Uworld Incorrect Deck

compound nevi

benign proliferations of melanocytes that both the dermis and epidermis. lesions slightly raised papules with uniform pigmentation and symmetrical sharp borders.

Anti-Smith antibodies

Antibodies to spliceosomal snRNPs Highly specific for SLE

exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of adrenal cortex

CAH treatment

small, noncoding form of RNA that contains modified bases (eg, dihydrouridine, ribothymidine, pseudouridine)

CCA sequence at 3' end: recognition sequence by proteins amino acid binding site

coreceptor for viral surgace glycoprotein

CCR5 HIV attaches to host cells using the viral surface glycoprotein gp120. which binds CD4 and CCR5. causes conformational change in gp120 that exposes gp41. mediating viral fusion to the host cell

maraviroc

CCR5 inhibitors can be used in treatment of R5 virus not not X4 virus. because they bind to CXCR4 chemokine not CCR5.

precursor B-ALL immunophenotying

CD10, CD19 vs. precursor T-ALL show CD2, CD3, CD5, CD7, CD8

EBV envelope glycoprotein gp350 binds to

CD21 which is normally on the surface of CD19 positive cells.

increase in RAAS and SNS stimulation exacerbates symptoms of

CHF

loop diuretics work at the thick ascending loop of henle

CHF treatment first line includes: furosemide

linear esophageal lacerations in HIV patient

CMV enlarged cells with intranuclear inclusions

heterophile antibody negative mononucleosis like syndrome

CMV infection transfusion of leukocyte laden blood products.

heterophile antibody negative mononucleosis-like syndrome in immunocompetent patients

CMV infection!

infarction risk after occlusion of feeding artery

CNS myocardium kidney spleen liver (dual and collateral blood supply via hepatic artery and portal vein)

viral or bacterial upper URI commonly exacerbates

COPD vs. allergens exacerbate asthma

dobutamine shows mild improvement in cardiac contractility due to

Gs protein-adenylate cyclase activation

colonization of gastric antrum

H pylori

carcinogenic due to oncogenic proteins and the insertion of the genome into the host chromosome

HBV

odds ratio

OR=ad/bc

inactivated vaccine

Rabies

haemophilus influenzae

'blood loving' organism that requires X (hematin) and V (NAD+) factors for growth. this can be accomplished by growing H influenzae in the presence of Staphylococcus aureus and demonstrating the 'satellite phenomenon', whereby H influenzae grow only near the beta-hemolytic S aureus colonies that produce the needed X and V factors.

RANK-L

'receptor for activated nuclear facter kappa-B' important role in osteoclast differentiation. paget's disease of bone has increased numbers of abnormal osteoclasts, excessive bone turnover and disorganized bone remodeling.

maternal inheritance

'red ragged' muscle fibers are seen in mitochondrial diseases. muscle fibers have this appearance because abnormal mitochondria accumulate under the sarcolemma. Mitochondrial diseases show maternal inheritance.

ADHD

stimulant medications are first line. work by increasing availability of norepinephrine and dopamine in the prefrontal cortex.

glioblastoma

within the cerebral hemispheres and may cross midline. contain areas of necrosis and hemorrhage.

electron acceptor for succinate dehydrogenase

FAD riboflavin is precursor for FMN and FAD deficiency leads to: angular stomatitis, cheilitis, glossitis, seborrheic dermatitis, eye changes (keratitis, corneal neovascularization), and anemia.

Hartnup disease

Failed absorption of tryptophan in intestine/kidneys, that causes pellagra from niacin deficiency Tx: high protein diet, nicotinic diet niacin

regular insulin

DKA initially treated with IV regular insulin. when subcutaneous, starts working within 30 mins and peaks 2-4 hours, and lasts 5-8 hours.

pancreatic islet amyloid deposition is seen with

DM2 vs. DM1 shows pancreatic islet infiltration with leukocytes

primase

DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA. without this, DNA polymerase cannot initiate DNA synthesis.

delirium vs dementia

Delirium has: Acuteness, impaired consciousness, fluctuating course, reversible symptoms and global memory impairment. dementia has a gradual onset, is irreversible, and does not involve fluctuations in consciousness.

rate limiting enzyme of the pentose phosphate pathway

G6PD deficiency hemolytic anemia during times of oxidative stress: antimalarials/sulfonamide, infections fava beans

fever, pharyngitis, sandpaper like rash, circumoral pallor, and strawberry tongue

GAS produce pyrogenic exotoxins leading to scarlet fever predispose to ARF and glomerulonephritis

thiazolidinediones increase transcription of insulin responsive genes

GLUT 4 adiponectin

calcium-sensing receptors are

GPCRs that regulate secretion of PTH in response to circulating calcium levels. defective sensing receptors in familial hyocaciuric hypercalcemia

deficiency of beta-glucocerebrosidase deficiency hepatosplenomegaly pancytopenia bone pain crises avascular necrosis 'wrinkle tissue paper'

Gaucher disease

continuous administration leads to initial rise then inhibition of FSH and LH secretion leads to decreased testosterone production

GnRH agonist: leuprolide used: prostate cancer

cool, clammy skin, tachycardia= vasoconstriction due to SNS: epinephrine and norepinephrine

Gq alpha 1 receptor phospholipase C IP3 and DAG protein kinase C

protease inhibitors

HIV antiretroviral medications that inhibit cleavage of the polypeptide precursor into mature viral proteins. their side effects as a class include hyperglycemia, lipodystrophy, and drug-drug interactions due to inhibition of cytochrome P450.

Reactive arthritis

HLA-B27 assoicated arthropathy that occurs within several weeks following a geniturinary or enteric infection. chlamydia, campylobacter, salmonella, shigella, or yersinia. it presents with sterile arthritis due to deposition of immune complexes.

HPV and neonates

HPV is a small DNA virus with a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, including the true vocal cords, cervix, and anus. infants can acquire respiratory paillomatosis via passage through an HPV-infected birth canal.

infects sacral dorsal root ganglia can be reactivated to cause recurrent genital lesions

HSV2

decreased Hbg and haptoglobin increased lactate dehydrogenase and unconjugated bilirubin levels

HUS

are diagnostic of traumatic mechanism and indicate: microangiopathic hemolytic anemia or mechanical damage

HUS, TTP, DIC, Cx schistocytes

chancroid

Haemophilus ducreyi infection presents with deep, painful ulcers with ragged borders that are associated with a grey exudate and inguinal lymphadenopathy. diagnosis by gram stain and culture of organism from scraping of the ulcer base.

STEMI ECG

I & aVL=circumflex artery V1-V4=LAD

region of sarcomere that contains Z line and sections of thin filaments that do not overlap with thick myosin filaments

I band width of the I band lengthens during muscle relaxation and shortens during contraction

modified smooth muscle cells that release renin and reside in the afferent arteriole

JG cells hyperplasia with chronic stimulation (renal hypoperfusion)

proto oncogenes

KRAS stimulation of cellular proliferation

47,XXY

Klinefelter syndrome present with tall stature, small firm testes, azoopermia, and gynecomastia. mild intellectual disability is seen in some patients, and the severity generally increases with each additional X chromosome.

nerve roots for lower extremity reflexes

L2= hip extension L3= knee extension L4= platellar reflex L5=foot S1= achilles/ankle reflex

inhibin B

LH stimulates the release of testosterone from leydig cells of the testes; FSH stimulates the release of inhibin B from the sertoli cells in the seminiferous tubules. testosterone and inhibin B induce negative feedback on LH and FSH production, respectively.

follicle granulosa cells

LH stimulates the theca interna cells of the ovarian follicle to produce androgens. aromatose within the follicle's granulosa cells subsequently converts these androgens to estradiol under FSH stimulation. the theca externa cells serve as a connective tissue support strature for the follicle.

negative feedback for LH and FSH

LH: testosterone FSH: inhibin B from the sertoli

Leukocyte adhesion deficiency

Late seperation of umbilical cord, AR loss of CD18 necessary for integrin formation, recurrent infections without pus, recurrent skin and mucosal infections without purulence and persistent leukocytosis

decreases hepatic synthesis of triglycerides and VLDL and reduces clearance of HDL

Niacin decrease renal excretion of uric acid, causing gouty arthritis

hepatomegaly and cherry red macular spot in infancy

Niemann-Pick disease vs. Tay Sachs= no hepatomegaly

degradation of type II collagen and proteoglycans within articular cartilage

OA

most important virulence factor expressed by uropathogenic E coli

P fimbriae otherwise they cannot bind to uroepithelial cells and infect the bladder, ureters, and kidneys.

intermittent claudication that is better with rest sleep better when sitting or hanging leg off the bed foot ulcers MH: HTN, DM, smoking, high lipids thinning of the skin and hair loss

PAD

carrier protein-mediated process freely filters

PAH filters to bowmans space secretion of PAH can be saturated at high blood concentrations

elevated ovarian androgen levels (testosterone) stimulate development of small ovarian follicles and prevent the formation of a single dominant follicle.

PCOS associated with elevated insulin and insulin reisistance

majority of water reabsorption in the nephron occurs in the

PCT passively with the reabsorption of the solutes

continuous murmur at left infraclavicular region with maximal intensity at S2

PDA small is asymptomatic

triad of hemolytic anemia, hypercoagulability, and pancytopenia suggests

PNH due to acquired mutation in the PIGA gene that causes absence of GPI anchor and assoicated deficiency of CD55 and CD59 complement inhibitor proteins

Absence of CD55 and CD59 hemoglobinuria pancytopenia thrombosis at atypical sites

PNH uncontrolled complement mediated hemolysis chronic hemolysis leads to iron deposition= hemosiderosis

PAH clearance= (urine PAH x urine flow rate) / plasma [PAH]

RPF

selective estrogen receptor modulators exhibit estrogen antagonist and agonist properties in a tissue-specific manner.

Raloxifene--has estrogen agonist activity on bone, which decreases bone resorption and improves bone density. it as estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer, it also acts as an estrogen antagonist in the uterus, and does not increase the risk of endometrial cancer (vs. tamoxifen-which does).

agonist and protective on bone antagonist on breast and uterus and protective

Raloxifene=SERM

GTP binding, signal-transducing oncoprotein

Ras

retroperitoneal

SAD PUCKER suprarenal glands, aorta and IVC, duodenum, pancrease, ureters and bladder, colon, kidneys, esophagus, rectum

P450 inhibitors

SICKFACES.COM S=sodium valproate I=isoniazid C=cimetidine K=ketoconazole F=fluconazole A=alcohol C=chloramphenical E=erythromycin S=sulfonamides C=ciprofloxacin O=omeprazole M=metronidazole grapefruit juice, amioderone, quinidine

celecoxib

Selective COX-2 inhibitor: acts mainly on enzymes of cells involved in inflammation. Tox: GI toxicity, but less than that of aspirin

promote initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II

TATA and CAAT boxes 25 and 75 bases upstream of transcription start site

promoter region that binds transcription factors and RNA polymerase II during the initiation of transcription

TATA box

never treated with monotherapy due to fast emergence of mycobacterial antibiotic resistance from rapid, selective gene mutations.

TB isoniazid ...only monotherapy with PPD positive and CXR negative

internuclear ophthlmolplegia

a disorder of conjugate horizontal gaze in which the affected eye (ipsilateral to the lesion) is unable to adduct and the contralateral eye abducts with nystagmus. convergence and pupillary light reflex are preserved. typically due to damage to the medial longitudinal fasciculus on doral pons.

leuprolide

a gonadotropin-releasing hormone agonist that causes a transient increase in pituitary LH secretion, which leads to a rise in testosterone levels. continuous use suppresses LH release and leads to a decrease in testosterone production.

phencyclidine

a hallucinogen that causes dissociative symptoms, agitation, hallucinations, and violent behavior. Ataxia, nystagmus, and memory loss are other distinguishing symptoms of PCP abuse.

scabies

a human mite infection assoicated with a pruritic papular rash with excoriations and burrows. patients with impaired cell-mediated immunity (HIV) often develop a very high mite burden. treatment with topical permethrin and/or ivermectin is generally curative.

fidaxomicin

a macrocyclic antibiotic that inhibits RNA polymerase. it is bactericidal against C difficile.

gallstone ileus

a mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen. pneumobilia- air in the biliary tract is a common finding.

flutamide

a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors. it is used in combination with long-acting gonadotropin-releasing hormone agonists for the treatment of prostate cancer.

riboflavin

a precursor of the coenzymes FMN and FAD. FAD participates in the tricarboxylic acid cycle and electron transprot chain by acting as an electron acceptor for succinate dehydrogenase (complex II), which converts succinate into fumarate.

binds to portion of extracellular domain of HER2 and prevents activation of a transmembrane tyrosine kinase downregulates cellular proliferation and promotes apoptosis

Trastuzumab

DMD can also be use to nonsense mutations (usually frameshift) leading to premature stop codons

UAA UAG UGA

stop codons

UAA, UAG, UGA halt protein synthesis by binding a release factor; they do not add amino acids to the polypeptide chain.

key growth factors that promote angiogenesis in neoplastic and granulation tissue

VEGF and fibroblast growth factor

loss of epidermal melanocytes

Vitiligo

chronic granulomatous disease

X-linked disorder resulting from deficiency of NADPH oxidase, the enzyme responsible for formation of reactive oxygen species in phagosomes. Neutrophils affected by this disorder are unable to kill catalase-producing organisms, resulting in recurrent bacterial and fungal infections that frequently involve the lungs, skin, and lymph nodes.

fragile X syndrome

X-linked disorder, most common cause of inherited intellectual disability. pathogenesis involves an unstable expansion of trinucleotide repeats (CGG) in the fragile X mental retardation 1 gene. dysmorphic facial features: large jaw, protruding ears, long face and macroorchidism.

structure of immunoglobulin

Y-shaped site of attachment to phagocytic cells (Fc receptor) is the tail of the Y. site for attachment of complement is the neck of the Y. sites for attachment to antigens (fab) is the horns of the Y.

dobutamine

a beta adrenergic agonist with predominant activity on beta1 receptors and weak activity on beta2 and alpha1 receptors. this facilitates the interaction between actin and myosin, resulting in increased myocardial contractility.

physostigmine

a cholinesterase inhibitor with a tertiary ammonium structure that can reverse both the central and peripheral nervous system symptoms of anticholinergic toxicity. neostigmine, edrophonium, and pyridostigmine have a quaternary ammonium structure that limits central nervous system penetration.

Acute renal allograft rejection

a condition that develops in some kidney transplant patients in which the recipient's immune system attacks the cells of the transplanted organ, leading to loss of kidney function associated with diffuse lymphocytic infiltration of the renal vasculature, tubules, and interstitium

amlodipine

a dihydropyridine CCB that can cause headache, flushing, dizziness, and peripheral edema.

pigmented thickened plaques that arise in flexural regions such as back of neck or axillae

acanthosis nigricans usually due to insulin resistance or obesity if sudden and rapid spread: GI/ lung cancer!!

dihydrobiopterin reducatase deficiency

account for 2% of PKU. although phenylalanine levels can be corrected with dietary restriction, downstream deficiencies of dopamine, NE, Epinephrine, and serotonin lead to progressive neurologic deterioration.

unbalanced robertsonian translocation

account for a minority of down syndrome cases. karyotyping shows 46 chromosomes with a translocation between 2 acrocentric nonhomologous chromosomes [eg, 46,XX, t(14;21)] dysmorphic features of down syndrome include epicanthal folds, upslanting palpebral fissures, a protruding tongue and excessive skin at the nape of the neck.

increased intracellular solute concentration draws free water into the cell, causing cellular and mitochondrial swelling

accumulation of Na+ and Ca2+ due to: ion pump failure due to ATP deficiency during cardiac ischemia

placental aromatase deficiency

accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in female infants and maternal virilization. at puberty: impaired ovarian estrogen leads to: amenorrhea, osteoporosis, and tall stature

antigens taken by APC to langerhans cells and presented to CD4+ cells>>cells migrate to skin>inflammatory response within 24 hrs

accumulation of fluid in the intercellular spaces of epidermis: spongiosus acute allergic dermatitis

peripheral edema

accumulation of fluid in the interstitial spaces. due to elevated capillary hydrostatic pressure, decreased plasma oncotic pressure, sodium and water retention, and impaired lymphatic drainage. in chronic HF, increased lymphatic drainage initially offsets factors favoring edema. acute changes are more likely to produce edema.

proteasome inhibition for MM leads to

accumulation of toxic intracellular proteins and excess proapoptotic proteins >>increased apoptosis

isoniazid is metabolized by

acetylation. the presence of fast and slow acetylators within the same population results in a bimodal distribution of the speed of isoniazid metabolism. slow acetylators are at increased risk of adverse side effects.

decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relaxation at the lower esophageal sphincter

achalasia reduced numbers of inhibitory ganglion cells in the esophageal wall.

FGFR3

achondroplasia gain of function pint mutation on the fibroblast growth factor receptor 3 gene normally inhibits excessive cartilage proliferation, particularly in long bones always active= severely restricted condrocyte proliferation in growth plate cartilage and decreased endochondral ossification.

uric acid is soluble at physiologic pH but can precipitate in the

acidic environment of distal tubules and collecting ducts.

rifampin resistance

acquired by modification of the rifampin binding site on the bacterial DNA-dependent RNA polymerase. common side efffects include hepatotoxicity, blood dyscrasias, and harmless red-organe discoloration of body fluids.

diphtheria toxin and pseudomonal exotoxin A

act by ribosylating and inactivating elongation factor-2, inhibiting host cell protein synthesis and causing cell death.

binding site of actin and myosin filaments

actin=Z line darkest line myosin=M line line within lines

hypovolemia triggers a variety of compensatory mechanisms to improve tissue perfusion

activate RAAS= increased aldosterone and endothelin release, increase vasopressin release, and increased sympathetic tone.

interferon alpha and beta

are produced by most human cells in response to viral infections. the production of alpha and beta interferons helps suppress viral replication by halting protein synthesis and promoting apoptosis of infected cells, limiting the ability of viruses to spread through the tissues.

triptans

are serotonin 5HT1B/tHT1D agonists that block postsynaptic uptake of serotonin

umbilicated, flesh colored papules on the skin and mucous membranes

molluscum contagiosum caused by poxvirus eosinophilic cytoplasmic inclusions

elevated circulating paraproteins

monclonal immunogloulins multiple myeloma rouleaux formation normocytic anemia, hypercalcemia, bone pain, and renal insufficiency

CD14 is a surface marker of the

monocyte-macrophage cell linage. large epitheliod macrophages are always present in granulomas.

Kinesin

motor proteins in anterograde transport reactivation of latent HVS- from cell bodies in the sensory ganglia to the skin and oral mucosa

mucormycosis diagnosed with

mucosal biopsy broad ribbon-like nonseptate hyphae with right-angle branching

monclonal paraproteins= immunoglobulins>elevated normocytic anemia hypercalcemia bone pain renal insufficiency

multiple myeloma

buildup of pressure compresses optic nerves externally, impairs axoplasmic flow within optic nerves, causing bilateral optic disc edema

papilledema young women obese daily headaches transient visual disturbances pseudotumor cerebri: idiopathic intracranial hypertension

localized candidiasis is common in HIV patients where as systemic form is common in

neutropenic patients lymphocytes=local neutrophils= systemic

several significant side effects: flushing, hyperglycemia, and hepatotoxicity... and GOUT

niacin reduce uric acid excretion

binding acetylcholine leads to immediate: Na+, Ca2+ influx K+ outflux

nicotinic receptors

sphingomyelin accumulation, lipid-laden foam cell accumulation in liver and spleen, cherry-red macular spot

niemann-pick disease sphingomyelinase deficiency

headaches, cutaneous flushing, lightheadedness, hypotension after medication use

nitrates

replicate within host cell nucleus using host cell DNA and RNA polymerases

papillomaviruses usually: DNA viruses= replicate in nucleus (except poxvirus) RNA viruses: replicate in cytoplasm (except orthomyxoviruses)

polysaccharides must be degraded to monosaccharides by

pancreatic and brush border amylases before they can be absorbed. monosaccharides can be absorbed directly. D-xylose is a monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency, and can be used to differentiate between pancreatic versus mucosal causes of malabsorption.

cleavage of proinsulin in

pancreatic beta cell secretory granules= insulin and C-peptide stored in granules until they are secreted in equimolar amounts.

frequent source of retroperitoneal hematoma

pancreatic injury SAD PUCKER suprarenal glands aorta and IVC duodenum pancreas ureters and bladder colon kidneys esophagus rectum

most common GI disorder in CF patients

pancreatic insufficiency lead to thick, viscous secretions in the lumens of the pancreas, leading to obstruction, inflammation, and fibrosis. symptoms=steatorrhea, failure to thrive, and fat soluble vitamin deficiency.

severe hypertriglyceridemia

pancreatic lipases can cause toxic levels of free fattly acids to be released within the pancreatic tissue, leading to acute pancreatitis. Fibrates are the most effective agents for the treatment of hypertriglyceridemia.

autodigestion and acute pancreatitis

pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. premature cleavage of trypsinogen to trypsin within the pancreas leads to uncontrolled activation of these zymogens, causing pancreatic autodigestion and acute pancreatitis.

aplastic anemia causes

pancytopenia- as bone marrow is replaced by fat cells and marrow stroma absence of splenomegaly and increased reticulocyte count with normal appearing cells on peripheral smear bone marrow helpful in diagnosis

cerebral vasoconstriction

panic attacks are associated with hyperventilation and decreased pCO2. hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow.

pattern of pervasive distrust of others beginning in early childhood

paranoid personality disorder lack of sustained relationships no fixed delusions and other psychotic symptoms

smooth muscle contraction/relaxation

phenylephrine- alpha 1 agonist=constriction atropine- M3 agonist (inhibits muscarininc receptors on bronchial smooth muscle)= relaxation

cortisol increases the conversion of NE to epinephrine in the adrenal medulla by increasing the expression of

phenylethanolamine-N methyltransferase

phenylalanine hydroxylase deficiency or BH4 deficiency leading to defective metabolism of: phenylalanine tryptophan and deficient: serotonin, dopamine, NE

phenylketonuria

surfactant development

phosphatidylcholine (lecithin) increases after 30 weeks gestation sphingomyelin levels remain fairly constant during the third trimester. L/S ration =/> 2.0 means adequate production to avoid neonatal hyaline membrane disease.

phospholipids and pulmonary surfactant

phospholipids, including dipalmitoyl phosphatidylcholine, are major component of pulmonary surfactant. the amniotic fluit lecithin to sphingomyelin ratio is measured in order to assess fetal lung maturity. the fetal lungs are considered mature when they are producing adequate surfactant to yield an L/S ratio greater than 2

serine kinase

phosphorylation of serine and threonine residues leads to insulin resistance induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon

suspected child abuse

physician should attempt to conduct a full evaluation that includes seeking permission to interview the child alone. following a full evaluation, physicians should contact CPS immediately with any child abuse concerns.

enzyme responsible for conversion of propionly CoA to methylmalonyl CoA

propionyl CoA carboxylase deficiency>>propionic acidemia can't metabolize: valine isoleucine methionine threonine odd chain fatty acids

constitutional and urinary symptoms with prostate gland tenderness on digital rectal examination

prostatitis due to enteric organisms: E coli Enterococci

prostacylin

protaglandin 12- synthesized from prostaglandin H2 by prostacylcin synthase in vascular endothelial cells. once secreted, it inhibits platelet aggretion and causes vasodilation to oppose the functions of thromboxane A2 and help maintain vascular homeostasis.

glossopharyngeal nerve

results in loss of gag reflex, loss of sensation in upper pharynx, posterior tongue, tonsils, and middle ear cavity, and loss of taste sensation on the posterior third of the tongue.

decreased serum haptoglobin levels increased LDH and bilirubin

schistocytes (helmet cells) fragmented erythrocytes: mechanical trauma from microangiopathic hemolytic anemias or prothetic cardiac valves

gingival swelling/bleeding perifollicular hemorrhages and coiled hairs collagen synthesis impairment

scurvy vitamin C deficiency tea and toast diet

medulloblastoma

second most common brain neoplasm of childhood. first is pilocytic astrocytoma- which is also in cerebellum, often at the vermis, but contains rosenthal fibers and astrocytes. medulloblastoma consists of sheets of small, blue cells,. like other 'PNET' tumors, medulloblastomas are poorly differentiated and have a bad prognosis.

congenital pyloric stenosis

secondary to hypertrophy of the pyloric muscularis mucosae. physical exam shows visible peristalsis and the presence of an olive-sized mass in the distal stomach or pyloric region.

secretin and S cells

secretin is produced by S cells in the duodenal mucosa in response to stimulatioin by intraluminal acidity. secretin stimulates the release of bicarbonate-rich secretions from the exocrine pancreas, which is the major source of acid-neutralizing bicarbonate entering the duodenum.

increases level of thyroxine binding globulin

see with estrogen increase: pregnancy estrogen replacement this leads to increase in total thyroid hormone levels but negative feedback normalize free T4

red ragged muscle fibers

seen in mitochondrial disease due to abnormal mitochondria accumulate under the sarcolemma maternal inheritance

factor VII

shortest half-life failure of prothrombin time to correct with vitamin K indicates factor VII deficiency usually due to liver disease

language development by age 2

should have vocab of 50-200 words and use 2 word phrases. Parent's concerns about delayed milestones should be validated; they should be reassured that children often catch up but may need help. further evaluation and regular monitoring are required.

diagnostic findings for mesothelioma

stain positive for cytokeratins and calretinin can appear cuboidal or flattened celled or have spindle cells

immunohistochemistry of mesothelioma

stain positive for cytokeratins and many also stain postive for claretinin

immunohistochemistry of mesothelioma

stain positive for cytokeratins and many also stain postive for claretinin associated with asbestos exposure

auer rods

stain positively for myeloperoxidase found in AML M3 (acute promyelocytic leukemia)

hepatic abscess causes and route of spread

staph A: hematogenous enteric bacteria (E coli, klebsiella, and enterococci): ascending biliary tract, portal vein pyemia, or direct invasion from adjacent area entamoeba histolytic, echinococcal: most prevalent cause of liver abscess in developing coutnries

HMG-CoA reductase inhibitors

statins- can be hepatotoxic. check hepatic transaminases prior to therapy.

95% confidence interval does not include the null value

statistically significant

steroidogenesis: first step in mitochondria and the rest in smooth ER

steroid producing cells contain a well developed smooth ER

ankylosing spondylitis

stiffness and fusion of axial joints and inflammation at the site of insertion of tendons into bone (enthesitis). involvement of the thoracic spine and costovertebral and costosternal junctions can limit chest wall expansion, leading to hypoventilation.

high HCG

stimulate TSH receptors and can cause paraneoplastic hyperthyroidism.

NE

stimulates beta1 adrenoreceptors, increase cAMP concentration within cardiac myocytes and leads to increased contractility, conduction, and heart rate. peripheral vasoconstriction occurs via stimulation of alpha1 adrenoreceptors in vascular smooth muscle cells and activation of an IP3 signaling pathway.

UAA, UAG, and UGA

stop codons

releasing factors recognize

stop codons UAA UAG UGA and terminate protein synthesis

most commonly injured structure of the rotator cuff syndrome is the

tendon of the supraspinatus muscle. because the supraspinatus is an abductor of the humerus, injury to its tendon causes pain on abduction of the arm.

complete contralateral sensory loss

thalamic lesion (VPL and VPM) no somatosensory projections to the cortex via thalamocortical fibers.

CAAT

the TATA and CAAT boxes are promoters of transcription in eukaryotic cells are located approximately 25 and 75 bases upstream from the transcription start site, respectively. they promote initiation of transcription by serving as binding sites for transcription factors and RNA polymerase II.

precursor of serotonin

tryptophan precursor to epi, NE, dopamine, melanin= tyrosine

precursor for serotonin

tryptophan serotonin syndrome- altered mental status, autonomic hyperactivity, and neuromuscular excitation (eg, hyperrelexia, clonus).

bilateral renal angiomyolipomas are associated with

tuberous sclerosis autosomal dominant condition. renal angiomyolipoma is a benign tumor composed of blood vessels, smooth muscle, and fat.

hypocapnia is caused by

upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance. hypocapnia implies ongoing alveolar hyperventilation.

ornithine transport into mitochondria is necessary for proper function of the

urea cycle defects cause neurological damage due to the accumulation of ammonia protein restriction improves condition by reducing amino acid turnover

protein restriction improves this condition by reducing the amount of amino acid turnover

urea cyle defect ornithine transport into mitochondria to conduct urea cycle is impaired

gives rise to the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters

ureteric bud

intracranial hypertension (papilledema), skin changes, and hepatosplenomegaly

vitamin A overuse allopecia, hepatic injury (cirrhosis)

Niacin

vitamin B3 or nicotinic acid. many dehydrogenases use NAD+ and NADP+, which are formed from niacin. deficiency=pellagra and is classically associated with the 4 D's: dermatitis, dementia, diarrhea, and if untreated, death.

catalyzes rate-limiting step of heme synthesis with enzyme: aminolevulinate synthase

vitamin B6 deficiency can lead to siderblastic anemia

severe hypoglycemia

with loss of consciousness is typically treated with intramuscular glucagon in the nonmedical setting and with intravenous dextrose in the medical setting.

hypertrophic cardiomyopathy

worse with decreased LV volume caused by decreased preload and/or afterload. dihydropyridine CCB and nitroglycerin should be avoided.

chronic arteriovenous shunt

would increase cardiac output due to increased sympathetic stimulation to the heart, decreased total peripheral resistance, and increased venous return. it would also cause the venous return curve to shift to the right because the circulating blood volume is increased through renal retention of fluids and because venous pooling is reduced by the increased sympathetic tone.

G6PD inheritance pattern

x linked recessive

HER2

blockage with monoclonal antibody trastuzumab downregulates cellular proliferation and promotes apoptosis-by preventing activation of a transmembrane tyrosine kinase.

abciximab

blocker of glycoprotein IIb/IIIa receptor normally promotes platelet binding to fibrinogen. GP IIb/IIIa is either deficient or defective in patients with Glamnsmann thrombasthenia.

flow=r to the 4th power

blood flow directly proportional to the vessel radium to the fourth power. resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power.

accumulated homogenistic acid causing: pigment deposits in connective tissue

blue-black deposits become apparent in slcerae and ear cartilage. due to deficiency of homogentistic acid dioxygenase severe arthritis in adult life. called: alkaptonuria

conductive hearing loss

bone conduction will be greater than air conduction (abnormal Rinne test), and the weber test will lateralize to the affected ear. in sensorineural hearing loss, air conduction will be greater than bone conduction (normal Rinne test), and the weber test will lateralize to the unaffected ear.

hypochromic, microcytic anemia due to iron deficiency will increase

bone marrow erythropoiesis lots of immature RBCs into blood. contain bluish cytoplasm and reticular precipitates of residual ribosomal RNA.

proximal ureter receives its blood supply

from the renal artery whereas the distal ureter is supplied by the superior vesical artery. circulation to the middle portions of the ureter is variable and anastomotic.

lactic acidosis in septic shock

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

elastin has rubber like properties due to its high content of

cross-linking of nonpolar (hydrophobic) amino acids: lysine, proline

cells of the ovary are

cuboidal epithelium involved in surface repair of defects from ovulation endometriosis commonly affects the ovary and results in infertility.

vibrio vulnificus

curved, gram negative, free living bacterium that grows in marine environments. transmission primarily occurs due to the consumption of raw seafood (eg, oysters) or wound contamination. usually there is a mild cellulitis. but patients with liver disease or iron overload are at high risk for severe, fulminant infection (sepsis, necrotizing fascitis).

ecthyma gangrenosum

cutaneous necrotic disease with a strong association with pseudomonas aeruginosa bacteremia. perivascular invasion and release of tissue destructive exotoxins, causing vascular destruction and insufficient blood flow to patches of skin that become edematous and subsequently necrose. pseudomonas infections are common in patients who are neutropenic, are hospitalized, have burns, or have indwelling catheters.

methemoglobin contains ferric rather ferrous iron (Fe3+)

cyanide binds ferric iron more and is treatment for toxicity

cheyne stokes breathing

cyclic breathing of apnea followed by gradually increasing then decreasing tidal volumes until the next apneic period. usually in advanced CHF

eosinophils and mast cells: synthesize and release C4, D4, E4

cysteinyl-containing leukotriene asthma block them with: montelukast

activates caspases and indirectly brings about cell death

cytochrome C mitochondrial enzyme shrinks tumors

role in mRNA translation regulation and mRNA degradation

cytoplasmic P bodies

essential fructosuria

fructokinase definciency is a benign disorder. although affected patients are asymptomatic, their urine will test positive for a reducing sugar due to the presence of unmetabolized fructose.

alcohols

function by disorganizing the lipid structure in membranes, causing them to be leaky, and by denaturing cellular proteins. they are bactericidal, tuberculocidal, fungicidal, and virucidal, but do not destroy bacterial spores.

