?
- Polycycstic liver disease - Berry Aneurysms - Mitral valve prolapse Cause: APKD1 mutated gene on Ch. 16
What genetic disorders increase the risk of a saccular or berry aneurysm?
- Polycystic kidney disease - Connective tissue disorders - Coarctation of the aorta
What are the most common causes of IUGR (intrauterine growth restriction)?
- Poor maternal nutrition - Hypertension - Infections - Congenital anomalies - Smoking
What are the derivatives of the neuroectoderm?
- Posterior pituitary - CNS neurons - Oligodendrocytes - Astrocytes - Ependymal cells - Pineal gland
What is thyroid dermopathy?
- Pretibial myxedema (nonpitting & thickening of skin) - Characteristic of hyperthyroidism due to Graves
What is the clinical use of PHENylephrine?
- Priaprism (alpha-1 on the corpora cavernosa to decrease blood flow) - Hypotension or shock (with low PVR) - Eye disorders or exams (mydriatic) - Nasal & sinus congestant (decongestant or vasoconstriction in sinus surgery)
Why do Cushing's disease patients develop hyperpigmentation of the skin?
- Primary pituitary adenoma secretes ACTH - ACTH stimulates melanocytes
How does primary sclerosing cholangitis present?
- Progressive fatigue - Pruritis - Icteric Sclera
How is prolactin secretion regulated?
- Prolactin increases dopamine synthesis & secretion from the hypothalamus - Dopamine itself inhibits prolacin secretion from the anterior pituitary
What is the MOA of bile acid resins like Cholestyramine & Colestipol?
- Promote binding & excretion of dietary fats that are bile-soluable - T/F the fats don't enter the blood stream effectively - Decrease serum LDL & total cholesterol levels
What is the treatment for Cholerae?
- Prompt H2O & electrolytes replacement - Tetracyclines to reduce the disease course
What are the derivatives of the 6th aortic arch?
- Proximal pulmonary arteries - Ductus arteriosus: connects the pulmonary trunk to the aorta (lung bypass)
What is the mechanism of C. difficile infection?
- Pseudomembranous colitis: Exotoxin that results in enterocyte death & watery diarrhea - Often follows ampicillin or clindamycin treatment
What happens in the lungs during exercise?
- Pulmonary resistance decreases to accommodate greater pulmonary blood flow - Decreased resistance improves gas exchange & allows an even distribution of blood throughout the lungs.
What does increased NADH result in?
- Pyruvate conversion to lactate - Stimulates fatty acid synthesis - Inhibits gluconeogensis - NB: this is part of the pathophysiology of ALCOHOLISM
What do the branches of S1 & L5 innervate?
- Quadratus femoris: laterally rotates the thigh - Oburator internus: laterally rotates when the leg is extended & abducts when the thigh is flexed
What is the Mentzer index?
- RBC MCV/RBC - < 13 in Px with iron deficiency anemia & <13 in patients with thalassemia
What is the drainage of the adrenal glands?
- RIGHT: right adrenal vein into the IVC - LEFT: left adreanl vein into the right adrenal vein into the IVC
What is the clinical presentation of Creutzfield-Jakob disease (CJD)?
- Rapidly progressive demintia & ataxia (cerebellar involvement) & involuntary muscle jerks "startle myoclonus) - Die within 6 m., onset in the 7th decade
What type of arrhythmia is Amiodarone used to manage?
- Recurrent ventricular fibrillation - Hemodynamically-unstale ventricular tachycardia
What does a mild B6 deficiency cause?
- Reduced decarboxylation reactions - Inhibited neurotransmitter production: symptoms of depression, irritability, confusion, convulsions - Cheliosis & glossitis - Microcytic anemia - Always supplement with isoniazid treatment b/c isoniazid inactivates pyridoxine by binding with B6
What is the pathogenesis of Ehlers-Danlos syndrome?
- Reduced hydroxylysine in collagen - T/F the content of collagen cross-links - Results in decreased tensile strength of collagen
What is Lethal Factor?
- Released by Bacillus anthracic - Zinc metalloprotease - Inactivates protein kinase that stimulates macrophages to release tumor necrosis factor alpha
What is the most common cause of 2ndary hyperparathyroidism?
- Renal failure - Symptoms: diffuse bone pain & proximal muscle weakness (+ pruritis if there is a deposition of excess Ca)
How doe spyloric stenosis present?
- S/S: nausea & vomiting at 3- to 6-weeks post birth; olive-shaped mass on physical exam - Patho: pyloric muscle hypertrophies & causes gastric outlet obstruction - Rx: surgical pyloroplasty
What are the S/S of tuberous sclerosis (TS)?
- Sagreen patch: rough, raised lesions that has the consistency of an organg peel (in the lumbosacral area) - Seizures - CT/MRI showing TUBERS (calcified hamartomas in the periventricular region = nodular proliferation of multinucleated atypical astrocytes) - Adenoma sebaceum: facial angiofibromas
What is the histological findings in Guillain-Barre syndrome?
- Segmental demyelination of areas of peripheral nerves (possibly including inflammation of the axons themselves) - This results in slower conduction velocity of action potentials through peripheral nerves & spinal nerve roots
What is the MOA of phyenlephrine?
- Selective alpha-1 agonist - This PHENomEnaL ElePHant tightens the alpha-1 RINg on a segment of arteriole - Mydriasis dues to alpha-1 activation of the radial muscle of the iris
What is the MOA of Clomiphene when used as a drug to combat infertility?
- Selective estrogen receptor antagonist in the hypothalamus & anterior pituitary - Shields negative feedback of estrogen & increases GnRH release - GnRH stimulates release of FSH & LH to stimulate the ovary
What is the major distinguishing factor of hepatitis E?
- Severe, often-fatal disease course in pregnant women: fulminate (20% mortality) - Hep E = RNA herpesvirus (nonenveloped, ssRNA)
What is the ECG finding in tamponade?
- Sinus tachycardia & low QRS voltages - Elecrical alternans (alternations of QRS height with each beat) is pathognomonic
What is the most common cause of multiple cerebral mass lesions in HIV-infected patients?
- Space occupying lesions due to toxoplasmosis infection - Usually at corticomedullary junction - Surrounded by edeam = mass effect
What is deficient in Niemann-Pick disease & how does it progress?
- Sphingomyelinase: sphingomyelin & cholesterol buildup in reticuloendothelial & parenchymal cells/tissue - Patients die by age 3
Which cancer causes parathyroid hormone-related peptide problems?
- Squamous Cell - Results in hypercalcemia & suppressed levels of PTH
When are theta waves seen on an EEG?
- Stage 1 sleep: transition from awake to sleep - 4-7 cycles per second
When are sleep spindles and K-complexes seen on EEG
- Stage 2 sleep: physiologic sleep - 45% of sleep
What results in delta waves of EEG
- Stage 3 or deep sleep - Slow waves that are < 3 Hz - 12% of total sleep
Describe the Trendelenburg gait.
- Standing still: pelvis sinks away from the affected muscles - Walking: trunk lurches to the lesioned side
What chronic condition can prednisone induce?
- Steroid-induced diabetes - Monitor blood glucose if the patient is on long-term therapy
What is the histological presentation of Hashimoto's?
- Substantial lymphocyte infiltration & germinal central formation - Characteristic = Hurthle cells (epithelial cells with eosinophilic granular cytoplasm)
What is the treatment for Toxoplasma infection?
- Sulfadiazine & Pyrimethamine - Trimethoprim/Sulfamethoxazole
What anastomosis in cirrhosis results in hemorrhoids?
- Superior rectal & Middle Rectal - Sign: bright red blood after a bowel moment
What are the main functions of rough endoplasmic reticulum?
- Synthesis of secretory proteins - N-linked oligosaccharide addition to proteins
What are the main uses of penicillin G?
- Syphilis - Gram- & gram +s that are not penicillin resistant
What type of drugs are used as prophylactic against migraines?
- TCAs (e.g. Amitriptyline) - Ergot Alkalodi derivative (e.g. Methysergide) - B-blocker (e.g. Nadolol or propanolol)
What hormones work via the Gs protien receptor pathway to increase adenylate cyclase activity to increase intracellular cAMP & protein kinase A levels?
- TSH - LH - FSH - ACTH - Glucagon - ADH - PTH
What differentiates clomiphene & tamoxifen?
- Tamoxifen: has agonist activity & promotes endometrial hyperplasia - Cloomiphenes: has antagonist activity: inhibits endometrial hyperplasia
How can you histologically distinguish iron deficiency anemai from a thalassemia?
- Thalassemia will have target cells - Both will be microcytic & hypochromatic
What is the mechanism of the gram-negative rod Bordetella pertussis's toxin?
- The A subunit inhibits membrane-bound Gi proteins that results in the accumulation of cAMP. - This results in histamine sensitization, increased insulin synthesis, lymphocytosis, and the inhibition of phagocytosis. - Result: whooping cough
What is the expected respiratory carbon dioxide change expected for every 1-mEq/L bicarbonate increase?
- The PCO2 should increase by 0.7mm Hg per 1mEq/L increase in bicarbonate. - A normal bicarbonate is 24 mEq/L & a normal PCO2 is 40 mmHG.
Define relative risk.
- The incidence rate of some outcome in those exposed to a risk factor divided by the incidence rate of those not exposed - RR = probability (exposed) / probability (control) - for COHORT studies
How do NSAIDS cause GI problems?
- They are nonspecific inhibitors of cycloxygenase enzymes - T/F they reduces the production of prostaglandin & thromboxane from arachidonic acid - Prostaglandins play an important role in preserving mucosal integrity
What hormones work via the Gq receptor pathway via phospholipase C & IP3/DAG pathway?
- Thyroid-releasing hormone - Growth hormone-releasing hormone - Gonadotropin-releasing hormone oxytocin - Angiotensin II - Bradykinin
How do microaneurysms show up on fundoscopic examination?
- Tiny, round, red spots arougd the macular area - Cause: diabetic retinopathy
What is the function of G6PD?
- To generate reduced nicotinamide adenine dinucleotid phosphate from oxidized NADH, which is then used to reduce glutathione - Glutathione detoxifies oxidizing agents
What is Boerhaave's perforation?
- Transmural perforation of the esophagus - Presents with Mackler triad: vomiting, lower thoracic pain, subcutaneous emphysema - Dx: endoscopy & Rx: surgery
What is the equation for PPV?
- True Positives divided by those who tested positive - Higher prevalence = higher PPV (increased numerator & denominator) & lower NPV (increased denominator only) - Lower prevalence = lower PPV (increase in denominator only) & greater NPV (increase in numerator & denominator) PPV = TP/(TP+FP) NPV = TN(TN+FN)
What are Benznidazole & nifurtimox used to treat?
- Trypanosoma cruzi (Chaga's disease) - South/Central America
Explain the process of serum sickness? What type of immune reaction is it?
- Type III: immune complex deposition (in skin: rash, in kidney: glomerulonephritis) - Humoral immune response against foreign protein: 7-10 days later as antibodies must be produced (requires T-helper cells)
What is the MOA of imatinib mesylate (Gleevec)?
- Tyrosine receptor kinase inhibior that acts on Philadelphia chromosom fusion protein product Bcr-ABl in CML. - Stops autophosphorylation & the unchecked proliferation of granulocytes in CML.
Why do emphysema patients often breathe through pursed lips?
- Upon expiration, larger airways collapse more (due to loss of elastic fibers & recoil) and lead to air trapping. - Pursed lips causes increased resistance & increases pressure to keep the airways open.
What physical symptoms characterize ALS?
- Upper & lower motor neuron signs: fasciculations, hyperreflexia in lower extremities and areflexia in the upper limbs - Biopsy of muscle: muscular atrophy due to lack of neuronal input
What does c-myc do?
- Upregulates the cell cycle (drives cell proliferation) - e.g. Burkitt's lymphoma
What lab values indicate an inability to dilute urine?
- Urine osmolaity > plasma osmolality - Normal specific gravity - Urine Na >40mEq/L
What extraintestinal manifestions are there for Crohn's patients?
- Uveitis - Migratory polyarthritis - Erythema nodosum
How does Candida albicans infections of the vagina present?
- Vaginal itching - Cheese-like discharge - Dx: 10% KOH prep = pseudohyphae
What drug classes inhibit microtubules?
- Vinca Alkaloids (Vincristine & vinblastine) - Rx: cancer (testicular & lymphomas)
How does the kidney respond to a high sodium diet?
- Volume expansion will increase stretch in baroreceptors located in the afferent arteriole - This leads to a reduced sympathetic activity - This leads to vasodilation of the glomerular afferent arterioles - Increases GFR & decreases Na reabsorption
In what 2 syndromes is Wilms' Tumor a member?
- WAGR - Beckwith-Wiedemann
What is Pott's disease?
- When TB invades the spinal column & causes bone destruction & compresses region of the spinal cord - 1st symptom is pain Rx: isonizaid + rifampin
What is the action of the piriformis & what innervates this muscle?
- When leg is extended: laterally rotates the leg - When the leg is flexed: abducts the leg
What is the mechanism of primary graft rejection?
- When neutrophil & platelet recover does not occur after transplation - Due to recipient immune system attack on alloantigens expressed on donor stem cells
When is tamoxifen prophylaxis indicated?
- When the patient has had a hysterectomy (i.e. no more risk of endometrial carcinoma) & the endrometrial estrogen receptors will no longer be stimulated. - It is an antagonist for DNA in breast tissue & an agonist in endometrial, bone & hepatic tissue
What is Placenta previa?
- When the placenta overlies the internal cervical os - This condition is painless
What is injured in the "straddle injury"?
- When the urethra below the urogenital diaphragam (at the junction of the membranous & penile) ruptures due to trauma - Result: urine flows into the scrotum & perineal region.
List the components of the WAGR syndrome?
- Wilms' Tumor - Aniridia (partial or complete lack of the iris) - Genital anomalies (gonadal dysgenesis, hypospadias, crytochidism...) - Mental Retardation
What is the classic presentation of Bruton's agammaglobulinemia?
- X-linked affected Male - Normal T-cell count - Recurrent bac infections after 6m = . influenzae, S. pneumo, S. aureus
What is the genetic basis of Duchenne's muscular dystrophy?
- X-linked disorder due to frameshift mutation - Progressive muscle weakness & early death due to accelerated rate of muscle breakdown
What is Ras?
- a plasma membrane protein that has GTP binding and GTPase abilities. - its activity is increased in some cancers BUT, it is not associated with translocations
What is reactive arthritis?
- a seronegative spondyloarthopathy with HLA B27 - an arthritis that follows a GI or GU infection by 2-4 weeks - "can't SEE, can't PEE, can't CLIMB A TREE" - Extra-articular manifestations include: 1) conjunctivitis 2) keratoderma blennorrhagia (papulosquamous skin rash on palms/soles) 3) Urethritis 4) Circinate balanitis (lesion on the penile shaft) 5) Aortitis (occasionally seen)
What sympatholytic drug is a selective alpha-1 blocker?
- azosin Prazosine, Doxzaosin, Terazosin - osin Tamsulosin
What 4 glycoprotein hormones share the same alpha subunit?
- beta-hCG (fertilized egg during 1st trimester & then placenta) - TSH (anterior pituitary) - LH (anterior pituitary) - FSH (anterior pituitary)
How does a cerebrovascular event of the anterior choroidal artery present?
- contralateral homonymous hemianopsia - hemiparesis - hemisensory loss
What causes central diabetes insipidus?
- decreased ADH production - hypernatremia & increased plasma osmolaity
What does the phrenic nerve supply?
- diaphragm, mediastinal pleura, pericardium - it arises from C3-C5
What 4 problems can HSV-1 cause?
- gingivostomatitis - keratoconjunctivitis - temporal lobe encephalitis - herpes labialis
What are the typical findings in VHL (Von Hippel-Lindau) syndrome?
- hemangioblastomas (when in brain: primary brain tumor with foamy cells & high vascularity) in cerebellum/retina/medulla - Increase in epo -> 2ndary polycythemia - 59% of Px develop bilateral renal cell carcinoma - Mean age of diagnosis = 29 years old (Very rare genetic disorder)
What is prophylthiouracil used to treat?
- hyperthyroidism: inhibits the synthesis of T4 & the peripheral conversion of T4 to triiodothyronine. - (rare) Tox: agranulocytosis, rash, edema
What does the PR segment represent?
- isoelectric (flat) portion of AV node conduction
What is the treatment for Hep B?
- lamivudine (reverse transcriptase inhibitor to inhibit viral repication) - interferon alpha (blocks viral replication)
What are the symptoms of 17-alpha-hydroxylase deficiency?
- primary amenorrhea - lack of 2ndary sexual characteristics - elevated aldosterone = hypokalemia (low potassium) & hypertension
What is a common side effect of Cabergoline?
- psychosis, nasal congestion, orthostasis, nausea/vomiting, headache - MOA: Inhibits prolactin secretion by dopamine receptor agonist action
What are the 2 actions of p53
- stops the cell cycle & activates DNA repair proteins - initiates apoptosis if repair cannot be made
What 2 types of cancer is EBV associated with?
- t(8:14) = Burkett's (b-cell) lymphoma - Nasopharyngeal carcinoma
What are negatively birefringent crystals?
- yellow & parallel - monosodium urate In aspirated joint fluid of a patient with gout
What drug ending indicates a selective alpha1 blocker?
-azosin: Prazosin Deoxazosin Terazosin -uz(l)osin: BPH drugs (Urinary alpha1 ZOne Selectively Incised Alfuzosin Tamsulosin
What drug name ending indicates a selective alpha2 agnoists
-onidine: Clonidine Apraclonidine Brimonidine
What is conjugation?
1 bac extends its mating pili to another without the F plasmid & transfers this plasmid to the 2nd bac (& maybe also some adjacent DNA)
What type of structures result when a fertilized oocyte divides between days 8 & 12?
1 of everything: - Monozygotic twins - Monoamniotic - Monochorinoic placenta
How does bronchiectasis present on CT?
1) "tram track" appearance of bronchi 2) Enlarged bronchiole with thickened wall 3) "Signet-ring" sign: diameter of the airway lumen greater than adjacent vessel Clinical: large amounts of purulent sputeum due to repeated infection
What is an osteosarcoma?
1) 2nd most common primary malignant tumor of bone (after multiple myeloma) 2) Peat incidence: males 10-20 years old 3) METAPHYSIS of long bones: distal femur, proximal tibial region (knee) 4) Predisposing factors: Paget's disease of bone, bone infarcts, radiation, familial retinoblastoma 5) Radiography: Codman's triangle or sunburst pattern 6) Poor prognosis
What is the pathology of Parkinson's disease?
1) A degenerative disorder of the CNS 2) Histo: Lewy bodies (alpha-synuclein) 3) Gross: depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons) 4) Rare cases linked with exposure to MPTP (a contaminnant in illicit street drugs)
What causes Sjogren-Larsson syndrome & how is this disease characterized?
1) AR: Mutation in the fatty aldehyde dehydrogenase gene on chromosome 17p 2) Congenital ichthyosis (dry & scaly fishlike skin) mental retardation; spastic paraplegia
What 3 conditions must be met to diagnose delirium?
1) Acute & usually fluctuating (hours to days) disturbance of consciousness (reduced ability to focus, sutain, or shift attention) 2) A change in cognition (e.g. memory disturbance, hallucination, or other perceptual disturbances) 3) Evidence of a direct physiologic cause (e.g. infection)
What are the possible causes of normocytic anemia?
1) Acute blood loss 2) Aplastic anemia 3) Chronic renal failure 4) Hemolytic anemia 5) Hereditary spherocytosis 6) Sickle cell anemia 7) G6PD deficiency 8) Paroxysmal nocturnal hemoglobinuria
What is the treatment for a suspected rapies infection?
1) Administer human rabies immune globulin to provide passive immunity 2) Followed with a series of 5 injections of killed rabies virus vaccination to develop active immunity
What histopathology is seen in Alzheimer's disease?
1) Amyloid proteins 2) Apo-E 3) Taupathy 4) Synaptic loss 5) Senile plaques 6) Neurofibrillary tangles 7) Granulovascular degeneration
What are the 6 clinical uses of Epinephrine?
1) Anaphylaxis 2) Bleeding (superficial) 3) Cardiac arrest 4) (local) Anesthesia 5) Bronchospasm (rarely used) 6) Coup induced by intubation or infation 7) Open-angle glaucoma
What are the 8 possible consequences of renal failure?
1) Anemia: failure of erthropoietin production 2) Renal osteodystophy: no vit. D production 3) Hyperkalemia: possible cardia arrhythmias 4) Metabolic acidosis: decreased acid secretion & reduced HCO3- production 5) Uremic encephalopathy 6) Na & H20 excess: CHF & pulmonary edema 7) Chronic pyelonephritis 8) Hypertension
What is the order of items within the common carotid sheath?
1) Artery is medial 2) Internal jugular is lateral 3) Vagus is posterior
What amino acids are modified in the Golgi?
1) Asparagine: N-oligosaccharide modification 2) Serine & Threonine: addition of O-oligosaccharides
What are the signs of nephrotic syndrome?
1) Azotemia 2) Hematuria 3) Oliguria 4) Hypertension
What is an osteoma?
1) Benign bone tumor 2) New pieces of bone grows on another piece of bone, often in the SKULL 3) Associated with Gardner's syndrome (FAP)
What is an osteoblastoma?
1) Benign bone tumor commonly in vertebral column 2) Interlacing trabeculae of woven bone are surrounded by osteoblasts 3) can be large 4) 20-40 years old
What is an osteoid osteoma?
1) Benign bone tumor on proximal tibia or femur 2) Interlacing trabeculae of woven bone are surrounded by osteoblasts 3) <2cm 4) Men <25 years old
What is an enchondroma?
1) Benign cartilaginous neoplasm found in intramedullary bone 2) Usually DISTAL extremities
What is the triad for Meigs' syndrome?
1) Benign ovarian tumor (fibroma) 2) Ascites: hypoactive bowel sounds & some abdominal guarding on deep palpation, fluid wave 3) hydrothorax (pleural effusion): decreased breath sounds
Name 3 anti-VEGF (vascular endothelial growth factor) antibodies that are used to inhibit tumor angiogenesis.
1) Bevacizumab 2) Sorafenib 3) Sunitinib
What are the 3 clinical uses of Isoproterenol?
1) Bradycardia 2) heart Block 3) Asthma (rarely)
What is the pathology of asthma?
1) Bronchial hyperresponsiveness causes reversible bronchoconstriction 2) Smooth muscle hypertrophy & Curschmann's spirals (shed epithelium from mucous plugs)
In which tissues does clomiphene & tamoxifen act as an antagonist?
1) CNS = vasomotor symptoms & sleep irregularities 2) Breast = breast cancer protection 3) bone PTH hormone = bone pain, hypercalcemia, arthralgias 4) Lipid profile = incrases HDL & triglycerids and decreased total & LDL cholesterol 4) Liver = increased protein synthesis, including clotting factors
What organisms are most often associated with Guillain-Barre Syndrome (GBS)?
1) Campylobacter jejuni 2) Haemophilus influenzae 3) Cytomegalovirus 4) EBV 5) Mycoplasma pneumoniae 6) Varicella--zoster Virus
How does Acetazolamide work to treat altitude sickness?
1) Can cause a hyperchloremic metabolic acidosis 2) The drop in pH results in increased breathing drive and higher O2 in the body 3) Result: Reverses the effects of hypoxemia
What are the main causes of aplastic anemia?
1) Carbamazepine (antiseizure drug) 2) EBV, HEP C, Parvovirus B19 3) Toxins (benzene & insecticides) 4) Cancer chemotherapeutics Hypocellular bone marow W/O abnormal cells
Which diuretics cause acidemia?
1) Carbonic anhydrase inhibitors - reduced HCO3- reabsorbtion 2) K+ sparing - hyperkalemia leads to K+ entering all cells (via H+/K+ exhcanger) & H+ exiting cells
What are the characteristics of the postrenal stage of acute renal failure?
1) Cause: outflow obstruction (stones, BPH, neoplasia) 2) NB: ONLY develops with bilatral obstruction
What are the characteristics of the intrinsic renal stage of acute renal failure?
1) Causes: acute tubular necrosis or ischemia/toxins. 2) Patchy necrosis leads to debris obstructing tubule & fluid backflow across necrotic tubule leads to a decrease in GFR 3) Urine has epithelial/granular casts
What are the 3 phases of posterior pituitary acute trauma?
1) Ceasation of secretion of ADH 2) Death of pituitary: release of all stored ADH 3) Persistent diabetes insipidus dues to injury to posterior pituitary
What are the types of emphysema?
1) Centriacinar: smoking 2) Panacinar: alpha-1-antitrypsin deficiency (or liver cirrhosis) 3) Paraseptal: bullae that rupture causing pneumothorax (often = otherwise healthy, young males)
What triad indicates classic carcinoid syndrome?
1) Chronic diarrhea 2) Intermittent facial flushing 3) Tricuspid stenosis murmur
What are the 2 main risk factors for hepatocellular carcinoma?
1) Chronic hepatitis 2) Exposure to toxins (aflatoxin)
What is a direct Coomb's test?
1) Coombs reagent is added to the patient's blood 2) Binds to autimmune Ig bound to several RBCs & causes agglutination
What are the characteristics of prerenal azotemia?
1) Decreased RBF (e.g. hypotension) 2) Reduced GFR 3) Na+/H2O & urea retained by the kidney
What are the lab test results that indicate Bernard-Soulier disease?
1) Decreased platelet count 2) Increased bleeding time
What are the lab test results that indicate DIC?
1) Decreased: platlet count 2) Increased: PT, PTT, & Bleeding Time
What is the pathogenesis of acute intermittent porphyria (AIP)?
1) Deficiency is porphobilinogen deaminase - leads to a deficiency in heme synthesis & buildup of intermediates like aminolevulinic acid & porphobilinogen 2) Acute attacks of GI, neurological/psychiatric, & heart symptoms 3) Onset after puberty, more common in women 4) Symptoms can be brought on by drugs that INDUCE cytochrome P450
In what environment is one more likely to isolate deoxyhemoglobin? What about oxygemoglobin
1) Deoxyhemoglobin (T form): low-O2 affinity state = peripheral capillaries 2) Oxyhemoglobin (R form): high O2 affinity state = pulmonary capillary bed
What is the classic triad of acute graft-versus-host disease (GVHD)?
1) Dermatitis 2) Hepatitis 3) Gastroenteritis
What are the signs of a long thoracic nerve injury?
1) Difficulty raising the arm above horizontal 2) Winged scapula
How does pneumonia present on CT?
1) Diffuse opacities of the lung parenchyma 2) Dense consolidations 3) Ground glass opacities
What type of exchange limitation is caused by emphysema?
1) Diffusion-limited exchange 2) Destruction of alveoli leads to a decreased surface area for gas exchange 3) T/F increased perfusion will not improve the exchange
What is the treatment for Clozapine-induced agranulocytosis?
1) Discontinuation of clozapine & 2) Administration of Granulocyte colony-stimulating factor (GC-SF)
What areas of the CNS are affected by a B12 deficiency?
1) Dorsal Columns: loss of propioception, pressure, vibration, & light touch 2) Lateral corticospinal tract: descending fibers to control limb movement 3) Spinocerebellar tract: modulation of movement & gait
What are the causes of QT prolongation?
1) Drugs: - Class IA or III antiarrhytmics - Phenothizines - TCAs 2) Hypocalcemia 3) Hypothermia 4) Cerebrovascular diseases 5) Ischemic heart disease 6) Idiopathic
What is the #1 & #2 cause of UTIs in young women?
1) E. coli 2) Staph saprophyticus
What are the 2 major clinical features of nephrotic syndrome?
1) Edema: low plasma oncotic pressue due to protein wasting & sodium retention from the collecting tubules 2) Massive proteinuria, hypoalbuminemia, hypercholesterolemia
What infects does the spleen clear? What if the spleen is gone?
1) Encapsulated bacteria 2) Prophylaxis with fluorquinolones and macrolides
What is the pathogenesis of a vascular fatty streak?
1) Endothelial Injury 2) Subendothelial space accumulates lipoproteins 3) lipoproteins are glycoslyated or oxidized and this recruits monocytes to the vessel walls 4) Monocytes enter the subendothelial space and convert to macrophages 5) Unregulated macrocytosis of the LDL cholestrol occurs that yields foam cells
What are the x-ray signs of a transposition of the great vessels?
1) Enlarged heart 2) Dome-shaped heart (fried egg yoke seen from the side) 3) Pulmonary vascular markings are increased
What is the pathology of Emphysema (Pink Puffer with barrel-shaped chest)?
1) Enlargement of air spaces and decrease in recoil resulting from destruction of alveolar walls 2) Increased elastase activity 3) Increased compliance due to loss of elastic fibers 4) Px exhale through pursed lips to increase airway pressure and prevent airway collapse during exhalation
What are the steps to DNA binding from circulation that a steroid hormone undergoes?
1) Enters cell membrane (lipophilic) 2) Binds to an intracellular receptor in the cytoplasm or within the nucleus 3) The hormone-receptor complex transforms to reveal the hormone's DNA binding domain 4) The hormone binds to the DNA enhancer element & generates gene transcription.
What is the symptoms of a C. trachomatisis congenital infection?
1) Eye inflammmation with purulent discharge & eyelid swelling at 5-14 days after birth 2) Can spread to the lungs & cause pneumonia between 4-11 weeks of life: rapid breathing, cough, & respiratory distress 3) Histo: BIG intracytoplasmic inclusions push the nucleus to the cell periphery.
What 2 lysosomal storage diseases are X-linked recessive (all others are autosomal recessive)?
1) Fabry's 2) Hunter's
What are the clinical symptoms of B12 deficiency?
1) Fatigue 2) Peripheral neuropathy 3) Macrocytic anemia Lab: elevated homocysteine & Methylmalonic Acid
What is the best treatment for cardiac tamponade?
1) First: Immediate volume resuscitation (IV fluids) to maintain cardiac output & increase preload 2) 2nd: Positive iontropes (dobutamine & pericardiocentesis)
What is the clinical triad for renal cell carcinoma?
1) Flank pain 2) Palpable abdominal mass 3) Hematuria + polycythemia (ectopic epo), fever, & weight loss If genetic, associated with von Hippel-Lindau syndrome (Ch. 3 mutation)
What is the equation for renal blood flow? What can be done to increase flow?
1) Flow = (change in pressure) / resistance 2) Decreasing resistance will increase flow: - low levels of dpamine dilate renal arterioles - bradykinin induces vasodilation of arterioles
What is the equation for renal blood flow? What can be done to decrease flow?
1) Flow = (change in pressure) / resistance 2) Increasing resistance will decrease flow: - Stimulating afferant alpha1-adrenergic receptors will vasoconstrict the arteriole - Stimulating afferant angiotension II receptors will vasoconstrict the arteriole
Patients with what genetic disorder are at risk for anemia when treated with isoniazid?
1) G6PD deficiency 2) The anemia will show histologically as Heinze bodies (dark inclusions of precipitated globin chains) & bite cells 3) anemia can also be produced after exposure to sulfonamides, antimalarial drugs and oxidative stress.
What is the mechanism of the cherry0red spot on the macula in Tay-Sachs & Niemann-Pick disease?
1) Ganglion cells filled with gangliosides (Tay-Sachs) or spingolipids (Niemann-Pick) are located outside the fovea & block the orange-red color of the choroid 2) Absence of ganglion cells within the fovea allow the choroid's normal color to be seen in this area (CHERRY-RED)
What does it mean for a gas to be perfusion-limited?
1) Gas equilibrates early along the length of a pulmonary capillary 2) Diffusion can be increased ONLY with an indrease in blood flow
What kind of disorder is Lesch-Nyhan and what is the pathogenesis?
1) Genetic: X-linked recessived 2) Deficiency in the production of hypoxanthine guanine phosphoribosyltransferase (HGPRTase) --> overproduction of purine & the accumulation of uric acid
How do patients with agromegaly present?
1) Glucose intolerance 2) Coarsening of facial features 3) Thickened fingers 4) Macroglossia -> obstructive sleep apnea Cause: GH-secreting adenoma
What are the 6 most common causes of DIC?
1) Gram - sepsis 2) Malignancy 3) Acute pancreatitis 4) Trauma 5) Transfusion reactions 6) Obstetric complications
How does the Na+/H+ exchanger in the proximal tubule facilitate Na & water resorption?
1) H+ is pumped into the tubual lumen 2) Luminal H+ then returns to the tubular cell in the process of HCO3- resorption: - H+ & HCO3- join to form H2O via carbonic anhydrase at the brush boarder - H20 & CO2 diffuse into the tubular cell 3) HCO2 is regenerated in the tubular cell (& sent to the bloodstream) & H+ is left behind to participate in the exchanger again.
What is the Tzanck preparation with Giemsa stain used for?
1) HSV: reveals multinucleated giant cells 2) Vesicular stomatitis virus infection
What are the symptoms of sever preeclampsia?
1) Headache 2) Blurry vision 3) Right upper quadrant abdominal pain 4) Hyperreflexia Rx: magnesium sulfate as a seizure prophylaxis
What is the initial response to high-altitude induced hypoxia?
