Uworld 5/17/18 - 5/24/18

what kind of virus is Hep C

+ssRNA virus (does not require ligase activity; this is just for DNA)

morphology of rsv

-ssRNA paramyxovirus2

tx for alzheimer's

1. enhanced cholinergic neurotransmission (e.g. donepezil) 2. neuroprotection via antioxidants (alpha-tocopherol, vit E) 3. NMDA receptor antagonism (memantine)

describe steps of base excision repair (eg repairing cytosine deamination creating unusual base uracil)

1. glycosylase cleaves altered base leaving an AP site (empty sugar phosphate site, apurinic/apyrimindic) 2. endonuclease cleaves 5' end and lyase (phosphodiesterase enzyme) cleaves 3' sugar phosphate 3. dna polyermase fills single nucleotide gap and ligase seals the nick

how to calculate tpr from parallel circuit

1/tpr = 1/r1 + 1/r2 + 1/ r3 etc... this estimates body circulation well

rule of 10s for pheochromocytoma

10% bilateral 10% extra adrenal (paragangliomas) 10% malignat

describe micro changes after ischemic stroke

12-24 hrs: red neurons (eosinophlic cytoplasm, pyknotic nuclei, loss of nissl substance) 24-72 hrs: PMN infiltration 3-7 days: macrophage/microglia infiltration and phagocytosis begin 1-2 weeks: reactive gliosis and vascular proliferation around necrotic area (liquefactive necrosis 1 week - 1 month) >2 weeks: glial scar formation (cystic area surrounded by dense glial fibers = >1 month)

mutation in follicular lymphoma

14,18 translocation overexpression of anti-apoptotic bl2 gene

oncogenic strains of hpv

16, 18

which men has medullary thyroid cancer

2 (A and B)

describe halothane hepatitis sx and presentation

2 days to 3 weeks after med exposure with fever, nausea, jaundice (scleral icterus), tender hepatomegaly, elevated AST, ALT, bili biopsy: centrilobular hepatic necrosis, looks like viral hepatitis

abortion consenting procedures for a minor

2/3rds states require parental consent prior to abortion 1/3 require parental notification but not consent

how much serum cholesterol reduced from statin

20-50%

AEs of risperidonee

2nd gen antipsychotic weight gain and hyperprolactinemia

what is ae of clozapine

2nd gen antipsychtoic for tx refractory schizophrenia assoc w/ agranulocytosis (reg monitoring of ANC needed)

platelet lifespan

3-7 days

highest peak of drug concentration is usually X after IV and IM dosing

30 min after IV 1 hr after IM

when do you start seeing micro signs of mi ?

4 hrs before 4 hrs, minimal change on micro

how long to reach steady state concentration (first order kinetics)

4-5 half lives

how long does it take kidneys to compensate for resp alkalosis

48 hrs renal excrete bicarb to compensate for resp alkalosis, stabilize ph toward normal range

what is MoA of finasteride

5 alpha reductase inhibitor used in tx of BPH and prevent conversion of testosterone to DHT DHT reduced, testosterone remains unchanged

what is direction of dna polymerase iii polymerase ability

5'-3'

how much oxygen does the heart extract from the boood

60-70%

what mutation in burkitt lymphoma

8;14 overexpression of c myc, txn regulator that controls cell proliferation

what is pathophys of CML

9, 22 translocation ABL proto-onc on chromosome 9 to chromosome 22 which is placed adjacent to BCR gene fusion protein with constitutive tyrosine kinase activity stimulates prolif of granulocytic precursos --> CML kinase function of fusion protein target of protein kinase inhibitor (imatinib)

what is a normal post void residual urine volume

<50 cc

what drug not to give to hereditary angioedema

ACE-I ACE normally converts angiotesnein into AII converts bradykinin into inactive metabolites if give ACE-I --> lead to bradykinin accumulation should NOT be used in patients, as it may precipitate hereditary angioedema

what is achondroplasia

AD exaggerated inhibition of cartilage prolfieration macrocephaly frontal bossing midface hypoplasia shortened limbs trident hand genu varum

labs of hep a

ALT and AST spike early bili and alk phos incerase later Anti-HAV IgM positive and marker of disease

auer rods found in

AML

what are sx and genetics of krabbe disease

AR galactocerebrosidase defeciency galactocerebroside and psychosine accum sx: progressive neurodegen, peripheral neuropathy, optic atrophy

describe lab findings in patient with factor XII deficiency

AR disorder hageman factor does not cause clinically significant bleeding normal bleeding time prolonged PTT normal PT

what is defect and genetic pattern of jervell and lange-nielsen syndrome

AR disorder profound bilateral sensorineural hearing loss and congenital long QT syndrome predisposes to ventricular arrhthmias (torsades, v fib) and sudden cardiac death secondary to mutations in genes that encode K channels (KCNQ1, KCNE1), encode alpha and beta subunits of voltage gated K channels slow acting component of outward K current (ventricular repol during phase 3) --> prolonged action potential duration and QT interval

t(9;22) associated with

BCR-ABL (philadelphia chromosome) CML

where is tubular fluid most dilute if no ADH present

CD (as hypotonic as 50 mOsm/L)

what are MoA of lumacaftor and ivacaftor

CFTR modulating meds potentially help patients with CF by restoring CFTR proteins to membrane (lumacaftor) enhancing protein function at membrane (ivacaftor) combo in pts with homoz f508 mutations have been shown to improve FEV and decrease pulm exacerbations

intranucclear and intracytoplasmic inclusions, along with colitis - what is cause

CMV

intranuclear basophilic inclusions characteristic of

CMV

what passes thru jugular foramen

CN IX, X, XI (inferior petrosal and sigmoid sinuses) posterior meningneal artery

what runs through optic canal

CNII opthalamic artery

if patient has defect with adducting eye, what is CN affected

CNIII

what runs thru superior orbital fissure

CNIII CNIV CNV1 (opthalamic nerve br) CNVI (abducens) superior opthalamic vein

organ susceptibility from greatest to least for infarction

CNS (5 min), myocardium (20-30 min), kidney (30 min), spleen, liver

what passes thru superior orbital fissure

CNV1

what runs through foramen rotundum

CNV2 (then it courses thru inferior orbital fissure to appear on face at infraorbital foramens as infraorbital nerve)

what runs thru inferior orbital fissure

CNV2, infraorbital vessels, branch from sphenopalantine ganglion

hypoxia induced vasoconstriction and emphysematous obliteration underlie pathogeneis of PH due to

COPD

what does chronic glucocorticoid use do to CRH, ACTH, and cortisol levels

CRH low ACTH low cortisol low ^cannot rise in response to stress glucocorticoids suppress synthesis and release of CRH from hypothalamus and bloc k ACTH stimulatory effect on anterior pituitary longterm suppression leads to atrophy of hypothalamic CRH releasing neurons, pituitary corticotrophic cells, and adrenal zona reticularis, and zona fasciculata

which anti-arrhythmic drugs are weakest Na channel blockers (dissociate the fastest)

Class IB they bind to Na channels in the inactivated state and dissociation from the channels occurs so rapidly, negligble effect on QRS duration

clearance of any given substance S calculated as

Cs = ([urine conc of S]X [urine flow rate])/(plasma concentration of S)

are mesangial cells part of JGA intraglomerular or extraglomerular

EXTRAglomerular

what dx assoc with berry aneyrsms

Ehlers danlos ADPKD (of circle of willis)

how to calculate oral bioavailability

F = (area under oral curve X iv dose)/(area under iv curve x oral dose) Iv drug has 100% bioavailabity, F = 1 refers to fraction of administered drug that reaches systemic circulation in a chemicaly unchanged form oral bioavailabilty is affected by gastric acidity and motility, capcacitliy of drug to be absorbed by gut, presence of material such as food/other drugs in gut, first pass metab by liver

which goes thru glycolysis faster: G6P or F1P?

Fructose 1 phosphate it can bypass PFK (rate limiting step of glycolysis)

what happens when efferent arteriole is dilated

GFR decreases RPF increases FF decreased

what happens when efferent arteriole is constricted

GFR increases RPF decreases FF increases

what are mixed osteoblastic/lytic mets lesions

GI breast

rifampin side effects

GI, rash, red-orange body fluids, cytopenias

what is leuprolide

GnRH analog

cause of acute epiglottisis

Hib (hib vax has dropped incidence a lot)

when does IMA branch off AA

L3 supples hindgut

what forms posterior surface of heart

LA lies directly over esophagus longstanding mitral stenosis/regurg --> progressive LA enlargement --> displace LA posteriorly and cause external compression of mid-esophagus with dysphagia (CV dysphagia) LA enlargement can cause compression of left recurrent laryngeal nerve --> voice hoarsenss and chronic cough

during norma diastole, what is relationship between LA pressure and LVEDP

LA pressure nearly equal to LVEDP as open MV offers minimal resistance to flow between the 2 chambers

varus stress test is for

LCL injury

describe lh, fsh effect on avarian follicle and production of androgens, estradiol

LH binds to theca interna cells of ovarian follicle --> androgens produced aromatase within follicle's granulosa cells converts androgens --> estradiol under stimulation of FSH theca externa cells are just connective tissue support for follicle (smooth muscle, fibroblast cells)

what does LH and FSH stimulate in testes

LH stimulates release of testosterone from leydig cells (testosterone provides negative feedback on LH) FSH stimulates release of inhibin B from sertoli cells in seminferous tubules (inhibin provides negative feedback on FSH)

which dna polymerase and 3' 5' proofreading exonuclease activity

I, II, and III

what would be abnormal if patient with Mitral Stenosis had concurrent Aortic Stenosis

LV diastolic pressure would increase

m3 receptors use what pathway

IP3, ca

what happens to PV curve in diastolic heart failure

LV diastolic-PV curve has reduced compliance blood volume in LV cavity and compliance of left ventricle increased lved pressures at same lved volumes shifts PV curve upward and to the left high lv filling pressures transmitted back to pulm vasculature --> pulm edema impaired RV filling or neurohormonal activation from low CO --> peripheral edema and elevated JJVP

when do you see pink frothy sputum with paraoxsymal cough

LV failure pulm edema, severe due to rupture of bronchial veins

what test before giving anthracycline antineo drugs (doorubicin)

LV function with echo or radionuclide ventriculography

vanc good for

MRSA c diff

names of protease inhibitors

NAVIR atazanavir darunavir indinavir ritonavir

what NM blocker to use in patients with crush, burn, denervating injuries, diseases, myopathies

NON-depolarizing agents (vecuroniu, rocuronium) this is b/c these patients have upreg of muscle nAChRs and/or rhabo --> release large amounts of K when succinylcholine is administered

OCD vs OCPD

OCD: compulsions performed in response to obsessions; certain multiples; rigidly applied rules. compulsions performed to reduce distress triggered by obsessions to prevent feared event. (rituals, arranging items in particular order, mental acts) must be time consuming (>1 hr/day) or cause significant distress or functional impairment. OCPD: lifelong pattern of insistence, control, orderliness, perfection. does not involve compulsions performed in response to intrusive obsessions

what is most common cause of a cryptogenic stroke

PFO (more so than ASD)

what group of cancers are medulloblastoma a part of

PNETs - primal, neuroectodermal tumors sheets of small cells with deeply basophilic nuclei and scant cytoplasm (small, round, blue cells) get abundant mitoses

what happens when you stop PPIs, regarding gastrin production

PPIs inhibit H-K-ATPase pump and decrease Hcl increase in gasric pH increases gsatrin formation --> induces hypertrophy of ecl and parietal cells stopping ppi: rebound gastric acid hypersecretion and reflux sx ppis can be tapered to help prevent AE

obesity hypoventilation syndrome is

Pickwickian syndrome restricted expansion of chest wall due to severe obesity --> hypoventilation with chroncially elevated PCO2 and reduced PO2

formula for relative risk reduction

RR reduction = (absolute risk control - absolute risk tx)/absolute risk control

what is SMA syndrome

SMA leaves aorta at level of L1 transverse portion of duodenum lies horizontally at level of L3 (between aorta and SMA) if angle between SMA and aorta <20 degrees --> transverse portion of duodenum can get entrapped --> sx of partial small bowel obstruction --> SMA syndrome occurs if there is diminished mesenteric fat (low bmi, weight loss, burns, catabolism, bed rest), lordosis, scoliosis --> lengthens spine resulting in decreased mobility of the sma

what psych drugs increase serotonin

SSRI SNRI TCAs

what do you use amiodarone for

SVT and ventricular arrythmias

what is etanercept MoA

TNF-alpha inhibitor domains derived from Fc portion of IgG1 and TNF receptor 2 serves as decoy receptor for TNF-a

tracts affected by ALS

UMN and LMN damage to motor neurons of anterior horn (LMN) demyelination of corticospinal tracts (UMN) loss of neurons in motor nuclei of V, IX, X, XII denervation atrophy of muscles (amyotrophy) middle aged ppl --> progressive --> 5 yr survival post diagnosis common cause of death: aspiration pneumoina

lab findings in ABPA (allergic bronchopulmonary aspergillosis)

VERY high serum IgE eosinophilia IgE plus IgG serum Ab to aspergillus

what is half life and formula

Vd X 0.7/CL steady-state concentration (or elimination of drug) achieved in 4-5 half lives

what is loading dose

Vd X Cpss / [bioavailability fraction] in patients with renal or hepatic impairment, the loading dose remains unchanged, but maintenance dose is decreased!!

what do nsaids do to kidney

acute interstitial nephritis or acute papillary necrosis

il4 does

age switching stimulates th0 to th2 (increases th2 subpop and stimulus for humoral immune response)

what diseases are related with AD

allergic disorder atopic diseases allergic rhinitis asthma (allergic triad)

which thalassemia is more common in SE asia

alpha

tx of mucormycosis

amphotericin b and surg debridement

what is PFA100 used for

analyzing platelet funtion abnormal in vWF, platelet dysfunction (even from NSAID use), and thrombocytopenia

what test for drug induced lupus

anti-histone ab (anti ds DNA ab rarely seen) ana positive in drug induced lupus and sle

what drugs can prolong QT

antiarrythmics like quinidine and sotalol

how to tx dvt

anticoag for >3 mo to prevent recurrent thrombosis initial tx with heparin (unfractionated heparin, LMWH, fandoparinux), followed by bridiging to oral anticoag (warfarin) other options: direct xa inhibitors (Xabans) and direct thrombin inhibits (dabigatran)

opioid delta receptor binding effects

antidepressant analgesia (PNS, some opioids)

where does h pylori affect stomach most

antrum

what cells have mhc class ii

apcs b cells, macrophages, DC, langerhans cells

where is tibial nerve injured

at level of popliteal fossa due to deep penetrating trauma or knee surg

what would pressure tracing look like in aortic regurg

backflow of blood from aorta into LV rapid loss of aortic pressure and elevated LVEDV with compensatory increase in LV stroke volume pressure tracing - loss of aortic notch (seen around aortic vlalve closure), rapid decline of aortic pressure during diatole, elevated peak LV and aortic systolic pressure. early closure of MV due to elevated LVDP

what lung disease would have predominant PMN in bronchoalevolar lavage fluids

bacterial pneumonia idiopathic pulm fibrosis

mhc class ii - type of antigen and presentation process

bacterial, antigens phagocytosed and digested by lysosomes within which Ag binds to MHCII

proapoptotic bcl 2 proteins

bak, bax, bim

what is dx of intussuception

barium enema (can be therapeutic...) surg intervention

MoA of amphotericin b and nysatin

bind to ergosterol

what does protein a do as a virulence factor)

binds Fc portion of IgG ab at complement binding site, preventing complement activation decreased c3b production, impaired opsonization and phagocytosis

moa of vincristine/vinblastine and toxicity

binds beta tubulin to inhibit MT formation tox: neuropathy

levetiracetam moa

binds to synaptic vesicle protein (sv2a) to module the release of GABA and glutamate neurotransmitters

where does autoimune gastritis affect stomach most

body so this can lead to pernicious anemia since parietal cells in body are destroyed, decreased IF and impaired b12 absorption

gram negative sepsis - talk about toxicity

body's systemic reaction to LPS endotoxin (component in some gram negative bacterial membranes)

zidovudine toxicity

bone marrow tox (anemia in up to 40% of patients)

beta 2 receptor agonists do what

bronchodilation, vasodilation, tocolyisis (smooth muscle of airways, peripheral vasculature, uterus)

complications of measles

bronchopneumonia encephalitis (acutely) acute disseminated encephalomyelitis (during recovery) subacute scloerising pancenephalitis (years later)

irritabilty, anxietey, depressed mood, insomnia, DECREASED appetite - what drug withdrawal

cannabis

what is merocrine cgland and what are examples

cells secrete via exocytosis no loss of cytoplasmic membrane ex: salivary, eccrine sweat, apocrine sweat

what are aes of forscarnet

chelate calcium renal wasting of mg --> hypomagensium and release of pth --> more hypocalcemia both hypoCa and hypoMg --> seizures

azithromycin used for

chlamydia mycoplasma hib moraxella

what does dermatitis herpetiformis look like

clusters of pruritis vesicles, plaques on buttocks and externsor surfaces of extremities

what substances more likely to induce mania

cocaine, stimulants

spherules endospores

coccidiodes inmitis

what are sx of saccular aneursym at junction of ACA and anterior communicating

compress central optic chiasm bitemporal hemianopia

how is listeria spread

contamined foot (meats, soft cheeses, raw veggies/fruits)

what are sx of ACA stroke

contralateral hemiplegia with lower limb affected more than upper limb bilateral ACA --> behavioral sx (abulia), primitive (moro grasp) and urinary incontinence due to damage of prefrontal cortex

when do yo uget contralateral hemiparesis and lower facial droop

cortical subcortical upper brainstem lesions affecting descending corticopsinal tract

which cox enzyme enhances platelet aggregation

cox1

granulomatous gastritis

crohn sarcoidosis mycobacterial infection

v cholera toxin

ctivates adenylate cyclase via gs adp ribosylation increases camp production in host cell causes secretory diarrhea, dehydration electrolyte imabalnces

why won't culture work for tetanus

culture does not yield organism, may take several days no serum toxin or ab test available

dx of cystercercosis

cysts, colex eosinphilia increased ESR

what are the symptoms and defect of gerstmann syndrome

damage to angular gyrus of dominant parietal lobe agraphia (inability to write) acalculia (inability to carry out math) finger agnosia (inability to identify individual fingers on the hand) left-right disorientation

what can be used to tx MRSA if patient is allergic to vanc

daptomycin (or linezolid)

what happens if you constrict afferent arteriole

decrease RPF and GFR FF stays same

how can alvelar hyperven result from v-q mismatch

decreased o2 and co2 exchange (pneumonia, pulm embolism) resultant hypoxemia --> peripheral chemoreceptors, increases resp drive above normal levels excessive co2 excretion by lungs --> hypocapnia hypoxemia persists since blood flowing thru highly oxygenated lung cannot absorb extra o2 to compensate for hypoxemic blood returning from poorly oxygenated regions increased A-a gradient

b pertussis toxin

disinhibits adenylate cyclase via g1 adp ribosylation increases camp increased histamine sens and phagocyte dysfunction

which dna polymerase has 5' to 3' exonuclease activity

dna polymerase i this allows it to remove rna primer created by rna primase and repair damaged dna sequences

function of il-10

downregulate immune responses

if h pylori is colonizing gastric antrum, what ulcer will occur

duodenal

injury to cnx

dysphonia (lack of innerv to laryngeal muscles) impaired swallowing w/ inability to elevate soft palate (lack of innerv to pharyngeal muscles) loss of gag reflex (efferent limb)

tx for candida

echinocandins c albicans - fluconazole

what is winter's formula for estimating appropriate compensation for metabolic acidosis

expected paco2 = [1.5*Hco3] + 8 +/-2

what hemorrhoids are painful

external innervated somatically by perianal area nerves - sensitive to pain

when do NTDs occur

failure of fusion of neural plate edges during 4th week of fetal development fusion begins in cervical region and proceeds toward cranial and caudal ends of neural tube (rostral and caudal neuropores)

what increases risk factors for epithelial ovarian cancer

fam hx, infertility, nulliparity, PCOS, endometriosis, BRCA1, BRCA2, lynch, post meno hormone replacement therapy

when is hib vax given

first few months of life

what does eso scc look like on histo

flattened polyhedral or ovoid epithelial cells w/ eosinophilic cytoplasm, keratin nests/pearls, intercellular bridging

tx for bzd overdose

flumanzenil

where does cnv2 exit the skull

foramen rotundum

what does compression arophy do to neurons

from increased intracranila pressure or mass lesion decrease in size and number of neurons

what is injured if a patient has executive dysfunction, personality changes secondary to orgniazational, restraint, and motivational systems

frontal lobe injury

dominant parietal lobe lesion

gerstmann syndrome right-left confusion, difficulty with writing and math

what is immune status to primary vs secondary infection for dengue

get lifelong immunity against same serotype, but individuals can be infected with a different serotype

tx for cah due to 21 hydroxylase defiency

give low doses of exogenous corticosteroids to suppress acth secretion removing excess acth stimulation, can decrease androgen production by adrenal corex

what does RBCs use for energy during starvation

glucose (no mitochondria)

tx for gon/chla

gon: 3rd gen ceph (ceftriax) chla: azithro, doxy need both to prevent pid

il-3 does

growth and differnetiation of bone marrow stem cells and produced by t helper cells

how to dx tetanus

h&p based on hx of penetrating wound in a patient who has not been vaccinated (booster every 10 yrs) burn, illicit drugs, soil, mva -- PENETRATING tetanus, trismus (lockjaw), sardonic smile (facial rimacing, risus sardonicus), muscle spasms, and high clinical suspicion, extension of truncal muscles (opisthonos)

what liver dx for skin pigmentation and dm

hemochromatosis

what virus is enveloped and contains partially double stranded circulr dna has rna dependent dna polymerase activity (reverse trasncriptase)

hepatitis b

when is oxygen curve shifted to left

high affinity hb fetal hg

drug that is not absorbed orally will have X first pass elmination and be X lipid soluble

high first pass poorly lipid soluble unavailable to liver for hepatic clearance

what is nadph needed for

high oxidative stress - nadph regeneraetes reduced glutathione reductive biosynthesis - synthesis of fatty acids, cholesterol, steroids, cytochrome p450 metbolism phagocytic cells - respiratory burst via nadph oxidase

sx of sarcoidosis

hilar adenopathy pulmonary infniltrates non caseating lung granulomas african american female

electrolyte abnormalities with loop

hypokalemia met alk hypocalcemia

il5 does

iga production eosinophils parasites

other virulence factors of n meningitides, besides pili

iga protease (destroy mucosal Ab) capsular polysaccharides (prevent phagocytosis and phagoysosome destruction) LPS (endotoxin, major source of toxicity) opa-proteins (endothelial attachment and invasion)

what are proinflammatory cytokines

il-17, ifn-g, tnf-a, il-2, il-1 (endothelium activation, increased chemokine expression, inductio of fever) il-1b - differentiation of th17 cells il-5 il-12 secreted by macrophages and induces differentiation of th1 cells and activation of NK cells ifn-gamma - secreted by th1 cells, activates macrophages, Ag presentation, death of epitheilal cells TNF: produced by macrophages, NK cells, T cells; proinflammatory mediator that promotes leukocyte recruitment and activates endothelium (expression of adhesion molecules)

congenital catract from

in utero rubella infection

what is ulceration of a wound

inadquate vascularization during healing not associated with excessive MMP or myofibroblast activity common sites: lower extremity wounds in conjunction with atherosclerotic peripheral vasc disease

antral involvement of h pylori can lead to duodenal ulcers how

increased local gastrin production and secretion

what does direct thrombin inhibitor do to ptt, pt, tt

increases ptt, pt, tt

histo of GI MALT lymphoma

infiltration of intestinal lamina propria with atypical lymphocytes atypical lymphocytes associated with h pylori infection of stomach

name TNF-a inhibitors

infliximab (Mab) adalimumab (Mab) etanercept (decoy receptor

name non-live vaccines (toxoid, subunit, conj, inactivated)

influenza IM pneumococcus dtap polio (inactivated) hep a hep b Hib HPV meningococcus

what are borders of femoral triangle

inguiinal ligmaent sartorius muscle adductor longus

what is antithrombin defieincy

inherited AD or acquired (cirrhosis, nephrotic syndrome) presents w/ venous thromboembolism (DVT, PE) resistance to heparin

moa of paclitaxel and toxicity

inhibits microtubule disassembly tox: neuropathy

how do MCL injuries usually occur

injury to medial twisting injury or blow to lateral knee while foot is planted (valgus stress)

moa of aminoglycosides

interfere with 30s ribosomal unit cause cell to misread mRNA halt protein syntheis

esophageal manometry for diffuse eso spasm

intermittent peristalsis and multiple simultaneous contractions on tracings from mid to lower eso

subtypes fo gastric adenocarcinoma

intestinal: bulky mass composed of glandular structures diffuse: gross stomach thickening with signet-ring cells

what is dexrazoxane

iron chelatin agent prevents anthracycline induced cardiotox

complications of ischemic colitis

ischemia and necrosis of intestinal wall --> acidosis, sepsis, gangrene, perforation colonoscopy: pale mucosa and petechial hemorrhages

what drugs should be used to tx ischemia induced ventricular arrhythmias

ischemic myocardium has higher than normal (less negative) resting membrane potential this delays voltage dependent recovery of Na channels from inactivated to the resting state so class IB agents (which bind to inactivated Na channels) are great

tx of blastomycosis

itraconazole

tx for strongyloides

ivermectin

what is a gram negative bacilli that turns maconkey agar pink (lactose fermenter), with a thick capsule, mucoid growth on culture

klebsiella

what do hamstrings do

knee flexion hip extension

temporal lobe injury causes

language, sensory interpretation, impaired membory behavioral changes

when does hirschsprung present

large area of bowel involved: first few days of life small: can go undetected for months/years

what does intermediate hemisphere of cerebellum do

lateral descending systems motor execurtion ipsilateral extremities (lateral corticospinal, rubrospinal

how to measure maturity of fetal lungs

lecithin to sphingomyelin ratio > 1.9 (until 33 weeks gestation lecithin and sphingomyelin equal; after 33 weeks lecithin levels rise dramatically)

what does lesion in lateral cerebellar hemisphere lead to

left dysdiadochokinesia (impaired rapid alternating movmeents) limb dysmetria (overshoot/undershoot during targeted movement) intention tremor (tremor during targeted movement)

what is artery most often used for bypass grafting

left internal mammary artery

examples of class 1B drugs for arrhythmias

lidocaine mexiletine

what sites are common sites of colon cancer mets

liver and lung

what eye finding if damage to right lateral geniculate nucleus

located in thalamus and relays visual info to ipsilateral primary visual cortex would lead to contralaterla homonymoous hemianopsia

what are lab findings in klinefelter syndrome

low testosterone increased LH and FSH (due to loss of feedback inhibition) increased estradiol

what should be used to tx behavioral and psychotic manifestations of delierium

low-dose antipsychotics like haloperidol first gen > second well tolerated and causes minimal sedative, antichol, hypotensive, eps effects

what is muscarinic receptor in brain

m1 stimulated: memory formation/cognitive functioning inhibition: confusion

what is muscarinic receptor in heart

m2 gpcr decrase in intracellular camp --> open K --> slows depolarization stimulate: decreases HR and atrial contraction inhibition: increases HR and contractility

northern blots used to identify

mRNA hybridized with probe containing nucleotide sequence complementary to mRNA of interest

schizoaffective disorder criteria

major depressive or manic episode concurrent with sx of shcizo lifetime history of delusions, hallucinations > 2 weeks in absence of major depression or mania mood sx present for majority of illness

what does gluteus maximus do

major extensor of thigh of hip innerv by inferior gluteal nerve

sx of hep a

malaise, fatigue, anorexia, nausea, vomiting, mild abdominal pain, aversion to smoking

lithium used mainly for what kind of bipolar features, and AEs

manic and depressive AEs: diabetes insipidus (chronic tubulointerstitial nephropathy) hypothyroidism (interferes with normal synthesis of thyroid hormone; can lead to compensatory increas ein tsh --> goiter; tx with levothyroxine, do not discontinue lithium tx), tremor ebstein anomaly (teratogenic)

ccr5 antagonist

maraviroc

what are risk factors for intussception

meckel diverticulum

when do you see glomeruli basement membrane splitting

membrnoprolif glomeruloneph alport syndrome

what causes subungual splinter hemorrhages

microemboli from IE

what has apical holoststolic murmur radiating to axilla

mitral regurg

loud first heart sound (s1), early diastolic sound (opening snap), mid diastolic murmur from turbulent flow in apex

mitral steonsis

sporangia

mold fungi (rhizopus)

what has medial band like callcifications

monckeberg's medical calcific sclerosis (medial calcinosis)

nonseptate hyphae that branch at wide angles

mucor and rhizopus

what are cast findings in ischemic tubular necrosis

muddy brown, granular, epithelial cell casts and free tubular epithelial cells in urine

bone marrow >30% plasma cells

multiple myeloma

what kinds of seizures are carbamazepine, phyeny, phenobarb

narrow spectum focal seizures secondar generalized seizures carb and pheny can worsen primary generlaized seizures...

what is most common extranial solid neoplasm in children

neuroblastoma

digeorge, what kind of infections

no t cells, so viral, fungal, protozoa

what is phentolamine

nonselective alpha blocker acts as vasodilator

what is isoprotenerol

nonselective beta agonist decreases PVR and DBP increases cardiac rate and output and pulse pressure

NNH

number of people who must be treated before 1 additional AE occurs

what can cause hypercholesterolemia

obstructive biliary lesions primary biliary cirrhosis

what causes deamination of dna bases (Cytosine --> Uracil; Adenine to Hypoxanthine)

occurs spontaneously or secondary to chemical exposure corrected by base excision repair (recognized and removed by specific glycosylases without disruption of phosphodiester backbone; apurinic and apyrimidinic residues removed by specific endonucleases; replaced with correct base by dna polymerase)

what dx do you get erythema nodosum

ocps drugs strep pharyngitis ibd sarcoidosis (painful, reddish nodules on shins)

ethambutol side effects

optic neuropathy

post op urinary retention after low abdominal surg

overdistention of bladder decreased micturition reflex decreased contracility of bladder detrusor muscle incomplete emptying

lamellar bone resembling a mosaic

paget

CMV encephalitis leads to

parenchymal micronodules and ventricular enlargement immunocompromised (HIV)

what type of arrthymia should be tx w/ adenosine

paroxysmal supraventricular tachy b/c adenosine causes conduction delay thru AV node

how to get horner syndreom

partial ptosis, miosis, anhidrosis lesions affecting ipsilateral lateral hypothalamus or sypathetic tracts in brainstem (lateral medulla)

what liver dx will start with prolonged pruritis and fatigue --> clay colored stools and osteoporosis

pbc, psc

what are AEs of lamivudine (nrti)

peripheral neuroaphty and lactic acidosis

what is positive tourniquet test for dengue hemorrhagic fever

petechiae after sphygmomanometer cuff inflation for 5 min

what to test before giving amiodarone

pft

which seizure drugs block Na channels

phenytoin carbamazepine valproate

what does poor cns penetration mean about a drug's lipophlicit

poor lipophilicy low volume of distirbution unlikely for drug to be eliminated in large amount by liver

what is cut in an episiotomy

posterior vaginal opening to perineal body transects vag lining and submucosal issue, but not external anal sphinter or rectal mucosa

when do you see granulomatous destruction of bile ducts

primary biliary cirhossis

th12 does

produced by macrophages stimulates growth/development of th1

21 hydroxylase defiency. what is the rxn that is impaired

progesterone --> 11 deoxycorticosterone in zona glomerulosa 17 oh progesterone --> 11 deoxycortisol in zona fasiculata

what does degenerative disease do to neurons

progressive loss with associated reactive glial changes

when are neural crests cell present in proximal colon and rectum

proximal colon - 8th week rectum - 12th week

what are larva currens in strongyloides

pruritic erytematous linear streaks occur on thighs/butt as larva migrate away from periana region

schizoaffective vs mdd or bp w/ psychotic features

psychotic sx occur exclusively during mood episodes

what kind of anesthesia would you give to women in labor, can't receive epidural (too late)

pudenal nerve block for perineal laceration repair

penetrating injury to 2nd intercostal space at left sternal border

pulmonary trunk

where are serotonin releasing neurons in CNS

raphe nucleus in brainsteam (midbrain, pons, medulla, axons project widely thru cns to synapse on structres like cerebral cortex, thalamus, hypothalaumus, etc)

what does thrombin time measure

rate of conversion of fibrinogen to fibin prolonged in patients with dficient, defective fibrinogen, congenital or acquired most common cause of acquired dysfibrinogenemia is liver disease

what kind of receptor uses ras

receptor tyrosine kinase

what is ALWAYS involved in hirscprung disease

rectum and anus (sigmoid only 75%)

when do you get acquired bronchiectasis

recurrent infection impaired drainage (CF) airway obstruction (foreign body aspiration) inadequate host defense (hypogammaglobinemia)

il-10 does

regulates balance between th1 and th2 produced by th2 inhibitrs synthesis of IFN-g --> decreases th1 subpopulation

toxicity of acyclovirs

renal toxicity

what does dorsal thalamus do

responsible for relaying info from spinal cord and other subcortical structures to cortex

sleep restriction behavioral tx

restrict time in bed to hrs when actually sleeping increase time in bed by 15 to 30 min increments when sleep efficiency is >90%

tx for ascites from cirhossis

restriction of Na intake combined with diuretics furosemide and spironolactone

what would flow volume pattern look like in atelectasis

restrictive

endomyocardial fibrosis

restrictive cardiomyopathy thickened and fibrosis of apical endocardial surface occurs in tropical regions

what mutation in men2

ret protooncogene sporadic and germline get proto-onc codes for membrane bound tyrosine kianse receptor in cel cycle regulation constitutive active receptor --> unreg cell proliferation

name a naked +ssRNA

rhinovirus (picorna virus)

which TB drug causes red orange discolartion of body fluids

rifampin

what tb drug to be careful of if patient is on protease inhibitor

rifampin (p450 inducer) it will decrease PI serum levels rifampin can be replaced with rifabutin in tx of TB on PIs

what test to dx allergic bronchopulmonary aspergillosis

serology: IgE and ab to aspergillus fumigatus also skin hypersensitivity testing

why is t3 supplementation not receommended to tx hypothyroidism

short half life patients experience wide fluctuations in plasma t3 t4 provides a more physiologic effect, preferred

what does digoxin do with APD and QT

shortens APD and QT interval shortening (increases contractility)

morphology of trpansomi cruzi

slender C or U shaped flagellated parasite w/ darkly staining nucleus and kinetoplast

which muscles use calmodulin

smooth muscle, they lack troponin in skeletal/cardiac cells --> calmodulin is not directly invovled in excitation-contraction coupling. helps intracelular ca activity, txn factor signaling

what is morphology of coccidiodes

spherules with endospores

protective mechanisms against bacteria in biliary tree

sphincter of oddi prevents reflux of nonsterile duodenal contents into biliary tree, bile salts inhibit bacterial growth, donstream biliary flow helps wash orgs away, bile secretory IgA helps prevent bacterial adherence

what causes GASTRIC varices

splenic vein thrombosis (due to chronic pancreatitis, cancer, abdominal tumors) splenic vein can develop blood clot from pancreatic inflammation short gastric veins drain fundus of stomach into splenic vein splenic vein thrombosis can increase pressure in short gastric veins and cause GASTRIC varices only in fundus

what is morphology of dengue virus

ssRNA virus (flavivirus) 4 different serotypes (DENV1-4)

what is most common cause of CAP

strep pneumo even in immunocompromised indivdiausl

tobacco smoking predisposes patients to CAP due to

strep pneumo mycoplasma

when is fadh2 producted

succinate --> fumarate in tca cycle by succinate dehydrogenase

what is contained in lateral compartment

superficial peroneal nerve proximal part of deep peroneal nerve acs in this compartment - producce loss of sensation in lower leg and dorsum of foot, as well as foot drop

describe path of great saphenous vein

superficial vein of leg - originates on medial side of foot courses anterior to medial malleolus, travels up medial aspect of leg and thigh drains into femoral triangle, few cm inferolateral to pubic tubercle

tx for dengue

supportive

how is carnitine made

synthesized from lysin and methionine vitamin c needed

scapular region aligns with what spinous processes

t7/t8 infeiror angle of scapula serves as origin of teres major

what happens to glycerol and FFA that are released from adipocytes into circulation

taken up by liver glycerol --> gluconeogenesis FFAs --> acetyl CoA --> ketones or TCA cycle (generate energy for gluconeogenesis)

names of nrtis

tenofovir emtricitabine lamivudine abavavir zidovudine

what are methylxanthines

theophylline, aminophylline cause bronchial dilation by blocking PDE activity --> increase intracellular concentration of cAMP

sputum of klebsiella - describe

thick, mucoid, blood tinged sputum (Currant jelly)