Neisseria gonorrhoeae

has high variability of its surface molecules-porins, opa proteins, polysaccharide, etc. this prevents the formation of protective immunity (even with infection and adequate antibiotics), and leads to susceptibility to repeat infection.

renal papillary necrosis

gross hematuria, acute flank pain, and passage of tissue fragments in urine. commonly seen in patients with sickle cell disease or trait, diabetes mellitus, analgesic nephropathy, or severe obstructive pyelonephritis.

ehlers danlos syndrome

group of rare hereditary disorders characterized by defective collagen synthesis. can be caused by procollagen peptidase dficiency, which results in impaired a cleavage of terminal propeptides in the extracellular space. patients of often have joint laxity, hyperextensible skin, and tissue fragility due to the formation of soluble collagen that does not properly crosslink.

cutaneous strawberry type capillary hemangiomas

grow in proportion to the growth of the child and then eventually regress. usually gone by age 7.

homeobox (HOX) genes

guide pattern of embryo development along the rostro-caudal, limb, and genital axes. HOXA13= hand-foot-genital syndrome distal limb defects: hypoplastic first digits and genitourinary malformations.

segmental demyelination of the peripheral nerves and an endoneural inflammatory infiltrate

guillain barre syndrome

lymphocytes with cytoplasmic projections

hairy cell leukemia indolent B cell neoplasm that infiltrates bone marrow and reticuloendothelial system. dry tap: due to fibrosis and bone marrow failure, leading to pancytopenia.

increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity

hallmarks of atypical subtype treatment resistant: use atypical features

halogenated inhaled anesthetics

halothane, enflurane, sevoflurane, desflurance metabolized by cyc P450 system by which they are converted to reactive intermediates that can cause heptaocellular damage (halothane hepatitis). patients present with acute hepatitis days after medication exposure, andliver biopsy may show centrilobular hepatic necrosis.

disorganized cartilage, fibrous, and adipose tissue in benign lung tumor

hamartomas asyptomatic 'coin lesion' in 50-60 years

single most important measure to reduce the risk of transmission of hospital acquired infections (MRSA)

hand hygiene

neutral amino acids in urine

hartnup disease mutation in neutral amino acid transporter treat: high protein diet daily niacin/NAD

carotid sinus reflex

has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus and medullary centers via the glossopharygeal nerve; the efferent limb carries parasympathetic impulses vis the vagus nerve.

methotrexate

folic acid antagonist used to treat ectopic pregnancy. it competitively inhibits the enzyme dihydrofolate reductase, which catalyzes the synthesis of tretrahydrofolate. DHF reductase inhibition causes the intermediate DHF to accumulate intracellularly.

isosorbide dinitrate

has low bioavailability due to extensive first-pass hepatic metabolism prior to release in systemic circulation. sublingual nitroglycerin is absorbed directly from oral mucosa into the venous circulation and has a higher bioavailability.

blocking histamine receptors with first generation antihistamines

have antimuscarinic, anti-alpha adrenergic, and anti-serotonergic properties. anticholinergic effects on the ocular ciliary muscles impair accommodation and cause blurring of vision for close objects.

Ornithine transcarbamylase deficiency

have discrete episodes of vomiting, tachypnea, and confusion/coma secondary to hyperammonemia. OTC deficiency is the most common disorder of the urea cycle and is characterized by hyperammonemia and elevated urinary orotic acid.

nitrate side effects

headaches and cutaneous flushing along with lightheadedness and hypotension due to systemic vasodilation.

thermal cycling PCR

heating for DNA strand denaturation, cooling for primer hybridization, and rewarming for primer extension and DNA synthesis

most common in children and affects metaphysis of long bones due to slower blood flow and capillary fenestrae

hematogenous osteomyelitis

route of metastasis to the skeleton

hematogenous seeding pelvis, prostate: via vertebral venous plexus

acute nausea

following administration of chemotherapy results from stimulation of the chemoreceptor trigger zone (CTZ), which lies in the area postrema of the dorsal medulla near the fourth ventricle.

bioavailability

fraction of administered drug that reaches the systemic circulation in a chemically unchanged form. non-IV route administration is always <1. F=9AUC oral x dose IV)/(AUC IV x dose oral)

long, narrow face, prominent chin and forehead, and large testes

fragile X syndrome developmental delay neuropsychiatric findings that overlap with: autism, ADHD

coronary sinus

freely communicates with right atrium. dilated when things increased right atrial pressure--pulmonary HTN.

Paraaminohippuric acid (PAH)

freely filtered from the blood in glomerular capillaries to the tubular fluid in bowman's space. it is also secreted from the blood into the tubular fluid by cells of proximal tubule by carrier protein-mediated process. the secretion of PAH can be saturated at high blood concentrations.

anatomic or functional vesicoureteral reflux

frequent bladder infections may weaken vesicoureteral junction and facilitate reflux

clear cell carcinoma

from renal proximal tubular cells. rounded or polygonal cells with abundant clear cytoplasm are seen on light microscopy. 'clear cells' are those with high glycogen or lipid content that dissolves during routine tissue preparation.

benign lymph node enlargement

in response to antigenic stimulation is asso. with a polyclonal proliferation of lymphocytes. a monoclonal lymphocytic proliferation is strong evidence of malignancy.

dermatitis herpetiformis associated with celiac disease

increased intraepithelial lymphocytes, loss of villus height, crypt hyperplasia, steatorrhea

colonic diverticula

increased intraluminal pressure case outpouching of the mucosa and submucosa through the muscularis- false diverticula

COPD flow volume loop

increased residual volume and TLC. both airway narrowing due to chronic bronchitis and decreased elasticity due to emphysematous destruction of interalveolar walls are responsible for the hyperinflation and airflow limitation.

small loop to the left

increased residual volume, TLC reduced EFR airway narrowing and decreased elasticity>>hyperinflation and airflow limitation

adverse effects of secondhand smoke exposure

increased risk of low birth weight asthma middle ear disease sudden infant death syn SIDS-due to impaired arousal and abnormal cardiovascular response to stimuli.

renal calculi

increased urinary calcium, oxalate, and uric acid promote salt crystallization increased urinary citrate and high fluid intake prevent calculi formation

fibrillin-1 (FBN1) gene mutation

marfan syndrome protein responsible for production and maintenance of elastic fibers. affects: CVS MSK eyes

defense mechanisms

mature defense mechanism involving a conscious choice not to dwell on a particular though or feeling. vs. repression with is not conscious.

ductus arteriosus derived from

6th aortic arch 4th= aortic arch 3rd= common carotid

pharyngeal pouches

1= middle ear and auditory tube 2=palatine tonsil crypts 3=thymus, inferior parathyroid glands 4=superior parathyroid glands, ultimobranchial body

drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome

2-8 weeks after exposure phenytoin carbamazepine allopurinol sulfonamides minocycline vancomycin fever, generalized lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction.

dengue virus

4 serotypes secondary infection is much worse high grade fever headaches severe myalgias joint pains

unbalanced robertsonian translocations account for a minority of Down syndrome cases

46, XX, t(14;21) epicanthal folds, upslanting palpebral fissures, a protruding tongue, and excessive skin at the nape of the neck.

klinefelter syndrome

47,XXY presents with tall stature, gynecomastia, and small, firm testes. decreased testosterone secretion by fibrotic testes causes oligospermia and infertility.

finasteride

5-alpha reductase inhibitor that suppresses conversion of testosterone to dihydrotestosterone. used for treatment of BPH and androgenetic alopecia.

in patients with: chronic aortic stenosis & concentric left ventricular hypertrophy >> atrial contraction contributes greatly to LV filling

A fib means loss of this>> sudden decrease in LV preload and CO>> systemic hypotension

tricyclic antidepressants

Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, doxepin, amoxapine. can cause confusion, constipation, and urinary retention.

PaO2<65

hypoxia

aromatase inhibitors

(anastrozole, letrozole, exemestane) decrease the synthesis of estrogen from androgens, suppressing estrogen levels and slowing progression of ER-positive tumors.

osler-weber-rendu syndrome

(hereditary hemorrhagic telangiectasia) is an autosomal dominant conditioin marked by the presence of telangiectasias in the skin as well as the mucous membranes of the lips, oronasopharynx, respiratory tract, gasterointestinal tract, and urinary tract. rupture of these telangiectasias may cause epistaxis, GI bleeding, or hematuria.

net excretion rate

(inulin clearance)(plasma concentration of substance)-(tubular reabsorption of substance)

maintenance dose equation

(steady state plasma concentration X clearance rate) divided by bioavailabillity. IV=1 for bioav. then multiple by hours and days.

loss of cardiomyocyte contractility occurs how long after onset of ischemia

60 seconds after 30 minutes, reversible contractile dysfunction, more leads to irreversible ischemic injury

attributable risk is calculated by

100 x [(RR-1)/RR]

lower angiotensin II levels, causing a reduction in systemic pressures and relative dilation of the efferent arteriole reduction in: GFR, FF

ACE inhibitors

ACE inhibitors and volume depletion

ACE inhibitors can cause significant first-dose hypotension in patients with volume depletion (eg, from diuretic use) or heart failure. to reduce the risk of first dose hypotension, ACE inhibitor therapy should be initiated at low dosages.

dehydration stimulates ADH secretion

ADH acts on the collecting ducts, increasing their permeability to water. thus, in the presence of ADH, the collecting ducts contain the most concentrated fluid in the nephron, while the thick ascending limb of the loop of Henle and distal convoluted tubule contain the most dilute fluid.

sertoli cells

AMH and regression of female internal organs leydig cells: stimulate wolffian ducts and make internal male organs. make testosterone which make external make organs

KRAS is a proto-oncogene vs. the tumor suppressors:

APC BRCA1 RB TP53

early-onset familial Alzheimer disease is associated with three gene mutations

APP (chromosome 21) presenilin 1 and presenilin 2 late onset familial Alzheimer disease is assoicated with apolipoprotein E4 genotype.

during the skeletal contraction cycle

ATP binding to myosin causes release of the myosin head from its binding site on the actin filament.

segmented viruses

BOAR: Bunyavirus Orthomyxovirus Arenavirus Reovirus (rotavirus) capable of genetic shifts through reassortment--involves exchange of entire genomic segments, a far more dramatic process than the point mutations responsible for genetic drift.

GABA-B receptor used to treat spasticity secondary to both brain and spinal cord disease

Baclofen can also use Tizanidine: alpha 2 agonist

liver P450 inducers

Barbs=phenobarbitol funny=phenytoin mom=modafinil refuses=rifampin greasy=griseofulvin carb=carbamazapine shakes=st. john's wort

gram negative coccobacillus

Bordetella pertussis

starry sky on histology

Burkitt's lymphoma very likely in HIV infection high mitotic index

disrupt actin cytoskeletal structure and intracellular signaling

C diff toxins: A and B cause: intestinal inflammation and fluid secretion

thick, viscous secretions in the lumens of pancreas, resulting in obstruction, inflammation, and subsequent fibrosis

CF pancreatic insufficiency

cytochrome p450 inducers

Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin decreased efficacy of warfarin. cimetidine, amiodarone, and trimethoprim-sulfamethoxazole inhibit warfarin metabolism, increasing the risk of bleeding.

disopyramide

Class IA antiarrhythmic depress phase 0 depolarization prolong repolarization increase action potential

disrupt cytoskeletal structure and intracellular signaling

Clostridium difficile A&B toxin A=intestinal inflam/fluid secretion B=cytotoxic

monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency

D-xylose used to differentiate between pancreatic vs. mucosal causes of malabsorption

HLA classes

I= HLAB27, expressed by all nucelated cless and present endogenous antigents to CD8 cells. II=DR,DP,DQ alleles are expressed by antigen presenting cells (macrophages, dendritic cells)and present predominantly foreign antigens to CD4 helper T cells. classI=IBD classII=RA, DM type I, and celiac.

presence of acute phase reactants increases the ESR

IL-1, IL6, TNF-alpha

produced by macrophages that induce chemotaxis and phagocytosis in neutrophils

IL-8 cause pus formation: protein rich fluid, dead leukocytes-mostly neutrophils

initial drug of choice for status epilepticus

IV benzodiazepines (lorazepam). work by enhancing the effect of GABA-A receptor, leading to increased chloride influx and suppression of action potential firing.

anti-Rh immune globulin

IgG anti-D antibodies that opsonize Rh+ fetal erythrocytes, promoting clearnace by maternal reticuloendothelial macrophages and preventing maternal Rh sensitization. it is routinely administered to Rh-negative women at 28 weeks gestation and immediately postpartum.

intracellular pathogens

Listeria monocytogenes Shigella flexneri Rickettsia species (multiple) E. coli strains Salmonella strains eliminated by cell-mediated response (T cells, macrophages, cytokines). impaired cell mediated immunity are at risk for invasive infections by these pathogens.

alcohol withdrawal

Long-acting benzodiazepines- diazepam or chlordiazepoxide in patients with advanced liver disease- use lorazepam, oxazepam, temazepam

breaks down monamine neurotransmitters (dopamine, NE, serotonin)

MAO inhibitors leads to buildup consume tyramine foods: aged cheeses, cured meats, draft beer cause tyramine-induced hypertensive crisis

each molecule consists of a heavy chain and a beta2-microglobulin

MCH class I

medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and marfanoid habitus

MEN2B episodic headache due to catecholamines from pheo

superantigens (toxic shock syndrome toxin) interact with

MHC molecules on APC and the variable region of T lymphocyte receptor cause nonspecific, widespread activation of T cell release IL2 from T cell TNF from macrophages

audible S3 gallop indicate severity of

MR increase atrial pressure leads to increase in ventricle volume/pressure

preferred diagnostic method for vertebral osteomyelitis

MRI of the spine should be suspected in patients with new/worsening back pain, fever, and recent endocarditis or bacteremia (staph A)

plaques contain foci of perivenular inflammatory infiltrates made up of autoreactive T lymphocytes and macrophages patchy demyelination

MS

DNA mismatch repair genes

MSH2, MLH1 HPPCC or lynch syndrome

anion gap metabolic acidosis

MUDPILES: Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates. DKA: treat with insulin, K+, saline

NNT

NNT=1/ARR

NO and arginine

NO is made from arginine by NO synthase. as a presursor, arginine supplementation may play an adjunct role in the treatment of conditions that improve with vasodilation, such as stable angina.

Thiazolidinediones

Pioglitazone Rosiglitazone reduce insulin resistance by altering gene transcription and protein synthesis through PPAR-gamma. takes several days to weeks after to take effect. can exacerbate HF, edema, weight gain

net filtration pressure

Pnet = (Pc - Pi) - (∏c -∏i)

oxidase positive non lactose fermenting gram negative rod

Pseudomonas A common: UTI in patients with catheters

Myastenia Gravis (MG)

Ptosis (inability to open upper eyelids), nasal smile abnormalities of the thymus

decreased CO

RAAS activation and increased sympathetic output raise arterial resistance (afterload) and exacerbate heart failure by making it more difficult for the failing hear to pump blood to the tissues.

direct contributors to sarcoidotic granuloma formation

Th1, IL-2, interferon-gamma

caused by gram positive actinomycete

Trophyeryma whippelii whipple disease rare systemic illness that involves small intestine, joints, and central nervous system. classic histologic findings include small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS positive, diastase- reisistant granules.

nitroprusside

a short acting venous and arterial vasodilator that decreases both preload and afterload. since these changes are balanced, stroke volume is maintained.

Mitochondrial vacuolization

a sign of irreversible cell injury- involved mitochondria have been permanently damaged.

pyrimidine dimers that are formed in DNA as a result of UV light is repaired by

a specific endonuclease complex that nicks the damaged strand on both sides of the dimer, excise the damaged segment, and DNA is replaced by DNA polymerase.

human multidrug resistance (MDR1) gene codes for P-glycoprotein

a transmembrance ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds. this protein reduce the influx of drugs into the cytosol and can increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.

kawasaki disease

a vasculitis of medium-sized arteries that presents with persistent fever for more than 5 days, bilateral conjuctivitis, cervical lymphadenopathy, and mucocutaneous involvement. coronary artery aneurysms are serious complication

extrinsic vs intrinsic pathway factors

aPTT: intrinsic XII XI IX VIII PT: extrinsic VII

gonadal artery arises from the

abdominal aorta

disulfiram like effects

abdominal cramps, nausea, headache metronidazole when combined with alcohol can cause due to acetaldehyde accumulation.

specificity

ability to correctly identify individuals without the disease. it should be high in confirmatory test to decrease false positives.

penicillins, cephalosporins, and vancomycin

able to disrupt the peptidoglycan cell wall of gram positive and gram negative organisms. the peptidoglycan cell wall of these organisms gives them the ability to survive osmotic stress; this ability is lost after treatment with these antibiotic agents.

systemic mastocytosis

abnormal proliferation of mast cells and increased histamine release. histamine causes hypersecretion of gastric acid by parietal cells in the stomach as well as a variety of other symptoms (eg, hypotension, flushing, pruritus)

upper motor neuron damage

above the anterior horn of lower medulla. leads to spastic paralysis, hyperreflexia, and an upgoing plantar reflex (Babinski sign) due to loss of descending inhibition over lower motor neurons in the anterior horn. lower motor neuron lesions cause flaccid paralysis, hypotonia, hyporeflexia, muscle atrophy, and fasciculations.

drug induced lupus erythematosus

abrupt fever, arthralgias, pleuritis, with positive anti-histone antibodies. linked to drugs metabolized by N-acetylation in the liver (procainamide, hydralazine, isoniazid). genetically predisposed individuals who are slow acetylators are at greater risk for developing DILE.

development of atherosclerotic plaque (atheroma)

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

cytochrome C

activates caspases in mitochondria and indirectly brings about cell death through intrinsic pathway apoptosis.

Rb tumor suppressor gene

active (hypophosphorylated): prevent cells from going pas the G1/S checkpoint. inactive (hyperphosphorylated): allows damaged cell to enter mitosis.

cefuroxime

acts against cell wall synthesis leads to organism destruction by placement in hypotonic solution

fas receptor

acts to initiate the extrinsic pathway of apoptosis. mutations involving the Fas recceptor of fas ligand can prevent apoptosis of autoreactive lymphocytes, thereby increasing the risk of autoimmune disorders such as SLE.

increased neutrophil count and decreased lymphocyte, monocyte, basophil, and eosinophil counts

acute effects of corticosteroids increase in neutrophils due to: demargination of neutrophils previously attached to the vessel wall.

urine darken with exposure to sunlight NO skin sensitivity deficiency of porphobilinogen deaminase

acute intermittent porphoryia

accumulation of ALA and PBG

acute intermittent porphyria inherited PBG demainase deficiency combined with ALA synthase induction treat: glucose/hemin inhibit ALA synthase activity

HUS

acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia labs: decreased hemoglobin and platelet count increased bleeding time, lactate dehydrogenase, bilirubin, BUN, and creatinine.

acute/subacute (2-4wks): migratory arthritis pancarditis sydenham chorea

acute rheumatic fever

acute stress disorder v. PTSD

acute: 3 or more days but less than 1 month PTSD: more than 1 month

worse prognosis with PSGN

adult onset poor prognosis and higer risk of chronic hypertension and renal insufficiency

total oxygen content of blood

affected by: hemoglobin concentration, oxygen saturation of hemoglobin (SaO2), and the partial pressure of oxygen dissolved in blood (PaO2). Anemia is characterized by decreased hemoglobin concentration (oxygen content) in the setting of normal SaO2 and PaO2.

unilateral renal stenosis

affected kidney is protected from high bp by the narrowing of the renal artery and may suffer ischemic damage, leading to glomeruli crowding. vs. other kidney is well perfused and shows changes of hypertensive nephropathy (eg, hyaline or hyperplastic arteriolosclerosis).

hematogenous osteomyelitis

affects children commonly usually at the metaphysis of long bones due to slower blood flow and capillary fenestrae could progress to suppurative osteomyelitis

light reflex pathway

afferent limb is the optic nerve, and efferent limb is the parasympathetic fibers of the oculomotor nerve. when an optic nerve is damaged, light in that eye will cause neither pupil to constrict (the nerve can't sense the light). however, light in the contralateral eye will cause both pupils to constrict (because motor pathways are intact).

Protein kinase C

after a ligand binds to a G protein-coupled receptor that activates phospholipase C, membrane phospholipids are broken down into DAG and IP3. protein kinase C is activated by DAG and calcium

acute pancreatitis

after gallstones, alcohol abuse is the second most common cause of acute pancreatitis. macrocytosis and AST:ALT >2 are indirect indicators of chronic alcohol consumption. alcohol related macrocytosis can occur independently of folate deficiency.

maximal velocity of skeletal muscle contraction increases as

afterload decreases =force against which muscle fiber has to contract highest contraction velocity=afterload is zero

increased collagen deposition accum. of cytoplasmic pigment sigmoid vent. septum

age related myocardial changes

baclofen

agonist at GABA-B receptor effective as monotherapy for the treamtment of spasticity secondary to both brain and spinal cord disease (MS). tizanidine also used

rises a bit trachea medium sized bronchi and then decreases all the way down to alveoli

airway resistance

nitrogen transfer

alanine is the major amino acid responsible for transferring nitrogen to the liver for disposal. during catabolism of proteins, amino groups are transferred to alpha-ketoglutarate to form glutamate. glutamate is then processed in the liver to form urea, the primary disposal form of nitrogen in humans. free ammonia is also excreted into the urine by the kidney for regulation of acid-base status.

dissolve lipid bilayer membranes and denature proteins of influenza virus, fungus, enveloped viruses

alcohol based disinfectants

lung abscesses

alcoholics are more likely than the general population to develop pulmonary infectioins and abscesses involving combinations of anaerobic oral flora (bacteroides, prevotella, fusobacterium, and peptostreptococcus) and aerobic bacteria. clindamycin covers most of these organisms and is thus the antibiotic of choice for treating lung abscesses.

hereditary fructose intolerance

aldolase B deficiency accumulation of toxic metabolite fructose-1-phosphate result in hypoglycemia and vomiting with fructose or sucross avoid: fructose sucrose

polyol pathway

aldose reductase converts glucose into sorbitol, which is slowly metabolized into fructose by sorbitol dehydrogenase. chronic hyperglycemia overwhelms this pathway, causing intracellular sorbitol accumulation and increased osmotic/oxidative stress. this accelerates cataract development in patients with diabetes and contributes to the pathogenesis of diabetic retinopathy, neuropathy, and nephropathy.

can't metabolize tyrosine to fumarate to send to TCA cycle and has urine turn dark after standing

alkaptonuria increase: homogentisic acid due to deficiency: homogentisic acid dioxygenase

3' to 5' exonuclease activity (proofreading)

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

organisms that lack peptidoglycan walls

all organisms of mycoplasma genus resistant to penicillins, cephalosporins, carbapenems, and vancomycin need to be treated with antiribosomal agents (eg, tetracyclines, macrolides)

different mutations at same genetic locus cause similar phenotypes

allelic heterogeneity more than one type of mutation is possible in a given gene, different mutations can cause protein alterations or loss of function, resulting in disease.

desmopressin effects on vWF

alleviate bleeding through endothelial release of vWF.

E coli K1 capsular antigen

allows bacteria to survive in the bloodstream and establish meningeal infection. lipopolysaccharide: bacteriemia and septic shock verotoxin (shiga-like): gastroenteritis, bloody heat stable/labile: watery gastroenteritis p fimbriae: UTI

sodium/calcium exchange pump

along with sarcoplasmic reticulum calcium-ATPase pump mediate calcium efflux from cardiac cells prior to relaxation

alpha 2 receptors and insulin

alpha 2 inhibit insulin secretion, beta 2 stimulate secreation alpha 2 is predominant--sympathetic stimulation leads to overall inhibition of insulin secretion.

BPH meds

alpha adrenergic antagonists: terazosin, tamsulosin---smooth muscle relaxants that work on the dynamic component bladder outlet obstruction. work within days to weeks but no not significantly affect prostate volume. 5-alpha reductase inhibors: finasteride, dutasteride---inhibit the conversion of testosterone to dihydrotestosterone and address the fixed component of bladder outlet obstruction. they reduce prostate volume but can take up to 6-12 months to achieve maximal effect.

reddish-pink globules on PAS stain: interalveolar septa destruction elevated LFTs dyspnea smoking: early onset basilar lung predominant

alpha-1-antitrypsin deficiency

complications of Fabry disease

alpha-galactosidase A deficiency early: neuropathic pain and angiokeratomas later: renal=nephropathy cardia=LV hypertrophy CNS=TIA, stroke

fabry disease

alpha-galactosidase A deficiency causes accumulation of the sphingolipid globotriasylceramide. the earliest manifestations of Fabry disease are neuropathic pain and angiokeratomas. glomerular (proteinuria, renal failure), cardiac (left ventricular hypertrophy), and cerebrovascular (TIA, stroke) complications in adulthood.

lower vermis and the flocculonodular lobe

also causes vertigo/nystagmus due to dysregulation of the vestibular nuclear.

hemoglobin levels are affected by

alterations in RBC survivial increased turnover RBCs cause false> HbA1c== low

internal ribosome entry

alternative method used by apoptotic cells whereby a distinct nucleotide sequence allows translater to being in the middle of the mRNA, while cell may be going apoptosis

spleen a mesodermal orgin

although it is supplied by the splenic artery (a branch of the major foregut vessel, the celiac trunk, it is not of foregut derivative.

abdominal pain, vomiting, and severe, cholera-like diarrhea with positive urine alpha-amanitin

amatoxin poisoning duet o poisonous mushroom ingestion bind DNA-dependent RNA polymerase type II and halt mRNA synthesis. ....affect organs with rapid cell turnover: GI, proximal CRT

vancomycin resistance

amino acid change from D-ala to D-lac

catabolism of proteins

amino groups transferred to alpha-ketoglutarate to form glutamate

antibiotic modifying enzymes add chemical groups: acetyl, adenyl, phosphate to a target drug and lead to

aminoglycoside resistance gentamicin

class III antiarrhythmic drugs

amioderone, sotalol, dofetilide block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential--prolonging repolarization and total action potential duration. sodium, calcium, potassium

hypoxia, hypotensive shock, and DIC after prolonged delivery in mom

amniotic fluid embolism fetal squamous cells are seen in pulmonary vasculature

amniotic fluid embolism

amniotic fluid entering the maternal circulation. hypoxia, hypotensive shock, and DIC. fetal squamous cells are seen in pulmonary vasculature during histologic evaluation.

antifungals that bind ergosterol

amphotericin B and nystatin azoles: inhibit synthesis of ergosterol caspofungin: blocks cell wall flucytosine: DNA and RNA synthesis griseofulvin: mitosis

hypospadias

an abnormal opening of the urethra proximal to the glans penis along the ventral shaft of the penis. incomplete fusion of urogenital folds.

theophylline

an adensoine receptor antagonist and indirect adrenergic agent with a narrow therapeutic index. it is predomonantly metabolized by the hepatic cytochrome oxidases. inhibition of these enzymes by concurrent illness (eg, infection with fever) or ingestion of certain drugs or substances (ciprofloxacin) can raise serum theophylline concentrations and cause toxicity (eg, seizures, cardiac arrhythmias).

ipratropium

an anticholinergic agent and derivative of atropine, treats obstructive lung disease by blocking aceytlcholine at muscarinic receptors, which prevents bronchoconstriction and reduces mucus secretion from the tracheobronchial submucosal glands.

pernicious anemia

an autoimmune disease characterized by CD4+ cell-mediated destruction of parietal cells. as parietal cells aredestroyed, their ability to secrete hydrochloric acid decreased, resulting in an elevated intraluminal pH that leads to upregulation of gastrin secretion. patients also develop vitamin B12 deficiency as a result of decreased intrinsic factor secretion.

acute intermittent porphyria

an autosomal dominant condition caused by porphobilinogen deaminase deficiency. most patients remain asymptomatic, but a minority present with acute attacks characterized by abdominal pain and vomiting, peripheral neuropathy, neuropsychological symptoms, and reddish-brown urine. treatment consists of intravenous glucose or heme preparations, which downregulate ALA synthase activity.

friedreich ataxia

an autosomal recessive condition that presents during childhood/adolescence with progressive gait ataxia (due to degeneration of the posterior columns and dorsal root ganglia). other features-hypertrophic cardiomyopathy (most common cause of death), skeletal abnormalities (eg, kyphoscoliosis, pes cavus), and diabetes mellitus.

Tay-Sachs disease

an autosomal recessive disorder caused by beta-hexosaminidase A deficiency, which results in GM2 ganglioside accumulation. key clinical features include preogressive neurodegeneration and a cherry-red macular spot. in contrast to patients with Niemann-Pick disease, those with Tay Sachs disease have NO hepatosplenomegaly.

alkaptonuria

an autosomal recessive disorder in which the lack of homogentisic acid dioxygenase blocks the metabolism of tyrosine, leading to an accumulation of homogentistic acid. features: black urine when exposed to air, a blue-black pigmentation on the face, and ochronotic arthropathy.

postpartum hemorrhage

an obstetrical emergency. bilateral ligation of the internal iliac artery can decrease uterine blood flow and control postpartum hemorrhage that is unresponsive to medical management.

pretibial myxedema

and Graves ophthalmopathy are specific features of Graves disease. caused by autoimmune response directed against the TSH receptor that results in accumulation of glycosaminoglycans within the affected tissues.

sodium/clacium exchange pump

and sarcoplasmic reticulum calcium ATPase pump are the main sources of calcium efflux from cardiac cells prior to relaxation

interscalene nerve block

anesthesai for shoulder and upper arm procedures. causes ipsilateral diaphragmatic paralysis due to anesthetizing the roots of the phrenic nerve (C3-C5) should be avoided in patients with chronic lung disease or with contralateral phrenic nerve dysfunction.

composed of blood vessels, smooth muscle, and fat

angiomyolipoma benign tumor if bilateral in kidneys associated with tuberous sclerosis

occlusion of proximal LAD

anteroseptal transmural ischemia, with ST elevations in leads V1-V4. occlusion of the LCX- transmural ischemia of the lateral wall of the left ventricle, with ST elevations mainly in V5 and V6, and possibly also in I and aVL.

routinely administered to Rh-negative women at 28 weeks

anti-Rh immune globulins- IgG anti-D antibodies

main protection against refection with influenza virus

anti-hemagglutinin antibodies neutralize the virus and primarily block binding to host cells

fever, dry skin and mucous membranes, flushing, blurred vision, and altered mental status

anticholinergic intoxication jimson weed (datura stramonium)

dimercaprol

antidote for arsenic poisoning pain, vomiting, diarrhea, hypotension, and garlic odor on breath causes: insecticides and contaminated water

SLE

antiphospholipid antibodies causing aPTT prolongation and false-positive RPR/VDRL at risk for arterial thromboembolism and unexplained, recurrent pregnancy loss

anxiety due to a medical condition

anxiety due to a general medical condition is diagnosed when symptoms are the physiological consequences of an underlying medical condition

teniae coli

are 3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix. if the appendix cannot be identified by palpation during an appendectomy, it can be located by following the teniae coli to their origin at the cecal base.

calcium-sensing receptors

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

most common cause of death in patients with tricyclic antidepressant overdose

are cardiac arrhythmias and refractory hypotension. inhibition of fast sodium channels in cardiac myocytes (and the His-purkinje system) is thought to be the major underlying cellular event.

both myasthenia and lambert eaton syndrome

are caused by poor signal transmission at the neuromuscular junction. lambert eaton syndrome is associated with underlying malignancy. antibodies to voltage gated presynaptic calcium channels are found in these patients.

mitochondrial diseases

are characterized by exclusively-maternal inheritance. variable severity of these diseases is explained by random distribution of normal and mutated mitochondria between daughter cells during mitosis; as a result, some cells may have completely healthy mitochondria, while other cells contain mitochondria affected by genetic mutation (heteroplasmy). 1. leber hereditary optic neuropathy 2. myoclonic epilepsy with ragged red fibers 3. mitochondrial encephalomyopathy with lactic acidosis and stroke like episodes

are ch

are cholinesterase inhibitors that are widely used as pesticides in agriculture. they inhibit the breakdown of acetylcholine, leading to a state of cholinergic excess. symptoms of organophosphate poisoning include salivation, lacrimation, diaphoresis, bradycardia, and bronchospasm.

selective estrogen receptor modulators (tamoxifen, raloxifene)

are competitive inhibitors of estrogen binding to estrogen receptors. they can have agonist or antagonist effects depending on the specific tissue. Tamoxifen has an estrogenic effect on the uterus and can cause endometrial hyperplasia and cancer.

zinc-finger motifs

are composed of chains of amino acids bound together around a zinc atom via linkages with cysteine and histidine residues. they recognize specific DNA sequences and are used by many transcription factors to bind DNA and alter activity of target genes. intracellular receptors that bind steroids, thyroid hormone, and fat-soluble vitamins act directly as transcription factors and contain zinc-finger binding domains.

neonates born to mothers with poorly controlled diabetes during pregnancy

are exposed to high maternal glucose levels in utero, resulting in excessive fetal insulin production and islet hyperplasia. fetal hyperinsulinemia persists for several days following birth and predisposes the infant to transient hypoglycemia.

VIPomas

are pancreatic islet cell tumors that hypersecrete vasoactive intestinal peptide (VIP), which increases intestinal chloride loss into the stool and causes excess losses of the accompanying water, sodium, and potassium. VIP also inhibits gastric secretion. Somatostatin inhibits the secretion of VIP and is used to treat the symptoms of VIPoma.

monamine oxidase inhibitors

are particularly useful in patients with treatment-resistant major depressive disorder with atypical features. increased appetite and sleep, leaden paralysis, rejection sensitivity, and mood reactivity are hallmarks of the atypical subtype.

amatoxins found in poisonus mushrooms

are potent inhibitors of RNA polymerase II (halting mRNA synthesis).

cardiac amyloidosis

areas of myocardium infiltrated by an amorphous and acellular pink material.

arginase deficiency

arginase produces urea and ornithine from arginine spastic diplegia, growth delay, and abnormal movements treat: arginine-free, low protein diet

temporomandibular disorder

arises from problems involving the TMJ, muscles of mastication, and the nerves that supply the jaw. because mandibular division of the trigeminal nerve supplies the middle ear and the muscles of mastication, TMD can present with both otologic symptoms and jaw pain.

aromatase deficiency

aromatase converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues. placental aromatase defficiency causes accumulation of androgens during pregnancy, resulting in ambiguous external genitalia in female infants and maternal virilization.

anesthetics with high tissue solubility are characterized by large

arteriovenous concentration gradients and slower onsets of action

glucose, bicarbonate, and amino acids decrease

as fluid runs along proximal tubule vs. PAH, creatinine, inulin, and urea: increase as fluid runs along proximal tubule

EBV

associated with Burkitt lymphoma and nasopharyngeal carcinoma.

aflatoxin

associated with G:C to T:A conversion, leading to increase risk of developing hepatocellular carcinoma.

helocobacter pylori antral gastritis

associated with formation of duodenal ulcers due to increased gastric acid production. this acidity caused by unchecked gastrin production due to the destruction of somatostatin-secreting cells in the gastric antrum. H pylori also releases cytotoxins that inhibit duodenal production of bicarbonate.

sudden onset back pain, hematuria, and oliguria

associated with high anion gap metabolic acidosis and osmolar gap anion gap=sodium-(Cl+bicarb) normal is 10-14 MUDPILES

cardiac myocyte action potential

associated with increased membrane permeability to sodium, and calcium and decreased permeability to potassium. going up with sodium, plateau with calcium, and down with potassium.