1) Hemoglobin-O2 curve shifts right as a result of increased 2,3-DPG) in order to release more O2 to tissue 2) The P50 (partial pressure of O2 @ 50% saturation of hemoglobin) will increase
What are the 3 main coagulation factor defects?
1) Hemophilia A (factor VIII deficiency) 2) Hemophilia B (factor IX deficiency) 3) vW disease: mild, most-common (deficiency of vonWillebrand factor leads to a defect in platelet adhesion and a decrease in factor VIII survival)
What does aflatoxin cause?
1) Hepatocellular carcinoma 2) This toxin is produced by Aspergillus flavus growing on peanuts & grains and intercaltes into host DNA 3) Contamination is a problem in Asia & Africa
Which viruses establish latency in the dorsal root gangila?
1) Herpes simplex 1 & 2 2) Varicella-zoster
What are the main infections that can result in Gillain-Barre?
1) Herpesvirus, CMV, EBV, HIV 2) Campylobacter jejuni gastroenteritis + stress
What drugs can cause SIADH?
1) High-dose IV cyclophosphamide 2) Carbamazepine 3) Vincristine 4) Vinblastine 5) Amitriptyline 6) Amiodarone 7) MAO inhibitors
What is elevated in Vit. B12 deficiency?
1) Homocysteine = No B12 co-enzyme for its conversion to methionine 2) Methylmalonic acid = No B12 for methylmalonyl-CoA mutase to convert this to succinyl-CoA & metabolize odd-chain fatty acid
What lab values indicate parathyroid carcinoma?
1) Hypercalcemia 2) Hypophosphatemia 3) Elevated PTH
What is the triad of a molar pregnancy?
1) Hyperemesis 2) Vaginal bleeding 3) Hyperthyroidism
What are the stimuli for insulin secretion?
1) Hyperglycemia (primary stimulus) 2) Increase in fatty acids in the blood 3) Increase in amino acids in the blood 4) Cortisol 5) GH 6) Gastrointestinal inhibitory peptide
What are the symptoms of serotonin syndrome?
1) Hyperpyrexia 2) Muscle rigidity 3) Cardiovascular collapse 4) Mental status changes
What is the usual presentation of preeclampsia?
1) Hypertension 2) Proteinuria 3) Nondependent edema (face & hands)
What are the 2 clinical uses of Prazosin?
1) Hypertension (2nd choice or 1st if patient has BPH) 2) BPH: symptomatic relief
What are the 2 clinical uses of Reserpine?
1) Hypertension (3rd line choice for mild/moderate cases) 2) Huntington's (relieves dyskinesia)
What are the 2 clinical uses of Fenoldopam?
1) Hypertensive emergencies = IV, short-term Tx 2) Postoperative hypertension
What is the pathology of Chronic Bronchitis (Blue Bloater)?
1) Hypertrophy of mucus-secreting glands in the bronchioles (small airways) 2) Reid index >50 3) Productive cough for > 3 consecutive months in 2(+) years 4) Findings: wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea
What is the clinical presentation of Lesch-Nyhan syndrome?
1) Hyperuricemia 2) Excessive production of uric acid = GOUT 3) Neuro: self-mutilation choreoathetosis, spasticity, mental retardation, aggressive behavior
What is Whipple's triad for an insulinoma?
1) Hypoglycemia 2) Hypoglycemic symptoms (headache/irritability) 3) Relief of symptoms with calorie intake LAB: high C-peptide (indicates taht serum insulin is endogenous)
What are the 5 main platelet abnormalities?
1) ITP: peripheral platelet destruction, antiplatelet antiboides, increased megakayrocytes 2) TTP: increased platelet aggregation leads to thrombosis and schistocytes, increased LDH (There are neurologic & renal symptoms, & fever) 3) DIC: schistocytes & increased fibrin split products 4) Aplastic anemia 5) Drugs (e.g. immunosuppressive agents)
What is the MOA of Tacrolimus & for what is it usually prescribed?
1) Immunosuppressive: transplant recepients 2) MOA: - Binds FK-binding protein & this complex inhibits the secretion of cytokines that activate lymphocytes (e.g. IL-2) - SE: nephrotox, CNS effects, hyperglycemia
What are the 2 causes of respiratory acidosis?
1) Inadequate ventilation (drugs or neurologic injury) 2) Impaired gas exchange (e.g. pulmonary edema)
How do central chemoreceptors respond to blood pH and partial gas pressures?
1) Increase PCO2 or decreased pH = increase in total peripheral resistance 2) Mechanism: systemic vasoconstriction via sympathetic outflow
What are the 5 actions of PTH?
1) Increases Ca absorption in the small intestine 2) Promoting Ca reabsorption in the renal tubules 3) INHIBITING phosphate reabsorption in the reanl tubules 4) Inhibiting further PTH release (negative feedback) 5) Stimulating 1,25-dihydroxyvitamin D
What are the primary functions of somatostatin?
1) Inhibits all GI & pancreatic exocrine & endocrine functions & inhibits the release of insulin 2) Inhibits GH & prolactin release by the pituitary
How does swallowing work?
1) Initiation: touch receptors near the pharyngeal opening are stimulated 2) Signals are sent to the swallowing center in the medulla & lower pons 3) Swallowing center sends impulses to the muscles of the pharynx & esophagus via cranial nerves
What is the 1st treatment for acute ICP (increased intracranial pressure)?
1) Intubate 2) Hyperventilate: CO2 is a powerful vasodilator of the cerebral vessels; thus, "blow it off" to cause vasoconstriction & decrease intracrainal blood
What are the possible causes of microcytic anemia?
1) Iron deficiency: decreased intake or increased loss through bleeding 2) Chronic inflammatory disease (e.g. rheumatoid arthritis) 3) Thalassemia 4) Sideroblastic anemia
What is the action of 2,3-DPG?
1) It binds to the beta chains of deoxyhemoclogin and DECREASES the affinity of hemoglobin for O2 2) This right-shifts the Hemoglobin-O2 curve 3) Is a response to high-altitude hypoxia
What is somatomedin's effect on GH secretion
1) It is part of the negative feedback system that regulates GH secretion 2) Synthetic forms can be used to treat acromegaly
What sympatholytic drug is a mixed alpha1, beta blocker??
1) Labetalol (also has intrinsic sympathomimetic activity) 2) Carvedilol
What is a Giant Cell tumor?
1) Locally aggressive benign tumor often around the distal femur, proximal tibial region (KNEE) 2) Radiology: "double bubble" or "soap bubble" 3) Spindle-shaped cells with mutinucleated giant cells 4) 20-40 year old Px
What is the function of Clara cells?
1) Location: terminal bronchiole 2) Produce the protein component of surfactant 3) Transport Cl ions 4) Site of cytochrome p450-dependent mixed-function oxidase in the lung
Which diuretics cause an increase in urine Ca2+?
1) Loops 2) Mechanism: - Abolish lumen-positive potential in thick ascending limb of loop of Henle -> decrease in paracellular Ca+ reabsorption -> hypocalcemia
What are the 3 MOAs of dopamine?
1) Low dose: Gs-coupled vascular D1 activation = up in blood flow to renal, mesenteric, & coronary vascular beds 2) Medium dose: Gs-coupled cardiac B1-receptors = positive inotropic 3) High dose: Gq-coupled vascular alpha-1 receptors to increase intracellular IP3/Ca2+ to vasoconstrict, increase PVR & Bp
How does maligancy cause hypercalcemia?
1) Lytic metastases to bone - up serum alk phos & hyperphosphatemia 2) PTH-related peptide production (with hypophosphatemia)
What are the signs of a coagulation factor defect?
1) MACROhemorrhage: hemarthroses (bleed into joints), easy bruising 2) Increased PT &/or PTT time
What are the most common paraneoplastic syndromes of a thymoma?
1) MG = myasthenia gravis 2) pure RBC aplasia 3) Hypogammaglobulinemia
What are the signs of platelet abnormalities?
1) MICROhemorrhage: mucous membrane bleeding, epistaxis, petechiae, purpura 2) increased bleeding time
What is a Osteochondroma?
1) MOST COMMON BENIGN bone tumor 2) Mature bone with cartilaginous cap 3) Males <25 years of age 4) Origin: long metaphysis
What diagnostic test results indicated multiple sclerosis?
1) MRI: multiple white matter plaques 2) CSF: IgG oligoclonal bands Rx: beta-interferon (from connective tissue fibroblasts)
What is the MOPP regiment & what is it used to treat?
1) Mechlorethamine, vincristine (Oncovin), Procarbazine, & Prednisone 2) lymphoma, Wilm's tumor, Choriocarcinoma
What is a complication of neonatal meningitis?
1) Menigeal scarring: can lead to a decrease in CSF absorption by arachnoid villi (= nonobstructive/communicating hydrocephalus) 2) Tx: shunt
What are the 2 main indications for carbonic anhydrase inhibitors like Acetazolamide?
1) Metabolic alkalosis 2) Alkalize the urine to remove a toxic drug
What 3 different enzyme deficiencies can result in homocystinuria?
1) Methionine synthase 2) Cystathionin synthases (converts homocysteine into cysteine): REQUIRES B6!! 3) Decreased affinity of cystathionine synthase for pyridoxal phosphate Result: mental retardation, osteoporosis, tall statue, kyphosis, lens subluxation
What CSF finding points to JC virus?
1) Myelin pasic protein = due to demyelination 2) Dx: CSF PCR for JC virus or Stereotactic biopsy
What are the 2 ways that glucose can enter a cell?
1) Na-independent facilitated diffusion with glucose transporters 2) Na-monosaccharide cotransporter system (intestinal cells, renal tubules, choroids plexus) SGLT-1
What are the signs of acute vitamin A (retinol toxicity)?
1) Nausea 2) Vomiting 3) Vertigo 4) Blurry vision Severe: drowsiness & altered mental status
What is renal osteodystrophy?
1) Nephron damage (Lab: increased creatine) reduces Ca reabsorption, impaired phosphate excretion & impaired vit. D activation. 2) Result: decreased serum Ca & increased phosphate = hypocalcemia 3) PTH increases & bone is reabsorbed: increased alk phos.
What are the 4 causes of Parkinsonism?
1) Neurodegeneration of the substantia nigra (idiopathic) 2) MPTP exposure 3) Adverse effects of neuroleptic meds 4) Ischemic damage to the basal ganglia
In a diffusion-limited situation, will O2 fully equilibrate along the length of the pulmonary capillary?
1) No. 2) As blood is oxygenated, the gradient driving O2 into the blood decreases. 3) T/F further equilibration would take more time &, in a diffusion-limited situation, there is not enough time & O2 will not equilibrate by the time it reaches the end of the capillary.
What is necessary for a diagnosis of delusional disorder?
1) Nonbizarre delusions (i.e. plausibel situations in reality), which are not attributable to another psychiatric disorder 2) Duration: @ least 1 month 3) Does NOT markedly impair the person's life: ramifications are limited to the delusional content
What 2 steps make bilirubin soluable?
1) Noncovalent binding to albumin (in liver) 2) Conjugation with glucuronate (in hepatocytes via UDP-glucuronyl transferase) to form bilirubin diglucuronide
Define Global aphasia.
1) Nonfluent aphasia with impaired comprehension 2) Both Broca's and Wernicke's areas are affected
What gasses are perfusion-limited?
1) O2 (in normal health) 2) CO2 3) N2O
What patients are most susceptible to chondrosarcoma?
1) Older men (30-60) 2) Malignant cartilaginous tumor of the pelvis, spine, scapula, humerus, tibia, or femur. 3) May be primary bone or from an osteochrondroma 4) Gross: expansile glistening mass within the medullary cavity
How is a brief psychotic disorder characterized?
1) One of the following: hallucinations, delusions, disorganized speech or grossly disorganized behavior 2) Duration: lasts @ least 1 day, but less than a month 3) Patient returns to full functionality 4) State NOT attributable to a general medial condition or other psychiatric disorder
Describe the pathway of an upper motor neuron.
1) Origination: primary motor cortex 2) Pass through posterior limb of the internal capsule, midbrain cerebral peduncles, ventral pons, & medullary pyramids 3) Majority decussate @ the caudal medulla 4) Run in the lateral white matter tracts in the spinal cord 5) Synapse on the lower motor neuron @ he ventral horn, in the gray matter
What 4 virus families are single-stranded (-), linear RNA?
1) Orthomyxoviruses 2) Paramyxoviruses 3) Rhabdoviruses 4) Filviruses
What are the signs of pulmonary edema?
1) Orthopnea 2) Dyspnea 3) Pulmonary rales 4) Systemic edema of extremities ("backward failure")
List the 6 benign bone tumors.
1) Osteoma 2) Osteoid Osteoma 3) Osteoblastoma 4) Giant Cell (Osteoclastoma) 5) Osteochondroma (exostosis) 6) Enchondroma
List the 3 malignant bone tumors.
1) Osteosarcoma (osteogenic sarcoma) 2) Ewing's Sarcoma 3) Chondrosarcoma
What is the cutaneous innervation of the median nerve?
1) Palmar hand: lateral portion up to the lateral 1/2 of the 4th digit 2) Dorsal hand: - distal to the proximal interphalangeal joints of the 1-3 digints - the dorsal aspect of the radial 1/2 of the 4th digit distal to the proximal interphalangeal joint - THENAL muscles ("Oaf"): Opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
What is the pathology of Hunter's & its clinical presentation?
1) Pathology: deficiency in lysosomal iduronate sulfatase; accumulation of dermatan & heparan sulfate 2) Clinical: Mild mental retardation, hearing loss, coarse facies, hepatosplenomegaly, agressive behavior, airway obstuction, but NO corneal clouding
What 3 drug classes are associated with allergic reactions?
1) Penicillins (esp: Methicillin & Nafcillin) 2) Cephalosporins 3) Sulfonamides S/S: fever, rash, eosinophilia
What are Lewy bodies?
1) Pink inclusions (aggregation of alpha-synclein proteins) in neurons of the substantia nigra 2) Patients with Parkinson's or Lewy body dementia
Besides hyperparathyroidism, what 2 signs can be indicative of MEN1?
1) Pituitary prolacinoma (galactorrhea) 2) Duodenal ulcers (gastrinoma in the pancreas causing Sollinger-Ellison syndrome)
Define Conduction aphasia.
1) Poor repetition, but fluent speech 2) Intact comprehension 3) Arcuate fasciculus: connects Broca's & Wernicke's areas
What are the 2 clinical uses of Terbutaline & Ritodrine?
1) Premature labor (delays labor) 2) Asthma (Terbutaline, not ritodrine)
What are the 2 most common cause of a failed closure of the ductus arteriosus?
1) Prematurity 2) Maternal rubella infection during pregnancy Rx: indomethacin (blocks PGE1 & can be used to close a PDA)
What is the difference between primary and 2ndary Membranoproliferative glomerulonephritis?
1) Primary = idiopathic 2) 2ndary = hep C & B, cryoglobulinemia, lupus, rheumatoid arthritis, maligancy cause - In either case, 20 years to end-stage renal disease
How does TB present on CT?
1) Primary: Ghon complex = hilar lymph nodes & subpleural parenchymal lesion 2) Secondary: lesions in the apical or posterior segments of the upper lobe +/- cavitary lesion
Which cells are "output" cells of the cerebellum? What neurotransmitter do they employ?
1) Purkinje cells 2) GABA: all these outputs are inhibitory
What are the symptoms of Kawasaki's? What is the treatment?
1) Px < 5 years old 2) Fever (40C/104F) 3) Red eyes = injected conjunctivae 4) Erythematous rash on palms & soles + edema 5) Tachycardia & mucosal inflammation 6) Lymphademopathy 7) Lab: Normocytic anemia & neutrophilic leukocytosis & elevated ESR Rx: Aspirin & IV Ig (prevent coronary artery aneurysm due to necrotizing vasculitis of sm/m muscular arteries)
What is the progression of CMV retinitis (usually only found in AIDS patients)?
1) Rapidly diminishing sight (loss of central vision with floaters & blind sptos) 2) Funduscopic exam: cotton-wool exudates -> necrotizing retinitis -> perivascular hemorrhages -> (lastly) retinal detachment Rx: ganciclovir & foscarnet
When is Procainamide indicated?
1) Re-entrant & ectopic suptraventricular & ventricular tachycardia 2) MOA: (Class 1a Na-channel blocker) increase action potential duration & increased QT interval = decrease in myocardial excitability & conduction velocity
What is the clinical presentation of Job's syndrome?
1) Recurrent staph abscesses 2) Pruritic eczema (papulovesicular dermatitis) 3) Multiple "cold" (i.e. noninflamed) skin lesions LAB: High levels of IgE: - T-helper cells cannot produce IFN-gamma & thus do not activate phagocytic cells - T/F -> a failure of neutrophil chemotatic response
What are the lab test results that indicate thrombocytopenia?
1) Reduced Platlet Count 2) Increased Bleeding time 3) NORMAL PT & PTT
What are the 2 clinical uses of dopamine?
1) Refractory or severe CHF, especially for patients with decreased renal blood flow & low Bp 2) Cardiogenic or septic SHOCK
Disorders of peroxisomes result in what 2 diseases?
1) Refsum's 2) Adrenoleukodystrophy - peroxisomes can no longer metabolize very-long-chain fatty acids & this results in problems with making myelin & hydrogen peroxide formation = progressive neurological damage
What 3 diseases are associated with HLA-DR4?
1) Rheumatoid arthritis 2) Diabetes mellitus 3) SLE
What is the action of NA+K+ATPase pump inhibitors (like Digoxin) on vascular smooth muscle & the kidney?
1) SM: increase of intracellular [Na] = blocked Na+Ca2+ exchange & an increase in vascular resistance & Bp 2) Kidney: impairment of tubular Na resorption
What organisms are capable of antigenic variation?
1) Salmonella species 2) Trypanosomes 3) Neisseria gonorrhoeae 4) Influenza virus
What 3 defects can result in a VSD?
1) Septum of the atrioventricular canal 2) Muscular septum 3) Distal conal septum
In acute renal failure, what is the indication for dialysis?
1) Severe hyperkalemia (elevated blood level of potassium) 2) A rapidly-rising potassium value 3) Severe acidosis 4) BUN >80 mg/dl or S/S uremia 5) Na Concentration <120mEq/L or >155mEq/L 6) Toxins: lithium or salicylates
Which respiration problems result in a large A-a gradient?
1) Shunt 2) ventilation-perfusion mismatch 3) Diffusion impairment
What is the difference between the action of Ca in smooth & skeletal muscle?
1) Smooth: Ca signals through myosin light chain kinase - Ca binds/activates calmodulin that activates MLCK - MLCK phosphorylates myosin to allow cross-bridges 2) Skeletal: Ca binds troponin to allow actin-myosin interaction
What are somatomedins and when are they released?
1) Somatomedins = insulin-like growth factors 2) Mediate metabolic changes necessary for growth & development 3) Act on hypothalamus & anterior pituitary via negative feedback to reduce growth hormone (GH) secretion
What symptoms indicate an infarction of the lateral medulla?
1) Spinal trigeminal nucleus: loss of pinprick sensation on the right face 2) Spinothalamic track: loss of pinprick sensation on the left below the neck 3) Inferior cerebellar peduncle: ataxia 4) Vestibular nucleus: nystagmus 5) Dorsal motor nucleus of vagus: hoarsness 6) Descending sympathetic fibers: Horner's syndrome (ptosis, miosis, anhidrosis)
What are the 4 major causes of food poisioning, nonbloody diarrhea?
1) Staphylococcus aureus 2) Clostridium perfringens 3) Enterotoxigenic E. coli (traveler's diarrhea) 4) Bacillus cereus
Describe the (INHIBITORY) indirect pathway in the brain.
1) Substantia nigra pars compacta sense INHIBITORY neurons to the striatum. 2) Striatum sense INHIBITORY output to the external segment of the globus pallidus; this inhibits the subthalamic nucleus 3) Subthalamic nucleus sends EXCITATORY neurons to the internal segment of the globus pallidus: this increases firing of GABA neurons that run from the GPi to the thalamus 4) Movement on the contralateral side of the body is inhibited
What can happen to sugars, proteins, & lysosomal proteins in the golgi?
1) Sulfonation of sugars in proteoglycans & tyrosine residues on proteins 2) Addition of mannose-6-phosphate to specific lysosomal proteins to target them to the lysosome
What 3 endogenous systems/agents constrict the efferent arteriole of the kidney?
1) Sympathetic nervous sytem 2) Angiotensin II 3) Vasopressin
What are possible squalae of celiac sprue?
1) T-cell lymphoma 2) Dermatitis herpetiformis (pruritic papular lesions located on the trunk & extensor surfaces)
What two diseases can causes a dilation of the aorta & dilation of the aortic ring that results in aortic regurgitation?
1) T. pallidum (syphilis) 2) Coarctation of the aorta
Which diuretics cause a decrease in urine Ca2+?
1) Thiazides 2) Mechanism: - Block luminal Na+/Cl- cotransport in DCT -> increased Na+ gradient -> increased interstitial Na+/Ca2+ exchange -> hypercalcemia
Which diuretic groups act on the luminal surface by inhibiting transporters, which do not?
1) Thiazides, Loops, K-sparing all act on the luminal surface 2) Carbonic anhydrase inhibitors inhibit a cytoplasmic enzyme 3) Spironolactone inhibitis steroid receptor function
What hormones act through nuclear steroid hormone receptors?
1) Thyroid hormones 2) Cortisol 3) Aldosterone 4) Vitamin D 5) Testosterone 6) Estrogen 7) Progesterone
What are the causes of secondary cardiac tamponade?
1) Trauma 2) hypothyroidism 3) Myocardial rupture 3) Complication of pericarditis (esp. due to malignancy or uremia)
What is the correct order of MI blood test markers?
1) Troponin I (elevated w/in 4 hours; remains for 7-10 days) 2) CK-MB (peaks w/in 24 hours & falls off) - best for monitoring post-MI for a new infarct w/in 1 wk 3) AST (increases over 1st 2 days; slowly declines): NOT SPECIFIC, like myoglobin 4) LDH (elevated 2-day post MI; remains elevated for 7 days)
What are 2 common causes of hyperprolactinemia?
1) Tumors 2) Antipsychotic drugs (dopamine antagonists = increase prolactin as dopamine usually inhibits prolactin release)
What are the characteristic lab values of the intrinsic renal stage of acute renal failure?
1) Urine osmolality: <350 2) Urine Na: >20 3) Fe of Na: >2% 4) BUN/Cr ratio: <15
What are the characteristic lab values of the postrenal stage of acute renal failure?
1) Urine osmolality: <350 2) Urine Na: >40 3) Fe of Na: >4% 4) BUN/Cr ratio: >15
What are the characteristic lab values of prerenal azotemia?
1) Urine osmolality: >500 2) Urine Na: <10 3) Fe of Na: <1% ***4) BUN/Cr ratio: >20
What are the 3 possible causes of macrocytic anemia?
1) Vitamin B12 deficiency 2) Folate deficiency 3) Pernicious anemia
What are the S/S of intussusception?
1) Vomiting (due to partial obstruction) 2) Bloody diarrhea 3) Hyperactive bowel sounds 4) Palpable mass (usually at the ileocecal junction)
What are the most common arteries targed by peripheral atherosclerosis?
1) abdominal aorta 2) Iliac 3) Femoral 4) Popliteal (can present with intermittent claudication) 5) tibial 6) popliteal
What are the 3 major mechanisms that limit the extent of coagulation?
1) activity of tissue factor pathway inhibitor 2) activity of antithrombin III 3) activity of activated proten C with cofactor protein S
When do extrapryamidal adverse effects of typical antipsychotic set in?
1) acute dystonia (1st hours after dose) 2) akinesia (1st few days after dose) 3) tardive dyskinesia (several months)
What is the DDx for target cells
1) asplenia 2) alpha & beta thalassemia
What lab value distinguishes Edwards' from Downs?
1) b-hCG: elevated in Down's and decreased in Edwards 2) SAME: low AFP & low estradiol
What 5 types of antibiotics inhibit protein synthesis?
1) chloramphenicol & clindamycin 2) linezoid 3) erythromycin 4) tetracycline & doxycycline 5) aminoglycosides
What is the Whipple triad & what does it indicate?
1) episodic hypoglycemia, CNA symptoms (confusion, stupor, convulsions, & coma), & reversal of CNS symptoms with glucose 2) insulinoma (islet; that is, B cell tumor), either benign or malignant = elevated C peptide & insulin levels
What cell types and cytokines drive asthma?
1) hyperresponsive T lymphocytes in the lung (esp. Th2) 2) Il-4, Il-5, Il-3
What is the mechanism of Gemfibrozil?
1) increases the activity of lipoprotein lipase & enhances clearance of triglycerides 2) Fibric acid derivative that acts on peroxisome proliferator-activated receptor-alpha protein
What is the action on heme synthesis in lead poisoning?
1) inhibition of aminolevulinic acid dehydratase 2) Denatures ferrochelatase 3) Denatures ribonuclease in RBCs (basophilic stippline due to ribosomes NOT breaking down)
What are the 4 toxicities of lead?
1) inhibits heme synthesis (binds to alpha-aminolevulinic acid dehydratase & ferroketolase) 2) competes with Ca ions for binding to other molecules 3) inhibits membrane enzymes (e.g. 5'-nucleotidase & Na-K pumps) causing hemolysis, renal cell damage & hypertension 4) inhibits active vit. D production
What makes a pneumonia "atypical"?
1) insidious onset 2) Nonproductive cough 3) streaky interstitial infiltrate on chest radiograph 4) Most common cause: Mycoplasma (confirm with cold agglutinin test): contains cholesterol in membrane 5) Rx: Erythromycin or tetracyclin (b/c NO CELL WALL)
Describe the 3 stages of syphilis?
1) painless chancre (localized) 2) SYSTEMIC (6 wks later): maculopapular rash (palms & soles), condylomata lata 3) Gummas (chronic graulomas), aoritis (vasa vasorum destruction), neurosphyilis (tabes dorsalis), Argyll Robertson pupil. SIGNS: broad-based ataxia, positive Romberg, Charcot joints, stroke w/o hypertension
What are the 3 stages of acute renal failure?
1) prerenal azotemia 2) intrinsic renal 3) postrenal
What are the 3 parts of the male urethra?
1) prostatic 2) membranous - through the urogenital diaphragm 3) penile
What drugs cause a lupus-like syndrome?
1) quinidine 2) minocycline 3) isoniazid 4) valproate 5) hydralazine 6) penicillamide 7) sulfasalazine 8) procainamide
What are the stage 1 & stage 2 symptoms of Reye's syndrome of aspirin tox?
1) vomiting, confusion, lethargy 2) stupor, hyperventilation, microvesicular fatty liver
What are the lab test results that indicate Glanzmann's thrombasthenia?
1) Increased bleeding time
How is acromegaly diagnosed?
1) Increased serum IGF-1 2) Failure to suppress serum GH following oral glucose tolerance test
What gasses are diffusion-limited?
1) O2 (emphysema & fibrosis) 2) CO
What drugs increase urine NaCl?
ALL diuretics: - Carbonic anhydrase inhibitors - Loops - Thiazides - K+-sparing
What disease classically presents with myoclonic fasciculations?
Creutzfeld-Jacob
How is the diffusion equation affected by emphysema?
Decrease in Area
Define Wernicke's aphasia.
Wernicke's is Wordy buy makes no sense: Wernicke's = "What?" 1) Fluent aphasia with impaired comprehension 2) Wernicke's area: superior temporal gyrus
What is the maximum point value for APGAR & what is each area evaluated?
10: - 7(+) = good survival - 4(<) = mortality risk 0-2 for each: Appearance Pulse Respiration Grimace Activity
What catalyses the prodrug prednisone into prednisolone?
11-beta-hydroxysteroid dehydrogenase
What catalyzes the production of testosterone by Leydig cells?
17alpha-hydroxylase (& 17beta-hydroxysteroid dehydrogenase)
When can an individual possess the capacity for awareness of a full rectum/bladder & are able to control bowel & urinary tract sphincters?
19-36 months
What antidepressants have the best cardiac profile?
1st Choice: SSRIs 2nd Choice: Monoamine oxidase inhibitors (MAOs) - also good for BPH patients b/c there are no anticholinergic activity
What does an ECG result of PR elongation indicate?
1st degree atrioventricular block
When is the oral stage of life?
1st year: passive dependence on eating & sucking
What is the DOC (& 2nd choice) for Absence seizures?
1st: Ethosuximide 2nd: Valproic acid
What are the drugs used to treat trigeminal neuralgia?
1st: carbamazepine 2nd: Phenytoin Both induce CYP450
What arteries supply the RV?
2 branches of the RCA: - Acute marginal - Posterior descending
What type of structures result when a fertilized oocyte divides within 3 days postfertiziation?
2 of everything: - Mono or dizygotic twins - Diamniotic - Dichorionic - 2 placentas
What is osteosarcoma?
2) Epidemiology: Males, 10-20 years old 3) Gross: METAPHYSIS of long bones 4) Radiography: 2 growth patterns: - Codman's Triangle: elevated periosteum - Sunburst growth pattern: reactive bone formation
What is the formula for MAP?
2/3 diastolic + 1/3 systolic Bp
@ what level of saturation does glucose stop being reabsorbed in the proximal tubule via the Na-gluclose cotransport?
200 mg/dl
What genetic mutation results in DiGeorge's? What are the characteristic features of this disease?
22q11 microdeletion CATCH-22: Cleft palate Abnormal facies Thymic aplasia Cardiac defects Hypocalcemia 22 deletion
What is the embryological source of cranial nerve VII & muscles of facial expression
2nd branchial arch
What symptoms indicate a manic phase?
3 of the following: 1) inflated self-esteem/grandiosity 2) Decreased need for sleep 3) Increased rate of speech/talkativeness (pressured speech) 4) Flight of ideas/racing thoughts 5) Distractibility 6) Increased goal-directed activity/psychomotor agitation 7) Increase in pleasurable activities without regard for consequences
What are the 3 ps of Multiple Endocrine neoplasia type 1?
3 tumors: Pancrease Pituitary Parathyroid
When does fibrinous pericarditis occur post MI?
3-5 days S/S: sharp, pleuritic chest pain, fever, pericardial friction rub
When is the oedipal/phallic phase?
36-6 years: strong attachment to parent of the opposite sex
What heart sound indicates volume overload?
3rd heart sound on auscultation
When is a heart rupture a risk post MI?
4-10 days
What day post MI is a patient at risk for ventricular wall rupture?
4-7: severe hypotension & results in cardiogenic shock
What is the karyotype of a complete mole?
46 XX (haploid sperm replicates within an empty egg)
What is the enzyme that converts arachidonic acid to leukotrienes?
5-lipoxygenase
On what chromosome is the FAP (familial adenomatous polyposis) genetic mutation found?
5: APC locus, loss of tumor suppression & increased risk of: - duodenal - gastric - liver - thyroid - CNS
What causes the "penis-at-12" phenomenon?
5alpha-reducatase deficiency: - genetic males with testes & ambiguous or female external genitalia - @ puberty, increased testosterone causes masculinization of the external genitalia 5alpha reductase converts testosterone to dihydrotestosterone that is required in utero to develop external genitalia
When is the latency phase of life?
6 years - puberty: children do not fixate
What is the karyotype of a partial mole?
69 XXX (2 haploid sperm fertilize a haploid egg)
What is the blood supply of the liver?
75%: portal vein 25%: hepatic artery BUT, they give equal O2
What is the pH of cervical mucus or sperm?
8.0
Are struvite calculi (ammonium, magnesium, & phosphate) radiolucent or radiopaque?
80% radiopaque Cause: Proteus vulgaris or Staphylococcus saprophyticus
What Mentzer index values distinguish iron deficiency anemia from thalassemia?
> 13 is iron deficiency < 13 is thalasemia
How many eggs must one eat to become biotin deficient?
> 20
What Reid index value indicates chronic bronchitis and hyperplasia of submucosal glands?
>0.4
What FEV1/FVC ratio is indicative of a restrictive disease?
>80
What does Niacin do to cholesterol levels?
@ high doses: - Raises HDL - Reduces VLDL
What are the acute phase symptoms of schizophrenia?
@ least 2 of the following for a 1-month period: 1) Delusions 2) Hallucinations 3) Disorganized speech 4) Grossly disorganized or catatonic behavior & Negative symptoms: flat affect, lack of motivation, or poverty of speech
Which is more common, hemophilia A or B?
A = factor VIII deficiency (more common) B = factor IX deficiency
How is primary sclerosing cholangitis characterized?
A disease associated with Ulcerative Colitis resulting in: - Inflammation - Obliterative fibrosis - Segmental constriction of intrahepatic & extrahepatic bile ducts (visualized as alternating strictures & dilations, or "beading" - Dx: PANCA (majority) - Rx: liver transplant - Proctocolectomy to eliminate the GI problems with UC & risk of colon cancer
What is chondrodysplasia?
A group of inherited skeletal disorders characterized by defects in type II collagen
What is oculocutaneous albinism?
A mutation in tyrosinase (converts tyrosine into dopa) that is the key, rate-limiting step in melanin production from phenylalanine
What causes Meckel's diverticulum?