AEs of linezolid

thrombocytopenia, optic neurits, increased risk of serotonin syndrome (proserotonergic drugs esp in combo)

risk factors of renal carcinoma

tobacco smoke, obesity, htn

what happens when you combine diphenhydramine and TCA amitryptiline

too much anticholinergic effect more common in elderly --> memory, confusion, hallucinations, dry mouth, blurry vision, no seat, tachy, falls

what does etoposide and teniposide inhibit

topoisomerase ii

examples of mechanically gated channels that open in response to mech deformation of a cell membrane

touch, hearing transform mechanical force into electrochemical signals

what does c myc do

transcription activation cmyc ongogene on chr 8 to Ig heavy chain on chr 14 c myc is nuclear phosphoprotein - transcription activator controlling cell proliferation, differenetiation, apoptosis

what is mutation in mantle cell lymphoma

translocation between cyclin d1 locus on chr 11 and Ig heavy chain locus on chr 14 increased production of cyclin d1, promoter of g1 to s phase transition during cell cycle

what kind of channel is CFTR

transmembrane atp-gated chloride channel channel pore opens after binding of 2 atp molecules --> cl ions flow thru, and Na and H2O follow --> hydrates mucosal surfaces

life cycle of strongyloides

transmitted by filariform larvae found in soil contaminated with human feces penetrate the skin and migrate hematogenously to the lungs enter alveoli and travel up bronchial tree to pharynx, where they are swallowed when larvae reach intestine, develop into adults, lay eggs within mucosa hatch into rhabditifirom/noninfectious larvae, migrate into intestinal lumen to be excreted in stool some rhabditiform larvae can molt directly into filariform larvae in GI or perianal skin --> cycle of autoinfection widespread dissemination of parasites throughout body (hyperinfectioN) --> multiorgan dysfunction or septic shock

listeria txn and dx

transmitted thru food ingestions (unpasterized milk) cause meningitis in immunocompromised adults also meningoencephalitis, bactermia neonate: transplacental/delivery --> neonatal meningitis grows well in cold temp (4-10 C) and can contaminate refrigerated food

rupture of plaque with fully obstructive thrombus would cause

transmural MI

left colic artery branches off IMA supply

transverse ad descending colon

what is pathophys of fat embolism syndrome

trauma dislodges fat globules from bone marrow --> travel thru marrow's vasc sinusoids and into pulm microvessels microvvesl occlusion --> pulm gas exchange and hypoxemia release of FFA from fat globules --> local toxic injury to endothelium --> potential lead to ARDs fat globules can escape lngs via AV shunts and open due to increased pulm artery pressure --> fat emboli-associated microvasc occlusion in CNS and in dermal capillaries --> rbc extravasation and petechia thrombocytopenia may be due to platelet adherenace and coating of fat microglobules

what are causes of hypothalamic lesions

trauma, infection, tumors, disease tumors in children - gliomas adults - mets

what nerve arises at level of middle cerebellar peduncle at lateral aspect of mid-pons

trigeminal nerve

what is hcg therapy used for

trigger the ovulatory cascade in oocyte donor when her follicles are mature

what 3 drugs inhibit dihydrofolate reductase

trimethoprim (in bacteria) methotrexate (humans, cell specific for s phase; prevents syntheiss of purine and thymidylic acid) pyrimethamine (protozoa; malaria, toxoplasmosis)

inoculation of candida albicans into serum at 37 for 3 hrs leads to formation of what

true hyphae from yeast growing hyphae called germ tubes

serum sickness is

type 3 HS rxn fever, prurutic rash, arthralgias, 7-14 days after Ag exposure beta lactam and sulfonamides

what are genetics of parents whose child gets down syndrome from robertsonian translocation

unaffected parent with a balanced translocation (fusion of 2 long arms) normal genetic complement

what do mucosal neuromas look like

unencapsulated, thickened prliferations of neural tissue

what kind of virus in hepatitis e

unenveloped, single stranded rna virus

what are examples of stimulus control behavioral tx of insomnia

use bed only for sleep/sex go to bed only when sleepy leave bed when unable to sleep, go to another room maintain a fixed wake-up time, including on weekends

what can be done to tx paraoxysmal svt

vagal stimulation via cortid sinus massage or valsalva manuever this can increase refractory period in the av node and help prevent a reentrant circuit from conducting if valsalva fails, can do iv adenosine

compare csf findings for viral vs bacterial meningitis

viral: wbc <500, lymph predominance; glucose normal; protein elevated but <150 bacterial: wbc >1000, pmn predominance; glucose <45; protein >250

why give b6 for those with hyperoxolauria stones

vit b6 decreases endogeous oxalate production --> decreases rate of stone formation

what has apob100

vldl and ldl

what dx do you think of if there are capillary hemangioblastomas in retina and/or cerebellum, congenital cysts and/or neoplasms in kidney, liver, pancreas

von hippel lindau disease (rare, AD condition; pts are increased risk for RCC, bilateral)

what are sx of mecel diverticulum

when sx: spontaneous but painless lower GI bleeding if intusception (which can be a lead point) --> colicky abdominal pain and currant jelly stools

if bbb, what do qrs complexes look like

widened

what neuro disease gets cystic degeneration of putamen

wilson's disease

indications for botulinum toxin

wrinkles (glabellar, face) lower esophageal sphincter in achalsia MS (spasms) Parkinsons (spasms)

wiskott-aldrich, what kind of infections

x linked immunodeficiency, eczema, thrombocytopenia combined b and t cell disorder

genetic inheritance pattern of hemophilia a or b

x linked recessive

equation for calculating anion gap

anion gap = serum [Na] - ([Cl] +[HCO3]) normal: 10-14

what are gram negative, lactose fermenting (macconkey) bacteria

fast fermenter: klebsiella, e coli, enterobacter slow fermenter: citrobacter and serratio

when do you see antimitochondrial Ab

primary biliar cirrhosis

name enzyme that degrades 6-mercaptopurine

xanthine oxidase --> converts to inactive metabolites, high levels of cytotoxic metabolites thiopurine methyltransferase (TMPT)

can crohn's affect esophagus

yes --> patchy inflammation, erosions, ulcers, strictures, fistulas

name examples of false diverticulum

zenker's esophageal diverticulosis

what do you expect if a patient has black color to their urine

alkaptonuria

MoA of metronidazole

binds to DNA in susceptbile cells, unravels helical DNA and breaks its strands protein synthesis inhibited and cell dies soon thereafer

most common gram negative bacilli causes of cap

e coli klebsiela pseudomonas enterobacter serratia proteus acinetobacter think in pts w/ imunosupression, impaired host defenses (infants, elderly, alcohlics)

what do you see antiRBC ab in

hemolysis

describe sx of goodpasture syndrome

anti-GBM ab disease hemoptysis, focal pulm consildation, glomerulonephritis that may rapidly progress to fenal failure

what is ipratropium

anticholinergic agent, derivative of atropine blocks action of acetylcholine at muscarinic receptors --> preventing bronchoconstriction and reducing parasymp stimulation of tracheobronchial submucosal glands in lungs less effective than beta 2 adrenergic agnoists effect starts 60-90 min after initiating tx enhances bronchodilatory effects of beta 2 adrenergic agents for tx of asthma and COPD

tx for tourette disorder

antipsychotics alpha 2 adrenergic receptor agonists behavioral therapy

what do you see smooth muscle Ab in

autoimmune hepatitis

nifedipine is

bronchodilator achieves this by blocking calcium influx into bronchial smooth muscle cells

primary infection with varicella zoster

children contagious chickenpox skin lesions appear as successive crops on face, trunk, limbs, crusted within 6 days of onset typically resistent to future episodes of chickenpox but can develop herpes zoster later in life IgG Ab measurable (in chickenpox takes 10 days after onset to develop)

major risk factors for squamous cell carcinoma of esophagus

cigarette smoking alcohol use achalasia

what are sx of maple syrup urine disease

impaired metabolism of branched chain amino acids (leucine, isoleucine, valine) sx: cerebral edema, seizures, sweet smell of urine

pulmonary artery on PA CXR

left side of mediastinal silhouette, just below aortic arch

consequence of rheumatic heart disease

mitral stenosis/regurg (sx: palpitations, exertional dyspnea) get LA enlargement and extrinsic compression of esophagus (solid food dysphagia)

what is the difference between a true and false diverticulum

true: all 3 parts of intestinal wall. mucosa, submucosa, muscularis false (pulsion): mucosa and submucosa only; herniate thru defects of muscular layer

where is SVC on CXR

behind first costal cartilage by confluence of right and left brachiocephalic veins flattened opacity parallel to vertebral column, terminates inferiorly at RA

how to determine probability if patient has disease if test is positive assume pre-test probability = prevalence in study

calculate PPV

what are sx of pheylketonuria

disorder in conversion of phenylalanine to tyrosine (defect in phenylalanine hydroxylase) undiagnosed and untreated PKU leads to significant intellectual disabilities

what is unique about prophase of meiosis ii

does not immediately follow a period of dna synthesis dna was duplicated prior to prophase of meiosis i

how does sarcoidosis form

dysregulated cell mediated immune response to an unidentified antigen --> granuloma formation lung granulomas are result of intra-alveolar and interstitial accumulations of cd4 t cells due to oligoclonal expansion, increased levels of il-2 and ifn-y

what is measured by PT

extrinsic pathway!!! VII (and common)

what is moraxella catarrhalis

gram neg diplococcus common upper resp infection (bronchitis, laryngitis, sinusiits) and otitis mdia causes bronchopneumonia in pts with COPD does not ferment lactose

sx of cystinuria

impaired renal cystine (homodimer of cysteine) transport leads to cytinuria sx: flank pain, hematuria, renal stones in childhood or adolescnce

how to visualized RV on CXR

lateral, since it forms anterior wall of heart

what is chronic tic disorder

one or more motor or verbal tics (not both) for >1 year

if pneumonia in right middle lobe, it is bordering what structure of heart

right border of heart --> right atrium therefore right middle lob pneumonia obscures xray silhouette of right heart border

how does metaphase of meisos i differ from metaphse of meiosis ii

spindles are not prepared to split centromeres tetrads are lined up along the metaphase plate, during anaphase the homologs separate from each other, with centromeres intact

barrett esophagus on endoscopy looks like

tongues of beefy red mucosa extending above LE sphincter into areas of normal pale pink squamous mucosa

how many patients with schizophreniform disorder eventually develop schizophrenia

2/3rds

what is delusional disorder

>1 delusion >1 mo, no other psychotic sx normal functioning apart from direct impact of delusions

what are sx and genetics of tay sachs disease

AR beta-hexosaminidase a GM2 (ganglioside) substrate sx: macular cherry red spot, progressive neurodegeneration

what is ratio for alcoholic hepatitis

AST/ALT > 2:/1

what courses thru foramen ovale

CNV3

what is most common cause of fatal sporadic encephalitis

HSV1

if pt has renal artery stenosis, what will happen to JG cells

JG cells will be stimulated to increase renin secretion long term hypoperfusion --> JG cells undergo hyperplasia

what dos Ach do to M2 and M3 receptors

M2 musc in heart: decreased HR, conduction M3 in vasculature: vasodilation no significant effect on ventricular contractility

where is epinephrine formed

NE --> epi in adrenal medullae

what do you suspect if patient has bilateral CNVIII schwannomas and multiple meningiomas

NF2 AD nervous system tumor

what attaches to anterior intercoondylar area

acl

features of lithium tox

acute gi: n/v/d; late neuro chronic: confusion, agitaiton, ataxia, tremors/fasciculations

melatonin in csf for

alzheimer decreases in melatonin show to correlate with progression of alzheimers

what happens with amyloid under congo red stain and viewed under polarized light

apple-green birefringence due to beta sheet structure

describe morph of hiv

bar shaped protein core surrounded by a glycoprotein envelope includes gp120 and gp41 glycoproteins diploid, 2+ ssRNA transcribed into dsDNA by reverse transcriptase present in capsid

air in peritoneal cavity suggests

bowel perforation

what is IgE independent mast cell degranulation

can be triggered by opioids, radiocontrast agents, some abx (vanc) activate protein A and PI3 kinase --> releases several mediators: histamine, bradykinin, heparin, enzyes, chemotactic factors sx: diffuse itching, pain, bronchospasm, localized swelling (urticaria)

how to tx MAC

clarithromycin (others abx used to)

procainamide MoA

class 1A antiarrhythmic drug, inhibits Na dependent phase 0 depol moderate K channel blocking activity, so prolongs APD and QT and increases risk of torsades

lidocaine MoA

class 1B antiarrhythmic drug blocks Na channel and inhibits phase 0 depolarization does not prolong QT

what does bzd overdose look like

cns depression with normal vital signs

difference in bleeding between coagulopathies and platelet defects

coagulopathies: deep tissue bleeding into joints, muscles, subcutaneous tissue platelet: mucocutaneous (epistaxis, petechiae)

what occurs when cells within heart, brain, or skeletal muscle are injured

creatine kinase leaks across damaged cell membrane and into circulation

esophageal manometry for cricopharyngeal dysfunction

decreased pharngeal tone or incomplete relaxation at upper esophageal sphincter

what is chronic granulomatous disease and whare are pts susceptible to

deficient intracellular killing (x linked immunodeficiency, inability of phagocytes to synthesize nadph oxidase, enzyme essential to lysosomal oxidative burst) recurrent infections with catalase+, like staph

cah due to 21 hydroxylase defiency

defiency in conversion of 17 hydroxyprogesterone to 11 deoxycortisol --> impairs cortisol synthesis decreased cortisol leves are sensed by hypothalamus and cause consequential increase in acth by anterior pituiatry

morph of blastomyces

dimorphic mold in cold, soil, organic matter, animals yeast in heat (human) round yeast, thick walls, broad-based budding (looks like bowling pin)

besides impaired adduction of ipsilateral eye, what else do you see in internuclear opthalmoplegia

diplopia and horizontal nystagmus of abducting eye convergence and pupillary light reflex are preserved

what is name of disease and common bugs that cause sore throat, cervical lymphadenopathy, coalescing pseudmembrane in children

diptheria corynebacterium

how does corynebacterium affect nervous system

diptheria toxin penetrates blood nerve barrier neuropathy - cranial nerves affected first

what causes patella fracture

direct blow to anteiror aspect of knee excessive force transmitted thru quads tendon (landing on feet after falling from height)

peau d'orange

direct invasion of dermis by inflammatory breast carcinoma erythema, invasion of lymphatic spaces by malignant cells --> lymedema with finely pitted appearance

what is pathophys of ARDS

direct or indirect pulm insults --> excessive cytokine release --> endothelial activation --> PMN migration to lungs --> degranulation with release of toxic mediators worsens the pulm alveolar and endothelial injury --> increased pulm capillary permeability, leakage of fluid into alveoli, and pulm edema assoc with pneumonia, sepsis, trauma, pancreatitis

name some factor xa inhibitors

direct: rivaroXaban (oral) apiXaban (oral) indirect fondaparinux

what does isoniazid do to the liver

directly hepatotoxic acute, mild hepatic dysfunction (10-20% of pts) transient increases in serum aminotransferases lasts for first 4-6 mo of tx; liver function tests return to baseline afterwards frank hepatitis can occur rarely and evolve into severe form with progressive liver dysfunction and death

moa of foscarnet

directly inhibits both dna polyermase in herpes virus and reverse transcriptase in hiv iv only

how to tx tardive dyskinesia

discontinue antipsychotic agent switch to 2nd gen antipsychotic (clozapine)

tx of warfarin induced skin necrosis

discontinuing warfarin fresh frozen plasma or protein c concentrate

what is MoA of chlorhexidine

disrupts cells membranes coag of cytoplasm not sporicidal antisepti of choice for many surg and percutaneous procedures contraindicted in neuro,oto, and opth procedures due to neurotox

too much IgA and n meningitides

disseminated infection if they produce too much serum IgA ab IgA attaches to bacteria, blocks attachment of IgM and IgG ab that induce complement-mediated bacterial lysis

what does staph aureus due to non IVDUs

disseminates from primary disease process (abscess, central line), moves by hematogenous spread to endocardium s aureus settles on valve leaflets due to blood flow turbulence

histo of whipple disease

distended macrophages in intestinal lamina propria

what should you not give elderly man with urticaria

don't give first gen antihistamines - these also block cholinergic (blurry vision, exacerbation of glaucoma, urine retention, delirium, constipation), alpha adrenergic (postural dizziness, falls), serotonergic (appetite, weight gain) they are lipophilic and cros BBB --> sedation and cog dysfunction

kidney transplant blod supply to ureter

donor renal artery anastomosed with recipient external iliac artery proximal 1/3 of donor ureter preserved, used to establish continuity from collecting system of kidney to recipient's bladder distal donor ureter susceptible to ischemia due to lack of anastomotic connections --> causes leakage of urine 5-10 days following tansplant

motion that causes damage to anterior talofibular ligament

due to inversion of plantar flexed foot

paget disease

eczematous exudate over nipple and areola

what does adding noncompetitive antagonist do to agonist drug

ed50 unchanged emax reduced b/c noncompetitive antag has reduced # receptors available for binding

methimazole side effects

edema, rash, agranulocytosis

cryptococcus sf

elevated opening pressure (increased vasc permeability 2nd to inflammation and/or yeasts obstructing csf outflow from arachnoid villi)

lab findings of conn syndrome

elevated serum aldo low plasma renin aldo remains elevated after oral saline load

staph aureus toxins

enterotoxin - superag, acts locally in gi tract, causing vomiting tss - superag, stimulates t cells, lead to widespread cytokine release and shock

what is dermatitis herpetiformis

erythematous pruritic papules, vesicles, bullae appear bilaterally and symmetrically on extensor surfaces assoc with celiac

zinc deficiency

erythematous skin lesions - vesicular, pustular ypogonadism impaired taste and smell night blindness impaired wound healing

what are sx of conn syndrome

excess aldosterone excess na retention and excess K and H secretion --> HTN, hypokalemia, metabolic alkalosis paresthesias and muscle weakness in some aitents

what do quads to

extend knee

where does dura end in spine

extends below spinal cord termination level tof form sac containing csf, nerve roots, cauda equina ends at s2 and fuses with filum terminale to connect to the coccyx

what accounts for the rubber like properties of elastin (stretching and recoling)

extensive cross linking between elastin monomers, facilitated by lysyl oxidase assembly related to collagen starts with tropoelastin (large polypeptide precursr); 700 mostly nonpolar AA contains lysine and proline --> few are hydroxylated tropoelastin secreted into EC space, interacts with microfibrils (fibrillin) that function as a scaffold lysyl oxidase deaminates some of lysine residues of tropoelastin --> formation of desmosine cross links between neighborhing polypeptides cross links account for rubber like properties of elastin

what is NOT found in terminal bronchioles

goblet cells (go from trachea to larger broncioles) submucosal mucous and mucoserous glands (go from trachea and bronchi, but not in bronchioles)

what are sx of osler-weber-rendu

hereditary hemorrhagic telangiectasia multiple telangiectasia of skin and mucosa recurrent epistaxis or GI bleeding (melena)

what drug withdrawal if n/v/d abdominal cramping, muscle aches pe: dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds

heroin

how to confirm dx of 21 hydroxylase defiency

high serum level of 17 hydroxyprogesterone

saquinavir moa

hiv protease inhibitor prevents cleavage of polyprotein precursors necessary for generation of functional viral proteins

which contacts of n meningitdes patient need prophylactic tx?

household kissing health care workers who directly contacted secretions

aes of acylclovir

hsv cyrstal nephropathy neurotox (deliriu, tremor)

what does SAH look like on noncontrast CT

hyperdensity seen within cisterns/sulci blood accumulates between pia and arachnoid

who should not get MR receptor antagonists

hyperkalemia or renal failure

when does hyperifection of strongyloides occur

immunosuppresants (corticosteroids) htlv1 infection ppl w/ impaired th2 cell immunity (antihelminthic action)

what causes wernicke encephalopathy

in chronic alcohol users have low thiamine at baseline give IV dextrose w/o thiamine supplementation prior --> acute drop of thiamine --> wernicke encephalopathy

what is reverse t3

inactive form that is generated almost entirely from peripheral conversion of t4

what are direct inguinal hernias prone to

incarceration due to wide neck uncommon to descend into scrotum best felt with pulp of finger on deep palpation

what will increase FF

increases in GFR decreases in RPF

loss of immunoglobulins and low molecular weight components of complement (factor B) makes patients with nephrotic syndrome vulnerable to what

infections, esp pneumococcal

MoA of zileuton

inhibits AA --> leukotrienes (lipoxygenase pathway)

how to tx norepinephrine leak

intense alpha 1 receptor mediated vasoconstriction, which can cause local tissue necrosis infiltration using syringe with fine hypodermic needle thru affected area with 10-15 cc of NaCl containing 5-10mg of phentolamine mesylate (alpha receptor blocker)

if penetrating wound to back to immediate right of vertebral bodies, what would be injured at t8 level

ivc

what cancer assoc with aspergillus flavus or parasiticus

liver cancer (hcc) aspergillus grow on food like corn, soy, peanuts --> produce aflotoxins --> categorized as a1, b2, g1, and g2 b1 is most common and most toxicity

risk factor for oropharyngeal aspiration

loss of consciousness dysphagia

what does foramen spinosum contain

middle meningeal artery middle meningeal vein meningeal (recurrent) br of cnv3 (supplies dura and symp fibers)

what kinds of arthritis for psoriasis

mild to severe may manifest as arthritis of dip, asymmetric, symmetric polyarthritis (RA), seronegative spondyloarthropathy, aggressive/destructive arthritis mutilans

coccidiodides morphology

molds at 25C spherules in human tissues spherules are covered by a capsule and contain endospores dimorphic

what sx does mom and fetus get if in utero infection of rubella

mom: low grade fever, maculopapular rash with cephalocaudal progression, posterior and auriicular and subocciptal lymphadenopathy. polyarthritis and polyarthralgia baby: sensorineural deafness, cataracts, cardiac malformations (PDA)

orchitis is complication of what viral infection

mumps

sciatic nerve innervates what

muscles in posterior thigh compt (hamstrings) tibial and common fibular/common peroneal nerves -- motor and sensory innervation to leg and foot

what is produced in pentose phosphate pathway

nadph

what drug withdrawal if dysphoria, irritability, anxiety, increased appetitiee

nicotine no significant pe findings

what is an Nn receptor

nicotinic acetylcholine receptor located in neural tissues hexamethonium is a potent nicotinic receptor antagonist

are depressive episodes necessary to dx bipolar i

no

how does atracurnium metabolize

non depol nm blocking agent spontaneously degrades in plasma and organ tissue = hofmann elimination

why coffee ground emesis in peptic ulcer disease

oxidation of heme iron by exposure to gastric acid

what does log dose response curve look like for reversible competitive antagonist added to full agonist

parallel shift to right in log-dose response curve- -> increase in ed50 no chnage in max effect

what is pathomys of chagas --> achalasia

parsitosis related inflammation and immune mediated cross rxn between parasite and enteric ganglia lead o destruction of submucosal (meissner) and myenter (auerbach) plexus denervation --> uncoordinated smooth muscle activity, increased eso tone, incomplete lower eso relaxation

cryptogenic strokes are assoc with

patent foramen ovale and ASD

what causes indirect inguinal

patent processus vaginalis

what is on tumor cell - pd1 or pdl1

pdl1 many tumor cells upregulate pdl1 expression to evade immune system

what are first signs that can be seen on ecg after acute TM MI

peaked t waves are first ecg sign (reflecting localized hyperkalemia) st segment elevation follows within min to hrs hrs to days: q waves in involved leads

oral anaerobes

peptostreptococcus, prevotella, bacteroides, fusobacterium

what is antigenic drift

point mutations in HA and NA genes slightly alter product proteins not species-species transmission; not major modification

sx of narcolepsy

poorly regulated REM sleep excessive daytime sleepiness, cataplexy, sleep attacks, hypnagogic/hypnopompic hallucinations, sleep paralysis

where are nicotinic cholinergic receptors

postanglionic neurons n symp and parasymp ganglia on skeletal muscle cells at NMJ

what two arteries does CNIII go between

posterior cerebral and superior cerebellar arteries (as it exits midbrain in interpeduncular space) very susceptible to ipsilateral posterior communicating artery aneurysms

aneurysms causing cn3 palsy most offten involve what artery

posterior comunicating

what is choridal inflammation associated with

posterior uveitis painless vision loss and floaters otphalmic exam may show inflammation/leukocytes in vitreous humor associated with systemic inflammatory disorders (IBD and ank spon)

if cutaneous anthrax is suspected in a patient without risk of occ exposure, what should you do

potential for bioterrorism suspected public health authroties contacted

how to confirm acute epiglottitis

prescence of edmatous epiglottis cherry red via inspection of epiglottis (though inspection should NOT BE DONE unless team is ready to provide surg airway by tracheostomy)

what sx of epidural hematoma

presents within hrs to days following procedure; pts report suddent onset of back pain, radicular pain, progression to complete/partial paralysis of lower back extremities

what is the mergency medical treatment and active labor act

prevent hospitals from inappropriately transferring, discharging, refusing to tx indigent patients all patients who present to ED must receive appropriate screening and med exam and condition stabilization

what is thrombin time

prolonged with meds that directly/indirectly inhibit thrombin

what is the blood supply of the proximal ureter vs distal ureter vs middle ureter

promixal: renal artery distal: superior vesical middle: variable and anastomotic (gonadal, common, internal iliac, aorta, uterine)

what surgery is life saving in men 2b

prophylactic thyroidectomy

moa of bortezomib (boronic acid containing dipeptide)

proteasome inhibitor used for multiple myeloma build up of misfolded, damaged, cytotoxic proteins (monoclonal Ig) --> apoptososis proteasomes also regulate pro/antiapoptotic proteins --> excess proapoptotic proteins induce apoptosis of malignant cells

western blots used to identify

proteins nitrocellulose membrane and probed with primary Ab specific for protein of interest

what is the morphology of candida

pseudohyphae with blastocinidia

what are sx of narcolepsy

recurrent lapses into sleep or napping multiple times within the same day occurring at least 3X weekly for 3 months at least 1 of the following: -cataplexy: conscious, brief episodes of sudden bilateral muscle tone loss precipitated by emotion such as laughter or joking; spontaneous abnormal facial movements without emotional triggers hypocretin 1 deficiency by CSF rapid eye movement sleep latency <15 min

where is svc

righ tof heart posterolateral to ascending aorta anterior ro right pulm artery just below level of carina

what is morphology of mucor/rhizopus

right angle branching, nonseptate hyphae

tx of als

riluzole moa: decrease glutamate release

what are live attenuated vacines

rotavirus varicella mmr

what is longest muscle in body

sartorius originates from anterior iliac spine and inserts into pes answerinus of anteromedial tibial shaft near tibial tuberosity

what does ventromedial hypothalamic nucleus do

satiety destruction --> hyperphagia

which rheum condition leads to pulm fibrosis

scleroderma

what is hogness (tata) box

second promoter region in eukaryotic genome; seen just to right of CAAT box located 25 bases upstream from txn start site promote initation of txn by acting as binding sites for general txn factors and RNA polymerase ii

what sx of glucagonoma

secondary dm necrolytic migratory erythema of skin

what does somatostatin decrease

secretin CCK glucagon insulin gastrin

supraoptic nucleus does

secretion of adh and oxytocin

arcuate nucleus regulates

secretion of dopamine (inhibits prolactin), growth hormone releasing hormone, gonadotropin-releasing hormone

histo findings of seborrheic keratosis

small cells resembling basal cells hyperkeratosis keratin containing cysts

what causes balanced vasodilation of both large arteries and veins

sodium nitroprusside useful for reducing blood pressure in htn emergency

how to tx cyanide toxicity

sodium thiosulfate works as antidote by providing additional sulfur groups for rhodenese (enhancing cyanide detox to thiocyanate, which is excreted in urine) used in conjunction with hydroxocobalamin (cobalt moeity binds to intracellular cyanide ions and forms cyanocobalamin, excreted in urine) and Na nitrite in mgmt of cyanide toxicity (promotes methemoglobin formation, which combines with cyanide to form cyanmethemoglobin)

Aes of acetazolamide and CA-I

somnolence paresthesias urine alk rare; metabolic acidosis dehydration hypokalemia hyponatremia

necrotizing pneumonia agents

staph aureus, e coli, klebsiella, pseudomoonas

vit b12 deficiency damages what

subacute combined degenration of dorsal and lateral spinal columns

how to differentiate b vs t cell ALL

t cell more likely to present with large anterior mediastinal mass --> compress great vessels --> mediastinal synrome compress esophagus causing dysphagia, while compression of trachea may lead to dyspnea nad stridor affects males more in late childhood thru young adulthood t cell only 15-17% of all

mantle cell lymphoma defect

t(11;14) cyclin d gene

what should you do before giving a tnf-alpha inhibitor

test for latent TB thru TST or IGRA

what is greatest risk of cryptoorchidism

testicular cancer if uncorrected, higher body temp --> leads to atrophy and necrosis of seminferous tubules --> decreased fertility & increased risk for testicular cancer

what is volume of distribution

theroetically required volume (in liters) if fdrug were completely contained in plasma) vary depending on how well drug distributes into tissues higher Vd - greater drug binds to tissues

right ventricular failure: time course and distinctive findings

time course: acute distinctive findings: hypotension, clear lungs, kussmaul sign

what do metalloproteinases do

tissue remodeling embryogenesis basement membrane penetration

what is risk factor for transitional cell carcinoma of bladder

tobacco smoke occupational exposures - rubber, aromatic amine-containing dye, textiles, leather (rubbers, plastics) incidence peaks in 70s and 80s men > women

how to calculate tpr from series circuit

tpr = r1 + r2 + r3 + r4 this estimates blood flow to individual organ well (artery + arteriole + capillary + venule + vein)

what are 2 major types of bone

trabecular (cancellous, spongy) cortical

what diseases does meitotic nondisjunction cause

turner klinefelter trisomies 13, 18, 21

early onset of sexual actiivty increases risk of cervical cancer by

twice risk if before age 18, vs those who start sex after age 21

what is moa of phenytoin

tx tonic-clonic, partial, status epilepticus inhibits abnormal electrical activity of brain, blocks voltage gated Na channels narrow tx index

2nd line tx for absence seizure

valproate

drugs that cause fetal neural tube defects

valproate, carbamazipine, phenytoin

what cv defects in tuberous sclerosis

valvular obstruction due to cardiac rhabdomyomas

tx of coag neg staph infection

vancomycin (due to widespread methicillin resistance) also gentamicin and/or rifampin in cases of deep seated MR CoNS or staph PVE if after susceptible, can switch to nafcillin or oxacilllin

dominant temporal lobe lesion (left sided)

verbal memory, word recognition

what anesthesia is predominantly eliminated by lungs

volatile, inhaled anesthetics

what causes femoral hernia

weakness of proximal femoral canal

what causes direct inguinal

weakness of tranversalis fascia (most often due to connective tissue abnormalities, chronic abdominal wall injury) so more common in elderly

injury to cnxi

weakness on head rotation away from side of lesion (lack of innerv to SCM) and ipsilateral shoulder droop (lack of innerv to trapezius)

side effects of olanzipine

weight gain metabolic side effects

paraneoplastic acth - what do you expect with weight

weight loss more common than classic central obesity of cushing

when do you see fat embolism syndrome

within 24-72 hrs of injury can develop up to 2 weeks later up to 33% in patients with bilateral fem fractures

can turner patients ever have natural spontaneous preg

yes, but increased risk of spontaneous abortion, down, turner in children

describe hemolytic disease of newborn (erythroblastosis fetalis)

destruction of fetal RBCs by maternal Ab directed against fetal erythrocyte antigens IgG Ab from mom cross placenta Rh(D-) mother with Rh(D)+ fetus due to small amounts of fetal blood crossing placenta and entering maternal circulation --> induce mom to create anti-Rh(D) Ab during pregnancy 1 subsequent pregnancies with Rh(D)+ fetus, Ab cross placenta and opsonize fetal RBCs --> hemolysis

how to dx pheochromocytoma

detect high levels of urinary and plasma catecholamines and metanephrines (catecholamine breakdown products)

what happens to bladder if UMN lesion

develop spastic bladder --> does not distend/relax properly due to loss of descending inhibitory control from UMN --> urge incontinence (e.g. MS)

standard dev vs standard error

deviation: reflects spread of individual values in normal distribution (measures the variability of the observations within a single sample) error: reflects variability of means (variance between means of different samples; helps estimate true mean of underlying population)

what can be used to prevent anthracycline induced doxorubincin cardiotox

dexrazaroxane - iron chelating agent

how to prevent anthracycline induced dilated cardiomyopathy

dexrazoxane chelating agent, blocks formation of Fe associated free radicals and inhibits formation of anthracycline-topoisomerase ii complexes in healthy cardiomyocytes

three disorders with microangiopathic hemolytic anemia

dic ttp hus

sx of m3 variant of aml

dic (bleeding, thrombocytopenia, prolonged pt, activated thromboplastin time) recurrent infections (neutropenia) pallor (anemia) ecchymoses (thrombocytopenia)

what can lead to deamination of cytosine, adenine, guanine to form uracil,hypoxanthine, and xanthin?

dietary nitrites if abnormal bases not removed and replaced w/ correct base, dna mutations and carcinogenesis may result

what sitmulates release of gastrin

dietary protein intake gastrin releasing peptide (from vagal stimula) increased gastric ph gastrin increases acid production by binding parietal cells and indrectly by binding ECL cells/inducing histamine release

parietal lobe damage

difficulities with spacial nd visual perception

histo of UC

diffuse inflammatory infiltrates with neutrophilic microabscess in crypt lumina

what do signet ring carcinomas look like on gross exam

diffuse involvemen tof stomach wall (due to loss of cell adhesion protein e cadherin) plaque lique appearance, ill defined, infiltrate large areas of stomach wall (leather bottle stomach - linitis plastica)

histology of burkitt lymphoma

diffuse medium sized lymphotes with high proliferation index represented by high Ki-67 fraction (close to 100%) starry sky, due to presence of benign macrophages

what drug has been administered if patient has disturbed color perception, anorexia, N/V/D

digoxin toxicity nonspecific GI and neuro sx

which antianginal drug has arterial dilation (decreased afterload)

dihydropyridine (amlodipine, nifedipine)

young patient who develops heart failure, what to expect

dilated cardiomyopathy due to viral myocarditis coxsackie, deno, influenza due to viral infection --> virus to infect and persist inside cardiomyocytes --> damage due to inadequate immune response to viral infection, virus persirs inside cardiomyocytes --> direct cytotoxic effect or destructive autoimmune reaction

timolol/non selective BB do what for glaucoma

diminish secretion of aqueous humor by ciliary epithileum

what is initial nidus of indective endocarditis

disruption of normal endocardial surface sterile fibrin-platelet nidus commonly occur in areas with max turbulence to blood flow (atrial surface of incompetent AV valves, or ventricular surface of incompotent semilunar valves, aortic pulmonic) then lead to activation of coag system vegetations are composed of fibrin, platelets; with RBC, leukocytes, and clusters of microorganisms embedded deep within the lesion

what is MoA of alcohols as a clinical disinfectant

disrupts cell membranes denatures proteins not sprocidal require presence of water for maximal activity, most effective at 60-90% concentration rapidly bactericidal and tuberculocidal, fungicidal, and virucidal

AEs of ketamine anesthesia

dissociative anesthesia (analgesia, amnesia, preserved consciousness) elevated pulse, BP, hallucinations, increased cerebral blood flow, ICP

what does ornithine decarboxylase do

dna stabilization and repair if inhibited - decreased cell growth and increased apoptosis

key feature of panic disorder is that they DO or DO NOT have a trigger?

do not have an obvious trigger can occur while relaxing, sleeping

names of integrase inhibitors

doluteGRAVir ralteGRAVIR

what is MoA of pramipexole

dopamine agonist have similar chemical structure to dopamine and directly simulates dopamine receptors

what is bromocriptine used for

dopamine agonist parkinson's and hyperprolactinemia

tx for women with hyperprolactinmia to restore preg

dopamine agonist - bromocriptine

homovanillic acid assoc with

dopamine metabolite psych conditions - substance use, psychosis, mood disoders decreased in patients with parkinsons

what is produced in substantia nigra

dopaminergic neurons (in parkinson's depleted)

what is DNA damage caused by ionizing radiation (xrays, gammarays)

double strand DNA breaks repaired by non homologous end joining

what happens when pd1 on t cells are bound by pdl1

downregulates immune response by inhibiting cytotoxic t cells

name some alpha1 blockers

doxazosin, prazosin, terazosin used to relax smooth muscle in arteries and veins --> decrease in PVR also in BPH: induce relaxation of smooth muscle in bladder neck and prostate --> decrease urinary obstruction

how to prevent kidney stones

drink lots of water

how to calculate drug conc

drug dose (mg)/ volume of distribution

wen do you see pigment accumulation within hepatocytes

dubin-johnsone - AR - conjugated hyperbilirubinemia hepatocellular accumulation of coarse pigmented granules causes liver to appear grossly black

how can pudendal nerve injury occur in female

due to stress placed on pelvic floor during labor, due to vulnerable cuved course around ischial spine

which ulcers improves with eating

duodenal ulcer (gstric ulcer worsens with food)

where are h pylori colonized and what kind of ulcers result

duodenal ulcers - gastric antrum h pylori in general likes to colonize antrum, especially early in disease course. associated with decreased somatostatin formation and increased gastrin secretion --> produce excess acid. -- peptic ulcers - gastric corpus not due to acid changes, but due to direct mucosal damage and chronic inflammation

infarct of anterior portion of medial pons

dysarthria and contralateral hemiparesis/lower facial palsy due to disruption of ipsilateral corticospinal (contralateral hemiparesis, babinski) and corticobulbar tracts (contralateral lower facial palsy, dysarthria) disruption of corticopontine fibers that convey motor info from cortex to ipsilateral pontine gray matter --> contralateral dysmetria and dysdiadochokinesia (ataxic hemiparesis)

characteristics of down syndrome

dysmorphic features birth weight and length below average hypotonia weak startle (Moro) cardiac defects

what is definition for persistent depressive disorder

dysthmia chronic depressed mood and at least 2 years (1 year in children/adolescents) depressive sx for at least 2 years presence of >2 of the following - poor appetite or overeating, insomnia or hypersomnia, low energy/fatigue, low self esteem, poor conc or difficulty making decisions, feelings of hopelessness no symptom free period for >2 mo

what is path of dystrophic calcification affecting aging aorta valve

dystrophic calc occurs in ell injury and death and in all types of necrosis normal calcium levels Ca deposites seen as fine, gritty, white granules or clumps on H&E histo: dark purple, sharp edged aggregates

what are class 1c antiarrythmics MoA

e.g. flecainide potent Na channel blockers that have increased effect at faster heart rates (use dependence) makes them more effective at treating tachyarryhmias (a fib) also prolong QRS interval (proarrhythmic effect) at higher heart rates little effect on total action potential or QT interval duration they are the slowest of class 1 agents to dissociate rom Na channel and do so during diastole. at higher HR, less time for med to dissociate from receptor --> leads to strong effect --> use dependence

pressure tracing of tricuspid regurg

early and large V wave on right atrial pressure training left sided pressure tracings minimally affected

sx of thrombocytopenia

easy bruising, petechiae, mucocutaneous hemorrhage (recurrent epistaxis, gingival hemorrhage)

what is assoc with burkitt lymphoma

ebv chronic ebv increases b cell proliferation, thought to increase risk of c myc translocation

MoA of caspofungin

echinocandin blocks synthesis of B1,3, d glucan, major component of candida and aspergillus cell walls

when do you see intrahepatic hydatid cysts with surrounding fibrous reaction

echinococcus

cushing syndrom sx, what do you suspect if acth level normal/elevated, and after high dose dex, acth and cortisol are NOT suppressed

ectopic acth production (small cell lung)

what are roth spots

edematous hemorrhagic lesions of retina found in IE

trisomy 18 sx

edwards syndrome dysmorphic facies (micrognathia, low set ears) clenched hands with overlapping fingers hypertonia

names of nnrtis

efavirenz, nevirapine

what drug targets ornithin decarboxylase

eflornithin is a topical OD inhibitor used to decrease rate of facial growth

what is found in scottape test for enterobius (pinworm)

eggs on scotch tape

describe murmur of aortic stenosis

ejection or midsystolic murmur of cresc-decresc config maximum intesntiy over right 2nd interspace radiates to neck/carotid arteries

what are lab findings of cholestasis for pbc

elevated alk phosphatase and cholesterol elevated igm

lab findings and path for neuroblastoma

elevated catecholamine metabolites (HVA, VMA) due to neural crest orgin biopsy dx: small, round bue cells and homer wright rosettes n-myc - poor prognosis

what are lab findings in exogenous hyperthryoidism

elevated free t4 suppressed tsh low/undetectable thyroglobulin small thyroid

dx of glucoma

elevated iop and abnormal visual field testing with decreased peripheral vision fundoscopic exam will show an increased cup to disc ratio due to loss of ganglion cell axons

pressure tracing of mitral stenosis

elevated left atrial pressure throughout cycle, peak atrial pressure at time of atrial kick, just before mitral valve closes at end of venricular diastole

what is cardiogenic pulm edema due to and cxr finding

elevations in hydrostatic pressure within pulmonary capillaries CXR: perihilar alveolar edema with cephalization of pulm vessels

how does cystercercosis spread in body once infected

embryos attach to and penetrate wall of small intestine, subsequently migrate hematogenously to tissues, including brain form cysticerci --> fluid filled larval cysts, surrounding invaginated scolex

when can physician intubate w/o consent

emergency

what is cryptorchidism

empty scrotum or hemiscrotum +/- mass in inguinal canal

names of fusion inhibitors

enFUviritide

where is av node

endocardial surface of RA near insertion of septal leaflet of tricuspid valve and orifice of coronary sinus

endocrine, paracrine, autocrine definitions

endocrine: release hromones into bloodstream to exert an effect on remote organ paracrine: secretions produced that reach nearby target cells by diffusion thru extracellular space autocrine: released into extracellular space, act directly on secreting cell

what is embryo of esophagus

endodermal foregut in thoracic cavity, descends posterior to trachea and anterior to vertebrae

what are endorphins and dynorphins

endogenous opioid peptides achieve pain relieving effects by activating opioid and k opioid receptors

how does h pylori protect itself from gastric acid

endogenous urease production (urease converts urea to ammonia, alkalinizes surrounding pH)

why does dystrophic happen in cardiac valves

endotheilial and fibroblast death secondary to chronic hemodynamic stress or atherosclerosis release of cellular degradation into valvular interestititum then promotes calcification and thickening of valve leaflets and annulus

what happens when you activate m3 receptors

endothelial cells: promote synthesis of NO --> diffused into vasc smooth mucle cells --> guancyl cyclase and gmp --> myosin light chain phosphatase --> dephosphorylates myosin and prevents interaction of myosin head with actin (smooth muscle relaxation and vasodilation everywhere else (bladder, GI, pupils, exocrine gland) --> m3 leads to gpcr --> ca increase --> smooth muscle contraction

how is iodide taken up by thyroid gland

energy dependent I/Na symporter located on basolateral membrane

what does digoxin do to av node

enhances vagal tone leads to increased effective refractory period and decreased conduction velocity thru av node use in patients with SVT

what are origin of cutaneous neurofibromas

enign nerve sheath neoplasms comprised of schwann cells embryologically derived from neural crest

what does pgsn look like on light micro

enlarged and hypercellular due to leuk infiltration and proliferation of endothelial and mesangial cells electron-dense deposits (humps) on epithelial side of bm immunoflurescence --> coarse granular deposits of igg an c3 (lumpy pumpy) involves all glomeruli in both kidneys kidneys are enlarged, swollen w/ multiple usrface punctuate hemorrhages

what is most common cause of VIRAL MENINGITIS

enterovirus (can cause encephalitis and acute flaccid paralyisis, but temporal lobe involvement is not typical)

most common causes of viral meningitis

enteroviruses (most common) - coxsackie, echo, polio arboviruses hsv2

what causes IgE dependent degrandulation

enviro exposures (food, stings) medications such as beta lactam and sulfonamide abx

what is lecithinase (alpha toxin)

enzyme with phospholipase c activity, major virulence factor produced by c perfringens toxin increases platelet aggregation and adherence molecule expression on leuk and endothelial cells --> vasooclusion and ischemic necrosis

what lung disease would have bronchoalveolar lavage fluid eosinophilia

eosinophilic pneumonias tropical pulm eosinophilia

what is name of disease and common bugs that cause sore throat, dysphagia, drooling, resp distress in children

epiglottitis haemophilus influenzae

what are freckles (ephelides) and solar lentinges

epiledes - increases melanin production by melanocytes solar lentigo: increases proliferation of melanocytes themselves both hyperpigmented and flat

when do you get exacerbation of printzmetal angina

episodic angina occurs at rest, physical activity, HR, BP no assoc w/ plaques tx with nitroglycerin or CCBs

where are cells of choroid plexus from

epithelial: neurecto mesenchyme: mesoderm

what are 2 classes of dopamine agonists

ergot: bromocriptine nonergot: pramipexole and ropinirole these meds have long half-life, delay need to start levodopa, postpone development of motor fluctations until layer in disease course

odonophagia and gerd

erosive esophagitis

what can tx anemia of chronic kidney disease

erythropoeissis stimulating agents (epo, darbepoetin alpha)

where do you get prortocaval anastomose

esophagus rectum umbilicus retroperitoneal

how is RPF estimated

estimated by calculating PAH clearance

tx of absence seizures

ethosuximide (inhibit t type Ca channels in thalamic neurons) valproate use if etho not tolerated/effective

what is myeloma kidney

excess excretion of free light chains (bence jones proteins) most common form of nephropathy in MM filtered by glomerulus in small amounts, reabsorbed in tubules when levels exceeed reabsorptive capacity, precipitate with Tamm Horsfall protein and forms casts that cause tubular obstruction and epithelial injury --> impaired renal function light micro: glassy casts, large, stain intensely eosinophilic deposition of light chain fragments in glomerular mesangium and capillary loops also cause renal failure in MM (AL amyloidosis)

where does cnv3 exit the skull

exits the skull thru foramen ovale (it also contains lesser petrosal nerve, accessory meningeal artery, emissary veins)