VSD

associated with low-pitched holosystolic murmur at the left sternal border. accentuates during maneuvers that increase afterload (handgrip maneuver). a small VSD is asymptomatic and produces a louder murmur due to higher interventricular pressure gradient.

cutaneous small vessel vasculitis

associated with medication- penicillins, cephalosporins presents with palpable purpura in the lower extremities. histo--marked perivascular inflammation of small blood vessels with fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei (leukocytoclastic vasculitis).

second generation antipsychotics

associated with metabolic adverse effects- weight gain, dyslipidemia, hyperglycemia, increased risk of diabetes. within the class, olanzipines and clozapines carry the greatest risk. clozipine needs monitoring for agranulocytosis.

polycystic ovary syndrome

associated with oligomenorrhea, hirsutism, and polycystic ovaries. disruption in intraovarian steroidogenesis causes anovulatory cycles and results in chronic estrogen stimulation with decreased progesterone secretion, placing PCOS patients at risk for endometrial hyperplasia/carcinoma.

mutations in VHL gene on chromosome 3p

associated with sporadic and hereditary renal cell carcinomas

intermittent respiratory symptoms in a patient with a ormal CXR, sputum eosinophils, and reduced FEV1 suggest

asthma common triggers: exercise, cold air, respiratory infection, and exposure to inhaled allergens (eg, dust mites, cockroaches, pet dander, mold, pollen)

frequent causes of pulsus paradoxus in absence of pericardial disease

asthma and COPD treat with beta adrenergic agonists (Gs GPCR)...produce relaxation of bronchial smooth muscle

excess of Th2 cell activity relative to Th1 cell activity may underlie the pathogenesis of asthma.

asthma sensitization phase, inhaled antigens stimulate Th2 cells to secrete IL4 and IL13, which promote B-lymphocyte class switching for IgE synthesis, leading to mast cell priming. Th2 cells also secrete IL-5 which activates eosinophils.

glial scar formed by

astrocytic processes

oval yeasts with thick walls and broad-based budding

blastomyces dermatitidis

hypertrophic cardiomyopathy

asymmetric ventricular septal hypertrophy and varable dynamic left ventricular outflow tract obstruction. maneuvers that increase preload or afterload will decrease murmur intensity. sudden standing, valsalva, or nitroglycerin

sillicosis

asymptomatic but can present with dyspnea on exertion and productive cough. silicosis is distinguished by calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrounded by fibrous tissue.

tRNA has CCA sequence

at 3' end that us used a recognition sequence by proteins

saddle pulmonary embolism

at bifuration of the main pulmonary arter. venous thromboembolism arises due to virchow triad: endothelial injury, venous stasis, and hypercoagulable state. malignancy causes a hypercoagulable state and is strong risk factor for venous thromboembolism.

norepinephrine synthesis in the brain

at locus ceruleus- a paired brainstem nucleus in posterior rostral pons near the lateral floor of the fourth ventricle. it projects to virtually all parts of the central nervous system and helps control mood, arousal (reticular activating system), sleep-wake states, cognition, and autonomic function.

kidney glucose filtration

at normal plasma concentrations of glucose, the renal tubules reabsorb the entire filtered load of glucose as this is below the maximum tubular reabsorption ability (transport maximum of glucose [TmG]). at higher plasma concentrations, glucose is excreted when the filtered amount exceeds the TmG.

asbestos exposure

at risk for asbestosis, pleural disease, and malignancies such as bronchogenic carcinoma and mesothelioma. bronchogenic carcinoma is the most common malignancy in this population, followed by mesothelioma.

invasive vascular procedures can be complicated by

atheroembolic disease involve kidneys, GI tract, CNS, and the skin how needle shaped cholesterol clefts within the atheromatous embolus.

chronic mesenteric ischemia

athersclerosis of the mesenteric arteries, resulting in diminished blood flow to the intestine after meals. causes postprandial epigastric pain (intestinal angina due to increased demand for blood/oxygen) with associated food aversion/weight loss.

chronic aortic stenosis and A. Fib.

atrial contraction contributes to left ventricular filling. loss of atrial contraction due to A. Fib can reduce left ventricular preload and CO sufficiently to cause systemic hypotension. decreased forward filling of the left ventricle can also result in backup of blood in left atrium and pulmonary veins, leading to acute pulmonary edema.

excess risk in the exposed population that can be attributed to the risk factor

attributable risk percent ARP=100 x [(RR-1)/RR]

goodpasture syndrome caused by

autoantibodies against alpha 3 chain of type IV collagen in glomerular and alveolar basement membranes (anti-GBM antibodies). patients typically present with rapidly progressive glomerulonephritis (nephritic syndrome) and alveolar hemorrhage (shortness of breath, hemoptysis).

pemphigus vulgaris

autoimmune bullous disease characterized by autoantibodies directed against desmosomal proteins (eg, desmoglein==whole circles) painful flaccid bullae and erosioins (ulcer like) affected the skin and mucosal membranes. the bullae spread laterally with pressure and new blisters may form with gentle rubbing. vs. bullous pemphigoid usually tense and full of liquid inside. separates from dermis. mucosal involvement is less common and Nikolsky sign is negative.

myasthenia gravis

autoimmune disease that causes a decrease in the number of functional acetylcholine receptors within the neuromuscular junction. this reduces the number of postsynaptic cation channels that can open in response to acetylcholine, which reduces the amplitude of motor end plate potential and prevents muscle fiber depolarization.

MS

autoimmune disorder of the central nervous system characterized by recurrent episodes of demyelination, leading to reduced saltatory conduction. internuclear ophthalmoplegia and optic neuritis are common manifestations.

angioedema

autosomal dominant or acquired via ACE inhibitor treatment. in hereditary angioedema, low C1 esterase inhibitor activity leads to in increase in bradykinin activity. ACE inhibitors should be NOT be used in these patients.

huntington disease

autosomal dominant trait it manifests with progressive dementia and choreiform movements. loss of neurons in the caudate nucleus and putamen is characteristic. behavioral: aggressiveness, apathy, or depression

wilson disease

autosomal recessive excessive copper deposition into tissues (eg, liver, basal ganglia, cornea). it typically presents in young adults with liver disease, neuropsychiatric symptoms (eg, gait disturbance, dysarthria, depression, personality changes), and Kayser-Fleischer rings on slit lamp examination.

alkaptonuria

autosomal recessive disorder caused by deficiency of homogentisic acid dioxygenase, an enzyme inovolved in tyrosine metabolism. excess homogentisic acid causes diffuse blue-black deposits in connective tissues. adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of the spine and large joints.

familial dysbetalipoproteinemia

autosomal recessive disorder characterized by elevated cholesterol and triglyceride levels. caused by defects in ApoE3 and ApoE4, leading to decreased clearance of chylomicrons and VLDL remnants. patients can develop eruptive and palmar xanthomas and premature aterosclerosis.

chediak-higashi

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

niemann-pick disease

autosomal recessive disorder that is common in the Ashkenazi jewish population. characterized by shingomyelinase deficiency and sphingomyelin accumulation, which causes hepatosplenomegaly and neurologic regression in infancy.

Gaucher disease

autosomal recessive lysosomal storage disorder that is characterized by beta-glucocerebrosidase deficiency and presents with pancytopenia and hepatosplenomegaly. glucocerebroside accumulation leads to distended macrophages with 'wrinkled tissue paper' appearance.

colle's fracture complication

avascular necrosis

beers criteria

avoid in geriatric patients: anticholinergics (first gen. antihistamines) alpha blockers TCA antidepressants benzodiazepines antipsychotics most antiarrhythmics skeletal muscle relaxants

schwannomas

biphasic pattern of cellularity (antoni A & B) and S-100 positivity arise from peripheral nerves, nerve roots, and cranial nerves.

polycistronic

bacterial mRNA can be polycistronic, meaning that one mRNA codes for several proteins. example--bacterial lac operon. the transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of regulatory elements.

insulin uses

basal, long acting: glargine, detemir basal intermediate: NPH postprandial, short acting: regular: best for IV use with DKA lispro, aspart, glulisine: best for postmeal hyperglycemia

alpha 1 receptors

basoconstriction

unilateral facial paralysis, decreased tearing, hyperacusis, and/or loss of taste sensation over the anterior two-thirds of the tongue idiopathic paresis of the facial nerve (CNVII)

bells' palsy

leukemoid reaction

benign leukocytosis (>50,000/mm3) that occurs in response to an underlying condition such as severe infection/hemorrhage, malignancy (eg, leukemia), or acute hemolysis. leukocyte alkaline phosphatase levels are normal or increased. peripheral smear can show increased bands, early mature neutrophil precursors (eg, myelocytes), and granules (eg, Dohle bodies) in the neutrophils.

strawberry hemangiomas (capillary hemangiomas)

benign vascular tumors of childhood. appear during the first weeks of life, initially grow rapidly, and typically regress by 5-8 years old. are composed of capillaries separated by connective tissue.

somatic symptom disorder

best managed with regularly scheduled medical visits that are not contingent on having active symptoms. unnecessary diagnostic testing and specialist referrals should be avoided.

isoproterenol

beta 1 and 2 receptor agonist that causes increased myocardial contractility and decreased systemic vascular resistance.

prevents interaction of epi and NE with beta 1&2 receptors

beta blockers block beta2>>bronchoconstriction

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

beta blockers, ACE inhibitors, angiotensin II receptor blockers, and aldosterone antagonists.

stress axis and opioid system

beta endorphin and ACTH derived from POMC

streptococcus pyogenes

beta hemolytic, bacitracin susceptible, and pyrrolidonyl arylamidase positive

defective transcription, processing, and translation of beta globin mRNA

beta thalassemia

landmark for lumbar puncture

between highest points of iliac crests L3/L4 or L4/L5

secretory phase of menstrual cycle

between ovulation and menses progesterone secretion from corpus luteum: glands coil and secrete glycogen-rich mucus endometrial stroma becomes edematous and have tortuous spiral arteries that extend from the deep layers to uterine lumen.

intracardiac fistula

between the aortic root and right ventricle will most likely demonstrate a left-to-right cardiac shunt as blood continuously flows from the aortic root (high pressure) to the right ventricle (low pressure).

PD-1 receptor and ligand

biding of programmed death receptor (PD-1) downregulates the immune response against tumor cells by inhibiting cytotoxic T cells. many cancers evade immune system by increasing expression of PD-1. Monoclonal antibodies blocking PD-1 help prevent T cell inhibition and promote apoptosis of tumor cells.

inhibit enterohepatic circulation of bile acids and lead to increase in hepatic production of triglycerides

bile acid binding resins

thiazolidinediones (pioglitazone)

bind to peroxisome proliferator-activated receptor-gamma (PPAR-gamma), an intracellular nuclear receptor that acts as a transcriptional regulator of many genes involved in glucose and lipid metabolism. improve insulin sensitivity by increasing expression of adiponectin.

opiate analgesics reduce pain by

binding to mu receptors and inhibiting synaptic activity in the central nervous system. activation of presynaptic mu receptors on primary afferent neuron leads to closure of voltage-gated calcium channels and reduced excitatory neurotransmitter release. binding to mu receptors on the post synaptic mu receptors on the postsynaptic membrane causes opening of potassium channels, efflux, and membrane hyperpolarization.

protein A in peptidoglycan cell wall of Staph. Aureus

binds to Fc portion of IgG leading to impaired complement activation, opsonization, and phagocytosis.

protamine sulfate

binds to heparin, causing chemical inactivation. vitamin K and fresh frozen plasma can be used to reverse warfarin effects.

raw egg whites have avidin with bind to

biotin and lead to deficiency affects carboxylation reactions

ingestion of lots of egg whites, also: poor diet congenital metabolic disorder

biotin deficiency cofactor for carboxylase enzymes: pyruvate to oxaloacetate

dihydrobiopterin reductase deficiency is a cofactor for

both phenylalanine hydroxylase and tyrosine hydroxylase downstream deficiencies of dopamine, NE, epinephrine, and serotonin can lead to progressive neurologic deterioration.

highest tubular osmolarity in the nephron

bottom of the loop of henle ...at end of descending

17alpha-hydroxylase deficiency

boys are phenotypically female at birth but girls develop normal genitalia. patients exhibit hypogonadism, hypertension, and hypokalemia.

low C1 esterase inhibitor activity leads to increases in

bradykinin activity ...and angioedema avoid ACE inhibitors

middle meningeal artery

branch of maxillary artery, which enters the skull at the foramen spinosum and courses intracranially deep to the pterion (where the frontal, parietal, temporal, and sphenoid bones meet). skull fractures at this site may cause laceration of this vessel, leading to an epidural hematoma.

maple syrup urine disease

branched chain alpha ketoacid dehydrogenase requires several coenzymes: thiamine, lipoate, coenzyme A, FAD, NAD (mnemonic: tender loving care for nancy). some patients with maple syrup urine disease improve with high dose thiamine treatment, but most require lifelong restriction of leucine, isoleucine, and valine.

DDX for psychotic disorders

brief psychotic disorder: less than 1 mo schizophreniform: 1-6 mos schizophrenia: more than 6 mos schizoaffective: mood symptoms and psychosis-not at same time delusional disorder: more than 1 mo, 1 or more delusions, no other symptoms

broad spectrum vs narrow spectrum anticonvulsants

broad= lamotrigine, levetiracetam, topiramate, valproic acid used for most seizure types narrow=carbamzapine, gabapentin, phenobarital, phenytoin used for focal onset seizures (can also be used for focal that has progressed to general)

beta adrenergic agonists control acute asthma and COPD exacerbations by causing

bronchial smooth muscle relaxation via increased intracellular cAMP

methacholine

bronchoprovocation that is administered to diagnose asthma. shows hyperresponsivity to the stimulus, leading to FEV1 reductions at lower doses than in those without asthma.

uniform, round, medium-sized tumor cells with basophilic cytoplasm and aproliferation fraction (di-67 fraction) approaching 100%

burkitts lymphoma associated with EBV

cross linking of multiple membrane-bound IgE antibodies

by a multivalent antigen results in aggregation of the FceRI receptors, causing degranulation and the release of preformed mediators (histamine and tryptase) that initiate an allergic response.

lac operon regulated

by two mechanisms: negatively by binding of the repressor protein to the operator locus and positively by the cAMP-CAP upstream from the promoter region. constitutive expression of the structural genes of the lac operon occurs with mutations that impair the binding of the repressor protein (lac I) to its regulatory sequence in the operator region.

small, red, cutaneous papules common in aging adults

cherry hemangiomas

monphosphorylation of acyclovir

by viral thymidine kinase is the first and rate limiting step in conversion of acyclovir to its active triphosphate form. acyclovir and related drugs (famciclovir, valaciclovir) are more effective agains herpes simplex virus and VZV than CMV and EBV.

tube traverses through the serratus anterior muscle, intercostal muscles, and parietal pleura

chest tube for drainage of pleural effusion midaxillary line at 4/5th intercostal space

calcium dependent adhesion molecules that bind epithelial cells together within tissues

cadherins form adherens junctions and desmosomes remove calcium from extracellular fluid= dissociation and loss of cell-cell adhesion

accumulation effect

can be applied to disease pathogenesis and exposure to risk modifiers. cumulative exposure to risk factor or risk reducer must sometimes occur for prolonged periods before a clinically significant effect is detected.

pyridoxine (B6) deficiency

can be caused with isoniazid--which is structurally similar. this antibiotic increases urinary excretion of pyridoxine causing a deficiency and competes for B6 binding sites leading to defective synthesis of neurotransmitters like GABA. isoniazid induced neuropathy can be prevented with B6 supplementation.

arteriovenous shunts

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

isoniazid

can be directly heptotoxic causing acute, mild hepatic dysfunction and frank hepatitis- fever, anorexia, and nausea, sometimes progressing to hepatic failure

glomerular filtration rate

can be estimated by the inulin or creatinine clearance,while the renal plasmaflow is calculated using the para-aminohippuricacid clearance. the filtration fraction (FF=GFR/RPF) is the fraction of the RPF that is filtered across the glomerular capillaries into Bowman's space. it is usually equal to 20% in healthy individuals. C(creatnine or PAH)=amount in urine TIMES flow rate DIVIDED by amount in serum

supplementation with thymidine

can bypass DHF reductase and reduce erythroid cell apoptosis due to folate deficiency

obesity, central obesity

can cause a pattern of extrinsic restrictive pulmonary function tests. the most common indicator of obesity-related disease is a reduction in expiratory reserve volume and functional residual capacity, but forced expiratory volume in 1 second, forced vital capacity, and total lung capacity are also decreased.

crohn disease with ileal resection

can cause bile acid malabsorption, which may lead to impaired absorption of fat-soluble vitamins (A,D,E,K). vitamin K deficiency can result in impaired coagulation with easy bruising, large hematoma formation in deep tissues and joints (hemarthrosis) after minor trauma, and prolonged bleeding after surgery.

opiod analgesics

can cause contraction of smooth muscles in the sphincter of Oddi, leading to increased pressures in the common bile duct and the gall bladder. patients who develop biliary colic due to this, must discontinue mu opioid analgesics and pain control with alternative agents suchs as NSAIDs.

Neiserria meningitidis

can cause sepsis and circulatory collapse in previously healthy young individuals. lipooligosaccharide, a virulence factor in pathogens outer membrane, is the major underlying cause of disease severity

first generation antihistamines

can cause significant side effects due to blockade of cholinergic, alpha adrenergic, and serotonergic pathways. they should be avoided in older patients with cognitive or functional impairments.

RBC loose mitochondria

can do first and final 3 steps of heme synthesis

antidepressant monotherapy

can induce mania in susceptible patients, especially those with unrecognized bipolar disorder.

supplemental oxygen administration in COPD

can lead to increased CO2 retention (oxygen-induced hypercapnia), resulting in confusion and depressed consciousness. the major cause of reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli.

vitamin E deficiency

can occur in individuals with fat malabsorption. deficiency of fat soluble vitamin is associated with increased susceptibility of the neuronal and erythrocyte membranes to oxidative stress. clinical manifestations include ataxia, impaired proprioception and vibratory sensation, and hemolytic anemia.

ventilation perfusion

lowest at the base and highest at the apex

cyanide toxicity

can occur in patients treated with nitroprusside. cyanide toxicity presents with altered mental status, seizures, cardiovascular collapse, lactic acidosis, and bright red venous blood. antidotal treatment of cyanide toxicity can be achieved by 3 different strategies: direct binding of cyanide ions (hydroxyocobalamin), induction of methemoglobinemia (sodium nitrite), and use of detoxyfying sulfur donors (sodium thiosulfate).

postpartum hemorrage

can result from abnormal placentation. prior uterine surgery can impair decidualization, resulting in myometrial invasion by villous tissue and a placenta that is abnormally adherent to the myometrium (placenta accreta).

tertiary syphilis

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

vitamin A overuse

can result in intracranial hypertensioin, skin changes, papilledema, skin changes and hepatosplenomegaly. toxicity occur after ingestion of a single high dose: nausea, vomiting, vertigo, and blurred vision.

vascular catheters, skin & soft tissue infections

candida pesudohyphae with blastoconida

inhibit fungal cell wall

capsofungin

drop in pulse amplitude during inspiration >10mmhg

cardiac tamponade

beta 1 adrenergic receptors found in

cardiac tissue and renal tissue but not vascular smooth muscle

prevent beta-oxidation of FA into acetyl CoA

carnitine deficiency impaired ketone body production by liver during fasting periods

most highly oxygenated blood in the fetus is

carried by the umbilical vein, which empties directly into the IFC via the ductus venosus. the umbilical arteries orginate from the fetal internal iliac arteries and carry deoxygenated blood back to the placenta via the umbilical cord.

odds ratio

case-control study is used to compare the exposure status of people with the disease to the exposure status of people without the disease. main measure of association is the odds ratio.

ethylene glycol ingestion

cause acute tubular necrosis with vacuolar degeneration and ballooning of the proximal tubular cells. findings- altered mentation, renal failure, high anion gap metabolic acidosis, increased osmolar gap, and calcium oxalate crystals in the urine.

mutations resulting in 2,3-BPG binding pocket's positive charge

cause hemoglobin A to resemble fetal hemoglobin, which binds oxygen with a higher affinity due to its inability to interact with 2,3-BPG.

genetic reassortment

cause influenza epidemics and pandemics. code for hemagglutinin or neuraminidase proteins (major antigenic shifts). this process can occur between human and animal strains of influenza A virus in avian or swine hosts.

repetitive pronation/supination of forearm (screwing things)

cause injury to radial nerve at passage through the supinator canal also due to: trauma, subluxation of the radius. cause: weakness during finger and thumb extension without wrist drop or sensory deficits

orthostatic hypotension

cause lightheadedness and syncope. decrease in systolic >20 mm Hg or diastolic >10 mm Hg blood pressure on standing from the supine position. medications alpha-adrenergic antagonists, diuretics, volume depletion, and autonomic dysfunction are common causes of orthostatic hypotension.

prolonged seizure, crush injuries, or drugs (statins)

cause myocyte injury rhabdomyolysis>>myoglobinuria>>renal failure

enterococcus

cause of UTIs. gram positive cocci in pairs and chains and when grown on blood agar, they do not consume hemolysis (gamma hemolytic)

anabolic steroid misuse

cause of acne, especially in competitive athletes. androgens stimulate follicular epidermal hyperproliferation and excessive sebum production.

thiazide and loop diuretics

cause significant volume depletion, activating the RAAS system, leading to hypokalemia and metabolic alkalosis. thiazide diuretics are more likely to cause hyponatremia and hypercalcemia; loop diuretics cause hypocalcemia.

facet joint osteophytes and hypertrophy of ligamentum flavum

cause: posture dependent lower extremity pain, numbness/paresthesia, and weakness

genomic imprinting

caused by DNA methylation, an epigenetic process in which genes can be silenced by attaching methyl groups to cytosine residues in the DNA molecule.

infectious mononucleosis

caused by EBV positive heterophile antibody fever, pharyngitis, lymphadenopathy, hepatosplenomegaly, atypical lymphocytosis increased incidence of Burkitt lymphoma and nasopharyngeal carcinoma

spontaneous deep intracerebral hemorrhage

caused by HTN vasculopathy involving pentrating branches of major cerebral arteries. usual locations--basal ganglia, cerebellar nuceli, thalamus, and pons. basal ganglia are supplied by lenticulostriate arteries, branches of MCA.

hypercalcemia in sarcoidosis

caused by PTH-independent formation of 1,25-dihydroxyvitamin D by activated macrophages. leads to increased intestinal absorption of calcium.

factor V leiden mutation

causes factor Va resistance to inactivation by activated protein C, may account for approximately 20% of cases of atypical venous thrombosis.

communicating hydroceles and indirect inguinal hernias

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

Myasthenia gravis

caused by circulating antibodies directed against acetylcholine receptors of the neuromuscular junction. autoantibody binding leads to receptor degradation, producing fluctuating weakness that worsens over the course of the day and most commonly affects the extraocular muscles (eg, ptosis, diplopia). most patients also have thymic abnormalities (eg, thymoma).

neuropathy due to DM

caused by diabetic microangiopathy which leads to nerve ischemia. another pathogenetic factor is the accumulation of sorbitol, which leads to osmotic nerve injury. the symmetric peripheral neuropathy is common. also due to non-enzymatic glycosylation of proteins-leading to increased thickness, hyalinization, and narrowing of the walls of the arteries. ischemic nerve damage.

congenital QT syndrome

caused by genetic mutations in potassium channel protein that contribute to outward rectifying potassium current. decrease in the outward potassium current leads to prolongation of action potential duration and QT interval. this predisposes to development of life-threatening ventricular arrhythmias (torsades de pointes) that can cause palpitations, syncope, seizures, or sudden cardiac death

deep intraparenchymal hemorrhage

caused by hypertensive vasculopathy of small penetrating branches of the cerebral arteries (charcot bouchard aneurysm rupture) vs. saccular aneurysms- cause subarachnoid hemorrhage

hartnup disease

caused by impaired transport of neutral amino acids in the small intestine and proximal tubule of the kidney. symptoms include pellagra-like skin eruptions and cerebellar ataxia, due to niacin deficiency. the diagnosis can be confirmed through detection of excessive amounts of neutral amino acids in the urine.

hepatic encephalopathy

caused by increased levels of ammonia and other neurotoxins in the circulation that lead to increased inhibitory neurotransmission and impaired excitatory neurotransmitter release. hepatic encephalopathy is frequently precipitated by a stressor (eg, gasterintestinal bleeding, infection) that increases blood ammonia levels. GI bleeding causes increased nitrogen delivery to the gut in the form of hemoglobin, which is then converted into ammonia and absorbed into the bloodstream.

fragile X

caused by increased number of CGG trinucleotide repeats on the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. this leads to hypermethylation and inactivation of FMR1.

ARDS

caused by injury of pulmonary epithelium and/or endothelium, and occurs most often due to sepsis or pneumonia. cytokines recruit neutrophils to the lung tissue, cause capillary damage and leakage of protein rich fluid into the alveoli.

epistaxis

caused by irritation of the highly vascular mucosa at the anterior nasal septum. the anterior nasal septum contains the kiesselback plexus. the anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region.

hereditary hemochromatosis

caused by missense mutation in HFE gene, resulting in excessive intestinal iron absorption and organ damage (cirrhosis, DM, cardiomyopathy, arthropathy) due to iron accumulation within parenchymal tissues.

erythema infectiosum (5th disease)

caused by parvovirus B19 nonspecific prodrome: malaise, fever, congestion. followed by 'slapped cheek' facial rash and lacy, reticular body rash. parvovirus is highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow.

traumatic aortic rupture

caused by rapid deceleration that occurs in motor vehicle collisions. the most common site of injury is the aortic isthmus, which is tethered by the ligamentum arteriosum and is relatively fixed and immobile compared to the adjacent descending aorta.

achalasia

caused by reduced numbers of inhibitory ganglion cells in the esophageal wall. esophageal manometry in achalsia shows decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relation at the lower esophageal sphincter.

gram negative sepsis

caused by release of LPS from bacterial cells during division or by bacteriolysis; LPS is not actively secreted by bacteria. lipid A is the toxic component of LPS; it causes activation of macrophages leading to widespread release of IL1 and TNF alpha which cause the signs and symptoms of septic shock: fever, hypotension, diarrhea, oliguria, vascular compromise, and DIC.

acute allergic contact dermatitis

caused by type IV hypersensitivity reaction to antigen on skin surface. erythematous, papulovesicular, weeping lesions spongiosis- accum. of edema fluid in the intercellular spaces of epidermis. with chronic exposure, lesions become less edematous, with thickening of the stratum spinosum and stratum corneum.

abusive head trauma

caused by vigorous shaking of an infant and results in--subdural hemorrhage (due to tearing of bridging veins) and retinal hemorrhages. red flags= injuries inconsistent with history or developmental age.

retinopathy of prematurity

caused oxygen therapy due to retinal particularization

MI

causes a sharp decrease in cardiac output due to loss of function of a zone of myocardium. on cardiac function curve, myocardial infarction would decrease both the slope and the maximal height of the line.

thiamine deficiency

causes beriberi and wernicke korsakoff syndrome dry berberi is characterized by symmetrical peripheral neuropathy; wet beriberi includes the addition of high output congestive heart failure.

defect in HGPRT leading to purine salvage pathway failure

causes degradation of hypoxanthine and guanine to uric acid Lesch-Nyhan syndrome must increase: de novo purine synthesis ...replace lost bases: increase in PRPP

methemoglobinemia

causes dusky discoloration of the skin (similar to cyanosis), and because methemoglobin is unable to carry oxygen, a state of functional anemia is induced. however, the blood partial pressure of oxygen will be unchanged as it is a measure of oxygen dissolved in plasma and is unrelated to hemoglobin functon.

primary and secondary TB

causes formation of Ghon foci in the lower lungs. secondary (reactivation) TB occurs in patients with prior TB infection that never cleared completely. reactivation occurs often in immunosuppressed patients and is characterized by apical cavitary lesions and hemoptysis.

androgenetic alopecia

causes hair loss primarily at the anterior scalp and vertex. it shows polygenic inheritance, with dihydrotestosterone (DHT) being the primary pathogenic factor. 5-alpha-reductase inhibitors decrease the conversion of testosterone to DHT and are effective for treating the condition.

prolonged exposure to loud noises

causes hearing loss due to damage to the stereociliated hair cells of the organ of Corti.

G6PD deficiency

causes hemolytic anemia and jaundice secondary to increased oxidative stress due to the lack of NADPH. glutathione reductase deficiency has a similar clinical consequence as its absence results in an inability to utilize NADPH to reduce glutathione.

Hep B

causes heptaocellular cytoplasm to fill with Hep B surface antigen. these inclusions are highly specific for hep B infection and have a finely granular, pale eosinophilic, ground glass appearance.

impaired beta-oxidation of fatty acids

causes hypoglycemia after prolonged fasting and insufficient levels of ketone bodies. acyl-CoA dehydrogenase catalyzes the first step in the beta-oxidation pathway and is the most commonly deficient enzyme. adults start ketone use after 1-2 days. children use as early as 8-10 hours.

aortic regurge

causes increase in total stroke volume and abrupt distension and rapid falloff of the peripheral arterial pulses, resulting in a wide pulse pressure. leads to bounding peripheral pulses and head bobbing with each heartbeat.

C1 inhibitor deficiency

causes increased cleavage of C2 and C4 and results in inappropriate activation of the complement cascade. C1NH also blocks kallikrenin-induced conversion of kininogen to bradykinin, a potent vasodilator associated with angioedema.

maternal hyperglycemia

causes increased transplacental glucose delivery to the infant, fetal hyperglycemia, and ultimately beta cell hyperplasia. resulting hyperinsulinemia caused by islet cell hyperplesia is associated with fetal macrosomnia and hypoglycemia after delivery.

giardia lamblia

causes injury to the duodenal and jejunal mucosa by adhering to the intestinal brush border and releasing molecules that induce a mucosal inflammatory response. secretory IgA, which impairs adherence, is the major component of adaptive immunity against G lamblia infection. conditions causing IgA deficiency predispose patients to chronic giardiasis.

oculomotor nerve compression by aneurysm

causes mydriasis, diplopia, ptosis, and 'down and 'out deviation of the ipsilateral eye

hypoventilation

causes of respiratory acidosis--heroin overdose

portal vein thrombosis

causes portal hypertension, splenomegaly, and varicosities at portocaval anastomoses. does not cause histologic changes to the hepatic parenchyma. ascites is uncommon as the obstruction is presinusoidal.

long-term use of supraphysiologic doses of glucocorticoids

causes suppression of the hypothalamic-pituitary-adrenal axis, which in turn leads to bilateral adrenocortical atrophy involving the zona fasciculata and reticularies. sudden cessation of the exogenous corticosteroids can precipitate adrenal crisis.

polymyositis

causes symmetric proximal muscle weakness. muscle biopsy reveals inflammation, necrosis, and regeneration of muscle fibers. over-expression of major histocompatibility complex class I proteins on the sarcolemma leads to infiltration with CD8+ T lymphocytes and myocyte damage.

trauma/sustained pressure to the neck of the fibula can injure the common peroneal nerve

causing weakness on foot dorsiflexion and eversion and impaired sensation over the lateral shin and dorsal foot, and between the first and second toes.

selective COX 2 inhibitor use with patients who have gastric peptic ulcer disease

celecoxib

Il-1 and TNF-alpha induce COX2 during inflammation---inhibited by

celecoxib if patient has history of peptic ulcer disease

give off branches to pancreas and stomach: pancreatic short gastric left gastroepiploic

celiac artery (splenic)

duodenal biopsy is confirmatory for

celiac sprue vs. ileum biopsy for crohns

IL6 and giant cell arteritis

cell mediated immunity is the primary mechanism underlying GCA. production of cytokines, IL6 in particular, is an important driver of this process and closely correlates with the severity of symptoms.

erythema multiforme

cell mediated inflammatory disorder of the skin characterized by erythematous papules that evolve into target lesions. it is most commonly associated with herpes simplex virus.

inhibition of transpeptidase with cephalosporin ceftriaxone leads to

cell wall instability and bacteriolysis. 5 such protein binding sites produced by strep pneumo

initial treatment for pseudomonas aeruginosa

cephlasporins- cefepime and ceftazidime

in tumor cells, ATP powered eflux pump protein actively removes

chemotherapeutic agents. P glycoprotein encoded by multidrug resistance (MDR1) reduce this: verapamil, diltiazem, ketoconazole

Friedreich ataxia

cerebellar ataxia (spinocerebellar tract degeneration) and loss of position/vibration sensation (dorsal column/dorsal root ganglia degeneration), kyphoscoliosis, and hypertrophic cardiomyopathy. foot abnormalities and diabetes mellitus are also common.

most common cause of spontaneous lobar hemorrhage, particularly in elderly

cerebral amyloid angiopathy occipital and parietal lobes

midline spisiotomy

certical incision from the posterior vaginal opening to the perineal body. transects the vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa.

early syphillis

chancre often have false-negative initial serologic testing. direct visualization of the organism (Treponema pallidum) by dark-field microscopy or fluorescent antibody testing is the gold standard for diagnosis but is not widely available.

bacterial mechanism of resistance to cephalosporins

change in structure of penicillin-binding proteins that prevent cephalosporin binding

viral mutations

changes in host range are most commonly caused by mutations in the viral encoded surface glycoprotein that mediates virion attachment to target host cell plasmalemma receptors. mutations in viral encoded capsid proteins, RNA polymerases, endonucleases, or proteases could nonspecifically affect viral replication in the standard host cell but would be less likely to significantly alter the range of host cell types that an enveloped RNA virus could successfully infect.