A persistence of part of the omphalomesenteric duct (vitelline duct or yok stalk) Dx: 99mTc pertechnetate radionuclide imaging b/c the diverticulum can contain gastric or pancreatic tissue & it will absorb this dye.
What results from combining an ACE inhibitor with a potassium-sparing diuretic?
A possible dangerous level of hyperkalemia: - ACE reduces angiotension II production and aldosterone is reduced (increases Na excretion & potassium retention)
What does paralysis in general indicate?
A problem in the motor neurons themselves (i.e. not a ganglion)
What respiratory cause of hypoxemia cannot be overcome by supplimental O2?
A shunt, e.g. alveolar collapse, where blood flows through some capillaries without any gas exchange
What newborn umbilical cord abnormality can indicated another congenital abnormality (usually cardiovascular)?
A single umbilical artery (there should be 2: to take deoxygenated blood from the fetus to the placenta)
What is a Struma ovarii?
A teratoma in which thyroid tissue has overgrown - presents with symptoms of hyperthyroidism
Where is a Robertsonian translocation?
A translocation between chromosome 21 & long arm of a second acrocentric chromosome (usually 14 or 22)
What is volvulus?
A twisting of a portion of the bowel around its mesentery - PEDs & elderly
What sympatholytic drug is a selective beta-blocker?
A-M + olol: (A BEAM) 1) Acebutolol (also has intrinsic sympathomimetic activity) 2) Atenolol 3) Betaxolol 4) Bisoprolol 5) Esmolol 6) Metoprolol
Do cervical roots emerge on top or below corresponding vertebrae?
ABOVE
Why are ACE inhibitors and NSAIDs a bad idea for the kidney?
ACE = decreased efferent arteriolar tone & decreased glomerular capillary perfusion pressuer NSAIDS = similar mechanism Potential for ARF (due to ATN) if there is a drop in blood volume for any reason
What is acetazolamide used for?
ACE family: - Altitude sickness - metabolic Alkalosis - Alkalinizing urine - glauComa - Epilpsy - Familial periodic paralysis
What type of drug is Lisinopril?
ACE inhibitor used for hypertensive Px.
What are the major actions of Captopril?
ACE inhibitor: 1) Arteriolar vasodiation (decreases afterload) 2) Venous vasodilation (decreases preload) 3) Decreased aldosterone (decreases preload)
When there is truncal obesity due to a pituitary adeonma, what is the cause of the obesity?
ACTH hypersecretion
What proteins are affected by tuberous sclerosis?
AD (Ch. ( & 16): tuberin & hamarin, they regulated cellular growth & differentiation Tumors: cortical tubers, renal angiomyolipomas, cardiac rhadbdomyomas, astrocytomas, pulmonary lymphangioleiomyomatosis Physical: ash-leaf spot, Shagreen patch, facial angiofibromas Presentation: mental retardation & epilepsy
What are the clinical hallmarks of NF1 (aka von Recklinghausen's disease)?
AD defect on long arm of Ch. 17: 1/4000 births - Cafe au lait spots - Neurofibromas - Lisch nodules (pigmented iris hamartomas) NB: NF1 is a risk factor for menigiomas
What is achondroplasia?
AD dwarfism: - Mutation in the fibroblast growth factor receptor 3 gene - Short limbs with normal trunk & skull size - IF they have a narrow foramen magnum, this can impinge on the brain stem & cause neurologic dysfunction or death
What is the microscopic pathology of hypertrophic obstructive cardiomyopathy (or asymmetric septal hypertrophy and idiopathic hypertrophic subaortic stenosis)
AD in 50% of cases: myofiber hypertrophy & disarray
What are amphetamines used to treat (main 2)?
ADD/ADHD Narcolepsy Modulate dopamine, serotonin, & NE
Where is ADH (vasopressin) & oxytocin synthesized
ADH (aquaporins): supraoptic nuclei of the hypothalamus Oxytocin (milk "let down"): paraventricular nuclei of the hypothalamus
What lab value indicates that a fetus will have Down's?
AFP reduction: "AFP goes down in Down's Syndrome"
What is the immunofluorescent picture in Berger's disease?
AKA: IgA nephropathy (post-infectious nephritic) - Nonlinear IgA deposits in the mesangium - Rx: ACE inhibitors & corticosteroids
What is Wallenberg's syndrome?
AKA: lateral medullary syndrome: 1) Stroke: dissection & thrombosis of vertebral artery & posterior inferior cerebellar artery
What is the pathology of X-linked sideroblastic anemia?
ALA synthase deficiency (the 1st & rate-limiting step in heme synthesis)
What lymphoma presents with aggressive onset of thrombocytopenia, anemia, and a lg. mediastinal mass?
ALL (Acute Lymphoblastic Lymphoma): - lymphoblasts in blood and bone marrow - Epidemiology: children < 15 years old
What is the mechanism of primary hemochromatosis?
AR inheritance: mutation in HFE gene - body over absorbs iron in the GI
How is Crigler-Najjar syndrome type 1 characterized?
AR: UGT-1 deficiency (Uridine diphosphate-glucuronoxyltransferase) - unconjugated hyperbilirubinemia b/c no conjugation of bilirubin with glucuronic acid - fatal within 18 months due to kernicterus
How is Dubin-Johnson syndrome characterized?
AR: defective hepatobiliary transport of certain organic anions - Conjugated hyperbilirubinemia - BENIGN
What OTC drug is contraindicated in gout patients?
ASPIRIN - b/c, at low doses it competes with uric acid for excretion
What are the liver enzyme levels in alcoholic hepatitis?
AST:ALT ratio >1.5 & normal alkaline phosphatase
What drug binds to the glycoprotein receptor IIb/IIIa on activated platelets & prevents fibrinogen from binding & therefore interfers with platelet aggegation?
Abciximab Rx: acute corinary syndrome & angioplasty
Why does diabetic retinopathy result in neovascularization?
Abnormal proliferation is due to impaired autoregulation of retinal blood flow
What drugs are preferred for treating hypertension in pregnancy?
About the ABC of Water. Yes, the fetus needs water to survive: - Alpha-methyldopa (methyldopa for materal use!) - Beta blockers, especially labetalol - CCBs - Hydralazine (IV for eclampsia)
What is a broad definition of acute renal failure?
Abrupt decline in renal function + increased creatinine and BUN over a short period of several days
What are symptoms of Reye's syndrome?
Abrupt onset of nausea & vomiting Followed by encephalopathy & jaundice Cause: fatty infiltration of liver b/c of impaired mitochondrial metabolism of fatty acids due to ASPRIN administration to a CHILD
What characterizes the optical pathology of Horner's syndrome?
Abscence of norepinephrine & no stimulation of the ciliary muscle: NO DILATION
What is the pathogenesis of throbotic thrombocytopenic purpura?
Absences of von Willebrand factor protease & there is hemolysis due to shear trauma in the vessels
What is thickened & hyperpigmented skin on the back of the neck & axillae?
Acanthosis nigricans: can be found in patients with diabetes, obesity, & GI malignancies
What is the normal physiology of an erection?
Accelerated blood flow increases pressure within the intracavernosal spaces & this blocks penile venous outflow. - abnormalities in venous outflow (e.g.e leak from dorsal vein to saphenous vein) can result in failure to attain &/or maintain an erection
What are the classic lab values of prerenal azotemia?
Accumulation of BUN & Cr in blood: - BUN rises out of proportion to Cr (Cr is filtered, no reabsorbed) = elevated BUN: Cr ratio
What are the symptoms of PMR associated with giant cell arteritis?
Aching of proximal muscles & girdle stiffness
What are premalignant, hyperkeratoic areas with surrounding erythema that often preceded the development of squamous cell carcinoma?
Actinic keratoses
How do Histamine & vasopressin act on target cells?
Activate phospholipase C, resulting in cleavage of phosphatidylinositol diphosphate to inositol triphosphate & diacyglycerol
What are the 2 most common porphyrias?
Acute intermittent (AIP) Porphyria Cutanea tarda (PCT)
Why do obese patients often have hyperestrogenism?
Adipose contains aromatase that converts androgens into estrogens
What is the most common cause of Conn's Syndrome?
Adrenal adenoma: increased aldosterone Histo: lipid-laden clear cells in a well-circumscribed adenoma
What cancer does the Human T-cell lymphotropic virus cause?
Adult T-cell leukemia
When is atropine indicated for heart therapy?
Advanced cardiac life support to block parasympathetic input to the heart: - Increases heart rate
What is the function of a desmosome?
Aka: Spot-adhering junction - Contents: keratin & desmoplakin (desmoglein), actin, & E-cadherin - Function: joins small, discrete sections of neighboring cells
What causes bilateral acoustic neuromas?
Aka: vestibular schwannomas Cause: Neurofibromatosis Type 2 - Mutation of the summor suppressor on Chromosome 22q Symptoms: hearing loss, headache, tinnitus, vertigo
What selective B2-agonists end in -buterol?
Al, Leva, Pir Rx: Asthma
What disorder is characterized by black urine (especially after long periods of standing) & arthralgias?
Alkaptonuria (deficiency of homogentisic acid oxygenase)
To which class of drug do busulfan, nitrosoureas, & cyclophosphamide belong?
Alkylating agents that bind to & disrupt DNA = antineoplastic
What is Busulfan used for?
Alkylator used to treat CML
What muscles does the hypoglossal nerve innervate?
All intrinsic & extrinsic tongue muscles (except the palatoglossus, which is innervated by the vagus & helps to raise the back of the tongue)
What is the pathological process of interstitial nephritis?
Allergic/Infective/Immunological disorder: inflammatory process that results in infiltration of the interstitum of the kidney with polymorphonuclear leukocytes & lymphocytes
What drug is used to treat acute tumor lysis syndrome?
Allopurinol
What drug is used to prevent &/or treat tumor lysis syndrome associated with chemo for rapidly growing leukemia/lymphoma cells?
Allopurionol: - inhibits xanthine oxidase to decrease hyperuricemia when DNA synthesis is inhibited
What are the endocrine hormones of the pancreas?
Alpha Cells: glucagon Beta islet Cells: insulin Delta islet cells: somatostain
What is the only adrenergic receptor that acts through a Gq mechanism (& increased DAG/IP3/Ca2+)
Alpha-1
What adreneric receptor is the only one to result in decreased cAMP?
Alpha-2: Gi = decreased cAMP
What is seen in pulmonary alveolar proteinosis?
Alveolar filling with proteinaceous material
What antiviral is also prescribed for Parkinson's? What is its MOA?
Amantadine (Rx: influenza & rubella): - Dopamine agonist: Promotes the synthesis, release, or reuptake of dopamine - SE: ataxia, dizziness, & slurred speech - Overdose: TOXIC PSYCHOSIS
What is the MOA of streptomycin?
Aminoglycoside that binds the 30S subunit & inhibits protein synthesis. Tox: neuromuscular blockade & ototoxicity
What antibiotic drug groups are known to cause ototoxicity?
Aminoglycosides Vancomycin
What drugs are notorious for their nephrotoxicity?
Aminoglycosides Vancomycin
What drugs, especially in combination, cause ototoxicity?
Aminoglycosides Vancomycin
What builds up in the urine when a patient has lead poisoning
Aminolevuline & coproporphrin III b/c of the inhibition of aminolevulinate dehydratase & ferrochelatase enzymes of the heme synthesis pathway
What enzyme in heme synthesis can be inhibited by heavy metal poisoning?
Aminolevulinic acid dehydratase - Elevated aminolevulinic acid & anemia
What antidepressance can cause the 3 "C"s (Coma, Convulsions, Cardiotoxicity)?
Amitriptyline (TCA) - can also cause sedation, confusion, memory loss, & mania
What is the DOC to treat cellulitis?
Ampicillin (beta-lactam antibiotic)
What is Placenta accretia?
An abnormally strong adherence of the placenta to uterine weall - Placental villi attach directly to the myometrium due to a defect in the decidua basalis layer
What is Ortner's syndrome?
An enlarged left atrium compresses the left recurrent laryngeal nerve: - Causes hoarseness - Is a branch of the vagus & innervates on "glossus", the palatoglossus
What causes the extrapyramidal adverse effects of antipsychotics?
An imbalance in dopamin & muscarinic receptor antagonism: - Dystonia (abnormal postures due to sustained & prolonged contraction of agonist/antagonist muscles) - Akinesia: absence of movement - Akathisia: restlessness that is relieved by movement - Tardive dyskinesia: involuntary choreiform movements of the lower face (e.g. rhythmic protrusion of the tongue, lip smaking, chewing)
What is the short-term compensation for high-altitude hypoxia?
An increase in 2,3-diphosphoglycerate (2,3-DPG) to release more O2 to tissues) - This causes an increase in the P50 (partial pressure of O2 at 50% saturation of hemoglobin) and a right shift in the hemoglobin-O2 curve
What is the histology of polymyositis?
An infiltrate of CD8+ T-lymphocytes & macrophages surround & destroy healthy muscle fibers - SPARES the extraocular & facial expression muscles - Progressive symmetric muscle weakness that is often subacute
What is the Schilling test?
An infusion of exogenous Intrinsic factor (usually produced by gastric parietal cells) that will enable vitamin B12 absorption and then radiolabelled B12 will be found in the urine: - Confirms a diagnosis of pernicious anemia
What is clindamycin used for?
Anaerobics: (often combined with an aminoglycoside) - penetrating wound infections of abdomen - UTIs in women
At what point in meiosis does trisomy 21 occur (i.e. the nondisjunction)?
Anaphase I or II (mitotic spindle unequally separates 21, usually in the mother's gamete)
What drug often given to treat breast cancer in postmenopausal woman can cause Steven-Johnson syndrome?
Anastrozole (aromatase inhibitor)
What is the pathogenesis of the tetralogy of Fallot?
Anterosuperior displacement of the infundibular septum during development in utero: - overriding aorta - pulmonary stenosis - right ventricular hypertrophy
What is the sensitive & specific serological diagnostic test for Rheumatoid arthritis?
Anti-CCP (citrulline-containing protein) antibodies
What is the action of Bcl-2 & bcl-x?
Antiapoptotic: prevents the release of cytochrome c & stops it from binding to APAF-1 & activating the caspase cascade
What is the MOA of Azathioprine?
Antimetabolite derivative of 6-mercapopurine - Interferes with the metabolism & synthesis of nucleic acids - Toxic to proliferating lymphocytes Rx: immunosuppression for autoimmune disorders (e.g. glomerulonepritis, hemolytic anemia) or with kidney transplants SE: Hyperglycemia
What is methotrexate used for?
Antimetabolite that inhibits dihydrfolate reductase in the S phase b/c it is structurally similar to folic acid: decreases purine nucleotide synthesis carcinoma leukemia trophoblastic disease rheumatoid arthritis ectopic pregnancy psoriasis abortifactant
What personality disorder presents with a complete disregard for the rights of others & criminal behavior?
Antisocial
What is Lorazepam used to treat?
Anxiety disorders
What are the cluster C personality disorders?
Anxiour or worried with abnormal fears about relationships, separation, & control: 1) Avoidant 2) Obsessive-compulsive 3) Dependent
Which bareoreceptor (in the carotid sinur or aortic arch) only responds to an INCREASE in Bp?
Aortic arch
What are the derivatives of the 4th aortic arch?
Aortic arch on the left Proximal right subclavian
What selective alpha2 agonists are used to treat open-angle glaucoma?
Apraclonidine & Brimonidine
What drug is used prophylactically to prevent blood loss in cardiothoracic surgery? What is its MOA?
Aprotinin: slows bleeding by blocking plasmin - Also inhibits streptokinase
What are the common physical findings in Rickets?
Areas of bone growth: - wrists (widened) - ankles (widened) - costrochondral junctions (rachitic rosary) These are all unmineralized, soft oseoid
What viral families have single-stranded, circular RNA?
Arenaviruses Bunyaviruses Deltaviruses
What cells maintain the BBB?
Astrocytes
What is the histological difference between an anaplasitc astrocytoma and a glioblastoma?
Astrocytoma lacks necrosis and vascular or endothelial cell proliferation
What musculoskeletal problem can be due to lithium use?
Ataxia: incoordination
What male-specific problem can arise due to familial hypercholesterolemia?
Atherosclerosis of the vessels of the male genitalia can cause erectile dysfunction
What is the antidote for acetylcholinesterase inhibitor overdose?
Atropine (muscarinic antagonist)
What is the MOA of Clozapine?
Atypical antipsychotic that blocks serotonin & dopamine receptors (D1 & D2) SE: agranulocytosis & seizures in nonepileptic Px
How is autoimmune hemolytic anemia differentiated from hereditary spherocytosis?
Autoimmune hemolytic anemia will have a positive direct Coomb's test
What is a common complication of CLL (chronic lymphocytic leukemia)?
Autoimmune hemolytic anemia with warm antibodes
What is the inheritance pattern for hereditary spherocytosis?
Autosomal dominant defect in spectrin protein of erythrocyte membranes - increased mean corpuscular hemoglobin concentration - large RBCs w/o a central pallor - Dx: osmotic fragility test - late complications: bilirubin gallstones & cholecystitis
What is the genetics of myotonic dystrophy?
Autosomal dominate with a CTG trinucleotide repeat with anticipation E.G. a mom with a 50-100 repeat can have a symptomatic child with a 1000-1500 repeat
What is DOC in a penicillin-allergic patient with a pseudomonal infection?
Aztreonam: inhibits cell wall synthesis
What is Waldenstrom's macroglobinemia?
B-cell neoplasm secreting lg. amounts of IgM: - headaches & vision problems (impaired crania blood flow) - weakness - weight loss - increased bleeding (due to inhibited clotting factors) - monoclonal M spike on serum protein electrophoresis (lg. spike in the gamma region)
Why does a molar pregnancy present with hyperthyroidism?
B-hCG has a alpha subunit shared with TSH & can sometimes cross-react with the TSH receptor
What does an increase in hemoglobin A2 indicate?
B-thalassemia minor = hypochromatic, microcytic anemia
What is the pulmonary vascular response to increased altitude?
B/C barometric pressure decreases, there is a decrease in alveolar partial O2 pressure. - This causes hypoxic vasoconstriction in the pulmonary vessels - This increases pulmonary arterial pressure (i.e. pulmonary vascular resistance) - If prolonged = Right heart hypertrophy
How do GnRH agnonists like Leuprolide act to reduce FSH & LH release in hormone-responsive prostate or breast cancer?
B/C the drug is not giving the physiological GnRH pulses, FSH & LH are downregulated after an initial burst.
What is the symptomatic difference between folic acid & B12 deficiency?
B12 has neuro in addition to megaloblastic anemia
Which vitamin is FADH2 derived from?
B2 (riboflavin): participates in the electron transport chain - FADH2 is generated when succinate is oxidized to fumarate
What vitamin is necessary for NADPH production?
B3 (niacin): used to make fatty acids & steroids & respiratory burst in WBCs (recycling of glutathione in RBCs) - Glucose 6-phosphate dehydrogenase requires B3 & it is the rate-limiting step in the O2 portion of the pentose phosphate pathway
What is the difference between Wernicke's encephalopathy & Korsakoff's pscyhosis
BOTH: B1 deficiency Wernicke's is reversible: - ataxia - confusion - nystagmus Korsakoff's is permanent (lesion in the mamillary bodies): - anterograde amnesia - confabulation - personality changes
What is the clinical use of TamsUlosin?
BPH "FLow of urine will reach its MAX once TAM (Tight, Alpha1A dominat Muscle in the lower UI) is SO LOOSe IN tone" - blocks alpha1A receptors in the prostate - SE: Ejaculation disorders
What is the clinical use of AlfUzosin?
BPH: preferentially acts on the lower Urinary tract, Alpha1 blocker
What neuroexam finding can indicate hypomagnesemia?
Babinski's sign
What bacteria has a capsule made of D-glutamate
Bacillus anthracis
What causes wollsorters' disease?
Bacillus anthracis (Gram +, aerobic, spore-forming rods) inhalation
What presents with an unpleasant, fishy-smelling vaginal discharge that is thin, gray-white & homogenous?
Bacterial vaginOSIS Dx: clue cells (bacteria coating epithelial cells)
What is the mechanism of action of aminoglycosides like gentamicin?
Bactericidal: inhibit formation of the initiation complex & cause misreading of mRNA - require O2 for uptake (ineffective against anaerobes) - Use: severe gram - rod infections - Tox: nephrotox, Oto, teratogenic
What anaerobe is a major colonizer of the colon?
Bacteroides
What anaerobic bacteria infection can result in pseudomembranous colitis when treated with Clindamycin?
Bacteroides Fragilis
What bac is the cause of cat scratch?
Bartonella henselae
What skin cancer is described as "pearly papules with overlying telangiectasias"?
Basal cell carcinoma
What is the function of the nigrostriatal tract?
Basal ganglia involved in movement production: - antagonism of D2-Receptors results in Parkinson-like movement & tardive dyskinesia (typical antipsychotics act here)
Where is the GLUT-2 receptor?
Basal surface of intestinal cells & transmits glucose into the blood
Unpack the mneumonic "B-FLAT Major" for the cells of the pituitary gland cells.
Basophilic: FSH LH ACTH TSH MSH
What is the etiology of renal insufficiency in Multiple myeloma patients?
Bence Jones proteins (antiboy light chains) result in renal damage by forming large, tubular casts that obstruct the renal tubular lumina & induce inflammation.
What is tertiary gain?
Benefit that the care provider derives from treating the sick individual
What is the initial DOC for generalized anxiety disorder?
Benxodiazepines
What fractional excretion of Na indicates intrarenal renal failure?
Between 2 & 4%
Where is the potential space in the pericardium?
Between the visceral & parietal layers
What is Waterhouse-Friderichsen syndrome?
Bilateral necrosis & hemorrhage of the adrenals cause by infection with N. meningiditis Dx: high potassium level, low Na, & no increase in serum cortisol level in response to ACTH administration Rx: cephalosporin, penicillin, chloramphenicol & glucocoritcoid replacemtn therapy with hydrocortisone
What is another name for Potter's syndrome?
Bilateral renal agenesis: - disruption in the interaction between the ureteric bud & the metanephrogenic tissue - fetus does not produce urine & t/f there is a lower amount of amniotic fluid (oligohydramnios) -> - Hypoplasia - Fetal compression with altered facies - Positioning defects of hands & feet
What is the action of resins (cholestyramine & colestipol)?
Bind bile acids and steroids in the small intestine & prevent their absorption
What is the MOA of polymxins?
Bind to Gram - bacterial cell membrane phospholipids & act like a detergent
What is the mechanism of insul & insulin analogs?
Bind to insulin receptor on cell membranes that activate tyrosine kinase that leads to glucose absorption. - Result: increased glycogen storage in the liver & glycogen & protein synthesis in muscle
How does norepinephrine act on target cells?
Binding to & activating adrenergic receptors
What is the MOA of lipopolysaccharidea (LPS)?
Binds & activates toll-like receptor 4
What is the MOA of Doxycycline?
Binds the 30S ribosomal subunit and prevents aminoacyl-tRNA attachment
What is the toxicity of Cyanide?
Binds the Fe3+ of cytochrome oxidase a3 & prevents the last enzyme of oxidative phosphorylation & ATP production?
What is the MOA of Dactinomycin?
Binds to & intercalates with dsDNA to prevent RNA synthesis (particularly rRNA)
What is the receptor MOA of PTH on the kidney?
Binds to basolateral hormone receptor in the proximal tubule cells that is coupled to adenylate cyclase via a Gs protein - Increased renal Ca reabsorption - Increased urinary cAMP - Phosphaturia
What is the toxicity of Antimycin A?
Binds to cytochrome c reductase & prevents further continuation of the electron transport chain in ATP synthesis.
What is the mechanism of the alpha toxin of S. aureus and Streptolysin O of S. pyrogens?
Binds to the membrane and allows ions and small molecules to enter the cell. This leads to swelling & eventual cell lysis.
What vitamin is needed as a cofactor for the conversion of propionyl coenzyme A to methylmalonyl coenzyme A?
Biotin
What selective B2-agonists end in -terol?
Bitolterol Formoterol (long-acting) Salmeterol (long-acting) Rx: asthma
Describe the Measles rash.
Blanching red that starts on the face & then moves down the trunk & limbs + fever
What are the most common fungal causes of pneumonia?
Blastomyces Coccidioides Histoplasma
How does Abruptio placentae present?
Bleeding with uterine contractions
What is the common MOA of cocains and tricyclic antidepressants?
Block reuptake of catecholamines into the presynaptic terminals
What is the MOA of Phenytoin?
Blocks Na channels & inhibits the generation of action potentials Rx: partial & generalized seizures SE: nystagmus, diplopia, lethargy, ataxia, tubulointerstitial nephritis (Up Cr), Up tox with anything that inhibits microsomal enzymes in the liver (e.g. cimetidine)
What is the MOA of Lidocaine as an anesthetic?
Blocks Na channels on neuronal membranes to reduce sensory impulse conduction from the periphery to the CNS - Nerve Sensitivity: 1) small > large 2) myelinated > unmyelinated
What is the MOA of Flutamide?
Blocks androgen receptors & prevents the body from usng sex steroids
What is the MOA of Reserpine?
Blocks catecholamine storage within the presyaptic neuron by preventing storage withing the presynaptic vesicles
What is the MOA of tentus toxin?
Blocks release of glycine from Renshaw cells in the spinal cord & results in "lockjaw" - Early symptoms: risus sardonicus (muscle spasm-induced grimace), poor prognosis, and opisthotones (severe hyperextension of the head, neck, & back)
What is the MOA of Carbamazepine?
Blocks repetitive activation of Na-channels
What is the MOA of Imatinib mesylate?
Blocks the ATP-binding site on the bcr-abl tyrosine kinase domain & is used to treat CML.
What is an indirect Coombs' used to assess
Blood compatibility (before a transfusion): detects unbound antibodies that can bind to RBCs from a normal, healthy doner.
What does the portal vein carry?
Blood from the alimentary canal, spleen, & pancreas to hepatic cells
What type of sputum is indicative of hosptial-acquired or alcoholic pneumonia?
Bloody sputum resembling dark jelly; caused by gram - rods: - Klebsiella pneumoniae - Psuedomonas - Enterobacter
What personality disorder presents with violent swings in affect, recurrent suicidal ideation, impulsivity, self-mutilation, & strained interpersonal relationships?
Boarderline
What are the principle functions of thyroid hormone in development?
Bone Growth CNA maturation
What neuro exam finding indicates a conductive hearing loss?
Bone is more effective than air conduction through the blocked ear canal (e.g. cerumen) or sclerosis of the ear ossicles or perforated membrane
What infection is characterized by relapsing fevers (~5 days of fever with ~ 1 week between episodes)?
Borrelia burgdorferi (spirochete): fever pattern is due to its ability to undergo antigenic variation
What are the signs of congenital syphilis?
Broad-based ataxia Positive Romberg Charcot joints Stroke w/o hypertension
What results from injury to the left posterior inferior frontal lobe?
Broca's (expressive aphasia) & (sometimes) brachiofacial weakness
What is damaged when a Px presents with expressive aphasia?
Broca's area (inferior frontal gyrus) NB: this is near the primary motor cortex, so lower arm & face paralysis can also occur.
What is commonly used to treat neuroleptic malignant syndrome?
Bromocriptine (a dopamine agonist to restore the depletion of dopamine signaling caused by drugs like haloperidol that blocks dopamine receptors)
What does RSV cause?
Bronchiolitis: gradually developing respiratory distress & paroxysmal wheezing
What infection causes undulating fever (peaks in the evening & falls at nighttime)?
Brucella (contaminated milk or direct livestock contact)
Where are Yersinia pestis buboes located?
Buboes (painful, enlarged lymph nodes) in the groin & armpits. - then can enter bloodstream and cause sepsis, DIC, pneumonia or meningitis
What type of fracture is caused by compression and results in a bulging or buckling of the periosteum?
Buckle: usually caused by accidents
What are the amide-type local anesthetics?
Bupivacaine Etidocaine Lidocaine Prilocaine
When is atrial natriuretic peptide secreted?
By the atria in response to increased extracellular fluid volume & causes dilation of the glomerular afferent arterioles
What are 3 examples of acute-phase proteins?
C-reactive protein Mannose-binding Lectin Pulmonary surfactant proteins - All produced by the liver - All are opsonins & activate complement
What are the key dermatome locations for the following disc locations: C2 C3 C4 T4 T7 T10 L1
C2 = head (covers the poserior 1/2 of a skull cap) C3 = upper neck C4 = between neck & shoulders T4 = nipples "T4 at the teat pore" T7 = xiphoid process T10 = umbilicus L1 = inguinal ligament (Oblique in shape)
What nerve roots contribute to the axillary nerve?
C5-6 (posterior cord branch)
What would a C5-C6 herniation result in?
C6 nerve root problems: -weak wrist extensors & biceps - Absence of right bicep & brachioradialis relex - Sensory: 1st & 2nd fingers
What is the tumor marker for breast cancer?
CA-15-3
What is the physiology of high fat food pain in patients with gallstones?
CCK (cholecystokinin) is released in the duodenum after a fatty meal (& amino acids) to induce gallbladder contraction & thus the stone obstruction causes pain.
What cells are the main effectors that mediated acute allograft rejection?
CD8+ T lymphocytes
What nerve is damaged when the eye appears "down & out"?
CNIII (occular motor): - Loss of superior & inferior rectus, inferior oblique muscles - Dominance of superior oblique & lateral rectus - Ptosis: loss of levator palpebrae superioris - Dilated pupils due to loss of parasympathetic fibers (unless the damage is an infarction)
What is the toxicity of Ephedra?
CNS & cardiovascular stimulation, arrhythmia, stroke, seizures
What is characteristic of MS (anatomical changes & symptoms)?
CNS demyelination with neurologic lesions within the white matter - S/S that are separated in time & anatomic location - Can have difficulty urinating or incomplete voiding - IMPORTANT: episodic symptoms last >24 hours; MRI: periventricular plaques in >90% of Pxs
What are the common symptoms of Multiple Myeloma?
CRAB: hyperCalcemia Renal insufficiency/failure Anemia Bone/Back pain (lytic lesions)
What do elevated levels of anticentromere antibodies indicate?
CREST variant of scleroderma
What is albuminocytologic dissociation?
CSF: increased protein concentration with normal cell count in the setting of normal glucose - Indicates GBS (Guillain-Barre Syndrome)
What is deposited in joints in pseudogout?
Ca pyrophosphate dihydrate crystals in CONNECTIVE tissues: weakly bifringent & rhomboidal in shape
What are the main causes of aortic stenosis?
Calcified valve Congenital bicuspid aortic valve Rheumatic heart disease
Which of the following are radiopaque? Calcium, Ammonium, Magnesium, NaCl, Uric Acid
Calcium
What type of renal calculi are Crohn's patients at risk for?
Calcium oxalate: B12 absorption is compromised & oxalate absorption is enhanced.
What bacteria presents with abdominal cramps, fever, & bloody diarrhea? (There are C-shaped organisms on stool analysis)
Campylobacter jejuni (Rx: erythromycin) - Untreated: Guillain-Barre syndrome - acute symmetric ascending muscle weakness with parethesias that begins in the lower extremities that results from an inflammation & demyelination of peripheral nerves
What causes a late-onset food poisoning with bloody diarrhea after eating reheated rice?
Campylobacter jejuni: enterocolitis Rx: erythromycin or ciprofloxacin
What is spironolactone used to treat (besides hypertension)?
Can be used to treat Conn's (primary hyperaldosteronism) - It is a potassium-sparing diuretic & also competitively inhibits the mineralcorticoid receptor - It is a steroid
What extra problem is associated with ovarian teratomas?
Can contain thyroid tissue (struma ovarii) & cause a hyperthyroid state
What drugs are contraindicated for treating hypertension in pregnancy?
Can't be ADded due to the risk of endangering fetus by losing water: ACEIs (fetopathy risk) ARBS (fetopathy risk) Diuretics (use with caution)
What causes intense pruritis with a thick, odorless, white, cottage cheese-like vaginal discharge?
Candida: buddy yeasts & hyphae on wet mount
What is the treatment for Enterobacter species?
Carbapenems (i.e. imipenem & meropenem) when resistant to penicillin/penicillinase via B-lactamase
What substance is formed in CO poisoning?
Carbon monoxyhemoglobin
What is the only human glycerophospholipid that is antigenic?
Cardiolipin (Diphosphatidylglycerol): it is recognized by antibodies against Treponema pallidum
What are the catalase and coagulase properties of S. epidermis?
Catalase-positive Coagulase-negative
What are the catalase, hemolytic, and coagulase properties of S. aureus?
Catalase-positive Coagulase-positive B-hemolytic
How is congenital rubella infection characterized?
Cataracts Glaucoma Pigmented retinopathy Cardiac malformations Deafness
What is the MOA of Beomycin?
Causes the formation of free radicals after binding DNA, which causes single- & double-strand breaks within the DNA
What is the radiographic picture of Staphlococcus aureus pneumonia (rare)?
Cavitations &/or abscesses within the lung fields
What is the treatment for gonococcal arthritis?
Ceftriaxone
Which anti-inflammatory drug is best to avoid gastric side effects?
Celecoxib: selective COX-2 inhibitor - decreases conversion of arachiodonic acid to prostaglandin G2 - Prescribe with caution due to heart side effects
What 2 diseases are associated with HLA-B8?