toxins/extracellular products of pseudomonas

exotoxin a collagenase elastase fibrinolysin phopholipase c dnaase

what skeletal abnormalities with extramedullary hematopoesis

expanding mass of progenitor cells in bone marrow --> thins bony cortex and impairs bone growth pathologic fractures maxillary overgrowth and frontal bossing (chipmunk facies)

what is outcome of ATN

experience tubular re-epithelization and regain renal function when assoc with multiorgan failure, renal function may be permanently impared (foci of interstitial scarring on micro)

what is common femoral artery a continuination of as it crosses inguinal ligament

external iliac artery

what is affected if you have a cn3 palsy

eye deviated downward and laterally (down and out) diagonal diplopia dilaiton of pupil and loss of accomodation (carries parasymp fibers to cilairy muscle and iris sphincter) ptosis

what does cn vi palsy look like

eye deviated medially (since abduction, horizontal diplopia)

what does cniv palsy look like

eye deviated upward (since it normally does depression while adducted) vertical and torsional diplopia (since it does internal rotation)

what nucleus is located in the dorsolateral aspect of caudal pons

facial nucleus

what is meckel's diverticulum

failure of omphalomesenteric (vitelline) duct to obliterate (this normally obliterates during 7th week of fetal life) most cases asx rectal bleeding, intestinal obstrction rule of 2's: 2% of population, 2 feet from ileocecal valve, 2 inches in length, 2% symptomatic, males 2x more likely often contains ectopic mucosa; gastric epithelium (leading to ulceration of adjacent mucosa, lower GI bleeding - melena, hematochezia); pancreatic tissue

what looks black on histo

fat globules osmium tetroxide imparts black color to fat

what is most serious complication of digoxin

fatal cardiac arrythmias precipitating: hypokalemia (increased digoxin binding), hypovolemia, renal failure severe: treated with anti-digoxin Ab fragments

triggers of hemolysis for g6pd

fava beans, infections (pneumonia, viral hep), primaquine, sulfa drugs

other complications of h pylori gastritis

fe deficiency anemia (chronic blood loss) MLAT lymphoma

hep a transmission

fecal-oral contaminated water or food, raw/steamed shellfish

what nerve innervates quadriceps muscle

femoral nerve

sx of inhaled anesthetic hepatotoxicty

fever, anorexia, nausea, myalgias, arthralgias, rash tender widespread liver inflammation and jaundice elevated ALT, AST prolonged PT (due to coag factor vii) leukocytosis eosinophilia

sx of invasive aspergillos

fever, cough, SOB, nodular or cavitary pulm infiltrate

sx of acute viral hepatitis

fever, malaise, anorexia, n/v, ruq abdominal pain after several days --> cholestasis (jaundice, pruritis, dark colored urine due to increase conj bili levels), acholic stool (lacks bili pigment)

how to tx primary hypertglyceridemia

fibrates nicotinic acid (decrease hepatic production of vldl)

which cholesterol drugs are first line for hyperTG

fibrates (gemfibrozil, fenofibrate) inhibit hepatic production of TG

what do valves look like after rheumatic heart disease

fibrous thickening and fusion of the valve leaflets (comissural) latency of 10-20 years between initial RF and symptomatic MS most patients manifesting during 40s-50s

what is filum terminale

filament connecting conus medullaris to posterior coccyx pia mater surrounding spinal cord projects downard to form filum terminale

il2 does

first IL produced by t cells after angtigen contact secreted by TH1 cells --> develop cd4, cd8, b cells

what does celiac trunk oxygenate

first main branch of AA provides oxygenated blood to spleen, stomach, liver, abdominal esophagus, parts of duodenum and pancreas

sx of rabies

first nonspeciifc flu like symptoms, then: perisistent fever, variabl consciousness encephalitis: hydrophobia, aerophobia, pharyngeal spasm, spastic paralysis, agitation paralytic: ascending flaccid paralysis coma, most patients die within weeks

what is first sign of uncal herniation

fixed, dilated pupil on side of lesion paralysis of oculomotor muscles, contralateral or ipsilateral hemiparesis contralateral homonymous hemianopsia with macular sparing

how does flucytosine work

fluorinated analog of cytosine covered by relatively fungus specific cytosine deaminase to 5FU --> rna miscoding and inhibition of dna synthesis

tx for legionella

fluoroquinolines (levofloxacin) or newer macrolides (azithromycin)

t(14;18)

follicular overexpression of anti-apoptosis protein Bcl2

where do you see bcl2 mutations

follicular lymphoma

what is contained in anterior compartment

foot extensor muscles anterior tibial artery deep peroneal (fibular) nerve --> damage leads to decreased dorsiflexoin of foot, foot drop, and claw foot

immune mediators for th2

for humoral immune responses il-4 --> IgE Ab by b cells IL-5 --> IgA Ab by b cells; activation/production of eosinophils

what is valsalva, what muscles used

forcibly exhaling against closed glottis full inhalation, close glottis, bear down w/o exhaling as one would during a bowel mvmt rectus muscles are recruited in this process - play largest role in develoment of resultant elevated intraabdominal and intrathroacic pressure

how does thyroid gland form

formed from outpouching of pharyngeal epitheliaum and subsequently descends to lower neck anterior to upper trachea and larynx lowest part of evagination forms thyroid gland and remaining portion forms thyroglossal duct --> extends from foramen cecum on dorsal surface of tongue to superior border of thyroid isthmus

what can tx cmv without needing intracellular activation

foscarnet

what does hormone sensitive lipase do and what activates it (what situations/hormones)

found in adipose tissue catalyzes mobilization of stored TG into FFA and glycerol activated in response to stress (catecholamines, glucagon, ACTH) inhibited by insulin stress hormones --> Gs on adipocytes --> cAMP --> PKA --> phorphorylates and activates HSL, stimulating lipolysis

what does lipoprotein lipase do

found on endothelial cells, degrades TG found in chylomicrons and VLDL similar to HSL, works in bloodstream to form FFAs --> into adiposcytes for storage or tissues (heart/skeletal muscle) for energy production SO OPPOSITE OF HSL; LPL used for storage

what are the 3 trinucleotide repeat disosrders

fragile x: cgg myotonic dystrophy: ctg huntington: cag

what is naegleri fowleri

free living, protozon parasite rapid meningoencephalitis with high motality rate found in fresh water, txn thru nasal inhalation during swimming --> spreads thru cribirom plate to olfactory cortex infection -- sx of encehaplitis, smell, taste abnormalities; frontal and temporal lobes, brainstem, and meninges

what are kinds of cardiac rupture and sx

free wall rupture - hemopericardium and cardiac tamponade ventricular septal rupture - VSD and left to right shunting papillary muscle ruptures - acute onset of severe MR

what is creatinine clearance like

freely filtred at glomerulus relatively insignificant tubular reabsorption or secretion

what should patients with hiv get for screening of cervical dysplasia/cncer

frequent pap smears

what is path of pudendal nerve

from s2-s4 passes between piriformis and coccygeus muscles exits the pelvis thru greater sciatic foramen re-enters pelvis near ischial spine, thru lesser sciatic foramen prior to dividing into its terminal branches

describe metabolism of fructose in liver

fructose --> phosphorylation by fructokinase to F1P --> aldolase b can use both F16BP and F1BP as substrates converts F1P into DHAP and glyceraldehyde glyceraldehyde --> phosphorylated to glyceraldehyde 3 phosphate by triokinase or converted to DHAP DHAP converted by triose phosphate isomerase to glyceraldehyde 3 phosphate --> glycolyssi

what does locus cereulus do

functions as principal site of NE synthesis in brain projects to all parts of CNS and helps control mood, arousal (reticular activating system), sleep-wake states, cognition, and autonomic function (BP control) abnormal activation of locus cerelus --> anxiety disorders

what does NADPH oxidase do

functions within activated phagocytes to produce reactive oxygen spcies (O2, H2O2, HO), acts directly as antimicrobial agents and activate granule proteases (elastase, cathespin g) present in phagosomes impaired intracellular killing by PMNs and macrophages --> recurrent bacterial and fungal infections

what do neurons produce in caudate nucleus and putamen

gaba releasing neurons (and cholinergic) are damaged in huntington

tx of rmv retinitis

ganciclovir guanosine nucleoside analog structurally simlar to acyclovir but expresses greater activity against cmv dna polymerase

aes of valganciclovir

ganciclovir prodrug severe neutropenia, can be exacerbated by other bone marrow suppressing agents (zidovudine, tmp/smx)

clinical indications for cmv

ganciclovir resistant cmv acyclovir resistant herpes infections

if h pylori is colonizing gastric body, what ulcer will occur

gastric

what happens when h pylori colonizes gastric body

gastric ulcer chronic inflammation --> multifocal atrphic gastritis nd reduction in # of acid-producing parietal cells delta cells not markedly reduced (acid secretion if low/normal) gastric ulcer results from direct mucosal damage caused by bacterial products (ammonia, cytotoxins) and resultant inflammatory response

common hepatic artery branches

gastroduodenal - pylorus, prox duodenum, pancreatic head right gastric - gastric fundus along lesser curvature, before comining with left gastric artery

MoA of glucocorticoids

gene transcription blocker inhibit phospholipase a2, inhibit release of downstream mediators, decreasing airway hyperresponsiveness and inflammation

describe absence deizures

generalized children 4-10 staring spells with momentary lapse of consciousness automatism may occur last 10 sec; immediate return to normal no postictal period, no recollection provoked by hyperventilation EEG 3hz spike-wave benign, resolve before puberty

causes of dilated cardiomyopathy

genetic disease, pregnancy, infiltrative disease, drug, toxins (anthracyclines, chronic alcohol abuse)

what do you expect to see on neuropath for stroke that happened 4 mo ago

glial scar formation cystic area surrounded by dense glial fibers

what are optic gliomas

glioma affects CNII NF1 immature astrocytes with microcystic degeneration and rosenthal fiers (elongated or corscrew intracytoplasmic eosinophilic bundles)

what is more medial, globus pallidus or putamen

globus pallidus is more medial putamen more lateral

when do you see RBC casts

glomerular bleeding from glomerulonephritis (PSGN)

what parts of kidney are permeable to urea

glomerulus pt inner medullary collecting duct thin regions of loop of henle

what does glucose 6 phosphate dehydrogenase catalyze

glucose 5 phosphate --> 6 phosphogluconate (rate limiting step in pentose phosphate pathway)

what does inferior gluteal nerve innervate

gluteus MAXIMUS responsible for extension/external rotation of thigh at hip injury - can't rise from seated position or climb stairs

what does superior gluteal nerve innervate

gluteus medium, minimus, tensor fasciae lata these muscles stabilize pelvis and abduct the thigh

what reaction in glycolysis requires nad+

glyceraldehyde 3 phosphate --> 1,3 bisphosphoglycerate

what is thyroglobulin

glycoprotein produced by thyroid follicular cells, makes up substantial component of follicular colloid serves as substrate for formation of thyroid hormone low levels = noninflammatory suppression of thyroid activity high levels = destructive thyryoiditis, can see in subacute granulomatous thyroiditis; hyperthyroidism

when do you see blomerular bm disruprtions and fibrin deposition in EM

goodpasture gbm breaks due to fibrinoid necrosis of glomeruli --> typically crescent formation crescent formation is fibrin escape into bowman's space

what is morphology of listeria

gram + rod can multiply in refrigerated, anaerobic, and microaerophilic conditions

how does listeria spread

gram positive bacillus facultative intracellular org able to avoid phagocytosis and spread intracellularly cell mediated immunity needed to clear listeria infection those w/o cell mediated immunity (infants, chemo, hiv pos)

c perfringes is

gram positive bcillus spores germinate in anaerobic enviro into vegetative cells --> produce phopholipase toxin that attacks cell membranes --> necrosis and redced blood supply --> spreading in enlargening anaerobic enviro produce gas, crepitus, visualized on radiographs

what does listeria look like

gram positive rod with tumbling motility, flagellar based (at room temps) facultative intracellular (grows within macrophages)

morphology of c boulinum

gram positive spore forming anaerobic bacillus syntheiss neurotoxins intracellulary, releases them by autolysis

what is filgrastim

granulocyte csf analog stimulates prolif/differentiation of granulocytes in pts with neutropenia

what vessel is used if need multiple bypass grafting

great saphenous vein surgeons access vein in medial leg, or near its point of termination in femoral triangle or upper thigh

what is border of greater sciatic foramen

greater sciatic notch of ileum, inferiorly by ischial spine and sacrospinous ligament, superioly by anterior sacroiliac ligament, posteromedially by sacrotuberous ligament

what does lumbar puncture show for SAH

gross blood or xanthochromia (yellow discoloration of csf)

which anesthesia is associated with liver issues and centrilobular hepatic necrosis

halogenated inhaled anesthetics halothane hepatitis halothane, enflurane, isoflurane, sevoflurane, desflurane modulate various neuronal ion channels --> CNS depression metabolized by hepatic cytochrome p450 system --> converted to reactive intermediates that can directly injure liver or lead to immune-mediated hepatocellular damage also causes malignant hyperthermia

what is MoA of iodine

halogenation of proteins and nucleic acids yes sporocidal less effective than chlorhexidine-alcohol cause more skin irritation and toxicit

what causes inhaled hepatotoxicity

halothane and inhaled anesthetics associated with highly fulminant hepatitis, cannot be distinguished from acute viral hepatitis histo get elevated aminotransferase levels due to massive hepatocellular injury and prolonged prothrombin time due to failure of hepatic synthetic function

what makes Hep C able have genetic instability/variability

has >6 genotypes and multiple subgenotypes variant strains differ primarily at hypervariable genomic regions (e.g. envelope glycoproteins) no proofreading 3'-5' --> exonuclease acitivity built into virion-encoded RNA polymerase! makes many errors during replication; several dozen subspecies of HCV typically present in blood of infected individual at any one time

what is def of erythrocytosis (polycythemia)

hct > 52% in men >48% in women can be due to true increas in RBC mass (absolute) or decrease in plasma volume (relative)

sx of high altitude sickness

headache, fatigue, nausea, dizzinss, slep disturbances hypobaric hypoxia common cause

what are different presentations of listeria based on age group

healthy: febrile gastroenteritis impaired cell mediated: invasive like sepsis, meningoencephalitis (AIDs, malignancy, extreme of age, pregnancy) pregnancy: flu like sx and intrauterine infction --> preterm labor and neonatal sepsis

posterior hypothalamic nuclei regulates

heat conservation (vasoconstriction and shivering) destuction --> hypothermia

structure of mhc class i

heavy chain and b2 microglobulin heavy chain highly polymorphic - allows them to present large variety of antigens

most common causative agents of septicemia and IE

hematogenos spread of infection to lung staph, strep

how do hiv patients get cmv retinits

hematogenous spread of cmv to eye most common cause of retinitis in hiv positive patients cd<50 complication: retinal detachment due to tearing of thin, atrophic scar tissue that forms in areas of prior inflammation

non dominant parietal lobe lesion (right)

hemineglect, constructional apraxia, denail of problem

describe normal hg conformation

hemoglobin a 2 alpha chains, 2 beta chains heme

what should you suspect if newborn has positive direct Coombs test, profound anemia, jaundice (kernicterus), generalized edema (hydrops fetalis due to accumulation of interstitial fluid)

hemolytic disease of newborn

main presenting pulm sx in goodpasture

hemoptysis histo: focal necrosis of alveolar walls and intraalveolar hemorrhages

what do you use IFN-alpha as tx for

hep b, c, hairy cell leukemia condyloma acunimatum kaposi sarcoma

how does procainamide get metabolized

hepatic acetylation slow acetylators have greatest risk for drug induced lupus (rapid acetylators less susceptible)

what kind of injury pattern from halogenated inhaled anesthetics

hepatocellular pattern mild asx aminotransferase elevation to fulminant hepatitis with 50% fatality rate can get liver with atrophy and shrunken on autopsy histo: widespread centrilobular necrosis and inclammation of portal tracts and prenchyma --> indistinguishable from fulminant viral hepatitis

what does low serum levels of c1 esterase inhibitor suggest

hereditary angioedema c1 esterase inhibitor suppresses activationof c1 complement compeonent and therefore rest of classic complement pathway inactivates kallikrein, which catalyzes conversion of kininogen to bradykinin

what is osler-weber-rendu syndrome

hereditary hemorrhagic telangiectasia AD prescence of telangiectasis in skin, mucous membranes of lips, oronasopharynx, resp tract, GI tract, urinary tract (rarely may involve brain, liver, spleen) rupture of these telangiectasis --> epistaxis, GI bleeding, hematuria

cmv and ebv - describe morphalophy

herpesviridae family - all have icosahedral core surrounded by lipoprotein envelope and have ds linear DNA only viruses to acquire envelopes by budding from nuclear membrane

absolute vs relative erythrocytosis

hg and hct cannot accurately diffeerentiate the two need direct measurement of rbc mass increased total rbc mass = absolute normal rbc mass = relative

roseola infantum caused by and rash looks like

hhv6 high fever for 3-5 days, with rash appearing once fever subsides macules and papules on trunk that spread to exremitis

what does chronic renal insufficiency do to testicles

high Cr and uremia uremia is toxic to testicles, suppresses testosterone production

what is reason for low bioavailability of oral nitrate

high first pass metabolism goes thru extensive first pass metab in liver prior to release in systemic circulation --> leads to low bioavailability and need for much higher doses of oral formulations compared to sublingual nitroglycerin it is NOT due to GI absorption--has nearly complete and rapid GI absoprtion

what drugs have high intrinsic hepatic clearance

high lipophilictiy and high volume of distribution high lipophilicity allows drug to cross cellular barriers more easily and enter hepatocytes, can be excreted in bile or thru other methods of elimination high lipid solubility assures wide distribution to many different tissues, including brain, liver, adipose tissue high lipphilic drugs are poorly elminated in kidney as these agents rapidly cross tubular cell membranes after filtration to reenter the tissues processed by liver preferentially into more polar compounds for easier elmination in bile and urine

what factors can increase diffusion speed across semipermeable membrane

higher molecular conc gradients larger membrane surface areas increased solubility (higher temp) diffusion speed decreases with increased membrane thickness, smaller pore size, higher molecular weights, and lower temperatures

what is propofol and hwhat is it like as an anesthesia

highly lipophilic used for induction and maintenance fo general anesthsia, procedural sedation when administered as IV bolus - onset of action 30 sec with duraiton of action <10 min administration causs rapid decrease in level of consciousness, global amnestic effect rapidly cleared from plasma, preferentially distributed to organs receiving high blood flow (Brain) --> leads to rapid onset of sedation over time, propofol is redistributed to organs receiving less blood flow (fat, muscle) --> redistibution accounts for rapid termination of drug action

how to confirm dx of mucormycosis?

histo exam of affected tissue is needed to confirm dx broad, ribbon like nonseptate hyphae with right angle brainching tissue invasion seen along blood vessels, vasc thrombosis and tissue necrosis can occur

when do you see fibrinoid necrosis

histo pattern of injury walls of blood vessels affected by vasculitis, malignant HTN, DM immue complexes and/or plasma proteins leaking thru damaged intima, being deposited within vessel wall

hiv does what with bacterial infetions

hiv decreases production of oponizing ab and recruitment of phagocytes to areas of infection pts with hiv are at higher risk for invasive bacterial infections, esp encapsulated organisms

what is an emancipated minor

homeless, parent, married, military service, financially independent, high school grad *once emancipated, do not need consent from parent/guardian

when do you get hyaline arteirolosclerosis

homogenous deposition in intima and media of small arteries and arterioles intima is thicken and arterial lumen narrowed assoc with diabetic microangiopathy

what should you suspect if fetus has severe functional anemia, tissue hypoxia, high output heart failure, non immune hydrops fetalis (negative Coombs test)

homozygous alpha thalassemia have no alpha globin chains and form gamma-4 tetramers with very high oxygen affinity

AEs of SERMs

hot flasehs venous thromboembolism endometrial hyperplasia and carcinoma (tamoxifen only)

hsp vs hus

hsp - systemic leukocytoclastic vasculitis caused by iga immune complex depositiion within small blood vessels of skin, kidneys, GI, joints palpable purpura, abd pain, arthalgias, acute GN NORMAL platelet count, coag studies

why are berry aneurysms prone to rupture when assoc with coarction

htn in branches of aortic arch proximal to coarct --> SAH there is also increased incidence of congenital berry aneurysms of circle of willis

what are risk factors of adult-type coarction of aorta

htn-associated complications --> LVHF, ruptured dissecting aortic aneurysm, intracranial hemorrhage increased risk of ruptured intracranial aneurysms (increased incidence of congenital berry aneuysms of circle of willis, aortic arch htn)

what does lateral hypothalamic nucleus do

hunger destruction --> anorexia

what is contained in bee venom

hyaluronidase phospholiapase other proteins - all of which intiaite an IgE mediated response

drug induced lupus

hydralazine procainamide isoniazide minocycycline quinidine

name first generation antihistamines

hydroxyzine promethazine chlorheniramine diphenhydramine

pyrazinamide side effects

hyepatotox, hyperuricemia

sx of somatostainoma

hyperglycemia or hypoglycemia (though secretion of insulin is stronger, so net result in hyperglycemia) steatorrhea gallbladder stones

Na chanel blockers an dMR antagonists

hyperkalemia metabolic acidosis decrease Na reabs in CD, lose driving force for K and H secretion (can't excrete K or H)

what is purpuse of hypermethylation of parent strand in dna replication in prokaryotes

hypermethylation of parent strand identifies non mutated strand for use as a template

histo of psoriasis

hyperparkeratosis acanthosis elongation of rete ridges mitotic activity above epidermal basal cell layer reduced/absent stratum granulosum epidermal cell layer suprior to dermal papillae thinned and contain dilated blood vessles (pinpoint bleeding when scale is removed from plaque - auspitz sign) PMN form spongiotic clusters in superfiical dermis and parakeratotic stratum corneum (munro abscesses)

what lung disease would have predominant cd8 t cells in bronchoalveolar lavage fluid

hypersensitivity pneumonitis

digeorge syndrome sx

hypertelorism micrognathia cleft palate cardiac defects (interrupted aortic arch, tet of fallot)

where do you see hyperplastic arteriolar changes (intimal fibroelastosis)

hypertensive nephropathy in pts with poorly controlled hypertension

where do you see systolic anterior motion of mitral valve

hypertrophic cardiomyopathy anterior mitral leaflet shifts towards aortic valve

what is cause of panic disorder sx of dizziness, weakness, blurred vision

hyperventilation decreased pco2 hypocapnia causes decreased cerebral perfusion and neuro sx

what peptide deficiencies cause narcolepsy

hypocretin1 (orexin A) hypocretin 2 (orexin B) produced only in neurons in lateral hypothalamus function to promote wakefuleness and inhibit REM sleep-related phenomenoma detect via CSF (not detectable in blood or tissues)

electrolyte abnormalities with CA inhibitors

hypokalemia met acidosis (can't reabs HCO3)

what do loop and thiazide diuretics do to K and acid/base status

hypokalemia and metabolic alkalosis they cause volume depletion, decrease distal tubule Na delivery, which activates RAAS --> aldo binds to CD and enhances Na reabs and promotes K and H loss

electrolyte abnormalities with thiazide

hyponatremia hypokalemia met alk hypercalc

what is bp status of carcinoid syndrome

hypotension (vs hypertension in pheo)

sx of anaphylaxis

hypotension - get collpase in pvr, increase vasc permeability dyspnea - stimulation of smooth muscle tone within bronchial wall, increase bronchial secretion urticaria and angioedema - vasodilitation and increased vasc permeability of skin capillaries v/abominal cramps/d - increased gi smooth muscle tone

where are oxytocin and vasopressin produced

hypothalamus produces released by posterior pituitary

name enzyme that activates 6-mercaptopurine and 6-thioguanine

hypoxanthine guanine phosphoryibosyl transferase (HGPRT) --> converts to active metabolites for purine synthesis inhibition

morph of coxsackie

icosahedral nucleocapsid and +ssRNA rna has protein on 5' end that acts as primer for txn by rna dependent rna polymerase

what are causes of diastolic heart failure

idiopathic or infiltrative disorders (amyloidosis, sarcoidosis, hemochromatosis) HFpEF transthyretin is a protein tetramer produced in liver, acts as carrier of thyroxine and retinol mutations in TTR gene --> increase tendency of TTR to misfold, producing amyloid tha infiltrates mycocardium (infiltrative cardiomyopathy)

velcro sounding crackles bilaterally

idiopathic pulmonary fibrosis

when do you use steroids for gout

if contraindications to nsaids and colchicine (e..g renal dysfunction, elderly) remember steroids increase hyperglycemia, increase blood glucose

when to suspect increased PVR as cause of RHF

if initially right ventricular wall thickening --> RV cavity enlargement as contractilce function begins to fail

what are the anti-inflammatory cytokines

il-4 il-10 - reduces production of proinflammatory th1 cytokines (il-2, IFN gamma) and MHC class ii expression; inhibits activated DCs and macrophages tgf-beta

what causes meckel diverticulum

ileal outgrowth results from failed obliteration of vitelline (omphalomesenteric) duct

what does femoral nerve innervate

iliacus and sartorius - flexion at hip quadriceps femoris - extension of leg at knee sneosry innerv to skin on anteiror thigh and medial leg knee buckling and loss of patellar reflex if injured

what would respiratory muscle fatigue, poor resp drive, or upper airway obstruction, do o paco2 and pao2

impair alveolar ventilation increased paco2 decreased pao2

what happens when you inhibit TNF-alph

impair cell mediated immunity needed to sequester mycobaceria within granulomas so tnf-alpha inhibitors promote reactivation of latent TB and increase risk of disseminated disease; also fungi; atypical mycobacteria

what causes abx resistance for tetracyclines

impaired influx/increased efflux inactivated enzyme

what is movement that is impaired in patella fracture

impaired knee extension (may have some b/c of intact medial and lateral retinaclum) patella improves knee extension, protects knee from direct injury, and improves nourishment of distal femur articular cartilage quads tendon inserts at superior pole of patella, wraps distally around patella to become patellar tendon, which inserts at tibial tuberosity

what is pathogenesis of stress related mucosal disease

impaired mucosal protection due to local ischemia caused by systemic hypotension and splachnic vasoconstriction --> curling ulcers = prox duodenum, assoc with severe trauma/burns cushing ulcers = esophagus, stomach, duodenum, intracranial injury - prone to perforation; consequence of direct vagus nerve stimulation, caused by elevated intracranial pressure, resulting in Ach release and hypersecretion of gastric acid

osteopetrosis

impaired osteoclast function persisetnece of primary spongiosa in medullary cavity fractures, deformities, hematologic cytopenias (obliteration of marrow space)

when does duodenal atresia occur

impaired recanalization of duodenal lumen due to failure of epithelial cell apoptosis during fetal life

autism

impaired social and verbal communication restricted interests stereotyped, repetitive behaviors (different from tics) --> rhythmic and regular, lack premonitory urge, stop with distraction, earlier age of onset

autism features

impaired social comm/interactinos restricted/repeititve intersts presentation by age 3

what does alcohol do to estr/testosterone

impairs hepatic degradation of estrogens ethanol's directly inhibits testosterone production

failure of proper descent of hindgut leads to

imperforate anus

when do you see low csf 5hydroxyindole acetic acid

impulsive, destructive, aggressive, suicide, violence

describe what measurement of nasal transepithlial potential difference does in CF

in intestinal and respiratory epithelia, cftr secretes chloride ions into lumen and has tonic inhibitory effect on opening of ENaC decreases Na reabsorption into the cell high luminal salt content helps retain water in the lumen, forming well hydrated mucus saline solution applied to nose -- CF have INCREASED Na absorption via EnAC, Na is absorbed intracellulary but chloride in saline solution is retained in lumen higher relatie amonts of negatively charged chloride on epi surface -> more negative transepithelial voltage difference

what is pyrogenic toxin

in strep pyyogenes responsible for scarlet fever and strep toxic shock syndrome only present in strains that have been lysogenized with a bacteriophage

dsm for adhd

inattentive or hyperactive/impulsive sx for >6 mo inattentive: lose focus, forgetful, misplaces things hyperactive: fidgety, hypertalkative, interrupts sx present before age 12 occurs in 2 settings, cause functional impairment subtype: predominantly inattentive, hyperactive/impulsive, combined

what would PV loop like like in a person with AV fisula

incerase cardiac preload by raising rate and volume of blood flow back to heart elongation of diastolic filling segment and higher end diastolic volume also b/c bypass arterioles --> TPR reducd, decreasing afteroload

what does mitral regurg look like on pressure catheterization tracing (wigger's diagram)

incompetent MV allows backflow of blood from LV during ventricular systole --> markedly elevated left atrial pressure creates early and large V wave this leads to atrial dilation and can precipitate A fib can get decomp HR over time

what is AE assoc with daptomycin

increasd CPK --> myopathy (Due to membrane disruption) monitor muscle pain/weakness

what does chronic AV shunt do to CO and VR

increase CO (increased sympathetic stimulation to heart, decreased TPR, increased VR) cause venous return curve to shift to right b/c circulating blood volume is increased thru renal retention of fluids and because venous pooling is reduced by increased symp tone

appropriate compensation for metabolic alkalosis

increase PaCo2 by 0.7 mmhg for eery 1meq/L rise in serum hco3

IV fluids do what to intravascular volume, LVEDV, end diastolic sarcomere length, SV and CO

increase intravasc and LVEDV this stretches end diastolic sarcomere length increased SV and CO

what can isolated mitral stenosis cause hemodynamically

increase left atrial diastolic pressure cause elevated PCWP pulm htn decreased PVR rv dilatation functional tricuspid regurg

what will allopurinol do to azathioprine levels

increase them allopurinol inhibits XO, which degrades azathioprine more azathiorpine can be converted to active metabolite 6-thioguanine --> incorported into cellular dna --> marrow suppression and decreased leukocyte production -- SO cna be used to amplify azathioprine's effect and reduce dose h/e if not watched carefully, can increase patient deaths and opportunistic infections

what would decreased chest wall compliance do to paco2 levels

increase work of breathing, get resp muscle fatigue, and alveolar hypoventilation --> increase in PaCO2 levels

what ar changes that occur during long term high altitude acclimatization

increased 2,3 dpg increased hgb production (hypoxia increases EPO production) increased pulmonary diffusing capacity vasc endothelial growth factor induced angiogenesis increase in cellular mitochondria counts hemoconcentration (due to hco3 diuresis and fluid shift)

what are AEs of erythropoeisis stimulating agents (erythropoietin, darbepoetin alpha)

increased HTN and thromboembolic events due to increased blood viscosity (as a result of elevation in red cell mass; and activation of epo receptors on vasc endothelial and smooth muscle cells)

what are advantages of conjugate vaccine

increased efficacy in elderly and children (<2 yrs) increased mucosal immunity reduces colonization (herd protection) increased immunogenic memory eg prevnar (pcv13) --> part of routine childhood vax, and also for immunocompromised pts and adults > 65 boosts immune response thru t cell recruitment

when you have idiopathic intracranial hypertension (pseudotumor cerebri) what happens to eyes

increased intraranial pressure transmitted thru CSF in subarachnoid space continueous with optic nerve sheat build up of pressure compresses optic nerves externally --> impairs axoplasmic flow with optic nerves, causing bilateral optic disc edema (papilledema) compared to normal funduscopy, patients with papilledema have elevation of optic disc with blurred disc margins

why is lipiduria common in nephrotic syndrome

increased lipoprotein synthesis by liver (b/c of albumin loss, synthetic function increass and increased glomerular capillary wall permeability --> lipid in urine in form of free fat and oval fat bodies (characteristic maltese cross appearance under polarized light)

what does na do for stone production

increased na leads to reduced na reabsorption in PT, lowers ca reabs --> hypercalciuria

what will renal disease scondary erythrocytosis look like

increased rbc mass increased epo (chronic renal disease --> ecreased epo)

cxr findings of pulmonary fibrosis

increased reticular interstitial markings

what are lab findings of 2 1hydroxylase deficiency

increased serum conc of 17 hydroprogeserone and androgens

appropriate compensation for acute resp acidsosis

increased serum hco3 by 1me/l for every 10 mmHg rise in paco2

causes of insufficient vitamin d leading to rickets

increased skin pigmentation limited sun inadequate intake exclusive breasfeding maternal vit d deficiency

valsalva maneuver X right atrial pressure

increases so could transiently cause right to left shunt

what does dirct factor xa do to ppt, pt, and tt

increases PTT an dPT no effect on TT

describe what happens when you consrict efferent arteriole

increases hydrostatic pressure in glomerular capillaries, increases GFR efferent arteriolar constriction continues to increase, GFR begins to decrease due to a flow-mediated rise in oncotic pressure in glomerular capillaries (as RPF decreases, slower capillary flow allows more time for filtration of plasma across flomerular membrane --> increased concentration of non filterable plasma proteins within glomerular capillaries --> elevating capillary oncotic pressure. so if RPF is low due to severe EA constriction --> substantially increased capillary oncotic pressure results in overall decrease in gfr)

what is cause of pulmonary hypertension due to LHF

increases pulmonary venous pressure and congenstion --> passive increase in pulmonary arterial pressure --> endothelial damage and capillary leakage of serum proteins into interstitium --> reactive vasoconstriction and structural remodeling of pulm vasculature (secondary to impaired NO availability and increased endothelin expression) --> increased vascular tone 1. increased diastolic filling pressure 2. increased LA pressure 3. pulmonary venous congestion 4. increased pulm arterial pressure 5. vasoconstriction 6. intimal thickening/fibrosis and medial hypertrophy (smooth muscle cell prolif; collagen deposition)

what does cck do

increases secretion of pancreatic enzymes and bicarb, gallbladder contraction, inhibiton of gastric emptying cck is produced by i cells of proximal small bowel mucosa, in response to FA and AA

moa of amantadine

indirect and direct dopaminergic agent enhances effects of endogenous dopamine some anticolinergic properties --> reduces tremors

what is moa of bleomycin and toxicity

induces free radical formation toxicity: pulmonary fibrosis

pheochromocytoma undiagnosed can be preciptated by what

induction of anesthsia can preciptate a catecholamine (EPI, NE) surge --> hypertensive crisis, flash pulm edema, a fib so those with germline RET mutations should be screened via urinary metaneprhine/catecholamine assay PRIOR TO SURGERY

chronic inflammation and scarring increases risk for

infective endocarditis (think: rheumatic heart fever, MVP, prosthetic valves, congenital heart disease) (also risk factors: conditions that promote bactermia/fungemia -> IVDA, dental)

where does spinal cord end

inferior border of l1 vertebra in adults l2/l3 in neonaes/infants

venous drainage for anterior abdominal wall and iliac crest

inferior epigastric --> external iliac (anterior abdominal wall) deep circumflex iliac --> external iliac (iliac crest)

what landmark will distinguish indirect from direct inguinal hernia

inferior epigastric vessels indirect: lateral to inferior epigastric (in internal inguinal ring) direct: medial to inferior epigastric (in hesselbach triangle)

what does aca supply

inferior frontal, medial frontal, superior medial parietal lobe, anterior 4/5 of corpus callosum, olfactory bulb and tract, anterior portions of basal ganglia and internal capsule

what does cn3 innervate

inferior, superior, medial rectus inferior oblique levator palpebrae muscles ptosis - paralysis of lebator palpebrae down and out (parasymp around cn3 can get damaged, which innervates iris sphincter and ciliary muscle --> fixed, dilated pupil, loss of accomodation)

what are 3 phases of wound healing

inflammatory: formation of fibrin clot, hemostasis, cytokines released by activated platelets and damaged cells --> migration of PMNs (24 hrs) and macrophages (2-3 days) to damaged area proliferative: 3-5 dys, fibroblasts and endothelial vascular cells proliferate to form, connective tissue and blood vessels (neovasc). epithelial cells proliferate at dermal edges and secrete basement membrane maturation: fibrosis (scar formation); 2nd week after injury. active fibroblasts synthesize collagen, elastin, other components of CT matrix

inguinal hernia vs femoral hernia

inguinal above inguinal ligament femoral below inguinal ligament

what is optimal site for femoral nerve block

inguinal crease at lateral border of feomral arery injecting at this site --> anesthetizes skin and muscles of anterior thigh, femur, knee also anesthetizes the saphenous nerve (terminal extension of femoral nerve) to decrease sensation in medial leg below the knee

AEs of NO

inhaled anesthetic that acts via NMDA receptor antagonism prolonged nitrous oxide exposure may lead to reduced methionine synthase --> megaloblastic anemia

flunisolide is

inhaled glucocorticoid used for proph tx of bronchial asthma inhaled gluco --> most prefered drugs for prophylactic tx of bronchial asthma potent, local, anti inflammatory effects

how does rifampin work

inhibit DNA dependent RNA polymerase, prevent txn and lead to deficiency of proteins need for mycobacterial survival

where do adrenergic neuron blocks like guanethidien work

inhibit NE release lower BP and HR do not cause bronchoconstriction

how do TCA and cocaine work

inhibit NE reputake by presynaptic neurons (cocaine can precipitate angina and MI by inducing vasospasm via this mechanism)

what is moa of trihexyphenidyl and benztropine

inhibit central muscariinci receptors (antichol) used to tx patients with drug-induced parkinsonism, tremor as predominant sx of diodopathic pd

why do nsaids help in tx acute gout

inhibit cox, decrease prostaglandin, exert broad anti-inflammatory effect that includes inhibition of PMNs (PMNs -->various cytokines and inflammatory mediators, continue inflammatory response, exacerbating gout)

MoA of montelukast and zafirlukast

inhibit cysLt1 are leukotriene d4 receptor antagonists (chronic asthma prophylaxis)

what does sulfonamide inhibit

inhibit dihydropterate synthetase when combined with TMP, have sequential blockade of bacterial folic acid pathway

what does exogenous glucocoritcoids do to HPA axis

inhibit entire HPA axis --> low levels of CRH, ACTH, and endogenous cortisol ACTH leads to potent trophic effect on adrenal zona fasiculata and reticularis long term suppression --> adrenocortical atrophy (zona glomerulosa is spared as AII is primary trophic hormone)

large increases in serum iodine lead to what effect

inhibit iodine organification (wolff-chaikoff) reduce thyroid hormone release

how do beta blockers work

inhibit neurotransmitter-receptor interaction in adrenergic synapses beta1 blockade: decreases HR beta 2 blockade: bronchoconstriction and wheezing

nsaids can trigger urticarida by

inhibition of COX1 --> metabolites shunted to form leukotriens --> increase vascular permeability

what does bcl2 do

inhibits apoptosis, promotes survival of tumor cells overexpression occurs in follicular lymphoma (translocation of bcl2 oncogene from chr 18 to Ig heavy chain on crh 14)

linezolid MoA

inhibits bacterial protein synthesis by bind to bacterial 23S rRNA of 50S subunit prevents formation of functional 70S intiation complex reqiured for bacterial protein translation

what does reserpine do

inhibits dopamine enetry into presynaptic vesicles reduces BP and HR

what is MoA of acetazolamide

inhibits enzyme carbonic anhydrase in PT block hco3 reabsorption in pt enhance hco3 and h20 excretion and increase urinary pH (and get metabolic acidosis)

what does alpha methyltyrosine do

inhibits enzyme that converts tyrosine --> DOPA (tyrosine hydroxylase) this inhibits production of catecholasmines used in pheochromocytoma

what is zileuton

inhibits leukotriene synthesis from AA via lipoxygenase pathway used as prophylactic therapy for asthma

what is moa of sofosbuvir and aes

inhibits nonstrutral protein 5B, rna depndent rna polymerase needed by hep c virus aes --> fatigue, nausea

MoA of terbinafine

inhibits synthesis of fungal membrane ergosterol by suppressing enzyme squalene epoxidase class of allylamines, used topically or PO

what is primary TB infection like

initial unchecked TB replication within alveolar space and alveolar macrophages after a few weeks, cd4 lymphocytes stimulated to release IFN-g --> activates macrophages and leads to infection control APC display mycobacterial Ag --> IL-12 --> CD4 to Th1 --> IFN-gamma --> activate macrophages to form fully acidified phagolysosomes, differentiate into epitheliod cells (surround extracelluar bacteria, digestive enzymes, reactive o2 species --> caseating necrosis)

describe apoptosis

initiation: triggered by intrinsic (mitochondria) mediated pathway or the extrinsic (receptor mediated) pathway. cell damage --> intrinsic; tnf to tnfr1 or fas ligand on cell surface receptor fas control: apoptotic signals tip balance for pro-apoptotic factors > anti-apoptotic factors. form mitochondrial permeability transition (MPT). release of cytochrome c and other pro-apoptotic proteins into cytoplasm (activate caspases) extrinsic apoptosis: binding of death ligand, death receptor allows for pro-caspase molecules to be brought into close proximity destruction: extrinsic and intrinsic pathways converge at this step; resulting in caspase activation. destroy cell components. cleave aspartic acid residues. initiator and effector caspases.

how do you perform pudendal nerve block

inject anesthetic intravaginally medial to ischial spine, thru sacrospinous ligament provides anesthesia to most of perineum

what can lead to knee flexion issues

injury to hamstring muscles (biceps, semitendinosus, semimembranosus), gracilis, gastroc, sartorius injury leads to decreased hip extension and knee flexion

what is scapula winging

injury to long thoracic nerve can occur during penetrating trauma or iatrogenically during axillary lymph node dissection, chest tube insertion paralysis of serratus anterior causes scapular winging (inability of serratus to hold scapua against thorax) weakness in abducting the arm above horizontal due to impaired rotation of scapula

what does achilles tendon do

inserts on posterior calcaneous acts in ankle flexion injured during sudden forces (sudden pivoting or rapid acceleration)

tx for DKA

insulin - allows cells to use glucose, decrease lipolysis and productioin of ketones --> increased serum bicarb; intracellular shift of K (decreases serum K) rehydration with NS: normalize serum Na conc, decrease serum osmolality

what do superAg do

interact with MHC class II and TCR outside of standard Ag binding sites --> initiate widespread and nonspecific activation of t cells they are synthesized by staphylococci, but are NOT bound to peptidoglycan cell wall