Axonal reaction

changes in the body of a neuron after the axon has been severed. this process reflects an increased protein synthesis that facilitates axon repair. enlarged, rounded cells with peripherally located nuclei and dispersed finely granular Nissl substance are seen. wallerian degeneration occurs in the segment of axon that has lost connection with the cell body.

symmetrical enlargement of the ventriculi

characteristic of communicating hydrocephalus. communicating hydrocephalus usually occurs secondary to dysfunction or obliteration of subarachnoid villi. this dysfunction is usually a sequelae of meningeal infection (including tuberculosis meningitis) or subarachnoid/interventricular hemorrhage.

pancreatic islet amyloid deposition

characteristic of type 2 diabetes mellitus. a strong linkage with HLA class II gene makeup, pancreatic islet infiltration with leukocytes (insulitis), and antibiotics against islet antigens are frequently seen in type 1 diabetes.

cirrhosis

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

acute respiratory distress syndrome (ARDS)

characterized by hypoxia and bilateral pulmonary infiltrates and is assoicated with pneumonia, sepsis, trauma, and pancreatitis. the associated pulmonary edema is noncardiogenic in nature, so the pulmonary capillary wedge pressure will be within the normal range (6-12 mm Hg).

sarcoidosis

characterized by noncaseating granulomas due to dysregulated cell-mediated immunity. activated antigen-presenting cells produce IL-12 which stimulates the differentiation of Th1-type CD4+ cells. Th1 cells produce IL-2 and interferon-gamma, which stimulate Th1 cell proliferation and macrophage activation, respectively.

synovitis

characterized by pain, erythema, swelling, and reduced range of motion in a joint. acute synovitis may represent serious pathology (septic arthritis), especially if accompanied by fever or leukocytosis; it should be evaluated urgently with synovial fluid analysis.

pituitary apoplexy

characterized by severe headaches, bitemporal hemianopsia (compression of the optic chiasm), and ophthalmoplegia (compression of the oculomotor nerve). it usually occurs in a preexisting pituitary adenoma. it is a medical emergency that requires urgent treatment with glucocorticoids to prevent acute adrenal crisis and circulatory collapse.

polymyositis

characterized by symmetric proximal muscle weakness. it is associated with antinuclear and anti-jo-1 autoantibodies. biopsy shows an endomysial mononuclear inflammatory infiltrate and patchy muscle fiber necrosis. polymyositis is similar to dermatomyositis but lacks the characteristic skin findings.

MEN 2B

charaterized by medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and marfanoid habitus. hyperparathyroidism is not a feature.

hypertensive vasculopathy of small penetrating branches of the cerebral arteries

charcot bouchard aneurysm rupture vs. saccular aneurysm=cause subarahnoid hemorrhage

IL8

chemikine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils. other significant chemotatic agents include n-formylated peptides, leukotriene B4, 5HETE (leukotriene precursor), and complement component C5a.

located in the area postrema of the dorsal medulla near the fourth ventricle

chemoreceptor trigger zone cause acute nausea due to chemo treatment

lymphogranuloma venereum

chlamydia trachomatis serotypes L1-L3 initial painless ulcers with later progression to painful inguinal lymphadenopathy 'buboes' and ulceration (vs. T pallidum=no buboes). chlamydial inclusion bodies are seen in host cell cytoplasm.

squamous cell debris that form a mass behind tympanic membrane

cholesteatoma

collections of squamous cell debris

cholesteatomas primary- negative pressure cause retractions secondary-infection, trauma, or surgery

inhibits enterohepatic circulation of bile acids leads to hypertriglyceridemia

cholestyramine

bile acid binding resins

cholestyramine colestipol colesevelam can increase triglyceride levels

anaplastic cytotrophoblasts and syncytiotrophoblasts without villi

choriocarcinoma dyspnea/hemoptysis due to pulmonary metastasis from hematogenous spread

axillary lymph node dissection is a risk factor for development of

chronic lymphadema involving the ipsilateral arm. chronic lymphedema predisposes to the development of angiosarcoma (stewart-treves syndrome).

atherosclerosis of mesenteric arteries

chronic mesenteric ischemia causes postprandial epigastric pain (intestinal angina) with food aversion/weight loss. similar to angina pectoris. increased demand for oxygen.

takayasu arteritis

chronic, large-artery vasculitis that primarily involves the aorta and its branches. it presents with constitutional (eg, fever, weight loss) and arterio-occlusive (eg, claudication, blood pressure discrepancies, pulse deficits) findings in patients age <40. histopathology shows-granulomatous inflammation of vascular media.

varicose veins

chronically elevated venous pressure in the lower extremities can lead to incompetent venous valves and venous dilation. venous congestion and tissue ischemia can result in venous stasis of dermatitis.

PAD symptomatic management inhibits platelet aggregation direct arterial vasodilator

cilostazol

antiarrhythmic that prolongs QRS duration with little effect on QT interval

class 1C agents flecainide block fast sodium channels responsible for ventricular depolarization (phase 0)

HLA class I vs class II

class I: B27 present on all nucleated cells and present to CD8 class II: DR, DP, DQ APC on macrophages, dendritic cells and present to CD4

autosomal recessive disorder severe disorder present within days of birth: jaundice, vomiting, and hepatomegaly

classic galactosemia

GALT deficiency galactose-1-phosphate accumulation E Coli sepsis

classic galactosemia liver toxicity and renal impairment due to galactose-1-phosphate accumulation

proinsulin

cleaved in pancreatic beta cells in secretory granules yeilds insulin and C peptide stored in granules until they are secreted in equimolar amounts.

PCOS patient desires pregnancy treated with

clomiphene estrogen receptor modulator that decreases negative feedback inhibition on they hypothalamus by circulating estrogen, thereby increasing gonadotropin production. anti-androgen meds for hhirsutism and acne not fertility.

PCWP

closely reflects LA and LVEDP. mitral stenosis leads to an increase in the LA pressure that is reflected as elevated PCWP during pulmonary artery catheterization. left ventricular filling may be normal, resulting in an increased pressure gradient between the LA and LV diastole.

PDA

clubbing and cyanosis without pressure or pulse discrepancy. complicated by eisenmenger syndrome severe coarctation of the aorta can cause lower extremity cyanosis. right to left shunting in patients with large septal defects and tetralogy of fallot results in whole body cyanosis

cavernous hemangiomas

clusters of dilated, thin-walled capillaries with little or no intervening nervous tissue. increased risk of seizures and may develop progressive neurologic deficits. these have tendency to bleed, further contributing to neurologic symptoms. appears as irregular hyperdense/bright mass on head CT.

SRY gene on Y chromosome

codes for testes-determining factor: differentiates the primitive gonads into testes. Sertoli cells produce anti-Mullerian hormone, which causes regression of the Mullerian ducts and suppresses female internal reproductive organ development. Leydig cells produce testosterone: differentiating wolffian ducts into internal male reproductive organs. Dihydrotestosterone is required for differentiation of the external male genitalia.

Biotin (Vitamin B7)

cofactor for all 4 carboxylase enzymes: pyruvate carboxylase, acetyl-CoA carboxylase, propionyl-CoA carboxylase, and 3-methylcrotonyl-CoA-carboxylase.

destruction of alveoli and adjoining capillary beds leading to decreased DLCO

early onset emphysema due to alpha-1-antitrypsin deficiency

ascorbic acid (vitamin C)

cofactor in hydroxylation of proline and lysine residues and is important in the synthesis of collagen. deficiency (scurvy) is characterized by microvascular bleeding, gingivitis, and impaired wound healing.

tetrahydrobiopterin BH4

cofactor used by hydroxylase enzymes in synthesis of tyrosine, dopamine, and serotonin. Phenylketonuria-result from BH4 deficiency intellectual disability, neurotransmitter deficiency (serotonin) hyperphenylalanemia treatment with low phenylalanine diet and BH4 supplementation.

Down syndrome

cognitive impairment, facail dysmorphism, and cardiac defects. 95% due to extra chromosome 21 due to nondisjunction. unbalanced robertsonian translocations or mosaicism are less common causes.

phenotypic mixing

coinfection of host cell by 2 viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the unchanged parental genome of the other strain. no change in underlying viral genomes and so the next generation of virions revert to their original, unmixed phenotypes.

inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization

colchicine side effects: nausea and diarrhea

uric acid precipitates in low pH in the nephron at

collecting ducts (tumor lysis syndrome)

cholesteatoma

collection of skin cells and cholesterol in a sac within the middle ear

postoperative hypoparathyroidism

common after thyroidectomy. surgical removal of or damage to the parathyroid glands results in a drop in parathyroid hormone levels, resulting in decreased calcium and phosphate resorption from bone and decreased calcium reabsorption by the kidneys.

folic acid deficiency anemia

common among alcoholism. megaloblastic anemia that can develop within weeks. peripheral blood smear shows macrocytosis, ovalocytosis, and neutrophils with hypersegmented nuclei.

hemosiderosis (iron overload)

common and serious complication of chronic hemolytic anemia and frequent blood transfusions. hemosiderin accumulation is the cardinal histologic finding. chelation therapy is indicated to reduce parenchymal iron deposition.

hemolytic uremic syndrome

common cause of acute renal failure in children. characterized by triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. most cases develop following a diarrheal illness caused by shiga toxin-producing organisms (E. coli and shigella).

bacterial antibiotic efflux pumps

common cause of drug/multidrug reisistance actively transport antibiotics out of the bacteria into the external environment using ATP, Na+ grandient, or proton electrochemical gradients for energy

Campylobacter jejuni

common cause of gastroenteritis and is typically acquired from contaminated food (eg, undercooked poultry) or domesticated animals (eg, household dogs). manifestations usually include fever, cramping abdominal pain, and watery diarrhea that may be bloody. stool studies typically show blood and leukocytes. associated with guillain-barre syndrome.

diabetic autonomic neuropathy

common in type 1 diabetics and can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. postvoid residual testing with ultrasound or catheterization can confirm inadequate bladder emptying.

injury at the neck of the fibular can cause injury to

common peroneal nerve weakness on foot dorsiflexion and eversion and impaired sensation over the lateral shin and dorsal foot, and between the first and second toes.

aminoglycoside resistance

commonly due to antibiotic modifying enzymes. these add chemical groups (acetyl, adenyl, phosphate) to the antibiotic, which diminishes its ability to bind to the 16S ribosomal RNA within the 30S ribosomal subunit.

DIC in pregnancy

commonly due to release of tissue factor (thromboplastin) from an injured placenta into maternal circulation. DIC presents with bleeding from incision sites, IV lines, and mucosal surfaces due to rapid consumption of clotting factors and platelets.

COPD exacerbation

commonly due to viral infection: rhinovirus, influenza virus or less commonly due to bacterial infections: H influenzae, moraxella catarrhalis, and strep pneumo

acute bacterial parotitis

commonly in elderly postoperative patients who are intubated and dehydrated. S aureus is the most common. diagnosis can be confirmed by imaging and elevated serum amylase level with a normal serum lipase level and no evidence of pancreatitis.

spinal stenosis

commonly in the lumbar region and presents with posture-dependent lower extremity pain, numbness/paresthesia, and weakness. the most common cause is degenerative arthritis of the spine, which results in narrowing of the spinal canal due to the intervertebral disc herniation, ligmamentum flavum hypertrophy, and osteophyte formation affecting the facet joints.

acoustic schwannomas

commonly located in cerebellopontine angle and arise from cranial nerve VIII. patients have ipsilateral sensorineural hearing loss/tinnitus and vertigo VIII, loss of facial sensation V and facial paresis VII. bilateral acoustic neuromas are associated with NF2.

dilation of the left ventricular cavity

commonly occurs in response to systolic dysfunction (ischemic heart disease, dilated cardiomyopathy) or certain types of valvular disease (aortic regurge, mitral regurge). chronic volume overload causes progressive eccentric hypertrophy that eventually leads to reduced ventricular contractility and decompensated heart failure.

heparin

commonly used for prevention of deep venous thrombosis in nonambulatory patients or those undergoing elective surgery, especially hip and knee surgery. heparin increases the effect of the naturally occurring anticoagulant antithrombin III.

coronary sinus

communicates freely with the right atrium and will become dilated secondary to any factor that causes increased right atrial pressure. the most common cause is pulmonary hypertension, leading to elevated right heart pressures.

incomplete obliteration of the processus vaginalis can lead to

communicating hydroceles and indirect inguinal hernias open space allows fluid/abdominal contents to come down into scrotum

analysis of variance

compares the difference between the means of 2 or more groups. t-test is used to compare the difference between the means of 2 groups. results from a t-test and ANOVA test will be equivalent when comparing the difference between the means of 2 groups.

neck of the antibody is site of attachment for

complement tail= phagocytic cells ears=antigens

empty ovum is fertilized by a haploid sperm

complete mole 23X>>duplication= 46, XX

brown pigment stones

composed of calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract. Beta-glucuronidase released by the injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. the liver fluke clonorchis sinensis has a high prevalence in East Asian countries and is a common cause of pigment stones.

complete hydatidiform mole

composed of cystic edematous hydropic villi as a result of trophoblast proliferation. serial measurements of beta-hCG should be performed following evacuation of a hydatidiform mole. persistently elevated or rising levels may signify the development of an invasive mole or choriocarcinoma.

elevated cholesterol

concentrations increase the likelihood of cholesterol precipitation and gallstone formation. high levels of bile salts and phosphatidylcholine increase cholesterol solubility and decrease the risk of gallstones.

fluid concentrations along proximal tubule

concentrations of PAH, creatinine, inulin, and urea increase as fluid runs along the proximal tubule, while the concentrations of bicarbonate, glucose, and amino acids decrease.

hearing loss

conductive: bone conduction greater than air conduction sensorineural: air conduction greater than bone

carcinoid tumors

confined to intestine do not cause carcinoid syndrome as their secretory products are metabolized by the liver before entering the systemic circulation. vs. intestinal carcinoid that metastasize to the liver and extraintestinal (eg, bronchial) carcinoids release vasoactive substances that avoid first-pass metabolism, resulting in carcinoid syndrome (eg, flushing, diarrhea, bronchospasm).

decrease in outward K+ current leads to prolongation of AP duration and QT interval

congenital QT syndrome can cause: ventricular arrhythmia, torsades de pointes, death!

bronchopulmonary sequestration

congenital malformation characterized by extra, nonfunctional lung tissue without communication to the tracheobronchial tree. recurrent pneumonia in the same site.

prion protein accumulation

considered a cause of prion diseases microscopic findings: vacuoles in the gray matter (spongiform encephalopathy) with no inflammatory changes. creutzfeldt-jakob disease

rabies vaccines

consist of various rhabdovirus strains grown tissue cell culture and then inactivated.

crescent formation

consists of glomerular parietal cells, lymphocytes, and macrophages along with abundant fibrin deposition. crescents eventually become fibrotic, disrupting glomerular function and causing irreversible renal injury.

reye syndrome

consists of hepatic failure and encephalopathy. the characteristic histological finding is microvesicular steatosis of hepatocytes without inflammation and cerebral edema.

wiskott-aldrich syndrome

consists of the triad: eczema, thrombocytopenia and combined B and T lymphocyte deficiency. onset of disease is early in life with thrombocytopenia present at birth and eczema and repeated infections, particularly by encapsulated organisms, following at 6 to 12 months of age.

side effects of opioids that do not subside with tolerance

constipation and miosis

mutation in janus kinase (JAK2), a cytoplasmic tyrosine kinase

constitutive tyrosine kinase activity, and consequently, in the cytokine-independent activation of signal transducers and activators of transcription (STAT) proteins (JAK-STAT signaling pathway).

translocation causes BCR gene on chromosome 22 to fuse with ABL gene on chromosome 9

constitutively active tyrosine kinase accelerate cell division and increase genetic instability.

integral membrane proteins

contain transmembrane domains composed of alpha helices with hydrophobic amino acid residues (alanine, valin, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine). these transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane.

marijuana

contains tetrahydrocannabinol, which stimulates cannabinoid receptors to produce a mild euphoria with inappropriate laughter, increased appetite, slowed reaction time/motor speed, and cognitive impairment. Tachycardia and conjunctival injection (red eyes) are the 2 most immediate physical symptoms of marijuana use.

PDA

continuous murmur with maximal intensity at S2. small PDA is often asymptomatic and usually detected incidentally during routine cardiac auscultation. common in premature and cyanotic congenital disease.

DM2 and elevated FFA

contribute to insulin resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis.

pyruvate dehydrogenase

converts pyruvate to acetyl-CoA, which is subsequently metabolized by oxidative phosphorylation. however, if inadequate oxygen is present in the tissues, pyruvate is converted to lactate by lactate dehydrogenase, leading to lactic acidosis.

hexokinase

converts some of the dietary fructose load to fructose-6-phosphate, which can then enter glycolysis; this pathway is not significant in normal individuals. useful in patients with essential fructosuria caused by fructokinase deficiency.

primary virulence factor of M tuberculosis and prevents macrophages from being bactericidal due to inhibition of phagolysosome acidification>>>caseating granulomas

cord factor: long, serpentine cords surface glycolipid on the cell wall

costosternal syndrome

costochondritis due to repetitive activity causes pain that is reproducible with palpation and worse with movement/position changes

repetitive activity leading to pain that is reproducible with palpation and worse with movement/position changes

costosternal syndrome (costochondritis)

phrenic nerve roots

course through he interscalene sheath. can be involved during shoulder surgery involving anesthesia to the brachial plexus

third part of the duodenum

courses horizontally across the abdominal aorta and inferior vena cava at the level of the third lumbar vertebra. the superior mesenteric vessels lie anterior to the duodenum at this location.

noncaseating granulomas in IBD is a hallmark of

crohn disease

attacks are due to accumulation of aminolevulinate (ALA) and porphobilinogen (PBG)

due to PBG deaminase deficiency Acute intermittent porphyria treat: glucose or hemin

muscarinic and nicotinic effects

d=diarrhea/diaphoresis u=urination m=miosis b=bronchospasm, bronchorrhea, bradycardia e=emesis l=lacrimation s=salivation nicotinic effects: muscle weakness, paralysis & fasciculations Atropine reverses muscarinic effects but not nicotinic. pralidoxime is a cholinesterase-reactivating agent that allows for degradation of excess acetylcholine and treats both muscarinic and nicotinic effects of organophosphates.

DM

daily foot inspection recommended

gerstmann syndrome

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

depolarization of bacterial cellular membrane and inhibition of DNA, RNA, and protein synthesis

daptomycin treat MRSA

urterine curettage of ectopic

decidualized endometrium only dilated, coiled endometrial glands and vascualarized edematous stroma.

beta blockers

decrease AV nodal conduction, leading to increased AV nodal refractory period. this correlates to PR interval prolongation on an ECG.

P-450 enhancers and warfarin

decrease efficacy of warfarin vs. inhibitors of P-450 increase risk of bleeding

thioamides (methimazole, propylthiouricil)

decrease formation of thyroid hormones via inhibition of thyroid peroxidase, the enzyme responsible for both iodine organification and coupling of iodotyrosines. propylthiouracil also decreases the peripheral conversion of T4 and T3.

normal morphological changes in the aging heart

decrease in left ventricular chamber apex-to-base dimension development of a sigmoid-shaped ventricular septum myocardial atrophy with increased collagen deposition accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes.

increase in amount of enzyme available in particular system will cause increase in Vmax but not Km

decrease in y-intercept and no change in x-intercept on lineweaver-burke plot

management of drug induced parkinsonism

decrease or discontinue offending medication anticholinergics--benztropine, trihexyphenidyl

CML

decreased alkaline phosphatase level vs. normal or elevated in leukemoid reaction demonstrate t(9;22) or BCR-ABL fusion gene or mRNA.

hyperventilation induced hypocapnia

decreased cerebral blood flow and cerebral hypoperfusion blurred vision, dizziness, lightheadedness

alzheimer disease

decreased levels of acetylcholine in the nucleus basalis of meynert and the hippocampus, caused by diminished activity of choline acetyltransferase.

postoperative urinary retention

decreased micturition reflex activity, decreased contractility of the bladder detrusor, and/or increased vesicle sphincter tone. treated with muscarinic agonist (bethanechol) or an alpha1 blocking drug.

pulmonary hypertension

develops in patients with systemic sclerosis as a result of damage to the pulmonary arterioles. it manifests with an accentuated pulmonary component of the second heart sound and signs of right-sided failure due to cor pulmonale.

right ventricular infarction

decreases RV stroke volume, which leads to diminished LV filling nad cardiac output despite preserved LV systolic function, resulting in hypotension and shock. because left-sided filing pressures are reduced, PCWP also decreases as it reflects left atrial pressure. patients have elevated central venous pressure due to impaired forward flow and backup of blood into the systemic venous system.

protective for ovarian cancer

decreasing frequency of ovulation OCP multiparity breastfeeding risk: BRCA mutation nulliparity infertility

terminally differentiated cell reverts to less specialized form

dedifferentiation can be induced by transcription factors

midshaft fractures of the humerus risk injury to

deep brachial artery and radial nerve which run together along the posterior aspect of the humerus.

uridine deficiency

defect in uridine 5' monophosphate synthase cause orotic aciduria mental retardation, megaloblastic anemia, and large amounts of urinary orotic acid.

Dubin-Johnson syndrome

defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinemia and jaundice. liver appears black due to impaired excretion of epinephrine metabolites, which histologically appear as dense pigments within lysosomes.

hyperimmunoglobulin M syndrome

defective immunoglobulin class switching due to defect in CD40 ligand-CD40 interaction. absence of CD40 ligand is the most common cause and is an X-linked recessive pattern. clinical features include recurrent sinopulmonary, gastrointestinal, and opportunistic infections.

recurrent infection with neisseria species

deficiency of the complement factors that form the MAC complex

classic salt wasting 21 hydroxylase deficiency

deficient cortisol and aldosterone synthesis adrenal androgen overproduction male-normal genitalia with vomiting, hypotension, hyponatremia, and hyperkalemia. females-ambiguous genitalia.

stress urinary incontinence

defined as an involuntary urine loss with increased intraabdominal pressure. pelvic floor strengthening (kegel exercises) targets the levator ani to improve support around the urethra and bladder.

single sarcomere

defined as the distance between two Z lines. Thin (actin) filaments in the I band are bound to structural proteins at the Z line, whereas thick (myosin) filaments in the A band are bound to structural proteins at the M line.

NAD and NADP are cofactors for many

dehydrogenase and reductase enzymes niacin (B3) is a precursor for NAD and NADP

cryptococcus neoformans

demonstrates round or oval budding yeast.

ductus arteriosus

derived from sixth embryonic aortic arch. a patent ductus arteriosus causes left-to-right shunting of blood that can be heard as a continuous murmur over the left infraclavicular region. indomethacin (aPGE2 inhibitor) can be used to close a PDA in premature infants, but surgical ligation is often necessary in older patients.

strong association with malignancy: lung colorectal ovarian

dermatomyositis

developmental field defect

describes multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells. holoprosencephaly is a developmental field defect characterized by a spectrum of fetal anomalies due to incomplete division of the forebrain (prosencephalon).

hep B immunized people

develop anti-HBs antibody. those who recover have anti HBs and anti HBc. chronic infection have HBs antigens for more than six months.

alpha 1-antitrypsin deficiency

develop early onset lower lobe predominant emphysema due to excessive alveolar elastin degradation. rubber like properties of elastin are due to high content of nonpolar amino acids and extensive cross-linking between elastin monomers facilitated by lysyl oxidase

hepatic schizonts

develop in the liver over 8-30 days continue treatment for 4 weeks after return with: mefloquine

severe mitral regurgitation

develop left sided volume overload with an S3 gallop due to the large volume of regurgitant flow reentering the ventricle during mid-diastole. absence of S3 gallop excludes severe chronic MR.

HZV (shingles)

develops due to reactivation of varicella zoster virus in the dorsal root ganglia (sensory neurons). it presents with a painful vesicular rash in a dermatomal distribution. intranuclear inclusions in keratinocytes and multinucleated giant cells are seen on light microscopy.

pulmonary actinomycosis

develops most commonly following aspiration and can be confused with lung abscess, malignancy, or tuberculosis. microscopic findings include vaguely filamentous, branching, gram positive bacteria and sulfur granules.

ptosis, 'down and out' gaze, and normal light and accommodation reflexes MH: DM

diabetic mononeuropathy involves cranial nerve III ischemia

wet mount

diagnose trichomonas vaginitis

chronic pancreatitis

diarrhea, weight loss, and epigastric calcifications in patient with chronic alcoholism manifest as exocrine insufficiency and malabsorption.

sequence of amino acids in growing polypeptide

dictated by interaction of mRNA codon with the tRNA that is mischarged with the incorrect amino acid (and not corrected by aminoacyl-tRNA synthetase proofreading) will incorporate the wrong amino acid into the growing polypeptide chain.

decreases AV nodal conduction by increasing parasympathetic vagal tone

digoxin lowers heart rate

changes in color vision and GI: anorexia, nausea, vomiting could indicate

digoxin toxicity ventricular arrhythmias are most serious complication

nonspecific GI/neuro: anorexia, nausea, vomiting fatigue, confusion, weakness changes in color vision

digoxin toxicity ventricular arrhythmias!!

Blastomyces dermatitidis

dimorphic fungus infection through inhalation of aerosolized fungus from the environment. flu like illness in immunocompetent. round or oval yeasts with thick walls and broad based budding.

histoplasma capsulatum

dimorphic fungus that is small, ovoid yeast at tissue temps. it replicates within macrophages and spreads through the lymphatic and reticuloendothelial system. immunocompetent patients usually have an asymptomatic pulmonary infection, but those who are immuncompromised can develop disseminated disease to the liver, spleen, and bone marrow.

primary treatment for diphtheria is

diphtheria antitoxin (passive immunization) this inactivates circulating toxin antibiotics should be administered to reduce continued production of toxin.

IgG against the exotoxin B subunit

diphtheria toxoid

avoidant personality

disorder is a maladaptive pattern of behavior characterized by social inhibition, feelings of inadequacy, and fear of embarrassment and rejection.

depersonalization/derealization disorder

dissociative disorder involving recurrent episodes of feeling detached from one's body and/or feelings of unreality.

short grastric veins

drain blood from the gastric fundus into the splenic vein. pancreatic inflam. can cause a blood clot within the splenic vein, which can increase pressure in the short gastric veins and lead to gastric varices only in the fundus.

superficial inguinal lymph nodes

drains most of cutaneous lymph from the umbilicus down, including the anus below the dentate line. glans penis and posterior calf, drain to the deep inguinal nodes.

half life (t1/2)

drug is almost completely eliminated after 5 half life intervals. 0=0% 1=50% 2=75% 3=87.5% 4=93.75% t(1/2)=(0.7 X Vd)/CL

nonnucleoside reverse transcriptase inhibitors

drugs that bind to sites on the reverse transcriptase, preventing RNA- and DNA-dependent DNA polymerase activities needed to carry out the viral DNA synthesis; prevents the transfer of information that allows the virus to replicate and survive nevirapine and efavirenz

ductal carcinoma in situ

ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane. is the precursor to invasive ductal carcinoma, the most common type of breast cancer.

ion pump failure

due to ATP deficiency during cardiac ischemia causes intracellular accumulation of Na+ and Ca2+. the increased intracellular solute concentration draws free water into the cell, causing the cellular and mitochondrial swelling that is observed histologically.

anti-nausea meds

due to GI results=5-HT3 receptor antagonists vestibular=antihistamines and anticholinergics migraine=dopamine antagonist

mucopurulent cervicitis

due to N gonorrhoeae and Chlamydia trachomatis can lead to PID>>scarring>>ectopic and infertility

low levels of drug that is metabolized by P450

due to P450 inducer concurrent use: decreases the concentration of the drug in plasma and its effectiveness. is with inhibitor of P450= increases plasma concentration and could lead to toxicity

cystic fibrosis

due to a 3 base pair deletion in CF transmembrane conductance regulator (CFTR) gene at amino acid position 508. mutation impairs post translational processing, insulting in shunting of CFTR toward the proteasome, with complete absence of protein on the cell surface. elevated chloride concentrations are found in most patients with CF.

acute intermittent porphyria

due to accumulation of aminolevulinate and porphobilinogen, due to PBG deaminase deficiency combined with ALA synthase induction---due to medications, alcohol sue, or low-calorie diet. management with glucose or hemin inhibits ALA synthase activity.

wernicke encephalopathy

due to admin of glucose to thiamine-deficient patients (eg, alcoholics), causes acute confusion, ophthalmoplegia, and ataxia due to increased thiamine demand. pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase require thiamine as a cofactor.

HBV and HCV increase risk of HCC

due to chronic hepatic inflammation and cell turnover. HBV is also carcinogenic due to the production of oncogenic proteins and the insertion of the HBV genome into the host chromosome.

DHF polyglutamate accumulation

due to competitive inhibition of DHF with methotrexate toxicity treated with: leucovorine

thoracic outlet syndrome

due to compression of lower trunk of the brachial plexus in the scalene triangle, the space bordered by the anterior and middle scalene muscles and the first rib. symptoms include upper extremity numbness, tingling, and weakness.

tibial nerve injury at level of popliteal fossa

due to deep penetrating trauma or knee surgery. typically weakness on foot plantarflexion, foot inversion, and toe flexion, with sensory loss over the sole.

presbyopia

due to denaturatio of structural proteins within the lens, leading to loss of lens elasticity. decreased synthesis and increased breakdown of collagen and elastin contribute to the development of skin wrinkles.

patella fractures

due to direct impact to anterior aspect of knee. acutely swollen knee, focal patella tenderness, inability to extend the knee against gravity, and a palpable gap in the extensor mechanism.

photoaging

due to excess UV light epidermal atrophy with flattening of rete ridges. decreased collagen fibril production and increased degradation of collagen and elastin in the dermis.

staph SSS in infants and children

due to exotoxin-mediated inflammatory response widespread epidermal sloughing with gently pressure.

pulmonary HTN and left sided HF

due to filling pressures transmitting backward to the pulmonary veins resulting in pulmonary venous congestion. leads to arterial remodeling (medial hypertrophy and intimal thickening with fibrosis can occur) but not to the extent that occurs in pulmonary arterial HTN

paroxysmal nocturnal hemoglobinuria

due to gene defect that leads to uncontrolled complement-mediated hemolysis (CD55, CD59) classic triad includes hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at atypical sites. chronic hemolysis can cause iron deposition in the kidney (hemosiderosis).

rubber like properties of elastin

due to high content of nonpolar amino acids and lots of cross-linking between elastin monomers facilitated by lysyl oxidase. excess degradation of elastin present in alpha-1 antitrypsin deficiency

malabsorption syndrome

due to impaired intestinal digestion and absorptioin. fats are the most affected macronutrient and so testing for stool fat with sudan III stain is best screening for malabsorptive disorders.

squamous metaplasia of the epithelial lining of pancreatic exocrine ducts

due to insufficiency leading to ADEK vitmain deficiency Avitamenosis A: squamouts metaplasia

lymph drainage testis vs scrotum

due to intra abdominal origin, lymphatic drainage of the testis is the para aortic lymph nodes. in contrast, lymph drainage from the scrotum goes into the superficial inguinal lymph nodes.

atrial fibrillation

due to irregular, chaotic electrical activity within the atria and presents with absent P waves, irregularly irregular R-R intervals, and narrow QRS complexes. atrioventricular node refractory period regulates the number of atrial impulses that reach the ventricle and determines the ventricular contraction rate in conditions where the atria undergo rapid depolarization.

autoimmune insulitis with progressive beta cell loss

due to islet leukocytic infiltration are common causes of type 1 DM vs. type 2 DM insulin resistance accompanied by relative insulin deficiency are main causes.

hypertensive arteriolar sclerosis

due to lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall>>> risk of thrombotic vessel occlusion lacunar infarct: deep brain structures

multiple myeloma effects on kidney

due to low PTH, decrease renal Ca reabsorption (hypercalciuria), decrease 1,25-dihydroxyvitamin D synthesis does not effect PTH related protein

contraction of smooth muscles in the sphincter of oddi

due to mu opioid use lead to spasm and increase in common bile duct pressures develop biliary colic, severe pain and cramping in RUQ discontinue meds and start something else: NSAID diclofenac ketorolac

short gastric arteries

due to poor anastomoses, gastric tissue supplied by short gastric arteries is vulnerable to ischemic injury following splenic artery blockage.

green discoloration of pus/sputum

due to presence of myeloperoxidase, a blue-green heme-based enzyme that is released from neutrophil azurophilic granules and forms hypochlorous acid.

testicular torsion

due to twisting of the testis around the spermatic cord (containing the gonadal artery), which can eventually lead to ischemia. the gonadal artery arises from the abdominal aorta.

fatty streaks

early lesions of atherosclerosis and can be seen as early as the second decade of life. appear as a collection of lipid-laden macrophages (foam cells) in the intima that can eventually progress to atherosclerotic plaques.

chronic granulomatous disease

due to x-linked mutation affecting NADPH oxidase. leads to inability to form the oxidative burst to kill organisms in their phagolysosomes. CGD can be diagnosed by absence of the normal blue and fluorescent green pigment produced by the nitroblue tetrazolium test and dihydrorhodamine flow cytometry test, respectively.

confirmatory test for celiac disease

duodenal biopsy shows villus flattening and intraepithelial lymphocyte infiltration. elevated IgA against translutaminase

Squatting in Tetralogy of Fallot

during a Tet spell increases systemic vascular resistance and decreases right to left shunting, thereby increasing pulmonary blood flow and improving oxygenation status. more blood will go through pulmonary artery than through VSD.

radial nerve injury

during its passage through the supinator canal may occur due to repetitive pronation/supination of the forearm, direct trauma, or subluxation of the radius. patients typically have weakness during finger and thumb extension (finger drop) without wrist drop or sensory deficits.

left ventricular blood flow occurs during diastole

during ventricular systole, the coronary vessels supplying the left ventricle are compressed by the surrounding muscle. systolic reduction in coronary blood flow is greatest in the subendocardial region, making this portion of the left ventricle most prone to ischemia and infarction.

hyertrophic cardiomyopathy

dynamic left ventricular outflow tract obstruction due to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum.