Celiac disease Dermatitis herpetiformis
What are oxyphils?
Cells of the parathyroid gland
Where can patients contract Chagas disease?
Central & South America via the reduvidd bug - chagomas (dermal granuloma) - myocarditis - CHF if not treated Chronic: arrhythmias, dilated cardiomyopathy, megacolon, megaesophagus
Which form of diabetes insipidus will be corrected by exogenous ADH administration?
Central DI
What is a neural complication of overaggressive treatment of hyponatremia (correction of the Na level at a rate faster than 1mEq/L/Hr)?
Central pontine myelinolysis (Osmotic demyelination): rate of osmolarity outstrips the brain's ability to adapt to the rising osmolarity -> neuronal shrinkage & death Clinical: dysarthria, dysphagia, flaccid quadriparesis (can lead to spastic or locked-in syndrome)
What drug group has a disulfiram-like reaction with alcohol use?
Cephalosporins (cefamandole, cefotetan, cefoperazone, cefmetazole)
What do intention tremors & ataxia indicated?
Cerebellar disease (e.g. with MS)
Where is the Rb gene?
Ch. 13
Where is the NF-1 gene?
Ch. 17
Where is the NF-2 gene?
Ch. 22: merlin tumor suppressor gene is mutated
Where is the APC gene?
Ch. 5
What causes secondary Achalasia?
Chagas' diseases (T. cruzi): destruction of the myenteric plexus of the esophagus - Dx: bird's beak on barium swallow (proximal constriction of the esophagus)
What 3 channels can be defective in Brtter's syndrome?
Channel dysfunction causes hypokalemia & metabolic acidosis: 1) Na+/K+/2Cl- (NKCC) 2) K+ channel 3) Cl- channel All in the thick ascending limb (where loop diuretics act)
What agar is used to cuture Legionella pneumophilia?
Charcoal yeast extract with increased iron & cysteine
How can you definitively diagnose a B12 deficiency?
Check methylmalonic acid levels: - B12 is a cofactor for the conversion of of Methylmalonyl CoA to succinyl CoA - Without B13, Methylmalonyl CoA is converted to methylmalonic acid
What is Dimercaprol used to treat?
Chelator of arsenic, mercury, gold, or lead
What is Succimer used to treat?
Chelator of arsenic, mercury, gold, or lead
What antibiotics inhibit the 50S subunit?
Chloramphenicol Erythromycin Clindamycin Linezolid
What drugs cause aplastic anemia?
Chloramphenicol Sulfonamides Alkylating agents
What drug causes gray baby syndrome?
Chloramphenicol (also causes aplastic anemia)
What 2 antipsychotics have the highest rist of neuroleptic malignant syndrome?
Chlorpromazine Haloperidol
What can cause hydrocephalus via CSF overproduction?
Choroid plexus papilloma
What 3 diseases are associated with HLA-DR3?
Chronic active hepatitis Sjogren's syndrome Type 1 diabetes mellitus
How is dementia characterized?
Chronic condition of cognitive decline with an INTACT level of consciousness
What syndrome is associated with montelukast (Asthma med)?
Churg-Strauss (autoimmune vasculitis)
What causes atypical pneumonia in those recently exposed to a bird?
Chylamydia psittaci (intracellular parasite w/o cell wall) Rx: 10-day course of doxycycline or tetracycline
In diseases that cause a decrease in intestinal cells, what step of lipid digestiong & absorbtion is impaired?
Chylomicron formation, this step occurs within the intestinal cells (reestrification)
What H2-blocker is associated with antiandrogenic effects? Which is NOT?
Cimetidine: gynecomastia & impotence Ranitidine: no such SE
What intermediate of the TCA cycle inhibits the rate-limiting enzyme of glycolysis & activates the rate-limiting enzyme of fatty acid synthesis?
Citrate - inhibits phosphofructokinase - activates acetyl CoA arboxylase
What is the formula for Clearance of Inulin (aka: GFR)?
Cl = (Urine inulin)(Urine volume) / (Plasma inulin)
What G proteins or channels are GABAa & GABAb receptors linked with?
Cl- channel, Gi "ABCi"
What is the DOC for H. ypylori infection?
Clarithromycin, amoxicillin, & PPI - 14 day regiment OR Metronidazole, tetracycline, bismuth subsalicylate, & PPI
What class of antiarrhythmics is Lidocaine?
Class Ib: - it blocks sodium channels & decrease action potential duration - selective for ischemic or depolarized purkinje & ventricular tissue Other Ib: mexiletine & tocainide
What is the liver histological picture of a chronic alcoholic?
Clear, macrovesicular globules of hepatic steatosis - Grossly: large, yellow, & greasy - Reversible
How does Cocaine-induced hepatitis present?
Clinical: Acute subfulminant hepatitis Histo: necrosis & microvesicular steatosis
What sympatholytic drugs are selective alpha-2 agonists?
Clonidine alpha-Methyldopa Guanabenz Guanfacine Apraclonine Brimonidine
What are the physical findings that indicate I-cell disease?
Coarse facial features Developmental delay Restricted joint movement Histo: intracytoplasmic inclusions in mesenchymal-origin cells.
Damage to what muscle can lead to postpartum urinary incontinence?
Coccygeus or levator ani (together = pelvic diaphragm)
What drug is used to treat acute gout?
Colchine: depolymerizes microtules to limit the inflammatory response to urate crystals
What are the derivatives of the 3rd aortic arch?
Common carotid artery Proximal part of the internal carotid
What is the MOA of heparin?
Complexes with Antithrombin II and increases its activity by 2000-fold
What is the pathogenesis of midgut volvulus?
Complication of intestinal malrotation in the 1st month of life when the midgut rotates less that 270 degrees (between week 10 & 12)
Why do injection drug users have a higher risk for hepatocellular carcinoma (HCC)?
Concomitant increased risk for Hep B & C, which are the direct cancer risk factors
What do antinuclear antibodies often indicated?
Connective tissue diseases like SLE
What is characterized by small, firm, umbilicated, skin-colored, pearly-white papules?
Contangious molluscum contagiosus virus skin manifestation
What is one of the 1st signs seen in a post-MI biopsy within 12 hours of the infarction?
Contraction bands @ the margin of the necrotic area due to elevated intracellular calcium & the resultant hypercontraction.
How does a cerebrovascular event of the middle cerebral artery (MCA) present?
Contralateral motor & sensory deficits that are greater in the face & arms than the leg
What is type 2 5apha-reductase for?
Conversion of testosterone to dihydrotestosterone in the prostate & genital target tissues
What is type 1 5alpha-reductactase for?
Conversion of testosterone to dihydrotestosterone in the skin
What does 17alpha-hydroxylase do?
Converts pregnenolone & progesterone to 17alpha-hydroxypregnenolne & 17alpha-hydroxyprogesterone respectively - Deficiency leads to increased sex hormone levels, decreased corisol levels & increased mineralocorticoid levels
What 2 enzymes are needed to produce cortisol? sex hormones?
Cortisol: 21beta-hydroxylase 17alpha hydroxylase Sex: 17alpha hydroxylase
What is seen in pathologica preparations of herpes zoster skin rashes?
Cowdry A inclusion bodies: eosinophilic inclusions surrounded by a clear halo
What organism causes Q fever?
Coxiella burnetti (a rickettsial org) - transmitted by aerosolized endospores - Q fever: high fever, headache, shaking malaise, myalgia - Can cause a life-threatening endocarditis (esp, if Px has abnormal heart valves)
What causes hand, foot, & mouth disease?
Coxsackie A (RNA virus)
What are the ocular manifestations of a Berry aneurysm?
Cranial nerve (CN III) compression due to the rupture of a thin-walled outpouching at a cerebral arterial branch point (anterior cerebral & communicating) - parasympathic fibers are compressed and this results in dilated, unreactive pupils (palsy)
What heart murmur is associated with congenital bicuspid aortic valves?
Crescendo-decrescendo sytolic ejection following an ejction click: aortic stenosis (resulting from valvular calcification)
What does a patient with chronic, intermittent abdominal pain, diarrhea, fever, & megoblastic anemia likely have?
Crohn's
What paraneoplastic syndrome is produced by small cell carcinoma?
Cushing's syndrome (ectopic ACTH)
What is overexpressed in Mantle cell lymphoma?
Cyclin D1 (proto-oncogene)
Why are CF males infertile?
Cystic fibrosis causes a bilateral absence of the vas deferens
How is T. gondii transmitted?
Cysts in raw meat Cat feces
What is Ganciclovir used for?
Cytomegalovirus
Where is lactate dehydrogenase located within the cell?
Cytoplasm
What change in gram + structure results in vancomycin resistance?
D-ala D-ala to D-ala D-lac amino-acid change for the cell wall inhibitor that vancomycin targets
What is the treatment for Wilson's?
D-penicillamine: promotes urinary copper excretion 2nd choice: copper chelators (e.g. Deferoxamine) Plasmapheresis if Px has fulminant hepatic failure
What builds up iwn 3-beta-hydroxysteroid dehydrogenase deficiency?
DHEA (Dehydroepiandrosterone) & pregnenolone due to this form of congenital adreanl hyperplasia
What are the side effects of Busulfan?
DNA alkylator - PULMONARY FIBROSIS - hyperpigmentation - bone marrow suppression - GI & CNS: insomnia, anxiety, headache
What type of virus is Hep B?
DNA hepadnavirus (enveloped, circular DNA)
What is the toxicity of Doxorubicin?
DNA intercalator that leads to strand breaks (Rx: breast cancer) - Cardiotox (dilated cardiomyopathy) - Myelosuppression & alopecia
What is bacterial transformation?
DNA is taken up directly from the environment by a bac
What is bacterial transposition?
DNA segments can jumpt to various locations within a genome as well as in a plasmid & can then by passed on.
Why do vitamin B12 & folate deficiency cause megaloblastic anemia?
DNA synthesis is impaired & with fewer cell divisions & more cytoplasm is present = increase MCV & hypersegmented neutrophils
What is C7 radiculopathies?
Damage (usually via herniation) to the C7 nerve root: - Tricep weakness: elbow extension limited - Weakness in extension of wrist & fingers - Sensory: pain & paresthesia of the middle finger
What is the Conus medullaris syndrome?
Damage to the distal part of the spinal cord that presents with: - lax anal tone - Urinary retension - incontinence - impotence - Bilateral saddle anesthesia (S3-5) may be present
What is Gerstmann's syndrome
Damage to the visual association cortex (angular gyrus): 1) Inability to distinguish right from left 2) Inability to identify fingers 3) Agraphia 4) Acalculia or dyscalcuia
What is the fucntion of Transforming growth factor-Beta?
Dampens the immune response
What is used to treat endometriosis?
Danazol (androgen): to decrease GRH to reduce luteinizing hormone & FSH secretion (decrease growth of endometrium) SE: menstrual irregularities, thrombotic events, benign hepatic adenomas, benign intracranial hypertension (psuedotumor cerebri), weight gain, & acne
What results in D2-receptor antagonism by chlorpromazine in the mesolimbic tract?
Decrease in positive symptoms of schizophrenia (hallucination, delusions, & frank psychosis)
What 4 diseases are associated with an imbalance of ACh & Dopamine?
Decreased Ach: - Alzheimers - Huntington's Increased Dopamine: - Schizophrenia Decreased Dopamine: - Parkinson's
What lab value is the hallmark of obstructive lung disease?
Decreased FEV1:FVC ration (to < 80%) - also increased FRC & TLC (FEV1:FVC is normal or increased with restrictive lung disease b/c FVC is reduced along with TLV)
How does long term steroid use induce diabetes?
Decreased glucose tolerance & counterregulatory action of the hormone: - increase glucose production by the liver by stimulating glconeogenesis & proteolysis in the skeletal muscle to release glucogenic amino acides into the vasculature
What are the lab values for anemia of chronic disease?
Decreased serum iron Decreased TIBC Normal % saturation
What are the common lab findings in Rickets?
Decreased: Ca, PO3, vit D, alkaline phosphatase Increased: PTH
Does smoking increase or decrease the risk of endometrial cancer?
Decreases
What does 2,3-DPG do to the hemoglobin curve?
Decreases its affinity for O2 = right shift
What is the chromosomal source of von Hippel-Lindau disease?
Defect in the VHL gene on Chromosome 3
What is the mechanism of AIP (Acute intermittent porphyria)?
Defect in the enzyme PBG (3rd step in heme synthesis): porphobilinogen deaminase (aka: uroporphyrinogen I synthase) - Result: aberrant accumulation of ALA (aminoleuvlinate) & PBG - Symptoms: neurovisceral: abdominal pain, muscle weakness, & anxiety/paranoia/depression & high PBG in urine (severe: port wine urine)
What is the mechanism of Porphyria cutanea tarda (PCT)?
Defect in the enzyme URO decarboxylase (5th step in heme pathway): - aberrant accumulation of URO - deficiency is inherited or acquired (iron, alcohol, estrogens, Hep C or HIV) - Symptoms: photosensitivity, chronic, blistering lesions on sun-exposed skin, no neuropsychiatric signs
What type of virus is Hep D?
Defective RNA deltavirus (requires Hep B to serve as an envelope)
What are the symptoms of vitamin E deficiency?
Defective lipid absorption Premature infants: RBC membrane deposits
What defect often results in myelin sheath malformation?
Defective long-chain fatty acid metabolism: - Peroxisome disfunction (long-chain fatty acid catabolism, detox, & microbial killing)
What is erythropoeitic porphyria?
Deficiency of ferrochelatase (no iron incorporation into protoheme) - disorder begins in childhood with marked photosensitivity
What causes type 1 dyslipidemia?
Deficiency of lipoprotein lipase (in capillary walls of adipose & muscle tissues) - Normally this enzyme cleaves triglycerides into free fatty acids & glycerol - No activation of this enzyme by VLDL cholesterol (apolipoprotein C-II) or chylomicrons
What personality disorder presents with clingy behavior & constantly need to be taken care of?
Dependent
What does the P wave represent?
Depolarization of the atria (NOT contraction)
What is a SE of magnesium treatment for preeclampsia?
Depressed tendon reflex
What are the vectors for Rickettsia rickettsii?
Dermacentor andersoni & D. variabilis (ticks)
What is the Rubella of rash like?
Descending: starts on the face - fever before (& resolves) rash, lymphadenopathy
What can be used to treat moderate cases of von Willebrand disease or hemophilia A?
Desmopressin (ADH analog): improves platelet function and promotes the release of vonWillebrand factor & factor VIII
What drug is used as prophylaxis against doxorubicin-associated cardiomyopathy?
Dexrazoxane
What type of murmur is heard with a classic case of acute bacterial endocarditis?
Diastolic: dues to large vegetations on the ricuspid valve that impede flow through the valve
What is the DOC for status epilepticus?
Diazepam
How does atypical pneumonia present on chest exam?
Diffuse, patchy inflammation localized to interstitial areas at alveolar walls
What are the exocrine hormones of the pancreas?
Digestive enzyme: amylase, lipase, trypsin, chymotripsin - Acinar cells (large, eosinophilic cytoplasm, pyramidal-shaped, polar)
What is required for development of the penis & scrotum during embryogenesis?
Dihydrotestosterone via functional 5alpha-reductase to convert testosterone to dihydro... Deficiency causes phenotypical female with bilateral testes & male internal urogenital tract. @ puberty, external genitalia will be masculinized
If hydroxyamphetamine is given as an eye drop to diagnose a nerve lesion, what would a pupilary dilation indicate? What if there is no response?
Dilation: a problem from the preganglionic neuron: - since this drug initiates norepinephrine release in the postganglionic neuron, if the pupil dilates, then this neuron is not damaged and the problem is earlier in the pathway. No change: the problem is with the postganglionic neuron as it SHOULD dilate with this drug
What are the 1st symptoms of botulism in adults?
Diplopia & dysphatiga Cause: contaminated canned goods & smoked fish
What type of drug is Dopamine?
Direct sympathomimetic, non-selective D-agonist
Which Coombs test detects antibodies attached to RBCs & which detects antibodies circulating in serum?
Direct: antibodies on RBCs Indirect: antibodies in serum
What is the difference between direct and indirect bilirubin?
Direct: conjugated Indirect: unconjugated
What is the MOA of superantigens (like TSST-1 by S. aureus)?
Directly bind to & activates MHC-II & T-lymphocyte receptors
What is the MOA of Digoxin?
Directly inhibits Na+/K+ATPase, this indirectly inhibits the Na+/Ca2+ exchanger & increases intercellular calcium. - POSITIVE INOTROPY - Rx: CHF & atrial fib
What is an Arnold-Chiari malformation?
Displacement of the hindbrain through the foramen magnum - causes syringomyelia: damage to the crossing fibers of the spinothalamic tract & bilateral loss of pain/temp sensation in the upper extremities
How do NSAIDS cause peptic ulcer disease?
Disrupt the mucus barrier by inhibiting prostaglandin synthesis
How does surfactant reduce surface tension?
Disrupts intermolecular forces (hydrogen bonds) between molecules of water
What is Hydrochlorothiazide used to treat?
Diuretic: inhibits NaCL reabsorption @ distal tubule (blocks the Na-Cl symporter on lumina) & reduces Ca excretion (Increases Na gradient = upregulates Na/Ca antiporter & sends more Ca to interstitium & more Na into the cell) 1) Hypertension 2) Chronic kidney stones (due to hypercalciuria)
What are neuroleptics?
Dopamine receptor-blocking agents (e.g. haloperidol: central receptor blocker) - Used to treat positive symptoms of schizophrenia: illusions/hallucinations, delusions & ideas of reference, agitation, talkativeness
How is prolactin endogenously regulated?
Dopamine secreted by the neuroendocrine cell nuclei of the hypothalamus suppress prolactin secretion from trophic hormone-secreting cells of the anterior pituitary. - Bromocriptine (drug) can stimulate this loop to inhibit prolactin
What syndrome presents with Brushfield's spots?
Down's: white spots in the periphery of the iris
What is the treatment for Rocky Mountain spotted fever (R. rickettsii) & Lyme disease (B. burgdorferi) infection?
Doxycycline (inhibits protein synthesis)
What is Niridazole used to treat?
Dracunculus medinensis (causes skin ulceration & inflammation)
What lab value indicates a neural tube defect in a fetus?
Dramatic increase in AFP (reduce risk with prenatal folate)
What does antihistone antibodies indicate?
Drug-induced lupus syndromes
What types of drug can cause hyperprolactinemia?
Drugs that suppress dopamine's effects (& its inhibitory effect on prolactin): e.g. Haloperidol, a typical antipsychotic
What is the ligamentum arteriosum a remnant of?
Ductus arteriosum (shunts blood from the pulmonary artery to the aorta in the normal fetal circulation)
What shunts blood from the left pulmonary artery to the aorta?
Ductus arteriosus: allows blood to avoid the high-resistance lungs & deliver more O2 blood to the rest of the body
What is fetal hydantoin syndrome?
Due to maternal use of anti-epileptics like phenytoin during pregnancy: - Abnormal skull & facies - Growth deficiency - Underdeveloped nails of fingers & toes - Mild developmental delay
Where is iron absorbed?
Duodenum
Where do G. lamblia trophozoites colonize?
Duodenum & jejunum: cause malabsorption & diarrhea Rx: Metronidazole
During which interval does isovolumetric relaxation occur in the heart?
During early ventricular diastole: ventricles relax with aortic & matral valves closed
What infection causes HUS (hemolytic-uremic syndrome)?
E. coli Result: Thrombocytopenia, Acute Renal Failure & DIC
What infection & CD markers are associated with Hodgkin's disease?
EBV CD45-,CD30+, CD15+/-
What are the early cellular changes due to ischemia? late ones?
Early: cellular swelling, organelle swelling, ribosomal disaggregation Late: organelle membrane damage & morphologic changes (cell blebs), cell surface deformities caused by cyoskeletal dysfunction, & nuclear changes (pyknosis, karyolysis, & karyorrhexis)
What causes a well-circumscribed granuloma in the liver?
Echinococcus infection
What is struma ovarii?
Ectopic thyroid tissue in the ovaries: - a benign functional cystic teratoma - Result: throtoxicosis &/or hyperthyroidism
What is papilledema?
Edema of the optic disc (often due to increased intracranial pressure)
What syndrome is associated with a defect in collagen type III?
Ehlers-Danlos Triad: Loose joins, decreased skin elasticity, genu recurvatum of the knee (knee is fixed in hyperextension)
What is acute coronary syndrome?
Either unstable angina or acute MI - T wave inversion of ECG indicates myocardial ischemia
What is the appearance of Papillomavirus warts?
Either: flat, raised or resemble a cauliflower
What urine test finding is diagnostic of carcinoid syndrome?
Elevated 5-HIAA
What is a serum marker of cell lysis?
Elevated uric acid level (from purine breakdown)
What infections are sickle cells, asplenic patients more at risk for?
Encapsulated Organisms: - Pneumococci - Meningiococci - Haemophilus & Salmonella osteomyelitis
What are Bronchial cells of Kulchitsky?
Endocrine cells of the trachea: - vesicles contain ADH, serotonin, calcitonin, somatostatin
What is a common cause of nosocomial UTI & subacute endocarditis?
Enterococcus Rx: ampicillin or vancomycin (if resistant)
From a clinical perspective, what 3 substances do lysosomes contain that are deficient in certain genetic diseases?
Enzymes for destruction of: 1) Cellular Mucopolysaccharides 2) Sphingolipids 3) Mucopolysaccharides Lack of these enzymes: lysosomal storage diseases
What type of molecules are the oncogenes "erb" & "HER2"?
Epidermal growth factor receptor encoding genes
What is the usual cause & presentation of a middle meningeal artery rupture?
Epidural hematoma due to a lateral blow to the head CT: "lens-shaped" density
What neuro exam finding indicates sensorineural hearing loss?
Equal bone and air conduction Cause: acoustic neuroma (schwannoma) compressing CNVIII where it enters the internal auditory meatus
What is a common side effect of bisphosphonates?
Esophagitis
What diuretic is the DOC for a patient with a sulfa allergy?
Ethacrynic acid Mannitol (but not for CHF or anuric patient)
What is a good way to remember what activity decreases O2 affinity to hemoglobin?
Exercise - Increase in temperature - Decrease in pH - Increase in CO2
What trinucleotide repeat results in Jacobsen's syndrome?
Expansion of CCG on Chromosome 11: - Mental retardation - Facial Dysmophisms - Cardiac defects - Thrombocytopenia - Trigonocephaly
What vessel supplies the external genitalia & a portion of the thigh?
External pudendal
What is the 1st line treatment for pyoderma gangrenosum (PG)?
Extraintestinal manifestations of IBD (inflammatory bowel disease) - Rx: Oral corticosteroids
What are the FEV1 & FVC values for an interstital lung disease?
FEV1 & FVC are both reduced & the ratio between the 2 remains the same
What do the basophils of the pituitary secrete?
FSH LH ACTH TSH
What hormone stimulates spermatogenesis?
FSH from the anterior pituitary gland
Which test for syphilis is the most specific?
FTA-ABS: dlurescent treponemal antibody absorption
What genetic disorder predisposes patients to thromboses in unusual locations (e.g. mesenteric veins) at an early age (<50)?
Factor V Leiden thrombophilia - heterozygous have a higher risk for thrombotic events
What causes a bicornuate uterus?
Failure of complete fusion of the paramesonephric ducts at there superior end.
What embryologic abnormality results in cleft lip?
Failure of the maxillary processes or the medial nasal processes to fuse
What are the signs of "forward failure"?
Fatigue due to insufficient CO to meet matabolic demands
What is Clomiphene used for?
Female infertility: - it is a selective estrogen receptor modulator and partial agonist of the estrogen binding site on the hypothalamus & pituitary - it increases secretion of gonadotropin-releasing hormone
What is required for normal iron absorption?
Ferrous iron requires apoferrin
What are the medial umbilical ligaments a remnant of?
Fetal umbilical arteries (carry blood from the baby to the mother)
What drug is used to revive bone marrow in order to prevent infection & decrease the duration of neutropenia associated with myelosuppressive chemo?
Filgrastim (G-CSF): - recombinate cytokine - stimulates production, maturation, & activation of neutrophils
What drug is a recombinant cytokine used to augment recovery of bone marrow?
Filgratim (granulocyte colony-stimulating factor)
What drug for BPH also promotes hair growth?
Finasteride: 5-alpha-reductase inhibitor that prevents further cellular growth
What is the antidote for benzo overdose?
Flumazenil (benzo receptor antagonist)
What is treatment for a benzo overdose?
Flumazenil (competative antagonist at the y-aminobuteric acid receptor
What is the treatment for a benzodiazepam overdose?
Flumazenil: a competitive antagonist of the GABAergic receptor
What is the antidote for a CNS stimulate overdose?
Fluoxetine (SSRI)
What is used to treate a severe Shigella infection (bloody diarrhrea)?
Fluroquinolones
Which develops quickly, vitamen B12 or folate deficiency?
Folate: deficient intake (diet), increased need (e.g. pregnancy), or impaired use (antimetabolate drugs)
What vitamin found in green leafy veggies is heat sensitive & can be destroyed by cooking?
Folic acid: methyl group transferer to form amino acids, purines, & thymidine Deficiency: megaloblastic anemia or neural tube defects
What is the change in menapause that brings on the usual lab results of increased LH and FSH?
Follicular depletion with a resultant decrease in estrogen secretion; this leads to no negative feedback on: - gonadotropin-releasing hormone - follicle-stimulating hormone (FSH) - luteinizing hormone (LH)
What is the most common non-Hodgkin's lymphoma?
Follicular t(14:18), bcl-2 protein (antiapoptotic) overproduced
What types of food can precipitate a gouty attack?
Foods rich in purine: meats (organ meats, e.g. kidneys) Rx: - NSAIDS (ibuprofen, naproxen, indomethaicn) - Colchicine if NSAID-allergic: SE = diarrhea, GI upset... (inhibits microtubule polyermization by binding to tubulin -> inhibits immune cell motility/activity)
What are the chemical markers of bone formation & bone resorption?
Formation: Alkaline phosphatase Resorption: hydroxyproline
What bacterium can be transmitted to humans via handling of rabbit tissue (or a tick or deerfly bite)?
Francisella tularensis - Well-demarcated skin lesion with a black base!! - Later: systemic symptoms (fever, headache, malaise)
What enzyme generates Glucose-6-phosphate?
From glucose via hexokinase
What is Tinea unguium?
Fungal infection of the nail with Trichophyton Rx: Griseofulvin (CYP450 inducer)
What is the DDx for organisms causing long branching filaments?
Fungi Nocardia asteroides Actinomyces israelii
What class of diuretics can worsen osteoporosis?
Furosemide & other loops (decrease Ca2+ absorption)
What diuretic is counter indicated in gout patients?
Furosemide (sulfonamide loop) b/c it raises serum uric acid levels - Inhibits Na-K-2Cl cotransporter to increase Na, K, & Cl excretion - Ototoxic
What type of molecule is "ras"?
G protein that cycle between 2 conformations: 1) Activated ras-GTP 2) Inactivated ras-GDP Mutation = oncogenic GTP binding with a loss of GTPase activity ( = permanently turned on)
How does Glucagon act on target cells?
G-protein receptors in the plasma membrane, an alpha subunit activates adenylate cyclase
What is the anti-cancer action of etoposide?
G2 phase action: inhibits topoisomerase II (results in irreversibel ds breaks in DNA) & prevents synthesis of components needed for mitosis
In what phase of the cell cycle does Bleomycin act?
G2: causes stand breaks in DNA via intercalation & free radical damage
What trinucleotide expansion results in Friedreich's ataxia?
GAA on Chromosome 9: - AR: pyramidal, dorsal, & spinocerebellar tracts are affected: - Progressive ataxia & neurologic delince - RIP: cardiomyopathy
What common GI problem makes a patient a bad candidate for bisphosphonates like Alendronate?
GERD: bisphosphonates can cause erosions of the esophagus
What glut transporter allows glucose to enter RBCs & brain?
GLUT 1
What glut transporter allows glucose to enter pancreatic beta cells?
GLUT 2
What glut transporter allows glucose to enter adipose & skeletal muscle cells?
GLUT 4
What can leuprolide be used for?
GRH analogue: - Pulsation: infertility - Continuous: prostate cancer & uterine fibroids
What analogue of y-aminobuteric acid is not approved for use with absent seizures?
Gabapentin
What is Foscarnet used for?
Ganciclovir-resistant cytomegalovirus: binds to pyrophosphate binding site of viral DNA polymerase
What is bacterial TRANSDUCTION?
Gene TRANSFER from a donor to a recipient by way of a bacteriophage
What is bacterial TRANSFORMATION?
Gene TRANSFER resulting from the uptake of DNA from a doner, often when a bacteria dies & surviving bac pick up the residual DNA.
What is bacterial CONJUGATION?
Gene transfer from a donor to a recipient by direct PHYSICAL contact between cells
What does the activation of an dopaminergic D2 receptor elicit?
Gi = decrease in cAMP - Extrapyramidal motor activity
What does the activation of an adrenergic alpha-2 receptor elicit?
Gi = decreased cAMP - Reduced central sympathetic outflow (decrease presynaptic NE release) - Decreased intraocular pressure (decreased aqueous humor secretion)
What G proteins or channels are 5-HT1, 5-HT2, 5-HT3, 5-HT4 receptors linked with?
Gi, Gq, Na+ channel, Gs "Albeit with a 5-feet HeighT, his IQ is Not Significant (IQNS)"
What can be given to counter a B-blocker overdose?
Glucagon
What is Oral Rehydration Therapy? as used for Cholera?
Glucose-containing sodium solution in a ration not exceeding 2 glucose molecules per 1 sodoum molecules - prevents dehydration by shifting fluid from the intestinal lumen into the circulation as a 2ndary effect of glucose-coupled Na transport into the mucosal cells
What is the DOC for B-blocker overdose?
Glugagon: - positive inotropic agent: increases intracellular cAMP independently of adrenergic receptor signaling (thus, it bypasses any adrenergic blockage)
What is the mechanism of acetaminophen toxicity?
Glutathione stores are depleted & toxic metabolites accumulate in the liver
What muscles abduct & medially rotate the thig to keep the pelvis level? (hint: damage results in Trendelenburg gait)
Gluteus medius & minimus (supplied by the superior gluteal nerve)
What is the most effective medical therapy for a uterine leiomyoma?
GnRH agonists like leuprolide - leads to a desensitization and downregulation of these receptors resulting in a hypogonadal state resembling menopause) - decreases both tumor & uterus size
What nerve structures are involved in proprioception?
Golgi tendon organs & muscle spindles (encapsulated mechanoreceptors)
What immunological mediated disease results in deposits at the alveolocapillary membrane?
Goodpasteur's
What renal disease often presents in otherwise healthy young males with hemoptysis?
Goodpasture's: Dx with anti-GBM antibodies in blood & kidney biopsy Rx: plasmapheresis & airway protection + steroids & cyclophosphamide
What G proteins are alpha1 & alpha2 receptors linked with?
Gq, Gi "AA flight 12 flies on the qi" (chi = air in chinese)
What G proteins are M1, M2, & M3 receptors linked with?
Gq, Gi, Gq "3M is quick (qiq) for posting"
What G proteins are H1, H2 receptors linked with?
Gq, Gs "Double-Hit is q.s. (L quantum sufficit [enough]"
How do patients with HIV meningoencephalitis present?
Gradual onset of slowly worsening dementia
What is the MOA of Vancomycin?
Gram +s: prevents the cross-linking of D-ala-D-ala subunits of the bacterial cell wall
For what infection would triple therapy with Ampicillin, gentamicin, & clindamycin be prescribed?
Gram-negative GI infection
What type of seizures is Phenytoin used for?
Gran mal (generalized tonic-clonic) Complex partial
What is the pathology of primary biliary cirrhosis?
Granulomatous destruction of the medium-sized intrahepatic bile ducts
In what tumor are Call-Exner bodies seen?
Graunulosa cell tumors (sex cord stromal tumor): ovarian follicles filled with eosinophilic material - secrete estrogen -> precocious puberty, endometrial hyperplasai, endometrial carcinoma
What is the most common cause of neonatal sepsis & meningitis
Group B Strep (GBS) - prophylaxis to mom = Penicillin G prebirth
What do the acidophils of the pituitary secrete?
Growth hormone Prolactin
What does the activation of an dopaminergic D1 receptor elicit?
Gs = increase in cAMP - Increased renal perfusion (Arterial dilation in the renal, mesenteric & coronary beds) - Decreased TPR & Bp
What does the activation of an adrenergic beta-2 receptor elicit?
Gs = increased cAMP - Reduced TPR & BP (skeletal muscle vasodilation) - Increased Airflow (Bronchodilation) - Delay of labor (Uterine relaxation) - Increased plasma glucose & decreased K+ (Glycogenolysis/Gluconeogensis)
What does the activation of an adrenergic beta-1 receptor elicit?
Gs = increased cAMP - increase HR, CO, & systolic BP (heart stimulation) - Increased ATII (increased renin release)
What G proteins are D1 & D2 receptors linked with?
Gs, Gi "2D grades makes everybody SIgh"
What G proteins are beta1 & beta2 receptors linked with?