MoA of adenosine

interacts with A1 receptors on cardiac cells and activates K channels, increasing K conductance causes transient conduction delay thru AV node, used for acute termination of PSVT rapidly metabolized in blood and tissues, brief duration of action

blood flow in kidneys path

interlobular areries --> arcuate arteries --> radial arteries --> AA --> glomerular capillaries --> efferent arterioles --> peritubular capillaries --> interlobular veins

what is structural change of NPH

intermediate acting adding protamine and zinc to delay absorption from injection site still have significant peak --> increases risk of hypoglycemia

what are internal thoracic arteries

internal mammary arteries they are pretty resistant to atherosclerosis an dused in bypass grafting

what structures do you need to avoid when doing a pudendal nerve block

internal pudendal artery inferior gluteal artery both run medial to PN injecting these vessels can lead to hematoma or arrhthmia from intravasc infiltration of local anesthetics (lidocaine)

what is path of crytopogenic organizing pneumonia

interstila pneumonia acute onset, fever, weight loss intraluminal plugs of granulation tissue and inflammatory debris in distal airways

what does ARDs do to lung compliance

interstitial edema and hyaline membrane formation along with fluid-filled alveoli collapse and atelectasis result in decreased lung compliance and increased work of breathing

which gastric adenocarcinoma assoc with solid mass tht projects into stomach lumen and composed of glandular forming cuboidal or colmnar cells

intesinal time

what does abnormal midgut rotation lead to

intestinal malrotaiton fixed by fibrous adhesive bands, cause obstruction and painful bilious emesis in newbown

where do meningiomas commonly grow

intracranial arise in region of dural reflection (falx cerebri, tentorium cerebelli)

vipoma

intractable diarrhea, hypokalemia, achlorhydria (hypotensve due to dehydration and vasodilation of vip)

RAS protein

intrinsic GTPase activity allows them to hydrolyze GTP prevents accumulation of active Ras (GTP) in absence of hormonal isgnaling Ras mutations lead to decreased intrinsic GTPase --> const active RAS --> constant/unreg cell proliferation common in colorectal and pancreatic tumors

what is measured by PTT

intrinsic pathway!!! XII, XI, IX, X, VIII (and common)

what can be used to estimate GFR

inulin clearance it is neither secreted nor reabsorbed by renal tubules

what do you need to calculate net extrection rate

inulin clearance plasma concentration of substance tubular reabsorption of substance

how to calculate total filtration rate

inulin clearance X plasma concentration of substance

what artery occluded if thigh claudication

ipsilateral external iliac or common femoral arteries and/or both superfical femoral and frofunda femroris arteries aortoiliac atherosclerosis can dminished blood flow to internal pudendal br of internal iliac artery, making it difficult to sustain an erection

injury to cnvii

ipsilateral facial paralysis (upper and lower) loss of corneal reflex (efferent limb) loss of taste in anterior 2/3 of tongue hyperacusis (lack of innervation to stapedius)

most common cause of transtentorial herniation

ipsilateral mass lesion --> increase in supratentorial pressure on side of lesion, forces ipsilateral parahippocampal uncus thru tentorial incisure

criteria for bipolar i disorder

irritable mood, hyperactivity pressure speech, decreased sleep need, grandiose delusions only need 1 mnic episode for d can have psychotic features (delusions/hallucinations)

what does capsaicin do

irritant found in chili peppers causes excessive activation of TRPV1 (TM cation channel), causes buildup of intracellular Ca and subsequent depletion of substance P (polypeptide neurotransmiter involved in txn of pain signals) defunctionalized afferent pain fibers initially topical capsaicin causes burning, stinging and erthema; but persistent exposure leads to moderate reduction in pain over time

what is wallenberg syndrome

ischemic injury to dorsolateral medulla (pica supplies it) presnet with loss of pain/temp over ispilateral face and contralateral body (damage of spinal trigeminal and spinothalamic tracts) ipsilateral bulbar muscle weakness (nucleus ambiguus) vertigo (vestibular nuclei) ipsilateral limb ataxia (inferior cerebellar peduncle) horner syndrome (descending sympathetic fibers)

why would isoprotenerol or lidocaine not be as good as phentolamine for tx norepinephrine leak/extravasation

isoprotenerol= b2 agonist can mediate vasodilation in striated muscle, renal, mesenteric vascular beds, decreased PVR with increased CO subcut tissue blood vessels have low b2 receptor density compared to alpha 1 receptors --> alpha 1 blocker more effective lidocaine can relax vasc smooth muscle via Na blockade, but less effective in ischemic, acidotic tissues

where to ablate for a flutter

isthmus between IVC and tricuspid annulus

why not PTU as tx for exposure to radioactive iodide

it does decrease formation of thyroid hormone and inhibit iodine organification h/e potassium iodide is much faster, more efficient

how to help turner patient achieve pregnancy

ivf with ovum donor (60% success) also need estrogen/progesterone therapy to create thick endometrial lining (gnrh pulsatile can't work; patient needs to have intact ovary, and turner patients dont have this)

where is tubular fluid most concentrated in kidney if there is no ADH present

junction between descending and ascending limbs of loop of Henle

if CN III palsy, where do you suspect aneurysm to be located

junction of right posterior comunicating arterty and ICA

how to tx cocaine withdrawal

just supportive tx

what does visceral leishmaniasis do

kala-azar progressive splenic enlargement and weight loss over months

dx for down syndrome in utero

karyotype fetal cells in amniotic fluid (amniocentesis)

what is pathogenesis of acne

keratinization of hair follicle with formation of keratin plug that blocks release of sebum hypertrophy of sebaceious glands with excss sebum production colonization of glands with propionibacterium acnes bacterial hydrolysis of TG in sebum and release of inflammatory fatty acids

what does brain use for energy during starvation

ketones glucose

what does thiamine do

key coenzyme for pyruvate dehydrogenase involved in glucose metabolism deficiency --> brain cannot properly metabolize glucose

kidney is primary site of X of most drugs liver is primary site of X

kidney -elimination liver- biotransformation in prep for elimination

which pneumonia classically affects alcoholics

klebsiella colonization of oropharynx, followed by aspiration when sleeping

what happens if chronic thiamine deficincy

korsakoff psychosis anterograde and retrograde amnesia, apathy, lack of insight, confabulation

what consensus sequence plays major role in initation of eukartyotic trnalsaiton process

kozak

what do dihydropyridine's target

l type ca channels in vasc smooth cell --> trigger vasodilation peripheral vasodilation reduces afterload, lead to decrease in cardiac work and myocardial o2 demand, and coronary vasodilation increases myocardial o2 supply

when do you get onion like thickening of arteriolar walls

laminated smc and reduplicated bm malignant htn (>120 DBP) kidneys, retinas, intestinal arterioles most affcted

what are epicardial vessels in heart

large coronary arteries of heart (e.g. right coronary)

what does valve of infective endocarditis look like

large friable vegetations on valve cusps along with destruction (rather than fibrosis) of valve leaflets

path of tibial nerve

large medial branch of sciatic nerve descends thru popliteal fossa together with popliteal vein and artery traverses posterior compartment of leg deep to soleus muscle (innervates gastroc, soleus, plantaris, tibilias posterior, flexor digitorum longus and flexor halluces longus) nerve enters plantar aspect of foot thru tarsal tunnel (flexor retinaculum and medial surfaces of talus and calcaneus) divides into medial and lateral plantar nerves --> sensory innervation over sole of foot and motor innervation to intrinsic foot muscles

what happens when serum adh levels are high

large osmotic gradient rives abs of free water into hypertonic medullary interstitum as h2o leaves tubular fluid, urea concnetration increases adh increases # of passive urea transporters in nner medullary collecting duct --> substantial fraction of highly conc urea to diffuse into medullary interestitium urea resporption contributes to 50% of total osmolarity of medulla

describe path of femoral nerve

largest br of lumbar plexus, originates from l2-l4 lumbar nerves emerges between psoas and iliacus muslces, passes under inguinal ligament (lateral to femoral artery) into thigh before branching in the femoral triangle into anterior and posterior division

what does cnv3 supply

largest br of trigeminal nerve motor and sensory sensation of TMJ and mandibular teeth, floor of mouth, cheeks, anterior tongue, skin lower part of face motor: muscles of mastication, floor, tensor veli palantini, tensor tympani of ear

what is name of disease and common bugs that cause hoarseness, barking cough, stridor, resp distress in children

laryngotracheitis (croup) parainfluenza virus (paramyxoviruses)

when is lowest drug concentration (trough)

last 30 min before next dose

what is most common to be injured in ankle sprain

lateral ankle ligaments are weaker than medial ligaments anterior talofibular most common --> get pain, ecchymosis at anterolateral aspect of ankle if stronger force, can injure multiple ligaments --> sig joint instability and nerve injury and joint disolocaiton/fracture

what does mca supply

lateral convexity of frontal, parietal, temporal lobes deep subcortical structures, internal capsule and basal ganglia ischemic stroke - common here; contralateral motor/sensory deficits, involving upper and lower extremitis and face

sx of AICA stroke

lateral pontine syndrome ipsilateral loss of pain/temp in face (due to infarc of trigeminal nucleus) ipsilateral facial weakness (Facial nucleus) ipsilateral hearing loss (cochlear nucleus) contralateral loss of pain/temp in trunk and extremities (lateral spinothalamic tract) cerebellar dysfunction (ataxia, dysmetria)

what should you look for if patient has >2 y/o has intussception

lead point, meckel, foreign body intestinal tumor

celiac trunk branches

left gastric (further divides into esophageal and stomach branches) --> supply blood to abdominal esophagus and upper stomach common hepatic, splenic arteries (dorsal pancreatic, short gastric, gastro-omental, greater pancreatic arteries) --> spleen, pancreas, and gastric fundus

how to distinguish left vs right sided frontal lobe lesion

left: apathy and depression right: disinhibition

which bug should you suspect in patient with very high fever with relative brady, smoker, watery diarrhea, headache, confusion, cough, initially only slightly productive cxr evidence of pneumonia lab findings: hyponatremia no bacteria show up on gram stain sputum

legionella (legionnaires)

all arthropod dx

leishmaniasis: sandfly bite plasmodium/malaria: anopheles mosquito chagas: reduviid bug bite borrelia burgdorferi/lyme: ixodes tickk

when do you get contralateral homonymous hemianopia

lesion behind optic chiasm

what causes contralateral hemineglect

lesion in nondominant (right parietal hemisphere

sx and lab findings in viral meningitis

less severe than bacterial NO focal neuro, seizures, mental status alterations neg gram stain and sterile culture

what drug do you give to reverse mtx toxicity

leucovorin (folinic acid) reduced form of folic acid, does not require DHFR to be converted to THF --> unaffected by mtx leucovorin given as part of chemo to rescue bone marrow, GI, mucosa from mtx toxicity when used in combo with 5-FU leucovorin potentiates action of 5-FU (by binding thymidylate synthetase) and is included in colorectal cancer chemo

what happens when you administer leuprolide continuously

leuprolide = GnRH analog initially it will cause transient rise in LH and testosterone production on initial administration however it will eventually suppress pituitary LH release and lead to reduced production of testosterone by leydig cells 5-alpha-reductase converts testosterone to DHT, so as testosterone decreases, get decreased DH

what are analogous structures to theca interna cells of ovarian follicle

leydig both stimulated by lh leydig secretes testosterone

renal biopsy of goodpasture

light micro - glomerular crescent formation and IF --> linear deposition of IgG and c3 on GBM

what does an increase in pco2 from 25- 100 lead to reaarding cerebral blood flow

linear increase in cerebral blood flow

xanthelasma on histo

lipid laden macrophages (foam cells) foam cells in superficial dermis

what are AEs of protease inhibitors

lipodystrophy (buffalo hump, central obesity, peripheral wasting) hyperglycemia (insulin resistance; diabetes) inhibition of p450

daptomycin MoA

lipopeptide abx with activity against gram+ orgs tx skin and skin structure infections and bacteremia disrupts bacterial membrane by creating TM channels --> intracellular leakage resulting cellular membrane depolarization and macromelcular inhibition --> cell death cannot permeate outer membrane of gram neg so not effective inactivated by pulmonary surfactant (ineffective for pneumonia)

what cause of neonatal meningitis is not susceptible to 3rd generation cephalosporins (cefotaxime, ceftriaxone)

listeria altered penicillin binding proteins it is susceptible to ampicillin

what bugs are resistant to cephalosporine

listeria (resistant PBPs) MRSA (resistance PBP) enterococci (resistant PBPs) atypicals (mycoplasma, chlamydia) no cell wall

vaccine for rubella

live attenuated

what is organ that is not very susceptible to infarction

liver has dual and/or collateral blood supply if hepatic artery occluded, portal venous supply and retrograde arterial flow thru accessory vessels (inferior phrenic, adrenal, intercostal arteries) exception: transplanted liver; develop biliary tree infarction and organ failure b/c collateral blood supply during transplant

what is contained in an advance directive

living will: patient's end of life wishes, specific directives regarding intubation, resucistation, enteral feeding, life-prolonging interventions health care proxy: allows patient to designate specific indivudal to make health care decisions should pt become incapacitated

when do you see tubular protein

lmw protiens (beta 2 microglobulin, Ig light chains) filtered by glomerulus and reabsorbed in renal tubules damage to tublar cells --> tubular proteins in urine ischemic tubular damage may be seen in advanced DN

sx of legionella

lobar consolidation several days of GI sx (V/D) prior to pulm sx

what is a mycotic aneurysm

local destruction and dilation of an arterial wall due to infection

path of CNIII in brainstem

located in rostral midbrain at level of superior colliculus and red nucleus exits at interpeduncular fossa

what structure is located in posterior rostral pons near lateral floor of fourth ventricle

locus ceruleus (paired brainstem nucleus)

who are most prone to barrett esophagus

long standing, severe acid reflex

what innervates serratus anterior

long thracic nerve c5-c7 nerve roots via brachial plexus, follows lengthy course along lateral chest wall

what are structural changes to long acting insulin analogs glargine and detemir

longer, flatter action profile glargina -AA substitutions - less soluble at physio pH --> precipate and be slowly released into circ detemir - covalently bonded fatty acid, promotes self aggregation and reversible binding to albumin, slow sustained release

why are patients on thiazide diuretics more likely to develop hyponatremia vs those on loop diuretics

loop diuretics destroy corticomedullary gradient, can't maximally concentrate urine and so lose BOTH salt and water thiazides - still have corticomedullary gradient, so can retain free water in response to ADH --> able to retain free water over Na --> hyponatremia

what does acute tubular necrosis look like on histo

loss of columnar epithelium, denudation of basement membrane interstitial edema epithelial cell vacuolization

how to get binasal hemianopsia

loss of vision in nasal fields of both eyes compress lateral part of optic chiasm (e.g. calcified carotid arteries)

what would increase plasma renin activity

low Na intake antihypertensiv emeds like diuretics, ACE-I, ARB

why are pulmonary infarcts hemorrhagic rather than ischemic

low density of lung tissue - allows blood seepage into tissue during infarction and dual blood supply (pulm, bronchial arteries), pulmonary infarcts are typically hemorrhagic (red) rather than ischemic (white)

screening tests for cushing

low dose dex late night salivary cortisol levels 24 hr urinary cortisol excretion

labs in hemolytic anemia

low haptoglobin increased indirect bili increased LDH

when is oxygen curve shifted to right

low oxygen affinity gb decreased pH, increased temp, increased 2,3, DPG

what would you expect to happen to tsh, t3, reverse t3, and t4 levels if patient takes exogenous t3

low tsh --> exogenous t3 will rapidly suppress tsh low t4 --> suppression of tsh will lead to decreased t4 secretion low rt3 --> low rt3 because less t4 available for conversion high t3 --> this is exogenous

what is allergic bronchopulmonary aspergillosis

low virulence fungus generally does not cause significant infections except in immunocompromised or debilitated patients colonizes the bronchial mucosa pts with CF or asthma can develop allergic hypersensitivity rxn to fungus --> ABPA, occurs in 5-10% of corticosteroid-dependent asthmatics intense inflammation and mucous plugging with exacerbations and remissions repeated exacerbations --> transient pulmonary infiltrates and proximal bronchiectasis

where is costal margin

lower edge of thorax anterior ends of 7th-10th ostal cartilages

signs of aortic coarctation in child/young adult

lower extremity claudication bp discrepancy between upper and lower extremitis delayed/diminished femoral pulses

SMA oxygenates

lower part of duodenum to first 2/3rds of transverse colon

what are right sided pressures or heart like

lower than left sided pressures (lower resistance in pulm vasc) rvdp similar to ra, cvp (1-6) pulm artery diastoli slightly higher (6-12) due to resistance to flow in pulm circ

what are lower, medial, lateral border of indirect inguinal hernia

lower: inguinal medial: inferior epigastric lateral: n/a

what are lower medial and lateral borders of direct inguinal hernia

lower: inguinal ligament medial: rectus abdominus lateral: inferior epigastric

most common brain mets

lung, breast, skin, renal cancer look like well circumscried masses along greywhite junction histo: reactive gliosis and edema

dx causes by nocardia

lungs (cavitary lesions) brain abscess skin immunocompromised

what is contained in femoral ring

lymphatic vessels and lymph node

what are osteolytic metastases

lytic = lucent due to osteoblast stimulation tend to represent aggressive cancer MM non small cell lung cancer non hodgkin lymphoma RCC melanoma

what receptors are present on endothelial surface

m3 receptors promote synthesis of NO --> diffused into vasc smooth mucle cells --> guancyl cyclase and gmp --> myosin light chain phosphatase --> dephosphorylates myosin and prevents interaction of myosin head with actin (smooth muscle relaxation and vasodilation

what does RT-PCR detect (DNA, RNA, protein)?

mRNA similar to regular PCR, generates sequence-specific primers thermostable dna polymerase, pool of dna triposphates for amplication template generated thru reverse transcriptase on mRNA sample --> cDNA strand that can then be amplified by PCR cDNA is complementary to mRNA sequence, contains exons of gene along with 5' and 3' untranslated regions

what do pd1 inhibitors do

mab against pd1 prevent binding of pd1 to pdl1 --> blocks t cell inhibtion, restoring cytotoxic esponse and promoting apoptosis of tumor cells used in advanced melanoma and certain lung cancers

anemias due to dna defects

macrocytic anemias - folate, b12

what cells release the proteases/elastastes that lead to alveolar destruction in copd

macrophages and PMNs

how dos measles (rubeola) rash lok like

maculopapular rash, head that progresses to trunk and extremitis

how does rubella rash look like

maculopapular rash, starting on head, progressing to trunk/extremeitis occipital and postauricular lymph

what are examples of sleep hygiene therapies for insomnia

maintain regular sleep schedule, avoid naps avoid caffiene after lunch avoid alcohol, smoking, large meals near bedtie adjust bedroom enviro to be quiet, dark, cool exercise regularly but not soon before bedime

what does vitamin a do

maintains orderly differnetiation of specialized epithelia, including mucus-secreting colmnar epithelia of ocular conjunctiva, resp and urinary tracts, and pancreatic and other exocrine ducts

what is hemolytic uremic syndrome

major cause of acute renal failure in young children from o157:h7 or shigella dysenteriae (shiga toxin) --> injure epithelium of preglomerular arterioles and glomerular capillaries --> platelet activation and aggreg, formation of microthrombi platelet consumption --> thrombocytopenia (<150,000); no purpura or active bleeding microangiopathic hemolytic anemia (conjunctival pallor) acute kidney injury (olig/anuria, hematuria, increased Cr) -- antecedent diarrheal illness (often bloody) hemolytic anemia with schistocytes thrombocytopenia acute kidney injury

what are sx of congenital syphilis

malformed teeth - hutchinson's incisors and mulberry molars

what causes dimpling in breast cancer

malignant infiltration of suspensory ligaments --> fibrosis and shortening --> skin traction with disotrtion of breast countour

difference between factitious disorder vs malingering

malingering - intentional falsificaiton of sx for personal gain (financial benefits, time off from work), obvious personal incentive factitious - absence of obvious rewards, with goal to assume sick role (attention and protracted care). patients are aware of sx and conceal attempts to simulate or cause them, but lack conscious awareness of why they do it. respond with denial and reject care if confronted with falsification.

what area of brain most affected by thiamine deficiency

mamillary body will undergo necrosis (it is part of papez ciruit, neural pathway of limbic system involved in cortical control of emotion/memory)

if bilateral CNV3 injury

mandibular drop and lack of jaw movement

carbamazepine used mainly for what kind of bipolar features, and AEs

manic aplastic anemia, siadh, ntds

valproate used mainly for what kind of bipolar features, and AEs

manic hepatotox, NTDs

t(11;14)

mantle cell lymphoma cyclin d1 locus on chr 11 and Ig of chr 14 increased production of cyclin d1, promoter of g1 to s phase transition during cell cycle

how does phenelzine work

mao-inhibitor irreversibly binds and inhibits mao a and b takes up to 2 weeks to regenerate mao after discontinuation

characteristics of polycythemia vera

marked erytrocytosis modest increase in granulocytes and platelets low epo characteristic increased rbc mass

histo of bone marrow for aplastic anemia

marked hypocellularity elements replaced by fat cells and marrow stroma aspiration produces dry tap

dx of glucagonoma

markedly elevated glucagon levels

what innervates muscles of mastication

massester medial pterygoid temporalis ^close the jaw lateral pterygoid - opens the jaw CNV3

describe pathophys of acute bronchial constriction

mast cell activation secondary to allergen interaction with IgE Ab or non-immune triggers get release of chemical mediators that cause immeiate bronchial constriction, bronchial wall edema, and increased mucus production (early phase reaction) also recruit eos, baso, PMNs, t cells lead to late phase bronchial obstruction --> occurs several hrs after triggering event

what is contracture

matrix metalloproteinases (MMPs) function in degradation of collagen and other proteins in ECM MMP is important in wound healing (myofibroblast accumulation at wound edges and scar tissue remodeling) amassed myofibroblasts --> wound contraction during healing by 2nd intention contractures may occur when unusually pronouncned mmp activity results in excessive wound contraction most often on palms, soles, anterior thorax, serious burn sites

describe structre of hep b

mature virion (dane particle) contains hexagonal protein core covered w/ lipid bilyer envelope studdent w/ proteins and carbs hbv genome = partially ds circular dna molecule within capsid

pathogenesis of ascites in patients with cirhossis

mchanical compromise of portal vein flow by fibrotic tissue vasoactive agents play a role by causing dilation of splahnic arterial vasculature and further intrahepatic vasoconstriction increased portal vein hydrostatic pressure --> ascitic fluid formation and decreased systemic perfusion pressure kidney --> decreased perfusion pressure (renal vasoconstriction in hepatorenal syndrome) --> avid Na and H2O --> increases ascites

what are viral exanthems whose maculopapular rashes begin on ead and neck and spread downward

measles (rubeola) german measles (rubella)

what are key sx of MMR

measles: coryza, conjunctivitis, cough, maculopapular rash mumps: salivary gland swelling rubella: diffuse maculopapular rash

what is hypoxic vs other causes of secondary erythrocytosis

measure SaO2 SaO2 < 92% (PaO2 <65) --> secondary polycthemia --> hypxoic

how to dx chronic granulomatous disease

measure neutrophil superoxide production dhf (dihydrorhodamine) flow cytometry nbt (nitroblue tetrazolium) testing

name examples of true diverticulum

meckel's normal appendix

where does semimembranous muscle insert

medial condyle of tibia

what does vermis of cerebellum do

medial descending systems (anterior corticospinal, reticulospinal, vestibulospinal, tectospinal tracts) motor execurtion

what is transtentorial herniation

medial temporal lobe (uncus) herniates thru gap between crus cerebri and tentorium

where is putamen

medial to insula, lateral to globus pallidus

where is hypoglossal nucleus located

medially on floor of routh ventricle at level of medulla exits at rostral end of preolivary sulcus

what does lesion in vermis of cerebellar do

mediates axial/truncal posture lesions will result in truncal ataxia (wide based unsteady gait) vertigo nystagmus (due to dirsuption of inferior vermis and flocculonodular lobe - vestibulocerebellum)

what does anterior hypothalamic nuclei do

mediates heat dissipaiton (coordinates cooling via inhibition of adrenergic input --> vasodilation and results in sweating) destruction --> hyperthermia

when do you see cystic dilaiton of CD

medullary sponge kidney medullary cysts (cuboidal or urothelial epi) seen

what brain tumor in cerebellumif sheets of primitive cells with many mitotic figures

medulloblastoma undifferentiated and aggressive 2nd most common brain neoplasm in children

TMP/SMX toxicity

megaloblastic anemia, SJS, TEN

what are inheritance patterns of down syndrome

meiotic nondisfunction (95%): extra chr 21 present in every cell, RR based on maternal age unbalanced translocation: all or part of additional chr 21 attached to another chr (high RR if balanced translation is present in one parents) mosaicism: some (not all) cells have extra copy of chr 21, nondisjunction even in early life, during mitosis (RR similar to normal population)

when do you see uniform, diffuse thickening of glmoerular cappilary walls on light micro

membranous glomerulopathy clinical manifestaitons include generalized edema, marked proteinuria, hypoalbuminemia, hyperlipid, lipiduria

men 1 sx and defect

men 1 gene mutation (tumor suppressor protein) pituitary adenomas primary hyperparathyroidism pancreatic endocrine tumors

marfanoid, mucosal neuromsas, medullary thyroid cancer, pheo, intestinal ganglioneuromas (constipation)

men 2b

rugal hypertrophy with parietal cell atrophy and decreased acidsecretion seen in

menetrier disease

joint line tenderness while knee is flex

meniscal injury

where do interstitial fibroblasts come from

mesoderm

what do capillary endothelial cells and cardiac myocytes come from embryo

mesoderm primitiv endothelium

what enzyme is needed to penetrate basement membrane

metalloproteinases zinc containing enzyes, degrade components of ECM and BM (composed of laminin and collagens iv and vii)

corpus predominant h pylori disease is associated with

metaplasia and malignancies (unlike antral predom disease)

what is hypercalcemia assoc with regarding claficiaton

metastatic clacification ca deposition occurs in more alkaline tissues --> acid excretion, like kidneys, lungs, systemic arteries, gastric mucosa

drugs that are alpha 2 agonists

metyhldopa clonidine decrease symp outflow and decrease BP

when to suspect beta thalessemia minor

microcytic anemia increased Hg a2 concentration peripheral blood smear: hypochromia and poikilocytes (spherocytes and target stells) mediterranean adult

what is histopath of hiv associated dementia

microglial nodules, groups of activated macrophages/microglial cells formed around small areas of necrosis, may fuse to form multinucleated giant cells

classic triad of hemochromatosis when Fe > 20g

micronodular cirrhosis diabetes mellitus skin pigmentation (bronze diabetes) increased risk of HCC, CHF, testicular atrophy/hypogonadism

what does aortic stenosis sound like

mid systolic ejection murmur heard best over right 2nd intercostal space with radiation to neck

what is parinaud syndrome

midbrain strokes at level of superior colliculus upward gaze palsy, absent pupilary light reflex, impaired onvergence

what supplies dominant parietal lobe

middle cerebral artery

what is a psuedoallergic drug rxn

mimics immunologic rxn occurs via non-immuno mechanism (direct immune cell activation, inhibited prostaglandin synthesis) e.g. rhinitis with NSAIDs, anaphylaxis to radiocontrast media, prurtisi with opiates

what diuretic would improve survival in patient with HF

mineralocorticoid receptors (spironolactone, eplerenone) prevent aldo from binding to its receptor in distal renal tubules --> increased Na and H2O excretion also block deleterious effects of aldo on heart, causing regression of myocardial fibrosis and improvement in ventricular remodeling

opioid kappa receptor binding effects

miosis dysphoria sedation analgesia (PNS, some opioids)

opioid overdose sx

miosis respiratory and cns depression

what gene is missing in turner's resulting in short stature

missing SHOX gene --> normally produces long bone growth patients have short stature

blastomycosis geographic area

mississippi ohio more western/central

what is most common cause predisposing someone to subacute infective endocarditis IF FROM THE US

mitral valve prolapse, esp if assoc with coexistant mitral regurg (also valvular sclerosis, mech valves

what are sx of classic, non salt wasting 21 hydroxylase deficiency

moderate deficiency girls: birth have ambiguous genitalia boys: present at 2-4 years with sx of early virilization

what does AML come from

monocytic precursors if subtypes m4 and m5 m6: erythroid precursors (elderly) m7: primary megakaryotces; t(1;22); down in children

how to differentiate bipolar disoder w/ psychotic features from psychotic disorder

mood sx and temporal relationship between mood sx and psychosis psychotic disorders, mood sx not prominent feature severe manic sx and delusions occur exclusively during manic episodes --> bipolar w/ psychotic features, not psychosis

what does cmv infection do during pregnancy

moom: mono like illness with fever and mild hepatitis highest risk of txn to fetus in 1st trimester in utero exposure, babies get: chorioretinitis, sensorineural deafness seizures, jaundice, hepaotmegaly, splenomegaly, microcephaly

where do indirect inguinal hernia tend to appear: left vs right, how do they happen

more common than direct right side occur due to failure of processus vaginalis to obliterate; allow adominal contents to protrude thru deep inguinal ring palpate deeply external ring with tip of finger

when to use ct myelogram

more invasive than mri reserved for patients who cannot undergo mri (pacemaker, metallic implants)

what are sx and genetics of gaucher dx

most common genetic disorder among ashkenazi jews AR b glucocerebrosidase deficiency glucocerebroside accumulation HSM, pancytopenia, severe bone pain

ciprofloxacin good for

most gram neg rods and bacilli (legionella, pseudomonas) not effective against anaerobic infections

what should you suspect if young women with persistent high grade hpv

most immunocmptent women, young, can combat hpv. 50% will experience spontaneous regression, only 5% will develop invasive cancer. immunosuppressed indivduals (HIV) unable to mount immune response due t cell deficiency. have persistent hpv infection, dna becomes incorportaed into epithelial cells. hiv coninfection can enhance expression of hpv viral oncogenes e6 and e7 --> cervical dysplasia/cancer

where is IVC seen on CXR

most inferior edge of right border of cardiac silhouette

when is adh secreted

mostly responds to plasma osmolality but also if ecv is depeted

polio affects that neurons

motor neurons of anterior horns purely LMN sx: flaccid paralysis, atrophy, areflexia, fasciulation

what does obturator nerve innervate

motor, sensory innervation to medial thigh injury during retroperitoneal pelvic lymph node dissection - loss of medial thigh sensation, ability to adduct thigh

what does lateral hemisphere of cerebellum do

motor/premotor cortices motor planning

what are sx and genetics of hurler syndrome

mucopolysaccharidiosis dysostosis multiplex (enlarged skull, abnormally shaped ribs and vertebrae) corneal clouding, blindness accumulation of heparan sulfate and dermatan sulfate due to alpha-L-iduronidase deficiency

diabetics - what fungal reaction

mucormycosis why DM? ketone reducase activity of rhizopus, allows it to survive in acidotic, hyperglycemic enviro. possibly to the releae of Fe from binding proteins during ketoacidosis

what does transitional cell carcinoma of bladder look like on cytoscopy

multifocal sessile or papillary tumors malignant epi cells - pleomorphic, hyperchromatic nuclei, increasd N/C ratio, disrupted orientatigon and polarity

what are MEN type 2 characteristics

multiple endocrine neoplasia type 2 AD germ line activating mutations of RET proto-onc 2a: medullary thyroid cancer, pheo, parathyroid hyperplasia 2b: medullary thyroid cancer, pheo, mucosal neuromas, marfanoid habitus

what do you suspect if patient has following features: 1. fatigability 2. constipation 2. bone pain, back and ribs commonly 4. elevated serum protein 5. renal failure

multiple myeloma 1. fatigability (anemia) 2. constipation (hypercalcemia) 2. bone pain, back and ribs commonly (bone lysis due to production of osteoclast-activating factor by meyloma cells) 4. elevated serum protein (monoclonal proteins) 5. renal failure

what neurotransmitter stimulates contraction of detrusor muscle

muscarinic cholinergic

what drug to tx bladder-emptying in patients with post-srug urinary retention

muscharinic cholinergic agnoist like bethanechol or a1 blocking drug

what is dantrolene

muscle relxant effective in malignant hyperthermia acts on ryanodine receptors on SR and prevents release of Ca into cytoplasm of muscle fibers

in order for an rna molecule purified from a virus (without capsid or envelope) to be infectious on its own, what does it need to be

must act as mrna that is capable of using host's intracellular machinery for translation +ssRNA (-ssRNA and dsRNA are NOT as they require additional enzymes)

what causes abx resistance for quinolones

mutated dna gyrase impaired influx/increased efflux

abx resistance in vanc

mutated peptidoglycal cell wall impaired influex/increased efflux

what causes abx reistance for rifamycins (rifampin)

mutated rna polyemerase

genetic sx of als

mutation of gene that codes for Cu-Zn superoxide dismutase (SOD1)

resistance for streptomycin

mutations in genes that encode ribosomal proteins --> lead to modifications in ribosomal bindings sites for these drugs also aminoglycoside modifying enzymes (transferases) mutated porins

what pneumonia should you suspect in patient: young adult, tracheobronchitis, pneumonia, mild fever, mild transient anemia, non productive cough cxr: bilateral diffuse infiltrates, looks more severe than sx gram stain: nothing

mycoplasma nothing on gram stain of sputum, organisms do not have peptidoglycan cell wall

CN 3 palsy leads to

mydriasis (parasymp damage) with diplopia ptosis down and out deviation of ipsilateral eye (Due to somatic efferent fiber injury)

how to get cn3 palsy

mydriasis, complete ptosis, down and out deviation of eye occur with nerve compression due to posterior communicating artery aneurysm or uncal herniation microvasc nerve ischemia ipsilateral lesion at level of anterior midbrain or midbrain tegmentum

where doyou see jak2 mutations

myeloproliferative (polycythemia, essential thrombocythemia)

what does strong inotropic effect of dobutamine do

myocardial o2 consumption increases --> this can trigger or exacerbate myocardial ischemia don't use in pts with decomp HF (but in pts with cardiogenic shock; benefits > risks)

what happens when sample size increases

n increases SE decreases CI becomes narrows and becomes more precise

other sx of salicylate intoxication

n/v, confusion, dizziness, tinnitus (buzzing sound), fever, tachypnea

AEs of succinylcholine

nAChR nonselective cation channel; opening not only allows Na influx but K release --> exaggerated hyperkalemia and life threatinign arrythmias in pts with crush, burn, denervating injuries/diseases, and myopathies --> these patients have upreg of muscle nAChR's and/or rhabdo --> large amount of K when succinylcholine is administered -- malignant hyperthermia (esp w/ halothane) in genetically susceptible patients bradycardia from parasymp stimulation or tachy from sympathetic effects

what can convert adp to atp

nadh

one potential way nmda leads to alzheimers

nbmda receptor overstimulation by glutamate may contribute to AD sx

sx of glucagonoma

necrolytic migratory erythema erythematous papules/plaques on face, perineum and extremities lesions enlarge and coalesce - central indurate area with peripheral blistering and scaling (brown, bronze) DM/hyperglycemia GI sx (diarrhea, anorxia, abomindal pain)

2 primary modes of cell death

necrosis apoptosis

what is typical cutaneous anthrax lesion

necrotic skin wound w/ erythematous and edematous border and a necrotic center after inoculation of spores of bacillus anthracis into skin

path of churg strauss (eosinophilc granulmoatosis with polyangiitis)

necrotizing vasculitis with granulomatous inflammation and eosinophilic infiltration of vessels and perivasc tissues

what does cholesterol look like on histo

needle shaped clefts that partially or completely obstructe arteries

lepromin skin test in patient with lepromatous leprsoy

negative, weak th1 cell mediated immune response extensive accumulation of acid-fast bacilli within marophages and often a th2 cytokine profile (il-4, il-5, il-10) more numerous, poorly demarcated plaques, widespread across body over time, bacterial load increases and nodular lesions coalesce -- development of leonine facies, degeneration and loss of nose/digits

what bugs have hypervariable pili

neisseria (both)

when does hirschsprung disease manifest

neonate neural crest cells migrate in craniocaudal direction to internal anal sphincter myenteric plexues does not form, aganglionic isgmoid colon/rectum segments become inactive and narrow intestinal obstruction and delayed passage of meconium, bilious vomiting, abdominal distension

what are sx of goodpasture syndrome

nephritic syndrome - htn, edema, acute renal failure, hematuria (dysmorphic red cells and casts), proteinuria alveolar hemorrhage - sob, hemoptysis, cxr infiltrates, hb in alveoli - increased alveolar o2 absorption and high DLCO

foscarnet toxicity

nephrotox electrolyte disturbances (hypocalcemia, hypoMg, hypokalemia)

when do you get oculomotor nerve plasies

nerve compression (PCA aneurysm) or microvasc nerve ischemia

biopsy findings of medullary thyroid cancer

nests, sheets of polygonal or spindle shaped cells with extracellular amyloid deposits (derived from calcitonin) neuroendocrine tumor, airses from calcitonin secretin parafollicular c cells sx: diarrhea, flushing, thyroid nodules, normal tsh and t4

how to calculate net renal excretion rate

net excretion rate = (inulin clearance)(Plasma concentration of Substance A) - (Tubular reabsorption of Substance A) this is total filtration - total reabsorption

describe renal excretion/secretion of glucose, Na, urea

net tubular reabsorption excreted amount < filtered amount

describe renal excretion/secretion of pah and creatinine

net tubular secretion excreted amount > filtered amount

what stains s100 positive

neural crest cell origin tumors schwannomas or melanomas

what can be consequence of metabolic derangements like DKA or hyperosmolar hyperglycmeia

neuro dysfunction --> altered mental status, focal neuro deficit, seizure

complications of lead poisoning in children

neuro: loss of milestones, cog impairment; behavioral problems; encephalopathy gi: constipation, abdominal pain, decreased vit d metabolism renal: interstitial nephritis heme: anemia

what is rett syndrome

neurodev disorder in girls normal developmet until 5-18 mo loss of motor and language skills steroetypic hand movments deceleration of head growth (early sign) seizures, intellectual disabilty, autistic, breathing abnormalities due to de novo mutations in x linked MECP2 gene

embryo of cerebellum, pineal gland, and retina

neuroectoderm

sx of nf1

neurofibromas (plexiform, slitary) optic gliomas pigmented nodules of iris (lisch) cutaneous hyperpigmented macules (cafe au lait)

aes of lithium

neuromusc excitability nephrogenic di hypothyroidism cardiac conduction defects

isoniazid sideeffets

neurotox (give b6), hepatotox

what is injured in clavicular fracture

neurovasc compromise, suclavian vessels and supraclavicular nerve

what is diruptive mood dysregulation disorder

new dx in dsm5 persistent irritability, frequent/developmentally inappropriate temper outbursts

interventricular septum rupture/defect: time course and distinctive features

new holosystolic murmur stepped up O2 level between RA and RV

what should you give elderly person with urticaria

newer gen antihistamines - loratidine, certirizine do not have same degree of antimusc, antiserotongergic, anti-alpha minimal side effects less lipophilc, do not cross BBB, nonsedating

when do you see bilateral acoustic neuromas

nf2

what cancer has dna mismatch repair gene mutations

nhpcc (lynch syndrome)

what does toxin of c diff do

niduces actin polymeraization, leading to mucosal cell death, necrosis of colonic mucosal surfaces, pseudomembrane formation

what is lysosomal storage disease with sphingomyelinase deficiency.

niemann pick disease

what does nifedipine and terbutaline do

nifedipine: CCB and results in myometrial relaxation by inhibiton of myosin light chain kinase mediated phosphorylation terbutaline: B sympathomimetic, inceases intracellular cAMP formation in myometrial cells; inhibits MLCK and relaxes smooth muscle

if lactiferos sinuses involved in malignant spread of ductal carcinoma, what PE changes

nipple disrchage superficial nipple changes

which antianginal drugs have venodilation/decreased preload effect

nitrates

what drugs are metabolized to nitric oxide and s nitrosothiols

nitrates (nitroglycerin, isorbide mononitrate, isosorbide dintrate) metabolized via mitocondrial aldehyde dehydrogenase within vasc smooth muscle cells

do selective b1 blockers, digoxin, affect qrs duration

no

can zolpidem be used to tx anxiety-induced insomnia

no should use bzd

which areas of ecg remain the same when taking beta blockers

no effects on QRS or QR interval durations

sx of lactate dehydrogenase deficiency

no nad+ regeneration high intensity physical activity --> muscle breakdown, pain, fatigue

what will happen to 46 xy with no sertoli cells

no sertoli cells, no amh, so no regression of mullerian system mullerian ducts will develop into internal female reproductive organs (fallopian, uterus, cervix, upper vagina) will also have male internal genitalia, b/c leydig cells are intact and will secrete testosterone, which will allow internal male repro to develop (epididymides, vas deferens, ejac duct, seminal vesicles) will have male external genitialia b/c testos --> DHT

describe renal excretion/secretion of inulin and mannitol

no tubular reabsorption or secertion filtered amount = excreted amount = GFR

PTH-rP is associated with what kind of lung cancer

non small cell lung cancer (NSCLC)

AE of atracurinium

nondepol NM blocking agent releases histamine and can produce fall in BP, flushing, bronchoconstriction also metabolized to laudanosine --> seizures