Acute extrapyramidal symptoms

dystonic reactions, akathisia, parkinsonism due to D2 blockade in the nigrostriatal pathway. first generation high potency antipsychotics (haloperidol, fluphenazine) strongly block D2 receptors and are the most likely antipsychotics to cause extrapyramidal symptoms.

hallmark of cell injury and death in the setting of normal calcium levels. result of endothelial and fibroblast death secondary to chronic hemodynamic stress or atherosclerotic inflammation

dystrophic calcification elderly= aortic sclerosis stiffing/outlfow obstruction= calcific aortic stensis

provides stabilizing interaction between sarcolemma and intracellular contraction apparatus

dystrophin

CD8+ cells recognize foreign antigens

each MHC class I molecule consists of a heavy chain and a beta2-microglobulin.

SNS regulates visceral function via 2 neuron signal transmission involving cholinergic preganglionic neurons and adrenergic postganglionic neurons

eccrine sweat glands and the adrenal medullae are exceptions to this rule as they are both innervated by cholinergic neurons. the parasympathetic system uses both preganglionic and postganglionic cholinergic neurons.

3 primary germ layers

ectoderm, mesoderm, and endoderm. the ectoderm gives rise to the surface ectoderm, neural tube, and neural crest. anterior pituitary from surface ectoderm. posterior pituitary from neural tube.

bacillus anthracis

edema factor is an adenylate cyclase that increases intracellular cAMP, leading to neutrophil and macrophage dysfunction and tissue edema. similar to bordatella pertussis.

nitrates are oxidizing agents

effective in treating cyanide poisoning due to their ability to induce methemoglobinemia--which contains ferric (fe3+) rather than ferrous iron (fe2+). cyanide binds to ferric iron more avidly than to mitochondrial cytochrome enzymes, diminishing cyanides toxic effect.

thiazide diuretics

effectively increase calcium reabsorption from the nephron. they are indicated in patients with nephrolithiasis secondary to hypercalciuria and contraindicated in hypercalcemia.

pharmacokinetics

efficacy- measure of maximum pharmacodynamic effect achievable with a drug. potency-refers to the dose of drug that is required to produce a given effect. drugs that bind their receptors with a higher affinity or are better able to gain access to their target tissues will have greater potency (lower ED50).

acute hepatic failure due to halothane use

elevated ALT and AST prolonged prothrombin time normal albumin levels due to long half life vs. chronic liver failure hepatosplenomegaly, palmar erythema, etc.

alpha fetoprotein

elevated in hepatitis, hepatocellular carcinoma sudden rise in AFP can be a sign of chronic liver disease harboring HCC

pretreatment with propranolol then epinephrine administration

eliminates the beta effects (vasodilation and tachycardia) leaving only alpha effect of vasoconstriction

adjustment disorder

emotional and behavioral symptoms occurring wihtin 3 months of an identifiable stressor. patient has significant distress and impairment but does not meet full criteria for another mental disorder.

klebsiella pneumonia

encapsulated, lactose-fermenting, gram-negative bacillus that appears mucoid in culture. it causes pneumonia in individuals with impaired host defenses, especially patients with alcoholism. klebsiella pneumonia- characterized by tissue necrosis and early abscess formation with production of thick, mucoid, blood thinged sputum (currant jelly sputum).

beta-endorphin

endogenous opiod peptide that is derived from proopiomelanocortin (POMC). polypeptide precursor that goes through enzymatic cleavage and modification to produce not only beta-endorphins but also ACTH and MSH. beta endorphin and ACTH derived from same precursor suggests close physiological relationship between the stress axis ad the opioid system.

fusion inhibitors

enfuvirtide bind the HIV transmembrane glycoprotein gp41 and prevent it form approximating the viral and host cellular membranes, which prevents HIV penetration into new host cells.

gram positive cocci in pairs and chains that are gamma hemolytic

enterococcus PRP positive can grow in bile and in 6.5% sodium chloride cause UTI, bacteremia/endocarditis, wound infection, or intraabdominal or pelvic infection in nosocomial setting.

most common cause of viral meningitis

enteroviruses of picornaviridae family

extensive glycosylation in the RER and golgi and then cleaved into

envelope proteins: gp120 gp41

congenital deficiency of propionyl CoA carboxylase

enzyme responsible for the conversion o propionyl CoA to methylmalonyl CoA leads to development of propionic acidemia. presents with lethargy, poor feeding, vomiting, and hypotonia 1-2 weeks after birth. valine, isoleucine, methionine, threonine, and odd chain fatty acid metabolism makes propionyl CoA.

Carcinoid syndrome

episodic flushing, secretory diarrhea, and wheezing. lead to pathognomonic plaque like deposits of fibrous tissue on the right-sided endocardium, causing tricuspid regurgitation and right-sided heart failure. elevated 24-hour urinary 5-hydroxyindoleacetic acid can confirm the diagnosis.

Prinzmetal angina

episodic, transient attacks of coronary vasospasm (at rest and at night), produce temporary ST elevations. triggers are cigarette smoking, cocaine/amphetamines, and dihydroergotamine/triptans. treatment is tobacco/smoking cessation and vasodilator therapy (nitrates, CCB)

granulomas

epithelioid macrophages that fused together to form multinucleated cells surrounded by band of lymphocytes involve chronic Th1 and macrophage activation

highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow

erythema infectiosum= parvovirus B19

peau d'orange

erythematous, itchy breast rash with skin texture changes analogous to an orange peel. key dermatologic presentation of inflammatory breast cancer and is caused by cancerous cells obstructing lymphatic drainage due to spread to the dermal lymphatic spaces.

absolute vs. relative erythrocytosis

erythrocytosis: hematocrit >52% check RBC mass: normal=plasma volume contraction as the cause of polycythemia= relative increase RBC mass=absolute

descending throacic aorta lies posterior to the

esophagus and the left atrium allows clear visualization with transesophageal echo, to detect dissection or aneurysm

ulcers that increase risk for malignancy

esphagus, stomach, and colon duodenal ulcers are not

blunt trauma to globe (eye) can cause orbital blowout fractures that may cause herniation into

ethmoid or maxillary sinuses

pulsus parodoxus

exaggerated drop (>10 mm Hg) in systolic blood pressure during inspiration. commonly seen in patients with cardiac tamponade but can also occur in severe asthma, COPD, hypovolemic shock, and constrictive pericarditis.

polyhydramnios

excessive accumulation of amniotic fluid presents with increased abdominal circumference out of proportion to gestational age. usually due to decreased fetal swallowing or increased fetal urination. fetal anomalies associated with impaired swallowing include gastrointestinal obstruction (eg, duodenal, esophageal, or intestinal atresia) and anencephaly.

separation anxiety disorder

excessive and distressing anxiety, more than month for kids and more than one and a half month for adults, due to separation from attachment figures. children have physical symptoms and nightmares.

contractures

excessive matrix metalloproteinase activity and myofibroblast accumulation in the wound margins during healing produce deformities of the wound and surrounding tissues, most often on the palms, soles, anterior thorax, or at serious burn sites.

hypoglycemia, in DM patient, can be precipitated by

exercise in patients with insulin-treated diabetes. uptake of glucose by skeletal muscle is mediated by the glucose transporter type 4, which is translocated to the cell membrane in response to insulin and muscle contraction.

uncal herniation

expanding space occupying lesions within the temporal love can cause elevated intracranial pressure with transtentorial herniation of the uncus. uncal herniation often compresses the ipsilateral third cranial nerve as it exits the midbrain, resulting in oculomotor nerve palsy with a fixed dilated pupil (due to preganglionic parasympathetic fiber damage).

hepatic angiosarcoma

exposure to carcinogens: arsenic, thorotrast, and polyvinyl chloride. tumor cells express CD 31- an endothelial cell marker.

phenylethanolamine-N-methyltransferase

expression increase due to cortisol increasing the conversion of NE and Epi in the adrenal medulla.

gallstones and pregnancy

extrogen-induced cholesterol hypersecretion due to upregulation of hmg-coA reductase activity and progesterone-induced gallbladder hypomotility are responsible for the increased incidence of cholelithiasis in women who are pregnant or using oral contraceptives.

fetal alcohol syndrome

facial dysmorphisms: short palpebral fissures, indistinct philtrum, thin vermillion border, poor growth, and neurobehavioral problems.

bells palsy

facial nerve exits stylomastoid foramen and courses through stubstance of parotid gland, where it divides into its 5 branches. parotid gland tumors compress this nerve, causing ipsilateral facial droop.

Mucormycosis

facial pain, headache, and black eschar in the nasal cavity in a patient with diabetic ketoacidosis. histologic exam is necessary for diagnosis. fungi show broad nonseptate hyphae with right angle branching. treatment consists of surgical debridement and antifungal therapy.

gap junctioins

facilitate communications and coordination between cells and play an important role in labor contractions. connexins are proteins that assemble into gap junctions and their density increases in the uterus before delivery in response to rising estrogen levels.

meckel diverticulum

failed obliteration of viteline duct spontaneous but painless lower GI bleeding. 99mTc-pertechnetate localizes ectopic gastric mucosa, and its increased uptake is diagnostic.

pancrease divisum

failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum. pancreatic ductal system remain separate, with the accessory duct draining the majority of the pancrease.

scaphoid bone

fall onto an outstretched hand. tenderness in the anatomical snuff box. the scaphoid bone is vulnerable to avascular necrosis due to its tenuous blood supply.

in absence of advance directive and designated health care proxy

family member should be contacted to act as surrogate decision maker followed by person who cares about and knows the patients wishes. in EM, treat without consent.

'park at venture avenue'

fastest to slowest conduction velocity: purkinje system atrial muscle ventricle muscle AV node need time for complete filling after atrial contraction

golgi tendon system

feedback system that monitors and maintains muscle force. GTOs are exquisitely sensitive to increases in muscle tension but are relatively insensitive to passive stretch. muscle spindle system is a feedback system that monitors and maintains muscle length.

paget's disease is associated with development of osteosarcoma

femur, tibia, humerus, or other bones destruction of normal trabecular bone, mixed areas of radiodense/radiolucent , perosteal new bone formation

fibrate medications

fenofibrate, gemfibrozil inhibit cholesterol 7alpha-hydroxylase, which catalyzes the rate-limiting step in the synthesis of bile acids. the reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol gallstones.

selective peripheral dopamine 1 receptor agonist arterial dilation, increase renal perfusion, and natriuresis

fenoldopam hypertensive emergency when patients has renal insufficiency

ductus venosus

feta blood umb. vein into liver diverted to IVC via ductus venosus

umbilical vein to liver, bypass hepatic circulation, then to IVC

fetal circulation

loss of 2,3 BPG binding packets positive charge cause hemoglobin A to resemble

fetal hemoglobin binds O2 with higher affinity due to its inability to interact with 2,3 BPG

lecithin and sphingomyelin

fetal lung lecithin production increases sharply after 30 weeks gestation, and phosphatidylglyercol prodcution increases at 36 weeks gestation. amniotic fluid sphingomyelin (S) level should remain approximately constant during the third trimester. an L/S ratio more than or equal to 2.0 indicates adequate surfactant production to avoid neonatal hyaline membrane disease.

septic aboration

fever, abdominal pain, uterine tenderness, and/or foul-smelling discharge after pregnancy termination. Staph. aureus and E. coli common due to seeding of the uterine cavity during instrumentation.

anticholinergic toxicity

fever, cutaneous flushing; dry oral mucosa; dilated, poorly reactive pupils; and confusion. tricyclic antidepressants, particularly amitriptyline, have strong anticholinergic adverse effects.

later stages of aortic stenosis

fibroblasts differentiate into osteoblast-like cells and deposit bone matrix, leading to progressive valvular calcification and stenosis.

knee anatomy

fibula is on the outer side when looking anterior tibia is larger and on the inside/middle when looking at anteriorly

treatment for C difficile infection other than oral vancomycin

fidaxomicin inhibits the sigma subunit of RNA polymerase bacteriocidal minimal systemic absorption

the amount that is filtered in glomerulus divided by the amount of plasma flow

filtration fraction

NSAIDs

first line for treatment of acute gouty arthritis. inhibit cyclooxygenase and decrease prostaglandin synthesis and exert a broad anti-inflammatory effect that includes inhibition of neutrophils. allupurinol should NOT be used as it can exacerbate acute arthritis.

synthesis of steroid hormones

first step is the conversion of cholesterol to pregnnenolone in the mitochondria. the remainder of steroidogenesis occurs in the smooth endoplasmic reticulum. steroid-producing cells contain a well-developed smooth endoplasmic reticulum.

syringomyelia

fixed segmental loss of upper extremity pain and temperature sensations, upper extremity lower motor neuron signs, and/or lower extremity upper motor neurons signs in the setting of scoliosis suggests syringomyelia. damage to the ventral white commissure and anterior horns.

nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors

flutamide used in combination with long-acting gonadotropin releasing hormone agonists in treating prostate cancer

involves both hemispheres at onset and treated with narrow spectrum antiepileptics

focal seizures -simple and complex narrow Rx: carb, gaba, phenobarb, pheny.

mefloquine chemoprophylaxis

for malaria must be continued 4 weeks after return from an endemic region to ensure the elimination of hepatic schizonts (which develop in the liver over 8-30 days). P ovale and P vivax have a dormant hepatic phase (hypnozoite) that may reactivate several months after return from an endemic region (if not treated with primaquine).

minors can consent

for medical treatment in certain circumstances, including legal emancipation (eg, parent, married), emergency care, and specific conditions (eg, sexually transmitted infection, pregnancy, substance abuse).

gluacoma

form of optic neuropathy characterized by increased intraocular pressure associated with increased production or decreased outflow of aqueous humor. topical prostaglandins (lantanoprost) increase outflow of aqueous via the uveoscleral pathway and are the preferred treatment for open-angle glaucoma.

left atrium

forms the majority of the posterior surface of the heart and resides adjacent to the esophagus. enlargement of the left atrium can compress the esophagus and cause dysphagia.

HbA1c

forms within circulating red blood cells as hemoglobin A is exposed to glucose, and HbA1c levels are useful indicator of average glycemic control over the erythrocyte life-span. HbA1c levels are affected by alterations in red blood cell survival; conditions that increase red blood cell turnover (eg, hemolytic anemia) can cause falsely low HbA1c levels.

hormone sensitive lipase

found in adipose tissue. breaks down stored triglycerides into FFA and glycerol. during starvation, this enzyme provides substrates for hepatic gluconeogenesis and ketone body formation.

brown adipose tissue

found in newborns and in hibernating mammals. brown cells contain several intracytoplasmic fat droplets and many more mitochondria than white adipose cells. they function to produce heat by uncoupling oxidative phosphorylation with the protein thermogenin.

treatment for GBS is

intrapartum penicillin or ampicillin prevents neonatal GBS sepsis, pneumonia, and meningitis

glucokinase

functions as a glucose sensor i pancreatic beta cells by controlling the rate of glucose entry into the glycolytic pathway. insulin release by pancreatic cells is stimulated by increased ATP production. mutations in the glucokinase gene are a cause of maturity-onset diabetes of the young.

binds HIV transmembrane glycoprotein gp41 and prevent it from approximating the viral and host cellular membranes, which prevents HIV penetration into new host cells

fusion inhibitors (enfuvirtide)

bind HIV transmembrane glycoprotein gp41 and prevent it from approximating the viral and host cellular membranes, preventing HIV penetration into new host cells

fusion inhibitors -enfuvirtide

vision problems in adolescent

galactokinase deficiency galactitol accumulation leads to cataracts

biliary sludge

gallbladder functions to actively absorb water from bile. galssbladder hypomotility causes the bile to become concentrated, promotoing precipitation and accumulation of particulate material. this forms a viscous biliary sludge that can cause transient bile duct obstruction (biliary colic) and promote cholesterol gallstone formation.

large gallstone through a cholecystenteric fistula into the small bowel causes

gallstone ileus travels down until lodged in ilium gas in the gallbladder and biliary tree due to the ileus

common causes of pancreatitis

gallstones and chronic alcoholism are 80% of cases. other causes- inherited or acquired hypertriglyceridemia can cause acute pancreatitis if the serum level of triglycerides exceeds 1000 mg/dl.

zollinger ellison syndrome

gastrinoma in small intestine/pancreas with peptic ulcers, heartburn, and diarrhea. patients have elevated gastrin levels that rise with exogenous secretin admin. secretin inhibits release of gastrin from normal gastric G cells.

involve both hemisphere and Rx with broad spectrum antiepileptics

generalized seizures -tonic-clonic -myoclonic (juvenile myoclonic) -absence

wobble

genetic code is 'degenerate' because more than 1 codon can code for a particular amino acid. wobble hypothesis--first 2 nucleotide positions on the mRNA codon require traditional base pairing, whereas the third 'wobble' nucleotide position may undergo less stringent base pairing.

high content of nonpolar amino acids and extensive cross-linking between elastin monomers

give elastin rubber-like properties. facilitated by lysyl oxidase

femoral nerve block to anesthetize skin and muscles of anterior thigh, femur, and knee

given at inguinal crease

pauci immune progressive glomerulonephritis

glomerular crescent formation without immunoglobulin or complement deposits.

bluish neoplasm underneath the nail bed

glomus tumor or subungual melanoma

Gs

glucagon TSH PTH activates adenylate cyclase, ATP to cAMP, then protein kinase A, phosphorylates serine/threonine residues, leading to activation/deactivation

GPCR

glucagon, TSH PTH Gq stimulate protein kinase A

Guacher disease histo

glucocerebroside accumulation leads to distended macrophages with a 'wrinkled tissue paper' appearance. vs. ALL: blast cells

most abundant amino acid in collagen

glycine triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each alpha chain, in which glycine occupies every third amino acid position.

sequence of single base DNA defects by base excision repair

glycosylases remove defective base empty sugar phosphate site is cleaved an removed by endonuclease and lyase DNA polymerase replaces missing nucleotide and ligase seals the final remaining nick

gout and PPRP

gout occurs with increased frequency in patients with activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines.

haploid genome and a peptidoglycan cell wall sandwiched between an outer membrane and an inner plasma membrane

gram negative bacterium have no nuclear membrane

10-14 days post MI

granulation tissue and neovascularization

myoglobuinuria

heme pigment (from myoglobin after degradation in the kidney) is toxic to tubular cells and can cause acute tubular necrosis. positive blood on urine dipstick in the absence of red blood cells on microscopic urinalysis suggests myoglobinuria.

hepatomegaly, DM secondary to pancreatic islet destruction, arthropathy, pituitary hormone deficiencies, hyperpigmentation, and cardiomypathy

hemochromatosis

golden cytoplasmic granules in macrophages taht turn blue with prussian blue staining

hemosiderin laden macrophages due to extravasation of RBCs and alveolar hemorrhage which is then phagocytosed by macrophages and the iron from hemoglobin is converted to hemosiderin

finely granular, pale eosinophilic, ground-glass appearance

hep B infection can cause HCC

PAN is commonly associated with

hepatitis B

hypoxemia with respiratory alkalosis

high altitude exposure over a course of a few days chronic respiratory alkalosis sets in, with corresponding decrease in serum bicarbonate level reflecting renal compensation.

prolactinoma

high levels of circulating prolactin supress GnRH secretion from the hypothalamus, leading to reduced secretion of LH and subsequent hypogonadism, anovulation, and amenorrhea. the resulting estrogen deficiency can cause osteoporosis with an increased risk for fragility fractures, and lead to vaginal dryness and atrophy.

factors that trap the drug in the plasma compartment resulting in low Vd (3-5 L)

high molecular weight high plasma protein binding high charge hydrophilicity

low volume of distribution: 3-5 L

high molecular weight high plasma protein binding hydrophilicity high charge

colorectal carcinoma secondary to IBD, especially ulcerative colitis

higher risk young age of onset more aggressive higher grade evolves from flat lesions multifocal should monitor regularly with biopsies.

inhaled anesthetic, such as halothane, can be associated with a

highly lethal fulminant hepatitis same as acute viral hepatitis elevated aminotransferases levels due to hepatocellular injury prolonged prothrombin time due to failure of hepatic synthetic function.

trazedone

highly sedating antidepressant commonly used to treat insomnia. priapism is a rare but serious adverse effect of trazedone.

screening for rare, life threatening disease

highly sensitive test should always be considered over a highly specific test when screening for life-threatening diseases, where identification of every person with the disease is important.

inflammatory mediators released in after mast cell and basophil degranulation

histamine and tryptase tryptase is relatively specific to mast cells and can be used as marker for mast cell activation

dimorphic fungus, ovoid yeast at tissue temp. replicates within macrophages

histoplasmosis disseminate to liver, spleen, and bone marrow in immunocompromised patients

unilateral visual pathway lesion beyond optic chiasm can cause

homonymous hemianopsia infarction of MCA, PCA, or anterior choroidal arteries

breaks down stored triglycerides into free fatty acids and glycerol

hormone sensitive lipase found in adipose tissue (vs. lipoprotein lipase found in endothelial cells) provides substrate for hepatic gluconeogenesis and ketone body formation during times of starvation

phthirus pubis

human pubic louse sexually transmit via skin-skin contact intense pruritus louse and nits can be visualized on exam. treat with topical permethrin.

intense lymphocytic infiltrate, often with germinal centers

hurthle cells: large oxyphilic cells filled with granular cytoplasm chronic lymphocytic (hashimoto) thyroiditis: common cause of hypothyroid

heavy menses after adolescents pelvic heaviness infertility

leiomyomas common, benign, uterine muscle tumor

proteins destined for the rough endoplasmic reticulum possess

hydrophobic, N-terminal peptide signal sequences deletions of these: cause inappropriate accumulation in the cytosol

occurs in the rough endoplasmic reticulum and requires vitamin C as a cofactor

hydroxylation of proline and lysine residues in collagen---helps it attain its maximum tensile strength. impaired collagen synthesis due to vitamin C deficiency can lead to: fragile vessels gingival bleeding ecchymosis petechia

organ rejection

hyperacute: mins-hrs antibodies to graft acute: less than 6 mos humoral/lymphocytic of naive immune cells chronic: mos-yrs low grade immune response refractory to immunosuppressants

thrombotic occlusion of the microvasculature with skin necrosis after warfarin

hypercoagulability exaggerated by preexisting protein C deficiency

glucagonoma

hyperglycemia (often as newly diagnosed DM) and necrolytic migratory erythema (blistering erythematous plaques with central clearing on the groin, face, and extremities. diagnose with elevated glucagon levels.

loss of free water with retention of electrolytes

hyperosmotic volume contraction diabetes insipidus or decreased fluid intake/excessive sweating

increase in activity of enzymes responsible for DNA synthesis=cells went from G1 to S phase

hyperphosphorylated RB=inactive >> cells allowed to transition unchecked from G1 phase to S phase in the cell cycle

single most important risk factor for the development of intimal tears leading to aortic dissection

hypertension HTN, smoking, DM, and hypercholesterolemia are all major risk factors of atheroscherosis, which predisposes more to aortic aneurysm formation.

PRPP synthetase is responsible for de novo synthesis of purine and pyrimidine nucleotides and can lead to

hyperuricemia and gout

Primary hyperaldosteronism

hypokalemia, hypertension muscle weakness and paresthesias

dandy walker malformation

hypoplasia/absence of cerebellar vermis, cystic dilation of fourth ventricle, posterior fossa enlargement. progressive skull enlargement.

weight gain bradycardia brittle nails myalgias and proximal weakness

hypothyroid myopathy

chronic lymphocytic (hashimoto) thyroiditis

hypothyroidism intense lymphocytic infiltrate, with germinal centers residual follicles may be surrounded by Hurthle cells

ABG and PE

hypoxemia due to ventilation/perfusion mismatch and respiratory alkalosis (hypocapnia) due to hyperventilation.

lung injury results in focal loss of type 1 penumocytes and hyperplasia of type 2 pneumocytes

idiopathic pulmonary fibrosis

multiple sclerosis

immune-mediated disorder of the CNS characterized by focal demyelination. histologically, plaques contain foci of perivenular inflammatory infiltrates made up primarily of autoreactive T lymphocytes and macrophages.. patchy demyelination occurs followed by astrocyte hyperplasia (glial scarring).

PSGN

immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 in the mesangium and basement membranes

most important opsonins (coating proteins) are

immunoglobulin G and complement C3b directly enhance phagocytosis

carnitine deficiency

impair FA transport from cytoplasm into mitochondria, preventing beta oxidation of FA into acetyl CoA. leads to cardiac and skeletal myocyte injury and impaired ketone body production by liver during fasting periods--due to lack of ATP from citric acid cycle

internalized silica particles

impair macrophage function by disrupting phagocytosis and promoting apoptosis. this increases the risk of mycobacteria infection (particularly M tuberculosis). multiple rounded nodules located in upper lobes with hilar lymph node calcifications.

crohn disease is associated with oxalate kidney stones

impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption. intestinal lipids then bind calcium ions, and the resulting soap complex is excreted. free oxalate (normally bound by calcium to form an unabsorbable complex) is absorbed and forms urinary calculi (enteric oxaluria).

thrombotic thrombocytopenic purpura

impaired function of the von villebrand factor-cleaving protease ADAMTS13 results in uncleaved vWF multimers that are significantly more prothrombotic and cause diffuse microvascular thrombosis, microangiopathic hemolytic anemia, and thrombocytopenia.

cystic fibrosis

impairment of CFTR reduces Cl secretion and increased Na absorption by the respiratory epithelia, resulting in dehydrated mucus. when saline is applied to nasal mucosa, the increased Na absorption in patients with CF causes a more negative nasal transepithelial potential difference, which can be used to diagnose CF.

acute arsenic poisoning

impairs cellular respiration and presents with abdominal pain, vomiting, diarrhea, hypotension, and a garlic oder on the breath. insecticides and contaminated water are common sources of arsenic. Dimercaprol is the chelating agent of choice.

chronic thiamine (B1) deficiency

impairs glucose utilization in the central nervous system. this occurs due to decreased activity of the enzymes that use thiamine as a cofactor: pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase. thiamine deficiency can be diagnosed if baseline erythrocyte transketolase activity is low but increases after addition of thiamine pyrophosphate.

ectopic pregnancy

implantation outside of the uterus. usterine curettage would reveal decidual changes in the endometrium due to progesterone secretion but no embryonic or trophoblastic tissue (eg, no villi)

snRNPs

important component of spliceosome, a molecule which removes introns from pre-mRNA during processing within the nulceus. spinal muscular atrophy is a disorder caused by mutations in the SMN1 gene, resulting in impaired assembly of snRNPs in lower motor neurons. infants often have flaccid paralysis due to degeneration of anterior horn cells in the spinal cord.

permissive effect of cortisol

improve response increase vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.

glycoprotein

in cell walls of actinomycete Tropheryma whippelii colors magenta with PAS and is diastase resistant, making this stain an excellent choice in evaluating for whipple disease.

stem cell have very long telomere and are present

in continuously replaced cells: basal cell layers of epidermis. bone marrow add TTAGGG repeats at 3' end of chromosome

2,3-BPG produced from 1,3-BPG by bisphophoglycerate mutase bypass ATP generating step of glycolysis

in erythrocytes 2,3-BPG decrease Hbg affinity for O2 occur in low O2 states

zero order kinetics

in first order kinetics, a constant fraction of drug is metabolized per unit time, so that amount metabolized changes based on the serum concentration. in zero-order kinetics, a constant amount of drug is metabolized per unit of time, independent of serum levels.

beta 1 receptors

in heart and renal juxtaglomerular cells but not in vascular smooth muscle.

hypocretin 1 &2 deficiency (orexin A&B)

in lateral hypothalamus that function to promote wakefullness and inhibit REM sleep related phenomena undetectable levels in hypocretin 1 in cerebrospinal fluid

oxidative metabolism of glucose

in pancreatic beta cells generates ATP. ATP-induced closure of the ATP sensitive potassium channel leads to membrane depolarization and subsequent insulin release.

gallstone formation

in patients with crohn disease--terminal ileum (most common site of involvement) are prone to developing gallstones. decreased bile acid absorption by the inflamed terminal ileum promotes cholesterol supersaturation of the bile, resulting in gallstone formation.

small vessel occulsion due to lipohyalinosis and microatheroma

in penetrating vessels supplying the deep brain structures lacunar infarctions

increase estrogen activity

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

hyperplastic arteriolosclerosis

in renal arterioles can result from and perpetuate malignant hypertension. diastolic pressures >120-130 mmHg pathological lesion is an onion like concentric thickening of arteriolar walls in the renal vasculature and elsewhere.

changes in membrane potential occur

in response to changes in neuronal membrane permeability to various cellular ions. the more permeable the membrane becomes for a cellular ion, the more that ion's equilibrium potential contributes to the total membrane potential.

intestinal microbiome

in the absence of intestinal microbial flora, C. Diff. can overgrow and produce exterotoxin (toxin A) and cytotoxin (toxin B). clinical disease resulting from C diff. overgrowth can range from transient diarrhea to severe pseudomembranous colitis.

attributable risk percent

in the exposed represents the excess risk in the exposed population that can be attributed to the risk factor. it can be easily derived from the relative risk using the formula: ARP(exposed)=100 X [(RR-1)/RR]

lenticular accumulation of galactitol

in the lenses of patients with galactosemia can cause osmotic damage and development of cataracts. cataracts may be the only manifestation of galactokinase deficiency.

haldane effect

in the lungs, the binding oxygen to hemoglobin drives the release of proton and CO2 from hemoglobin. in peripheral tissues, high concentratioins of CO2 and H+ facilitate oxygen unleading from hemoglobin (Bohr effect).

ovarian vein thrombosis

in the puerperium. symptoms include fever and localized abdominal or flank pain. most thrombosis is right sided and can extend to the IVC; left ovarian vein thrombosis can extend to the left renal vein.

branched chain ketoaciduria

inability to degrade branched chain alpha-amino acids: leucine, isoleucine, and valine defect in branched chain alpha keto acid dehydrogenase complex---requires thiamine as cofactor

hyperphosphorylated Rb is

inactive cells allowed to transition unchecked from the G1 phase to the S phase in the cell cycle

common cause of unilateral fetal hydronephrosis

inadequate canalization of ureteropelvic junction vesicoureteral refux= common cause of nonobstructive fetal hydronephrosis

common side effects of ACE-inhibitors

include decreased GFR, hyperkalemia, and cough. angioedema is a rare, but life-threatening side effect.

milrinone and inamrinone

increase cAMP leading to increased contractility also vasodilation limits use in hypotensive patients

exercising muscles

increase in CO splanchnic vasoconstriction modest increase in mean blood pressure as vasodilation within active skeletal muscles significantly decreases the total systemic vascular resistance.

sulfonylureas

increase insulin secretion by pancreatic beta cells independent of blood glucose concentration. long-acting sulfonylureas (glyburide, glimepiride) have a high incidence of hypoglycemia, especially in the elderly.

arteriovenous shunt

increase preload and CO

elevated TRH due to hypothyroidism can

increase prolactin secretion and lead to hyperprolactinemia lactotroph cells express TRH receptors

alpha adrenergic agonists

increase systolic and diastolic blood pressure by stimulating alpha1-adrenoreceptors in the vascular walls, causing vasoconstriction. increase venous tone and elevated bp, cause reflexive increase in vagal tone resulting in decrease HR and slowed AV node conduction.

during exercise, blood shows

increase: mean venous CO2 content ...muscle making more CO2 arterial O2 and CO2 content remain constant

IL-2

increased activity of T cells and natural killer cells anti-cancer effect

risk factors for acne

increased androgen levels obstruction of pilosebaceous glands by oil based hair products mechanical irritation of skin follicles sports triggers acne due to the use of tight fitting clothing and protective gear.

peripheral venous capacitance

increased by nitrates due to venodilation reduce preload and LVEDV and pressure

work of breathing

increased elastic resistance: pulmonary fibrosis fast, shallow breaths increased airflow resistance: asthma, COPD slow deep breaths

lipoprotein production in minimal change disease

increased in the liver (ie, hyperlipidemia) due to low oncotic pressure. hyperalbuminnuria.

selective vasoconstriction of the efferent arteriole

increases hydrostatic pressure in the glomerular capillaries, and therefore increases the glomerular filtration rate. as efferent arteriolar constriction continues to increase, the glomerular filtration rate begins to decrease due to flow-mediated rise in oncotic pressure in the glomerular capillaries. filtration fraction always increases with increasing efferent arteriole constriction.

gastrointestinal hormones produced by gut mucosa that stimulate pancreatic insulin secretion in response to sugar-containing meals

incretins two hormones with incretin: glucagon-like peptide (GLP) gastric inhibitory peptide these are independent of blood glucose levels and occur prior to blood glucose elevation

gastrin levels rise in response to exogenous secretin

indicate neoplasm (secretin should inhibit gastrin from normal gastric G cells) zollinger ellision syndrome

extramedullary hematopoiesis

indicated by presence of erythroid precursors in organs such as the liver and spleen. characterized by erythropoietin-stimulated, hyperplastic marrow cell invasion of extramedullary organs. most frequently caused by severe chronic hemolytic anemias, such as beta-thalassemia.

cholinmimetics

indicated for non-obstructive urinary retention, paralytic ileus, and glaucoma side effects: nausea, vomiting, abdominal cramps, diarrhea, dyspnea and increased secretions (sweating, lacrimation and salivation)

failure of prothrombin time correction with vitamin K

indicates factor VII deficiency which is often due to underlying liver disease . factors II, VII, IX, and X are vitamin K dependent coagulation factors synthesized in the liver.

increased blood oxygen saturation between 2 right-sided vessels or chambers

indicates the presence of a left to right shunt. if the abnormal oxygen increase occurs between the right atrium and the right ventricle, a VSD is likely present. small VSDs produce a holosystolic murmur that is loudest over the lower left sternal border.

inferior epigastric vessels help guide indirect and direct inguinal hernias

indirect=lateral and continue into the scrotum direct=medial ...do not protrude into the scrotum

myoglobin

individual hemoglobin molecule are structurally analogous to myoglobin. if separated, the monomeric subunits will demonstrate a hyperbolic oxygen-dissociation curve similar to that of myoglobin.

hairy cell leukemia

indolent B cell neoplasm predominantly found in middle aged men and characterized by bone marrow failure and infiltration into the reticuloendothelial system, causing massive splenomegaly. 'dry tap' with bone marrow aspiration. lymphocytes with cytoplasmic projections.

respiratory papillomatosis

infants can acquire via passage through an HPV infected birth canal. HPV is a small DNA virus with a tropism for stratified squamous epithelium, which protectively lines anatomical areas that undergo frequent friction and abrasion, including the true vocal cords, cervix, and anus.

enterohemorrhagic E. Coli O157:H7

infection is a common cause of bloody diarrhea and can lead to hemolytic uremic syndrome. it is associated with consumption of undercooked ground beef and elaborates a Shiga-like toxin capable of inhibiting protein synthesis in colonic mucosal cells and renal endothelial cells. this particular strain of E coli is unable to ferment sorbitol and does not produce a glucuronidase.

primary amebic encephalitis

infection with Naegleria fowleri free living, motile protozoan that lives in warm water. acute fever, headache, confusion, and neck stiffness. diagnosis confirmed when motile trophozoites are seen on cerebrospinal fluid wet mount.

mycobacterium avium complex

infections are a common opportunistic infection in patients with advanced AIDS. it often spreads through the reticuloendothelial system and causes nonspecific symptoms- fever, fatigue, weight loss, diarrhea, lymphadenopathy, and hepatosplenomegaly. prophylaxis with azithromycin can prevent MAC infection and is recommended for patients with AIDS who have CD4 counts less than 50.