Gs, Gs "BaBy goes to SS (sunday school)"
What sympatholytic drug is a false trasmitter?
Guanadrel Guanethidine
What sympatholytic drug is a release inhibitor?
Guanethidine
Where is urobilinogen producted?
Gut: bilirubin diglucuronide is reduced by gut bacteria
What are the most common causes of otitis & sinusitis?
H. influenzae (gram -) Moraxella catarrhalis (gram -)
What are the microbio risk factors for B12 deficiency?
H. pylori D. latum infection (both can affect directly/indirectly absorption in the terminal ilium)
What is the DDx for target cells on a peripheral blood spear?
HALT: Hemoglobin C disease Asplenia Liver disease Thalassemia
What are the major side effects of Epinephrine?
HAT on the head & heart: - Headache, restlessness, cerebral Hemorrhage - Angina and cardiac Arrhythmias - Tachycardia & palpitations
What are the major side effects of isoproterenol?
HAT on the head & heart: H = headache A = Angina & cardiac Arrhythmias T = Tachycardia & palpitations
What are the major SE of Dobutamine?
HAT on the heart: - Hypertension - Angina & cardiac Arrhythmias - Tachycardia
What are the major side effects of Dopamine?
HAT on the heart: - Hypertension - Angina, Arrhythmias - Tachycardia
What is the most common type of primary malignant tumor found in the liver?
HCC: hepatocellular carcinoma
What lab results indicate primary hyperparathyroidism?
Hypercalcemia -> metastatic calcification & duodenal peptic ulcers hypophosphatemia increased alk phos increased PTH levels -> osteitis fibrosa cystic (excessive bone resoption & fibrous replacement of the marrow leaving cystic spaces (brown tumors)
What paraneoplastic syndrome is caused by squamous cell carcinoma of the lungs?
Hypercalcemia: cells produce parathyroid homone-related peptide.
What is the typical presentation for MEN1?
Hyperparathyroidism (hypercalcemia & hypophosphatemia)
What do cafe au lait macules look like?
Hyperpigmented, sharply=bordered, ovoid macules: - >5mm pre-puberty & >15 mm post-puberty - 6+ are needed to consider a diagnosis of NFT1
Does steroid use result in hyper or hypotension?
Hypertension due to the mineralocorticoid properties of steroids (increased Na retention)
What type of drug is Metoprolol?
Hypertension: a cardioselective B-blocker
What is Clonidine used for?
Hypertension: it is an alpha2-receptor agonist
What do the following symptoms indicate? - Anxiety & irritability - Neuromuscular excitability - Tetany - Intracranial calcifications - Dental abnormalities - Cardiac conduction abnormalities
Hypoparathyroidism Causes: thyroidectomy, metastatic cancer, DiGeorge's syndrome
What is the most treatable form of dementia?
Hypothyroidism
What are the Ann Arbor staging notation for lymphoma?
I = single lymph node or single extralymph organ II = >/=2 sites on the same side of the diaphragm III = >/=2 sites on both sides of the diaphragm - A without constitutional symptoms - B without constitutional symptoms IV = disseminated disease (extralymphatic organs)
What cells secrete cholecystokinin?
I cells: promotes gallbladder contraction after ingestion of fatty acids or amino acids
What is the MOA of Norepinephrine
I'm NO Epinephrine because I can't activate B2 receptors: - A1 = A2; B1 > B2
What are the lab results for stage I & II of Lyme disease?
I: elevated IgM for B. burgdorferi (for 2 weeks) II: elevated IgG (6 wks later)
What are the different defects that cause the familial dyslipidemias (I, III, IIa, IV, V)?
I: lipoprotein lipase defect III: altered lipoprotein E IIa: decrease in LDL receptors IV: hepatic overproduction of VLDL V: increased heaptic production & decreased clearance of VLDL
Why is a lumbar puncture dangerous in patients with an increased ICP?
ICP drops too much and this can depress the entire ventricular system and allow for further herniation of the brain.
What heart murmur indicates a VSD?
II-III/VI holosystolic murmur - Best heard @ the left sternal boarder
Which interlukin is secreted by helper T lymphocytes that stimulates the growth of helper & cytotoxic (CD8) T lymphocytes to fight VIRAL infections?
IL 2
What interleukin is secreted by activated T lymphocytes & functions similarly to granulocyte macrophage colony-stimulating factor?
IL3
What interleukin is secreted by helper T lymphocytes and promotes the growth of B lymphocytes to fight bacterial infections?
IL4
What interleukin is a major chemotactic factor for neutrophils?
IL8
What is the treatment for Bruton's agammaglobulinemia?
IV Ig No tyrosine kinase gene = no B lymphocyte differentiation
What does the trochlear nerve innervate?
IV: superior oblique muscle. Injury leads to CN IV palsy: diplopia that worsens when they look down and away from the affected side
What is a common side effect of an overose of corticosteroids?
Iatrogenic Cushing's syndrome (moon facies & buffalo hump)
How does a lacunar ischemia present?
If long-term: dementia If acute: (basal ganglia & pons) - pure motor deficits (face, arm, & leg paralysis) - sensory deficits (sensory loss in face, arm, & leg)
What is Berger's disease?
IgA nephropathy: - IgA in the mesangium - most common cause of nephritic syndrome worldwide - Concurrent with an upper respiratory infection
What is the most common selective Ig deficiency syndrome & how does it present?
IgA: mucosal deficiency leads to sinus & lung infections
What is the most common selective immunoglobulin deficiency?
IgA: sinus & lung infections
What is the most common serum antibody seen in Multiple Myeloma?
IgG (55%) Iga (25%)
What causes RBC lysis in autoimmune hemolytic anemai?
IgG targets RBC antigens
What is Rheumatoid factor?
IgM antibody directed against the Fc portion of IgG
What tricyclic antidepressant can reduce night terrors & enuresis?
Imipramine: decreases stage 4 sleep
Are isolation, acting out, sissocation, denial, fixation, identification, isolation of affect, projection, rationalization, reaction formation, splitting, repression, or displacement mature or immature defense mechanisms?
Immature
How does cirrhosis show up in a liver biopsy?
bridging fibrous septae (that look like brad scars linking portal tracts)
What is the preferred antibiotic for community-acquired lobal pneumonia (high fever, productive cough, acute onset)?
ceftriaxone: broad spectrum, 3rd-generation cephalosporin against: - S. aureus - H. influenzae - S. pneumoniae
What artery supplies the gallbladder, stomach to proximal duodenum, pancrease & the liver?
celiac: embryonic foregut
What is the MOA of Shiga toxin?
cleaves rRNA of the host cell
What is tumor lysis syndrome?
complicationof lymphomas & other bulky cancers due to cytotoxic therapy & dying tumor cell contents overwhelm the body: - Excess potassium = heart arrhythmias & weakness - Excess uric acid (DNA breakdown) = gout & renal failure Rx: allopurinol (to reduce uric acid production) & glucose/insulin to combat hyperkalemia
How does a cerebrovascular event of the anterior cerebral artery present?
contralateral motor weakness, greater in leg than in arm, & mild sensory deficits
What cell population defect causes Hirschsprung's disease?
craniocaudal neural crest cell migration failure to distal colon: no parasympathetic ganglion cells & no coordinated peristalsis (functional obstruction of the colon) Symptoms: constipation, distended abdomen, bilious vomiting Rx: resecetion of the aganglionic segment of the colon
What is the MOA of both cyclosporine & tacrolimus?
Immunosuppressants: - Bind to intracellular proteins called immunophilins (Cyclosporine = cyclophilins; Tacrolimus = FK-binding proteins (FKBP-12)) - These protein-drug complexes then interfere with intracellular signaling events that occur after T-lymphocyte receptor ligation - T/F prevent T lymphocyte activation Rx: Transplant recepients to prevent rejections SE: nephrotoxicity
What would a C4-C5 disc herniation result in?
Impingement upon the C5 root: limited shoulder abduction - Weak deltoid - Weak infraspinatus - Sensory: shoulder & upper, lateral arm
What is the pathogenesis of I-cell disease?
Improper intracellular trafficing: - Failure to add a mannose-6-phosphate residue to proteins that should be directed to lysosomes - Result: membrane-bound intracytoplasmic vacuoles that are filled with fibrillogranular material (lipids, mucopolysaccharides, oligosaccharides)
Where do Naegleri fowleri live?
In fresh water
What patients should avoid Tyramine?
In patients taking MAOs b/c this will block liver MAO A & cuase the high-pressure TYRE of AMINE crisis
How does Bell's palsy present clinically?
Inability to close the eye or seal the corner of the mouth on the affected (ipsilateral) side
How do steroids block the production of cytokines?
Inactivate NF-kB, a transcription factor that induces proinflammatory cytokine production
What is the mechanism of action of C. diptheriae's exotoxin & P. aeruginosa's exotoxin A?
Inactivates elongation factor 2, causing pharyngitis & the pseudomembrane of the throat. Rx: antitoxin (to prevent membrane spread & airway obstruction), penicillin or erthyromycin & DTP vaccine
What is the pathogenesis of Meckel's diverticulum?
Incomplete obliteration of the vitelline duct (yolk stalk); usually asymptomatic Complication: bleeding 2% of population & 2 ft. from ileocecal junction
How is the diffusion equation affected by pulmonary fibrosis?
Increase in Thickness
What causes metabolic acidosis?
Increase in acid: - Ion gap - Hypovolemic shock via lactic acid Decrease in base: - Diarrhea - Kidney failures
What causes respiratory alkalosis?
Increase in ventialtion leading to a decrease in serum CO2 & excess bicarb. Causes: - Increased drive (drugs or CNS disorders) - Anxiety/Fear
What is the MOA of gonadotropins when used to treat female infertility?
Increase overian follicular maturation SE: weight gain & fluid retention
What are the lab test results that indicate Vitamin K deficiency?
Increased PT & PTT
What is cystinuria?
Increased levels of lysine & arginine in the urine due to a defect in amino acid reabsorption in the proximal tubule leading to a wasting of: - lysine, arginine, cystine Elevated cystine leads to recurrent stone formation (S/S severe pelvic pain & elevated creatinine due to postrenal failure caused by the stone) Rx: hydration & alkalization of urine
What neurological symptoms are seen with vitamin B12 deficiency?
Increased methylmalonic acid levels impairs myelin synthesis: - Primary impact: posterior & lateral spinal columns - Paresthesias & impaired proprioception + megaloblastic anemia
Why is Sildenafil contraindicated in patients taking nitrates?
Increased risk of priapism & hypotensive shock - Phosphodiesterase inhibitiors promote higher levels of cGMP & smooth muscle relaxation - Nitrates vasodilated by releasing nitric oxide in smooth muscle, which also raises cGMP levels
What lab values indicated hemosiderosis?
Increased serum iron Normal TIBC Increased % saturation
What is the mechanism of albuterol?
Increases conversion of cAMP by adenylate cyclase: - activates B2-adrenergic receptors on smooth muscle cells to activate adenylate cyclase. - Adenylate cyclase then converts ATP to cAMP - SMOOTH MUSCLES RELAX
How does the kidney respond to hypovolemic shock?
Increases glomerular capillary hydrostatic pressure through intravascular fluid retention & efferent arteriole constriction to retain GFR
What is the action of VIP (vasoactive intestinal polypeptide)?
Increases intestinal water & electrolyte secretion
What is the MOA of Phenobarbital?
Increases the duration of Cl channel opening
How is Crytococcus neoformans visualized?
India ink stain Reservoir: pigeons
What is Beck's triad?
Indicates hemopericardiua: 1) Hypotension 2) Increased JVP 3) Distant heart sounds
When is Amiodarone indicated & what are its toxicities?
Indication: Vfib TOX: hypotension, PULMONARY FIbrosis, thyroid dysfunction, hepatotox, ocular changes, bradyarrhythmia & torsades
What protease inhibitor is associated with crystal-induced nephropathy?
Indinavir: precipitates in the urine & obstructs its flow Rx: HIV/AIDS
What is the treatment for Gilbert's disease?
Indirect hyperbilirubinemia: mild decrease in glucoronyltransferase activity Rx: phenobarbital
What type of drug is Clonidine?
Indirect sympatholytic, selective alpha2 agonist
What are 2 drugs that can be used to treat nephrogenic DI?
Indomethacin HCTZ (hydrochlorothiazide)
What is the 1st line DOC for acute gout?
Indomethacin (NSAID): blocks prostaglandin synthesis
How do fibrates increase HDL?
Induce the synthesis of the major HDL cholesterol apolipoproteins (apoA-1 & apoA-2)
What is the MOA of Shigella toxin?
Induces cytokine release & causes hemolytic uremic syndrome: bloody & mucus-rich diarrhea
What is undulant fever?
Infection by Brucella: - E.G.: B. melitensis (gram -, coccobacilli, intracellular bac that stains with a modified acid-fast) - From contaminated milk products or contact with sick livestock - Symptoms: undulating fever, weakness, loss of appetite
What is the mechanism of HIV encephalitis?
Infection of brain macrophages & microglia: - Histo: microglial nodule = multinucleated giant cells (fusion of HIV-infected microglial cells
What vessel supplies Wernicke's area?
Inferior division of the left MCA: to the posterosuperior portion of the superior temporal lobe
What nerve innervates the gluteus maximus?
Inferior gluteal: extends & laterally rotates the thigh
What causes NRDS (neonatal respiratory distress syndrome)?
Inflammatory cell-mediated endothelial injury & t/f disruption of alveolar or capillary integrity with leakage of protein-rich fluid exudate into alveoli
What are fibromuscular dysplasias of the kidney?
Inherent structural defects of the renal artery wall that impair perfusion: - leads to stimulation of the renin-angiotension-aldosterone axis that leads to vasoconstriction & volume expansion - Rx: surgery
What is the MOA of fluoroquinolones (such as ciprofloxacin)?
Inhibit DNA gyrase & topoisomerase of gram-negative bac.
What is the mechanism of statins?
Inhibit HMG-CoA reductase (3-Hydroxyl-3-methylglutaryl-CoA) the rate-limiting step of cholesterol biosynthesis
What is the MOA of sulfamthoxayole-trimethoprim & trimethoprim?
Inhibit folate synthesis: pteridine & PABA are incorporated into folic acid = inhibition of nucleic aci & amino acid formation
How does Cushing's syndrome cause poor wound healing?
Inhibition of collagen synthesis by glucocoritcoids
What is the MOA of antifungals like fluconazole & terbinafine?
Inhibition of ergosterol synthesis
What is the MOA of dapsone?
Inhibition of folic acid synthesis
What is the mechanism of action of C. botulinum's toxin?
Inhibition of the release of acetylcholine into the synaptic cleft. This leads to muscle weakness and paralysis?
What is the MOA of rifampin? What is it used for?
Inhibits DNA-dependent RNA polymerase encoded by the rpo gene Rx: - Antimycobacteria - Leprosy (to delay dapsone resistance) - Chemoprophylaxis for N. meningitidis exposure & also for kids exposed to H. influenzae
What is the mechanism of action of Losartan?
Inhibits angiotension II receptor: angiotension II is formed from angiotension I by the ACEnzyme in the lung capillaries
What is the MOA of exemestane?
Inhibits aromatase: no conversion of testosterone to estradiol & androstenedione to estrone - forms an irreversible bon with aromatase
What is the MOA & use of piperacillin?
Inhibits bacterial cell wall synthesis Rx: gram +, P. aeruginose, Enterobacteriaceae Use in combo with B-lactamase inhibitor such as tazobactam
What is the MOA of Sildenafil?
Inhibits cGMP phosphdiesterase (PDE5) which increases cGMP leading to smooth muscle relaxation in the corpus cavernosum to increase blood flow to the corpus vascularity
What is the mechanism of diptheria toxin?
Inhibits elongation factor EF2-alpha: - Normally: EF2-alpha complexes with guanosine triphosphate & binds to the ribosome to initiate the translocation step of protein synthesis.
What is the MOA of isoniazid?
Inhibits mycobacterial cell wall formation by inhibiting enzymes required for mycolic acid synthesis.
What is the mechanism of action of zanamivir?
Inhibits neuraminidase enzyme that is critical to the influenza life cycle (A & B) & blocks the release of progeny virons as there is no cleavage of neuraminic acid to release the viron with host cell membrane cover.
What is the MOA of ethambutol?
Inhibits the arabinosyl transferase-mediated synthesis of arabinogalactin for mycobacterial cell walls
What is Rotenone's toxicity?
Inhibits transfer of electrons to ubiquinone & thus stops ATP production
What is the MOA of acyclovir, ganciclovir, and famciclovir?
Inhibits viral DNA polymerase
What does tongue deviation indicate?
Injury to the LMN of the hypoglossal nerve (CNXII) on the opposite side due to unopposed action of the opposite genioglossus muscle
Where is creatinine kinase (CK) found?
Inner mitochondrial membrane, on myofibrils, & in the muscle cytoplasm - Catalyzes the production of ATP - Types: MM (skeletal muscle), MB (cardiac muscle), BB (brain)
What is the Rx for chronic hepatitis B?
Interferon-alfa to block viral RNA & DNA synthesis
What type of surgery predisposes patients to vitamin A deficiency?
Intestinal (esp. if ileum is involved) - absorbtion requires micelles formed with bile salts
What conditions show Mallory bodies on histological exam of liver tissue?
Intracytoplasmic hyaline inclusions derived from cytokeratin intermediate filaments: - Primary biliary cirrhosis - Wilson's - Chronic cholestatic syndromes - Hepatocellular tumors - Alcoholic Cirrhosis
What is the MOA of Alprostadil?
Intraurethral prostaglandin pellet that increases arterial inflow & decreases venous outflow via binding G proteins & stimulating adenylyl cylase Tox: priapism if given as an intracavernosal injection
What is intussusception & how does it present?
Invagination of intesting upon itself (usually at ileocecal junction) @ 6-36 m. old S/S: intermittent & crampy abdominal pain with current-jelly stool due to rectal bleeding
What is 2.3-BPG's relationship with O2 affinity?
Inverse: high levels decreases O2 affinity
What is non ion gap vs. ion gap acidosis?
Ion gap acidosis: caused by an increase of anions (such as lacate) Non ion gap: caused by a loss of bicarb with an increase in Cl Anion Gap = [Na+] - [Cl-] - [HCO3-] Normal anion Gap = 10-16 mEq/L
What is prescribed prophylactically in asymptomatic patients with a positive PPD?
Isoniazid & B6 (the latter to prevent neurotox)
What is the action of hydroxyamphetamine?
It causes the release of norepinephrine
What does 21-hydroxylase do?
It converts progesterone to deoxycorticosterone on the way to aldosterone - without this, there is a virilization of the female genitalia at birth - without this, there is no feedback inhibition on renin & Px have elevated Bp
What drug can be used to "rescue" bone marrow after methotrexate administration?
It delivers folinic acid that can be reduced to methylene tetrahydrofolate & will thereby bypass the dihydrofolate reducate enzyme that is inhibited by methotrexate
How does hydroxyurea help sickle cell patients?
It increases fetal hemoglobin production in place of hemoglobin S & thereby reduces RBC sickling and complications there of.
What is the MOA of Ethambutol?
It inhibits arabinosyl transferase to decrease arabinogalactan (a component of mycobacterial cell walls)
What is the MOA of ethanbutol?
It inhibits arabinsyl transferase enzymes needed for mycobacterial cell wall formation Tox: hyperuricemia, GI distress, optic neuritis, visual loss
How does cocaine dilate pupils?
It inhibits norepinephrine reuptake and thus keeps the ciliary muscle stimulated
What is EDTA used to treat
It is a Ca chelator used to treat LEAD poisoning
What is the MOA of Gabapentin?
It is a GABA analog & blocks H-current modulators
What is the MOA of Desmopressing acetate (DDAVP)?
It is a synthetic analog of ADH & binds to V2 receptors in the collecting ducts to increase water resorption - Used to treat diabets insipidus - Stimulates release of vonWillebrand factor & factor VIII by stimulating the V1a receptor (used to treat coagulation disorders: vW disease, mild Hemophilia A, thrombocytopenia)
What is the MOA of Pilocarpine?
It is an acetylcholine mimetic - causes miosis & contraction of the ciliary muscle - Rx: open (wide-angle) & closed (narrow-angle) glaucoma
How does E. histolytica infection present?
It is an amoebal dysentery associated with liver abscess formation
What is Benztropine used for?
It is an antimuscarinic that improves the tremor & rigidy in patients with Parkinson's
Why is Alendronate a DOC to treat multiple myeloma?
It is an ornal bisphosphonate: - Lowers serum Ca2+ - Helps to decrease pain & fractures by inhibiting bone resorption through the reduction of the # & activity of osteoclasts
What is FAD used for?
It is an oxidizing agent used to make double bonds: e.g. production of fumarate from succinate in the TCA cycle
What is the toxicity of 2.4 Dinitrophenol?
It is an uncoupling protein that results in decreased ATP
How does AZT stop reverse transcriptase on a molecular level?
It is converted in cells into a nucleoside triphosphate & becomes incorporated into DNA. However, without a hydroxyl at the 3' carbon, it cannot form a phosphate bond & elongate.
How does etoposide induct apoptosis?
It stabilizes topoisomerase II-DNA complex during the G2 phase & prevents G2 completion & DNA strands break. This triggers apoptosis.
What causes mutifocal leukoencephalopathy & typically affects only immunosuppressed people though reactivation of latent infection?
JC virus: - altered mental status - motor deficits (hemiparesis or limb ataxia) - hemianopia
What disease is associated with HLA-BW22?
Kawasaki's
For what autoimmune disease is prednisone contraindicated?
Kawasaki's b/c it might increase the risk for coronary aneurysm
What are brown granular deposits in the cornea?
Kayser-Fleischer rings: copper deposits
Which cells in the skin are already dead?
Keratinized epithelial cells (e.g. stratum corneum layer of the skin)
What commonly-used antifungal also has antiandrogen effects?
Ketoconazole - used in polycycstic ovarian syndrome to prevent hirsutism
What drug directly inhibits testosterone biosynthesis?
Ketoconzaole (antifungal)
Why is alkalosis coupled with potassium wasting?
Kidneys avidly take up H+ to restore the pH and these are exchanged with potassium
What results from bilateral lesions of the amygdala?
Kluver-Bucy syndrome: - hyperorality - hypersexuality - disinhibition
What syndrome is associated with bilateral obliteration of the amygdala?
Kluver-Bucy syndrome: hyper (orality, sexuality, & disinhibited behavior)
What spinal nerve controls the inguinal region dermatome?
L1: also includes the femoral triangle and superolateral quadrant of the buttock
What spinal nerve controls the anterior & lateral thigh dermatome?
L2
What causes a child to present with anorexia, hyperirritability, altered sleep patterns, & decreased play?
LEAD poisoning
What are the 1st signs of lead poisoning? How do these symptoms then progress?
LEAD-induced porphyria: 1) Loss of developmental milestones (esp. speech), abdominal complains (intermittent vomiting, pain, & constipation) 2) Ataxia, altered state of consciousness, coma, seizures, encephalopathy 3) Permanent consequences: learning & cognitive deficits, aggressive behavior
What is the Lab Value hallmark of PCOS?
LH hypersecretion: - Obesity - Hirsutism - Oligo or amenorrhea - Acanthosis nigricans (velvety hyperpigmentation) - Hyperglycemia, hyperlipidemia, insulin resistance
What does uvula deviation indicate?
LMN lesion contralateral to the side to which the uvula is deviating OR UMN vagus nerve (CNX) lesion will cause the uvula to deviate toward the side of the lesion
Which anticoagulant does not require any laboratory monitoring?
LMWH = low-molecular-weight heparin - activates antithrombin III - administer subcutaneously
What is Asprin tox at low & high doses?
LOW: tinnitus, abdominal pain, vomiting, & tachypnea HIGH: respiratory alkalosis, metabolic acidosis, hypotension, coma, & DEATH
What drug causes hallucination, delusions, dilated pupils, and potentially marked anxiety or depression, nausea, weakness, & parethesias?
LSD: lysergic acid diethylamide
What artery supplies the LV, the RV?
LV: left (or obtuse) marginal (follows the left border of the heart) RV: Right marginal (follows the right border of the heart)
What is the DOC for CNS stimulate street drugs?
Labetalol: nonselective alpha & beta antagonist that blocks hypertension & cardiac stimulation &/or Neurolepics: to control agitation & psychotic symptoms &/or Diazepam: to control possible seizures
What is MacConkey's agar used to culture?
Lactose-fermenting enterics: E.coli Klebsiella
What are the characteristic facial features of fragile X?
Large Ears & Jaws, & Macro-Orchidism in males EVERYTHING (chromosome, face...) is BIG
What drug has the side effect of a brown darkening of the iris?
Latanoprost: prostaglandin prodrug used to increase the outflow of aqueous humor in glaucoma or increased intraocular pressure - side effect occurs in 10% of patients
What muscle lowers the jaw?
Lateral pterygoids: innervated by mandibular branch of the trigeminal "Lateral Lowers, M's Munch" M = Masseter, teMporalis, Medial pterygoid
What does Clostridium perfringens produce which causes gas gangrene, cellulitis, & diarrhea?
Lecithinase
What is the toxicity of C. perfringens?
Lecithinase exotoxin that results in myonecrosis, gas gangrene, & hemolysis
What vein is the source of the bleed when an alcoholic bleeds from the mouth?
Left gastric (b/c of the anastomoses between the left gastric and the azygos)
What infection presents with macrophages containing amastigotes and clinical symptoms of hepatosplenomegaly, malasie, anemia, & weight loss?
Leishmainia donovani (sandfly transmission) Rx: Sodium stibogluconate
What disease presents with high fever with uniform renal impairment & mild hepatitis after a recreational freshwater exposure?
Leptospirosis
Why are benzos prefered over barbiturates in the treatment of anxiety?
Less likely to lead to respiratory depression and central cardiac depression
What drug can be used to reduce the megaloblastic anemia caused by methotrexate therapy?
Leucovorin (5-formyltetrahydrofolic acid): - bypasses dihydrofolate reductase (blocked by methotrexate) to replenish the folate pool
What type of degenerative dementia presents with visual hallucinations, problems with executive & visuospatial functions, & trouble driving?
Lewy body Dementia: Dementia + 2 of these 1) Cogntivie fluctuations 2) Visual hallucinations 3) Parkinsonism Lewy bodies are eosinophilic & involve the entire cerebral cortex (stained by alpha-synuclein)
What is another name for nonbacterial thrombotic endocarditis?
Libman-Sacks endocarditis (a symptom of SLE): - single or multiple 1- to 3-mm verrucous deposits on the edge of either surface of the valve leaflets on any heart valve - Usually, mitral, aortic, & tricuspid - Histo: immune complexes, mononuclear cells, hematoxylin bodies, fibrin, & platelet thrombi - Healing = fibrosis, scarring, & calcification = valve damage, regurg, & predisposition to bac. endocarditis - fibrin & platelet thrombi may embolize systemically
What is neuroleptic malignant syndrome?
Life-threatening extrapyramidal side effect of antipsychotic agents: - hyperpyrexia - autonomic instability - severe rigidity Rx: Dantrolene (muscle relaxant), discontinuation of all neuroeptics, & supportive care
What test is used to detect single-point mutations?
Ligase chain reaction (LCR): used to diagnose carriers of disease genes
How are bile ductules identified histologically?
Lined by simple cuboidal epithelium & each luminal cell has a single centrally-located nucleus
What is an endotoxin?
Lipopolysaccharide-lipid A, a part of the bacterial membrane of all gram-negative bac (except L. monocytogenes)
What is the risk factor for developing Ebstein's anomaly?
Lithium exposure during gestation: - apical displacement of the septal & posterior tricuspid valve leaflets = atrialization of the right ventricle & displacement of the anterior leaflet
Where is Alanine aminotransferases (ALT) found?
Liver = marks hepatocyte damage
What is the radiographic picture of Streptococcus pneumoniae infection?
Lobar consolidation
What culture is used to grow Corynebacterium diptheriae?
Loeffler's medium, blood agar, tellurite plate
What is the MOA of Furosemide?
Loop diuretic: - Inhibits co-transport of Na, K, & Cl in the thick ascending loop of Henle - This reduces the medullary concentration gradient & the lumen gains a positive potential - T/F divalent cations are not absorbed as much (including Ca)
Which diuretics cause alkalemia?
Loops & Thaizides: 1) "Contraction Alkalosis": Volume contraction -> increased ATII -> Na+/H+ exchange in proximal tubule-> increased HCO3- 2) K+ loss leads to: K+ exiting all cells (via H+/K+ exchanger) & H+ enters cells 3) "Paradoxical aciduria": In a low K+ state, H+ (rather than K+) is exchanged for Na+ in principle cells, leading to alkalosis
What type of drugs for CHF cause a urinalysis with the following findings: - pH 5.5 - increased NaCl, K, Ca concentrations
Loops (like furosemide): Loops Lose calcium, stimulate acidification by increasing distal Na delivery & transport (this causes a favorable electric gradient for K & H+ secretion)
What loops are used to treat congestive heart failure?
Loops like furosemide to treat the edema
What is the mutation involved with Wilms' tumor?
Loss of WT1 tumor suppressor gene on chromosome 11q
What is the most common presentation of Burkitt's in North America?
Loss of appetite Sever Constipation Abdominal pain or distention Cause of symptoms: enlarged lymph nodes in the abdomen
What is the molecular picture of nephrogenic diabetes insipidus?
Loss of arginine vasopressin receptor 2 function
How does Kartagener's result in female infertility?
Loss of fimbrae & tubal cilia "sweeping" leads to immobile eggs that do not advance through the fallopian tubes @ normal rates - microtubule dysfunction
What is the classical pattern of sensorineural hearing loss in older patients?
Loss of hair cells at the organ of Corit in the proximal portion of the basilar membrane (loss of hearing high-pitched sounds)
What genetic mutation can cause colorectal cancer?
Loss of the APC tumor suppressor gene on chromosome 5q
What can help DDx a chest pain to be a pulmonary embolism?
Low O2 saturation
What are the lab results that indicates Edwards' syndrome?
Low: maternal AFP, estradiol, B-human chorionic gonadotropin
Is pepsin a high or low pH active enzyme?
Low; if antacids or used protein digestion can be impaired and patients will often have constipation
What agar is used to culture TB
Lowenstein-Jensen (no growth of gram-positive respiratory flora)
What causes neurogenic claudation?
Lumbar spiral stenosis - back or buttocks pain induced by walking or prolonged standing. - Pain relieved by rest or forward flexing of the vertebral column.
Where is the GLUT-5 receptor?
Lumen of the gut: Na-dependent absorbtion of fructose
What are the physical exam signs of Streptococcus pneumoniae pneumonia?
Lung consolidation resulting in: - Bronchial breath sounds - Dull resonance - Increased tactile fremitus
What is deficient in Pompe's?
Lysosomal alpha-1,4-glucosidase: necessary for the hydrolysis of the outer branches of glycogen - glycogen is deposited in the myocardium & thus, "Pompe's trashes the Pump" by the 6th month of life
What is defective in Gaucher's
Lysosomal beta-glucocerebrosidase: - Hepatosplenomegaly - Aseptic necrosis of the femus, bone crises - Gaucher's cells
What sympatholytic drug is a nonselective beta-blocker?
M-Z + olol: 1) Nadolol 2) Propranolol 3) Penbutolol (also has intrinsic sympathomimetic activity) 4) Pindolol (also has intrinsic sympathomimetic activity) 5) Timolol
What are the lab values & symptoms of a patient with Wiskott-Aldrich
MALE (x-linked) Symptoms: (TRIAD) - Recurrent pyrogenic infections - Eczema (itchy erythematous rash) - Thrombocytopenia LAB: - Elevated IgA, IgE - Normal IgG - Low IgM = pathology b/c there is no IgM response
What are the 2 problems that Spironolactone is used to treat?
MOA: aldosterone receptor antagonist - Hyperaldosteronism - Edematous states (heart/liver/kidney failure)
What is the MOA of metoclopramide & what are it's main SE?
MOA: antiemetic that also relaxes the pylorus (Rx: gastroparesis) SE: parkinsonism-type extrapyramidal effects
What is the toxicity of tricyclic antidepressants?
MOA: inhibit neuronal reuptake of norepinephrine, seratonin, & other amines - Mental status changes - Hypotension - Anticholinergic tox: flushing, hyperthermia, dilated pupils, intestinal ileus, urinary retention - Ventricular arrhythmias
What prostaglandin E1 analog is contraindicated in pregnancy (& why)?
Misoprostol: increases producing & secretion of gastric mucous barrier - it is an abortifactant & can cause diarrhea
What type of inheritance pattern does Leber's hereditary optic neuropathy have?
Mitochondrial: - mother to child only, but not all children of an affected mother will be affected. - Ratio of normal to abnormal mitochondria inherited will determine whether the disease manifests itself phenotypically.
What heart pathology is associated with Ehlers-Danlos syndrome?
Mitral valve prolapse
What causes a self-limited localized infection consisting of nonerythematous, pearly, dome-shaped papules on the skin of children or immunosuppressed patients?
Molluscum contagiosum (a poxvirus)
Where does poliovirus affect the spinal cord?