AEs of vecuronium

nondepolarizing NM blocker competitively competes with Ach at nicotinic end plate receptor may prolong paralysis

which antianginal drugs have primary effect by coronary vasodilation

nondihydropyridines dihydropyridines nitrates

what are sx of neuroblastoma

nonrhythmic conjugate eye movments jerking movements of trunk and limbs (opsoclonus-myoclonus syndrome --> paraneoplastic, autoAb response to CNS ag) most common extracranial solid neoplasm of childhood arises from neural crest of adrenal medulla/syp ganglia present at age <2 with firm abdominal mass (adrenal gland) and const sx (weight loss, fatigue) bone marrow infiltration --> anemia, pancytopenia, orbital mets --> proptosis and/or periorbital ecchymoses spinal cord compression from spinal cord compression (epidural invasion; dumbell tumor)

sofosbuvir moa

nonstructural protein 5B (NS5B), rna dependent rna polymerase needed for hep c virus replication requires intracellular activation

what are janeway lesions and how do they form

nontender, macular, erythematous, palms, soles septic embolization from valvular vegetations, composed of bacteria, PMNs, necrotic material, subcut hemorrhage

nondominant temporal lobe lesion (right sided)

nonverbal memory, musical ability

can physicians say whether someone is their patient to a stranger/friend

nope nope unless person is directly involved in patient's care

what neurotransmitter is made in the locus ceruleus

norepinephrine it is located in dorsal pons

what do the bowel of patients with primary lactase deficiency look like on histo

normal

what would PCWP be in ARDS

normal (6-12 mmHg) (this helps distinguish noncardiogenic pulm edema from ARDS/high altitude from cardiogenic edema)

describe lab findings in patient with factor VII deficiency

normal bleeding time normal PTT prolonged PT

describe lab findings in patient with factor VIII deficinecy

normal bleeding time prolonged PTT normal PT

what does esophageal manometry show for achalasia

normal contraction of upper esophageal sphincter, decreased amplitude of peristalsis in mid esophagus, INCREASED TONE and incomplete relaxation at LES

how does patent foramen ovale form

normally septum primum moves against septum scndum, closing foramen ovale over time: fibrosis and tissue remodeling fuse the flap closed --> incomplete fusion occurs in approx 25% of normal adults (resulting in a PFO)

tx for graves opthalmopathy

not mediated by thyroid hormone or adrenergic stimulation do not respond to beta blockers immune mediated respond to glucocorticoid therapy

what does hyperventilation do to po2 or arterial oxygen content

nothing, may slightly increase it

how are pyrimidine dimers removed

nucleotide excision repair specific endonuclease complex detects abnormalities in the DNA structure caused by formation of DNA photoproducts endonuclease complex nicks the damaged strand on both sides of pyrimidine dimer, defective region excised DNA polymerase synthesized new DNA in place of damaged DNA DNA ligase seals final remaining nick

pressure tracing of aortic stenosis

obstruction of LV outflow resulting in discordance of LV and aortic systolic pressure peak LV systolic pressure significantly higher than aortic systolic pressure

where are MLF lesions common

occur with lacunar stroke in pontine artery distribution bilateral lesions in MS

how to tx acylovir nephrotoxicity

occurs 5-10% of patients who receive acyclovir IV excreted in urine via gfr and tubular secretion crystallization, crystalluria, renal tubular damage can occur can be prevented/tx with adequate hydration and reduction in rate of drug infusion

what are sx of costrosternal syndrome (costocondritis, anterior chest wall syndrome)

occurs after reptitive activity, involves upper costal cartialge and costocondral or costosternal junctions reproduced with palpation worsened with movmeent or changes in position do not have palpable warmth, swelling, or erythema

what is lumbosacral plexopathy

occurs during fetal descent as result of direct compression of lumbosacral trunk present with foot drop, numbness of lateral aspect of leg and dorsum of foot transient condition, sx resolve within a year

what does intussecption look like

occurs in children <2 y/o ileocecal valve intermittent, severe, colicky abdominal pain currant jelly stools palpable mass in RLQ invagination of portion of intestine into lumen of adjacent intestinal segment --> impaired venous return from invaginated segment of the bowel --> ischemia and necrosis of wall sometimes assoc with viral infection

definition of menopause

occurs on average at age 51 diagnosable retrospectively after 12 months of amenorrhea ovarian failure before age 35 --> premature absence of menstrual cycles: hypoestrogenic sx: hot flashes, vag dryness usually dx clinically but serum elevated serum FSH confirms dx OCs may mask vasomotor sx of menopausal transition

when do you get free wall rupture post MI

occurs within 5-14 days after large anterior TM MI (LAD occlusion) infected myocardium is substantially weakned by coag necrosis, neutrophilic and macrophage infiltration and lysis of myocardial connective tissue rupture of LV --> hemopericardium and cardiac tamponade get sudden onset of chest pain and profound hypotension and shock rapid progression to pulseless electrical activity and death

how do ocps treat hirsuitism in pcos

ocps suppress lh secretion from pituitary --> decrease ovarian androgen production also increase sex hormone binding globulin synthesis by liver --> decrease free testtoerone levels

histoplasmosis geographic area

ohio mississippi more midwest

what % do atheroslcerotic plaques become sx enough to cause angina

only when they obstruct 75% or more of luminal cross sectional area if below this, usually don't cause sx of angina...

examples of temperature gated ion channels

open in response to heat, responsible for human sensation of external temp

what has high maternal alpha fetoprotein

open ntds (anencephaly, ventral wall defects, multiple gestation)

what is the adductor hiatus

opening in aponeurosis of adductor magnus at distal 1/3 of femor, allows passage of femoral vessels into popliteral fossa

what are lab findings in neural tube defects

opening persists between neural tube and aminotic cavity leakage of alpha fetoprotein and AchE into amniotic fluid AFP can cross placenta and also be detected in maternal serum these are prenatal screenings of NTDs

what does dynorphin do

opioid peptide modulates pain produced in periaqueductal gray, rostral ventral medulla, and dorsal horn of spinal cord

what is penicillium marneffei

opportunistic infection in immunocompromised, like AIDS (SE Asia)

main manifestations of candida in immunocompetent people

oral thrust vulvovaginal candidiasis cutaneous candidiasis

tx for cryptorchidism

orchiopexy before age 1 (between 6 mo-1 yr)

what is atropine usd for

organosphophate/cholinergic poisoing

what non-bone marrow transplants can cause graft versus host disease

organs rich in lymphocytes (liver) or transfusion of non irradiated blood

what is most common cause of lung abscess

oropharyngeal aspiraition forms a cavitary lesion with air-fluid level indolent, fever, night sweats, weight loss, cough foul smellling sputum (anaerobes)

morphology of influenza a

orthomyxovirus -ssRNA RNA depndent RNA polymerase must gain entry into host cell

on xray see avulsion site of tibial tubercle, what disease

osgood schlatter disease

what substances have no concentration change along PT

osmolality of tubular fluid Na K Na and K are reabsorbed in concentrations approx equal with water in PT

where do thyroid follicular cells come from embryologically

outpouching of endothelial lining of pharyngeal epithelium

ways to get lithium toxicity

overdose, volume depletion (decreased GFR), drug interactions (thiazide, nsaids, ace-i, tetracyclines, metronidazole)

what is osgood schlatter disease

overuse injury of the secondary ossification center (apophysis) of tibial tubercle common cause of knee pain in young adolescent athletes after growth spurt presents as pain and swelling at tibial tubercle, where patellar ligament inserts repetitive quads contraction (jumping) and chronic evlusion cause proximal patellartendon to separate from tibial tubercle during healing --> callous formation causing tubercle to become elevated and promienent

what is major maladaptive complication of dilated cardiomyopathy

overwhelming wall stress --> LV enlargement and contractile dysfunction decreased ventricular contractility decreased CO --> decompensated HF also increases risk of ventricular arrhtymia (sudden cardiac death)

antagonists of m3 receptors - examples

oxybutinin used for urge incontinence decrease production of ip3 and release of CA --> smooth muscle relaxation titrate carefully, don't want super anticholienrgic effect

what are mutations associated with aflatoxin hcc

p53 identified in most indivduals who develped hcc >90% are G:c --> T:A transversion in codon 249 research suggests that combo of chronic aflatoxin exposure and hep b increases the risk of developing HCC

what is retinal ischemia associated with

painless transient monocular vision loss (amarusis fugax) is most commonly causd by atherosclerotic emboli originating from ipsilateal carotid artery embolic plaques and retinal whitening (due to ischemia) affects older pts with vascular risk factors (eg htn, dm)

what is medullary thyroid cancer

palpable nodule and elevated serum calcitonin neuroendocrine tumor, calcitonin secreting c cells nests or sheets of polygonal/spindle shaped cells amyloid deposition extracellular (consisting of full length calcitonin) elevated calcitonin can lead to diarrhea, flushing, but usually Ca is normal (due to down reg of calcitonin receptors)

what vitamins are deficient in CF

pancreatic insufcieincy and fat malabsorption --> decrase ADEK

what cancers have ras overexpression

pancreatic, gallbladder, colon, endometrial, thyroid, lung

what is definition of aplastic anemia

pancytopenia (anemia, thrombocytopenia, neutropenia, reticulocytopenia, morph normal cell lines) without splenomealy

how to dx schistosoma

parasite eggs in stool (stercolais eggs are NOT found in stool)

what can nitroprusside turn into

parenteral vasodilator quick onset/offset mechanics rapid bp control in pts with hypertensive emergency metabolized in body to release NO and cyanide ions

is remodeling in PH due to left heart disease reversible?

partially, follwoing correction of underlying abnormality

what does left atrial pressure/filling look like normally on pressure tracing

passive filling of LA with blood from pulmonary veins occurs in sync with LV systole LAP gradually increases to approx 10 mmHg in normal heart with characteristic V wave created at end of passive filling

what is the strongest single risk factor predictive for suicide

past history of attempted suicide (patients with previous attempts are 5- times more likely to make another attempt)

how do you do lumbar puncture

patient in rebumcent (preferred for accurate opening pressure measurement) or sitting position l3/4 or l4/5 space (well below spinal cord termination site) l4 vertebral body lies on a line drawn between highest points of iliac crests (confirm via palpation)

what is path of gvhd in terms of immune cells involved

patients are severely immunodeficient immunocompetent donor t cells from graft to survivve and migrate into host tissues, recognize host mhc antigens as foreign and become sensitized donor cd4 and cd8 cells then destroy host cells

sx of pneumocystis pneumonia

patients w/ hiv cd4<200 weeks/days of slowly worsening dyspnea and fever affects both lungs and appears as bilateral reticulondular pulm infiltrates on cxr

what is on t cell -- pd1 or pdl1

pd1

what growth factors control fibroblast migration and proliferation

pdgf tgf-b - critical for stimulating CT synthesis and remodeling of EC matrix. tgf b --> decreases during maturation of wound healing to limit amount of collagenous scar tissue. hyperttrophic/disfuring scars can be caused by persistently elevted tgf-b --> increases fibroblast prolif and activity fibroblasts in hypertrophic scars have altered tgf-b signaling (due to increased tgf-b receptor expression)

how to tx group b strep

penicillin ampicillin 3rd gen cephalosporins

tx for scarlet fever

penicillin V

what is m3 receptor found and what does it do

peripheral vasc --> smooth muscle relaxation, vasodilation, hypotension (inhibited: smooth muscle contraction, vasconstriction, htn) lung --> bronchoconstriction (inhibited: bronchodilation) bladder --> detrusor contraction (inhibited: detrusor relaxation, urinary retention) eyes --> pupillary sphincter muscle contraction (miosis), cilary muscle contraction (accomodation) (inhibited: mydriasis, cycloplegia, acute angle glaucoma in elderly) gi --> increased peristalsis, salivary, gastric secretions (inhibited: constipation, dry mouth, decreased acid) skin --> increased sweat (inhibited: increased temp from decreased sweating)

what does meckel diverticlum look like on imaging with radioisotope Tc pertechnetate

pertechnetate has affinity for parietal cells of gastric mucosa, including atopic sites increased uptake in periumbilical/RLQ is characteristic

how are particles that lodge distal to terminal bronchioles get cleared

phagocytosis by alveolar macrophages (destroy by lysosomal degradation or transport to pulm lymphatics or terminal bronchioles for clearance by mucociliary system)

what drug causes gingival hyperplasia

phenytoin 50% of patients who have had 3-4 mo of pheny tx b/c of increased expression of PDG gingival macro are exposed to increased amounts of pdgf --> stimulate proliferation of gingival cells and alveolar bone

what is MEN2

pheochromocytoma medullary thyroid cancer (malignancy of parafollicular thyroid c cells) parathyroid hyperplasia (men 2a) or mucosal neuromas & marfanoid habitus (men 2b)

t(9;22)

philadelphia chromosome CML translocation of ABL gene to BCR --> protein that inhibits apoptosis, promotes mitogenesis, increases tyrosine kinase activity

opioid mu receptor binding effects

physical dependence euphoria resp and cardiac depression reduced GI motility sedation analgesia (CNS, most opioids)

abx for gram neg anaerobic bacteria that can produce beta lactamase consider for patient who has necrotic foul ulcer with diabetes

piperacillin and tazobactam metronidazole carbapenem clindammycin need to consider polymicrobial infection so above have good gram+ and gram- (including pseudomonas) and anaerobic coverage

cushing syndrom sx, what do you suspect if acth level normal/elevated, and after high dose dex, acth and cortisol are suppressed

pituitary adenoma (cushing disease)

what does tibial nerve do for sensation

plantar side of foot

what is important in gonococcal abx resistance

plasmid conjugation

what do serotonin releasing neurons do

play role in sleep wake cycle, anxiety, mood, psychosis, sexuality, eating behavior, impulsivity

pentamidine is used to tx

pneumocystis pneuumonia

candida in immunocmpromised peopl

pneumonia esophagitis right sided endocarditis abscesses candidemia

where are schwann cells

pns transition from surface of brain and spinal cord --> occur within cranial vault and spinal canal

name live attenuated vaccines

polio (oral) MMR rotavirus influenza (intranasal) yellow fever varicella, zoster

lichen planus looks like

polygonal, planar, pruritic, purplish wrists, hands, trunk, legs fine white lines (wickham striae) on plaque surface

what is neuropeptide y

polypeptide neurotransmitter in CNS and ANS play a role in appetite and pain perception npy antagonists -have been investigated as potential antiobesity drugs

what hiv polyprotein product is glycosylated,

polyprotein product of env gene is glycosylated to become gp160 gp160 is proteolytically cleaved within ER and golgi to form gp120 and gp41 gp120 mediates viral attachment by binding to cd4 receptor of suceptible cells gp41 anchors gp120 via noncovalent interactions, mediating fusion process between viruses and target cells

virulence factors for n meningitides

polysaccharide capsule (impairs phagocytosis of bacteria) LPS (cytokine production, leading to circulatory collapse) pili (permit bacterial attachment to resp mucosa) IgA protease (cleaves secretory IgA --> otherwise inactivate pili)

what is in portal venous system

portal, splenic veins smv

lepromin skin test in patient with tubeculoid leprsoy

positive, since they exhibit a stron cd4 th1 immune response to mycobacterium leprae th1 = il-2, ifn-g, and il-12 lead to activation of macrophages that kill m leprae, limit disease extent localized inflammation damages skin and cutaneous nerves --> development of small nmbre of hypopigmented well demarcated plaques with decreased sensation

where are histamine and orexin produced

posterior hypothalamus (arousal, wakefulnness)

what does anterior choroidal artery supply

posterior limb of internal capsule, optic tract, lateral geniclate body, choroid plexus, uncus, hippocampus, amygdala

what drug do you give to people who have been exposed to radioactive iodine isotopes (nuclear accident)

potassium iodide competiviely inhibits thyroid uptake of radioactive iodine isotopes, often administered following nuclear accidents, to protect thyroid and prevent development of radiation-induced thyroid carcinoma

what does cyanide do

potent mitochondrial toxin binds to fe3+ in cytochrome c oxidase inhibits etc and halts aerobic respiration inc ell presents with altered mental status, seizures, cv collapse, lactic acidosis, BRIGHT RED VENOUS BLOOD most likely to occur in pts receiving high nitroprusside doses/prolonged infusions, or those w/ renal insufficiency normally metabolized in tissues by rhodanese, enzyme that transfers sulfur molecule to cyanide to form thiocyanate --> less toxic and excreted in urine cyanodie OD depletes available sulfur donors, allowing cyanide to accumulate in toxic amounts

what happens when you suddenly stop glucocorticoids after prolonged use

precipitate adrenocortical insufficiency and adrenal crisis

what is a type a adverse drug reaction

predictable reaction due known pharmacologic properities of drug (e.g. gastritis assoc with NSAIDs)

what can increase estrogen

pregnancy, ocp, hormone replacement therapy

17 b alpha hydroxylase defiency. what is rxn that is impaired

pregneleone --> 17 oh pregnenolone progesterone --> 17 oh progesterone

what are sx of non classic delayed 21 hydroxylase deficiency

premature pubarche or sexual prcoity in school age children young women can present with acne, hirsuitism, menstrual irreg

what can minors consent to in most states

prenatal care stis contraception drug/alcohol rehab

what do strawberry hemangiomas do in terms of growth

present at birth intiially grow in proportion to child regress spontaneously at or before puberty capillary hemangiomas begin to fade between ages of 1-3 yrs 75-95% will regress completely by age 7

graves disease, specific sx

pretibial myxedema - induration/thickening of skin over shins graves opthalmopathy - retro-orbital tissue expansion, displace globe forward (proptosis) caused by autoimmune response directed against TSH receptor that results in accumulation of GAGs within affected tissues tsh receptor ag is present on fibroblasts, adipocytes, other tissues thyroid dermopathy - stimulation of fibroblasts by TRAb and activated t cells --> excess production of GAGs and adipogenesis

what is mesna used for

prevent hemorrhagic cystitis due to cyclophosphamide or ifosfamide binds acrolein, toxic metabolite from these drugs

what is bacitracin

prevents mucopeptide transfer into growing cell wall, inhibiting bacterial cell wall synthesis

MoA of botulinum toxin type b

prevents presynaptic release of Ach from nerve terminal at NMJ (regeneration of nerve terminal eventuall occurs in 3 mo, so effect is temporary)

when to suspect vertebral osteomyelitis

previous infectious (skin, soft tissue, uti) that can hematogenously spread OR from direct invasion (trauma, local spinal procedure) OR direct pready from adjacent soft tissue infection localized bony back pain, low grade fever, recent staph bactermia should be suspected in new neuro findings and fever, with or w/o back pain

besides kaposi, hhv8 can cause what in hiv infected patients

primary effusion lymphoma (arising from b cells) most commonly in hiv infected patients histo: large cells, big nuclei, prominent nucleoli

sx of klinefelder

primary hypogonadism azoospermia small/firm testes absent secondary male characterstics tall gynecomastia cognitive impairment

xanthelasma (and other xanthoma) associated with

primary or secondary hyperlipdemia iit looks like papule or plaque, yellow

describe HSV1 encephalitis and imaging findings

primary oropharyngeal infection that travels via the olfactory tract or from the reactivation of latent virus int he trigeminal ganglion with subsequent spread into the cerebral vault CT/MRI/macro brain exam: edema and hemorrhagic necrosis of temporal lobe, usually unilaterally dx: PCR of CSF tx: IV acyclovir

pili in n meningitides do what

primary virulence factor that allow n meningitides to attach to and colonize nasopharyngeal epithelial surface pili undergo significant antigenic variation (on-off gene switching and horizontal gene transfer) --> difficult vax target also play a role in bacterial movement and epithelial penetration during invasion

what is primary b cell response vs secondary b cell response

primary: activated b cells transform into plasma cells --> ag specific igm majority of activated b cells proliferate in erminal centers and transform into memory cells secondary: b cells to secerete other major subtypes of Ig during subsequent encounters

what are sx of dengue

primary: asx or self-limited (high grade fever, headache, retro-orbital pain, bleeding, diffuse macular rash, muscle, joint pain, leukopenia, thrombocytopenia, elevated liver enzymes) secondary: different viral serotype, more sever ilnness (ab depdent enhacement of infection, enhanced immune complex formation; accelerated t lymph response). secondary: dengue hemorrhagic fever - capiallary permeability, can be manifested by marked thrombocytopenia, prolonged fever, resp/circ failure, shock. more hemorrhagic tendencies

sx of rabies

prodromal: fever, pharyngitis, pain around bite acute encephalitis later paralysis, confusion, hyperactivity, focal neuro deficits, and coma

why are coag negative staph good at binding to prosthetic valves

produce a polysaccharide slime faciliate prosthetic device adherence (e..g staph epidermidis)

b hcg is produced when after fertilzation

produced by syncytiotrophoblast after implantation occurs 6-7 days after fertilization at earliest (detectable in serum ~8 days after fertilzation, since needs to be <5 IU/L; in urine 14 days after fertilization, when reaches 20 IU/L)

what is IL-17

produced by th17 cells, recruits PMNs to stimulate production of antimicrobial peptides improves host defense against fungi and bacteria at epithelial and mucosal surfaces dysreg --> autoimmune

what is MoA of hydrogen peroxide

produces destructive free radicals that oxidize cellular components yes sporocidal excellent for disinfecting inanimate objects, less effective when used on organic materials used for skin cleansing and wouund debridement

what is there proteinuria in diabetic nephropath

progressive loss of negative charge of GBM (heparan sulfate moieties) that form charge barrier, upregulation of heparanase expression by renal epithelial cells leakage of albumin and other plasma proteins initial stages <300 mg/day lost give ace-i to reduce urinary excretion of albumin and slow progression

what are examples of relaxation tx for behavioral tx for insomnia

progressive muscles contracted and relaxed in sequence relaxation response (Breathing, mental focus on peace)

what is nfkb

proinflammatory txn factor regulates cytokine production, adhesion molcule expression, cell survival found in cancers and inflammatory diseases (RA, IBD)

hepatitis b virus infection phases (proliferative and integrative)

proliferative: entire virion and all related Ag of episomal hbv dna are present. virus hbsAg and HBcAg are expressed in conjunction with MHC class i molecule. expression activates CD8 t cells --> destroy infected hepatocytes. virion itself does not have cytopathic effect integrative: HBV dna, incorporated into host genome of hepatocytes that survived immune response. infectivity ceases and liver damage tapers off when AB appear and viral replication stops. HCC risk remains elevated b/c HBV DNA has been integrated into host genome.

what lab pattern would you expect in hem a or b

prolonged PTT normal PT normal TT hem a has factor VIII deficiency hem b has factor IX deficiency (christmas disease)

what is the function of the CAAT box in eukaryotes

promoter of transcription located 70-80 bases upstream from txn start site promote initation of txn by acting as binding sites for general txn factors and RNA polymerase ii

tx of rabies

prophylactic vax - high exposure risk post exposure proph - rabies Ig and vax --> NOT effective after sx onset

what cancer if older man with osteoblastic lesions

prostate cancer

when do you see trophozoite/cysts in stool

protazoal infections (giardia, entamoeba)

vitamin e deficiency

protects fatty acids from oxidation vitamin e deficiency - cell membranes predisposed to oxidative injury long axons and rbcs most susceptible --> neuromusc disease (skeletal myopathy, spinocrebellar ataxia, polyneuropathy) and hemolytic anemia involvement of dorsal column in spinal cord --> loss of proprioception and vibratory sense spinocerebellar tract --> ataxia, peripheral nerve dysfunction --> hyporeflexia

what does protein do for stone production

protein increases acid production (from metab of sulfur containing aa's) acids are buffered with bone salts --> increased Ca excretion (hypercalciuria) increased acid load --> increases citrate reabs in PT --> hypocitruria

frothy, foamy urine means

proteinuria (think nephrotic syndrome)

sx of duchenne

proximal lower extremities, back, pelvis, shoulder girdles affected first. 1. ambulation difficulities - clumsy, slwo, waddling gait 2. gower sign - progressive weakness in proximal musculature, need hands to support wieght while standing 3. calf pseudohypertorphy - hypertrophy initialy in response to proximal muscle weakness, later replaced by fat/connective tissue 4. asymmetric weakneing of paraspinal muscles - kyphoscoliosis wheelchair bound by age 12 scoliosis can lead to restrictive pulm funfction

how are most inhaled particles that lodge in bronchial tree get removed

proximal transport by ciliated epithelial cells (mucociliary clearance) line pulmonary airways from trachea --> proximal portion of respiratory bronchiole mucus and fluid secreted act to trap particles suspended in inspired air trapped particles are swept upward toward pharynx by cilia that collectively beat in direction of pharynx mucus and debris are then swallowed or expectorated upon reaching pharnx

what are gram negative, lactose non fermenters, oxidase positive

pseudamonas

psgn vs hus

psgn - no anemia

what are complications of psoriasis

psoriatic arthritis nail changes: yellow brown, pitting, thickening, crumbling inflammatory disorders of the eye: conjunctivities, blepharitis, uveitis

what drugs block peripheral conversion of t4 to t3

ptu glucocorticoids amiodorane iopanic acid non selective beta blockers (propranolol)

wh are expiratory flow rates higher than normal when corrected for lung volume in pts with pulm fibrosis?

pulm fibrosis thickens and stiffens pulm interstitium increased lung elastic recoil, airway widening due to increased outward pulling (radial traction) by surrounding fibrotic tissue this decreases airflow resistance --> supernormal expiratory flow rates --> higher than normal when corrected for lung volume

sx of blastomyces

pulm infection in immunocompetent ppl asx or CAP like symptoms or chronic pneumonia granuloma formation extrapulm occurs in immunocompromised patients (skin, bone, GU)

what happens to lungs with CHF left sided

pulmonary venous htn produces pulm interstitial edema in interlocular septa, edematous widening of alveolar septa, intra-alveolar accumulation of edema fluid impaired gas exchange

how to stimulate pregnancy in person with hypogonadotropic hypogonadal anovulation

pulsatile gnrh (need intact pituitary and ovary for this to work)

what does naloxone bind to

pure opioid receptor antagonist mu receptors greatest binding site, but still binds to kappa and delta

what kind of diseases are digeorge syndrome patients susceptible to

pure t cell lymphopenia no t cells --> recurrent viral and fungal infections (also b/c of no parathyroids --> hypocalcemia --> tetany)

what are different subtypes of persistent depressive disorder

pure: criteria for MDD never met intermittent major depressive episodes persistent major depressive: criteria for MDD met throughout previous 2 years

what is moa of foscarnet

pyrophosphate analog used for ganciclovir resistant cmv

what does estrogen do to thyroid levels

raises circulating tbg reduces free t4 and t3 this leads to transient increase in tsh, leading to increased thyroid hormone production until additional tbg becomes saturated with thyroid hormone free t4 and t3 levels restored so ultimatey just an increase in TOTAL T4 and T3 free levels remain normal euthyroid tsh levels no normal

what is esmolol and MoA

rapid acting, short duration beta blocker (class ii) slows rate of discharge of sinus or ectopic pacemakers and increases refractory period of AV node no effect on QT interval

tx of hypovlemic shock (most important intervention)

rapid infusion of blood crystalloid solutions such as normal saline

what are sx of acute epiglottitis

rapidly progressive fever severe sore throat drooling progressive airway obstruction, stridor severe inflammation & edema of epiglottis and larynx small children: fever, dysphagia older children and adult: sore throat

what are whipple disease sx

rare small intestine, joints, cns acintinomcte proliferates only within macrophages of tissues, provoking no inflammatory response as a consequence middle aged caucausian males, malabs w/w diarrhea and weight loss arthropathy, polyarthritis, psych, cardiac abnormalities

why do patients get warrfarin induced skin necrosis

rare complication that occur in ppl with protein c or s deficiency early loss of protein C --> transient hypercoagulable state promotes microvasculature occlusion and hemorrhagic skin necrosis

what is affected in glucagonoma

rare tumor of alpha cells of pancreatic islets of langerhans

what is von hippel lindau disease

rare, AD condition presence of capillary hemangioblastomas in retina and/or cerebellum congenital cysts, neoplasms in kidney, liver, pancreas increased risk of RCC, bilateral

where are craniopharyngioma from

rare, slow growig benign intracrnaila tumor found in children, located in suprasellar region derived from remnants of rathke's pouch - evagination of surface ectoderm, lines fetal oral cavity; protrusion of roof of mouth - anterior pituitary gland (adenohypohphysis); posterior lobe of pituitary (enruohypophysis) forms outpouching of dicencephalon and is derived from neuroectoderm

can vaccinated varicella individuals still get primary VZV/herpes zoster

rarely can still develop subsequent primary VZV infection usually mild infection

RAS pathway

ras becomes activated when growth factor binds to receptor Tyr Kinase on cell membrane --> autophosph of receptor adaptor proteins interact with Ras --> GDP removal and GTP binding activated Ras then begins a phosphorylation cascade --> activation of mitogen activated protein (MAPK) --> enters nucleus to influence gene txn

what is reid index

ratio of thickness of mucous gland layer in bronchial wall submucosa to the thickness of bronchial wall between respiratory epithelium and bronchial cartilage sensiitve measure of mucous gland enlargement >40% (normal value) correlate well with duration and severity of chronic bronchitis

describe herpes zoster

reactivation of latent varicella-zoster virus within dorsal root ganglia --> elderly or immunocompromised varicella IgG ab and dermatome-centered, vesicular, painful rash

thyroidectomy, what nerve is injured

recurrent laryngeal nerve weak posterior croartytenoid muscles - hoarseness, impaired breathing

aes of vanc

red man syndrome nephrotoxicity

what are BB used for as antiarrythmic

reduce risk of ventricular arrythmia by decreasing automaticity reduce size of ischemic myocardium by decreasing myocardial o2 demand

describe JG apparatus and how it detects Na/flow rate

reduced blood flow is sensed by JG apparatus consists of macula densa and JG cells macula densa are tall, narrow cells locaed in DT, monitor salt content and tubular flow rate info transmitted to nearby JG cells located in wall of afferent arteriole, which contain renin zymogen granules

PFTs of COPD

reduced expiratory airflow velocity increased RV, TLC limitation of Vt due to hyperinflammation

why does obstructive sleep apnea lead to recurrent obstruction of upper airway durign sleep

reduced ventilation causes transient hypercapnia and hypoxemia reflexive systemic and pulmonary vasoconstriction, endothelial dysfunction, abnormal venous return and CO --> sypmathetic cardiac stimulation so can lead to pulm HTN and RHF will develop systemic htn due to chronic symp stimulation and elevated plasma NE levels lose normal diurnal variation in BP --> a fib, arrhythmias, CAD, increased risk of sudden cardiac death

what happens when you add carbidopa to levodopa

reduces most peripheral side effects of levodopa (n/v due to DA stimulating emetic center in brain stem; tachy due to increased peripheral formation of catecholamines; postural hypotension; hot flashes) h/e behavioral changes (anxiety, agitation, insomnia, confusion, delusions, hallucinations) from levodopa worsen with addition of carbidopa - more dopamine becomes available to the brain to alleviate these effects, reduce dose if not possible, give atypical antipsych like clozapine

why does adh also increase h20 absorption in cortical segment of cd

reducs amount of free water delivered to medullary collecting duct prevents excess water from being absorbed into medullary interstitium (this would dilute osmotic gradient and reduce maximum achievable urine urine conc

why is regular insulin not proferred as mealtime bolus insulin

regular insulin forms dimers due to hydrogen bonding btween c termini of b chains --> can form hexamers in presence of zinc ions this leads to short delay in absorption following subcut injection --> higher postprandial glucose levels and subsequent hypoglycemia (since delayed)

a drug with low rate of redistribution from one compartment to another will B in intravasc and be eliminated by X

remain in intravasc be eliminated in kidneys

if a mass is composed of fat, smooth muscle, and blood vessels, in kidney what is it

renal angiomyolipoma can be dx with an abdominal ct scan as radiodensity of fat is less than that of water

gross hematuria in elderly patient, think

renal or urothelial neoplasm

what dx do you think of when patient with nephrotic syndrome gets sudde onset abdominal or flank pain, hematuria, left sided varicoceles, elevated LDH

renal vein thrombosis well known complication of nephrotic syndrome (hypercoag state). loss of anticoag factors thru glomerular capillary wall, esp antithrombin 3, is responsbile for thromboembolic complications elevated LDH due to renal infarction left sided varicocele -RVT is causing impaired left gonadal venous drainage

where are renin secreting tumors

reninomas rare, smal, solitary, benign JG cell neoplasms

morphology of rotavirus

reovirus dsRNA purified RNA --> incapable of inducing viral protein synthesis in a host cell on its own needs a specific viral RNA polymerase present in intact virion, must gain entry into the host cell

when do you use base excision repair

repairing various non-bulky dna base alterations including depurination, alkylation, oxidation, deamination

what lengthens QT interval

represents time required for ventricular depol and repol rough estimate of action potential duration drugs that prolong cardiac action potential and QT interval - class 1A and III antiarrhthymics (notable exception in this class is amiodarane)

what is postherpetic neuralgia

residual neuropathic pain in affected dermatome post singles sensitization of afferent nerves in dorsal horne may last several months or longer, but have a burning stabbing, gnawing character

what is relationship between LA pressure and LVEDP in diastole in mitral stenosis

resistance to blood flow from LA to LV increase in LA pressure normal LVEDP (if LA pressure is high to overcome resistance between LA and LV)

what is fat embolism syndrome

resp distress non focal neuro distrbance chest lesions thrombocytopenia anemia after multiple long bone fractures fat globules dislodged from mbone marrow enter marrow vascular sinusoids, occlude pulm microvessels, impairing gas exchange can occlude cerebral white matter, brain stem, and spinal cord --> neuro sx

acid/base disturbance from salicylates

respiratory alkalosis - stimulate medullary resp center, resulting in increased ventilation and loss of co2 in expired air ag metabolic acidosis - develops 12 hrs later; high concentrations of salicylates increase lipolysis, uncouple ox phos, inhibit CAC; accumulation of organic acids in blood, which bind bicarb --> increasing AG

serotonin syndrome sx

restlessness, ams, hyperreflexia, clonus, diaphoresis, tremors

if you cannulate femoral artery above inguinal ligament, you risk hemorrhage into

retroperitoneal space if accidental puncutre of posterior wall, can get blood to track along loose connectie tissue surrounding vessel and accumulate within interfasial planes of retroperitnoeum **bleeding in retroperitoneal space CANNOT be controlled with external compression, can lead to life-threatening hemorrhage affected patients --> develop hemodynamic instability and ipsilateral flank pain

what kind of virus is hiv (stranded ness)

retrovirus +ssRNA requires reverse transciptase for intergration into host genome enveloped

what is cftr in sweat ducts like, vs resp and intstinal glands

reversed! cftr reduces salt content of sweat by reabsorbing luminal chloride and stimulating ENac to increase Na absorption from lumen into the cells CFTR mutation --> sweat has high Cl and Na content

what is use of nalaxone

reverses analgesia, sedation, hypotension, resp depression reversal effect within minutes duration dose dependent (1-4 hrs) competes with narcotics, displacing them from opioid receptors must be given parenterally secondary to complete metabolic inactivation by liver when administered orally

what is seen in stool of someone with strongyloides

rhabtditiform larvae (eggs and adults are only seen in intestinal biopsies)

what dx can affect both mitral and oartic valves

rheumatic heart disease

when do you hear MR

rheumatic heart disease MR within first few decades of life

what is the most common cause predisposing to subacute endocarditis in LMICs

rheumatic heart disease late complication 10-20 years complication of acute rheumatic fever - migratory arthritis, carditis, valvulitis, sydenham chorea, erythema marginatum, subcut nodules

what are molds out of opportunistic fungi

rhizopus (mucor) and aspergillus

why is adult vertebral bone susceptible to osteomelitis

rich and vascular marrow increasing age can cause nutrient arteries to develop corkscrew anatomy, bacteria more easily penetrate marrow cavity and cause local infection

what is proph tx for n meningitides for contacts

rifampin it penetrates all body compartments, including upper resp tract, eliminate nasopharyngeal colonization (others: cipro but this is not used in children due to connective tissue injury; ceftriaxone IM) give within 24 hrs of dx

compare right sided and left sided colon cancers

right (ascending): grow large, bulky masses, protrude into colonic lumen due to relataively large caliber of ascending colon. more likely to bleed and case iron defieciency anemia. bleeding is occult and detected by fecal occult blood testing. left (rectosigmoid): smaller, infiltrte wall of colon, encircling and narrowing lumen. more likely to cause obstruction --> alterered bowel habits, abdominal distension. n/v

sx of left MCA stroke

right sided hemiparesis and hemisensory loss speech areas located in dominant (left) hemisphere --> expressive (broca) and receptive (wernicke) aphasia

where does serratus anterior originate and insert

riginates on surface of first 8 ribs, inserts on medial border of scapula stabilizes and rotates scapula upward once deltoid/supraspinatus abduct arm up to horizontal position, serratus anterior and trapezius rotate glenoid cavity superiorly --> complete abduction of arm over head

what is toxoplasma encephalitis AND who gets it

ring enhancning lesions in parietal, frontal lobes after ingestion of oocysts from soil or cat litter immunocompromised (HIV)

what kind of virus is hep a

rna picornavirus

what kind of worm is strongyloides

round worm

stain of crytococcal reveals

round, oval budding yeast via india ink stain

tx of hemorrhoids

rubber band ligation, cut off blood supply to lesion and cause them to degenerate

what are togaviruses

rubella, german measles, eastern/western equine encephalitis

what is wound dehiscence

rupture of previously closed wound result from insufficient granulation and scar tissue formation --> inadequate wound contraction or excessive mech stress wound rupture most commonly occurs in abdominal wounds that are subject to increased intrabdominal pressure

what divids sciatic foramen into greater and lesser

sacrospinous ligament

characteristic of hypoxia secondary erythrocytosis

sao2<92% (pao2 < 65)

what does genitofemoral nerve innervate

scrotum, labia majora, medial thigh (injury from abdominal retractors)

what is budd chiari syndrome

secondary to thrombotic occulsion of hepatic veins and/r intra or supra hepatic ivc venous occlusion --> sinusoidal pressure to increase, portal htn, ascites, hsm

tnf alphadoes what

secreted by activated macrophages and t cells --> promotes luek recruitment, induces sytemic inflammatory response, regulates apoptosis

what is wallerian degeneration

segment of axon that has lost connection with cell body represents degeneratiion of axon and myelin distal to point of injury swelling and irreg are noted in distal segment of axon 1 week, axon is destroyed and fragments are digested by schwann cells and macrophages similar changes occur in sgment proximal to injury degeneration of proximal segment extends to closest node of ranvier

histo of guillain barre

segmental dymyelination of peripheral nerves inflammatory infiltrate located within endoneurium (innermost layer of connective tissue that surrounds a nerve axon and its corresponding blood vessel) largely lymphocytes and macrophages extends from small vessels (perivenular) to associated nerve axon macrophage strip the myelin sheath from axon lipid laden macrophages are seen post engulfment of myelin

what is responsible for cross mixing of human NA and HA with animal HA and NA in influenza

segmented genome allows for "genetic reassortment" when 2 distinct strains infect same cell avian and human flu a virus coinfection --> human type HA and animal type NA being packaged together into the same virion --> novel strain also known as "antigenic SHIFT"

what is phenylephrine

selective a1 adrenergic receptor agonist causes marked arterial vasoconstriction IV increases SVR and BP induced BP -- baroreceptor mediated increase in vagal tone --> decreases SV and slowed HR pulse pressure decreased b/c of reflex decrease in SV and increased afterload (SBP - DBP)

what does esmolol do

selective b1 negative inotropic and chronotropic effects

which nsaids would NOT impair platelet function

selective cox 2 inhibitors (platelets predominantly express cox 1) e.g. celecoxib

what drugs can reduce collateral blood flow in heart

selective vasodilators of coronary vessels like adenosine and dipyridamole they cause redsitrubtion of blood thru the the collateral microvessels and coronary arterioles --> reduce collateral blood flow arterioles with ischemia are maximally dilated prior to drug administration use of these agents causes vasodilation of coronary arterioles in nonischemic regions leads to decreased perfusion pressure within the collateral microvessels supplying the ischemic myocardium --> diverting blood flow from ischemic areas to nonischemic areas (CORONARY STEAL) leads to hypoperfusion and potential worsening of existing ischemia

what parkinson drug works by inhibint MAO-B in brain, resulting in decreased central dopamine deregulation

selegeline

what is pes anserinus

semitendinosus, gracilus, sartorius

what is sensory innervation of femoral nerve

sensation for arch of foot, shin, anteromedial thigh

what happens when pudendal nerve is damaged

sensory br innervates external genitalia, skin around anus and perineum; motor br innervate pelvic floor muscles, external urethral and anal sphincters weakness of perineal musculature --> fecal, urinary incontinence perineal pain sexual dysfunction

injury to tibial nerve at tarsal tunnel would hav

sensory loss over side with intrinsic foot muscle weakness plantarflexion and inversion intact since these fibers innervated muscles proximally

if patient has problem with corneal reflex, what CN affected

sensory: CNv1 motor: CNVII

what does invasive strep pneumo infection look like

sepsis bacterial meningitis

wedge shaped infarts in peripheray of lung indicte

septic pulmonary emboli wedge shaped b/c of triangular perfusion field of small arteries at lung periphery

what is primary vs secondary erythrocytosis

serum EPO can be used to differentiate primary vs secondary primar: low EPO caused by myeloproliferative disorders (polyythemia vera) secondary: increased EPO due to chronic hypoxia from high altitudes, smoking, COPD, abnormal secretion by neoplastic or otherwise diseased tissues

what does staph aureus do to the heart

settles on valve leaflets (due to blood flow turbulence) causes perforations in heart valves, ruptures chordae tendinae, sends septic emboli to lung (if right heart endocarditis) or to brain/systemic circ (if left heart endocarditis)

other causes of pancytopenia without splenomegaly

sever b12 and folic acid deficiency anemia acute leukemias certain forms of myelodysplastic syndrome (MDS)

sx of mycoplasma pneumonia

several weeks of nonproductive cough and mailase infects multiple lobes of lung, causes bilateral patchy infiltrate on cxr

what is cause of nucleated RBCs and extramedullary hematoposesis in hemolytic disease of newborn

severe anemia stimulates release of immature nucleated RBCs and extramedullary hematopoeisis (liver, spleen, other tissues)

most frequent cause of extramedullary hematopoiesis

severe chronic hemolytic anemias, like B thalassemia

what are sx of classic saltwasting 21 hydroxylase (boys and girls)

severe deficiency girls: present at birth w/ ambiguous genitalia boys: 1-2 weeks with failure to thrive, dehydration, hyperkalmeia, hyponatremia

sx of hyperkalemia

severe muscle weakness cardiac arrhthmias premature atrial/ventricular beats AV block ventricular tachy/fib

klinefelter syndrome is

sex chromosome aneupoloidy results in 47 xxy karyotype atrophied, hyalinized seminferous tubles (low inhibin levels) and damaged leydig cells (low testosterone) lack of feedback inhibition --> increases LH and FSH --> increase sestrogen levels