1 of 2 branches of the external iliac artery and takes off immediately proximal to the inguinal ligament

inferior epigastric artery supply: lower anterior abdominal wall

isthmus of the horseshoe kidney lies anterior to the aorta and posterior to the

inferior mesenteric artery IMA limits ascent o the horseshoe kidney

crohn disease

inflammatory bowel disease characterized by patchy inflammation that can occur throughout the entire gastrointestinal tract. gross path shows skip lesions, cobblestoning of the mucosa, bowel wall thickening, and creeping fat. vs. ulcerative colitis contiguous inflammation that extends from the rectum. ulcerations are shallow and involve only mucosa and submucosa; pseudopolyps are seen.

TNF-alpha cytokine produced by macrophages must target with autoimmune condition

infliximab: monoclonal antibody to TNF-alpha etanercept: recombinant TNF receptor fusion protein

secondary bacterial pneumonia

influenza infection alters the respiratory epithelium and can increase the risk of secondary bacterial pneumonia. the leading pathogens are Strep. pneumoniae, Staph. aureus, and haemophilus influenza. elderly are affected most commonly but S aureus can affect young healthy patients.

beta blockers

inhibit renin release by blocking beta-1 receptor mediated regulation of RAAS system--results in decreased ATI/II, aldosterone

bile acid-binding resins

inhibit the enterohepatic circulation of bile acids. this leads to diversion of hepatic cholesterol to synthesis of new bile acids, increased uptake of cholesterol from the circulation, and reduced blood LDL levels. however bile acid binding resins increase hepatic production of triglycerides and can cause hypertriglyceridemia.

common side effect of Atropine

intraocular pressure may precipitate acute closed angle glaucoma

prolactin inhibition and secretion

inhibited by hypothalamic dopaminergic pathways but secretion is stimulated by thyrotropin releasing hormone. in patients with hypothyroidism, the increased production of TRH by the hypothalamus can lead to hyperprolactinemia

BB decrease bp by

inhibiting renin release by JGC through antagonism of beta-1 receptors on these cells decrease RAAS also leads to decreased renal sodium and water retention

normally filtered at glomerulus and completely rebasorbed by the proximal convoluted tubule

inhibition of Na+ couple carrier mediated transport of glucose by proximal tubule would cause: glucose clearance to approach value of GFR typically estimated by clearance of inulin

selegiline

inhibitor of MAO type B and can prevent MPTP induced damage of dopaminergic neurons used to delay progression of parkinson disease. neurologist use combinations of selegiline, anticholinergics, and amantadine until they no longer provide control of symptoms. only then is levodopa/carbidopa introduced.

Bcl-2 normally

inhibits apoptosis and promotes survival of tumor cells oncogene

ethanol

inhibits gluconeogenesis and can cause hypoglycemia once hepatic glycogen stores are depleted.

tuberoinfundibular pathway

inhibits prolactin secretion. disruption by tuberoinfundibular pathway D2 receptor blocking antipsychotics may cause hyperprolactinemia with galactorrhea and amenorrhea. other pathways: mesolimbic and mesocortical pathways for congition and behavior regulation. nigrostriatal pathway for regulating coordination of voluntary movements.

mechanism of action of colchicine

inhibits tubulin polymerization into microtubules side effects: nausea, abdominal pain, and diarrhea.

ganciclovir

inhibits viral synthesis by blocking CMV DNA polymerase. it also blocks host DNA polymerase to a lesser degree, which leads to hematologic side effects-- neutropenia, anemia, and thrombocytopenia.

Trendelenberg sign/gait

injections given at superomedial part of the buttock risk injury to the superior gluteal nerve. this leads to trendelenberg sign. injections at the superomedial, inferomedial, and inferolateral regions of the buttock risk injury to the sciatic nerve. the superolateral quadrant of the buttock is a relatively safe site for intragluteal injections, although the anterolateral gluteal region is preferred.

preventable adverse event

injury to a patient due to failure to follow evidence-based best practice guidelines.

foot droop and eversion with toe extension dysfunction

injury to common peroneal nerve usually at neck of fibular by compression or fracture loss of sensory to dorsum of foot

musculocutaneous nerve

innervates the major forearm flexors (eg, biceps brachii, brachialis) and coracobrachilalis (flexes and adducts the arm) and provides sensory innervation to the lateral forearm. it is derived from the upper trunk of the brachial plexus (C5-7) and can be injured by trauma or strenuous upper extremity exercise.

crohn disease

insidious onset of abdominal pain, diarrhea, and weight loss and fever. prone to fistulas/abscesses as lesion affect the entire thickness of the bowel wall. perianal disease (eg, skin tags, fissures) also common.

pleiotropy

instances where multiple phenotypic manifestations result from a single genetic mutation. most syndromic genetic illnesses exhibit pleiotropy.

fluid in the pleural space

insulate sound vibrations that originate in the airways. decreased tactile fremitus and decreased intensity of breath sounds. high density of pleural fluid compared to normal lung tissue also causes dullness to percussion.

superantigens (TSS)

interact with major histocompatibility complex molecutles on antigen-presenting cells and the variable region of the T lymphocyte receptor to cause nonspecific, widespread activation of T cells. the results in the release of IL2 from the T cells and IL1 tumor necrosis factor from macrophages. --leading to TSS.

selective COX2 inhibitor for gout treatment

interleukin 1 and TNF alpha activation celecoxib minimal effect on COX1 and so minimal gastroduodenal toxicity

ureters lie anterior to

internal iliac artery posterior to gondal vessels

during initial phase of ARDS

intersitial and intraalveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes.

downregulation of gastric acid secretion

intestinal influences- ileum and colon release peptide YY which binds to ECLs counteracting cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine release from ECLs.

integration of double stranded HIV DNA

into the host cell's chromosomes is necessary to induce viral gene expression and prevent degradation of the viral genome. Raltegravir is an integrase inhibitor that disrupts HIV genome integration, preventing synthesis of viral mRNA.

HZV histology

intranuclear inclusions in keratinocytes and multinucleated giant cells

after a total gastroectomy

intrinsic factor is a glycoprotein that is normally secreted by parietal cells in the stomach and is necessary for the absorption of vitamin B12 in the ileum. patients who have undergone a total gastrectomy require lifelong vitamine B12 due to inability to produce IF. pepsin and HCI is not required due to pancreatic and intestinal proteases.

markers for renal function

inulin and mannitol ...no tubular reabsorption or secretion (goes right through) glucose, sodium, urea ...net tubular reabsorption PAH & creatinine ....net tubular secretion

kidney filtration

inulin=GFR and so if glucose is blocked at PCT and cannot be reabsorbed then it's clearance is approximately that of insulin.

kaposi's sarcoma

involve skin and GI tract and is common in HIV patients not on antiretroviral therapy. reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or polyploid masses. biopsy show spindle cells, neovascularization, and extravasated RBCs.

diabetic mononeuropathy

involves CN III caused by central ischemia, which affects the somatic nerve fibers but spares peripheral parasympathetic fibers. symptoms include ptosis, a 'down and out' gaze, and normal light and accommodation reflexes.

adhesion of cells to the extracellular matrix

involves integrin-mediated binding to fibronectin, collagen, and laminin. differential expression of integrin subtypes affects adhesion properties of individual cells, and has been found to correlate with malignant behavior in a number of tumors.

factitious disorder

involves the conscious and deceptive feigning or self-production of physical or psychological symptoms to obtain attention and medical care from health care personnel. there is an absence of obvious rewards. vs. malingering which is for personal gain-financial, benefits, time off from work, etc.

renal plasma flow

is RPF=PAH clearance=(urine[PAH] x urine flow) / plasma [PAH] RBF=(PAH clearance)/(1-hematocrit)

dietary fructose

is Phosphorylated in the Liver to Fructose 1 Phosphate and Rapidly Metabolized, because it Doesn't Pass through PFK 1, which is a Regulatory Enzyme of Glycolysis.

Oppositional defiant disorder

is a behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures. it does not involve the more severe violations of the basic rights of others seen in conduct disorder.

chemokine receptor CCR5

is a coreceptor that enables the HIV virus to enter cells. Blockade of CCR5 by chemokine receptor antagonists prevents viral entry into host cells.

legionella pneumophila

is a facultative intracellular gram-negative bacillus that can cause a systemic infection. symptoms frequently include high fever, cough, confusion, and diarrhea. most common laboratory abnormality seen with legionella pneumonia is hyponatremia, and sputum Gram stain often shows many neutrophils but few or no organisms.

poison ivy dermatitis

is a form of allergic contact dermatitis, which is a type IV hypersenstivity reaction mediated primarily by T lymphocytes. it manifests as intensely pruritic erythematous papules, vesicles, or bullae that often form linear patterns.

kartagener syndrome

is a form of primary ciliary dyskinesia characterized by the triad of situs inversus, chronic sinusitis, and bronchiectasis. occurs due to mutations that impair the structure or function of cilia. cystic fibrosis also causes chronic respiratory infections, but it is not associated with situs inversus.

Buspirone

is a nonbenzodiazepine anxiolytic used to treat generalized anxiety disorder. it has a slow onset of action, lacks muscle relaxtant or anticonvulsant properties, and carries no risk of dependence.

Buprenorphine

is a partial opioid receptor agonist that binds with high affinity but has low intrinsic activity. in patients on long-term opioid therapy, buprenorphine can displace the other opioids and precipitate withdrawal.

adenoma to carcinoma sequence

is a series of gene mutations that leads to the development of colon andeocarcinoma. TP53 tumor suppressor gene mutation is part of the final step in the sequence and leads to malignant transformation of preexisting large adenomatous polyps. mutation of the APC tumor suppressor to KRAS protooncogene then to TP53 mutation

alpha 1 antitrypsin

is a serine protease inhibitor that regulates the activity of elastase in the lung. inherited deficiency of AAT leads to alveolar destruction and panacinar emphysema. accumulation of improperly folded AAT proteins in hepatocytes can lead to liver dysfunction and cirrhosis in some patients.

NF1

is a single, gene autosomal dominant disorder. it occurs due to mutation on the NF1 gene located on chromosome 17. Cafe-au-lait spots, multiple neurofibromas, and lisch nodules are the most common symptoms.

telomerase

is an RNA-dependent DNA polymerase that synthesizes telomeric DNA sequences that can replace the lost chromosomal ends of the telomeres. cancer cells typically contain increased telomerase activity to allow for continued proliferation.

acute acalculous cholecystitis

is an acute inflammation of the gallbladder in the absence of gallstones. it typically occurs in critically ill patients (eg, those with sepsis, severe burns, trauma, immunosuppression) due to gallbladder stasis and ischemia. clinical findings may be subtle and include fever, right upper quadrant pain, and leukocytosis.

Folic acid (B9)

is an essential cofactor in nucleic acid synthesis, and a deficiency of either folate or vitamin B12 results in megaloblastic anemia.

abetalipoproteinemia

is an inherited inability to synthesize apolipoprotein B, an important component of chylomicrons and very low-density lipoprotein. lipids absorbed by the small intestine cannot be transported into the blood and accumulate in the intestinal epithelium, resulting in enterocytes with clear or foamy cytoplasm.

zollinger-ellison syndrome

is caused by gastrin-secreting tumors (gastrinomas) involving the small intestine or pancreas. patients typically have peptic ulcers (often beyond the duodenal bulb), abdominal pain/acid reflux, and diarrhea. the condition is frequently associated with multiple endocrine neoplasia type 1.

imperforate hymen

is caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina. adolescent patients typically present with primary amenorrhea, normal secondary sexual characteristics, and cyclic abdominal or pelvic pain due to accumulation of menstrual blood in the vagina and uterus (hematocolpos).

burkitt lymphoma

is characterized by aggressive rapid growth and a 'starry sky' microscopic appearance. translocation of the c-Myc oncogene on the long arm of chromosome 8 with the Ig heavy region on chromosome 14 produces a nuclear phosphoprotein (c-Myc) that functions as a transcription activator.

liquefactive necrosis

is characterized by complete digestion and removal of necrotic tissue with formation of cystic cavity. hypoxic CNS injury is often followed by liquefactive necrosis. abscess formation due to bacterial or fungal infection also like this.

autism spectrum disorder

is characterized by impaired social communication/interactions and restricted, repetitive interests or behaviors. it can occur with or without language and intellectual impairment.

schizotypal personality disorder

is characterized by long-standing pattern of eccentric behavior, odd beliefs, perceptual distortions, and social anxiety despite familiarity.

obesessive-complusive disorder

is characterized by persistent, intrusive thoughts leading to repetitive, ritualistic behaviors. serotonergic antidepressants (SSRI) are treatment of choice.

transforming growth factor beta

is critical for fibroblast migration, proliferation, and connective tissue synthesis. increased TGF-beta activity is responsible for the hypertrophic, keloid scarring and fibrosis of the lung, liver, and kidney that occur with chronic inflammation.

mosaicism

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

prognosis of colorectal adenocarcinoma

is directly related to the stage of tumor (not to the grade!). extend of tumor expansion is characterized by stage of tumor. the degree of tumor differentiation (from well-differentiated to anaplastic) is referred to as the grade. tumor stage is the most important criteria for determining prognosis.

primary cause of morbidity in acute rheumatic fever

is heart failure from severe pancarditis. mitral stenosis develops years or decades after the original illness. joint involvement is usually transient.

perfusion and ventilation in the lung

is highest in the base of the lung and lowest in the apex; however, the variability in perfusion is greater than that in ventilation. this causes the ventilation/perfusion ratio to follow the opposite gradient. it is lowest in the base and highest in the apex.

selection of control subjects in case-control studies

is intended to provide an accurate estimation of exposure frequency among the nondiseased general population. cases and controls should be selected based on disease status, not exposure status.

work of breathing

is minimized in patients with increased elastic resistance (e.g. pulmonary fibrosis) when their respiratory rate is high and tidal volume is low (fast, shallow breaths). in contrast, patients with diseases that increase airflow resistance (e.g. asthma, COPD) breathe at a lower rate/higher tidal volume (slow, deep breaths) in order to minimize the work of breathing.

lung abscess

is most often due to aspiration of anaerobic oral bacteria such as Peptostreptococcus, prevotella, Bacteroides, and Fusobacterium species. risk factors for lung abscess include conditions that increase aspiration risk: alcoholism, drug abuse, seizure disorders, previous stroke, and dementia. CXR=air fluid level symptoms: indolent and include fever, night sweats, weight loss, and a cough producing foul-smelling sputum.

vitamin K

is necessary for the carboxylation and functionality of coagulation factors II,VII,IX, and X. newborns who do not receive prophylactic supplementation are at risk for bleeding complications. patients with cystic fibrosis are also at risk for vitamin K deficiency due to poor absorption of fat-soluble vitamins.

DVT in patient <50yrs, inherited disease?

is no change after activated protein C>>>factor V leiden factor Va resistant to inactivation by activated protein C

digital clubbing

is often associated with prolonged hypoxia. it can be found in patients with large-cell lung cancer, tuberculosis, cystic fibrosis, and suppurative lung diseases such as empyema, bronchiectasis, and chronic lung abscesses.

dietary fructose

is phosphorylated in the liver to F1P and is rapidly metabolized because it bypasses PFK-1, the major rate-limiting enzyme of glycolysis. other sugars (eg, glucose, galactose, mannose) enter glycolysis prior to PFK-1 and as a result are metabolized more slowly.

marfan syndrome

lens dislocation and aortic root dilatioin. arachnodactyly, scoliosis, and mitral valve prolapse.

protein kinase A

is responsible for the intracellular effects of the G protein-mediated adenylate cyclase second messenger system. Hormone receptors that use this system include the TSH, glucagon, and PTH receptors.

proximal ureter receives its blood supply from the renal artery whereas the distal ureter

is supplied by the superior vesical artery supply to the middle is variable and anastomatic.

cytomegalovirus retinitis

is the most common cause of disease in patients with untreated AIDS who have CD4<50/mm3. diagnosis is made by funduscopy, which typically reveals yellow-white, fluffy retinal lesions near the retinal vessels with associated hemorrhage. treatment with ganciclovir is required to prevent blindness.

echinococcus granulosus

is the most common cause of hydatid cysts. spilling of cyst contents can cause anaphylactic shock. surgical manipulation should be performed with caution.

cerebral amyloid angiopathy

is the most common cause of spontaneous lobar hemorrhage, particularly in the elderly. the most common sites of hemorrhage include the occipital and parietal lobes. amyloid angiopathy is a consequence of beta-amyloid deposition in the walls of small to medium sized cerebral arteries, resulting in vessel wall weakening and predisposition.

trochlear nerve palsy

is typically traumatic or idiopathic and presents with vertical diplopia that worsens when the affected eye looks down and toward the nose (eg, walking downstairs, up-close reading). patients may compensate by trucking the chin and tilting the head away from the affected eye.

riboflavin vitamin B2)

is used in dehydrogenase reactions involving FMN and FAD.

absorbed copper

is used to form ceruloplasmin, which accounts for 90-95% of circulating copper. senescent ceruloplasmin and the unabsorbed copper are secreted into bile and excreted in stool, which is the primary route for copper elimination.

mucosal hemorrhage and patchy areas of necrosis

ischemic colitis two mechanisms: hypoperfusion due to low CO occlusion due to atheroma, thrombosis, embolism weak lower extremity pulses=extensive athersclerosis

inadequate blood supply to the brain caused by arterial thrombosis or embolism leads to

ischemic stroke. first microscopic changes are 12-24 hours after injury and show intense eosinophilic staining of the neuronal cytoplasm. 24-72 hours-neutrophils 3-7 days-macrophage/microglia 1-2 weeks- reactive gliosis more than 2 weeks-glial scar

increased myocardial contratility and SVR with

isoproterenol beta 1 and 2 receptor agonist

occurs in lymphoid follicles located in the lymph node cortex where they form germinal centers

isotype switching requires CD40 receptor on B cell and CD40 ligand on T cells IgG= main serum immunoglobulin of the secondary response

fasting state energy use

ketone bodies produced in liver used by mitochondria of peripheral tissues brain preferentiall uses glucose, but will utilize ketones for most of its energy needs during prolonged starvation erythrocytes lack mitochondria and are unable to use ketones

horseshoe kidney

kidneys are fused at the poles. isthmus of the horseshoe kidney usually lies anterior to the aorta and posterior to the inferior mesenteric artery. during fetal development, the IMA limits the ascent of the horseshoe kidney.

ATP powered motor protein that facilitates anterograde transport of neurotransmitter containing secretory vesicles down axons to synaptic terminals.

kinesin

ELISA

known antigen fixed to surface and patient serum added add anti-human immunoglobulin antibodies coupled to peroxidase chromogen substrate added and modified by linked enzyme detectable color change

sound more audible at end expiration> decrease in lung volume brings heart closure to the chest wall

left ventricular gallops S3 and S4

mycoplasma genus

lack peptidoglycan cell walls and are resistant to agents that target cell wall such as penicillins, cephalosporins carbapenems, and vancomycin. need to be treated with antiribosomal agents (eg, tetracyclines, macrolides).

Hep C and proofreading

lacks proofreading 3' to 5' exonuclease activity in its RNA polymerase. its envelop glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation

progressive proximal muscle weakness with reduced/absent reflexes predominantly involving lower extremities usually associated with malignancy

lambert-eaton myasthenic syndrome small cell lung cancer

latissimus dorsi

large thoracolumbar muscle that originates from the iliac crest and lumbar fascia to the spinous processes of T7-12 and lower ribs, and inserts at the bicipital groove of the humerus. is innervated by the thoracodorsal nerve. primary functions include extension, adduction, and medial rotation of the humerus.

nitrates predominantly affect

large veins SM relaxation lead to venodilation leads to decrease in preload and decrease in demand

abscess formation

largely driven by neutrophil recruitment and activation leading to the release of cytotoxic granules that kill bacteria but also cause liquefying necrosis of surrounding tissue. lung abscess=several days of fever, cough with copious sputum and CXR of cavitation with air fluid level.

tabes dorsalis

late form of neurosyphillis causes progressive degeneration of the dorsal column and dorsal roots of the spinal cord. manifestations include loss of proprioception and vibratory sensation, severe lancinating pains, and sensory ataxia (wide based gait, positive Romberg sign). many patients have Argyll Robertson pupils.

directly inhibits ferrochelatase and sigma-aminolvulinic acid (ALA) dehydratase

lead

coarse erythrocyte basophilic stippling and microcytic hypochromic anemia

lead poisoning young children ingesting pain chips and industrial workers inhaling particulate lead are at risk.

cortisol increases expression of pehnylethanolamine-N-methytransverase (PNMT)

leading to increased conversion of NE to epinephrine in the adrenal medulla

alpha galactosidase A deficiency

leads to accumulation of sphingolipid globotriaosylceramide in the vascular smooth muscle, glomerular/distal tubule cells, cardiac myocytes, and dorsal root and autonomic ganglia. early manifest as neuropathic pain and angiokeratomas. then proteinuria, renal failure, left ventricular hypertrophy, TIA, stroke in adulthood.

chronic opioid use

leads to development of tolerance to analgesic effects and most side effects, with the exception of constipation and miosis. to prevent bowel complications, it is recommended that patients be treated prophylactically with adequate fluid intake and daily laxatives.

increased osteroclast activity in multiple myeloma

leads to elevated serum calcium and reduced parathyroid hormone production. this decreases renal calcium reabsorption, causing hypercalciuria. hypercalcemia and light chain cast nephropathy cause progressive renal failure, leading to reduced 1,25-dihydroxyvitamin D synthesis.

increased number of CGG trinucleotide repeats on fragile X mental retardation 1 (FMR1) gene on long arm of X chromosome

leads to hypermethylation and inactivation of FMR1 Fragile X syndrome

carotid sinus massage

leads to increase in parasympathetic tone causing inhibition of sinoatrial node activity, slowing of conduction through the AV node, and prolongation of AV node refractory period. useful in vagal maneuver for termination of paroxysmal supraventricular tachycardia.

small intestinal bacterial overgrowth post gastric bypass

leads to malabsorption of most vitamins: B12, A, D, E but increased production of folic acid and vitamin K ....leading to nausea, bloating, abdominal discomfort, and malabsorption.

mitral valve regurgitation

leads to markedly elevated left atrial pressure during atrial diastole, leading to the characteristic early and large V wave on left atrial pressure tracing.

leftward shift (decreased P50) of oxygen dissociation curve

leads to reduced ability to release oxygen within peripheral tissues--causing renal hypoxia, increased erythropoietin synthesis, and compensatory erythrocytosis.

leprosy skin test

lepromatous-macrophages remain inactivated due to inability of TH1 cells to recognize M leprae antigens. see high acid fast bacilli within macrophages and often a TH2 cytokine profile IL 4,5,10. tuberculoid- activated macrophages. see TH1 cytokine profile IL 2, 12, IFN-gamma.

Femoral nerve lesion causes:

lesions due to trauma, nerve compression, stretch injury or ischemia can cause weakness of the quadriceps muscle, loss of patellar reflex, and loss of sensation over the anterior and medial thigh and medial leg.

dietary restriction of branched-chain amino acids

leucine, isoleucine, valine treatment for maple syrup urine disease

peripheral smear: increased bands, early mature neutrophil precursors, granules (basophilic oval inclusions) in neutrophils

leukemoid reaction

URI then purpua

leukocytoclastic vasculitis perivascular inflammation of small blood vessels with fibrinoid necrosis and a predominance of neutrophils and fragmented neutrophilic nuclei

stimulates neutrophil migration to sites of inflammation

leukotriene B4 others: C5a and IL-8

GnRH analog

leuprolide continuous transient increase in pituitary LH/testosterone levels then suppression and decrease

prostatic plexus

lies within the fascia of the prostate and innervates the corpus cavernosa of the penis, which facilitates penile erection. as a result, prostatectomy or injury to the prostatic plexus can cause erectile dysfunction.

neuroleptic malignant syndrome

life threatening adverse reaction ot antipsychotic medications characterized by diffuse muscle regidity, hyperthermia, autonomic instability, and altered sensorium. meds should be stopped and supportive care provided, and dantrolene can be used to reduce muscle rigidity.

paranoid personality disorder

lifelong pattern of pervasive suspicion and distrust. they do not have fixed delusions and other psychotic symptoms.

nicotinic receptors

ligand gated ion channels that open after binding acetylcholine cause immediate influx of: sodium calcium and outflux: potassium

hyperestrinism in liver cirrhosis

likely arises due to increases in androstenedione production, androgen aromatization, and sex hormone-binding globulin concentration (preferentially binds testosterone). impaired estrogen metabolism by the liver may also be a contributing factor. a decreased free testosterone/estrogen ratio leads to gynecomastia, testicular atrophy, decreased body hair, and spider angiomata---estrogen's effects on arteriolar dilation.

isthmus of aorta (right after branches)

likely to rupture due to trauma rapid deceleration isthmus: tethered by ligamentum arteriosum and is more fixed and immobile compared to descending aorta.

yellowish eyelid papule or plaque containing lipid-laden macrophages is

likely xanthelasma. occurs in association with primary or secondary hyperlipidemia. cholestatic conditions such as primary biliary cirrhosis are a potential cause of hypercholesterolemia leading to xanthelasma.

degree of overlap between healthy and diseased population curves

limits the maximum combined sensitivity and specificity of a quantitative diagnostic test. the degree to which sensitivity or specificity is affected depends on the chosen cutoff value.

increased acitvity of cyclooxgenase 2

linked to some forms of colon adenocarcinoma regular aspirin use is suggested to decrease adenomatous polyp formation.

ovarian cancer pathogenesis

linked to the frequency of trauma and repair at the ovarian surface. OCP, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation.

septic shock due to release of endotoxin in blood stream: found in outer membrane of gram negative bacteris: LPS

lipid A is the toxic component of LPS

normal PaO2 and SaO2 and low O2 content

lower hemoglobin concentration due to chronic blood loss: menstruation

Vitamin E

lipid soluble vitamin deficiency mimic friedreich ataxia ataxia (degeneration of spinocerebellar tracts), loss of position and vibration sense (degeneration of the dorsal columns, and loss of tendon relfexes (due to peripheral nerve degeneration.

lacunar infarcts caused by

lipohyalinosis, microatheroma formation, and hardening/thickening of the vessel wall (arteriolar sclerosis) normal head CT and in the deep brain structures

N meningitidis sepsis and circulatory collapse due to virulence factor

lipooligosaccharide

daptomycin

lipopeptide antibiotic with activity limited to gram positive organisms, including MRSA causes depolarization of bacterial cellular membrane and inhibition of DNA, RNA, and protein synthesis.. assoicated with increased creatine phosphokinase levels and an increased incidence of myopathy.

postprandial short acting insulin

lispro aspart glulisine

hypothyroidism and nephrogenic diabetes insipidus are most common adverse effects of long term

lithium therapy serum TSH and renal function (BUN and creatinine) should be monitored routinely.

lowest risk for infarction

liver dual blood supply by hepatic artery and portal vein

disseminated candida infection

local defense against candida is performed by T cells vs. systemic infection is prevented by neutrophils. due to this, localized candidiasis is common in patients with HIV but neutropenic individuals are more likely to have the systemic form of the disease.

NE extravasation and resulting vasoconstriction can lead to necrosis and can be prevented by

local injection of alpha 1 blocking drug i.e. phentolamine

cortisol receptors

located within the cytoplasm and translocate to the nucleus after binding to their substrate. in the nucleus, the cortisol-receptor complex binds to hormone-responsive DNA elements, altering gene transcription to enhance hepatic glucose production and limit peripheral glucose utilization. cortisol and growth hormone contribute to glucose homeostasis during prolonged fasting.

newer generation antihistamines

loratidine cetirizine good for elderly

born with one germline defect in RB1 and then additional somatic mutation

loss of heterozygosity hereditary retinoblastoma risk: bilateral and multifocal retinoblastoma osteosarcoma sporadic: 2 spontaneous somatic mutations in single retinal cell= unilateral tumor.

turner syndrom (45,X)

loss of paternal chromosome X in neonates, causes lymphedema and cystic hygromas. short stature, primary amenorrhea, and aortic anomalies

fibular neck fracture can sever the common peroneal nerve

loss of sensation over the dorsum of the foot

resting membrane potential

low concentration of sodium and chloride in the cell and high concentration of potassium in they cytoplasm.

S3

low frequency sound occurring during early diastole after S2. left ventricular gallops (S3 and S4) are best heard with bell of the stethoscope over the cardiac apex while the patient is in the left lateral decubitus position at the end of expiration.

reguritant flow into LA in acute mitral regurge>> increased LA pressure and increased LVEDV (preload)>>

low resistant pathway also decreased LV afterload and a resultant increase in EF.... but overall decrease in FORWARD stroke volume

dopamine

low-dose dopamine infusion stimulates D1 receptors in the renal and mesenteric vasculator, resulting in vasodilation and increased blood flow to these sites. increasing doses of dapamine stimulates beta1 and alpha1 receptors, resulting in increased cardiac output and elevated systemic vascular resistance. at higher end of the dose range, the increase in afterload can result in decreased cardiac output.

dopamine low vs. high dose

low=D1: renal and mesenteric vessels> vasodilation and increase blood flow high=beta/alpha1: increase CO and increase SVR

direct arteriolar vasodilators

lower blood pressure but trigger reflex sympathetic activation and stimulate the renin-angiotensin-aldosterone axis. this results in tachycardia and edema. to counteract such compensatory effects, these agents are often given in combination with sympatholytics and diuretics.

V/Q gradient in lung with patient standing

lowest at the base and highest at the apex due to variability in perfusion greater than ventilation (even though both are highest at the base of the lung and lowest at the apex)

several days of fever, cough productive of copius sputum (foul smelling), and CXR= cavitation with air fluid level

lung abscess activated neutrophils release cytotoxic granules (lysosomes) containing myeloperoxidase and other digestive enzymes that destroy extracellular bacteria

between 1950-2000, rising rates of tobacco use resulted in an increase in

lung cancer incidence and mortality

reverse transcription polymerase chain reaction used to detect and quantify levels of

mRNA in a sample (messenger RNA transcript containing BCR and ABL exons)

suffix of biological agent indicates what type of med it is

mab= monclonal antibody cept=receptor molecule nib=kinase inhibitor

hydrocephalus in infants

macrocephaly and poor feeding enlarged ventricles untreated leads to spasticity due to stretching of the periventricular pyramidal tracts, developmental delays, and seizures.