Motor neurons in the anterior horn Rx: prevent via vaccine
What is the most common presentation of von Willebrand diseases?
Mucocutaneous bleeding (e.g. after a dental extraction)
How does Kaposi's infiltration of the GI present?
Mucosal bleeding: - Hematochezia - Hematemesis - Melena (black-colored stools)
What causes dysentery?
Mucosal destruction leading to purulent (epithelial cells) & bloody stools: - Persists with fasting - Cause: Shigella (verotoxin inactivates 60S subunit & kills epithelial cells) & some E. coli species
Where is the GLUT-4 receptor?
Muscle & adipose tissues
What genetic mutation renders a patient immune to infection with certain strains of HIV?
Mutated CCR5 (homozygous): - CCR5 receptor is a chemokine receptor on macrophages that facilitates viral entry into cells.
What genetic defect results in Marfan's?
Mutation of the fibrillin-1 gene on chromosome 15 = defective microfibrils - elastin in aorta - suspensory ligaments of the lens of the eye
What organism presents on X-ray with consolidations that are typically noted in the apical or posterior portions of the upper lobe or superior portions of the lower lobe?
Mycobacterium tuberculosis
What usually causes systemic miliary TB?
Mycobacterium tuberculosis: hematogenous spread via seeding of the pulmonary venous return to the heart to affect the liver, bone marrow, spleen, adrenal glands, meninges...
What type of infection is cold antibody agglutination used to detect?
Mycoplasma
What are the causes of eosinophilia?
NAACP: (release Major Basic Protein) 1) Neoplasia 2) Asthma 3) Allergies 4) Collagen vascular diseases 5) Parasitic infection
What deficiency causes chronic granulomatous disease?
NADPH oxidase: no superoxides from molecular O2
What results from a loss of function of the NF2 gene on chromosome 22q?
NF2 gene no longer produces a protein that interacts with the cell membrane & cytoskeleton: - AD Neurofibromatosis type 2 with bilater vestibular (CNVIII) schwannomas & meningiomas Mneumonic: NF type 2 = Ch. 22
What drugs are used in hypertensive emergencies?
NFL ENAbled for a fast touchdown: 1) Nitroprusside & Nitroglycerin (NO providers) 2) Nicardipine (CCB) 3) Fenoldopam (D1-agonist) 4) Labetalol (apha-1, B-agonist) 5) ENAlaprilat (ACE inhibitor)
What is the DOC class for costochondritis or pericarditis?
NSAIDs
What channels are Nn & Nm receptors linked with?
Na channel, Na channel "Both Nn & Nm contain the N of Na+"
What G proteins are NMDA receptors linked with?
Na+, Ca2+, K+ channel "Nmda also contains the N of Na+"
What is the toxicity of drain cleaners?
NaOH or KOH = GI erosion & metabolic alkalosis
What is the treatment for opiate overdose?
Naloxone
What is the antidote for opiate (heroine/morphine) overdose (sleepy, lethargic, comatose with miotic pupils, low Bp & depressed respiration)?
Naloxone (opiod-receptor antagonist)
What are the side effects of octreotide (exogenous somatostatin) administration?
Nausea Vomiting Diarrhea Gallstone-related illness
What are the symptoms of acut gastritis?
Nausea Vomiting Hematemesis Histo: diffuse erythematous patches on the lumen of the stomach
What are predisposing disorders for Budd-Chiari?
Nearly complete obstruction to the blood flow by an acute clot in the hepatic veins or the IVC Predisposing disorders: - Hematologic (polycytemia veria, essential thrombocytosis) - Thrombotic diatheses (antiphospholipid antibody syndrome, factor V Leiden) - Pregnancy - OC use - Intra-abdominal neoplasms (hepatocellular carcinoma, renal cell)
What is Budd-Chiari syndrome (BCS)?
Nearly complete obstruction to the blood flow by an acute clot in the hepatic veins or the IVC Predisposing disorders: - Hematologic (polycytemia veria, essential thrombocytosis) - Thrombotic diatheses (antiphospholipid antibody syndrome, factor V Leiden) - Pregnancy - OC use - Intra-abdominal neoplasms (hepatocellular carcinoma, renal cell)
What are the only pathogenic gram - diplococci?
Neisseria
What is the presentation of a patient with pheochromocytoma?
Neoplasm of the chromaffin cells (neural crest derivatives that synthesize & release catecholamines): - Hypertension (bursts or chronic) - Palpitations - Headache - Tremor - Sweating - Sense of apprehension
What is overproduced in Waldenstrom's macroglobulinemia?
Neoplastic plasma cells produce monoclonal imunoglobulin M heavy chains: - leads to hyperviscosity syndrome & often to Raynaud's
What is the toxicity of polymyxins?
Nephro & Neuro: dizziness, drowsiness, confusion, nystagmus, blurred vision
How does osteomyelitis show up histologically?
Neutrophils & bone necrosis on micrscopic exam Cause: S. aureus or M. tuberculosos (macrocytic predominance if M. tub...)
What drug is most effective med to increase HDL?
Niacin
What 3 drugs often cause cutaneous flushing?
Niacin Adenosine Vancomycin
What are "B symptoms"?
Night sweats, fever, & weight loss Hodgkin's lymphoma symptoms with enlarged mediastinal lymphadenopathy - 50% of patients have EBV
What is cylophosphamide used for?
Nitrogen mustard alkylating agent Rx: cancer, Wegener's granulomatosis & polyarteritis nodosa
Can there be "carriers" of AD diseases?
No.
What do glomeruli of diabetic patients with ESRD (End-Stage Renal Disease) look like histologically?
Nodular glomerulosclerosis
What are the characteristics of Renal Tubular Acidosis (RTA)?
Non-anion gap, hyperchloremic, metabolic acidosis
What is the MOA of the superantigen that causes TSST-1 (toxic shock syndrome) by S. aureus?
Nonspecificallly binds & activates lympocytes: fever, rash, shock
What 2 neurotransmitters does Monoamine oxidase (MAO) decrage?
Norepinephrine Serotonin
What do Pheochromacytomas produce?
Norepinephrine & Epinephrine - These are tumors of neural crest-derived tissue Rx: alpha-blockage (DOC: phenoxybenzamine, long-lasting, noncompetitive, irreversible alpha-blockers)
What area of the brain shows a decreased number of neurons in Alzheimer's disease?
Nucleus basalis of Mynert
What type of breast cancer is Tamoxifen useful for?
ONLY estrogen receptor-positive beast cancer: - blocks estrogen receptors to impeded the production of estrogen-responsive genes
What is Lambert-Eaton syndrome?
Oat (small) cell carcinoma produces antibodies against presynaptic Ca channels @ the neuromuscular junction: - proximal muscle weakness - decreased deep tendon reflexes - diplopia
What nerve innervates the adductor muscles of the thigh? What patients are at risk for damage?
Obturator (athletes: can be entrapped between muscles)
What nerve innervates the obturator internus & superior gemellus?
Obturator internus: laterally rotates & flexes the thigh
What is the DOC for agromegaly?
Octreotide (somatostatin analog that suppresses GH secretion @ the anterior pituitary)
What is the drug treatment for carcinoid syndrome?
Octreotide: somatostain analog that inhibits secretion from neuroendocrine tumors (also used with VIPomas that secrete vasoactive intestinal polypeptide)
What brain lesion would cause a spastic paralysis of the arm & leg on one side of the body?
On the CONTRALATERAL side of the brain either: 1) primary motor cortex 2) medullary pyramid 3) lateral white matter tract of the spinal cord above C5
What filarial nematode causes river blindness?
Onchocera volvulus
What is ivermectin used to treat?
Onchocerca volvulus infection (causes River blindness)
What is Ivermectin used for?
Onchocerciasis (River Blindness)
What 5HT3 receptor antagonist is used to treat the nausea & vomiting associated with chemo?
Ondansetron
What does an isolated prolonged PTT indicate?
One of the following: 1) Factor XI, IX, & VIII deficiency 2) Presence of factor VIII inhibitor 3) Use of Heparin 4) Presence of lupus anticoagulant
What does a prolonged PT (& INR) indicate?
One of the following: 1) Warfarin therapy 2) Liver Disease 3) Factor VII deficiency 4) Vitamin K deficiency
What does a combination of prolonged PT, INR, and bleeding time indicate?
One of the following: 1) Warfarin therapy 2) Liver Disease 3) Factor VII deficiency 4) Vitamin K deficiency 5) vWF deficiency NB: the same as PT & INR, + vWF for platelet
What is arcus lipoides
Opaque rings found on the endge of the iris that indicate type IIa familial dyslipidemia (familial hypercholesterolemia)
What are the physical exam finding that indicate mitral stenosis?
Opening snap with a delayed, rumbling late-diastolic murmur
What is the period of maximum susceptibility to teratogens?
Organogenesis: between weeks 3 & 8 of development
What family of viruses is Influenza a member?
Orthomyxovirus
What are tender, violaceous, subcutaneous nodules of the palms & soles indicated of?
Osler's ndoes of bacterial endocarditis
What disease can present with Heberden's or Bouchard's nodes?
Osteoarthritis: - Heberden's: osteophytes @ the distal interphalangeal joints - Bouchard's: ostephytes @ the proximal interphalageal joints
What are Heberden's nodes on distal interphalangeal joins of fingers manifestations of?
Osteoarthritis: destruction of articular cartilage
What differentiates Osteomalacia from osteoporosis?
Osteomalacia: new matrix can be synthesized, but it cannot be mineralized (usually due to vitamin D deficiency) Osteoporosis: reduced synthesis of new bone matrix
What is a jaw-related complication of chronic bisphosphonate therapy?
Osteonecrosis of the jaw (avascular necrosis of the jaw)
What other cancers are kids with retinoblastoma at risk for?
Osteosarcomas in their teens: - Rb gene mutation on ch. 13: no E2F regulation and cells easily move into S phase
What tumors can CA-125 mark?
Ovarian & malignant epithelial tumors
What is female pseudohermaphroditism?
Ovaries are present & external genitalia are virilized/ambiguous
What is the main step in melanin production?
Oxidation of tyrosine via tyrosinase in melanocytes
What are the major side effects of PHEnyleprine?
P = prostatic hyperplasia symptoms H = hyperemia (rebound) due to chronic use with nasal/sinus congestion E = elevated Bp in Px with hypertension HYPERtensive crisis with MOAIs
What are the HLA b27 diseases?
PAIR: Psoriasis Ankylosing spondylitis IBD Reiter's syndrome
What is the most common cardiovascular abnormality seen in congenital rubella syndrome?
PDA
What is indicated with pelvic or lower abdominal pain with an abnormal, foul-smelling vaginal discharge?
PID: - Can involve endometrium, fallopian tubes, ovaries, peritoneum - Orgs: Neisseria & Chylamydia
What type of drug is omeprazole?
PPI
What 3 conditions can Omeprazole be used to treat?
PPI: - GERD - Zollinger-Ellison syndrome - Peptic Ulcer disease
How can you calculate the PPV if given the sensitivity, specificity and pre-test probability?
PPV = 1) Convert the pre-test probability to an odds ratio 2) Calculate the the test's positive likelihood ratio (LR+) = sensitivity / (1-specificity) 3) Multiply #1 x #2
What is the MOA of Prazosin?
PRessured Alpha 1 ZOne Selectively INcised: - Vasodilation (blocks Gq -> decreased IP3/Ca2+) in veins & arterioles. NO significant sympathetic activation - Urinary sm. relaxation @ base of the bladder, prostate, & urethra - Reduces plasma lipids
What pathway is monitored when treating a patient with Heparin?
PTT (intrinsic coagulation pathway) - Heparin activates antithrombin III -> decreases thrombin & inhibits factor Xa
What does PT measure? PTT?
PTT: VIII, IX, XI, XII PT: VII Both: X, V, prothrombin, & fibriniogen
What nerve ends mediate pressure, coarse touch, vibration, & tension
Pacinan (large, ovid, 1-2 mm by 0.1-0.7 mm)
What characterizes erythema nodosum?
Painful erythematous nodules on the lower legs (+ fever & malaise) Diverse etiology: drugs, infections, inflammatory diseases
What are the Dx criteria for rheumatic fever?
Pancarditis Polyarthritis Sydenham's chorea Subcutaneous nodules Erythema marginatum Lab: Leukocytosis with neutrophilia
What viruses have double-stranded, circular DNA?
Papillomaviruses Polyomaviruses
What viruses are a member of the paramyxovirus family?
Parainfluenza RSV Mumps Measles
What presents with an inspiratory stridor, seal-like barking cough, retractions, & coryza?
Parainfluenza virus = CROUP
What cause croup?
Parainfluenza virus is a common cause
What virus causes croup?
Parainfluenze X-ray: steeple sign: narrowing of the upper trachea
What happens in late-stage amyotrophic lateral sclerosis?
Paralysis of the respiratory muscles
What personality disorder presents with the inherent belief that the world is a dangerous & threatening place, distrust everyone, & believe various conspiracy theories?
Paranoid
What are the utricle and saccule for?
Part of the vestibular apparatus in the ear & responsible for seansing changes in head position with respect to linear acceleration
What type of seizures is Carbamazepine used to treat?
Partial complex
What viral infection presents after a fever with a facial rash (bright red, blanchable, on the cheeks with perioral pallor) followed by a diffuse trunk & extremities rash that waxes and wanes with temperature over 3 weeks
Parvovirus B19 (5th disease) Rx: nothing, self-limiting
What causes "fith disease" of childhood with a bilateral, red, maculopapular cheek rash with a "slapped cheek" appearance (erythema infectiosum)?
Parvovirus B19 (ssDNA virus)
What bacteria cause skin abscesses & are most likely transmitted via dog/cat bite?
Pasteurella multocida (gram - rod)
What is the most common congenital heart disease in adults? How can it present?
Patent foramen ovale (PFO) - Migraine with aura - Right-to-left cardiac shunts - Stroke in a young patient (venus thrombi bypass pulmonary circulation and cause paradoxical emboli)
What 3 seizure meds induce the CYP450 system?
Penytoin Carbamazepine Phenobarbital
What type of limited gas is O2, diffusion or perfusion?
Perfusion: gas exchange can only increase or decrease with an increase or decrease in blood flow.
What is the radiographic picture of Mycoplasma pneumoiae infection?
Peribronchial pneumonia pattern with STREAKS of infiltrates
Laceration of what region can lead to post-vaginal delivery incontinence in the mother?
Perineal body: convergence of several muscles of the urogenital diaphragm (anterior to the anus) - Bublospongiosus - External anal sphincter - Perineal muscles
What is the primary defect in diabetes type 2?
Peripheral insulin resistance due to decreased glucose uptake in muscle & adipose - Possible cause: defective downstream signaling pathways causing either a decreased number of insulin receptors on the cell surface or signaling errors after insulin has bound to the receptor Hyperglycemia presents with polyuria, polydipsia
What is Zenker's diverticulum?
Pharyngeoesophageal diverticulum: - Outpouching of the esophageal wall above the level of the upper esophageal sphincter - Pathogenesis: herniation of mucosa though defective muscular layer
What sympatholytic drug is a nonselective alpha blocker?
Phen__amine: Phentolamine Phenoxybenzamine
What anti-seizure medication is effective in all seizure types except absence seizures?
Phenytoin SE: sedation, ataxia, nystagmus, hirsutism, gingival hyperplasia
What are the risk factors for the Tetralogy of Fallot?
Phenytoin Alcohol Also: 22q11 syndrome association
What is fetal hydantoin syndrome?
Phenytoin-associated fetal defects: - growth deficiencies - skull & facial feature abnormalities - mental retardation - underdevelopment of nails in the fingers & toes
What is a catecholamine-screting tumor of the adrenal medulla?
Pheochromocytoma: - increased plasma epinephrine & norepinephrine - Symptoms: hypertension, diaphoresis, headaches, heart palpitations
What is the dominant component of pulmonary surfactant?
Phosphatidylcholine (aka lecithin) - Produced in adequate amounts by the 36th week of gestation
When does crossover or recombination occur in meiosis?
Phrophase I
What is the antidote for antimuscarinic drug (atropine, scopolamine, Jimson weed) overdose (hot & dry skin + CNS stimulation)?
Physostigmine (acetylcholinesterase inhibitor)
What is the antidote for atropine poisoning?
Physostigmine: reversibly inhibits acetylcholinesterases to increase the amount of acetylcholine at the cholinergic receptor - ONLY use in SEVER overdose Light poisoning: supportive care, activated charcoal, benzos
What type of virus is Hep A?
Picornavirus: Linear ssRNA
What are RBCs containing schizonts characteristic of?
Plasmodium infection (late stage of the asexual form of the parasite) transmitted by the female Anopheles mosquito: flu-like symptoms
What is the key call mediator in the pathogenesis of atherosclerotic plaque?
Platlet-Derived Growth Factor: recruits platlets and smooth muscle to intimal lining to produce an extracellular matrix that becomes a fibrous plaque
What organism causes a chest X-ray picture of diffuse infiltrates bilaterally along with a cough & shortness of breath in an HIV patient?
Pneumocystis jiroveci
What is the most common etiology of acute-onset of pleuritic chest pain in otherwise young, healthy men?
Pneumothorax
What is the genetic root of Becker's muscular dystrophy?
Point mutation in the dystrophin gene
What are natural sources of atropine & scopolamine?
Poisonous plants: deadly nighshade & jimson weed
What are signs of vitamin D deficiency in the elderly due to poor nutrition/feeding?
Poor Dentition Loss of appetite Creeping dementia
Eating what puts immunocompromised patients or pregnant women at risk for listeriosis?
Poorly pasteurized milk Soft cheeses Coleslaw Ready-to-eat turkey & pork
What builds up in the urine of patients with acute intermittent porphyria?
Porphobilinogen: due to a deficiency in urophorphyrinogen I synthases
What is the most commonly diagnosed porphyria?
Porphyria cutanea tarda - Deficiency of uroporphyrinogen decarboxylase - Can result in 2ndary hemochromatosis
What test confirms autoimmune hemolytic anemia?
Positive direct Coombs test after lab values indicate hemolytic anemia: - Elevated LDH - Increased indirect bilirubin - Low haptoglobin levels
What distinguishes postrenal from prerenal azotemia?
Post: normal BUN: Cr ratio, lack of highly concentrated urine Pre: increased BUN:Cr ration, highly concentrated urine
What is the MOA of Amiloride?
Potassium-Sparing Diuretic: - Inhibits Na reabsorption transportion @ the cortical collecting duct - T/F reduces K secretion at the same time
What is the MOA of spironolactone?
Potassium-Sparing diuretic: - Competitive aldosterone receptor antagonest: Na reabsorption & K secretion are inhibited @ the cortical collecting duct - it is a steroid
What results from prolonged oligohydramnios (<0.5 L of amniotic fluid)?
Potter's (lethal): hypoplastic lungs, flattened facies, & clubbed feet
What is the difference between the site of estrogen production in pre & postmenopausal women?
Pre: produced in ovaries Post: adrenal gland via aromatase
Where is the narrowing in a Px with infantile coarctation of the aorta?
Preductal: between subclavian artery & ductus arteriosus
What is Abruptio placentae?
Premature separation of the placenta from the uterus (despite normal location of implantation) due to rupture of defective maternal vessels in the decidua basalis - Risk factors: hypertension, cocaine use, short umbilical cord, trama, cigarette smoking, uterine fiboids, advanced age, sudden uterine decompression, premature membrane rupture, bleeding diathesis
What distinguishes a case of phyelonephritis from a UTI?
Presence of WBC casts in the urine. Indicates renal parenchyma involvement
What is Mesna used for?
Prevent hemorrhagic cystitis in patients taking cyclophosphamide: - supplies a free thiol group to bind to & inactivate the toxic metabolite acrolein in the kidney
How do integrases treat HIV?
Prevents the formation of a proviral infection
What organism is part of the normal oral flora & can be responsible for abscesses in the mouth, pharynx, brain, & lung?
Prevotella melaninogenica
What drugs ill precipitate a severe anemia with jaundice, pallor, dark urine, & back pain in patients with G6PD?
Primaquine Sulfonamides
What are the 3 stages of Paget's disease of the bone
Primary abnormality: overproduction & overactivity of osteoclast 1) Osteolytic lesion of marked bone resorption 2) Disorganized bone formation - Bone-specific alkaline phosphatase = up to 10x normal - Phosphate = normal - Ca = slightly elevated or normal 3) Sclerotic or Burned-out phase
What chronic autoimmune liver disorder can present with sever itching, hepatomegaly, & xanthomas?
Primary biliary cirrhosis LAB: antimitochondrial antibodies HISTO: Granulomatous destuction of medium-sized intrahepatic bile ducts
How do renin levels distinguish 1 from 2ndary hyperaldosteronism?
Primary: high renin Secondary: low renin
What are the kidney-targeted drugs used to treat gout? What is their MOA?
Probenecid & sulfinpyrazone: compete with uric acid for reaborbtion in the kidney
What is the clinical presentation of Steven-Johnson's
Prodrome: fever & fatigue, then skin & mucocutaneous lesions that begin as erythematous macules, progress to form bullae, & then slough
What happens when a polyomavirus is reactivated?
Progressive multifocal leukoencephalopathy (in immunosuppressed patients)
What hormone maintains lactation?
Prolactin from the anterior pituitary
How does von Willebrand's present?
Prolonged bleeding time after trauma, surgery, nosebleeds, & hematomas
What is the MOA of amphetamines for ADD treatment?
Promote the release of catecholamines (dopamine & norepinephrine): - increases the concentration in the synaptic cleft - Dopaminergic activity in the CNS stimulates & leads to increased attention
What is vitamin D's main function?
Promotes Ca & PO3 absorption from the GI
How is a PDA maintained in an infant & how is it medically closed?
Prostaglandin I2 Rx: indomethacin inhibits PGI2 formation
What are the only endogenous agents that allow dilation of the afferent arteriole of the kidney?
Prostaglandins - Their production blocked by NSAIDs and COX-2 inhibitors = increased vascular tone & constriction
What reverses heparinization?
Protamine sulfate: it is + charged and binds - charged heparin decrease antithrombin III activation (& thereby reinstating levels of thrombin & factor Xa)
When a Px is vitamin K deficient, why do they exhibit a coagulation overactivation?
Protein C is not gamma-carboxylated & thus does not become active to cleave factors Va & VIIIa
What is Strep pyogen's major virulence factor?
Protein M: inhibits complement system & protects from phagocytosis
What type of molecule is "myc"?
Protein transcriptional activator that binds DNA & activates many growth-related genes
What protein is formed when a patient has CML?
Protein tyrosine kinase bcr-abl: due to the Philadelphia chromosome translocation (9:22)
What is the MOA of bacterial/viral superantigens?
Proteins that nonspecifically cross-link MHC class II molecules with certain T-cell receptor (TCR) subsets - Inappropriate activation of these T-cells (2-20% of all T-cells) - Supraphysiologic production of cytokins: IL-1, TNFalpha, IL-6, IL-12, interferon-gamma.
How is Warfarin monitored?
Prothrombin time (PT): prevents synthesis & gamma-carboxylation of vitamen K-depenent factors (II, VII, IX, & X, proteins C & S) via vit. K antagonism Mneumonic: WEPT: Warfairin, Extrinsic, PT
What 2 signals are needed to activate T-lymphocytes?
Provided by APCs (macs, dendritic cells, B lymphocytes): 1) Major histocompatibility complex/peptide 2) CD28-B7 interaction
What is the most common cause of pneumonia in CF patients?
Pseudomonas Rx: Gentamicin
What bacteria causes hospital-acquired or drug-resistant UTIs and produces a blue/green pigment & fruity odor?
Psuedomonas aeruginosa (gram -, anaerobic bacillus)
What is the leading cause of death in cystic fibrosis patients?
Pulmonary infection by alginate-producing P. aeruginosa
What is doxycycline particularly useful for?
Px with renal failure needing an antibiotic: - it binds to the 30S subunit & prevents attachment of aminoacylt-tRNA - Rx: atypical pneumonia (Chlamydia & Mycoplasma) - SE: GI distress, photosensitivity, rash
With what underlying disease is pyoderma gangrenosum associated?
Pyoderma gangrenosum: boggy, red ulcers with purulent, necrotic bases (painful to the touch)
What is pyridoxine used for?
Pyridoxine = vit. B6 - cofactor in amino acid catabolism, heme synthesis, & glycogen breakdown Deficiency: angular stomatitis, glossitis, dermatitis, & seizures
What drug can reverse an isoniazid overdose induced seizure?
Pyridoxine b/c isoniazid is a competitive antagonist of pyridoxal kinase that helps to synthesize GABA from vit B6 (pyridoxine).
What antimalarial med can also be used to covert atrial fibrillation or suppress ventricular arrhythmias?
Quinidine
What are the major SE of Terbutaline & Ritodrine?
RAT in the brain, HAT on the heart, & PET in the Lungs: R = restless A = anxiety T = tremor H = hyerglycemia & hypokalemia A = angina & Arrhythmias T = Tachycardia P = low PO2 (early in Rx for severe asthma) E = edema (pulmonary, rare) T = tolerance
What type of virus is Hep C?
RNA flavivirus (Enveloped RNA) - Blood borne
What are ribozymes?
RNA molecules with catalytic activity: - bind target RNA & cleave the phosphodiester backbone @ specific cutting sites
How does Q fever present?
Sudden onset of 1(+): - High fevers - Chills - Severe headache - Malaise - Myalgia - Confusion - Soar throat - Nonproductive cough - Nausea/vomiting - Abdominal pain - Chest pain Dx: serologic testing for antibodies to Coxiella burnetii antigens
What is the treatment for a Nocardia pneumonia?
Sulfa-based antibiotic, IV, high dose: sulfamethoxazole
What is the treatment for toxoplasmosis?
Sulfadiazine & pyrmethamine
What is the treatment for T. gondii?
Sulfadizine & pyrimethamine
What is the 1st line therapy of ulcerative colitis?
Sulfasalazine: - Metabolized to 5-aminosalicylic acid in GI tract & decreases local inflammation - SE: Renal insufficiency & increased risk of a bleed
What is the treatment for ulcerative colitis?
Sulfasalazine: compo of sulfapyridine (antibacerial) & mesalamine (anti-inflammatory) - SE: malaise, nausea, sulfonamide tox, reversible oligospermia Also, 6-mercatopurine & methotrexate can be used
What drug group can cause Kernicterus?
Sulfonamides: they displace bilirubin from protein, resulting in excess free bilirubin
What triptan is a DOC for the acute treatment of migraine?
Sumatriptan (serotonin agonist @ the 5-HT1d recetpr): reduces migraine severity
What 5HT(1B/1D) receptor agnoist is used to treat acute migraine & cluster headaches?
Sumatriptan: MOA = vasoconstriction of cerebral & meningeal vessels SE: (rare) coronary vasoconstriction
What vessel supplies Broca's area?
Superior division of the left MCA: to the posterior-inferior frontal lobe
Where is a Pancoast tumor located?
Superior pulmonary sulcus; grows towards thoracic inlet & can damage structures that exit that region: - bracial plexus, stellate ganglion, & sympathetic chain
What structures run through the tarsal tunnel (posterior to the medial malleolus)?
Superior to Inferior: "Tom, Dick, And Very Nervous Harry": - Tibialis posterior tendon: plantar flexion & inversion - flexor Digitorum longus tendon: plantar flexion of foot & flexion of the 2nd-5th toes - posterior tibial Artery - posterior tibial Vein - tibial Nerve - flexor Hallucis longus tendon
What is the MOA of Tacrolimus?
Suppresses cellular immunity by binding to the intracellular protein FKBP-12 & inhibits the activation of T lymphocytes
What are the lends of the eye, epidermis, & anterior pituitary derived from?
Surface ectoderm
What are the main "things" innervated by the 3-neuron oculosympathetic pathway?
Sweat glands of the forehead Smooth muscles of the eyelid Pupilary ciliary muscle - Interruption of any of the 3 neurons results in Horner's syndrome
What heart sound is present in sickle cell patients?
Systolic ejection murmur due to increased SV & velocity to compensate for anemia - Heard when Hb falls below 6 mg/dL & blood viscosity decreases (increased turbulence) - Over mitral or aortic valve
What infection causes tabes (i.e. shriveled) dorsalis?
T. pallidum = neurosyphilis progressively demyelinates & scleroses the posterior nerve roots - reduced reflexed, decreased pain, decreased proprioception (will show a positive Romberg test) Rx: doxycycline
What spinal nerve controls the dermatome at the level of the umbilicus?
T10
What spinal nerve controls the dermatome directly inferior to the umbilicus?
T11
What spinal nerve controls the dermatome region interior to the anterior iliac crest?
T12
What is 1st line treatment for prostatitis & UTI?
TMP-SMX: inhibits dihydrofolate reductase (TMP) & dihydropteroate synthases (SMX) 2nd choice: fluroquinolones
What are the TPR, CO, HR, & MAP values for Epinephrine?
TPR = decreased CO = increased HR = increased MAP = NA or increased
What is Meigs' syndrome?
TRIAD: - overian fibromas - ascities - hydrothorax
What is the clinical presentation of a cocaine user?
Tachycardia Dilated pupils Angina Nosebleed MOA: sympathomimetic that inhibits neurotransmitter reuptake (e.g. NE)
What is the first line drug choice for BPH & what is that drug's mechanism of action?
Tamsulosin: - Smooth muscle tension is mediated by alpha-1-adrenergic receptors and these are selectively blocked.
What does a young child with decreased eye contact, increased startle, macrocephaly, seizures, ataxia, & cherry-red spots on the macula have?
Tay-Sachs: deficiency of hexosaminidase A & subsequent accumulation of ganglioside within cells
What color is a patient's urine when they have myoglobinuria?
Tea-colored
Where is B12 absorbed?
Terminal ileum (in the presence of intrinsic factor)
Where in the GI tract is vitamin B12 absorbed?
Terminal ileum via binding to intrinsic factor (secreted by gastric parietal cells)
Where are bile acids recirculated to the liver?
Terminal ilium via a Na-bile cotransporter
What are the ester-type local anesthetics?
Tetracaine Chloroprocaine Procaine Novacaine Propoxycaine If a Patient is allergic to one, avoid all
Which antibiotics inhibit the 30S subunit of prokaryotic ribosomes?
Tetracycline Aminoglycosides
What antibiotic is associated with teeth discoloration?
Tetracyclines
How is N. gonorrhoeae cultured?
Thayer-Martin agar (chocolate agar plate suffused with vancomycin, colistin, & nystatin (VCN) to suppress endogenous growth)
What are the major side effects of Fenoldopam?
The FELLOW has FAITH in D1-receptors: 1) Flushing 2) Angina (rare) 3) Increased IOP (FENOLdopam may FILL the eye) 4) Tachycardia (reflex) 5) Hypotension/Headache
What happens if a fetus in homozygous for an SOX9 mutation and the male gonade does not form testes?
The individual will have no Sertoli cells (no MIS & no 17b-estradiol) & no Leydig cells (no testosterone): - female internal genitalia: persistence of the paramesonephric ducts b/c no mesonephric duct stimulation via testosterone & no MIS - female external genitalia: no DHT production
Why do Mg levels rise with renal failure?
The only regulatory method of Mg is through renal exretion Mg levels of 2-4 mEq/L = vomiting, nausea, lightheadedness Mg levels greater than 4 = depressed consciousness, respiratory depression & cardiac arrest
How does Horner's syndrome affect pupil constriction?
The pupil cannot dilate b/c there is an absence of norepinephrine (there is a lesion in the postganglionic neuron, which prevents neuroepinephrine from being released) & t/f no stimulation of the ciliary muscle
What is the 1st committed step of fatty acid synthesis?
The synthesis of malyonyl-Coa via Acetyl-CoA carboxylase
What is the pathogenesis of paroxysmal nocturnal hemoglobinuria?
There is an insufficient synthesis of glycosyl-phosphatidylinositol anchors, which stabilize proteins that protect RBCs from complement-mediated cell lysis
What causes the bradykinesia in Parkinson's
There is excessive inhibition of the ventral lateral nucleus of the thalamus - Loss of dopaminergic neurons in the substantia nigra leads to a lack of inhibition of the globus pallidus, which would lift the inhibition of the thalamus. Rx: levadopa or ablation of the internal segment of the globus pallidus (pallidotomy) in refractory cases
What nerve structures respond to temperature changes?
Thermoreceptors (naked, small, nonmyelinated nerve fibers)
What does Fanconi's anemia predispose patients to?
These patients have pancytopenia and have an increased risk of infection, anemia, fatigue, & bleeding
What is the classic behavior of a child with tetralogy of Fallot?
They squat during cyanotic spells to compress the femoral arteries to decrease their right-to-left shunt
What type of diuretics should be avoided in a patient with multiple myeloma?
Thiazides: worsen hypercalcemia by increasing reaborption of Ca2+
What is the mechanism of glitaxones (rosiglitazone, pioglitazone)?
Thiazolidinediones: increase sensitivity to insulin - Stimulate peroxisome proliferator-activated receptor-gamma; this leads to increased glucose uptake in muscle & adipose
What is the toxicity of oligomycin?
This antibiotic blocks ATP synthesis by binding to the stalk of the ATP synthases. T/F it blocks protein re-entry to the matrix.