AEs of midazolam

short acting IV BZD AEs: decreased BP (systemic vasodilation), resp depression esp when combined with opiates

AEs of propofol

short acting IV anesthetic potenitates action of GABA at GABA-A receptor significant hypotension during induction of anesthesia due to systemic vasodilation

albuterol is

short acting, selective beta 2 adrenergic agonist first line tx for acute bronchial asthma bronchodilatory effects are independent of parasympathetic innervation

what are 3 classes of bzd

short half life (<6 hrs): triazolam, oxzepam, midazolam intermediate (6-24 hrs) alprazolam, lorazepam, temazepam long (>24 hrs): diazepam, chlordiazepoxide, flurazepam

what kind of bzd should you prescribe to minimize daytime side effects (fatigue, impaired judgment)

short or intermediate acting, taken before bedtime triazolam, oxzepam, midazolam (short) alprazolam, lorazepam, temazepam (intermediate)

injury to upper brachial plexus leads to

should adduction, elbow extension, forearm pronation bellman or water's tip pose

what is trendelberg sign

shows whether there is superior gluteal nerve injury weakness of gluteus medius and minimus muscles, can't contract, will cause pelvis to sag toward unaffected (contralteral) side when patient stands on the affected leg when walking, patient will learn toward affected ipsilateral side to compensate for hip drop (gluteus medius lurch)

what does irreversible neuronal injury look like

shrinkage of neuronal body, deep eosinophilia of cytoplasm, pyknosis of nucleus and loss of nissl substance transient, profound hypoxia, ischemic injury, toxic can be causes

what is histo feature of one type of gastric adenocarcinoma

signet ring carcinoma (1 of 2 major types of gastric adenocarcinoma) consists of cells that do not form glands cells contain abundant mucin droplets that push nucleus to one side, lead to appearance of signet ring

what gastric adenocarcinoma assoc with infiltration of stomach wall

signet ring cell (diffuse carcinoma, linitis plastica)

how do silicosis and tuberculosis relate

silicosis is assoc with increased risk of TB silicosis impairs macrophage effector arm of cell mediated immunity, integral to immune response against mycobacteria macrophage phagolysosomes are disrupted by internalized silica particles --> release of particles and viable mycobacteria (inhibit immune system's ability to control infection) extracellular release of lysosomal enzymes is though to contribute to alveolar and interstital lung injury prolonged exposure to silica particles leads to macrophage apoptosis

what is microarray analysis

similar to southern and northern blotting involves hybridization of large # of probes at once genomic dna or cdna being analyzed labeled w/ fluorescent tag and placed on gene gene chip containing complementary sequences for large # of genes

what does adenosine and dipyridamole do in myocardial perfusion imaging studies

simulate generalized coronary vasodilation caused during exercise induces ischemia in areas of myocardium perfused by occluded vessels allowing detection of ischemic areas that would not otherwise be seen in resting heart

relative glucocorticoid defiency can lead to

since glucocorticoids help maintain normal vasc tone hypotension/shock higher stress dose needed to compensate for increased physio demands and prevent development of adrenal crisis

what is kartagener syndrome

situs inversus immotile cilia due to microtubular dynein arm defect infertility, recurrent sinusitis, and bronchiectasis occur

karteneger syndrome triad

situs inversus chronic sinusitis bronchiectasis

what are assoc dx with pbc

sjogren's, raynaud's, scleroderma, autoimmune thyroid, hypothyroid, celiac

what are sx of gvhd

skin, liver, gi most frequently affected diffuse maculopapular rash that has preilection for palms and soles, may desquamate gi - diarrhea, intestinal bleeding, abdominal pain liver - abnormal lfts

what happens to QRS complex duration during exercise

slihgly reduced due to increase in cardiac conduction velocity at faster HR

slowest conduction speed and fastest

slowest: AV fastest: purkinje

what are charcot bouchard aneurysms and if they rupture what do they cause

small (<1mm in diameter) occur in patients with longstanding htn found in arteriols that supply basal ganglia, internal capsule, deep white matter can rupture and cause INTRACEREBRAL hemorrhage

which lung tumor has more acth paraneoplastic

small cell lung cancer (can also be seen with bronchial or pancreatic carcinoid)

what is obturator canal

small gap in obturator membrane (fibrous sheet, covering obturator foramen) allows obturator artery, vein, nerve to travel from pelvis to thigh

what is small intestinal bacterial overgrowth

small intestine is colonized with facultative anaerobes, lactobacili, enterococci, gram pos aerobes enteric bacteria can produce vitamins (vitamin K, folate), inhibit proliferation of surrounding pathogenic bacteria, and digest unabsorbed dietary sugars and convert them to fatty acids characterized by overproduction of Vit K, folate, associated with nausea, bloating, abdominal discomfort, malabsorption assoc with gastric bypass surg

histo of whipple disease

small intestine mucosa containing enlarge, foamy macrophages packed with rod shaped bacilli and pas positive, diastase resistant granules (lysosomes and partially digested bacteria)

morph of parvovirus b19

small nonenveloped icosahedral virus linear, ssDNA genoe no polmerase in virion

what is morphology of histoplasma

small oval yeast with macrophages

what are sx and genetics of bloom syndrome

small stature infertility predisposed to malignancy sun sensitive facial rash AR --> chromosomal instability

what tx if patient starts off with absence seizures but then develops generalized tonic-clonic seizures

so b/c 2 kinds of seizures late onset absence epilepsy (10-12) is assoc with increased incidence of generalized tonic/clonic or myoclonic broad spectrum needed for both valproate - for both absence and tonic-clonic

where is cryptoccus found

soil, pigeon droppings transmitted respiratory but not via person-person contact

difference between somatic sx disorder vs illness anxiety disorder

somatic sx: excessive anxiety and preoccupation with >1 unexplained sx illness anxiety: fear of having serious illness despite few or no sx and consistently negative evaluations

damage to corpus collosum leads to

split brain syndrome cannot transfer interhemispheric transfer of info (patient unable to retrive w/ one hand an object palpated with the other)

sx of variant prinzmetal angina

spontaneous episodes of rest and nightime angina transient ST elevation on ambulatory ECG monitoring transient, sudden, significant reduction in luminal diameter of epicardial coronary artery due to spasm, lead to rief MI coronary vasopsasm occurs in normal vessels and at plaque sites

what is histo of acute viral hepatitis

spotty necrosis with balooning degeneration (hepatocyte swelling with wispy/clear cytoplasm) councilman bodies (eosinophilic apoptotic hepatocytes) mononuclear cell infiltrates

dx of heptatitis e

spread fecal-oral high mortality rate observed in infected pregnant women young/middle aged adults in Asia, africa, mexico incubation period of sex weeks self limited diseases, not associated with chronic liver disease or charrier state can detect hev ag or hev rna in stool or liver in earliest stages of inection (when patient is asx) serum transaminases and igm anti-hev titers --> rise in assoc with clinical illness

standard deviation of a series of sample means is

standard error of the mean estimates how far the sample mean is likely to be from unknown population mean SE - estimated consering both SD and size of sample (n) via SD/sqrt(n)

organisms that can cause vertebral osteomyelitis

staph (most common aureus, or caog neg) gram negs (pseudomonas)

what bug can adhere to normal valves

staph aureus

what is protein A a virulence factor for

staph aureus forms part of outer peptidoglycan layer of s aureus

what is most common cause of acute bacterial right sided endocarditis in IVDU

staph aureus it causes right sided endocarditis with septic embolization into the lungs

what bug has igG binding outer membrane proeein

staph aureus (protein a binds fc portions of igg molecules, preventing opsonization, phagocytosis, complement fixation)

pentrating truama, lung abscess agents

staph, strep

what does hemolysin do and what is it a component of

staphlyococci hemolysis destroys PMN, macro, platelets secreted factor, not bound to cell wall

how to differentiate absence seizure from inattention

staring episods from absence do not occur out fo boredom or lack of focus cannot be interrupted by verbal/tactile simula (inattention - can be interrupted, usually due to boredom)

exogenous steroid vs klinefelter

steroid: acne, male pattern baldness, hastened epiphyseal closure, aggressive behavior

what are life threatening side effects of lamotrigine

stevens johnson syndrome (<10% of body surface area) toxic epidermal necrolysis (>30%) characterized by flu like sx followed by widespread mucocutaneous epidermal necrosis histo: epidermal necrosis and subepidermal bullae

what drug withdrawal if increased appetite, hypersomnia, intense psychomotor retardation, severe depresion (crash), vivid dreams

stimulants (cocaine, amphetamines) sx occur hrs - days of cessation no significant PE findings

epinephrine moa

stimulates both alpha and beta increases pulse rate, pulse pressure, decreases PVR (b/c of b2 > a1 effect)

nigrostrial degeneration results in X of Gpi by suthalamic nucleus, which causes X of thalamus

stimulation of Gpi by subthalamic nucleus inhibition of thalamus --> reduced activity of thalamus and its projections to cortex --> rigidity and bradykinesia

what is stimulus control therapy vs sleep hygiene

stimulus control: dissociate the bedroom from any stimulating activities that do not involve sleep and the fear of not sleeping sleep hygiene: focuses on teaching patient about importance of regular sleep schedule; effects of exercise, diet, alcohol, enviro factors

what are sx of scarlet fever

strep pharyngitis after incubation with GAS for 1-5 days fever, malaise, abdominal pain, sore throat pharnx: red, swollen, gray-white exudates, tongue inflamed red papillae --> red strawberry after 1-2 days, rash on neck/armpits/growth --> generalizes to rest of body rash begins as scarlet spots/blotches --> widespread, sunburn with goose pimples (sandpaper like rash) cheeks appear flushed --> are around mouth is pale (circumoral pallor) end of first week: desquamation in armpits, groin, tips of fingers/toes

what bugs have IgA proteases

strep pneumo N gonorrhea cleave Ig Ab --> preventing interfering with bacterial adhesion to mucous membranes

what bugs have antiphagocytic capsule as primary virulence factor

strep pneumo hib neisseria

sx of stress vs urge vs overflow incontinence

stress: leakage w/ coughing, lifting, sneezing (sphincter dysfunction or weakness when intrabdominal pressure > urethral sphincter pressure --> involuntary urine leakage) urge: sudden, overwhelming urge to urinate overflow: incomplete emptying, persistent involuntary dribbling (post void resisdual urine volume high). due to impaired detrusor contractiility or outlet obstruction

what do intestinal type adenocarcinomas look like

strongly resemble colon cancers well-formed glands consist of columnar or cuboidal cells grow as nodular, polyploid, well demarc masses that rapidly expand within gastric lumen these lesions often ulcerate/bleed, must be differnetaied from peptic gastri culcers

how can resistance to rifampin occur

structural alteration of DNA dependent RNA polymerase

uti and kidney stones assoc with

struvite stones form only in assoc with upper UTI with urea-splitting bacteria (klebsiella, proteus)

what do you suspect if there are cutaneous facial angiomas, leptomeningeal angiomas skin involvement in V1 and V2 areas mental retardation, seizures, hemiplegia, skull radioopacities tram track calcifications in skull

sturge weber (encephalotrigeminal angiomatosis) rare congenital neurocutaenous disorder

where does biceps femoris insert

styloid process of head of fibula

what should you suspect endocarditis cause is strep viridans

subacute bacterial endocarditis following dental work preexisting valvular abnormality subacute (weeks)

what are the mature defense mechanisms

sublimation: channeling impulses into socially acceptable bheaviors suppresion; putting unwanted feeligns aside to cope w/ reality

where should you biopsy a child with hirschsprung

submucosa of narrow part of colon failure of neural crest cells to migrate to intestinal wall (cells develop into ganglion cells of SUBMUCOSAL/meissner and myenteric/auerbach plexi of bowel wall) since cells migrate caudally, rectum is always involved

complications of diptheria

submucosal edema and pseudomembrane aspiration --> obstruct respiratory tract --> usffocation toxin if systemically absorbed goes to heart and brain: myocarditis/HF neuro toxicity

what structure do both CNIII and CNV1 go through in brain

superior orbital fissure

function of il-3

support growth and differentiation of bone marrow stem cells

tx of hep a

supportive completely recovery in 3-6 weeks usually give hep a vax as prophylaxis

what does iliohypogastric nerve innervate

suprapubic skin (injury during closure of pfannenstiel skin incisions --> result in burning pain and paresthesias)

what is barrett esophagus

sustained epitheilal damage of esophagus promotes metaplastic replacement of normal stratified squamous epithelium with intestinal type columnar cells with goblet cells adaptive at first, as intestinal type epithelium is more resistant to gastric acid major risk factor for esophageal adenocarcinoma --> develops from metaplastic intestinal epithelium in distal part of esophagus

what is derivved from common cardinal veins, and embryo of veins

svc all veins in developing embryo drain into sinus venosus --> drains into primitive atrium of developing heart in early embryonic development, body's veins fall into 3 main groups --> umbilical, vitelline, cardinal umbilical vein degenerates, vitelline veins from portal system cardinal veins form sonstituents of systemic venous circulation

describe pressure ranges/waveforms from doing balloown tipped pulmonary artery catheter

svc: small amplitude oscillations. pressure remains unchanged as catheter is placed into RA. 1-6 mmhg 2. as catheter advances across tricuspi into RV, pulsatile waveform. peak = strength of RV contraction. lowest pressure is just below RA. systolic 15-30 3. as catheter advances across pulm valve into main pulm artery, presure waveform shows sudden increase in diastolic pressure, no change in systolic. diastolic rise due to pulm cap resistance and transmission of LAP. pa diastolic 6-12 4.when catheter is advanced into distal PA, venous type waveform appears. PCWP. venous pressure in left heart. usually equal to PA diastolic. 6-12

what is hemorrhagic cystitis

sx of progressive hematuria and suprapubic tenderness caused by nitrogen mustard based chemo, like cyclophosphamide, or one of its analogs (ifosfamide) agents metabolized by kidneys into acrolein--> excreted in urine acrolein is toxic to uroepithelial cells, cause cell death and necrosis

compare and contrast myasthenia gravis and lambert eaton syndrome

sx: MG: weakness is worse at end of day or with exertion, extraocular muscles affected first LE: weakness improves during day with exercise, weakness of proximal muscles associated with MG: thymoma LE: pre existing malignancy (common small cell lung cancer) pathogenesis: MG: Ab against post synaptic Ach receptors LE: Ab against pre-synaptic calcium channels tensilon test (edrophonium) MG: improvement or resolution of weakness LE: no clinical improvement nerve stimulation studies MG: decremental response LE: incremental response

what is a superior sulcus tumor/pancoast syndrome

sx: extensive smoking history, hemoptysis, shoulder pain pancoast syndrome: tumor at lung apex arise in superior sulcus (groove formed by subclavian vessels) apical location allows for extensive tumor spread: -shoulder pain: radiating towards axilla and scapula, most common presenting symptom. involvement of lower brachial plexus (arm paresthesia, weakness, muscle atrophy) -horner syndrome: involvment of cervical symp ganglia: ipsilateral ptosis, miosis, anhydrosis -upper extremity edema: compression of subclavian vessels -spinal cord compression: paraplegia from tumor extension into intervertebral foramina also rib destruction pain in distrubtion of c8, t1, t2 nerve roots

describe neurotransmitters of sympathetic nervous system (pre and post ganglionic

symp nervous system regulates visceral function via 2 neuron signal transmission involving cholinergic pre-ganglionic neurons and adrenergic post ganglionic neurons preganglioinc: cholinergic (Ach) post ganglioinic: adrenergic (NE) exceptions: eccrine sweat glands post ganglionic are Ach adrenal medulla chromaffin cells release NE and EPI directly into circulation after AChh stimulation -- symp preganglioinc arise from thoracocolumbar spinal cord and release Ach which binds postgang receptors in symp chain and prevertebral ganglia post gang neurons release NE, activating alpha beta receptors within target organs.

what can dorsiflexion and/or eversion causing high ankle sprain do to syndesmotic structures

syndesmotic structres (interosseus membrane, anterior/posterior, tranverse tibiofibular ligaments, connect tibia and fibula) injury to these strutures uncommon would present with unstable ankle joint with tenderness at distal tibiofibular joint

what is fondaparinux

synthetic pentasaccharide factor xa inhibitor none of the required long saccharide nits that bind to thrombin and much lower antithrombin activity compared to unfractionated heparin

sequelae of sleep apnea

systemic hypertension pulmonary hypertension and RHF increased risk for arrhythmias

what has anti-topoisomeraise 1 (anti scl 70) ab

systemic sclerosis

what are sx of acute hep b

systemic, skin, joint sx hepatomegaly, RUQ pain elevated ALT and AST levels (>10x normal) serum like sickness syndrome lymphadenopathy pruritic urticarial vasculitis rash usually nonicteric DNA virus - incubation period of 30-180 days sexual, IV, vertical txn

M3 varian of AML has what genetic abnormality

t(15;17) RARalpha on chr 17 and PML on chr15 --> chimeric PML/RARalpha --> abbnormal RAR --> inhibits promyelocyte differentiation and triggers development of acute promyelocytic leukemia also called acute promyelocytic leukemia

burkitt genetic defect

t(8;14)

compare t4 and t3

t4 (thyroxine) is the major secretory product of the thyroid gland t3 (triiodothyronine) is most active form of thyroid hormone, small amount is released by thyroid gland; majority arises from peripheral deiodination of t4 most of circulating thyroid hormone is form of t4, provides most of feedback suppression of tsh release. t3 still suppresses tsh

how to calculate prob of AR child if given prevalence in population

take prevalence = q2 solve for q carrier frequency = 2pq (but b/c p is high b/c most people don't hav e disease, can just do) = 2q then do p(mother gives recessive allele) x P (unknown parent gives recessive allele, based on pop data) x P (donor gives recessive allele) = 1/2 X 2q X 1/2

why raloxifene vs tamoxifene

tamoxifene is SERM w/ strongestrogen antagonist in t breast and on bone h/e agonist activity on utereus increases risk of endometrial hyperplasia/cancer, not appropriate for routine use in osteoporosis -- raloxifene estrogen activity on bone (decreases bone resorption, improves bone density, decreases risk of vertebral fractures), estr antag on breast; estr ANTAG on uterus, does not increase risk of endometrial cancer

tamoxifen vs raloxifene

tamoxifene: anti estrogen in breast; estrogenic effect in bone and endometrium raloxifene: anti-estr in breast and endometrium, estrogenic in bone

when would you find proglottids in stool

tapeworms (taenia solium, saginata, diphylobothrium latum) a segment = proglottid

b1 effect

targets heart increase HR, contractility, conductance e.g. epi, dopamine, dobutamine, isoprotenerol

b2 effect

targets peripheral vasculature (smooth muscle) bronchi uterus vasodilation, decreased BP (esp diastolic), bronchodilation, relaxation (tocolysis) e.g. isoprotenerol, terbutalne

a1 effect

targets peripheral vasculature, bladder, eye increases BP (systolic mostly), contracts internal urethral sphincter, mydriasis (contraction of pupillary dilator muscle) e.g. epi, NE, phenylephrine

why is doxepin not good for tx delirium

tca has antichol effects, which worsen delirium

what is cd28

tcell surface protein, interacts wiht b7 on apcs --> constimulating signal necessary for t cell activation blocking cd28 --> inhibits t cell activation (ctla4 also binds to b7, but has inhibitory effect on activated t cells)

when do you get granulomatous inflammation

temporal (giant cell) arteritis most common form of systemic vasculitis in adults

what are osler nodes and how do they form

tender, violaceous nodules, pulmp of fingers and teos immune comlex deposiition in skin

what is perineal body and what anchors to it

tenindous center point o the perineum, separates he urogenital and anal triangles blends anteirorly with perineal membrane and superiorly with rectovesical or rectovaginal septum bulbospongiosus external anal sphincter superficial and deep transverse perineal muscles fibers from external urethral sphincter, levator ani, muscular coat of rectum

what cv disorder with digeorge

tet of fallop interrupted aortic arch - ortic arch is atretic or segment of arch is absent affected pts - poor LE pulses, resp distress, variable cyanosis, chf, also develop during first days of life

function of il-13

th2 type helper cell promote ige production by b cells

how do bile acid resins work

they inhibit bile acids from entering enterohepatic circulation diversion of hepatic cholesterol to synthesis of new bile acids increased uptake of LDL cholesterol from circulation --> reduced blood LDL levels

injury to obturator nerve leads to

thigh adduction medial thigh sensory loss

macro findings of ALS

thin anterior roots mild atrophy of precentral gyrus

why is vaccination against pilus protein of n gonorrhea difficult

thru antigenic variation, each gonococcus can modify pilus protein expressed, so can avoid host defenses to some degree pili mediate adherence to mucosal epithelium when host produces ab against gonococcal pili, mucosal adherence inhibited only 1 pilus gene expressed at a time h/e structural genes for pilus proteins undergo antigenic variation at high frequency undergo recombination with each other to produce new antigenic types of pili pili ar protein polymers

how does UV rays damage DNA

thru formation of abnormal covalent bonds between adjacent thymine or cytosine residues (pyrimidine dimers) the dimers interfere with base recognition during transcription and replication DNA mutations can result if damage is not repaired

what are examples of anterior mediastinal masses

thymoma teratoma thyroid cancer (terrible) lymphoma terrible t's

what happens when thyroid fails to migrate properly

thyroid can reside anywhere along thyroglossal duct's path, including tongue (lingual thyroid) enlargement of lingual thyroid --> obstructive sx, esp during times of heightened thyroid stim (puberty/pregnancy) if only source of thyroid tissue, significant hypothyoridism occurs if it is removed

what is test for graves

thyrotropin receptor ab (TRAb) they bind and activate tsh receptor, increasing release of thyroid hormone by gland

what is contained in deep posterior compartment

tibial artery peroneal artery tibial nerve ACS in this comparment --> decreased sensation in plantar surface, decreased toe flexion, pain with passive toe extension

what nerve is responsible for plantar flexion and inversion, toe flexion

tibial nerve

papillary muscle rupture: time course and distinctive features

time course: 3-5 days sx: severe MR with flail leaflet

what does menopause affect more regarding bone loss/location

trabecular bone, especially in dorsolumbar vertebral bodies trabecular thinning, perforation with loss of interconnecting bridges continued aging - cortical bone - composes most of appendicular skeelton neck of femur fractre very common, has both trabecular and cortical bone, common site of osteoporotic fracture

what does coronary artery vaspospasm in prinzmetal's look like on

transient ischemia with ST segment elevations may cause q wave TM MI, even w/o atherosclerotic lesions how to distinguish -- vasospasm of prinzmetal's angin responds promptly to vasodilators (nitroglycerin)

c perfringes can also cause, in addition to gas gangrne

transient watery diarrhea caused by toxin formed when large quantities of clostrial spores are ingested germinate in GI --> toxin --> delayed onset

what is holosytolic murmur that increases with inspiration

tricuspid regurgitation

pulm trunk embryology

truncus arteriosus neural crest cell migration partitions truncus arteriosus into 2 great arteries (aorta, pulm) by causing fusion and twising truncal and bulbar ridges normal spiral relation between aorta and pulm artery

embryo of ascending aorta

truncus arteriosus gives rise to pulm trunk portion of aortic arch develops from 4th pharngeal arch

whipple disease caused by

tryopheryma whippelii gram positive actinomycete

what stimulates iodine trapping

tsh

what causes graves opthalmopathy

tsh receptors present on fibroblasts, adipocytes, other tissues stimulation of orbital fibroblasts and adibocytes by TRAb and activated t cells secrete excess amounts of GAGs --> expansion of ground substance of retro-orbital tissues this, along with excess adipose deposition, displaces globe forward; leads to restricted movement of extraocular muscles (diplopia)

what are renal angiomyolipomas associated with

tuberous sclerosis (bilateral renal angiomyolipomas --> 80-90%)

what do you suspect if patient has kidney, liver, pancreatic cysts, CNS involvement via cortical and subependymal hamartomas, cutaneous angiofibromas (adenoma sebaceum), visceral cysts, renal angiomyolipomas, cardiac rhabdomyomas

tuberous sclerosis AD

when should you suspect MEN1

tumors of parathyroid, pituitary, pancreas (3 Ps) primary hyperPTH - asx hypercalcemia or renal stones prolactin secreting adenomas (prolactinomas) - menstral irreg/galactorrhea; headache or bitemporal visual field deficits enteo-hepatic neuroendocrine tumors - gastrinoma, insulinoma (frequent cause of tumor-related death in MEN1, often mets)

describe production of surfactant in fetus

type 2 pneumoncytes produce pulmonary surfactant (phospholids, dipalmitoylphophatidylcholine v impt) surfactant decreases alveolar surface tension (create lipid-rich monolayer, separates alveolar gas from underlying aqueous fluid) prevent atelectasis and end expiratory collapse and increases pulmonary compliance

what vessel has highest oxygen content in fetus

umbilical vein > ductus venosus > IVC > heart > ductus arteriosus > aorta > tissues > umbilical arery SVC does not participate in circulation of oxygenaed blood in fetus! only contains deoxy blood

what is another cause of down syndrome, besides meiotic nondisjunction

unbalanced robertsonian translocation (minority of down syndrome cases) shows 46 chromosomes with translocation between2 acrocentric nonhomologous chromosomes (46 XX, (t14;21) e.g.) one parent has ovum with balanced translocation with 2 repeat 21, with 1 normal sperm with 1 21, = 3 21s

what happens in unilateral renal artery stenosis

unilateral: no CKD, but hypertension can occur, as secretion of renin by one kidney will lead to systemic vasoconstriction and retention of salt/water by both kidneys

what direction will mandible move towards if you have unilateral injury of jaw

unopposed action of contralateral pterygoid muscles deviation of mandible toward paralyzed side on opening the mouth

what differentiates plaque of unstable angina vs stable

unstable: ulcerated, partially obstructed from a fixed atherosclerotic obstruction w/o superimposed thormbosis

where is sa node

upper anterior RA at opening of SVC

when do you get contralateral hemisensory loss

upper brainstem lesion affecting ascending somatosensory pathways (DCML, anterolateral)

what lobe is affected in klebsiella

upper lobe, right lung b/c aspiration occurs while suspine get liquefying necrosis of lung with early abscess formation

what is most common type of incontinence in MS patients

urge due to loss of CNS inhibition of detrusor contraction in bladder as dx progresses, bladder can become atonic, dilated --> overflow incontinence

what does an ovulation predictor kit measure

urinary LH becomes positive 24 hrs before ovulation once released, sperm may fertilize it for up to 24 hrs

superior veiscal artery and branches supply

urinary bladder and ductus deferns

risk factors for UTI

urinary obstruction (BPH) fecal incontinence neurogenic bladder (diabetes) frequent/indwelling catheterization

dx of legionella

urine Ag test sputum difficult and unreliable b/c unique LPS chains on outer membrane inhibit gram stain. it is a gr- rod

what should you measure if patient has metabolic alkalosis

urine chloride (and volume status): 1. vomiting/nasogastric suctioning - low urine cl (<10 meq/L) (due to loss of cl in secretions; loss oc cl also imapirs hco3 excretion by kidney, worseining met alkalosis). tend to have hypotension too. give fluids and cl- repeletion with isotonic saline (saline responsive) 2. thiazide or loop diuretic use - have high urine Cl (>20 me/L) while use ongoing, low urine Cl after stopped. thiazide and loop diuretics block na and cl absorption. distal delivery of nacl increases and volume depletion stimules aldo. increase na reabsoroption at expense of increased K and H losses --> met alkalosis. tx with isotonic saline (saline responsive) 3. mineralocorticoid excess: primary hyperaldo or hypercortisolism --> met alkalsois. increased Na reasb and decreased K and H. have HTN and high urine Cl (>20). cannot be corrected with isotonic saline (saline unresponsive)

what can cause angelman and prader-willi

usally due to chromosomal deletion can be due to loss of expression of maternal/paternal imprinted components of critical region of chr 15 ---> uniparental disomy (2 copies from 1 parent, no copies from other parents)

what drug cladribine

used in hairy cell leukemia tx cytotoxic purine analog resistant to degradation by adenosine deaminase

what are path findings in idiopathic pulm fibrosis

usual interstitial pneumonia patchy invovlement with dense fibrosis and fibroblastic foci alveolar wall collapse leads to formation of cystic spaces (honeycombing) lined by hyperplastic type 2 pneumocytes or chroniolar epithelium (honeycomb fibrosis) predominant in sbpleural and paraseptal spaces

when can nondisjunction occur in turner syndrome patients

usually meioitc nondisjunction during gametogeneisis --> missing X in all cells 45X sometimes mitotic nondisjunction --> missing x chromosomes in only some cells (mosaic turner [45X/46XX]) minotyr have both XX but structurally abnormal/missing some genetic material (X fragments, isochromosomes); 46XX

sx of polyhydramnios in mother

uterine enlargement out of proportion to gestational age complications: preterm labor, placental abruption, uterine atony (uterine overdistention) maternal respiratory compromise as abdominal cavity impairs lung expansion

what does vasopressin bind to

v1 - causes vasoconstriction and increased pg release v2 - adh

what does vagus nerve do to bronchioles

vagus nerve, parasympathetic when stimulates, Ach released in airways, acetylcholine produces bronchoconstriction by acting on muscarinic receptors

which test do you do if you suspect MCL tear

valgus stress test knee extended, place one hand along lateral thigh and press inward while other hand is placed on medial aspect of ankle, pushed outward laxity of knee and/or medial joint line widening indicates MCL injury

histo of duchenne

variation in muscle fiber shape and size, regenerating fibers, and increased amounts seen on light micro

what is type of rhabies vaccine

varous rhabdovirus strains inactivated (by beta propiolactone)

when do you see encephalomalacia

vascular dementia due to ischemic stroke

what does cmv retinitis look like

vascular sheating associatd hemorrhage histo: full thickness retinal necrosis and edema with eventual replacement by atrophic scar tissue

when to use adenosine

vasodilator in chemical cardiac stress tets fast acting antiarrhtyhmic for svt

what tx to reduce MR

vasodilators (Nitroprusside) increase forward CO and reduce pulm congestion in patients with MR

nitrates have predominant effect on veins or arteries

veins! predominant effect is venodilation, which reduces preload (decreasing LV wall stress, EDV and pressure) reduces myocardial oxygen demand only modest reduction in afterload due to arterial vasodilation only modest coronary artery dilation and recution of coronary vasospams

what does coronary sinus do

venous drainage from myocardium, delivers deoxygenate blood to RA runs travnsverly in left AV groove on posterior aspect of heart, opens into RA between IVC and tricspud at CS orifice

where is dopamine produced in brain

ventral tegmental area substantia nigra pars compacta (in midbrain) involved in mesolimbic and mesocortical pathways (cognition, behavior) nigrostriatal pathway (coordination of voluntary movements) tubeoinfundibular (prolactin secretion)

what are tachyarrythmias

ventricular extrasystole atrial fib

what is pulmonary alveolar proteinosis

very gradual worsening of dyspnea and productive cough bilateral patchy pulm opacification due to intraalveolar accumulation of amorphous protein and phospholipid material (constituents of surfactant)

what does flocculonodular lobe of cerebellum do

vestibular nuclei balance and eye movements

what is inhertiance pattern of pheochromocytoma

vhl ret (men 2) nf1 (neurofibromatosis) arises from neuroendocrine cells in adrenal medulla

describe life of hep b inside infected cell

virion enters cell capisid is released into cytoplasm and viral genoma transferred into nucleus viral dna repaired to form fully ds circular minichromsome that is capable of being transcribed into viral mRNAs replication of genome occurs within a newly synth capsid containing full length viral mRNA transcript reverse transcriptase (both rna and dna dependent dna polymerase activty) acts on rna template to create ssDNA that converts back into circular, partially dsDNA mature capsid is enveloped by portion of ER containing virally coded proteins to form completed virion

what is a scotoma

visual field defect that occurs due to path process that involves parts of retina or optic nerve discrete area of altered vision, surrounded by zones of normal vision lesions of macula --> central scotoma often occur in processes that affect the retina or optic nerve (e.g. MS, diabetic retinopathy, retinitis pigmentosa; demylinating diseases)

describe intracellular calcium regulation in excitation-contraction coupling in cardiac myocytes

voltage depndent ca channels (l type) activated during phase 2 of cardiac action potential (depolarization) permit influx of Ca into myocytes ca influex sensed by ryanodine receptors in SR --> triger further releae of Ca (ca induced ca release) into cytoplasm --> increases Ca 100 fold ca goes thru myofilament network and binds to troponin c tropomyosin moved out of way so actin/myosin can interact myocyte relaxation: Ca efflux from cytoplasm. intracellular Ca is removed via Na/Ca exchange pump (NCX) and SR Ca-ATPas pump (SERCA). NCX uses large Na conc gradient to pump Ca out of cell, remove intracellular ca for 3 Na ions. SERCA: ca-atpase pump that actively transfers ca from cytosol to lumen of SR at expense of ATP hydrolysis

what ic clearance

volume of plasma cleared of drug per unit time, index of how well a medicaiton is removed from circulation determines dose rate required to maintain a steady-state plasma concentraiton

what do you suspect if patient has neurofibroma, optic nerve glioma, lisch nodule, cafe au lait spots

von recklinhausen disease or NF1 (inherited PNS tumor) lisch = pigmented nodules of iris cafe au lait - hyperpig cutaneous macules

where are JG cells located

wall of afferent arteriole they are modified smooth muscle cells with renin-containing zymogen granules

what intestinal areas are most susceptible to ischemic damage during hypotensive states

watershed areas splenic flexure (border between SMA and IMA) rectosigmoid junction (border between sigmoid artery and superior rectal artery these lie between regions of perfusion of major arteries = nonocclusive ischemia rare to have ischemia in rectum, since it has collateral supply via rectal arteries

what are sx of excessive vasoactive intestinal peptide secretion (VIPoma)

watery diarrhea, hypokalemia, achlorhydria (pancreatic cholera) --> WDHA syndrome vip stimulates pancreatic bicarb and chloride secretion binding to intestinal epithelial cells leads to adenylate cyclase activation and increased cyclic amp production --> Na, Cl, H2O secretion into bowel (secretory watery diarrhea, often >3L/day) diarrhea does not have blood, poss, and does not improve with diet (e.g. osmotic, like lactose intolerane)

sx of lead poisoning in adults

weakness abdominal pain constipation headache, cog sx, peripheral neuropathy blue lead lines at junction of teeth and gingivae basophilic stoppling of peripheral blood smear (abnormal degradation of rRNA due to lead induced inhibiton of nucleotidase) --> hypochromatic microcytic anemia --> inhibition of delta-ALA dehydratase; resultant rduced incorporaiton of Fe intoo heme

peptic ulcer disease and men 1 =

wermer syndrome

what is uniparental disomy

when a person receives 2 copies of a chromosome from same parent, no copy from other parents e.g. Pradder willi and angel syndrome

triad for congenital rubella

white pupils sensory neural deafness pda

how to tx tca overdose heart findings

widened qrs interval or ventricular arrhthmias -> NaHCO3 increases serum pH (favors non ionized neutral form of drug, making it less accessible to bind to Na channels) NaHCO3 increases extracellular Na concentration --> overcome competitive, rapid Na channel blockade induced by TCAs

what will o2 disassociation curve look like if hemoglobin is monomeric

will look like myoglobin curve --> hyperbolic oxygen disassociation curve

free wall rupture: time course and sx

within 5-14 days sx: pericardial tamponade, JVD, distant heart sounds

why not bzd to tx deliriuim

worsen confusion esp in elderly only if delirium due to alcohol/bzd withdrawal

what stains platelets

wright's stain color platelets purple

where does heparin operate

xa and iia (thrombin) ptt and tt will be prolonged theoreticaly pt should also be prolonged, but not seen in lab (heparin reagent neutralize minimize this effect)

what enzymes inactivate azathioprine

xanthine oxidase thiopurine methyltransferase

what is the disease in which nucleotide excision repair is damaged

xeroderma pigmentosum severe photosensitivy, development of skin cancer at young age

histoplasma morphology

yeast form in body micro: oval yeast cells within macrophages

what is macula

yellowish spot approx 1.5 mm in diameter located near center of retina prescence of densely packed cones few overlying cells, no blood vessels each macular cone --> single bipolar cell --> single ganglion cell the visual acuity in macula (and fovea) > any other retinal area neural fibers that serve macula transmit to area of occiptal visual cortex, separate from area of representation of peripheral fields (leads to macular sparing if lesion in occiptal cortex)

does excess ACTH from paraneoplastic source lead to hypercortisolism

yes b/c of co-secretion of alpha-MSH (melanocyte stimulating hormone); ACTH and MSH both derived from POMC direct stimulation of MC2R receptor on melanocytes by ACTH

can mumps caus aspetic meningitis

yes but not in immunized child mumps is accompanied by parotitis in 50% o cases

can you get hypotension from digoxin

you can - bradyarrythmias and severe V/D leading to hypovelmia h/e it is also a positive inotrope --> increased CO hypotension variable

what do metalloproteinases do

zinc containing enzymes degrade copmonents oc ECM essential for proper tissue remodeling during wound healing

when do you get rugal thickening with acid hypersecretion

zollinger ellison syndrome

timeline of micro changes after MI

0-4 hrs: minimal change 4-12 hrs: early coag necrosis, edema, hemorrhage, wavy fibers 12-24 hrs: coag necrosis, marginal contraction band necrosis 1-5 days: coag necrosis, PMN infiltrate 5-10 days: macrophage phagocytosis, neovascularization 2 weeks-2 months: collagen deposition/scar formation

describe inflammatory process of lobar pneumonia congestion, red, gray, resolution

1. congestion (0-2 days): PMN respond to bacterial components, release cytokines, increase permeability of pulmonary capillary endothelium --> accumulation of RBCs and abundant proteinaceous fluid in alveolar space. lobe becomes heavy and red. 2. red hepatization (2-4 days) - protenaceous fluid transforms into fibrin, confluent exudate of fibrin, PMN, RBCs. liver like lobe. Red, firm, airless. 3. gray hepatization (4-7 days) - RBC disintegration, increased leukocyte infiltration --> Gray > Red. PMN replaced by macrophages. 4. resolution (>7 days) - Macrophages secrete digestive enzymes that liquefy fibrinous exudate. reabsorbed, expectorated, phagocytozied by macrophages. Lung parenchyma regains normal appearance by 3 weeks.

what becomes compressed in transtentorial herniation

1. ipsilateral CNIII (down, out, ptosis) 2. ipsilateral PCA (contralateral homonymous hemianopsia, macular sparing) 3. compression of contralateral cerebral peduncle against tentorium --> damage to contralateral corticopsinal tract leads to ipsilater hemiparesis. compression of ipsilateral cerebral peduncle --> contralateral hemiparesis 4. brainstem (duret) heomorrhages - occur in pons/midrain due to stretching and rupture of basilar artery. fatal

pulmonary and cns microvasc parenchymal dysfunctionin fat embolism syndrome due to