6-mercaptopurine

mainly degraded in the liver by xanthine oxidase. allopurinol (XP inhibitor), can increase the concentration of 6-MP significantly. both 6-MP and 6-thioguaninee are prodrugs that require activation by hypoxanthine-guanine phosphoribosyl transferase.

vitamin A

maintains differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjuctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts. avitaminosis A can cause squamous metaplasia of such epithelia to a keratinizing epithelium. CF leads to ADEK vitamin deficiency

steady state plasma [ ] times clearance divided by bioavailability

maintenance dose bio fraction= 1 if IV

Anti-hemagglutinin antibodies

major adaptive immune mechanism that prevents reinfection with the influenza virus.

ventral pancreatic bud is a precursor to

major pancreatic duct dorsal pancreatic bud: majority of pancreatic tissue

alpha-1-antitrypsin (AAT)

major serum inhibitor of extracellular elastase typically develop early-onset panacinar emphysema due to unchecked elastase activity. exposure to smoke dramatically accelerates the development of emphysema in patients with AAT deficiency and should be avoided.

multiple origins of replication

make eukaryotic DNA replication quick and effective despite the large size and complexity of the genome compared to that of prokaryotic organisms.

choriocarcinoma

malignant form of gestational trphoblastic disease composed of anaplastic cytotrophoblasts and syncytiotrophoblasts without villi. it often presents as dyspnea/hemoptysis due to pulmonary metastasis from hematogenous spread.

older children with absence seizures

may also develop generalized tonic-clonic or myoclonic seizures. although ethosuximide is effective against isolated absence seizures, it does not suppress tonic-clonic seizures. valproate is used for both types of seizures.

enhancers and silences

may be located upstream, downstream, or within a transcribed gene; these gene sequences function to increase and decrease the rate of transcription, respectively. promoter regions are typically located 25 or 75 bases upstream from their associated genes and function to initiate transcription.

paraneoplastic syndrome of hypercoagulability

may be seen in some patients with cancer, especially adenocarcinomas of the pancreas, colon, or lung. superficial venous thromboses may therefore appear in one site and then resolve, only to recur in another site==Trousseau syndrome (migratory superficial thrombophlebitis), an indication of visceral cancer.

medically intractiabl esymptoms of parkinson disease

may benefit from high-frequency deep brain stimulation of the globus pallidus internus or subthalamic nucleus as it promotes thalamo-cortical disinhibition with improved mobility.

odds ratio

measure of strength of an asso. between an exposure and outcome. odds that an outcome occurred in the presence of a particular exposure compared with the odds that the outcome occurred in the absence of that exposure. OR=ad/bc

korotkoff sounds

measures pulsus paradoxus inflate bp cuff above systolic pressure and gradually deflate. first audible during expiration and the pressure at which they are heard through all phases of respiration quantifies pulsus paradoxus.

rupture of the left ventricular free wall

mechanical complication of anterior wall myocardial infarction that usually occurs within the first 5-14 days after MI. rupture leads to hemopericardium and cardiac tamponade, causing profound hypotension and shock with rapid progression to pulseless electrical activity and death.

increased intestinal iron absorption decreased hepcidin

mechanisms to increase iron due to: mutation of HFE protein cause enterocytes and hepatocytes to sense falsely low iron levels.

ACE inhibitors effect on kidneys?

mediates vasoconstriction of efferent renal arterioles. leading to a reduction in renal perfusion, GFR, and renal filtration fraction. for patients with bilateral renal artery stenosis, use of ACE inhibitors should be closely monitored as they can participate acute renal failure.

trigger IgE independent mast cell degranulation: diffuse itching and pain, bronchospasm, and localized swelling (urticaria)

meds: opioids radiocontrast agents antibiotics: vancomycin

acute tubular necrosis predominantly affects the renal

medulla terminal proximal tubules and thick ascending limb of the loop of henle- they are in medulla

multiple endocrine neoplasia type 2B

medullary thyroid cancer, pheochromocytoma, marfanoid habitus, and oral and intestinal mucosal neuromas.

urethral injury

membranous segment of urethra in male, below prostate, is the weakest point. injury associated with pelvic fractures. the anterior urethra is most commonly damaged in saddle injuries. inability to void with a full bladder sensation, a high-riding boggy prostate, and blood at the urethral meatus are suggestive of urethral injury, particularly in the presence of a pelvic fracture. if urethral injury is suspected, placement of a foley catheter is contraindicated.

most common presentation of Cryptococcus neoformans infection

meningoencephalitis pulmonary cryptococcus N. usually: asymptomatic cough, scant sputum, dyspnea, pleuritis chest pain

tricyclic antidepressant overdose

mental status changes, sezures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic findings. sodium bicarbonate is used to treat associated cardiac toxicity and works by increasing serum pH and extracellular sodium (alleviating fast sodium channel blockade).

Confidence interval

meta analysis groups results of several trials to increase statistical power and provide an overall pooled effect estimate. if confidence interval doesn't include the null value, then the result is statistically significant.

gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of henle, and distal convoluted tubules.

metanephric mesoderm

schistocytes suggest

microangiopathic hemolytic anemia HUS, TTP, DIC, or mechanical damage. coagulation studies are normal in HUS-TTP but abnormal in DIC.

thrombotic thrombocytopenic purpura

microangiopathic hemolytic anemia and thrombocytopenia are essential to diagnosis neurologic symptoms are not present in 1/3 of patients

predominant cell in the necrotic area 3-7 days after onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris.

microglia

flial scar

microglia move to area of ischemic infarct approximately 3-5 days after the onset of ischemia and phagocytize the fragments of neurons, myelin, and necrotic debris. a cystic space replaces the necrosis, and astrocytes form a glial scar along the periphery.

HIV assiciated dementia

microglial nodules- groups of activated microglia/macrophages around small areas of necrosis- and multinucleated giant cells

kinesin

microtubule-asso., ATP powered motor protein that facilitates the anterograde transport of neurotransmitter containing secretory vesicles down axons to synaptic terminals.

damage to the brainstem at/below the level of the red nucleus

midbrain tegmentum, pons results in decererate (extensor) posturing. vs. damage to neural structures above the red nucleus- cerebral hemispheres, internal capsule. typically results in decorticate (flexor) posturing.

midgut volulus, intestinal obstruction, fibrous bands connecting retroperitoneum in RLQ to the right colon/cecum

midgut malrotation (i.e. around SMA)

intestinal malrotation

midgut undergoes incomplete embryological counterclockwise rotation. it can present as intestinal obstruction (due to compression by the adhesive bands) and midgut volvulus (intestinal ischemia due to twisting around the blood vessels).

termination of first trimester pregnancy

mifepristone is a progesterone antagonist (progesterone is necessary for implantation and maintenance of pregnancy), that is used with misoprostol- a prostaglandin E1 agonist. methotrexate is a folic acid antagonist and can also be used in termination of pregnancy.

PDE3 inhibitor leading to cAMP increase and venous dilation

milrinone

selective phosphodiesterase (PDE)-3 enzyme inhibitor

milrinone and inamrinone lead to cAMP increase increase contractility and also systemic vasodilation don't use in hypotensive patient

sickle cell disease

missense mutation that causes valine to replace glutamic acid at position 6 in the hemoglobin beta globin chain RNA contains the pyrimidine base uracil, whereas DNA contains the base thymidine.

MAO

mitochondrial enzyme that breaks down monoamine neurotransmitters (eg, dopamine, norepinephrine, serotonin). Tyramine-induced hypertensive crisis can occur in patients taking MAO inhibitors who consume foods containing high amounts of tyramine (eg, aged cheeses, cured meats, draft beer).

native valve infective endocarditis predisposing condition

mitral valve prolapse with regurgitation RHD remains a frequent IE in developing nations

elevated left atrial pressure during systole (seen on pressure waves)

mitral valve regurge mitral stenosis: elevated pressure throughout

Cytomegalovirus (CMV)

monospot test is positive in most cases of epstein barr virus-associated mononelosis. in immunocompetent patients with a heterophile antibody-negative mononucleosis-like syndrome, the most likely diagnosis is CMV

chronic renal allograft rejection

months to years after transplant. worsening hypertension and slowly rise in serum creatnine. mediated by chronic, indirect immune response against donor alloantigens and results in obliterative intimal thickening, tubular atrophy, and interstitial fibrosis.

major depressive disorder psychotic

more than or equal to two weeks of depressed mood, impaired concentration, decreased appetite/weight loss, sleep disturbance, and suicidal ideation. psychotic symptoms: delusions of causing evil, auditory hallucinations

NSAID-associated chronic renal injury

morphologically characterized by chronic interstitial nephritis and papillary necrosis.

glycine

most abundant amino acid in collagen. triple helical conformation of collagen molecules occurs due to the repetitive amino acid sequence within each alpha chain, in which glycine occupies every third amino acid position.

cytochrome P450 oxidase (microsomal monooxygenase) system

most chemical carcinogens enter the body in an inactive state (ie, as procarcinogens). these pro-carcinogens are converted into active metabolites by the cytochrome P450 oxidase system. individual susceptibility to chemical carcinogens depends on the activity of these P450 enzymes, which is genetically determined.

classic galactosemia

most common and severe galactosemic disorder and presents within days of birth with jaundice, vomiting, and hepatomegaly. autosomal recessive

cavernous hemangioma

most common benign liver tumor. microscopically, these tumors consist of cavernous, blood-filled vascular spaces of variable size lined by a single epithelial layer. the biopsy of a suspected hemangioma is not advisable, as the procedure has been known to cause fatal hemorrhage and is of low diagnostic yield.

enterovirus

most common cause of aseptic meningitis.

inadequate canalization of ureteropelvic junction

most common cause of unilateral fetal hydronephrosis due to high compliance.

accessory nipples

most common congenital breast anomaly resulting from failed regression of mammary ridge in utero. they are usually asymptomatic but can become tender along with breast tissue during times of hormonal fluctuation.

congenital CMV

most common eye related complication is chorioretinitis.

down syndrome

most common genetic cause of intellectual disability. short neck, low set ears, epicanthnic folds, and slanted palpebral fissures. karyotype with 47 chromosomes with 3 copies of chromosome 21.

von willebrand disease

most common inherited bleeding disorder. has autosomal dominant pattern of inheritance and variable penetrance. absence of von willebrand factor leads to impaired platelet function (prolonged bleeding time) and coagulation pathway abnormalities due to decreased factor VIII activity (prolonged partial thromboplastin time).

deltaF508

most common mutation of CF transmembrane regulator protein in patients with cyctic fibrosis. this mutation leads to protein misfolding and failure of glycosylation, followed by proteasome-mediated degradation and significantly decreased number of transmembrane CFTR.

epithelial ovarian cancer

most common ovarian malignancy. histologic findings include anaplasia of epithelial cells with invasion into the stroma, along with multiple papillary formations with cellular atypia. epithelial ovarian tumors produce CA-125, which can be used as serum marker for this condition.

germinomas

most common pineal gland tumor and present with obstructive hydrocephalus and dorsal midbrain (parinaud) syndrome. germinomas in the suprasellar region cause endocrinopathies due to pituitary/hypothalamic dysfuntion.

fibrinous pericarditis

most common type of pericarditis and is characterized by pericardial inflammation with a serous, fibrin-containing exudate in the pericardial space. pleuritic chest pain and a triphasic friction rub are frequently seen. common causes include viral infection, myocardial infarction, uremia, and rheumatologic disease (SLE, RA).

aplastic anemia

most commonly due to a toxic effect or autoimmune response causing apoptosis of pluripotent stem cells (pancytopenia). bone marrow biopsy reveals hypocellularity with an abundance of fat cells. fanconi anemia-inherited cause of AA that presents with short stature and absent thumbs and has increased risk of malignancy.

asthma and COPD exacerbation

most frequent causes of pulsus paradoxus in the absence of significant pericardial disease. beta-adrenergic agonists control acute asthma and COPD exacerbations bu causing bronchial smooth muscle relaxation via increased intracellular cAMP

renal disease caused by light chain cast nephropathy

multiple myeloma free light chains form obstructive casts in the renal tubules. osteolytic lesions, hypercalcemia, anemia, or acute kidney injury. monoclonal paraproteins are not detected by urine dipstick (which detects only albumin) but both spot and 24 hour protein concentrations will be elevated. intact immunoglobulins, IgA, IgG, IgM, are too large to pass through the glomerulus.

brachial plexus C5-C7 derived nerve

musculocutaneous motor: forearm flexors sensory: lateral forearm

vitamin K: gamma carboxylation of coagulation factors: II, VII, IX, X

must for newborns especially CF patients due to low absorption of fat-soluble vitamins (K)

hypothyroid myopathy

myalgias, proximal muscle weakness, elevated creatine kinase levels, and delayed relaxation of deep tendon reflexes. diagnosis can be confirmed with an elevated TSH level. other common causes of myopathy with elevated CK levels are inflammatory myopathies, muscular dystrophies, and HMG-CoA reducatase inhibitors.

DNA-binding proteins include transcription factors

myc, CREB steroid receptors (cortisol, aldosterone, progesterone) thyroid hormone receptor fat soluble vitamin receptors (vitamin D, retinoic acid) DNA transcription and replication proteins.

TB cord factor

mycobacterium tuberculosis intracellular pathogen: this blocks phagolysosome acidification and leads to formation of caseating granulomas

genomes or organisms

mycoplasma: single, circular DNa fungi: diploid DNA viruses: haploid DNA

subacute combined degeneration

myelopathy associated with vitamin B12 deficiency. degeneration of both the ascending (dorsal columns) and descending (corticospinal tract) pathways. loss of position and vibration sensation, ataxia, and spastic paresis are common manifestations.

polycythemia vera

myeloproliferative disorder characterized by uncontrolled erythrocyte production. virtually all patients with polycythemia ver have a mutation in JAK2, a non-receptor (cytoplasmic) tyrosine kinase associated with the erythropoietin receptor.

common primary cardiac tumor>>most arise in the left atrium peduncluated mass- scattered cells within a mucopolysaccharide stroma

myxoma

primary cardiac neoplasm

myxomas arise in left atrium. cause mitral valve obstruction of mitral valve leading to diastolic murmur and decreased CO dyspnea, syncope, fever, weight loss scattered cells within a mucopolysaccharide stroma and abnormal blood vessels with hemorrhaging.

treat opioid intoication/overdose

naloxone pure opioid receptor antagonist greatest affinity to mu receptors

undetectable levels of hypocretin-1

narcolepsy hypocretin-1 and 2: produced in hypothalamus promote wakefulness inhibit REM sleep-related phenomena

vitamin C

necessary for hydroxylation of proline and lysine residues in pro-collagen. vitamin C deficiency (scurvy) often in malnuourished individuals and leads to capillary bleeding, poor would healing, and periodontal disease. in children, bony deformities and subperiosteal hemorrhages are also characteristic.

probability of not having a disease given a negative test result

negative predictive value NPV=#true negatives/total number of negative tests

membranous glomerulopathy

nephrotic syndrome in adults solid malignancy, viral hepatitis, and SLE 'spike and dome' appearance

pharmocologic nitrates

nitroglycerin, isosorbide mononitrate, isosorbide dinitrite are metabolized by NO and S-nitrothiols in vascular smooth muscle cells, leading to an increase in cyclic guanosine monophosphate (cGMP) that stimulates vasodilation. large veins are predominantly affected, leading to increased venous capacitance and reduced venous return (preload), which decreases left ventricular wall stress and myocardial oxygen demand to relieve anginal symptoms.

decrease preload and afterload with SV maintained

nitroprusside short acting venous and arterial vasodilator.

undifferentiated (anaplastic) tumors

no resemblance to the tissue of origin composed of pleomorphic cells with large, hyperchromatic nuclei that grow in disorganized fashion. also contain numerous, abnormal mitoses and giant tumor cells.

digoxin toxicity

nonspecific GI and visual symptoms--nausea, vomiting, confusion, weakness. elevated potassium is another sign due to inhibition of Na-K-ATPase pumps.

digoxin toxicity

nonspecific GI--anorexia, nausea, vomiting, neurologic--fatigue, confusion, weakness changes in color vision are a more specific but rare finding. life threatening ventricular arrhythmias are the most serous complication.

janeway lesions

nontender, macular, and erythematous lesions typically located on the palms and soles of patients with acute infective endocarditis and are the result of septic embolization from valvular vegetations. can also develop osler nodes and splinter hemorrhages.

diagnostic tests for syphilis

nontreponemal: antibody to cardiolipin-cholesterol-lecithin antigen (RPR, VDRL) treponemal: antibody to treponemal antigens (FTA-ABS, TP-EIA)

part of normal flora in upper respiratory tract are common cause of acute otitis media, sinusitis, and bronchitis do not form a polysaccharide capsule

nontypeable strains of Haemophilus influenzae

normal circulating testosterone levels low concentration of testosterone in seminiferous tubules

normal HPG axis and leydig cells dysfunction sertoli cells: not making adequate androgen binding protein

adenoma to carcinoma sequence

normal colon APC inactivation hyperproliferative epithelium KRAS activation adenoma p53 inactivation carcinoma

Viridans streptococci

normal inhabitants of the oral cavity and are a cause of transient bacteremia after dental procedures in healthy and diseased individuals. in patients with pre-existing valvular lesions, viridans strep can adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis. vs. staph aureus which can infect intact valves.

measures of central tendency

normal-mean, median, and mode are all at the center. negatively skewed-the 'hill is sliding to the left' and the mode is at top, median after that and mean after that. positively skewed-'hill is sliding to the right'

intravascular catheters associated with

nosocomial bloodstream infections allow skin bugs: staph A and staph epi to enter bloodstream

adrenal insufficiency

not able to increase glucocorticoid production in response to acute stress. adrenal crisis characterized by severe hypotension, abdominal pain, vomiting, weakness, and fever. aggressive fluid resuscitation, treatment requires immediate glucocorticoid supplementation.

highest risk factor for HPV infection

not using consistent barrier contraceptives for STI prevention carcinogenic strains are: 16, 18, and 31

preschool age children's ideas on death are

not yet developed; think it is temporary or reversible and that people's grief is their fault. finality of death understood around age 7.

site of ribosomal subunit maturation and assembly

nucelolus ..a round, basophilic body within the nucleus RNA polymerase I ...functions in nucleolus to transcribe the 45S pre-rRNA gene= codes for ribosomal RNA components

cumulative incidence

number of new cases of a disease over a specific period divided by total population at risk at the beginning of the study

number needed to treat

number of patients that need to be treated with a medication to avoid an additional negative outcome. NNT is calculated by dividing 1 by the absolute risk reduction (the difference between the control and experimental group event rates). lower NNT values present more beneficial treatments.

vitamin B12 deficiency

obtained through diet from animal sources, which places strict vegans at risk for dietary deficiency. this deficiency takes years to develop due to the large hepatic B12 reserve--4-5 years presents with megaloblastic anemia and potentially irreversible neurologic deficits--paresthesias, weakness, ataxic gait

malaria

p ovale and p vivax: have dormant hepatic phase and can reactivate several months after return. treat: primaquine p falciparum does not have dormant phase

paraneoplastic syndromes

occur due to production of hormone like substances from tumor cells. can also be immune reaction against tumor cells that cross react with normal cells. neurologic paraneoplastic syndromes are autoimmune.

apoptosis

occur through intrinsic (mitochondria-mediated) pathway or the extrinsic (receptor-initiated) pathway. both converge in the activation of caspases. caspases are proteolytic enzymes that cleave cellular proteins.

features of malignant cause of back pain

occurrence at night not relieved with rest/analgesics advanced age systemic symptoms

abacavir hypersensitivity reaction

occurs in 2-8% of patients and is strongly associated with the HLA-B*57:01

dystrophic calcification

occurs in damaged or necrotic tissue in the setting of normal calcium levels; metastatic calcification occurs in normal tissue in the setting of hypercalcemia.

staphylococcal scalded skin syndrome

occurs in infants and children due to the production of the exotoxin exfoliatin by staphylococcus species. causes widespread epidermal sloughing, especailly with gentle pressure (nikolsky's sign).

DNA replication

occurs in the 5' to 3' direction on both strands. in contrast to the continuous synthesis of the leading strand, lagging strand synthesis occurs discontinuously and is composed of short stretches of RNA primer plus newly synthesized DNA segments (Okazaki framents). as a result, lagging strand synthesis requires the repetitive action of DNA primase and DNA ligase.

menopause

occurs on average at age 51 and is diagnosable retrospectively after 12 months of amenorrhea. an elevated serum FSH level confirms the diagnosis. patient can have hypoestrogenic symptoms: hot flashes and vaginal dryness.

kozak consensus sequence

occurs on eukaryotic mRNA and is defined by; (gcc)gccRccAUGG, in which R is either adenine or guanine. this sequence helps initiate translation at the methionine start codon (AUG)

urinary acid excretion

occurs primarily in the form of NH4+ and titratable acids (H2PO4-). in metabolic acidosis, urinary pH decreases due to increased excretion of free H+, NH4+, and H2PO4-. bicarbonate is completely reabsorbed from the tubular fluid in acidotic states.

mycobacterial antibiotic resistance

occurs when active TB is treated with drug monotherapy. results in rapid, selective gene mutations. isoniazid monotherapy may be used for patients who have a positive PPD and a negative chest x-ray.

superior mesenteric artery syndrome

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

tumor lysis syndrome

occurs when tumors with a high cell turnover are treated with chemotherapy. they lysis of tumor cells causes intracellular ions, potassium and phosphorous, and uric acid to be released into serum. uric acid is soluble at physiologic pH, but it can precipitate in the normally acidic environment of distal tubules and collecting ducts. prevention=urine alkalization with hydration and/or allopurinol.

posttranslational cleavage of protective and signaling sequences within/outside the cell or origin

occurs with proteins that are destined for secretion from the cell. removal of nonfunctional polypeptide sequences once the protein has reached its target site--by specific endoproteases.

significant renal hypoperfusion leads to hyperplasia

of JG cells in afferent arteriole of nephron due to JG increasing renin secretion to combat hypoperfusion

phosphorylation of serine and threonine residues

of insulin receptor and insulin receptor substrate by serine kinase leads to insulin resistance. this type of phosphorylation can be induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon.

moderately elevated alkaline phosphatase

of unclear etiology should be followed up with a gamma-glutamyl transpeptidase. help distinguish is hepatic or bone origin (is elevated then liver).

small PDA

often asymptomatic and found incidentally at left sternal border

biotin acts as a CO2 carrier

on the surface of carboxylase enzymes and is an essential cofactor for numerous reactions, including the conversion of pyruvate to oxaloacetate and fatty acid metabolism. excess ingestion of avidin, found in egg whites, has been associated with biotin deficiency. this condition presents with mental status changes, myalgias, anorexia, macular dermatitis, and lactic acidosis.

acute effects of corticosteroids

on the white blood cell count include an increased neutrophil count and decreased lymphocyte, monocyte, basophil, and eosinophil counts. the increase in the neutrophil count results from 'demargination' of neutrophils previously attached to the vessel wall. can also cause corticosteroid-induced psychosis.

reticulocyte count increases dramatically

once vitamin B12 is administered hemoglobin and erythrocyte count levels rise more gradually and take up to 8 weeks to normalize

permissiveness

one hormone allows another to exert its maximal effect. cortisol exerts this effec on many hormones to help improve the response to a variety of stressors. ----cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.

vascular smooth muscle cells

only cells in within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms and other matrix components. progressive enlargement of the plaque results in remodeling of the extracellular matrix and VSMC death, promoting development of vulnerable plaques with an increased propensity for rupture.

env gene- gp 160

only one that is glycosylated. subsequently cleaved in the golgi apparatur to form the envelope glycoproteins gp120 and gp41. responsible for immune evasion and host cell binding.

phase 2: plateau of AP in cardiomyocytes

open of L-type Ca++ channels close some K+ channels

pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness for 6 or more months

oppositional defiant disorder defies authority figures and refuses to follow rules easily annoyed, angered, resentful, or vindictive blames others for own mistakes deliberately annoys others

fetopathy due to ACE inhibitors

or angiotensin II receptor blockers- angiotensin II is necessary for normal renal development. use of these antihypertensive drugs during pregnancy can result in fetal anuria, oligohydramnios, pulmonary hypoplasia, limb contractures, and calvarium defects.

postoperative hypoparathyroidism treatment

oral calcium and vitamin D

psoas muscle

originates at the anterior surface of the transverse processes and lateral surface of the vertebral bodies at T12-L5. acts primarily to flex the thigh at the hip and lateral rotation and abduction of the thigh. intraabdominal or distal infections can spread to this. abdominal pain, fever, and weight loss.

prevents release of newly formed viral particles

oseltamavir inhibits neuraminidases that usually cleave and release

telangiectasias of skin and mucous membranes: lips, oronasopharynx, respiratory tract, GI tract, urinary tract

osler-weber-rendu syndrome= hereditary hemorrhagic telangiectasia autosomal dominant rupture of telangiectasias: epistaxis GI bleed hematuria

impaired synthesis of type 1 collagen by osteoblasts

osteogenesis imperfecta type 1 collagen: predominant in osteoid

defective synthesis of type 1 collagen by osteoblasts

osteogenesis imperfecta findings: fractures after minimal trauma, blue sclerae, and small, malformed teeth. transmitted by autosomal dominant inheritance.

imaging of bone metastases

osteolytic or osteoblastic bony pain in an older man with osteoblastic lesions on imaging is suspicious for prostate cancer.

low bone mass fragility fractures normal Ca and PTH

osteoporosis

vitamin D deficiency due to poor diet, inadequate sunlight, or GI malabsorption can lead to

ostomalacia decreased mineralization of osteoid

atypical lymphocytes in EBV infection

overserved in peripheral blood smears of patients with EBV represent activated CD8+ cytotoxic T-lymphocytes. these activated T-lymphocytes function ot destroy virally-infected B-lymphocytes.

parent's authority to make medical decisions for their children can be challenged in cases in which

parents a child is at significant risk for harm. physicians are justified in obtaining a court injunction to proceed with life saving medical treatment of the child.

nontypeable strains of H flue

part of normal upper respiratory tract flora cause otitis media, sinusitis, and bronchitis do not form polysaccharide capsule, immunity not conferred by vaccination

aplastic crisis in sickle cell anemia and other chronic hemolytic disorders

parvovirus B19 nonenveloped single stranded DNA virus

inflammation is characterized by

passage of circulating inflammatory leukocytes into the inflamed tissue. the steps involved include margination (increased vascular leakage leading to hemconcentration and decreased wall shear stress--contact of neutrophils with endothelial lining), rolling (roll on endothelium via loose binding of sialyated carbohydrate groups), activation (sample chemokines secreted by inflamed tissue activating integrins by inducing signaling cascade leading to conformational change in integrins necessary for binding), tight adhesion and crawling (tightly attached to endothelium via CD18 beta 2 integrins to ICAM-1), and transmigration (migrate out of vasculature and adhering to PECAM1).

mouse like ordor and cellulitis 24 hours after dog/cat bite

pasteurella multocida

warfarin induced skin necrosis

patients on warfarin develop transient hypercoagulable state due to the short half life of protein C. this is further exaggerated by preexisting protein C deficiency and can result in thrombotic occlusion of the microvasculature with skin necrosis.

nitrate free period

patients taking daily maintenance nitrates need to have a nitrate-free period every day to avoid tolerance to the drug. may be due to decreased vascular sensitivity to nitrates and an increased sensitivity to endogenous vasoconstricting agents.

reactivation of JC virus

patients with advanced AIDS cause progressive leukoencephalopathy confusion, ataxia, and motor deficits. multifocal areas of white matter demyelination with no mass effect or enhancement

antisocial personality disorder

pattern of violating the rights of others, engaging in unlawful behaviors (eg, physical aggression, illegal occupations), and lacking remorse for transgressions. individuals must be 18 or older and have history of conduct disorder prior to age 15.

maternal serum quadruple screen

performed to assess risk of congenital defects in fetuses. accurate dating is important for determining whether levels of alpha-fetoprotein and other analytes are abnormal for gestational age. patients with a history of irregular menses are at risk for inaccurate pregnancy dating.

fatigue, peripheral neuropathy, and atrophic glossitis MH: autoimmune thyroiditis megaloblastic anemia

pernicious anemia due to autoimmune destruction of gastric mucosa leading to atrophic gastritis causing profound hypochlorhydria and compensatory increase in gastrin levels.

tertiary ammonium structure that reverses both central and peripheral system symptoms of anticholinergic toxicity

physostigmine neostigmine, edrophonium, and pyridostigmine have a quaternary ammonium structure that limits central nervous system penetration. ...only reverse peripheral symptoms.

complications of hereditary spherocytosis include

pigmented gallstones and aplastic crises from parvovirus B19 infection abnormalities in spectrin and ankyrin cytoskeleton proteins increased osmotic fragility on acidified glycerol lysis testing confirms diagnosis. hemolytic anemia, jaundice (increase indirect bilirubin), and splenomegaly.

direct muscarinic agonist cause pupillary constriction in the denervated eye

pilocarpine

antibiotic to treat gram negative enteric rods and against bacteroides fragilis

piperacillin-tazobactam

piriformis syndrome

piriformis passes through the greater sciatic foramen and is involved with external hip rotation. muscle injury or hypertrophy can compress the sciatic nerve in the foramen, causing piriformis syndrome.

sever headaches, bitemporal hemanopsia, ophthalmoplegia preexisting pituitary adenoma

pituitary apoplexy emergency! treat: glucocorticoids prevent acute adrenal crisis and circulatory collapse

dysphagia, esophageal web formation, and iron deficiency anemia

plummer vinsion syndrome findings- koilonychia (spoon shaped nails) and a shiny red tongue. treat with iron supplementation for symptom improvement.

throat issues and spoon shaped nails

plummer vinson syndrome also has iron deficiency anemia

CMV

pneumonia and cytoplasmic inclusion bodies histologically points to opportunistic infection with cytomegalovirus, an enveloped virus that contains a double stranded DNA genome.

proteins necessary for lactose metabolism by E. Coli are

polycistronic unique to bacterial mRNA transcription and translation of these bacterial proteins is regulated by a single promoter, operator, and set of regulatory elements

polyenes, azoles, echinocandins, and pyrimidines

polyene antifungals (eg, amphotericin B, nystatin) act by binding ergosterol in the fungal cell membrane.

anencepahly causes

polyhydramnios due to impaired swallowing

glucose to sorbitol to fructose

polyol pathway use: aldose reductase sorbitol dehydrogenase

POMC

polypeptide precursor that goes through enzymatic cleavage and modification to produce: beta endorphins ACTH MSH relationship between stress and opioid response

polymicrobrial infection after C-section fever, lower abdominal pain, and malodorous vaginal discharge

postpartum endometritis urterine infection portal of entry: cervix/vagina

bladder dysfunction in diabetic patient includes elevated

postvoid residual volume inability to sense a full bladder and incomplete emptying. ultrasound and catheterization can confirm inadequate bladder emptying.

pharmocodynamics

potency: dose for 1/2Vmax efficacy: Vmax

microdeletions involving the paternal chromosome 15q11-13 region maternal uniparental disomy

prader-willi syndrome loss of paternal chromosome neonatal hypotonia, extreme hyperphagia and progressive obesity, hypogonadism, and small hands and feet.

behavioral change stages

precontemplation (denial of problem), contemplation (acceptance of problem and thinking about change but done nothing), preparation (planning to make change in near future), action (putting active changes into place), and maintenance (maintaining change over the long term).

most adverse drug reactions are

predictable due to known pharmacologic properties of the drug- gastritis due to NSAID use. unpredictable reactions are less common and are due to genetic differences, immune interactions, or other mechanisms.

cystic medial degeneration

predisposes to the development of aortic dissections and aortic aneurysms. frequently seen in Marfan syndrome.

blastoconida

presence of central vascular catheter and receipt of parenteral nutrition are risk facters for candidemia. displays pseudohyphae with blastoconidia.

mitochondrial myopathy

presence of lactic acidosis and ragged skeletal muscle fibers histologically. variable clinical expressions in affected family can occur due to heteroplasmy, coexistence of distinct versions of mitochondrial genomes in an individual cell.

hemosiderin-laden macrophages

present in pulmonary alveoli indicates chronic elevation of pulmonary capillary hydrostatic pressures, most commonly as a result of left-sided heart failure.

pituitary tumors

present with headaches, hemianopsia, and hypopituitarism; the most common hormonally active (functional) adenomas are prolactin-secreting adenomas (prolactinomas). which can cause galactorrhea and amenorrhea in women. in men, they often present with hypogonadism. prolactin suppresses GnRH.

idiopathic intracranial hypertension

presents in young obese women with daily headache (worse during valsalva), bilaterally symmetric papilledema, and transient visual disturbances. increased intracranial pressure compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema.

HSV2

presents with fever and painful vesicular genital rash. infects sacral dorsal root ganglia and can be recurrent

HSV6 roseola

presents with fever for 3-5 days followed by a truncal rash. it is also the most common cause of febrile seizures.

renal infarction

presents with flank pain, hematuria, elevated lactate deydrogenase, and a wedge-shaped kidney lesion on CT scan. the most common cause of renal infarction is systemic thromboembolism, often due to thrombus formation during atrial fibrillation. the brain and kidneys are more likely than other organs to suffer embolic infarctions because they are perfused at higher rate.

maple syrup urine disease

presents with irritability, dystonia, poor feeding, and a 'maple syrup/burnt sugar' scent to the patient's urine within the first few days of life. dietary restriction of branched-chain amino acids (leucine, isoleucine, valine) is the treatment.

aortic coarctation in child/young adult

presents with lower-extremity claudication (pain and cramping with exercise), blood pressure discrepancy between the upper and lower extremities, and delayed or diminished femoral pulses. turner syndrome (45,XO) is associated with coarctation of aorta in up to 10% of cases.

acute promyelocytic leukemia

presents with persistent infection and coagulopathy causing hemorrhagic signs and symptoms. bone marrow biopsy classically reveals promyelocytes with intracytoplasmic Auer rods. APL is associated with a t(15;17) chromosomal translocation that causes fusion of the retinoic acid receptor alpha gene and promyelocyte leukemia gene.

nutcracker effect

pressure in the left renal vein may become elevated due to compression where the vein crosses the aorta beneath the SMA. causes hematuria and flank pain. pressure can also be elevated int he left gonadal vein, leading to formation of a varicocele.

class 4 antiarrhythmics (verapamil, diltiazem)

prevent recurrent nodal arrhythmias (PSVT). work by blocking calcium channels in slow-response cardiac tissues, slowing phase 4 (spontaneous depolarization) and phase 0 (upstroke). reduce impulse conduction velocity in the SA and AV nodes.

allopurinol and rasburicase

prevent tumor lysis syndrome and gout

posterior cruciate ligament

prevents posterior displacement of the tibia relative to the femur when the knee is flexed. it attaches to the posterior part of the intercondylar area of the tibia and the anterior part of the lateral surface of the medial epicondyle of the femur. vs. ACL which attaches to the later femoral condyl.

nitrates

primarily venodilators and increase peripheral venous capacitance, thereby reducing cardiac preload and left ventricular en-diastolic volume and pressure. nitrates also have a modest effect on arteriolar dilation and cause a decrease in systemic vascular resistance and cardiac afterload.

popliteal artery

primary concern for both anterior and posterior dislocations of the knee joint rigidly fixed proximal and distal to knee joint by adductor magnus and soleus muscles

HFE protein mutations leading to decreased hepcidin and DMT1 expression by enterocytes leading to iron overload

primary hemochromatosis increased risk for liver cirrhosis and hepatocelllular carcinoma

klinefelter syndrom (47,XXY)

primary hypogonadism characterized by low testosterone and elevated gonadotropin (FSH,LD) levels. elevated estradiol results in gynecomastia.

isotype switching

primary immune response to a new antigen initially results in plasma cells that only produce IgM. isotype switching later occurs in the germinal centers of lymph nodes and requires interaction of the CD40 receptor on B-cells with the CD40 ligand expressed by activated T-cells. IgG is the main serum immunoglobulin of the secondary response.