What is the difference in prognosis for those heterozygous and homozygous patients with familial hypercholesterolemia?
This disease is AD: 1) Homozygous: MI in 1st decade of life 2) Heterozygous: elevated LDL that may manifest in middle age
What cause of sudden death does malignant hypertension predispose to?
Thoracic aortic dissection: pain radiates to the back & ECG will appear normal!
Where do gram + organisms inhibit penicillin?
Those with B-lactamase--including some S. aureus strains--secrete it into the surrounding space (there is no space between the cytoplasmic membrane & the peptidoglycan layer of the cell wall)
What type of viruses are capable of genetic/antigenic shift?
Those with segmented genomes that can exchange segments (e.g. influenza: negative-stranded RNA virus) & can result in periodic changes int he surface antigen of the virus: - H antigens: hemaglutinin - N antigens: neuraminidase
What is interleukin-11 (aka oprelvekin) used to treat?
Thrombocytopenia: stimulates megakaryocyte & platelet growth
What is the function of zonula occludens?
Tight Junctions: - Prevent leakage across the intracellular space - Found toward luminal side of epithelial cells
What does the QT interval represent?
Time between the start of ventricular depolarization and the end of ventricular repolarization - from the onset of the QRS complex to the end of the T wave
What does the PR interval represent?
Time of initial depolarization of the atria to the initial depolarization of the ventricles (a pathological delay can occur here)
What is an early sign of salicylate toxicity?
Tinnitus
Why are excercising patients not loosing too much CO2 due to increased respiration?
Tissue CO2 production due to aerobic respiration
What selective alpha2 agonist is used as a central acting skeletal muscle relaxant?
Tizanidine
How do (some) bacteria use IgA protease?
To cleave secretory IgA & colonize mucosal areas
What is the principle function of the anterior cruciate ligament?
To prevent anterior subluxation (misalignment) of the knee relative to the femur anterior in the fully extended position.
What lifestyle factor doubles the risk of peptic ulcers?
Tobacco use
What causes "red man" syndrome (RMS)?
Too rapid infusion of vancomycin Rx: slow or pretreat with antihistamine
What type of drug is Bacitracin?
Topical antibiotic: prevents isoprenyl dephosphorylation & t/f bacterial wall synthesis
What is the MOA of Terbutaline & Ritodrine?
Tow 2 BeTA LINES, the RIghT sTRINgs used to Relax uTeRINE muscle - Selective B2 agonists - Uterine relaxation (Gs coupled B2 receptors) - Bronchodilation (Gs coupled B2 receptors)
What results from injury to the left temporopareto-occipital junction?
Transcoritical sensory aphasia: 1) poor comprehension 2) good repetition 3) nonfluent speech
What lab test can distinguish between iron deficiency anemia and lead poisoning anemia? They both present with hypochromatic, microcytic anemia
Transferrin saturation: - In iron-deficiency, it is increased (b/c there is no iron to saturate) - in lead poisoning, it is elevated or normal (b/c there is no iron loss)
What is a common sequela of Rotavirus infection?
Transient lactose intolerance due to brush border of the small intestine being shed.
What drug is a monoclonal antibody against HER-2 that can kill breast cancer cells over expressing HER-2?
Trastuzumab
What is the most common cause of vaginal discharge worldwide?
Trichomonas (motile, flagellated parasite) -> symptomatic vaginitis Rx: Metronidazole
What causes a greenish vaginal discharge, friable cervix, & motile cells on wet prep?
Trichomonas vaginalis Rx: metronidazole
What infection causes profuse, frothy discharge that is associated with vulvovaginal pruritis, tenderness, & burning?
Trichomonas vaginalis: - Histo: small pear-shaped flagellate orgs on web mount - Can cause small, red, punctuate leasions on the cervix & vagina
What accidental overdose presents with hallucinations, dry mouth, flushing, urinary retension, & mydriasis?
Tricyclic antidepressants (excess anticholinergic activity)
What is Bactrim?
Trimethoprim-sulfamethoxazole
What is the 1st line therapy for P. jiroveci pneumonia?
Trimethoprim-sulfamethoxazole
What presents in 10% of patients with pancreatic adenocarcinoma?
Trousseau's Syndrome: migratory thrombophlebitis + normal signs of acute weight loss, steatorrhea, & atypical DM (increase thirst & urination)
Which T cells (type 1 or 2) are involved in a type IV hypersensitivity reaction?
Type 1 (Th1)
What type of T-helper cells (type 1 or 2) are involved in mediating an antibody response?
Type 2 (Th2)
What is familiarl hyperbetalipoproteinemia?
Type II hyperlipidemia (LDL cholesterol receptor dysfunction): - Elevated plasma LDL & t/f increased in plasma cholesterol
What type of familial hypercholesterolemia is associated with a defect of LDL cholesterol receptors?
Type IIa
What results in extremely high triglyceride levels & visibly foamy plasma?
Type V: mixed hypertriglyceridemia - Elevated VLDL cholesterol levels
What type of proto-oncogene is "abl"?
Tyrosine kinase activity. - In CML, is translocated from Ch. 9 to 22 & fuses with bcr
Which condition is associated with sclerosing cholangitis: UC or Crohn's
UC. This results in dilation of the biliary ducts, fibrosis of the liver & eventual hepatic failure.
Which disease almost always affects the rectum: UC or Crohn's
UC: 50% of UC cases are even limited exclusively to the rectum
What results in an abnormal plantar reflex or Babinski's sign?
UMN injury with the lesion to the corticospinal tract above S1
What does a positive leukocyte esterase & nitrite on urine dipstick, + fever, indicate?
UTI
What does Staphylococcus saprophyticus cause in young adults?
UTIs
Which has a higher cancer risk: UC or Crohn's?
Ulcerative colitis
What is Sucralfate used for?
Ulcers & traveler's diarrhea: it binds to an ulcer base & provides protection
What is the ligamentum teres hepatis a remnant of?
Umbilical vein (carries O2 blood from mother to baby)
What is the MOA of DNP (2,4-dinitrophenol)?
Uncoupler: destroys the mitochondrial membrane's proton gradient
What is the MOA of pyrazinamide?
Unknown; however, its activity requires conversion by pyrazinamidase
What UTI-causing organisms often result in struvite stones?
Urease-positive (alkalize the pH of the urine): - Proteus - Klebsiella
What infections can cause urolithiasis with ammonium magnesium phosphate (aka struvite) stones?
Urease-producing orgs: - Proteus vulgaris - Staphylococcus - Klebsiella
What is accumulated in Lesch-Nyhan syndrome?
Uric Acid: - There is a deficiency of HGPRT in the purine salvage pathway. - T/F guanine & hypoxanthine cannot be recycled to IMP & GMP respectively - Guanine & hypoxanthine are instead converted to uric acid - ALSO: de novo purine synthesis is increased & this results in MORE uric acid
What is tumor lysis syndrome?
Uric acid stone formation due to excessive cell turnover after chemo (esp. with lymphoma)
What is found in the urine of patients with the most common porphyria?
Uroporhyrin due to a deficiency in uroporphyrinogen decarboxylase in patients with porphyria cutanea tarda
What results from prostaglandin F2alpha activation?
Uterine contractions & bronchoconstriction
@ what receptors does ADH act?
V2 (basolateral side of principal cells) - activates Gs-mediated cyclic AMP - This mobilizes aquaporin transmembrane channels to the luminal surface - Net water moves from the collecting duct lumen to the hyperosmolar interstitium
What are the 3 congenital heart lesions that cause late cyanosis (L to R shunt)?
VSD ASD PDA
What are the 3 causes of Eisenmenger's syndrome?
VSD ASD PDA S/S: late cyanosis & digital clubbing after the L to R shunt shifts to R to L & becomes cyanotic
What does bloody, foul-smelling vaginal discharge suggest?
Vaginal foreign body
What nerve innervates the palatal archers & uvula?
Vagus (CNX)
What is a side effect of nonselective B-blockers?
Vasoconstriction of peripheral vessels by blocking B2-mediated vasodilation
What test approaches 100% sensitivity for detecting syphilis?
Veneral Disease Research Laboratory (VDRL) test: FTA-ABS absorption test
Through what nucleus of the thalamus do all sensory modalities of the body (including dorsal column & spinothalamic tract) pass through?
Ventral posterolateral nucleus
Where is Dopamine synthesized?
Ventral tegmentum & substantia nigra
How does a cerebrovascular event of the vertebral artery present?
Vertebrobasilar system: ipsilateral cranial nerve defects & contralateral motor weakness - diplopia - dysarthria - vertigo - ataxia
What does the QRS complex represent?
Vetricular depolarization
How does intracellular insulin act?
Via a tyrosine kinase cascade
What type of colonic polyp is a risk factor for colorectal cancer?
Villus adenoma
What is the action of Vincristine?
Vinca alkaloid: binds to tubulin & prevents polymerization into microtubules. T/F there is no mitotic spindle formation & no mitosis. Rx: testicular carcinoma & Hodgkin's & non-Hodgkin's lymphomas
If a patient has no T lymphocytes, what infections are they susceptible to?
Viral & intracellular bacteria
What precipitates DeQuervain's throiditis?
Viral illness causes a transient hypothyroidism: - tender thyroid gland - elevated ESR - fatigue, cold intolerance, cool skin, decreased delirium tremens Rx: nothing
What does cobalamin deficiency result in?
Vit B12 deficiency: decreased methionine synthesis from homocysteine - megaloblastic anemia (no folate derivatives for DNA synthesis are recycled b/c methyltetrahydrofolate is not converted to tetrahydrofolate) - paresthesias & ataxia due to subacute combined degeneration (of the dorsal & lateral spinal columns) - Reduced epinephrine, creatine, & melatonin b/c methionine is a precursor
What causes scurvy?
Vit. C deficiency resulting in a defect in hydroxylation of proline & lysine residues of collagen
When are Class IC agents (flecainide & encainide) indicated?
Vtach or intractable supraventricular tachycardia MOA: phase 3 of the action potential Tox: increased post-MI mortality
How does Cushing's syndrome manifest in muscle tissue?
Wasting due to catabolic effects of cortisol
What syndrome develops rapidly (days to weeks) with adrenocortical insufficiency and an overwhelming bacterial infection (N. meningitidis), rapidly progressive hypotension, shock, DIC, & widespread purpura?
Waterhouse-Friderichsen syndroma
What is the fetal period of resistance?
Week 1 & 2: either the fetus will be survive the teratogen or it will fail to survive at all. "all-or-none" response
What lab test can confirm a rickettsial infection (rash on palms & soles)?
Weil-Felix reaction for this gram - bac - Serologic fluorescent antibody screen - Positive: cross-reacting antigens from Proteus vulgaris
What results from injury to the left posterior superior temporal gyrus?
Wernicke's (fluent/receptive) aphasia & may involve visual dificits
What disease causes hemosiderosis & gliosis of the mamillary bodies?
Wernicke-Korsakoff syndrome = secondary to vitamin B1 (thiamine) deficiency in chronic alcoholics - Hemosiderin is due to repeated hemorrhages
What is locked-in syndrome?
When a patient is fully aware, but can move only the extraocular muscles
What is La belle indifference?
When a person has a strikingly cavalier attitude about something very serious
What is primary gain?
When an individual subconsciously expresses an internal conflict as a symptom of a physical or mental illness, leading to a relief of their anxiety
What is hydrocephalus ex vacuo?
When brain mass is progressively lost, cerebrospinal fluid accumulates to fill the void.
When is ciprofloxacin used to treat UC?
When it is complicated by strictures & infections of the GI (NOT 1st line Rx)
When does Acetaminophen become toxic?
When its metabolism is saturated & N-acetyl-p-benzoquinone imine (NAPQI) is produced. This damages hepatocytes - NAPQI cannot be detoxified by endogenous glutathione - Lab: Huge elevations in aspartate aminotransferase & alanine aminotransferase (due to centrilobar necrosis) Rx: activated charcoal within 4 hours & N-acetylcysteine
When are beta waves seen on EEG?
When someone is awake & concentrating
What causes a urachal fistula?
When the allantois fails to regress; predisposes to a UTI
What connection caus increase the rist of testicular torsion?
When the tunica vaginalis is attached high on the spermatic cord
Under what conditions are carcinoid syndrome present?
When there is a liver metastases of a GI carcinoid (b/c then the liver cannot metabolize the serotonin produced within the liver)
When can neuroendocrine tumors cause carcinoid syndrome?
When they met to the liver and serotonin is no longer metabolized by 1st-pass hepatic metabolism: - diarrhea, cutaneous flushing, asthmatic wheezing, Rt-sided heart disease
What causes Microscopic Polyarteritis (MPA)?
White individual - Activation of neutrophils & monocytes by perinuclear antineutrophil cytoplasmic antibodies (p-ANCAs) leads to inflammation & vasculitis in small arteries (esp glomerulous & pulmonary capillaries): - S/S: dark brown stools, palpable purpura along extremities, reddish sputum
What is the main reservoir of Borrelia burgdorferi?
White-footed mouse
What ECG is indicative of WPW (Wolff-Parkinson-White) syndrome?
Wide QRS with relatively short PR invervals & slurring of the initial parts of the QRS complex - Cause: congenital accessory pathway leads to pre-excitation of the ventricle; the slurred upstroke is the delta wave - Result: suptraventricular tachycardia: palpitations followed by syncopy
What is secondary gain?
Willful invention of symptoms in order to obtain something desired or avoid something unpleasant
What metabolic disease can mimic Parkinson's?
Wilson's: copper builds up in the putamen - Dx: low leves of serum ceruloplasmin, increased heaptic copper content, & increased urinary copper excretion - Rx: D-penicillamine (copper chelator)
What is the pathogenesis of Bruton's?
X-linked agammaglobulinemia: - NO signaling molecule (Bruton's tyrosine kinase) to tell B cells to develop = NO immunoglobulins (low IgG & IgM, NO IgA) b/c of a mutation on the X chromosome (Xq21.22) - Susceptible to extracellular pyogenic bacterial infections: H. influenzea, S. pyogenes, S. aureus, S. pneumoniae
What is familial hypophosphatemic rickets?
X-linked dominant bone disease: - Defect in the resorption of phosphate by the proximal renal tubule - Abnormal regulation of 25-(OH) vitamin D activation
What is the pathogenesis of Alport's syndrome?
X-linked genetic disorder with absent or mutated type IV collagen: - Renal disease - Nerve disorders (deafness) - Ocular disorders EM: split basement membrane due to the collagen IV mutation (kidneys & ears)
What is the genetics of Hunters & Hurlers?
X-linked recessive
What does a deficiency of the CD40 ligand on activated CD4+ lymphocytes cause?
X-linked, hyper-IgM syndrome: - Deficiency of IgG - Normal/Elevated IgM - Recurrent pyogenic infections (no IgG opsinization) & P. jiroveci pneumonia b/c of the defect in cell-mediated immunity
How does midgut volvulus present on X-ray? Clinically? What are possible complications?
X-ray: Twisted & overdistened colon with a coffee-bean shape & lack of septa & haustra Clinical: vomiting & constipation Complications: compromised blood supply -> ischemic necrosis & perforation
Does Candida vaginitis present with a discharge?
Yes, white & odorless Rx: Fluconazole
Is osmotic diarrhea relieved by fasting?
Yes: - Osmotic gap (290 - 2(Na(stool) + K(stool)) > 50 mOsm - No increase in fecal fat - Classic Causes: celia disease, lactose or fructose intolerance
What drug can stop the bronchoconstriction due to aspirin allergy?
Zileuton: Inhibits the 5-lipoxygenase pathway to block the conversion of arachidonic acid to leukotrienes
How do you calculate Mean Corpuscular volume (MCV)?
[Hematocrit/RBC count] x 10
In 80% of people, what artery supplies the AV node?
a branch of the RCA 20% = branch of the left main coronary artery
How is von Hippel-Lindau disease characterized?
abnormal blood vessel growth leading to angiomas and hemangioblastomas in the: - Retina - Brain - Spinal Cord - & elsewhere
What is bronchiectasis?
abnormal dilation of the proximal & medium-sized bronchi (>2mm in diameter) caused by destruction of the muscular and elastic components of the bonchial walls
What is another name for Guillain-Barre syndrome?
acute inflammatory demyelinating polyradiculopathy. NB: radiculopathy: disease of spinal nerve roots and spinal nerves
What is the action of teres minor?
adduct & laterally rotates the arm
What is the action of the infraspinatus?
adducts the arm and laterally rotates the glenohumoral joint
What type of drug is Pazosin?
adrenergic blocker, selective alpha1 blocker
What enzyme is deficient in Maple syrup urine disease?
alpha-ketodehydrogenase: - inability to degrade branched amino acids (isoleucine, leucine, valine) I LoV Maple Syrup
What are the TPR, CO, HR, & MAP values for NOrEpinephrine?
alpha1 = alpha 2 = Beta1 >>> Beta2: TPR = Increased CO = NA or decreased (reflex) HR = decreased (reflex) MAP = Increased
What are the TPR, CO, HR, & MAP values for phenylephrine?
alpha1 >> apha2: TPR = increased CO = reduced (reflex) HR = reduced (reflex) MAP = increased
What drugs cause ototoxicity?
aminoglycosides & vancomycin
What enterococcus infection treatment can lead to pseudomembrane formation?
ampiclin
What GI side effects do typical antipsychotics like Haloperidol causes?
antimuscarinic: constipation
What causes microangiopathic hemolytic anemia?
any mechanical trauma to RBCs: - Defective prosthetic cardiac valves - TTP - Hemolytic uremic syndrome - DIC
How does congenital syphilis present?
asymptomatic at birth - Cranial VIII defect (hearing problems) - Cutaneous lesions (palms & soles) - Anemia, jaundice, hepatomegaly
What information does the medial geniculate nucleus of the thalamus receive?
auditory info from the inferior colliculi
How do Gaucher's patients present?
beta-glucocerebrosidase lacking (AR): 1) Organomegaly (esp. spleen & reticuloendothelial organs) 2) Bone pain, Anemia, Thrombocytopenia (bone marrow infiltration) 3) fatigue Dx: Radiograph changes: 50% have abnormal cortex of distal femur = "Erlenmeyer flask"
What are the TPR, CO, HR, & MAP values for Isoproterenol?
beta1 = beta2 >>> alpha 1 TPR = decreased CO = increased HR = increased MAP = decreased
How does Syringomyelia present?
bilateral sensory defects in the upper extremities dues to enlargement of the central canal of the spinal cord
What is the MOA of Vinblastine?
binds tubulin and blocks microtubule polymerization & mitotic spindle assembly SE: bone marrow suppression, alopecia, SIADH
What type of drug are Pentolamine & phenoxybenzamine?
bleh
What is the MOA of trimethoprim-sulfamethoxazole?
blocks the synthesis of folate: - Trimethoprim inhibits bacterial dkhydrofolate reductatase - Sulfamethoxazole inhibits dihydropteroate synthase
Along what nerve do baroreceptors from the carotid sinus send signals to the medulla regarding vaso-tension?
blossopharyngeal
What is the histological sign of extramedulllary hematopoiesis?
dacryocytes or "teardrop cells"
What lung parameter is changed equally in obstructive & restrictive lung disease?
decrease in vital capacity (insufficient amount of air exhaled or inhaled)
What skin disorder goes along with celiac disease?
dermatitis herpetiformis: pruritic papules & vesicles
What is another name for a benign cystic teratoma of the ovary?
dermoid cyst (3 germ cell layers)
What is bronchiectasis?
dilation of the bronchial tree secondary to mucus plugging (usually seen in Px with a history of repeated lung infections e.g. CF Px)
What is the key component of fungal endospores that allow them to resist dehydration, heat, & chemicals?
dipicolinic acid (e.g. present in Coccidioides immitis: causes coccidioidomycosis in the southwest US)
What type of drug is Fenaldopam?
direct sympathomimetic, selective D1-agonist
What is the MOA of polymyxins?
disrupts the cell membrane's osmotic properties
What drug can result in PED teeth discoloration?
doxycycline
What processes lead to centrolobular necrosis of the liver?
hypoperfusion + retrograde congestion = left or right-sided heart failure or shock
What Bp effects can typcial antipsychotics have?
hypotension (anti-alpha receptor action)
What are the main side effects of B-blockers?
impotence bronchoconstriction hypoglycemia cold extremities
Where are Leydig cells located?
in the interstitial spaces between the seminiferous tubules?
How does HPV cause carcinoma?
inactivates tummor suppressor genes such as p53 (viral protein E6) & Rb (viral protein E7)
What are some causes of sideroblastic anemia?
incomplete synthesis of heme: - Drug interactions (ethanol, isoniazid, chloramphenicol) - Lead poisoning - Nutritional deficiencies of pyridoxine/copper - genetic disorders
What results from prostaglandin E2 activation?
increase in body temperature
What is the pathogenesis of the allergic reaction to aspirin
increase leukotriene syntheses leads to bronchoconstriction: b/c the cyclooxygenase-catalyzed prostaglandin pathway is blocked
What is the MOA of hydralazine?
increases cGMP & causes smooth muscle relaxation (greater effect on arterioles than veins) to reduce afterload - Rx: essentail hypertension and CHF SE: compensatory tachycardia (angina), Up fluid retention, & lupus-like syndrome with long-term use
What type of drug is reserpine?
indirect sympatholytic, storage blocker
What is the action of Teichoic acid on gram + bacteria?
induces tumor necrosis factor alpha and interleukin-1 production
What vessel prohibits a horseshoe kidney from ascending?
inferior mesenteric artery
Which virus is known for its hemagglutinin antigen
influenza
What viral illness predisposes to subsequent bacterial pneumonia in an otherwise helathy individual?
influenza via damage of the epithelium of the upper respiratory tract
What is the mechanism of action of the botulinum toxin?
inhibition of acetylcholine release, which results in flaccid paralysis
What is the MOA of finasteride when used to treat BPH, prostate cancer, & male pattern baldness?
inhibits 5alpha reductase (in prostate, epididymis, seminal vesicles, & skin) from converting testosterone to dihydrotestosterone - Can increase levels of estradiol - Dutasteride has the same MOA
How does prolactin suppress menstration?
inhibits FSH and GRH & promotes breast milk production
What clotting/bleeding problem can be indicated by petechiae?
insufficient platelets
Why is there an increase in hepatic glucose production in type 2 DM?
insulin resistance results in a decreased ability to suppress gluconeogensis in the liver
What does Schistosoma masoni cause?
intestinal schistosomiasis - Intestinal cancer - Liver infection - Katayama fever (sub-Saharan Africa, South America)
What are the neurofibrillary tangles of Alzheimer's composed of?
intracellular inclusions of microtubule binding protein tau
How does alpha1-antitrypsin deficiency harm the liver?
intrahepatic accumulation of abnormal alpha1-antitrypsin protein
What do schistocytes indicated?
intravascular hemolysis
What causes hypochromic, microcytic RBCs?
iron deficient anemia: low MCV + low serum iron & ferritin & high TIBC
What acne drug is absolutely contraindicated for pregnant women?
isotretinoin
What section of the GI absorbs the largest net amount of water?
jejunum (colon only absorbs 400 mL/day out of 9L/day total)
What antiantrogen is used to treat hirsutism & polycystic ovarian syndrome?
ketoconazole (inhibits adrenal desmolase needed for steroid synthesis)
What is a rare but serious side effect of metformin?
lactic acidosis due to over suppression of hepatic gluconeogenesis & promotion of glycolysis
What is the treatment for ectopic pregnancy?
laparoscopic rescection
In what phase of the cell cycle does Etoposide act?
late S & G2: inhibits topoisomerase II (normally this enzyme untangles chromosomes and separates replicated DNA strands as well as DNA repair)
What is a common extraintestinal manifestation of Chron's disease?
migratory polyartheritis
What is the target organelle for chloramphenicol & erythromycin?
mitochondira: has 30S50S robosomal system (a reminent of its prokaryotic origin)
What is the most common valvular lesion?
mitral prolapse - late systolic murmor with a midsystolic click - predisposes to infective endocarditis
What is the most common heart pathology after chronic rheumatic heart disease?
mitral stenosis
What happens when there is a lesion in the inferior frontal gyrus (Broca's area)?
motor/nonfluent/expressive aphasia: - Can understand - Cannot produce ("no boca")
What cells of the Gi secrete CCK (cholecystokinin)?
mucosal neuroendocrine cells - primarily in the dudenum - pyramidal, extend from the BM to the lumen with microvilli & secretory granules
What is Bombesin a tumor marker for?
neuroblastoma, lung, & gastric cancer
In what cancers is the constitutive ras G protein activated?
neurofibromatosis
What is the treatment for Chagas?
nifurtimox
How does class 1 lupus nephritis present on light microscopy? clinically
no apparent pathology on LM; nephrotic syndrome
What causes hemiballism of the limbs?
lesion of the contralateral subthalamic nucleus cause uncontrollable flailing
What is the role of the pylorus?
limit the rate of gastric emptying: it contracts in response to each peristalic wave
Where is NE synthesized?
locus ceruleus in the brain
What drug can be used to treat IBS?
loperamide (an opioid antidiarrheal)
What lab values indicate an isolated respiratory alkalosis?
low CO2 and low HCO3- levels
What are the side effects of etoposide
plant alkaloid that acts in the late S and early G2 & inhibits topoisomerase II - Tachycardia - Nausea, vomiting - Shortness of breath - hematuria - melena - myelosuppression - alopecia
Where are cystic astrocytomas found?
posterior fossa of children (these are low-grade astrocytomas)
What are the major side effects of Prazosin?
prazoSIN: - Syncopy (1st dose) due to marked orthostatic hypotension - Increased retention of Na & H2O - Nonspecific dizziness & headache
How can lymphoblasts be distinguished from mature lymphocytes?
lymphoblasts have fine, homogenous chromatin, irregular nuclear boarders, & scant cytoplasm - Found in ALL (Dx: peripheral blood smear)
What defect results in Fabry's?
lysosomal alpha-galactosidase A: T/F ceramide trihexoside accumulates, resulting in: - peripheral neuropathies of the hands & feet - angiokeratomas, heart, & renal disease - X-linked recessive
What drug class can cause acute cholestatic hepatitis?
macrolides
What liver disease is strongly associated with UC?
primary sclerosing cholangitis - inflammatory fibrosis of the intra & extrahepatic bile ducts - hyperbilirubinemia, jaundice, ultimately cirrhosis - Dx: endoscopic retrograde cholangiopancreatography ("beading" along the biliary tree) - Up risk for cholangiocarcinoma
What type of proteins are bax and bak?
proapoptotic: trigger release of caspase-activating proteins to trigger cell death
What is the bac most often responsible for osteomyelitis in diabetic patients?
pseudomonas aeruginosa
What is the cellular lining of the vas deferens (where the sperm travel after maturing in the epididymis)?
pseudostratified columnar epithelium
What is the cellular lining of the epididymis (where sperm acquire motility)?
pseudostratified columnar epithelium with stereocilia
How does psoriatic arthritis present?
psoriasis (nonpuritic scaly or silvery erthematous plaques with well-defined borders) + joint symptoms with acute onset in 1/3 of patients - Joint swelling asymmetrically in distal interphalangeal joints - some patients have sausage-like finger from inflammation of the digital tendon sheaths
What can be a severe compication of bleomycin therapy?
pulmonary fibrosis (~1 month after initiation of treatment) & ARDS
How does blockage of a penetrating artery in the internal capsule present?
pure motor or sensory deficits
Where does pain occur in intermittent obstruction of the gall bladder?
referred pain near the right scapula & pain after eating (due to gallbladder contraction)
Which anemia is caused by lead poisoning?
sideroblastic: - Lead binds to sulfhydryl groups of heme-synthesis enzymes: alpha-aminolevulinic acid dehydratase & ferroketolase)
What is the cellular lining of the rete testes (@ the testicular hilum & where the sperm is transfered from the sminiferous tubules to the ductuli efferentes to the epididymis)?
simple cuboidal cells
What antiantrogen is used to treat class III/IV congestive heart failure, primary hyperaldosteronism, diuretic-induced hypokalemia)?
sironolactone (steroid binding inhibitor)
How does congenital herpes infection present?
skin (vesicles), eyes (keratoconjunctivitis), and mouth (vesicles) or localized CNS infection, all within 4 weeks of birth - CNA: temp. instability, RDS, poor feeding, letharcy
What type of nephritis results in eosinophilia of the kidney interstitium?
drug-induced interstitial nephritis
What are "pressor" drugs?
drugs used to increase Bp
What results from an apolipoprotein E receptor deficiency?
dysbetalipoproteinemia: VLDL cholesterol remnants are not removed from the circulation: - Elevated VLDL cholesterol, triglyceride, & cholesterol - Xanthomas
What is pica?
eating nonnutritive substances - can indicated Lead poisoning
What problems occur in stage 4 (delta wave) sleep?
enuresis sleepwalking night terrors
How does AIN (acute interstitial nephritis) present?
eosinophilic casts in the urine elevated fractional excretion of Na
What cells produce CSF?
ependymal cells that line the ventricles
What is the ingested form of vit. D called?
ergosterol
Damaging which nerve will result in a monotone voice?
external laryngeal nerve (terminal branch of the superior laryngeal, a branch of the vagus)
What nerve innervates the anterior compartment of the thigh?
femoral (flexes the thigh & extends the knee)
What are the S/S of Rocky Mountain spotted fever?
fever sever headache red conjunctivae rash on palms and soles Rx: tetracycline (e.g. doxycycline) or chloramphenicol FAST (or death)
What does infection by Brucella canis cause?
fever, malaise, hepatosplenomegaly
What antiantrogen is used to treat BPH & male pattern balness?
finasteride (5alpha-reductase inhibitor)
What is lacking in Krabbe's disease & how does it present?
galactosylceramide B-galactosidase deficiency: galactocerebroside - optic atrophy - spasticity - Early death via deposition in intermediary of the brain
What are the GRAIN lab results that indicated sarcoidosis?
gamma-Globulinemia Rheumatoid arthritis elevated ACEnzyme levels Interstitial fibrosis Noncaseating granulomas
Which type of ulcer results in weight loss & pain with food?
gastric Rx: 14-day triple therapy - Bismuth - Omeprazole - Amoxicillin or tetracycline
What artery supplies both the head of the pancreas & the duodenum?
gastroduodenal artery (branch of the celiac trunk) & superior mesenteric
Where are Mallory-Weiss tears found?
gastroesophageal junction: a nonpenetrating mucosal tear
What results from injury to the left sylvian region?
global aphasia, hemianopia, hemiplegia
What is the defect in VonGierke's?
glucose-6-phosphate deficiency: - severe fasting hypoglycemia with large stores of glycogen in the liver - hepatomegaly - increased blood lactate levels
What muscle(s) extends and laterally rotates the thigh & assists in standing from a sitting position?
gluteus maximus (inferior gluteal nerve)
What infections does the complement pathway clear?
gram negative
What deficiency results in McArdle's?
gycogen phosphorylase: glycogen in skeletal muscle cannot be broken down - cramping - myoglobinuria with strenuous exercise
What is the common presentation of glioblastoma?
headache, focal neurologic findings, nausea, vomiting, seizure
What is the histological appearance of intravascular hemolysis?
helmet cells & schistocytes
What heaptic vein carries deoxygenated blood from the liver back to the heart?
hepatic vein
In what cancers is alpha-fetoprotein elevated?
hepatocellular carcinoma and nonseminomatous germ cell tumors (yolk sac tumor)
What is within the omental foramen?
hepatoduodenal ligament that contains the common bile duct, hepatic artery proper & hepatic portal vein
What are the physical exam finding that indicate aortic regurg?
high-pitched blowing diastolic murmur with widened pulse pressure
What "essential" amino acids can be synthesized by a healthy adult?
histidine & arginine
What are the physical exam finding that indicate mitral regurg?
holosytoci high-pitched blowing murmor @ the base of the heart with a radiation to the left axilla
What are the lab results that indicated Vitamin D intoxication?
hypercalcemia hyperphosphatemia decreased serum intact PTH levels
What does a peaked or hyperacute T wave indicate?
hyperkalemia (or, early MI or myocaridal ischemia)
What are fibrates used to treat?
hypertriglyceridemia E.G. Genfibrozil
What can cause an isolated respiratory alkalosis?
hyperventilation due to anxiety/panic/pain (sympathetic stimulation) or high altitude or low O2
What does Chvostek's sign (ipsilateral contraction of the facial muscles when the facila nerve @ the angle of the jaw is tapped) indicate?
hypocalcemia
What can hypersecretion of ectopic thyroid tissue cause?
menstrual abnormalities: amenorrhea & oligomenorrhea Location of (congenital) ectopic thyroid tissue: anywhere along the course of the throglossal duct beginning beneath the the tongue @ the foramen cecum
Where are water-soluable vitamins absorbed?
small intestine
What endogenous hormone inhibits HCl secretion?
somatostatin
How does E. coli acquire the Shiga-like toxin that can cause bloody diarrhea & hemolytic-uremic syndrome?
specialized tranduction transfer: a lysogenic bacteriophage incorporates foreign DNA into its host.