1. release of mediators from platelets which adhere to and coat fat emboli (thrombocytopenia) 2. systemic activation of lipoprotein lipase and intravasc release of toxic levels of oleic acid anemia due ot increased rbc aggreg and estruction --> pulm hemorrhage

steps of basement membrane penetration

1. tumor cells detach from surrounding cells with decreased expression of adhesion molecules like e cadherin 2. tumor cels adhere to bm, increased expression of laminin and other adhesion molecules 3. invade basement membrane via enhanced secreton of proteolytic enzymes (metalloproteinases, cathespin d, protease)

what is mortality rate of pulmonary anthrax

100% nearly

varicella vaccine recommendations

12-18 mo children women of childbearing age adults with sustained risk of exposure household contact of immunocompromised vaccine-induced immunity dissippates over time IgG ab do not confer immunity gainst latent irus in DRG

how does c diptheria toxin work

2 subunit AB exotoxin B (binding) binds specifically to heparin binding epidermal growth factor receptor on cardiac and neural cells B subuit induces endocytosis of toxin --> releases toxin A subunit A subunit inhibits host cell protein synthesis by catalyzing ADP ribosylation of protein elongation factor 2 (EF-2) Ef-2 necessary for tRNA to insert new AAs into growing protein chain during translation --> inhibits cell protein syntheiss acts locally, causing resp cell necrosis with formation of fibrinous, coag exudates

how/when to screen for down syndome

2nd trimester - quadruple screen at15-18 weeks gestation low AFP and unconjugated estriol levels - associated with DS and correlate with decreased fetal levels increased bHCG and inhibin a (secreted from placenta, possibly due to compensatory placental hyperfunction)

what is a type b adverse drug reaction

3 types: exaggerated sensitivty: predictable rxn occuring at lower than expected exposure (e.g. tinnitus after 1 aspirin dose) idiosyncratic: unpredictable reaction in certain patients (e.g. nonimmune hemolytic anemia with primaquine in g6pd) due to genetic differences or complex metabolism immunologic (drug allergy): unpredictable, specific immuno rxn (type 1-4 hypersens rxns)

what are ependymomas

3rd ost common brain neoplasm in cihldren arise in walls of ventriculi, hamper csf flow and cause hydrocephalus form gland like structures called rosettes

what is EML4-ALK NSCLC

4% patients with NSCLC have inversion of short arm of chromosome 2 --> fusion gene between EML4 (echinoderm mt associated protein like 4) and ALK (anaplastic lymphoma kinase get constit active tyrosine kinase, causes malignancy often young non smokers, adenocarcinma, lack mutations in EGF or Krase kinase activity is target of protein kinase inhibitor crizotinib

ebv and hiv

50% of systemic b cell lymphomas and almost all primary cns lymphoma

which abx act on 50 subunit. what about 30

50s: chloramphenicol, clindamycin, linezolid, macrolines 30s: tetracycline, doxycycline, aminoglycosides

what is the 68/95/99 rule

68% of all observations lie within 1 SD of mean 95% within 2 SD of mean 99.7% within 3 SDs of mean when considering normal distribution, exactly 95% of observations lie within 1.96 SDs of mean (z score) 99% lie within 2.58 SDs (z score)

what is azathioprine a prodrug of

6MP

when is Bhcg detectable in serum

8 days after fertilization

mutation in CML

9;22 (philadelphia chro) BCR-ABL fusion protein product - constitutively active tyrosine kinase that accelrates cell divison and increases genetic instability can be identiifed using RT-PCR (identify mRNA transcript containing both BCR and ABL exons in affected cells)

maintenance dose formula

= Cpss (steady state plasma concentration) X CL / [bioavailability fraction] = mg/min for IV drugs = bioavailability = 1 if you need to figure out dosing for a certain time period, multiply this by # hrs for dosing

time period for brief psychotic disorder

>1 day but <1 month full return to function

delusional disorder is

>1 delusion in absence of other psychotic sx (hallucinations, disorganized speech and behavior)

what do sarcoid granulomas produce

ACE 1,25 hydroxycholecalciferol (active form of vit D) so pts will have elevated ACE and hypercalcemia

what is first dose hypotension

ACE-I --> caused in patients with volume depletion (from diuretic use) or heart failure ACE-I causes abrupt removal of vasoconstrictive effects of AII --> decreased PVR and precipitous drop in BP in susceptible patients to avoid first dos hypotension, ACE-I should be initiated at low dosages

what is tuberous sclerosis

AD liver, kidney pancreatic cysts CNS involvement - cortical and subependymal HAMARTOMAS cutaneous angiofibromas (adenoma sebaceum), visceral cysts, variety of other hamartomas angiomyolipomas cardiac rhabdomyomas seizures major complication

what is tuberous slcerosis

AD cortical tubers and subependymal hamartomas in brain, with consequent seizure and cognitive disability cardiac rhabdomyomas, facial angiofibromas, leaf-shaped patchs of skin lacking pigment (ash-leaf patches)

what is brugada syndrome

AD mutation in cardiac Na or L type Ca channels lead to pseudo right BBB, ST segment elevation in leads V1-V3, increased risk of ventricular tachyarrythmias, sudden cardiac death

what is hereditary angioedema

AD condition painless, nonpitting, well circumscribed edema face, neck lips, tongue internal organs can be invovled: if affects tracheobronchial tree -> resp obstruction, fatal GI: abdominal pain, vomiting, diarrhea

what is nf2

AD nervous system tumor bilateral CNVIII schwannomas and multiple meningiomas

what does ADH do to urea

ADH increases urea reabsorption in medullary collecting tubules by increasing # of cell surface transporters strengthens osmotic gradient needed to produce maximally concentrated urine

what is genetic inheritance pattern of congenital adrenal hyperplasia (21 hydroxylase deficiency)

AR

what are genetics and sx of niemann pick disease

AR excess sphingomeylin -- enlarged, foamy, vacuolated cells on electron microscopy lipid-laden foam cells accumulate in liver and spleen (HSM) and CNS (hypotonia, neurodegen) after a period of normal development, infants fail to attain new skills and low previously acquired milestones get cherry-red macular spot death occurs by age 3

what is mutation of chediak-higashi syndrome

AR immunodeficiency (defect in pmn phagosome lysosome fusion --> abnormal giant lysosomal inclusions that are visible on light microscopy of peripheral blood smear), albinism, neuro defects (nystagmus, peripheral and cranial neuropathies) recurrent pyogenic infections (staph, strep) abnormal melanin storage --> partial oculocutaneous albinism

what are sx and genetics of metachromatic leukodystrophy disease

AR arylsulfatase a deficiency cerebroside sulfate accum sx: progressive neurodegeneration, peripheral neuropathy

what is alkaptonuria

AR disorder of tyrosine metabolism deficiency of homogentisic acid dioxygenase blocks homogentisic metabolsim, preventing conversion of tyrosine to fumarate homogentisic acid accumulates in body and is excreted in urine, imparting black color to urine if allowed to sit and undergo oxidation retained homogentisic acid selectively binds to collagen in connective tissues, tendons, cartilage leads to ochronosis (blue/black pigmentation in ears, nose cheecks) and ochronotic arthropathy (manifests in adulthood)

what are sx of primary ciliary dyskinesia

AR, mutation in proteins responsible for normal flagellar and ciliary structure/function upper and lower resp tract infections (impaired mucociliary clearance) chronic cough chronic sinusitis recurrent otitis media bronchiectasis (permant abnormal airway enlargemnet) situs inverusus (randomization of left, righ body asymmetry infertility due to impaired function of sperm flagella (men) and immobility of fallopian tube cilia (women)

most common causes of spontaneous intracranial hemorrhage in young adults

AV malformations ruptured cerebral aneurysms sympathomimetic drugs (cocaine)

MoA of omalizumab

Anti-IgE ab inhibits IgE binding to mast cells good for those with severe persistent asthma to lower IgE levels and improve allergen induced bronchial constriction

if left gastric vein has increased pressure due to portal htn, what is result

BOTH gastric and esophageal varices

what do you think of if immunohisto stain of tumor is positive cd31 and is assoc w/ past arsenic or polyvinyl chloride exposure

CD31 = PECAM1 platelet endothelial cell adhesion molecule arisen from vasc endothelial cell liver angiosarcoma (vasc endothelial cell) associated with carcinogen exposure associated with arsenic (exposure to pesticides), thorotrast (former radioactive contrast medium), polyvinyl chloride (plastic widely used in industry)

how to calculate confidence interval of mean, where 95% is observation

CI of mean = mean +/0 1.96 (SD/sqrtn))

what innervates muscles of mastication

CNV3 mandibular division of trigeminal nerve (middle ear and muscles of mastication)

what supplies motor innervation to tongue

CNXII (palatoglossues muscle innervated by CNX, only exception)

sx of multiple myeloma

Calcemia (hyper) --> due to bone destruction. Fatigue, confusion, constipation Renal failure - infiltration of kidney by plasma cells, deposition of amyloid. bence-jones casts in tubules, hypercalc --> mets calc; inflammation by macrophages and giant cells Anemia (normocytic, normochromic) Bone resorption (Il-1 and Il-6 secretion by neoplastic cells, activates osteclasts -> osteopenia). punched out lytic lesions on xray Infection - monoclonal Ig by abnormal plasma cells impairs normal Ig.M protein (monoclonal Ig) in serum and monocloncal light chains (Benc-Jones) is characteristic. HyperIg --> rouleux formation and increased ESR (amyloid due to accumulation of monoclonal Ig light chains. contributes to renal failure, heart, tongue, nervous system)

what lab finding would you expect in patient with primary hyperaldosteronism (aldosterone producing tumor eg)

DECREASED renin increased aldo

southern blots used to identify

DNA radiolabeled dna probe containing a sequence complementary to an area of interest used for hybridization restriction site mutations can be detected by southern blotting b/c alter dna fragment lengths, altering electrophoresis migration patterns

what happens in menopause with hormones

FSH levels increase due to resistant ovarian follicles and lack of feedback from inhibin estradiol and progesterone levels decrease serum estradiol not reliable indicator of menopause due to typical fluctuations and gradual dcline after menopause: estrone is produced outside ovaries and replaces estradiol as predominant circulating estrogen

if h pylori - atrophic gastritis involving body and fundus, what cells lost

G cells and decreased gastric acid production at inrcreased risk for gastric adenocarcinoma

FF =

GFR (which can be estimate by inulin or Cr)/RPF (which can be estimated by PAH) typical ff = 20%

what happens when afferent arteriole is constricted

GFR and RPF both decrease FF remains unchanged

ceftriaxone used for

HAS POOR ANAEROBIC ACTIVITY h flu klebsiella neisseria serratio

what lab finding would you expect in patient with secondary hyperaldo (renovasc htn, malignant htn, renin tumor, diuretic use eg)

HIGH renin HIGH aldo

what dx do you expect in patient with AIDS patient with progressive cognitive decline

HIV associated dementia cd4<200 subcortical dementia (attention/working memory problems, executive dysfunction, slow info processing) hiv affects subcortical/deep gray matter pathogeneiss: inflammatory activation of microglial cells hiv infected monocytes cross BBB to become perivascular macrophages activated macrophages and microglial cells form groups around areas of necrosis, fuse to form multinucleated giant cells neuronal damage occurs from inflammatory cytokine release by macro/microglial cells, direct toxic effects if hiv proteins

intranuclear acidophilic inclusions characeristic of

HSV

pt with microangiopathic hemolytic anemia, thrombocytopenia, AKI

HUS

when do you get flaccid bladder (where is lesion)

LMN (e.g. cauda equina) large residual volume after attempted emptying; urinary incontinence at end of day (full bladder > urinary sphincter pressure)

sx of ALS

LMN: muscle weakness, atrophy, fasciulation UMN: spasticity, hyperreflexia, path reflexes

stab found in fourth intercostal space in midclavicular line would strike

LV only after passing thru bulk of left lung

if chest pain, diaphoresis, palpitations/tachy, what is on differential

MI aortic dissection/rupture - more tearing pain, radiates to back pe - dyspnea tension pneumothorax - dyspnea

what are structures derived from neural crests

MOTEL PASS melanocytes odontoblasts tracheal cartilage enterochromaffin cells laryngeal cartilage parafollicular cells of thyeroid adrenal medulla and all ganglia schwann cells spiral membrane

heart findings post rheumatic fever

MR within first few decades of life mitral stenosis also occurs, but generally middle age (diastolic; opening snap, delayed rumbling mid-to-late diastolic murmur), heard best at cardiac apex mixed mitral disease (stenosis and regurg) in older patients

what is optic neuritis associated with

MS causes monocular vision loss over several weeks with painful eye movement afferent pupillary defect with hyperemia and swelling of optic disc on funduscopy

what is fastest conduction speed to slowest conduction speed in heart

Mnemonic: Park At Venture Avenue (fastest to slowest) Purkinje (2.2 m/sec) Atrial (1.1 m/sec) Ventricular (0.3 m/sec) AV (0.05 m/sec)

MoA and resistance to ethambutol

MoA: inhibition of arabinosyl transferase resistance: increased activity of enzymes involved in cell wall polysaccharide synthesis

what is von recklinghausen syndrome

NF1 inherited pns tumor syndrome fibromos, optic nerve gliomas, lisch nodules (pigmented noduls of iris) and cafe au lait spots

how to calculate number needed to harm

NNH = 1/absolute risk increase absolute risk increase = adverse event rate in tx group - control group

how to calculate nnt

NNT = 1/absolute risk reduction

does cryptococcus form hyphae

NO

are CAAT or TATA enhancer regions

NO they are txn promoter sites

where do direct inguinal hernias pass

NOT thru deep inguinal ring pass only thru superficial inguinal ring covered only by external spermatic fascia, in contrast to indirect inguinal hernias, which are covered by all 3 spermatic fascial layers

anaerobic glycolysis, what product is made to continue energy production

Nad+ regenerated from nadh when pyruvate --> lactate

what do you suspect if patient has contenital telangiectasis, and rupture of them causes epistaxis, GI bleeding, hematuria

Osler-Weber-Rendu (hereditoary hemorrhagic telangiectasia) AD

which substances have concentrations that increase as fluid runs along PT

PAH* (90% secretion) creatinine* (20% in pos glomerular capillaries secreted in PT, and in low plasma concentrations) inulin* (not secreted into renal tubules) urea (freely filered from glomerular capillaires, poorly reabsorbed from PT, less so than PAH or inulin. renal hanlding varie throughout different tubular systems, ultimately secreted in very high concentrations) (solutes are secreted, or nonreabsorbable) * = rapidly increasing concentration in tubular fluid. substances that behave in this fashion are freely filtered from glomerular capillaries and are poorly reabsorbed from PT. H2O reabsorbed faster than these substances

what do beta blockers prolong on ecg

PR interval it is the period from beginning of atrial depol to beginning of ventricualr depol longer pr interval --> longer it takes for electrical stimulus to travel from SA node to ventricles via AV node, bundle of his, fasicular branches BB slow AV nodal conduction --> increased AV nodal refractory period --> correlated to PR interval prolongation on ECG

tx for post herpetic neuralgia

TCA (decrease reuptake of HT and NE; inhibit pain signals) anticonvulsants (decrease depol of neurons in CNS) lidocaine (decrease depolarization of neurons in peripheral nerves) topical capsaicin (loss of membrane potential in nociceptive fibers, depletes substance p)

what are gram negative, lactose non fermenters, oxidase negative

TSI agar, no H2S production: shigella TSI agar, H2S production (black): salmonella, proteus

WPW vs reentrant tachy

WPW: acessory pathway pre-excited ventricles ahead of normal conduction pathway --> pre-excitation result is a shortened PR interval, with early upslope (delta wave) at start of each QRS complex, and widened QRS interval -- widened QRS converts to narrow QRS during tachyarrythmia b/c accessory pathway no longer pre-excited the ventricles, but instead forms a re-entrant circuit back to the atria

what do you think of if you have male sex, family history of hemarthrosis (in a maternal male relative) suggests

X linked coag like hemophilia A or B also think of in sx of intramuscular hemorrhage, hemarthrosis, prolonged or delayed bleeding after surg procedures

what are sx and genetics of fabry disease

XLR alpha galactosidase a deficiency ceramide trihexoside accumulation (globotriaosylceramide) sx: neuropathic pain angiokeratomas in adolescence and multi-organ involvement (renal, CV, cardiac) in adulthood

how long does it take for immune system to gear immune system up to target TB

a few weeks

tx of anaphylaxis

a1 receptors - counteract vasidilation of cutaenous and viscera vasc, increase BP b1 - increased contractility and CO, improve perfusion b2 - increase bronchodilation

what does adenosine do

a1 receptors on cardiac cels and activates K channels, increase K conductance transient conduction delay thru AV node causes peripheral vasodilation

what artery supplies the liver describe branches it originates from

abdominal aorta --> celiac trunk--> common hepatic --> proper hepatic

what happens if lateral body folds do not develop/close

abdominal contents herniate thru ventral wall defect --> omphalocele, gastroschisis

sx of epithelial ovarian cancer and tumor marker

abdominal distension, ascites, pleural effusion, bowel obstruction, decreased appetite, weight loss, ovarian mass CA-125 (protein produced by ovarian epithelia -- markedly elevated in cancerous ovarian cells compared to normal cells)

how does a fib occur

aberrrant electtial impulses that arie within regions of heightened atrial excitability (pulm veins) once triggerd, af --> electrical remodeling of atrai and development of shortened refractory periods and increeased conductivity creation and persistance of multiple eectopic forci and reentrant impulses within the atria --> increase risk and chronicity of subsequent episoders (AF --> AF)

what does it mean for virs to be infectious

able to induce viral protein sythesis and genome replication in host cell

what are ventricular response in AF dependent on

abnormal atrial impulses thru AV node each time AV node is excited, enters refractory period during which additional atrial impulses cannot be transmitted to ventricules SO AV node refractory period regulates ventricular contraction most atrial impulses never reach ventricles usually 90-170 bpm atrial excitation is chaotic, ventricular rate is rreg, no set intervals between contractions

what are AV fistulas

abnormal communication between an artery and vein, bypasses arterioles (major resistance source) av shunts allow blood under arterial pressure to directly enter the venous sytem can be congenital or acquired increase preload and decrease afterload high volume av shunts can eventually result in high output cardiac failure physical exam: pulsatile mass with a thrill on palpation; auscultation: constant bruit over site

what causes anorectal hemorrhoids

abnormal distension of anal areriovenous plexus, which normaly forms the anal cushions (venous sinusoids and connctive tissue) that are important for maintaining fecal continence chronically increased venous pressure to straining/breakdown of supprotive tissue --> cushions bulge into canal, become inflamed, thrombose, prolapse

what is tardive dyskinesia

abnormal involuntary movements of mouth, tongue, face, extremitis, trunk assoc with prolonged exposure to antipsychotics (development of supersensitivity of post synaptic d2 receptors following prolonged d2 blockade, imbalance between d1 and d2 receptor mediated effects) lip smacking, facial grimacing, tongue protrusions, choreoathetoid mvmts of head, limbs, trunk

what is venous drainage of internal hemorrhoids

above dentate line superor rectal vein --> IMV (to portal system)

describe ecg of a fib

absent p waves irreg irreg rr intevals narrow qrs rapid, irreg, low amplitude fibrallatory waves are also frequently seen and represent chaotic, ocntinous atrial depolarization

why is sublingual nitro so fast with onset of action

absorbed directly from oral mucosa into venous circulation has higher bioavailability

tx of c perfringes

abx, emergent debridement prognosis is oor tissue loss consdierable

what are the most common breast anomalies in women and men

accessory nipples (polythelia, supernumerary nipple) due to failure of involution of mammary ridge occur anywhere along embryonic nipple line between axilla and perineum, bilateral in 50% of patients

confidence interval

accounts for variabiility due to sampling by including the SE in its calculation CI of mean = mean +/- [z core for confidence level] X SE

what do aminoglycoside abx do to kidney

accumulate within renal cortex, cause acute tubular necrosis proximal tubular vacuolar degeneration is usually seen

why greenish hue in HCC

accumulation of bile secreted by well-diffentiated hepatocytes

components of informed conset

accute description alternative tx risks/benefits patient's understanding and preference answer all of patient's ?s

what happens to renal arterioles initially when you give ace-i and gfr

ace preferentially vasoconstricts efferent give ace-i --> dilation of efferent --> decrease gfr also decrease in SVR also leads to reduction in GFR

what can tx acute angle closure glaucoma

acetazolamide CA present in eye tissues. modulates hco3 formation in aqueous humor. inhibiting ca will decrease hco3 and aqeous humor formation --> used to relieve intraocular pressure in open and angle closure glaucoma

what is n acetylcysteine used for

acetominophin overdose (sx: n/v lethargy, hepatotox, nephrotox) NAC - reduce acetominophen induced liver injury; restore hepatic glutathione stores

path of mucormycosis

acquired by spore inhalation ascends from nasal passage to sinuses/orbits, then sometimes to brain, leading to confusion, neuro deficits, death

what do nitrates do

activate guanylate cyclase and promote conversion f guanosine triphosphate to cGMP --> dephosphorylationof myosin light chains, causes vasc smooth muscle relaxation primarily affect large veins (venodilation) --> decrease preload --> decrease myocardial oxygen demand

describe process of horizontal conjugate gaze

activation of frontal eye field in cortex projects to contralateral PPRF sends efferents to ipsilateral CN VI at level of facial colliculus in dorsal pons CNVI projects to ipsilateral rectus muscle (abduct eye) and contralateral medial rectus nucleus of CNIII (adduct eye) via MLF

what do lab findings in hereditary angioedema look like

active kallikrein and bradykinin levels increased bradykinin, c3a, c5a mediate angioedema by increeasing vasodilation and vasc permeability levels of c4, substrate for c1 esterease, low)

how to differentiate acute/chronic graft rejections following host t and b cell sensitizaton against graft mhc ag VS GVHD

acute and chronic graft rejections occur following host t and b cell sensitization against graft MHC antigens immune response leads to graft failure WITHOUT significant involvement of other organ systems

what is orthopnea

acute exacerbation of baseline pulm edema, occurs when central venous, pulm venous, and cardiac filling pressures are increased by redistribution of blood that had been pooled in dependent veins back into central circulation

what is stress related mucosal disease

acute gastric mucosal defects develop in response to severe physio stress (shock, extensive burns, sepsis, trauma, intracranila injury) multiple, small, circular lesions in stomach range from superficial to full thickness ulcers can perforate or bleed

what is most comon presenting sx of postprocedure atheroembolism

acute kidney nijury (oliguria, azotemia) elderly pats with preexisting renal atherosclerosis other organs commonly affected: GI, CNS, retinal

triad for fat embolism syndrome

acute onset neuro abdominalities hypoxemia petechial rash

sx of acute HSV encephalitis

acute onset of headache, fever, mental status changes, cranial nerve deficits (bell's palsy), seizures temporal lobe damage: receptive apasia and personality changes (hypersexuality, aggreg) inflammation of brain parenchyma

what causes TM infarct

acute plaque change which produces superimposed thrombus, completely occludes involved coronary artery

what can scarlet fever predispose you to

acute rheumatic fever GN

when do you see dilation of sinusoids/perivenular hemorrhage

acute venous outflow obstruction of liver (budd chiari)

immune histo findings in acute vs chronic gastritis

acute: inflammatory infitlrate mostly PMNs chronic: lymphocytes, lymphoid follicles, plasma cells biopsy specimens - curved or spiral shaped bacilli

signs of patella fracture

acutely swoellen knee focal patella tenderness inability to extend knee against gravity palpable gap in extensor mech

what does obturator nerve innervate

adductor muscles of thigh and skin of medial aspect of thigh

what deficiency exists in severe combined immune deficiency

adenosine deaminase

paraventricular nucleus regulates

adh, crh, oxytocin, trh

cushing syndrome sx. what do you suspect if acth levels are suppressed

adrenal adenoma/malignancy or exogenous

when do you see way casts

advanced renal disease (chronic renal failure) shiny, translucent tubular structres, formed in dilated tubules of enlarged neprhons that undergo compensatory hypertrophy in response to reduced renal mass

what mosquito transmits dengue

aedes aegypti

describe path of mhc i and viral ag presentation

after penetrating cell, virus uncoats and releases core proteins viral polypeptides are processed in host cell cytoplasm and combined with mc class i in ER foreign ag is then presented in assoc with mhc class i protein --> cd8 lymphocytes that cell needs to be destroyed infected cell eliminated via apoptosis

what is macular degeneration

age related most common cause of blindness in patients > 50 y/o progressive loss of central vision, due to deposition of fatty tissue (drusen) behind retina (dry MD) and neovasc of retina (wet MD)

how to prevent hemorrhagic cystitis due to cyclophosphamide

aggressive hydration adn mesna mesna (2 cercaptoethanesulfonate) - sulfhydryl compound that binds and inactivates the toxic metabolites of chemo agents in urine

erythromycin gi side effects due to

agonist at motilin in stomach and duodenum, contributing to gi side effects

clozapine side effects

agranulocytosis and seiures

why lung hyperinflation in COPD

airflow restriction --> compensatory lung hyperinflation widen airways, improve airflow hyperinflation reduces IRV, limiting max tidal volume COPD patients require extra time for exhalation, increasing amounts of air can become trapped in lungs during rapid breathing --> further reduction in tidal volume --> dynamic hyperinflation major cause of dyspnea and exercise limitation in COPD

what is sturge weber syndrome

aka encehpalotrigeminal angiomatosis rare, congenital neurocutaneous disorder cutaneous facial angiomas, leptomeningeal angiomas mental retardatio, seizures, hemiplegia, skull radiopacities tram track calcifications of skull

tx of cystercercosis

albendazole

how to screen for early stage diabetic nephropahty

albumin specific urine dipsticks

what drug withdrawal if tremors, agitation, anxiety, delirum, psychosis pe: seizures, tachy, palpitations

alcohol get htn within 12-24 hrs

what are risk factors for esophageal squamous cell carcinoma

alcohol tobacco n nitroso containing foods (preserved, pickled veggies) underlying esophageal disease (achalsia, prior injury) betel nuts high temp liquids

what are causes of dilated cardiomyopathy. what kind of heart failure results

alcoholic doxorubicin selenium viral systolic dysfunction (increased LV volume and shifting of LV PV curve to right due to thinning of ventricular wall/increased compliance

why does significant extracellular fluid volume expansion not occur in primary hyperaldo?

aldosterone escape it limits edema and hypernatremia the htn and increased blood volume increases rbf, gfr, and anp --> na excretion (natrieuresis)

what is conn syndrome

aldosterone producing adenoma appear as well-defined yellow tumor

if lesion in spleniumof corpus collosum, can get

alexia w/o agrpahia

what is MoA of formaldehyde and glutareldhyde

alkylate and cross link dna and proteins sterilize instruments that cannot withstand autoclave temp

what is splitting

all bad or all good all or nothing thinking unable to integrate pos and neg qualities of self or others into a cohesiv/realist whole splitting is common in borderline personality disorder, can contribute to unstable relationships and mood instability

causes of acute interstitial nephritis

allergic inflammation of kidney fever, rash, eosinophilia nsaids, penicillins, cephalosporins, diuretics, allopurinol

what happens when you combine allopurinol and 6-mp

allopurinol is a xanthine oxidase inhibitor xanthine oxidase degrades 6mp so therefore, conc of 6mp will decrease (chemotherapy dose of 6mp will need to be reduced by 75%) allopurinol does not impact 6-thioguanine in same way

what is phenylephrine

alpha agaonist some selectivity for a1 receptors

structure of mhc class ii

alpha and beta polypeptide chains

serum tumor marker for HCC

alpha fetoprotein normally produced by fetal liver and yolk sac during gestation moderately elevated in patients with chronic liver disease, but v elevated in HCC

clonidine moa

alpha2 agonist decreases BP, decreases CNS outflow

what does clonidine do

alpha2 reeptors in brainstem reduced sympathetic outflow from CNS --> decrease PVR, HR, BP no effect on contractility

what is a cutaneous, strawberry type, capillary hemangioma

also called juvenile hemangioma consist of unencapsulated aggregates of closely packed, thin walled capillaries multiple, found in skin, bucut, oral mucosa, lips also occur in liver, spleen, kidneys present at birth, grow in proprotion to child

what does somatostatin do

also known as ocreotide decrases production of vip, gastrin, glucagon, cck

hypocapnia implies

alveolar hyperventilation

MoA of streptomycin

aminoglycoside widespread resistance, so only for TB, plague, tularemia only IV interferes with 16s rRNA of 30S ribosomal subunit, thereby preventing bacterial protein synthesis

abx resistance mechanism for aminoglycoside

aminoglycoside modifying enzymes mutated ribosomal subunit protein (methylation, inhibits ability of aminoglycosides to interfere with protein trnalsation) mutated porin protein (efflux pump that decreases drug's concentration)

what is drug that lengths QT interval but does not increase risk of torsades that much

amiodarone has a more homogenous effect on venricular repolarization compared to other drugs (less QT dispersion)

what is inulin clearance like in kidney

amount excreted = amount filtered (no tubular reabsorption or secretion) used to calculate glomerular filtration rate

what is pah clearance like in kidney

amount excreted > amount filtered tubular secretion used to calculate renal plasma flow

when drug metabolism occurs via 1st order kinetics, half life is

amount of time required to lower drug concentration by 50%

tx for listeria

ampicillin

what cancer has ALK oncogene mutation

anaplastic large cell lymphome non small cell lung it is an oncogene (anapolastic lymphoma kinase) that codes for TM receptor tyrosine kinase

southwestern blot for

anayzing dna-binding proteins mix of southern and western blot recognized by ability to bind specific ligonucleotide probes

what has low alpha fetoprotein

aneuploides (trisomy 18, 21)

what is an acute increase in intraocular pressure associated with

angle closure glaucoma - painful monocular vision loss, headache, vomiting, conjunctival injection with poorly reactive mid dilated pupil open angle glaucoma results in progressive, painless, bilateral vision loss with optic disc cupping

classic findings in DKA

anion gap metabolic acidosis fruity breath AMS dehydration abdominal pain tachypnea hyperglycemia ketosis mild hyponatremia normal/elevated serum K increased plasma osmolality

where to ablate for atrial fib

another area, besides AV node opening of pulm vein in LA area is target for radiofrequency ablation

what are sx of hemolytic uremic syndrmoe

antecedal diarrheal illness, often bloody platelet consumption --> thrombocytopenia microthrombi lead to erytrocyte damage --> schistocytes hemolytic anemia -- pallor, weakness, tachy damage to glomerular endothelial cells --> AKI (oliguria, anuria, increases Cr) in approx 50% of cases caused by e oli o157:h7 or shigella dysenteria. shiga toxin enters circulation from bowel and induces capillary endothelial damage

what does red nucleus do and where is it

anteiror midbrain participates in motor coordination of UE

what is most common site of acute compartment syndrome

anterior

what supplies general sensory innervation (touch, pain, temp, etc)

anterior 2/3: CNV3 (mandibular branch) poster 1/3: CNIX posterior area of tongue root: CNX

what supplies taste sensation of tongue

anterior 2/3: chorda tympani br of CNVII posterior 1/3: CNIX posterior area of tongue root and taste buds of larynx/upper eso: CNX

where do saccular aneurysms usually forma nd what are sx

anterior and posterior communicating arteries ACA: compress optic chiasm --> bitemporal hemianopia PCA: compress oculomotor nerve, ipsilateral mydriasis, ptosis, down and out eye

what is path of piriformis

anterior aspect of sacrum, occupies most space of greater sciatic foramen inserts on greater trochanter of emur, externally rotates thigh when extended and abduct thigh when flexed superior gluteal vessels and superior gluteal nerve run above piriformis below piriformis: inferior gluteal vessels, internal pudendal vessels, multiple nerves (sciatic nerve)

what stabilizes ankle laterally

anterior inferior tibiofibular anterior talofibular posterior talofibular calcaneofibular ligaments

what are MEN 1 characteristics

anterior pituitary adenomas primary hyperparathyroidism (PTH adenomas or hyperplasia) neuroendocrine tumors of pancreas/ GI tract (gastrinoma, insulinoma) more frequent: adrenocorticol adenomas, neuroendocrine thymomas due to mutation in MEN1 gene NOT ASSOC WITH MEDULLARY THYROID CARCINOMA

what is at risk of injury if you have penetrating trauma at left sternal border

anterior surface of heart, mostly RV skin and subcutis pectoralis major external intercostal internal intercostal internal thoracic a and veins transversus thracis muscle parietal pleura pericardium RV myocardium &pleura would be injured but left lung would not be punctured, no middle lobe on left side and superior lobe of left lung is displaced laterally by cardiac impression

what kind of TM MI if v1-v3 and i, avl affected

anterior v1-v3 lateral i, avl anterolateral thrombus may be completely occluding left main coronary artery

what else do lipids do

anti inflammatory properties, improve endothelial dysfunction, stabilze atherosclerotic plaques

dx for pbc

anti mitochondrial bodies in serum

what are the drugs associated with osteoporotic fractures

anticonvulsants that induce cytp450 (phenobarb, pheny, carbamazepine) --> increase vit d catabolism aromatase inhibitors, progesterones --> decrease strogen gnrh agonists --> decrease testosterone and estrogen ppis --> decrease Ca absorption glucocorticoids --> decrease bone formation (increase osteoclast diff and avticity, decrease osteoblast, inhibit gi ca abs)

trazodone AEs

antidepressant depression-related insomnia priapism anticholinergic effects

what can clomiphene be used for

antiestrogen stimulates ovulation by blocking feedback inhibition of estrogen on hypothalamus, enhancing release of pituitary gonadotropins best used to achieve fertility with ovulatory failure who are normogonadotropic, normoprolactinemic, euthyroid

MoA of flucytosine

antimetabolite transformed into 5FU in fungal cell wall, inhibits protein synthesis by replacing uracil with 5-FU in fungal mRNA

what is oxybutynin

antimusc agent, used for urge incontinence (detrusor overactivity)

what are virulence factors of bacillus anthracis

antiphagocytic poly-y-d-glytamic acid capsule anthrax exotoxin - trimeric toxin composed of protective ag, edema factor, lethal factor (zinc dependent protease, inhibits mitogen activated protein kinase signaling, causing apoptosis, multisystem phsio disruption) protective ag functions to translocate both edema and elthal factor into cytosol neither toxin can take effect w/o protective ag once inside cell, edema factor acts as calmodulin-dependent adenylate cyclase, increases cAMP concentration get accumultion of fluid within and between cells, suppresion of PMN and macrophage

what is anticardiolipin ab mean

antiphospholipid ab syndrome - unprovoked/recurrent arterial and venous thrombosis or recurrent spontaneous abortions

what is interferon b

antiviral cytokine decreases inflammatory cell movmenet across BBB can be used to tx MS

what do you suspect if coronary sinus is dilated

any dilation of RA will cause coronary sinus to be dilated elevated right sided heart pressure due to pulm htn (also those with anomalous venous drainage into CS, persistent left SVC and total anomalous pulm venous return)

what does reduced compliance look like on a volume vs pressure curve

any given volume, pressure will bei ncreasd volume lower at same pressure

what decreases risk of epithelial ovarian cancer

anything that decreases frequency of trauma and repair at ovarian surface OCPs, multiparity, breastfeeding, salpingo oopherectomy protetive b/c they decrease frequency of ovulation

where can cn3 disruption occur

anywhere along nerve's path, from oculomotor nucleus in midbrain to extraocular muscles within the orbit actively enlarging intracranial aneurysm - risk of imminent rupture

what causes left sided varicoceles in healthy pubertal men

aorta and SMA can compress the left renal vein --> increased intravasc pressure in left gonadal vein with retrograde blood flow and varicocele formation

complication of parvovirus b19

aplastic crisis in SCD and immunocompromised

apocrine vs eccrine sweat glands

apocrine: catecholamine eccrine: cholinergic BB can modulate eccrine activity and reduce emotionally driven (anxiety) stimulation of eccrine sweating

how do cytotoxic t lymphocytes kill foreign pathogens

apoptosis intrinsic (mitochondria mediated) extrinsic (receptor initiated) both pathways converge in activation of caspases, which are proteolytic enzymes that cleave cellular proteins

path of aqueous humor production in eye

aqueous humor produced by epithelial cells of ciliary body secreted into posterior eye chamber and transferred thru pupil into anterior eye change anterior chamber angle (iridocorneal angle) contains trabecular meshwork thru which aqueous humor diffuses into Schlemm's canal (scleral venous sinus) and into episcleral and conjunctival veins

what is foramen cecum and terminal sulcus

area dividing posterior 1/3 from anterior 2/3 of tongue

name some direct thrombin inhibitors

argatroban bivalirudin dabigaran (oral)

sx of acoustic neuroma

arises from vestibular portion of cnviii exists brainstem from pontomedullary junction, lateral to facial nerve, enters cerebellopontine angle (between cerebellum and lateral pons) ipsilateral sensorineural hearing loss and tinnitus (ringing/buzzing) due to impairment of cochlear portion of nerve damage to vestibular component may result in vertigo, dysequilibrium, nystagmus

where does sartorius muscle attach

asis

what insulin type has reversed lysine and proline residues at c terminal end of b chain

aspart, lispro, gluisline rapid insulin this structural change prevents polymerization, allows rapid absorption from injection site insulin analogs more closely replicate physio insulin and give better control of posrandial glucose, less risk of hypoglycemia

mucormycosis vs invasiv easpergillosis causing rhinosinusitis

asper: septate anrrow hyphae with sharp angle branching

what infection can result in eventual proximal bronchiectasis

aspergillus fumigatus allergic bronchopulmonary aspergillosis (ABPA) can result in transient recurrent pulmonary infiltrates and eventual proximal bronchiectasis

what neural cell forms glial scar

astrocytic processes

what does cerebral amyloid angiopathy cause

asx or may lead to recurrent intracerebral hemorrhage bleeds afffect small areas of cerebral hemispheres, present w/ headache and focal neuro deficits (paresis, sensory loss)

accessory nipples look like

asx, but may swell or become tender similar to normal breast tissue before or during menses, pregnancy and lactation hyperpigmentation, epidermal thickening, pilosebaceouss tructure, montogomery areolar tubercles, smooth muscle bundles (areola) and possible mammary glands and multiple ducts

how does wernicke encephalopathy present

ataxia, nystagmus, opthalmoplegia, anterograde amnesia

what causes intermittent claudiation

atherosclerosis of larger named arteries obstruction of blood flow results from fixed stenotic atheromatous lesions (lipid-filled intimal plaques, bulge into arterial lumen) --> ischemic muscle pain pain relieved by rest b/c residual blood flow is adequate to meet metabolic demands of resting muscle (claudication - muscle pain with excerrise that remits with rest)

what does normal aging do to neurons

atrophy gradual neuronal loss

what does exogenous thyroid ingestion look like in thyroid glnd

atrophy of thyroid follicles exogenous t4 suppresses tsh, decreases iodine organification and colloid formation

what is the PSIS

attachment site for sacrotuberous and posterior sacroiliac ligaments in iliac crest sacral dimples overlie posterior superior iliac spine, s2 vertebral level

what is mycobacterium kansaii

atypical mycobacterium similar disease to TB acid fast water contaminent

what is path of goodpaasture

autoAb against alpha 3 chain of type iv collagen found in gbm and pulmonary capillary membrane (anti-gbm ab) ab formation can be triggered by prior viral resp infection but most diopathic the ab inflamme/injure glomerular and alveolar bm --> glomerulonephriits and alveolar hemorrhage

what does graves disease do

autoab that bind to and activate tsh receptor (TRAb) triggers release of thyroid hormones --> thyrotoxicosis increased expression of beta adrenergic receptors in various organs --> subsequent hyperadrenergic state --> htn, tremor, heat intolerance, paliptations/tachy, hyerreflexia

what does direct coombs test show

autoimmune hemolysis

what is heparin induced thrombocytopenia

autoimmune phenomenon causes arterial and venous thrombosis produce skin findings like warfarin necrosis, but also have thrombocytopenia and recent heparin use

chronic gastriti with antral sparing

autoimune gastritis cd4 t cell mediated parietal cell destruction --> impaired gastric acid and intrinsic factor secretion --> achlohyrdria and pernicious anemia

micturation reflex

autonomic spinal reflex mediated by sensory and motor fibers from nerve centers at s2-s4 parasymp causes detrusor muscle contraction and internal urethral sphincter relaxation symp causes internal sphincter contraction and helps with sensing full bladder

what kind of raction is happening if there is cell body rounding, peripheral displacement of nuclei, disperson of nissl substance to periphery of cell

axonal reaction this occurs when axons become severd due to trauma --> injury causes specific changes in both proximal and distal segments of axon and neuronal body nissl substance becomes fine, granular, dispersed throughout cytoplasm (central chromatolysis) occurs 24-48 hrs after injury maximal changes occur 12 days after injury reflect increased synth of proteins by cells in order to degenerate severed axon

how to differentiate b vs t cell via immunohistochemistry

b cell: cd10, cd19, cd20 t cell: cd2, cd3, cd4, cd5, cd7, cd8

beta 1 blockers do what

b1 - heart and renal jg cells decrease heart rate and contractility, block cateholamine induced renin release by kidney

what ar risk factors for esophageal adenocarcinoma

barrett eso gerd obesity (b/c of increased acid reflux into esophagus) tobacco

what are bugs that cause culture negative endocarditis

bartonella, coxiella, mycoplasma, histoplasma, chlaymydia HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

what does DNA glycosylase do

base excision repair removes nitrogen base from sugar phophate backbone

what to test/monitor with hydroxychloroquine

baseline and regular follow up opthalmologic exams

what to test before giving mtx

baseline cxr and lfts

what does basilar artery suppl

basilar artery supplies large portion of brain, most of brainstem and bilateral cerebellar hemispheres

spread of rabies

bats 1st, raccoons 2nd virus travels retrograde via peripheral nerves to DRG --> brain (where replication occurs) then spreads to other organs via neural pathways

antiapoptic bcl 2 proteins

bclx and bcl2

describe stages of oocyte meiosis

begins at utero at 4 weeks gestation (primordial germ cells migrate from yolk sac to developing gonadal region) differentiate into oogonia, multiply by mitosis --> primary oocyte primary oocytes are completely developed in female embryos by 5th month of gestation --> arrested in prophase of meiosis i (chromosome pairs in tetrad, can undergo genetic recombination) normal menstrual cycle hormones (FSH, LH) stimulate primary oocyte to resume diffentiation (polar body degenerates) prior to fertilization, secondary oocytes are arrested in metaphase of meisosis ii during fertilization --> ovum and second polar body fertilized embryo diploid (ovum and sperm pronuclei)

how does atherosclerosis progress

begins in childhood development of focal intimal thickening due to accumulation of lipid-laden macrophages and ECM (fatty streaks) with age streaks become plaques advanced develop lipid rich core and areas of calcificaiton

what is venous drainage of external hemorrhoids

below dentate line (inferior rectal vein -->) internal pudendal vein -> internal iliac veins (to caval system)

what is acanthosis nigricans and acrochordons suggest about patient

benign - insulin resistance (increased insulin and IGF stimulate epidermal and dermal proliferation). e.g. DM, acromeg, obesity malignant - neoplasms (GI, GU); gastric adenocarcinoma most common cause occurs commonly in axillae, posterior neck, groin (flexural areas) -- appear on other areas too acrochordons = skin tags - pedunculated outgrowths of normal skin

what is mastocytosis

benign, pruritic infiltration of skin by mast cells more common in children scratching --> degranulation of mast cells and assoc urticaria --> severe flushing or syncope

what does seborrheic keratosis look like

benign, tan, brown epi tumor skin of middle aged or elderly indivudals found anywhere on body tumors --> variable appearance (macules raised, wart like, stuck on, greasy, velevety, well demarc border) rapid onset of numerous KS --> undiagnosd internal malignancy (leser trelat sign)

what drug withdrawal if tremors, anxiety, perceptual disturbances, psychosis, insomnia pe: seizures, tachy, palpitations

benzodiazepine

what are the most common causes of SAH

berry aneurysm = saccular occur at circle of willis, with ACA being most common also av malformations

what is dobutamine

beta adrenergic agonist predominant activity on beta 1 receptors (weaker activity on beta 2 receptors) minimal activity on alpha 1 receptors uses: refractory heart failure associated with severe LV systolic dysfunction and cardiogenic shock stimulates beta adrenergic receptors --> increased cAMP --> positive inotropy (contractility, major) and chronotropy (HR, minor) --> increases CO and decreases LV filling pressures mild vasodilation: decreased SVR, slight reduction in BP (can't use in severely hypotensive pts)

where does amyloid deposit in alzheimer

beta amyloid plaues early in disease found in medial temporal lobe (hippocampus, amygdala, entorhinal cortex) composed of central Abeta core, surrounded by dystrophic neurites AB can also occur in media/adventitia of cerebrl vessels (amyloid angiopathy) --> hemorrhage

what drug was used if it helped relieve tachycardia and chest pain, but precipated asthma/COPD exacerbation

beta blocker

which antiangial drugs have primary heart rate decrease effects

beta blockers nondihydropyridines (verapamil, diltiazem)

what causes abx reistance for penicillins

beta lactamase, extended spectrum beta lactamase mutated pbp mutated porin protein

what do you need to give to pregnant women at risk of premature delivery (<32 weeks)

betamethasone or dexamethasone help accelerate fetal lung maturation of type 2 pneumocytes by stimulating surfacant production prevent neonatal resp distress syndrome

which substances have concentrations that decrease as fluid runs along PT

bicarb glucose* amino acids* (solutes are reabsorbed) * avidly reabsorbed

turner syndrome, what heart defects

bicusid aortic valve aortic coarction

what are sx of NF2

bilateral acoustic neuromas multiple meningiomas, gliomas, ependymomas of spinal cord

where do neural crests come from

bilateral, paired strips of cells, arising from ectoderm at margin of neural tube

what cholesterol med leads to hypertriglyceridemia

bile acid resins (cholestyramine, colestipol, colesevelam) other AEs: GI upset, impaired absorption of nutrients and drugs increase hepatic production of TG and increase release of TG VLDL particles into circulation, leading to hyperTG

what are function of enhancer regions

bind activator proteins that facilitate bending of DNA DNA bending allows activator proteins to interact with general txn factors and RNA polymerase ii at promoter; increasing rate of txn they can be located upstream or downstream from gene being transcribed and may be near gene or thousands of bp away

mu opiods do what to bowel

bind mu receptors in bowel, slow gut motility

MoA of griseofulvin

bind polymerized MT, disrupt fungal mitotic spindle, prevent fungal cell mitosis only effective in dermatophytosis

when should you use class 1A antiarrythmic drugs

binds to Na channels in open state and are more specific for suppressing arrythmias arising from areas of normal automaticity (lidocaine is more specific to inactivated channels in ischemic myocardium) have significant K blocking ability, prolong action potential, increase risk of ventricular arrythmias (torsades)

what is imipenem

binds to PBPs, inhibit final step of peptidoglycan synthesis in bacterial cell walls can use cilastin in conj with imipenem b/c it prevents renal metabolism of impipenem, competitively inhibitng dehydropeptidase on renal tubule brush border

what does pentasaccharide sequence do

binds to antithrombin and causes a confo change that increases its ability to inactivate factor xa

what does lead do to body

binds to sulfhydryl groups on proteins, replaces Ca in Ca dependent cellular functions directly inhibit senzymes in heme synthesis

what is moa of anthracyclines (doxyrubicin) and major toxicity

binds with topoisomeraise ii to cleave dna (break dna, cause cell death) binds to Fe to generate free radicals toxicity: dilated cardiomyopathy - develop sx of heart failure weeks to years post tx; from anthracycline-toposisomerase 2 complex that forms in healthy cardiomyocytes. depends on dose received.

histo pattern of schwannomas

biphasic with high cellular areas (antoni a pattern) intermixed with myxoid regions of low cellularity (antoni b pattern) antoni a: spindle cells that form palisading patterns with interspersing nuclear free zones called verocay bodies s100 positive (due to neural crest orign)

which type of bipolar disorde rmore likely to get antidepressant induced mania

bipolar i disorder (manic episodes) greater risk than those with bipolar ii disorder (hypomanic and epressive)`

when do you give finasteride

bladder outlet obstruction due to BPH 5alpha reductase inhibitor; reduced DHT decreases prostate gland over 6-12 mo

what are osteoblastic metastasis

blastic = sclerotic due to osteblasts indicates more indolent course prostate cancer small cell lung cancer hodgkin

what does class iii antiarrhthmic drugs do

block K channels and inhibit outward K currents during phase 3 of cardiac action potential - prolong repolarization and total action potnetial duration

what does tca overdose do to heart

blockage of fast Na channels QRS and QT prolongation and cardiac dyrhthmias

MoA of vancomycin

blocks glycopeptide polyermaization by binding tightly to D-alanyl-d-alanine

cocaine moa

blocks reuptake of NE, HT,and DA causes cardiac ischemia, htn, seizures

initial eval for osteomyelitis

blood cultures MRI of spine (most sensitive for osteomyelitis) (ct guided bone biopsy for isolating organsm after imaging confirms dx)

what is most similar between systemic and pulm circulations

blood flow per minute if not aligned: pulm speed > systemic: LV overloaded systemic > pulm: LV would empty completely *volume output of left ventricule must match output of RV. balance needed to maintain continous blood flow; exists both at rest and exercise

how to diagnose lead poisoning

blood lead level urine delta-aminolevulinic acid is also elevated

what venous system has lowest oxygen content in body

blood that has finished oxygenating heart (i.e. coronary sinus) heart has capillary density far exceeding that of skeletal muscle o2 extraction from arterial blood is very effective within heart; resting myocardium extracts 60-70% of oxygen from blood

what to monitor if on lithium therapy

blood urea nitrogen creatinien

what does mitral regurg sound like

blowing, holosystolic murmur heard best over cardiiac apex radiates to axilla

what are signs of embolism

blue toe livedo reticularis with normal peripheral pulses --> suspicious for atheroembolic disease (cholesterol containing debris bets dislodged from larger arteries and lodges in smaller vessles

pathogenesis and causes of aplastic anemia

bone marrow failure due to hematopoietic stem cell deficiency (cd34) autoimmune, infections (parvo, ebv), drugs (carbazepine, chloramphenicol, sulfonamides), radiaton/toxins (benzens, solvents)

what has similar mechanism to toxin of bacillus anthracis

bordaella pertussis called adenylate cyclase toxin like edema factor, toxin functions as calmodulin dependent adenylate cyclase, causes phagocyte dysfunction and edema disinhibits adenylate cylcase thru gi adp-ribosylation this helps bordatella colonize resp tract

what is tourette disorder sx

both multiple motor and >1 vocal tic (not necessarily concurrent, >1 yr) motor: facial grimacing, blinking, head/neck jerking, shoulder shrugging, tongue protrusion, sniffing vocal: grunts, snorts, throat clearing, barking, yelling, coprolalia (obscenities) tics wax and wane, can be suppressed temporarily, and are preceded by premonitory urge onset age <18, more common in boys, age 6-15 comorbid psych conditions: ADHD and OCD common

difference between unfractionated heparin and LMWH

both unfractionated heparin and LMWH can bind to antithrombin to increase its activity against factor xa only unfractionated heparin is able to bind both antithrombin and thrombin, to allow antithrombin to inactive thrombin (>18 saccharide unts)

what does pca branch off of and supply

br off basilar artery at level of pontomesencephalic junction supplies CNIII and IV and other midbrain structures, thalamus, medial temp lobe, splenium of corpus callosum, parahippocampal gyrus, fusiform gyrus, occiptal lobe

what does artery of percheron supply

br off either right or left PCA supplies bilateral thalami and dorsal midbrain -

what are saccular aneurysms and risk factors

branch points on circle of willis most affect anterior circulation chronic smoking, poorly controlled HTN unruptured asx, but can hav eheadache and CN effects

what cancers are assoc with dna repair enzyme mutations

brca1, brca2 - breast, ovarian lynch xeroderma pigmentosum fanconi anemia

what does glycogen phosphorylase do

breaks down glycogen for energy production by glycolysis epinephrine --> cyclic amp mediated phos of glycogen phosphorylase --> activates the enzyme can also be phosphorylated by muscle contraction via intracellular ca conc and amp under extreme conditions

why is breast development normal in person with androgen insensitivity syndrome

breast dev normal due to production of estorgen by aromatase

BRCA mutations lead to

breast, ovarian cancer also pancreatic adenocarcinoma

what is the morphology of blastomyces

broad based budding, yeast

what is in rodenticides

brodifacoum, long acting 4 hydroxycoumarin acts similarly to warfarin

what is exception to continuous circ circuit

bronchial circuit supplies o2 to pulmonary parenchyma from systemic circ but drains mosttly to LA (not RA; so there's a R --> L shunt) accounts for <5% of systemic CO

what are 2 other major morph categories of pneumonia, besides lobar

bronchopneumonia - infection of terminal bronchioles --> patchy consolidation of number of lobules interstitial pneumonia - infection of interstitial tissue of lug or no alveolar infiltrate. atypical pneumonias.

what is name of UR sx, wheezing, cough, respiratory distress in children

bronciollitis RSV

what does candida look like on micro

budding yeasts with pseudohyphae germ tube test dx of albicans

what is fornix in brain

bundle of axons, originates from hippocampal subiculum, projects to mamillary body part of papez circuit, damge can lead to wernicke encephalopathy

accessory pathway that hypasses AV node

bundle of kent allow recurrent temporary tachyarrhtymias due to AV re-entry circuit involving AV node and acessory pathway WPW (wolff-parkinson-white) pre-excitation syndrome, most common re-entry circuit responsible for paroxysmal, narrow QRS complex (SVT) tachy

what is mutation in burkitt lymphoma

c myc ongoene on long arm of chr 8 to Ig heavy chain region on chr 14 causes constitutive overproduction of c-myc, nuclear phosphoprotein that fucntions as txn activator

chronic doses of vit c can facilitate

ca oxalate stones

what foot position would person with tibial nerve injury present with

calcaneovalgus position (dorsiflexed and everted)

what is clinical course of ATN (acute tubular necrosis)

can get from hypotension from hemorrhage 1. initiation: lasts about 36 hrs. slight decrease in urine output as renal tubular cell damage begins. 2. maintenance: 1-2 weeks. tubular damage fully established and patients commonly have oliguria, fluid overload, electrolyte abnormalities (hyperkal, metabolic acidosis). gfr stabilizes at level below normal. serum Cr rises. 3. recovery: re-epithelization of tubules. gfr recovers as tubules clear casts and debris. tubular cells recover more gradually. transient polyuria and loss of electrolytes due to impaired tubular resorption and decreased renal conc ability. get complete restoration of renal function

what are lab findings of pituitary adenoma of lh and fsh -->

can get increased testosterone can get excess acth --> androgen production BUT excess cortisol production sx would dominant would NOT get increased 17 hydroxyprogesterone (vs CAH 21 hydroxylase deficiency)

how to increase oxygen delivery to heart, if it already extracts so much oxygen

can only be achieved thru increased coronary blood flow

what does candida and smv due to immunocompromised patients with esophagus

candida: exudative esophagitis cmv: ulcerative esophagitis in distal eso

what fungal infection to suspect if patient has central venous catheter, parenteral nutrition, sepsis, and blood cultures growin gyeast

candidemia candida colonizes catheters, and likes the parenteaal nutrition solution

what is the primary component of the vaccine for n meningitides

capsular polysaccharide quadrivalent conjugate vaccine - capsular polysaccharide ag (A, C, Y, W) fused to diptheroid toxin, allows polysac to be displaced on MHC of APCs --> T cell response serogroup b vaccine: capsular polysacc for serogroup b are very simlar to human neural cell adhesion molecules; MOLECULAR MIMCRY; so new vaccine uses recombinant proteins instead of capsular poly quad for routine; serogroup b is for high risk (asplenia, complement deficiency)

meningococccal vaccines target what

capsular polysaccharides (these prevent phagocytosis and allow pathogen to replicate in bloodstream; also inhibit phagolysosome destruction inside phagocytes)

what is morphology of cryptococcus

capsule (india ink stain)

anticonvulsants associated with SJS/TEN

carbamazepine phenobarb phenytoin lamotrigine

acetazolamide does what for glaucoma

carbonic anhydrase inhibitor decreases aqueous humor secretion by ciliary epitheliaum (also alpha-2 AR agonists do this)

what is verapamil

cardio selective CCB class iv antiarrhthmic slows sinus rate prolongs PR interval, slows conduction thru AV node does not prolong QT interval

cgd, what kind of infections

catalase producing organisms

PFK 1 does what

catalyzes rate limiting step in glycolysis F6P --> F1,6,BP

where is the trochlear nerve

caudal midbrain nerve exits dorsal midbrain, just below inferior colliculus (below red nucleus) only cranial nerve to decussate before innervating target (superior oblique)

what effect does opioid analgesics have in GI tract

cause contraction of smooth muscles in sphincter of oddi increased pressure in common bile duct and gallbladder can lead to biliary colic (severe cramping, RUQ pain) tx: discontinue mu opioid analgesic, use NSAID instead

mu opioids do what to histamine

cause histamine release, leading to vasodilation of blood vessels and itching use cautiously in pts with hypotension

what is hemochromatosis

caused by mutation affecting HFE protein normally interacts with transferrin receptor to form a complex that functions as a sensor of irone stores mutations that inactivate the HFE protein cause enterocytes and hepatocytes to detect falsely low Fe levels increases Fe accumulation by: 1) enterocytes respond by increasing apical expression of divalent metal transporter (DMT1), increasing Fe absorption from intestinal lumen 2) hepatocytes decrease hepcidin synthesis. low hepcidid --> increased ferroportin expression on basolateral surface of enterocytes. Increases Fe secretion into circu

what happens if medial medulla is damaged

caused by occlusion of ASA contralateral hemiparesis (damage of lateral corticospinal tract) contralateral hemisensory loss (DCML) ipsilateral tongue tongue paralysis (hypoglossal nucleus)

how is cystercercosis spread

caused by taenia solium (pork tapeworm) ingestion of EGGS from stool of tapeworm carriers (infected uncooked pork, which contains larval cysts but not eggs, does not lead to neurocystercercosis)

what is occlusive ischemia of bowel

caused by thromboembolic states (hypercoag, a fib) or atheroembolic (aortic instrumentation) but these are rarer than nonocclusive ischemia

what is chagas disease

caused by trypanosoma cruzi (protozoan) vetor:reduviid bug latin america nonischemic cardiomyopathy, secondary achalasia, megacolon and megaesophagus sx: dysphagia (solids --> liquids), regurg, chest pain, ulceration, constipation, odonophyage (food impaction) high risk for esophageal cancer

pes anserinus bursitis

causes anteromedial knee pain occurs in runners

follicular lymphoma has what b cell ag on surface

cd 19, 20, 79a (like all b cells) cd21 cd10

what is predominant lymphocyte in sarcoidosis

cd4 t cells (this drives granuloma formation) intraalveolar and interstitial accumulation of cd4 t cells in sarcoidosis results in high cd4/cd8 t cll ratios in bronchoalveolar lavage fluid (>2:1)

immuno of psoriasis

cd4 t cells activate cd8 t cells in epidermis after interacting with APC in skin interaction between two types of t cells, the DCs, and keratinocytes --> production of cytokines (tnf, il-12, ifn-y) and keratinocyte growth factors keratinocyte proliferation, inflammation and angiogenesis

tx of n meningitides

ceftriaxone for 2 weeks

what has atrophy of intestinal villi

celiac disease

what is holocrine gland and what are examples

cell lysis releases entire contents of cytoplasm and cell membrane lipid rich secretory product ex: sebaceous glands, meibornian glands (of the eyelid)

granuloma formation immune mediators

cell mediated immunity th1 cd4 cells, il-2 (this stimulates th1 type cell proliferation), IFN-y (macrophage activation)

what is apocrine gland and what are examples

cells secrete via membrane bound vesicles ex: mammary glands

macular lesions impair X vision and result in X scomata

central for both

if injury above facial nucleus, what happens to face

central lesion (UMN) if affected facial nucleus, would get full facial paralysis

where are central lines placed

central venous system to allow rapid infusion neck (internal jugular vein) or chest (subclavian vein) advanced until catheter tip enters SVC derivsed from common cardinal veins

anterior pons infarct - are cerebellar deficients contralateral or ipsilateral to infarct

cerebellar deficits are contralateral to the lesion as the pontocerebellar arising from pontine gray matter decussate and enter cerebellum thru contralateral middle cerebellar peduncle

what are sx of vhl disease

cerebellar hamngioblastomas retinal hemangiomas liver cysts high risk for bilateral RCC

what is tonsillar herniation

cerebellar tonsils diplace thru foramen magnum and compress medulla

most common site of medulloblastoma and sx

cerebellar vermis increased intracranial pressure (morning headaches, vomiting, lethargy) cerebellar dysfunction - tumor compresses adjacent structures

what can be seen in pilocytic astrocytoma on histo

cerebellum most common brain neoplasm of childhood pilocytic astrocytes and rosenthal fibers low-grade, better prognosis than medulloblastoma

what does an increase in o2 from 50- 100 lead to reaarding cerebral blood flow

cerebral perfusion remains constant only severe hypoxia (pO2 <50) leads to rapid increase in cerebral blood flow and intracranial pressure

sx of fragile x

cgg trinucleotide repeats on X chromosome intellectual disability, long narrow face large protruding ears macrocephaly macroorchidism

giant cytoplasmic granules in PMN and monocytes in - what immunodeficiency

chediak-higashi

CNv2 sensation where

cheeck, nares, upper lip, teeth, pharyngeal palate, maxillary sinuses

vaccine schedule for rubella

children 12-15 mo, again at 4-6 y/o nonpregnant coming of childbearing age who lack serum b against rubella --> at tiem of vax, women should avoid pregnancy for next 4 weeks

inclusion conjuctivitis seen in

chlamydia trachamotis infection of newborn

describe neurotransmitters used in pre-and post parasymp

cholinergic Ach for both pregang aris from CN nuclei and from sacral spinal cord, release Ach which binds to post ganglionic nicotinic receptors found within parasymp ganglia or near walls of target organs post gang also release Ach --> activating muscarininc receptors within target organs

what neurotransmitter is made in nucleus basalis of meynert houses

cholinergic neurons (in Alz, these neurons secrete less Ach)

MoA of donepezil

cholinesterase inhibitor improve cognition, behavior, and functioning in activities of daily living but do not prevent progression of cerebral degeneration, do delay institutionaliaszation and mortality

what is most common eye-related complication of congenital CMV infection

chorioretinitis

what chromosome has apc

chromosm 5

where is vhl gene

chromosme 3

where is rb gene

chromosome 13

mutation in NF1

chromosome 17 NF utmor suppressor gene, codes protein neurofibromin

mutaition in NF1

chromosome 22 NF2 tumor suppressor gene encodes protein merlin

risk factors for gastric adenocarcinoma

chronic gasritis cigarette smoking h pylori high salt/nitrosamines

what dx leads to recurrent infections with bacteria and fungi lungs, skin, lymph, nods and liver commonly involved diffuse granuloma formation

chronic granulomatous disease X linked inactivating mutation affecting nadph oxidase impaired respiratory burst inhibit phagocytic intracellular killing get recurrent infections with catalase positive bacteria and fungi (catalase positive orgs can destroy the hydrogen peroxide produced by their own metabolic activity)

what causes atopic dermatitis

chronic inflammatory skin dosrder, triggered by various enviro factors present by 5 y/o infants: diaper area usually spared older kids: lichenification in flexural distribution intense pruritis AD: caused by mutations affecting proteins such as filaggrin or other components of epidermis, impairment of skin barrier. immunologic exposure toenviro allergens and microbial ag --> immune hypersensitivity high levels of IgE, peripheral eosinophilia, high cAMP PDE in leukocytes

what is primary biliary cirrhosis

chronic liver disease autoimmune destruction of intrahepatic bile ducts and cholestasis (elevated alk phos) common in middle aeed women, severe pruritis at night one of first sx reported. also fatigue PE: HSM, xanthomatous lesions in eyelids or skin/tendons as dx progresses: jaundice, steatorrhea, portal htn, osteopenia

deletion of 13q associated with

chronic lymphocytic leukemia

most common causes of cirrhosis in us

chronic viral b/c hep alcohol hemochromatoiss NAFLD diffuse hepatic fibrosis w/ replcement of normal lobulararchitecture by fibrous lined parenchymal nodules

what is open angle glaucoma

chronic, progressive loss of peripheral vision optic neuropathy characterized by atrophy of optic nerve head common with advancing age and in AAs associates with elevated intraocular pressure (due to increased production or decreased outflow of aqueous humor)

dx of alzheimer's

chronically progressive, pre senile dementia cortical atrophy no other radio or lab abnormalities it is a dx of exclusion

if a varicella zoster strain lacks viral phosphorylating enyzmes, which drug will be most effective as tx

cidofuvir is a nucleoside monophosphate that requires only cellular kinases for activation acyclovir, valccylovir, famcyclovir, and ganciclovir are all nuceloside analogues that require both herpes viral (thymidylate kinase) and cellular kinases for converstion to active nucleoside triphosphate form -- also foscarnet - pyrpophosphate analog viral DNA polymerase inhibitor, does not require viral kinase activation -- this mutation common in AIDS patients

provoke coronary vasospasm

cigarette smoking cocaine, amphetamines dihyrdoergotamine/triptans ergots: constricts vasc smooth muscle via stimulation of both alpha adrenergic and serotonergic receptors

what covers terminal bronchiols

ciliated cuboidal epithlium and club cells

what is subfalcine herniation

cingulate gyrus herniates under falx cerebri compressing ACA

suprachiasmatic nucleus does

circadian rhythm reg and pineal gland function relay light to other hypothalamic nuclei and to pineal gland

what drugs lengthen QRS duration in rate-dependent manner

class 1c antiarrhtymics (strong use dependence)

what is MoA of ibutilid

class III antiarrythmic (K channel blocker) used for acute termination of a flutter and a fib prolongs qt interval, high risk of torsades

how does dofetilide work

class iii antiarrhtmic drug blocks outward K current during repolarization increases QT interval duration, does not affect QRS duration demonstrate reverse use dependence (slower HR, more QT interval prolonged)

what drugs are used as rate control for management of atrial tachyarrythmias (a flutter, a fib)

class iv (CCBs) like diltiazem it slows sinus rate, prolongs conduction thru av node, and depresss myocardial contractility

what is verapamil

class iv antiarrythmic CCB that slows SA and AV nodal conduction increases coronary blood flow, reduces myocardial O2 demand (can mask ischemia during stres testing) verapamil does not affect QRS duration

pathophys of obstructive sleep apnea

closure of upper airway due to relaxation of pharyngeal muscle tone during sleep other risk factors: obesity, tonsillar hypertrophy, hypothryoidism when airway is occluded, PO2 declines, PCO2 rises, until chemoreceptors in carotid body and brainstem trigger arousal and pharyngeal tone returns

what is cidofovir used for and aes

cmv retinitis, use tox: nepthrotox w/ proteinuria or elevated Cr

where is somatostatin secreted

cns panceratic delta cells

AEs of phenytoin

cns --> cerebellum and vestibular system --> ataxia and nystagmus gingival hyperplasia, course facial features, hirsutism megaloblastic anemia (metab of folic acid affected) induced p450; decreased blood level of many meds pregnancy - fetal hydantoin nsyndrome

what innervates afferent limb of corneal reflex

cnv

what is pseudodementia

cognitive impairment in association with depression

what vessels in heart help to alleviate ischemia and preserve myocardial function

collateral circulation

FAP associated with increased risk of

colon cancer adrenal adenomas thyroid cancer

blood supply of colon

colon receives blood from marginal artery of colon (artery of drummond), anastomotic system of arteries supplied by SMA and IMA distal colon receives blood from internal iliac artery

what are sx of bilateral pontine hemorrhage

coma due to disruption of reticular activating system total paralysis with extensor posturing due to corticospinal and corticobulbar tract injury and pinpoint pupils, secondary to descending sympathetic tract damage

what is name of disease and common bugs that cause nasal congestion, discharge, sneezing, cough, sore throat in children

common cold (nasopharyngitis) caused by: rhinovirus, flu virus, coronavirus

sx of gilbert disease

common familial disorder of bilirubin glucuronidation production of udp glucoronyl transferases is reduced mild unconj hyperbilirubinemia --> provoked by one of the classic triggers (hemolysis, fasting, physical exertion, febrile illness, stress, fatigue) lfts, cbc, blood smear, retic all normal

how to tx ventricular arrhthmias post MI

common in first 24-48 hrs tx with antiarrhtmic drugs (amiodorane, lidocaine)

when can patient refuse treatment

communicates a choice understands info provided appreciates consequences rationale given for decision

muscle injury or hypertrophy of piriformis

compress sciatic nerve --> sciatica (pain, tingling, numbness of puttocks along nerve distribution) --> priformis syndrome muscle can be tender w/ deep palpation or on stretching w/ adduction and internal rotation

what are moa of entacapone/tolcapone, dopa decarboxylase inhbitors (carbidopa)

comt inhibitors - entacapone, tolcapone dopa decaroxylase inhibitors - carbidopa decrease breakdown of levodopa in peripheral tissues, increase amount of levodopa available to cross BBB

what causes LVH (concentric vs eccentric

concentric: pressure overload like chronic HTN, aortic stenosis; parallel sarcomeres eccentric: volume overload like aortic/mitral regurg, ischemic heart disease, dilated cardiomyopathy, series sarcomeres

where do drugs with low distribution volume go

confined to bloodstream tend not to diffuse readily thru hepatocytes into bile drugwith low vd will be highly plasma protein bound and hydrophilic --> less available for hepatic metab and more readily available for excretion unchanged in urine

primary lactase defiency

congenital acquired rare AR condition common, typically arises from decreased or ceased production of lactase by mid childhood common among asians (90%) and other non-whites

what are sx of sturge weber syndrome

congenital (not inherited) facial port-winse stain and leptomeningeal capillary-venous malformation

complication of german measles (Rubella)

congenital rubella syndrome

microcephaly, mental retardation, cataracts, deafness, pda, pulmonic stenosis - what virus

congenital rubella syndrome

sx of dubin johnson

conjugated chronic hyperbilirubinemia, not assoc with hemolysis direct bili fraction at least 50% otherwise normal liver function profile must be present

what does patellar ligament do

connects tiia to patella patella connected to quads (rectus femoris, vastus intermedius, vastus medialist, vastus lateralis)

what is temporomandibular disorder

constellation of sx, includes unilateral facial pain, worsens w/ jaw movement, headache, ear discomfort originate from tmj derangement, contraction of muscles of mastication, hypersensitivity of nerves that supply the jaw

sx of PCA stroke

contralateral hemianopia due to infarction of visual cortex macular sparing b/c of MCA collateral circulation

sx of an MCA stroke, right

contralateral hemiparesis and hemisensory loss involving face and upper limb infarction of corresponding motor and sensory cortices lower limbs spared or minimally affected anosognosia (lack of insight), partial neglect of contralateral side (damage of non-dominant, right parietal lobe), conjugate gaze deviation toward side of stroke, contralateral homonymous hemianopsia (damage optic radiations in subcortical temporoparietal lobe)

what happens if dorsolateral thalamus is damaged

contralateral hemisensory loss can develop excrutiating pain on side of their deficits (thalamic pain syndrome)

what does avitaminosis a do to pancreatic duct

contribute to squamous metaplasia of epithelial lining of pancreatic exocrine ducts ==> keratinizing epithelium (vitamin a and retinoic acid are quired to mainatain orderly diffentiation of specialized epithelia, including mucus secreting columnar epi)

what does superior colliculus control; what would damage lead to

controls vertical gaze damage to dorsal midbrain in superior colliculus causs parinaud syndrome (upward gaze palsy, absent pupillary light reflex, impaired convergence)

what does coagulase in staph aureus do

converts conversion of fibrinogen to fibrin by activiating prothrombin fibrin-coating of organism and resistance to phagocytosis

what vascular beds in body are most susceptible to atherosclerosis

coronary and lower abdominal aorta these have turbulent blood flow (bends, branches), which disrupts vasc wall integrity, leads to endothelial cell dysfunction also leads to decreased shear stress on vasc walls and prolonged endothelial contact w/ cholesterol particles

what bug has intracellular polyphosphate granules

corynebacterium diptheria granules within cytoplasm with methylene blue staining

what org is clumped, gram positive with polar granules that stain deeply with aniline dyes

corynebacterium diptheriae nonmotile, unencapsulated, gram + rods clumps (resemble chinese characters...) or joined in V or Y shaped chains

which 2 bugs both inactivate ef-2

corynebacterium diptheriae pseudomonas diptheria toxin similar to exotoxin a when ef 2 is ribosylated and inactivated, halt human cell protein synthesis, cause cell death

sx of cryptococcus lung infection and dx tests

cough, scant sputum, dyspnea, pleuritic chest pain (though usually asx) can be dx by micro exam of bronchopulm washings and lung tissue (red yeast on mucicarmine stain)

what does lateral femoral cutaneous nerve innervate

courses deep to inguinal ligament to innervate anterolateral thigh skin injured during hyperreflexion of thighs in lithiotomy position for pelvic surg or vaginal delivery injuries - anterior and lateral thigh numbness (meralgia paresthetica)

what does cox 1 and 2 do

cox 1: phsiologic role in normally functionigng tissues (platelets, GI) cox 2: inflammation; may play a rle in local production of PGI1 in vasc endothelial cells and smooth muscle cells selective cox 2 inhibitors have been assoc with increased incidence of cvd events, may be related to decreased production of pgi2

where can schwannomas occur

cranial vault and spinal canaltoo can arise from any CN except CNII (which is covered by oligodendrocytes) most common intracranial: cerebellopontine angle at CNVIII --> acoustic neuromas (tinnitius, vertigo, sensorineural hearing loss)

if brain mass histo shows cystic spaces filled with thick, brownish-yellow fluid rich in cholesterol, what kind of tumor

craniopharyngioma on imaging can also see dystrophic calcification on micro: cysts lined by cords/nests of stratified squamous epithelium with peripheral palisading and internal areas of lamellar wet keratin

sx of rickets

craniotabes (ping pong ball skull) delayed fontanel closure frontal bossing hypertrophy of costochondral joints (rachitic rosary) widening/thickening of wrists femoral and tibial bowing (genu varum) = unmineralized osteoid matrix and epiphyseal growth plate cartilage (widening and cupping)

what happens in a roux en y gastric bypass surgery

create small gastric pouch, removed from remainder of stomach, attached to jejunum via gastrojejunal anastomosis larger bypassed portion of stomach and duodenum reattached to jejunum distally closed end gastroduodenal limb in which bacteria can proliferate and ferment any food that may be diverted into this segment

when do you see 14-3-3 protein in CSF

creutzfeldt-jakob disease neurodegenerative dx caused by prions

MoA of cromolyn

cromolyn and nedocromil inhibit mast cell degranulation and prevent release of preformed chemical mediators do not influence bronchial constriction directly, typically used to prevent acute attacks good for pts with seasonal sx, aspirin hypersensitivity, and exercise induced asthma

what is moa of cisplatin and toxicity

cross links dna to inhibit dna syntheiss tox: nephrotox, ototox, peripheral neuropathy

moa of cyclophosphamide

cross links dna to inhibit dna synthesis tox: hemorrhagic cystitis, bladder cancer

what do you suspect if budding yeast wiht thick capsules

cryptococcus

testing for cryptococcus

csf, india ink - thick polysaccharide capsules sero testing - latex agglutination, c neoformans capsular ag in csf

cyclophosphamide requires bioactivation by

cytochrome p450 2b

what does toxin of c perfrignes do

cytolytic toxin (alpha-toxin, or PLC) degrades cell membrane phospholipids, causing cell destruction

what is C-ANCA

cytoplasmic staining antineutrophil cytoplasmic antibodies 90% sens and spec fo granulomatosis with polyangiitis (wegener's) TARGETS NEUTROPHIL PROTEINASE 3

what is amifostine

cytoprotective free radical svanger decreases nephrotox associated with platinum containing and alklyting chemo agents decrease xerostomia (dry mouth)

lamuvidine moa

cytosine analog nrti must be phosphorylated to active form by intracellular kinases inhibits hiv reverse transcriptase thru viral dna chain termination

what are 6 mercaptopurine and 6 thioguanine

cytotoxic purine analogs inhibit de novo purne synthesis

when would you have increased crh, decreased acth, decreased cortisol?

damage to corticotroph cells of anterior pituitary

how do you get arcuate scomata

damage to particular region of optic nerve head --> visual field defect follows arcuate shape of nerve fiber pattern

what is reperfusion injury

damaged tissue will die at accelerated palce thr apoptosis or necrosis after resumption of blod flow process is termed reperfusin injury secondary to one or more following mechanisms 1) oxygen free radical generation by parenchymal cells, endothelial cells, leukocytes 2) severe, irreversible mitochondrial damage described as mitochondrial permeability transition 3) inflammation, attracts circulating PMNs that cause additional injury 4) activation of complement pathway, causing cell injury and further inflammation

sx of basilar artery occlusion

damages base of pons, so damage corticopsinal, corticobulbar tracts, parmedian tegmentum quardiplegia bulbar dysfunction (facial weakness, dysarthria) oculomotor deficits (horizontal gaze palsy)

describe process of fertiliziation

day 0: fertilized second meiotic division completes and zygote forms zygote travels thru fallopian tube and undergoes mitotic divisions (first cleavage, day 1) --> creating smaller cells (blastomeres) that are known as morula (days 2-3) morula enters uterus 3-4 days after fertilization, develops blastocystic activity --> blastocyst (days 4-5) blastocyst implants 6 days after fertilization (6-7 days) outer cell mass (trophoblast) differentiates into cyto and syntiotrophoblast. synthiotroophoblast invades endometrial connective tissue 6-7 days after fertilization and starts secreting B-hCG this signals corpus luteum in ovary to continue producing progesterone

sx of obstructive sleep apnea

day time somnolence non restorative sleep with frequent awakenings morning headaches affective and cognitive sx snoring

sx of simple insomnia

daytime fatigue but do not have sx of nonrestorative sleep, morning headaches, elevated BP

what would exacerbation of pre-existing hep b look like with antigens

declin followed by a spike in ag levels

what do prostaglandin f2alpha (latanoprost, travoprost) and cholinomimetics (pilocarpine, carbachol) do for glaucoma

decrease IOP by increasing outflow of aqueous humor ciliary muscle and pupillary sphincter of iris receive parasymp innervation from cholinergic fibers of CNIII cholinomimetics -cause miosis by promoting contraction of sphincter of iris; causes anterior chamber angle to become wider and make trabecular meshwork more accessible to outflow of aqueous humor cholinergic agnoists promote ciliary muscle contraction, cause lens to become more convex

mu opioids do what to parietal cell acid

decrease acid secretion

what happens to these vitamins in small intestinal bacterial overgrowth: B12, Fe, A, D, E, zinc, K, folate

decrease b12, Fe, A, D, E, zinc b12 - decreased intestinal absorption of free and IF bound v12, bacteria compete for use of b12 Fe - decreased intestinal absorption (mucosal injury from bacterial toxins, unconj bile acids, short FA acids) ADE - malabsorption of fat (K sxception) zinc - malabsorption of small intestines; also diarrhea increased K and folate

tx of glaucoma

decrease iop with drugs that dcrease production of aqueous humor or increase outflow

how can resistance to isoniazid occur

decreased bacterial peroxidase activity before it can inhibit mycolic acid synthesis, INH must be converted to active form by mycobacterial catalase-peroxidase enzyme

causes of polyhydramnios

decreased fetal swallowing (ancephaly, GI obstruction like duodenal, esophageal, intestinal atresia) increased fetal urination (from high fetal cardiac output, alloimmunization, parvovirus, fetomaternal hemorrhage, anemia, twin to twin transfusion) (maternal diabetes, multiple gestations - less so)

lab values in HUS

decreased hg decreased platelet count decreased haptoglobin increased LDH increased unconj bili bleeding time increased increased BUN, Cr but all other lab values normal (normal thrombin, prothrombin time, normal fibrinogen and d dimer)

what are advantages of polysaccharide vaccine

decreased incidence of replacement strains due to lack of mucosal immunity con: moderate level sof intermediate affinity ab (no t cell involvement); not immunogenic in children age 2 due to relatively immatre humoral ab response; e.g. ppsv23 --> for adults >65 and 2-65 with certain medical conditions

what does esophageal manometry look like for scleroderma

decreased peristalsis DECREASED tone at LES

appropriate compensation for acute resp alkalosis

decreased serum hco3 by 2 me/l for every 10 mmhg decrease in paco2

spirometry findings in restrictive lung disease

decreased: TLC, VC, IC, FRC, RV, VC, FEV1 FEV/FVC ratio increased b/c the FEV1 decreases less than fvc

what does citrate act as activaotr for

decreases glycoclysis (powerful inhibitor of PFK-1)

what can reduce mitral regurg

decreasing SVR --> causes more pressure gradient --> increase in ratio of forward to regurgitant flow amount of blood flowing through forward or regurgitant depends on total LV afterload resistance to forward flow: determined by SBP (aortic pressure) resistance to regurgitant flow: determined by MV orifice size during systole and degree of LA compliance (in chronic MR; LA becomes more compliant and lower LA, so more regurgitant flow)

deep brain stimulation of what structures in brain would lead to relief of parkinson sx

deep brain stimulation inhibits if you inhibit GPi or subthalamic nucleus --> thalamo-cortical disinhibition --> improved mobility

wha supplies scrotum/labia majora and perineum for venous drainage

deep external pudendal artery supply

what is defect in beta thalassemia

defective transcription, processing, translation of beta globin mRNA leads to defieicny of beta globin chains required for normal Hg synthesis sometimes: point mutations prevent rna polymerase from binding to promoter region --> beta globin deficiency --> increased gh a2 and hemoglobin f (a2y2) NOT A PROTEIN FOLDING DEFECT

what is most common cause of aortic stenois in elderly patients

degenerative calcificaion of aortic valve leaflets

what are main causes of virilization in patients with cah 21 hydroxylase

dehydroepiandrosterone and androstenedion (adrenal androens) NOT pure testosterone - only synth in minimal quantities by adrenal gland (androgens undergo peripheral conversion to testosterone)

what gene defect causes duchenne muscle dystrophy

deletion of dystrophin gene xlinked recessive dystrophin is structural protein of muscle fibers, absence causes muscle fiber destruction (myonecrosis) disease onset age 2-5

what are sx of tca overdose

delirium, seizures, cardiac abnormalities ( arrythmias, conduction delays), severe hypotension, anticholinergic toxicity (hypertheria, flushing, dry mouth, urinary retention) overdose sx: blockage of cardiac fast Na channels and inhibition of muscarinic Ach histamine, alpha 1 adrenergic receptors

what happens in dilated cardiomypathy due to viral myocarditis

depletion of cardiomyocytes with subsequent fibrosis (weakned myocardial contractility --> systolic dysfunction, volume overload, ventriculardilation --> evventric hypertrophy

what does chronic inflammation due to h pylori in antrum do

depletion of somatostatin producing cells (delta cells) h pylori releass cytotxins that inhibit duodenal production of bicarb acid load emptied into the underprotected duodenum --> duodenal ulcer

AEs of succinylcholine

depolarizing NM blocker causes muscle paralysis by acting at nicotinic acetylcholine end plate receptor AEs: hyperkalemia, malignant hyperthermia

how does succinylcholine work (phase 1 and 2 block)

depolarizing NM blocking agent attaches to nicotinic Ach receptor, depolarizes NM end plate Na channels surrounding end plate rapidly become inactivated and cannot reopen until end plate is repolarized succinylcholine induced depolarization remains isolated to end plate --> flaccid paralysis (phase 1 block) -- continued aministration of succinylcholine, continuous depoarization of endplate gives way to gradual repolarization as nAChR becomes desensitiized to effects of succinylcholine (phase 2 block)

lamotrigine used mainly for what kind of bipolar features, and AEs

depressive benign rsh, SJS

what influenes survival rate of gastric adenocarcinomas

depth of invasion thru gastric wall and regional lymph node involvement mets often present at time of involvement and commonly involves supraclavicular node (virchow) and periumbilical nod (sister mary joseph)

embryo of descending aorta

derived from fusion of embryonic right and left dorsal aoras thoracic cavity, starts left of vertebral column and approaches midline as it descends towards diaphragm

indication for terbinafine

dermatophytosis (tinea)