What is the histological pattern of Creutzfeld-Jakob disease (CJD)?
spongiform degeneration: - vaculated appearance of the cortex due to deposition of abnormal PrPsc prtoein along with reactive astrocytosis - decreased number of neurons in the cortex in the absence of inflammatory changes
What are the derivatives of the 2nd aortic arch?
stapedial & hyoid artery
How are the lymph nodes changed in Bartonella heniselae infection?
stellate abscesses & tender Also, there can be sterile, suppurative papules at the site of inoculation
What are the main functions of smooth ER?
steroid biosynthesis membrane synthesis repair detoxification (liver has a lot)
What causes an S4 heart sound?
stiffness of hypertrophied ventricle
What kidney disease is characterized by subepithelial humps on EM?
subepithelial humps
Which rotator cuff muscle medially rotates the arm?
subscapularis
What is the MOA of Clonidine?
this CLOWN's CLONe ID is INE: Inhibiting NE exocytosis by igniting presynaptic alpha2-receptor Gi -> decrease in cAMP -> decrease PKA -> decrease Ca2+ influx Central depressor: decreases CO & PVR to lower Bp (DOES NOT reduced renal blood flood), initially vasoconstriction due to possynaptic alpha2 activation Reduces GI motility / Increases fluid absorption / decreases secretion
What is the MOA of Reserpine?
this SERPENT lets CA RESERve PINE away by blocking vesicular uptake pumps: CA depletion: - irreversibly inhibits Mg2+, ATP-dependent CA uptake pumps on storage vesicles, then MAO breaks down extravesicular CA - depletes CA store in central/peripheral nerve terminals & in the Adrenal Medulla - Lowers Bp: decreased CO & PVR - Striatum: Dopamine depletion suppresses extrapyramidal motor activity
What tract is responsible for the dopaminergic control of prolactin?
tuberoinfundibular: antagonists to D2-receptors in this region will cause hyperprolactinemia. E.G. Chlorpromazine (antipsychotic) is such a drug that antagonizes this receptor.
What receptors do Heroin & other opiates target?
u stimulation in brain and GI: - Brain = pleasure - GI = decreased motility & constipation
What is the term for abnormal or incomplete rotation of the intestine?
volvulus = twisting of loops of bowel Presentation: bile-containing vomit or bowel obstruction
What does a patient deficient in Glucose-6-phosphatase (final step in bluconeogenesis to produce glucose from glucose-6-phosphate) have?
vonGierke's disease - Abnormal accumulation of glycogen within liver cells
When is a thrombotic emboli a risk post MI?
weeks to months later
What is compartment syndrome?
when a lacerated artery bleeds into a closed space: - greater than expected pain - decreased blood flow @ the site of injury
What results from damaging the accessory nerve root?
winging of the scapula (trapezius) and impaired neck rotation (sternocleidomastoid)
How do IgG & IgM bind to gram - back in the classical complement pathway?
with the Fc region
What is the toxicity of isoniazid?
Hepatitis hemolysis in G6PD Px lupus-like syndrome Neurotoxicity
What infection is associated with 30% of polyarteritis nodosa patients?
Hepatitis B
What typically causes an irregular mass lesion in the liver?
Hepatocellular carcinoma
When is the patellar reflex lost?
Herniation affecting the L4 nerve root: - pain & sensory loss over anterior thigh & interior shin, + motor deficits of the quadriceps
What does HSV-2 cause?
Herpes genitalis & neonatal herpes - 1st lesion appears as ULCERS
What type of virus is EBV?
Herpes: double-straded, linear, DNA genome
What type of drug is Venlafaxine?
Heterocyclic antidepressant SE: anxiety, agitation, headache, weight loss, insomina
What are the clinical signs of epiglottis?
High fever dysphagia drooling inspiratory stridor respiratory distress X-ray: thumbprint sign (epiglottis thickening & aryepiglotic folds Cause: Hemophilus influenzae
What is the presentation of pediatric roseola?
High fever (3-5 days) conjunctivits otitis media malaise - Blanching macular rash on the neck and trunk that spreads to face & extremities
What is metabolic alkalosis?
High pH + increased plasma bicarbonate Cause: addition of alkaline compounds (antacid) or loss of acid (vomiting)
What is Thioridazine used to treat?
Schizophrenia (as a last resort b/c of SE) SE: neuroleptic malignant syndrome, cardiotoxicity, retinopathy
What personality disorder is characterized by interpersonal awkwardness, a tendency not to relate well to others, & an inability to understand why others don't find the same things interesting as they do? (also, they tend to have odd beliefs & eccentric appearance)
Schizotypal
What is the origin of neurofibromas
Schwann cells + perineural & endoneural components
What are "transposable elements"?
Segments of DNA that are able to move from 1 location to another
How does Cushing's result in proximal limb weakness?
Selective atrophy of fast-twitch (type 2) myofibers
What enables working muscle to have a greater blood supply during exercise?
Selective vasodilation via metabolic factors: lactate, potassium, & adenosine - Overcomes sympathetic effect that exercise also induces to vasocontrict via alpha receptors
What monoamine oxidase-B drug is used to increase the availability of dopamine in Parkinson's treatment?
Selegiline
What is Waterhouse-Friderichesen syndrome?
Sepsis with adrenal insufficiency
What is the pathogenesis of the right heart valvular disease of cardinoid syndrome?
Serotonin-mediated fibroelastosis
What is the MOA of Fluoxetine?
Serotonin-specific reuptake inhibitor
What organism can cause hospital-acquired, drug-resistant UTIs & produce a red pigment & discoloration of the urine?
Serratia marcescens
What testicular cells secrete mullerian-inhibiting factor, & thus causes mullerian ducts to regress?
Sertori cells
How is transferrin saturation calculated?
Serum iron / TIBC TIBC = 1.4 x serum transferrin
What ECG picture is a sign of Digoxin toxicity?
Severe bradycardia (36 bpm) with complete heart block - Often precipitated by an increase in FUROSEMIDE (increases K-secretion & thus, this hypokalemic state potentiates the effects of digoxin) Rx: Digoxin immune FAB
How is ARDs (Acute respiratory distress syndrome) characterized?
Severe lung injury with acute hypoxemia & pulmonary edema resulting from increased pulmonary capillary permeability
What gram-negative, nonmotile facilitative anaerobe causes abdominal pain, high fever & bloody diarrhea in the developing world?
Shigella flexneri
How does hereditary spherocytosis result in anemia?
Shortened life span & increased destruction of unstable RBCs: - Disease results in decreased elastic deformability of RBC cell membranes
What is Beck's Triad?
Signs of cardiac tamponade: 1) Distant heart sounds 2) Increased JVP 3) Hypotension Also, pulsus paradoxus: systolic Bp drops by >10mmHg on inspiration
What type of genome do the following viruses have? Picornaviruses Calciviruses Flaviviruses Togaviruses Coronaviruses Retroviruses
Single-stranded (+), linear, RNA
What part(s) of the body are associated with the 2nd stage of Lyme disease?
Skin, CNS, heart, & joins
What is the MOA of beta-blockers that allows them to help with coronary artery disease?
Slows phase 4 depolarization & prolong's diastole: increase coronary artery filling - Decreased sympathetic tone decreases the inward Na+ current
What is the MOA of Somatrem?
Somatotropin (GH analog) that stimulates the release of insulin-like growth factor-1 (aka somatomedin) from the liver Rx: GH deficiency
What is the site of lymph drainage of the liver?
Space of Diss (between sinusoidal endothelial cells & hepatocytes)
What are Call-Exner bodies?
Spaces between granulosa cells in ovarian follicles & in granulosa cell tumors
What type of fracture is most likely due to child abuse from bone twisting?
Spiral fracture
What K+ sparing diuretic also has antiandrogen effects?
Spironolactone - used to prevent hirsutism in polycystic ovarian syndrome
What is the hallmark of hemophilia?
Spontaneous hemarthrosis (bleeding into joints) caused by - Deficiency of factor VIII (hemophilia A) or factor IX (hemophilia B)
What causes rose-gardener's disease?
Sporothrix schenckii (fungus) - Pustule or ulcer at entry point with ascending lymphangitis (rarely causes a systemic effect)
What is "rose gardener's disease"?
Sporothrix schenckii fungal infection: - necrotizing granulomatous lymphocutaneous skin infection - S/S: local pustule with nodules in the distribution of draining lymph nodes
The patient is a smoker and X-ray revelas a large hilar mass with signs of cavitation. What's the Dx?
Squamous cell carcinoma: also can present with paraneoplastic production of parathyroid hormone-related peptide (PTHrP) that causes HYPERcalcemia (-> urolithiasis)
When do you monitor INR (international normalized ratio)?
Standarizes prothrombin (extrinsic pathway) time: warfarin - INR should be between 2 & 3
What is the second leading cuase of community-acquired UTIs?
Staphylococcus saprophyticus (gram +)
What is CML?
Stem cell disorder that results in the overproduction of myeloid cells (mature forms)
What is the mechanism of sulfonylureas (glyburide & glipizide)?
Stimulate the release of endogenous insulin stores: close potassium channels in B-cells that leads to an influx of Ca, cell, depolarization, & insulin release
What is the MOA of PTH on the kidney to make acitve vitamin D?
Stimulates 1-alpha hydroxylase to produce 1,25-OH vitamin D from 25-OH vitamin D
What is the action of metformin?
Stimulates glycolysis in peripheral tissues, decreases intestinal glucose absorption, & decreases hepatic gluconeogensis - Side effects (of all biguanides): lactic acidosis; t/f always give hospitalized patients (who have to stop their metformin) IV insulin
How does FSH induce the conversion of testosterone to 17-beta-estradiol in the ovaries?
Stimulates the enzyme aromatase within the graulosa cells to convert testosterone to 17-beta-estradiol in the overian follicle. - Testosterone gets to the granulosa cells via diffusion from the theca cells where it is produced
What is the frequency of the slow waves of the stomach and small intestine?
Stomach: 3Hz Small intestine: 12 Hz
What is the triad for parathyroid adenomas?
Stones, bones, abdominal groans, & psychic moans: 1) Nephrolithiasis 2) Osteoporosis or osteitis fibrosa cystica 3) Constipation, nausea, vomiting, ulcers, pancreatitis, gallstones 4) Depression, lethargy, & eventual seizures
What is the presentation of Scarlet fever?
Strep pyrogenes: fever, soar throat, strawberry tongue Rash: trunk, neck, limbs, NO palms/soles. Post rash: desquamation of palms & soles
What is the most common cause of community-acquired, lobar pneumonia?
Streptococcus pneumoniae
How does the blockage of an anterior cerebral artery present?
Stroke: contralateral motor & sensory deficits in the leg & foot
What ovarian tumor presents with symptoms of hyperthyroidism in 5-15% of patients?
Struma ovarii: - monodermal teratoma that contains thyroid tissue - Increased risk of malignant thyroid carcinoma arising from this tumor
What are the major side effects of Reserpine?
Such a RESERVE depletion makes me 2SAD: CNS: Sedation, pArkinsonism, Depression GI: Secretion of gastric acid, Abdominal pain, Diarrhea
What is the use of ondansetron?
antiemetic: selective serotonin receptor antagonist SE: headache, malaise, constipation
What physical diagnosis finding is characteristic of parathyroid-hormone-secreting adenoma?
History of renal stones & neck nodule
What drug is used both as an antitumor agent and for sickle cell?
Hydroxyurea: antitumor (Rx: CML) & also raised fetal hemoglobin levels
What characterizes the 3rd phase of Lyme disease?
Migratory joint pain Chronic arthritis Encephalopathy Acrodermatitis
What drug, used to treat gastric ulcers induced by NSAID use, is an abortofactant?
Misoprostol (Prostaglandin E1 analog)
What is the treatment for bulimia?
SSRIs (e.g. fluoxetine)
What type of anti-depressants cause serotonin syndrome when combined?
SSRIs (e.g. paroxetine, fluoxetine, sertraline, citalopram) + MAO inhibitors (e.g. Tanylcypromine, phenelzine)
What is a rare complication of long-term heparin therapy? What's the treatment?
HIT: heaprin-induced thrombocytopenia - Heparin-specific antibodies form complexes with heparin & platelets - Results in platelet activation, clot formation, & steadily dropping platelet levels Rx: Direct thrombin inhibitors (Argatroban & Lepirudin)
What HLA is found in patients with Hashimoto's?
HLA-DR5
What conversion do statins inhibit?
HMG CoA to mevalonic acid Side effect: muscle pain or injury similar to myositis (MOI unknown)
What HPV causes genital flat warts & is associated with cervical dysplasia & carcinoma?
HPV types 16 & 18
What are the HACEK organisms?
Haemophilus Actinobacillus Actinomycetemcomitans Cardiobacterium hominis Eikenella corrodens Kingella kingae Can all cause culture negative endocarditis
What muscles does the sciatic nerve (tibial & common peroneal divisions) innervate?
Hamstrings (posterior thigh muscles): extend the thigh & flex the leg
What Bunyavirus can cause ARDS?
Hantavirus - transmitted via rodent droppings & saliva
What tumors is Tartrate-resistant acid phosphatase a marker for?
Hariy cell leukemia (a B-cell tumor)
What does methemoglobin do to the hemoglobin curve?
Has a decreased affinity for O2 = right shift
What is the classic presentation for prolactinoma (most common pituitary adenoma) in a woman?
Headaches Galactorrhea Bitemporal hemianopsia
Where is Aspartate aminotransferase (AST) found?
Heart, liver, skeletal muscle
What is another term for hemoglobin clumping?
Heinz Bodies (e.g. G6PD deficiency)
What brain tumor is a feature of vonHippel-Lindau disease?
Hemangioblastoma (benign) of the cerebellum or retina: - Patients present with headache - Findings include papilledema, nystagmus, & ataxia (& 2ndary polycytemia due to epo secretion by the tumor) - Tx: surgical resection
What does a radiologic study showing soft tissue swelling, bone destruction, & periosteal reaction indicate?
Hematogenous osteomyelitis - Usually due to Staphylococcus aureus
What catalyzes the oxidation of heme to biliverdin?
Heme oxygenase
What left-shifts the O2 dissociation curve?
Hemoglobin will have a higher affeinity for O2: - Fetal hemoglobin - Increased pH - decreased temperature - decreased 2,3-DPG levels - decreased arterial CO2 pressure
What causes a newborn to present 2-7 days after birth with GI, intracranial, umbilical, mucosal, circumcisional, &/or cutaneous bleeding?
Hemorrhagic disease of the newborn caused by vitamin K deficiency Lab: elevated PT & PTT with normal platelet count & bleeding time
What are the % risks for needle-stick contraction of Hep B, C, & HIV
Hep B: 30% Hep C: 10% HIV: 0.3 - 0.45%
What is Protamine sulfate used for?
Heparin OD - heparin is negatively charged and this positively charged molecule binds to it to reverse its effects
What causes hyperlipidemia in nephrotic syndrome?
Hepatic overproduction of lipids + a defect in lipoprotein lipase
What type of cells are found in the liver's space of Disse?
Hepatic stellate cells (Ito/lipocytes): - filled with lipid droplets containing vitamin A - produce collagen in response to liver injury
What is the treatment for Wilms' tumor?
MOPP regimen: Mechlorethamine Oncovin (vincristine = neurotoxic) Procarbazine Prednisone
What is the treatment for mycoplasma pneumoniae infection?
Macrolides (e.g. azithromycin)
Which antacid can buffer gastric acid?
Magnesium oxide
Why are ACE inhibitors prescribed after a patient recovers from an MI?
Maintenance therapy to reduce ventricular remodeling
In what disease do the kidneys appear grossly flea-bitten?
Malignant hypertension
What does Cromyolyn do?
Mass cell mediator release inhibitor Rx: asthma prophylaxis
Is humor (appreciating the amusing nature of an anxiety-provoking or adverse situation) a mature or immature defense mechanism?
Mature
What differs in presentation between an infant with intussusception & Meckel's diverticulum?
Meckel's = mild (blood in stool, & mild tenderness) Intussusception = abrupt & severe presentation (paroxysmal bouts of screaming, vomiting, diarrhea, & bloody bowel movements w/in 24 hours of onset)
What cause an intense inflammatory response in the bronchi & alveoli (pneumonitis) within hours in a neonate?
Meconium aspiration syndrome
Where in the medulla do vibratory & proprioceptive info course?
Medial: medial lemniscus
What the does the allantoic duct eventually become?
Median umbilical ligament "allaNtosis" has an "N", as does "mediaN"
What structures are the remnants of the umbilical arteries?
Medical umbilical ligaments
What nerve structures are responsible for light discriminatory touch?
Meissner's (small, encapsulated, on dermal papillae of glabrous/hairless skin)
What is acral lentiginous?
Melanoma that often appears on the palms & soles of dark-skinned individuals
What cell type should be stimulated when a patient is at risk for neutropenia & throbocytopenia (e.g. because of cancer chemo)?
Meloid stem cell: progenitor of neutrophils, basophils, eosinophils, macs, & platelets
What nerve structures respond to static touch?
Merkel's disks (cup-shaped, encapsulated)
What tract is antagonized by typical anti-psychotics and thought to exacerbate negative symptoms of schizophrenia?
Mesocortical (cognition pathway) D2-receptors
What does a deficiency in Arylsulfatase A result in?
Metachromatic leukodystrophy (AR): - Central & peripheral demyelination - Ataxia - Dementia
Where is osteosarcoma usually found?
Metaphysis of long bones: - Characterized by formation of new bone matrix - Most common primary malignancy of bone
What selective B2-agonists end in -terenol?
Metaproterenol
Unpack the mneumoic "MUDPILES" in regards to anion gap metabolic acidosis?
Methanol Uremia Diabetic/ethanol ketocaidosis Paraldehyde Isoniazid/Iron toxicity Lactic acidosis Ethylene glycol Salicylates (& Rhabdomyolysis)
How is Pneumocystis jiroveci pneumonia diagnosed?
Methenamine silver stain of lung biopsy tissue Rx: - Sulfamethoxazole-trimethoprim - pentamidine - dapsone
What amino acid can donate methyl groups?
Methionine (S-adenosyl-L-methionine) E.G. used in the synthesis of phosphatidylcholine
What is the initial treatment for esophageal dysmotility?
Metoclopramide: promotility agent
What sympatholytic drug is a synthesis inhibitor?
Metyrosine
What does the oblique fissure of the right lung separate?
Middle from inferior lobe
What is the classical presentation for CML?
Middle-aged person - Weakness - Weight Loss - Left Upper Quadrant Pain LAB: increased # of cells of myeloid lineage + t(9:22)
What problem is associated with ngiotensin-converting enzyme inhibitors, timethoprim, and heparin?
RTA IV: inability to secrete sufficient acid into the urine due to hypoaldosteronism - hypoaldosteronism leads to decreased Na reuptake in the distal convoluted tubule & collecting duct - This decreases excretion of K into the urine = kyperkalemia - Hyperkalemia results into H+ ion shift to the extracellular fluid to maintain a K balance = metabolic acidosis - The alkalotic environment of the renal tubule cells = low ammonia & H+ production & secretion. T/F the kidney cannot secrete the excess bodily acid - Low ammonia = unbuffered urine & a low pH (below 5.5)
What does a midshaft fracture of the humerus cause injury to?
Radial groove structures: radial nerve & deep brachial artery - "Great Extensor Nerve": wrist drop (inability to extend wrist & matacarpophalangeal joints of all digits)
Are hyperuricemia kidney stones radiolucent or radio-opaque?
Radiolucent: not seen on X-ray
What drug prevents growth, survival, and division of Estrogen-positive cancer cells and is thereby prescribed to certain breast cancer patients?
Raloxifene: it also increases bone mass
What drugs are H2-receptor antagonists?
Ranitidine Cimetidine Famotidine Rx: inhibit acid secretion at the histamine receptor
Where is serotonin synthesized?
Raphe nucleus
What is the equation for clearance? (L/min)
Rate of drug elimination / plasma drug concentration
What genetic mutation ca result in reintoblastoma and osteosarcoma?
Rb tumor suppressor gene on chromosome 13q
In what type of heart problem can Adenosine be used?
Re-entrant supraventricular tachycardia: binds to A1 receptors & induces a heart block within the AV node
What is the action of statins?
Reduce cholesterol biosynthesis in the liver by preventing the formation of the precursor mevalonate
What is a patient at risk for post-thyroidectomies if not given levothyroxine?
Reduced: - Glycogenolysis - Gluconeogenesis - Lipolysis B/C thyroid receptors are located on bones in both the CNA & autonomic nervous systems
What causes prerenal azotemia?
Reduction of GFR due to a decreased vascular supply to the kidney - Heart failure - Sepsis - Renal artery stenosis
What reflex action happens with norepinephrine?
Reflex bradycardia due to an increased in SV.
What is the clinical use of Dobutamine?
Refractory or severe CHF
What is the iodine status of a pregnant woman?
Relative deficiency: due to increased renal clearance
How does COX-1 inhibition lead to ulcers?
Removes the prostaglandin syntheses that is protective to gastric mucosa
What sympatholytic drug is a storage blocker?
Reserpine
How does HSV move in the peripheral nervous system?
Retrograde axonal transport to the neuronal cell body to remain latent in the dorsal root ganglia
What confirms a Benzo overdose?
Reversal of symptoms (coma & respiratory depression: both are rare) by flumazenil
What is Aminocaproic acid used for?
Reverse the thrombolytic effects of: - Streptokinase - Urokinase - Tissue plasminogen activator MOA: inhibits fibrinolysis
What is the most common cause of mitral stenosis?
Rheumatic heart disease - delayed, rumbling, late diastolic murmor
What is Ulnar deviation of the fingers a late manifestation of?
Rheumatoid arthritis
What is the treatment for Hep C?
Ribavirin + pegylated interferon alpha
What causes replacement of throid & surrounding tissue with fibrous tissue?
Riedel's thyroiditis - presentation: dysphagia, stridor, dyspnea, hypothroidism or euthyroid - DDx: thyroid carcinoma
Which TB drug induces p450?
Rifampin
What are the main drug types that induce the cytochrome p450 system?
Rifampin Fluconazole Protease inhibitors Digoxin Warfarin Oral Controceptives
What is the most poten antituberculous med?
Rifampin (blocks DNA-dependent RNA polymerase) SE: liver toxicity
What causes a physiological right-shift of the Oxygen-Hemoglobin curve in exercising persons?
Right shift = decrease affinity of hemoglobin for O2 & more tissue-unloading of O2: 1) Decrease: tissue pH (up H+ concentration) 2) Increase: Temperature & partial pressure of CO2
What does a right or left shift in the O2 dissociation curve indicate?
Right: decreased affinity for O2 (lower % of bound O2 @ a given partial pressure) Left: increased affininity for O2 (greater % of bound O2 @ a given partial pressure)
What are Auer rods?
Rod-shaped bodies in myeloid cells = fused lysosomes - found in APL (acute, promyelocytic leukemia; M3)
What is the MOA of Class IA antiarrhythmics?
Rx: atrial or ventricular arrhythmia MOA: - block Na channels and slow conduction velocity -> this slows phase 0 & t/f increases QRS duration - block potassium channels -> increases AP duration & ERP (effective refractory period
What drugs, in combo with St. John's wort cause serotonin syndrome?
SSRs (liek sertraline) Seratonin Syndrome: mental status changes, autonomic changes (fever, diaphoresis, tachycardia, tremor, rigidity)
What does an ST-elevation indicate? What about an ST-depression? Q wave?
ST-Elevation = transmural ST-Depression = subendocardial Q wave = transmural
What is the MOA of 5-Fluorouracil?
S-phase-specific antimetabolite: - Inhibits thymidylate synthase - T/F blocks the production of thymidine (no pyrimidines)
What is the pathogenesis of pyomyositis?
S. aureus infection of skeletal muscle - due to bacteremia from IV drug use or dental work) - often large leg muscles - S/S: muscle pain, swelling, fever
What bacterial cause of pneumonia is a gram-positive cocci that grows in chains and possesses a glycoprotein capsule?
S. pneumoniae; it is also bile soluble
What is the picture of Pneumocystis infection?
S/S: dry cough, dyspnea, hazy bilateral hilar infiltrate on chest X-ray Rx: Trimethoprim/Sulfamethoxzaole
How does a patient with an L5-S1 disc herniation present?
S1 nerve root damage: - Pain & paresthesia & sensory loss over: back of thigh, lateral posterior calf, & lateral foot; loss of motor of gastrocnemius w/ or w/o deficit in foot eversion - LOSS of Achilles relfex
What does the Achilles tendon reflex test?
S1-2 nerve roots - a diminished deep tendon reflex = LMN injury NB: "Count up" Achilles reflex (S1, S2) Knee jerk (L3, L4) Biceps (C5, C6) Triceps (C7, C8)
What nerve roots is the pudendal nerve derived from?
S2-4
What level are the nerves that control erection?
S2-4 (sympathetic fibers)
What heart sounds indicate hypertrophic cardiomyopathy?
S4 (due to stiff walls) Ejection murmur (mild outflow tract obstruction due to septal hypertrophy) Rx: b-blocker or non-dyhydropyrine Ca channel blocker (verapamil)
What are the branches of the RCA in a "right-dominate" person?
SA nodal branch Acute marginal artery AV nodal branch Posterior descending artery
What are the major side effects of Clonidine?
SAD: Sedation Allergic dermatitis Dry mouth & Depression WITHDRAWEL syndrome: hypertensive crisis
What are the mature defense mechanisms?
SASH: Altruism Humor sublimation supression
How are carbohydrates absorbed across the apical membranes?
SGLT-1: glucose & galactose GLUT5: fructose Portal circulation access is through GLUT2 cotransporter
What kidney problem shows up as wire-loop appearance under EM?
SLE (systemic lupus erythematosus) due to subendothelial basement membrane deposits
What is the most commonly obstructed artery in the gut & what does it supply?
SMA (superior mesenteric artery): embryonic midgut (duodenum to the proximal 2/3 of the transverse colon)
What is a rare complication of measles?
SSPE: subacute sclerosing panencephalitis - 7-9 years after infection - personality changes - lethargy, difficulty in school, odd behavior - Late changes: dementia, severe myoclonic jerking, eventyal flaccidity & decorticate rigitiy -> rip
What is rheumatoid factor?
an IgM autoantibody that is directed against the Fc region of the patient's IgG antibody: immune complexes form
What is pregnenolone?
an intermediate in the conversion of cholesterol into adrenal steroids
What 2 drugs inhibit aromatase via reversible competition?
anastrozole & letrozole
What is the major problem with Rubella (or German measles) infection?
antenatal infection = CRS (congenital rubella syndrome) - High degree of fetal mortality - Cardia & ophthalmologic defects - RARE: SSPE-like syndrome
What histamine-related effects can typical antipsychotics have?
anti: sedation
Where is ACh synthesized in the brain?
basal nucleus of Meynert
What genetic translocation results in follicular (B-lymphocyte) lymphoma?
bcl-2 (antiapoptotic) from 18 to 14 (Ig heavy chain locus)
What is the triad for congenital toxoplasmosis?
chorioretinitis hydrocephalus intracrainal calcifications Early: maculopapular rash, jaundice, hepatomegaly
What H2-antagonist is an inhibitor of the cytochrome p450 system?
cimetidine (Rx: ulcers; SE: headache, confusion, gyncomastia, thrombocytopenia)
What antiantrogen is used to treat prostate cancer?
flutamide (competitive androgen inhibitor @ the testosterone receptor)
What defective transporter is missing in Hartnup's disease?
for Neutral amino acids (all except proline) @ the renal & GI tracts - Result: aminoacidurias - can manifest as Pellagra b/c tryptophan is used to make niacin with B6 as a cofactor
Where is the horizontal fissure of the right lung on the anterior chest?
fourth rib anteriorly: separates superior from middle lobe
What can cross the vilous epithelial cell membrane of the small intestine via simple diffusion?
free fatty acids & monoglycerides: breakdown product of triglycerides by pancreatic lipase & bile salts
What enzyme deficiency results in galactosemia & galactosuria?
galactokinase: converts galactose into glucose
What accumulates in galactosemia?
galactose-1-phosphate & galactitol - Galactokinase phosphorylates galactose to galactose-1-phosphate & G1PUR converts this to glucose-1-phosphate. - G1PUR is lacking in galactosemia
What is S-100 a tumor marker for?
melanoma neural tumors astrocytoma
What disease presents with proliferation of the mesangial cells in the glomerulus?
membranoproliferative glomerulonephritis or (slight proliferation) in class II lupus nephritis
What are the symptoms of rhabdomyolysis?
muscle pain, weakness, "coca-cola colored" urine
What is the muscle-related complication of statin use?
myalgia or rhabdomylosis Especially when combined with any inhibitor of cytochrome P450 enzyme CYP3A4 (that metabolizes statins) - E.G. erythromycin
What is idopathic myelofibrosis?
myeloproliferative syndrome in which bone marrow is gradually replaced by collagen fibrosis - Lab: anemia, mild thromocytosis, mild neutrophilia - Gradual bone marrow failure results in extramedullary hematopoiesis in spleen
What are the side effects of methotrexate?
myelosuppression mucositis elevated liver enzymes renal toxicty
What are the clinical features of SIADH?
nausea lethargy seizures coma Lab: - hyponatremia - serum hypo-osmolality - urine hyperosmolarity - decreased hemocrit (2ndary to dilution
What nerve receptors are sensitive to pain caused by mechanical stress, extreme temperatures, & cytokines such as bradykinin & histamine?
nociceptors
What drug interacts with Epinephrine to cause severe hypertension or even cerebral hemorrhage?
nonselective Beta-blocker
What embryological structure is the nucleus puposus a remnant of?
notochord
How does renal cell carcinoma or prostate carcinoma damage the kidneys?
obstructive damage by a neoplastic mass
What cells are infected by the JC virus?
oligodendrocytes: results in progressive multifocal leukoencephalopathy
What information does the lateral geniculate nucleus of the thalamus receive?
optic tract
Where is warfarin metabolized?
p450 system
At what pH is it advisable to administer bicarb to correct an acidosis?
pH < 6.9
Which part of the nervous system controls accomodation or cycloplegia?
parasympathtic control of the ciliary muscle via cholinergic receptors
What is the presentation of congenital CMV infection?
petechial rashes jaundice hepatosplenomegaly sensorineural hearing loss
What enzyme is lacking in phenylketonuria (PKU)?
phenylalanin hydroxylase: usually converts phenylalanine to tyrosine using tetrahydrobiopterin as a cofactor
What tumor can cause paroxysmal hypertension, palpitations, anxiety, & drenching sweats?
pheochromocytoma: tumor of the adrenal medulla that leads to the overproduction of epinephrine
What is the MOA of statin-inducted ATN?
secondary to obstruction or via toxic effect on renal tubules
What happens when there is a lesion in the superior temporal gyrus (Wernicke's area)?
sensory/fluent/receptive aphasia: - can speak fluently - cannot understand others or what they say themselves
What nerve damage results in "waiter's tip" palsy?
suprascapular nerve: loss of lateral roation of the humerus at the shoulder (supraspinatus & infraspinatus)
Which rotator cuff muscle is most often injured?
supraspinatus: initiator of abduction (first 15 degrees of the arc; deltoid does the rest)
What genetic translocation results in mucosa-associated lyphoid tissue lymphoma?
t(11:18)
What translocation is associated with APL version of AML?
t(15:17) - Rx: all-trans retinoic acid to restore differentiation & conventional chemo
What gene fusion is characteristic in Acut promyelocytic leukemia (APL)?
t(15:17) = PML + retinoic acid receptor Rx: retinoic acid to mature the leukemic cells
What genetic translocation results in Burkitt's lymphoma?
t(8:14): C-myc (Ch. 8) & immunoglobulin heavy chain (Ch. 14) locus
What selective B2-agonists are used to stop premature labor?
terbutaline & ritodrine
What are the symptoms of hypocalcemia?
tetanny & incrased neuromuscular excitability + decreased serum PTH
What are the 4 clinical uses of Clonidine?
the CLOWN needs to HOLD the lighter: 1) Hypertension (2nd choice) & hot flashes (due to menopause) 2) Opiod & Alcohol withdrawal 3) Loss of behavioral control (ADHD) 4) Diabetic Diarrhea due to sympathetic neuropathy
What results from taking an MAO with a tyramine food (aged cheese, liver, red wine)?
the tyramine will not be metabolized and, as a vasoactive compound, can cause a drastic increase in Bp & hypertensive crisis & "serotonin syndrome" - MAO example: Phenelzine
What is the formula for physiologic dead space (Vd)?
tidal vlume x ([arterial CO2 pressure - expired air CO2 pressure] divided by the arterial CO2 pressure or Vt x ([PaCO2 - PeCO2] / PaCO2)
What is Carbamazepine used to treat?
tonic-clonic (grand mal) & partial (focal) seizures
What is a toxicity of Quinine?
torsades de pointes - This drug is an isomer of quinidine, an antiarrhythmic - Antiprotozoal action: prevents separation of dsDNA & thus inhibits DNA replication & transcription
What cell type lines the bladder, calyces, ureters, & upper urethra?
transitional cell epithelium
Where in the brain are anaplasic oligodendrogliomas located?
usually: frontal lobes
What does the T wave represent?
ventricular repolarization
Which part of the myocardium is the first to undergo necrosis due to prolonged ischemia?
ventricular wall (last to be perfused)