Ghon complex of TB

primary infection: lower lobe of lung secondary: apical lobe

osteoporosis

primary- not caused by a medical disorder but by caucasian ethnicity, female sex, advanced age, positive smoking history, prior glucocorticoid use normal calcium, phosphorus, and parathyroid hormone levels

gluconeogenesis

principal source of blood glucose after 12-18 hours of fasting. gluconeogenesis uses many glycolytic enzymes, but hexokinase, PFK, and pyruvate kinase need to be bypassed as they are unidirectional. the initial steps of gluconeogenesis involve the conversion of pyruvate to oxaloacetate and oxaloacetate to phosphoenolpyruvate by pyruvate carboxylase and phosphoenolpyruvate carboxykinase, respectively.

locus ceruleus= paired brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle

principle site for norepinephrine synthesis in the brain controls: mood, arousal, sleep wake, cognition, autonomic function

1-beta

probability of rejecting a null hypothesis when it is truly false. it is typically set at 80% and depends on sample size and difference between outcomes.

dystrophic intramural deposition of calcium salts in the setting of chronic inflammation

procelain gallbladder increased rise adenocarcinoma of the gallbladder manifestation of chronic cholecystitis and often found in association with multiple gallstones.

alternative splicing

process by which a single gene can code for various unique proteins by selectively including or excluding different DNA coding regions (exons) into mature mRNA.

Ehlers-Danlos syndrome

procollagen peptidase deficiency impaired cleavage of terminal propeptides in the extracellular space. joint laxity, hyperextensible skin, and tissue fragility due to formation of soluble collagen that does not properly crosslink.

toxigenic strains of corynebacterium diptheriae

produce diphtheria toxin, which irreversibly inhibits host protein synthesis due to ADP-ribosylation of elongation factor-2. local effects include pseudomembranous pharyngitis; systemic effects include potentially life-threatening myocarditis and neuritis. immunization with diphtheria toxoid generates protective circulating IgG against the exotoxin B subunit.

infarcts involving anterior portion of medial pons

produce dysarthria and contralateral hemiparesis/lower faial palsy due to disruption of the ipsilateral corticospinal and corticobulbar tracts. the trigeminal nerve arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid pons.

IgAprotease

produced by N. meningitiditis, N gonorrheoease, strep pneumoniae, and H. influenza. this enzymes cleaves secretory IgA at its hinge region, rendering it ineffective. secretory IgA exists on mucosal surfaces and in secretions and acts to bind and inhibit the action of pili as well as other cell surface antigens that normally mediate mucosal adherence and subsequent penetration.

IL-4

produced by TH2 T-helper cells stimulates antibody isotype switching, particularly to IgE

gycerol

produced by degradation of triglycerides in adipose tissue can be used by glycerol kinase in the liver and kidney to synthesize glucose during gluconeogenesis.

interferons alpha and beta

produced by human cells in response to viral infections. halts viral protein synthesis and promotes apoptosis of infected cells. limits the spread of the virus through the tissues.

beta hCG

produced by the syncytiotrophoblast after implantaiton, whcih generally occurs 6-7 days after fertilization at the earliest. beta HCG is typically detectable in the serum 8 days after fertilizaiton and 14 days in the urine.

DMD

progressive proximal muscle weakness in young boys due to increased muscle fiber degeneration. it is caused by frameshift mutations or nonsense mutations in the dystrophin gene that leads to the formation of a truncated, defective protein. nonsense mutations introduce premature stop codons--UAA, UAG, UGA

exudative phase>leakage of protein-rich fluid into alveolar space>proliferative phase>fibrotic phase

proliferative phase=1-2weeks later ARDS

qualitative platelet disorder

prolonged bleeding time due to uremic toxins impairing platelet aggregation and adhesion. normal PT and aPTT usually in renal dysfunction leading to uremia. dialysis removes the toxins and partially reverses the abnormality.

toxic shock syndrome

prolonged use of tampons or wound packing- allow staph A to replicate locally and release pyrogenic toxic superantigens into the blood. superantigens bind to MHC II complex of antigen presenting cells without processing and nonspecifically activate T cells. leads to release of cytokines-IL1,2 and TNF alpha and beta, interferon gamma causes hypotension, high fever, organ failure, diffuse, erythematous rash.

anterolateral left ventricle infarction

prolonged, burning substernal pain and ST segment elevation in leads I and V3-V6. common consequences-left ventricular failure, cardiogenic acute pulmonary edema, pulmonary venous hypertension (congestion), and transudate of plasma into the lung interstitium and alveoli.

dystonia

prolonged, repetitive muscle contractions due to basal ganglia cervical (torticollis), blepharospasm, writer's cramp vs. myoclonus: sudden, brief, sometimes sever (shock like) muscle contraction

frontotemporal dementia

pronounced atrophy of prefrontal cortex with later degeneration of anterior temporal cortex. it manifests initially with changes in personality, social behavior, and language that progress over time to a more global dementia with obvious neurocognitive deficits.

3' to 5' exonuclease activity

proofreading all 3 prokaryotic DNA polymerases can do only DNA I have 5' to 3' exonuclease activity- used to remove RNA primer synthesized by RNA primase

steps for central venous catheter infections prevention

proper hand hygiene, full barrier precautions during insertion, chlorhexidine skin disinfection, avoidance of femoral insertion site, removal of the catheter when it is no longer needed.

MAC infections are common in AIDS patients: fever fatigue weight loss diarrhea lymphadenopathy

prophylaxis= azithromycin

CFTR

protein is a transmembrane ATP-gated chloride channel. defects in CFTR result in thick, plugging mucous and elevated sodium and chloride levels in sweat.

insulin>> tyrosine kinase/phosphatidylinositol-3-kinase stimulation promotes glycogen synthesis by activating

protein phosphatase dephosphorylates (activates) glycogen synthase

ubiquitin

protein that undergoes ATP dependent attachment to other proteins, labeling them for degradation. these modified proteins enter the proteasome and are degraded into small peptides. impairment of the ubiquitin-proteasome system can contribute to development of neurodegenerative disorders, like parkinson's and alzheimers

conjugate vaccines

provide higher, longer lasting antibody titers relative to pneumo polysaccharide vaccines. stronly immunogenic in infancy due to both B and T cell recruitment. the pneumo polysac. vaccine is poorly immunogenic in infants due to relatively immature humoral antibody response.

iliohypogastric nerve

provides sensation to the suprapubic and gluteal regions and motor function to the anterolateral abdominal wall muscles. abdominal surgery (eg, appendectomy) can damage the nerve and cause decreased sensation and/or burning pain at the suprapubic region.

lymphatic drainage of the rectum

proximal to the anal dentate line occurs via the inferior mesenteric and internal iliac lymph nodes. areas distal to the dentate line drain primarily into the inguinal nodes.

dermatitis herpetiformis

pruritic papules, vesicles, and bullae that appear bilaterally and symmetrically on the extensor surfaces. associated with celiac disease- intraepithelial intestinal lymphocytic infiltrate

hypocalcemia and hyperphosphatemia despite elevated PTH levels

pseudohypoparathyroidism end-organ resistance to parathyroid hormone .....defect in downstream signaling. albright hereditary osteodystrophy: ....pseudohypoparathyroidism, short stature, short metacarpal/metatarsal bones

common cause of urinary tract infections in patients with indwelling bladder catheters

pseudomonas aeruginosa--oxidase positive, non lactose fermenting organism.

common complications of psoriasis

psoriatic arthritis, nail pitting, and uveitis

schizoaffective disorder

psychosis must occur in the absence of major mood episodes but mood episodes must be present for a majority of lifelong illness. vs. bipolar and major depression with psychotic features, psychotic symptoms occur exclusively during mood episodes.

pO2 in the left atrium and ventricle is lower than that in the

pulmonary capillaries due to mixing of oxygenated blood from the pulmonary veins with deoxygenated blood from the bronchial circulation and the thebesian veins. only some of the bronchial veins return to right heart most of it goes to left heart through pulmonary veins.

elevated left-sided diastolic filling pressures transmitting backward to the

pulmonary veins secondary pulmonary hypertension

vibrio cholerae and entertoxigenic E coli cause a

purely toxin mediated watery diarrhea. toxins modify electrolyte handling but don't cause cell death; therefore, no erythrocytes or leukocytes are typically noted on stool microscopy.

class IA antiarrhythics

quinidine, procainamide, and disopyramide are sodium channel blocking agents that depress phase 0 depolarization. they also prolong repolarization due to moderate potassium channel, blocking activity, increasing action potential duration in cardiac myocytes.

annular ligament impingement

radial head subluxation (nursemaid's elbow) results from sudden traction on the outstretched and pronated arm of a child. affected children are usually in little distress unless attempts are made to move the elbow. the annular ligament is torn and displaced in this injury.

disrupt double stranded HIV DNA to integrate into the host cell's chromosomes

raltegravir integrase inhibitor if can't integrate then can't transcribe viral genome by host cellular machinery and is eventually degraded by nucleases

exogenous T3 supplementation

rapidly suppresses TSH levels by increasing negative feedback, which in turn decreases T4 secretion from the thyroid gland. rT3 also decreases because less T4 is available for conversion (T3 cannot be converted into rT3)

reid index

ratio of the thickness of submucosal bronchial glands to the thickness of the bronchial wall between the epithelial basement membrane and the bronchial cartilage. higher values correlate with increased duration and severity of chronic bronchitis.

jarisch-herxheimer

reaction is an acute inflammatory reaction that occurs within hours of treatment for spirochetal (eg, syphilis) infections. the rapid lysis of spirochetes releases inflammatory bacterial lipoproteins into the circulation and causes acute fevers, rigors, and myalgias.

sacroiliitis associated with

reactive arthritis HLA-B27 genitourinary or enteric infection

recall bias vs. detection bias

recall is due to inaccurate recall of past exposure and occurs with retrospective studies such as case control studies. those with adverse effects are more likely to recall risk factors than those who have not experienced an adverse event. detection bias refers to the risk factor itself leading to extensive diagnostic investigation and increase probability that a disease is identified.

natural killer cells

recognize and kill cells with decreased MHC class I antigen cell surface expression, such as virus-infected cells and tumor cells. they are large lymphocytes that contain perforins and granzymes in cytoplasmic granules. NK cells kill target cells by inducing apoptosis.

strep penumo vaccine

recommended for young patients and the elderly polysac. vaccine is unconjugated vaccine that induce T cell independent humoral immune response.

familial chylomicronemia syndrome

recurrent episodes of acute pancreatitis. eruptive skin xanthomas--hypertriglyceridemia. tendon xanthoma and xanthelasmas--hypercholesterolemia.

innervate all intrinsic muscles of the larynx except: cricothyroid

recurrent laryngeal

panic disorder

recurrent, unexpected panic attacks and should be considered in young, healthy adults who come to the ED with unexplained chest pain. benzodiazepines can provide rapid relief.

kehr sign

referred pain to the C3-C5 shoulder region due to phrenic nerve sensory fibers around the diaphragm becoming irritated. due to ruptured spleen, peritonitis, hemoperitoneum

wallerian degeneration

refers to the process of axonal degeneration and breakdown of myelin sheath that occurs distal to a site of injury. axonal degeneration does not occur in the central nervous system due to the persistence of myelin debris, secretion of neuronal inhibitory factors, and development of dense glial scarring.

elevated systemic blood pressure causes

reflexive increase in vagal tone, result in decreased heart rate and slowed atrioventricular node conduction

site of water reabsorption in kidney

regardless of the patient's hydration status, the majority of water reabsorption in the nephron occurs in PCT passively with reabsorption of solutes.

RNA splicing creates loops of unbound DNA

regions of the gene that code for introns remove them via splicing to form mature mRNA

suprachiasmatic nucleus

regulates cicadian rythm. processes light information received from the retina and relays it to other hypothalamic nuclei and the pineal gland to modulate body temperature and the production of hormones such as cortisol and melatonin. melatonin supplementation is recommended for the treatment of insomnia associated with jet lag.

mitral regurge vs. stenosis

regurge: holosystolic murmur best over the cardiac apex with radiation to the axilla. stenosis: holosystolic murmur has opening snap at beginning of diastole with a low pitched, mid-diastolic rumbling murmur at the cardiac apex.

primaquine added to chloroquine to eradicate intrahepatic stages of malaria and prevent

relapses

neurocysticercosis

relatively common cause of seizures in patients from central and south america. imaging- cystic brain lesion

ATP binding to myosin causes

release of the myosin head from its binding site on the actin filament

during antigen processing in macrophages, invariant chain is

removed from MHC-invariant complex and replaced by external protein. MHC-peptide (alpha chain, beta chain, and external protein) is expressed at the cell surface.

sporadic and hereditary

renal cell carcinomas are asso. with VHL mutations on chromosome 3p.

hypoxia of which organ stimulates hematocrit

renal cortical cells sense hypoxia and respond by synthesizing and releasing erythropoietin. erythropoietin stimulates the production of erythrocytes in the bone marrow.

renal ammoniagenesis

renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in the urine and bicarbonate that is absorbed into the blood. this is responsible for the vast majority of renal acid excretion in chronic acidotic states.

beta blockers inhibit

renin from justaglomerular cells through antagonism of beta-1 receptors on these cells. inhibition of renin release prevvents activation of renin-angiotensin aldosterone pathway which results in decreased vasoconstriction and decreased renal sodium.

meglitinides

repaglinide nateglinide can reduce postprandial glucose excursions.

sickle cells disease and spleen

repeated splenic infarctions ultimately result in splenic atrophy and fibrosis--typically complete by childhood/adolescence. after autosplenectomy, predisposed to infections with encapsulated bacterial organisms. develop megaloblastic anemia due to increased folic acid requirements-due to increased RBC turnover.

atheroclerosis initiated by

repetitive endothelial cell injury leads to chronic inflammatory state in the underlying intima of large elastic arteries as well as in large and medium sized muscular arteries.

chronically elevated FFA levels contribute to insulin

resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis DM type 2 and acanthosis nigracans

inhibit DNA-dependent RNA polymerase, thereby preventing transcription and leading to deficiency of proteins necessary for mycobacterial survival.

resistance to: rifampin rifabutin

KRAS activating gene mutations

resistant to treatment with anti-EGFR drugs cetuximab panitumumab

superimposed respiratory acidosis

respiratory failure if PaCO2=[1.5*HCO3]+8+_2

HIV pol gene mutation

responsible for acquired reisitance to reverse transcriptase inhibitors, protease inhibitors, and integrase strand transfer inhibitors. --usually due to inconsistent use of meds. mutations of the env gene enable escape from host-neutralizing antibodies.

lysogenic bacteriophages

responsible for converting nonpathogenic Corynebacterium into toxigenic Corynebacterium. Toxigenic strains elaborate the diphtheria exotoxin, which causes pseudomembranous pharyngitis and potentially life-threatening systemic effects (eg, myocarditis, neuritis).

niacin (B3) deficiency

result in pellagra: dermatitis diarrhea dementia niacin can be synthesized from tryptophan

occlusion of the right coronary artery

result in transmural ischemia of the inferior wall of the left ventricle, producing ST elevation in leads II,III, and aVF as well as sinus node dysfunction.

hirschsprung disease

result of migration of neural crest cells, which are precursors of ganglion cells of intestinal wall plexi. since neural crest cells migrate caudally, the rectum is always affected in hirschsprung disease.

hereditary spherocytosis

results from red cell cytoskeleton abnormalities, most commonly spectrin and ankyrin. hemolytic anemia, jaundice, and splenomegaly are classic manifestations. spherocytes are seen on peripheral blood smear.

increased bone marrow erythropoiesis

results in an accelerated release of immature red blood cells (reticulocytes) into the bloodstream. reticulocytes contain bluish cytoplasm and reticular precipitates of residual ribosomal RNA.

deficiency of galactose-1 phosphate uridyl transferase

results in classic galactosemia. vomiting, lethargy, jaundice, and E. Coli sepsis. cessation of breastfeeding and switching to soy-milk-based formula is recommended.

X-inactivation (lyonization)

results in conversion of inactivated X chromosome into compact heterochromatin (barr body). heterochromotin is condensed chromatin composed of heavily methylated DNA in tight association with deacetylated histones. it has a low level of transcriptional activity. vs. euchromatin, which is loosely arranged and exhibits a high level of transcriptional activity.

high altitude

results in hypoxemia with respiratory alkalosis. over a course of a few days, chronic respiratory alkalosis sets in, with a corresponding decrease in the serum bicarbonate level reflecting renal compensation.

vitamin K deficiency

results in impaired clotting factor carboxylation. newborsn are at risk for vitamin K deficiency due to poor transplacental transfer of vitamin K and low content in breast milk. all newborns should receive vitamin K prophylaxis to prevent bleeding complications.

HF

results in stimulation of sympathetic nervous system and the RAAS systems to maintain effective intravascular volume. inactive angiotensin I is converted to active angiotensin II by endothelial-bound angiotensin-converting enzyme in the small vessels of the lungs.

communicating hydrocele

results when serous fluid accumulates within the tunica vaginalis in the setting of a patent processus vaginalis. presents as a painless swelling that transilluminates on examination.

cannulation above the inguinal ligament for cardiac cath, increase the risk of

retroperitoneal hemorrahge. injury to the femoral artery is less likely to cause intraperitoneal bleeding due to the external iliac artery coursing underneath the peritoneum. pelvic trauma with fracture or Gyn procedure will have intraperitoneal bleeding.

inactive form of thyroid hormone that is generated almost entirely from the peripheral conversion of T4

reverse T3

cor pulmonale

right ventricle hypertrophy suspect in young patient with: fatigue, progressive dyspnea, atypical chest pain, or unexplained syncope.

pressures in heart

right-sided pressures in the heart are lower than left sided pressures due to lower resistance in the pulmonary vasculature. right--1-6mm Hg pulmonary artery--6-12 mmHg due to high resistance to flow in the pulmonary circulation.

hypercalcicuria

risk factor for calcium kidney stones in adults increased GI absorption, increased bone resorption, or decreased renal tubular calcium reabsorption. most people remain normcalcemic due to regualtion of plasma calcium levels by vitamin D and PTH.

ligament that projects from uterus through inguinal canal into the labia majora

round ligament of the uterus

postauricular and occipital lymphadenopathy

rubella caused by togavirus rash begin on face and spread to trunk

infraorbital nerve

run along orbital floor in groove in maxilla before exiting the skull just inferior to the orbit damage: paresthesia of upper cheek, upper lip, and upper gingiva

infraorbital nerve

runs along the orbital floor in a groove in the maxilla before exiting the skull just inferior to the orbit. damage can result in paresthesia of the upper cheek, upper lip, and upper gingiva. in addition, the inferior rectus muscle can also become entrapped, limiting vertical gaze.

subarachnoid hemorrhage

rupture of saccular (berry) aneurysm or AVM. severe vasospasm 4-12 days after the initial insult is the major cause of morbidity and mortality in patients recovering from SAH. Nimodipine, a selective calcium channel blocker, is often prescribed to prevent this vasospasm.

decrease standard error by increasing

sample size proper technique= lowers selection bias

highly contagious disease that presents with an intensely pruritic rash (worse at night)

scabies in flexor surfaces of wrist, lateral surfaces of the fingers, and the finger webs. excoriations with small, crusted, red papules scattered around the affected areas. diagnosis is confirmed by skin scrapings from excoriated lesions that show mites, oval, and feces under light microscopy.

PID leads to:

scarring of the fallopian tubes, leading to ectopic pregnancy and infertility

DIC on peripheral smear shows

schistocytes

thromboangiitis obliterans (buerger disease)

segmental, inflammatory vasculitis that affects the small and medium sized arteries and veins of the distal extremities with inflammatory, intraluminal thrombi and sparing of the vessel wall. it is usually seen in young, heavy smokers, and can present with digital ischemia and ulceration, extremity claudication, Raynaud phenonmenon, and superficial thrombophlebitis.

PAN

segmental, tranmural, necrotizing inflammation of medium- to small-sized arteries. renal artery often prominent. kidneys, heart, liver, and GI tract are most commonly effected--leading to ischemia, infarction, or hemorrhage. cutaneous- palpable purpura. lungs are rarely involved.

fenoldopam

selective peripherl dopamine 1 agonist given IV for hypertensive crisis. lowers blood pressure in patients with renal insufficiency. causes arteriolar dilation, increases renal perfusion, and promotes diuresis and natriuresis.

undescended testes

seminiferous tubules atrophy if uncorrected due to higher body temperatures, resulting in decreased fertility and increased risk for malignancy. Orchiopexy (surgical placement of the testes in the scrotal sac) can minimize damage and decrease risk for testicular cancer.

heterophile antibody test (monospot test)

sensitive and highly specific for EBV infection. EBV commonly infects B cells, stimulating them to proliferate continuously. it is an oncogenic virus that promotes polyclonal B cell proliferation and heterophile antibody production.

children experience physical symptoms and nightmares when separated from attachment figures

separation anxiety disorder

fever, abdominal pain, uterine tenderness, and/or foul smelling discharge after pregnancy termination

septic abortion seeding of the uterine cavity during instrumentation: staphylococcus aureus and E. coli

joint pain leukocyte count >100,000/mm3

septic arthritis Rx= antibiotics

proinflammatory cytokines induce insulin resistance through activation of

serine kinases> serine phosphorylation on beta subunits of IR and IRS-1> inhibits tyrosine phosphorylation of IRS-1 by IR>>hinder down stream actions of insulin catecholamines, glucocorticoids, and glucagon=same effect with: phosphorylation of threonine

alpha-1 antitrypsin (AAT)

serum protein that, through the inhibition of neutrophil elastase, reduces tissue damage caused by inflammation. histologically: AAT deficiency can demonstrate reddish-pink globules on periodic acid-schiff stain; these globules represent unsecreted, polymerized AAT in the periportal hepatocytes.

fever, pruritic skin rash, and arthralgias 7-14 days after exposure to an antigen

serum sickness type III hypersensitivity vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration usually due to: chimeric monoclonal antibodies, nonhuman immunoglobulins

earliest beta-hCG can be detected in serum and urine

serum: 8 days urine: 14 days

Thiamine (vitamin B1)

serves as a coenzyme for a number of important dehydrogenase enzymes, including transketolase, alpha ketoglutarate dehydrogenase, and pyruvate dehydrogenase.

ablation of thoracic sympathetic trunk can be used to treat

severe axillary hyperhidrosis sweating mediated by cholinergic postganglionic fibers of the sympathetic nervous system.

necrotizing fasciitis

severe infection of subcutaneous tissue and deep fascia==surgical EM! infection polymicrobial or Strep pyogenes--PYR positive, beta hemolytic, gram positive cocci that grows in chains.

increase in effective stroke volume/EF on pressure volume loop

shift in isovolumic relaxation line to the left- indicating less residual blood volume in the ventricle at the end of systole.

invades GI mucosa by gaining access to microfold cells in ileal peyer patches through endocytosis

shigella

splenic infarctions result in splenic atrophy and fibrosis

sickle cell disease autosplenectomy infection with encapsulated bugs increased RBC turnover leads to increase need for folic acid: prone to folic acid deficiency and megaloblastic anemia.

high baseline plasma insulin level in setting of normoglycemia

sign of insulin resistance in peripheral tissues

west nile virus

single strand flavivirus transmitted by mosquitos, most commonly in the summer. most infections are asymptomatic or may present with a flu like illness, often with a maculopapular or morbilliform rash. neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; patients may have parkinsonian features.

zika virus

single stranded RNA virus infects fetal neural progenitor cells, causing severe congenital malformations (eg, microcephaly, arthrogryposis), cerebral cortical thinning, and possible fetal demise.

unmyelinated nerve fibers

slower conduction primary sensory/afferent: slow pain heat sensation olfaction efferent: postganglionic autonomic neurons

cardiac action potential conduction speed

slowest in the atrioventricular node and fastest in the Purkinje system. conduction speed of the atrial muscle is faster than that of the ventricular muscle. (park at venture avenue)

tumors stain for neuroendocrine markers: neural cell adhesion molecules (NCAM)=CD56 enolase chromogranin synaptophysin

small cell carcinomas

eosinophilic granulomatosis with polyangiitis (churg-strauss)

small to medium vessel vasculitis characterized by late-onset asthma, rhinosinusitis, and eosinophilia. mononeuritis multiplex due to involvement of the epineural vessels of peripheral nerves is common.

cherry hemangiomas

small, red, cutaneous papules common in aging adults. they do NOT regress spontaneously (vs. superficial hemangiomas that appear in first weeks of life and then regress) and they typically increase in number with age. light microscopy of these lesions shows proliferation of capillaries and post capillary venules in the papillary dermis.

emphysema

smoking or alpha 1 antitrypsin deficiency decreased forced expiratory volume in 1 second/forced vital capacity ratio, increased total lung capacity, and decreased diffusing capacity--due to destruction of alveoli and adjoining capillary beds.

esophageal squamous cell carcinoma risk factors include

smoking, excessive alcohol consumption, and intake of foods containing N-nitroso compounds. characterized by: polyhedral/ovoid epithelial cells with eosinophilic cytoplasm, keratin nests within or between cells.

important component of the spliceosome removes introns from pre-mRNA

snRNPs

serves as a sulfur donor to promote hepatic rhodanese-mediated conversion of cyanide to thiocyanate, which is excreted in the urine

sodium thiosulfate treatment of cyanide toxicity also with: hydroxycobalamin sodium nitrite

esophageal squamous cell carcinoma

solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders. areas of keratinization and the presence of intercellular bridges are characteristic. typically present with progressive solid and eventually liquid dysphagia and weight loss.

atypical pneumonia

sore throat persistent cough CXR= patchy infiltrate usually due to mycoplasma or chlamydia no cell wall treatment with bacterial protein synthesis inhibitor: macrolide or tetracycline

detect DNA-binding proteins such as transcription factors, nucleases, and histones

southwestern blot vs. northern: RNA southern: DNA western: protein

niemann-pick disease

sphingomyelinase deficiency causes accumulation of the lipid sphingomyelin. clinical features include hepatospenomagaly, neurologic regression, and a cherry-red macular spot in infancy.

cerebellar ataxia

spinocerebellar tract degeneration and loss of position/vibration sensation, hyphoscoliosis, and hypertrophic cardiomyopathy. friedreich ataxia

colonic watershed areas

splenic flexure and rectosigmoid junction lie between regions of perfusion of major arteries. susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency.

normal commensal GI organism unless there is a break in mucosa>>invasion and subsequent hematogenous dissemination to healthy muscle tissue, resulting in

spontaneous gas gangrene other risk factors: IBD immunosuppression

clostridium speticum

spore forming, exotoxin-producing, gram-positive organism that is the most common cause of spontaneous gas gangrene (eg, rapid-onset pain, hemorrhagic bullae, tissue crepitus). underlying colonic malignancy is the greatest risk factor for infection. part of normal GI tract--breakdowns in the gastrointestinal mucosa can lead to invasion.

actinic keratoses increase risk for

squamous cell carcinoma

Turner syndrome

streak ovaries, amenorrhea, and infertility are implications. patients usually have short stature, webbed neck, shield chest, and low posterior hairline. bicuspid aortic valve is the most common cardiac comorbidity.

stress incontinence and kegl exercises

stress urinary incontinence is defined as involuntary urine loss with increased intraabdominal pressure. pelvic floor strengthening targets the levator ani to improve support around the urethra and bladder.

incontinence

stress- leakage with cough, lift, sneeze--decreased urethral sphincter tone, urethral hypermobility urge-sudden, overwhelming urge to urinate--detrusor hyperactivity overflow-incomplete emptying and persistent involuntary dribbling--impaired detrusor contractility bladder outlet obstruction

crohns disease complications:

strictures due to muscularis mucosae hypertrophy leading to obstruction of bowel. fistulas abscesses can have skip lesions from mouth to anus.

small cell carcinoma

strongly associated with smoking and is usually centrally located. arises from primitive cells of the basal layer of the bronchial epithelium. immunohistochemical stains positive for neuroendocrine markers: neuron specific enolase, chromogranin, synaptophysin. light microscopy: round or oval cells with scant cytoplasm and large hyperchromatic nuclei.

autoimmune paraneoplastic syndrome affecting cerebellar purkinje fibers leading to degeneration

subacute cerebellar degneration due to: small cell lung Cx breast, ovarian, uterine Cx

myelopathy associated with B12 deficiency

subacute combined degeneration degeneration of dorsal columns and corticospinal tracts. loss of: position, vibration, sensation, ataxia, and spastic paresis

thoracentesis should be above the 8th rib in the midclavicular line, 10th rib along the midaxillary line, and 12th rib along the posterior scapular or paravertebral line to avoid risk to

subcostal neurovascular bundle (run along rim of ribs) damage to abdominal structures is possible

channel unacceptible thoughts or impulses into socially acceptable behavior

sublimation vs. reaction formation: unacceptable feelings are transformed into their opposites (towards that same object)

hirschsprung disease

submucosal (Meissner) and myenteric (auerbach) autonomic plexi are absent in the affected segment of the bowel. the submucosa of the narrowed areas is the most superficial layer where the absence of ganglion cells can be seen. barium enema shows narrowing in the rectosigmoid area. proximal to the obstruction, the bowel is dilated and filled with feces.

nephrotic syndrome is a hypercoagulable state

sudden-onset abdominal or flank pain, hematuria, and left-sided varicoceles suggest renal vein thrombosis, a well-known complication of nephrotic syndrome. loss of anticoagulant factors, especially antithrombin III, is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome.

rash begins at face and spreads to trunk and extremities

suggestive of rubeola and rubella. the additional finding of postauricular lymphadenopathy indicates that rubella is the most likely etiology.

studies have linked increased activity of COX2 to some forms of colon adenoarcinoma

suggests: aspirin use decreases adenomatous polyp formation

clavulanic acid

sulbactam and tazobactam are beta lactamase inhibitors. concurrent administration of calvulanate with amoxicillin expands amoxicillin's spectrum of activity to include strains of beta-lactamase synthesizing bacteria that are resistant to amoxicillin alone.

catalyzes conversion of 7-dehydrocholesterol to cholecalciferol (vitamin D3) in the skin

sunlight

lower extremity lymph drainage

superficial lymphatic system divided into medial and lateral tracks. medial track-runs up to superficial inguinal lymph nodes, bypassing the popliteal nodes.--lesions on medial foot cause inginal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas.

pityriasis versicolor (tinea versicolor)

superficial skin infection caused by Malassezia species. causes erythematous, hyper/hypo pigmented macules and patches. Malassezia forms spores and hyphae, producing the 'spagehetti and meatballs' appearance on KOH prep light microscopy.

great saphenous vein

superficial vein of the leg that originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up to the medial aspect of the leg and thigh. it drains into the femoral vein within the region of the femoral triangle, a few centimeters inferolateral to the pubic tubercle--good place to get graft.

superficial and deep inguinal rings are physiologic openings in the

superficial: external abdominal oblique aponeurosis deep: transversalis fascia orchiopexy: go through superficial

collateral flow to areas supplied by inferior mesenteric artery

superior mesenteric artery. these arteries have a pair of anastomoses: marginal artery of drummond, which is the principle anastomosis, and the inconsistently present arc of riolan

posteromedial papillary msucle

supplied by posterior descending artery vs. anteromedial papillary muscle supplied by LAD

omeprazole and other proton pump inhibitors

suppress the activity of the gastric parietal cell H/K ATPase leading to an increase in the pH of the gastric lumen.

hyperprolactinemia

suppresses secretion of GnRH, which leads to reduced estrogen in women. low estrogen levels are a risk factor for accelerated bone loss.

craniopharyngiomas

supracellar tumors found in children and composed of calcified cysts containing cholesterol crystals. they arise from remnanats of Rathke's pouch, an embryonic precursor of the anterior pituitary.

SADPUCKER

suprarenal glands Aorta and IVC duodenum pancreas ureters & bladder colon kidneys esophagus rectum

rotator cuff muscles

supraspinatus- abduction infraspinaturs-external rotation teres minor-adduction and external rotation subscapularis-adduction and internal rotation

CD14

surface marker of the monocyte-macrophage cell lineage. the caseating granulomas of TB almost always contain large epitheloid macrophages with pale pink granular cytoplasm and surface CD14 at the periphery.

portal triad (pringle maneuver)

surgical technique used to distinguish the source of RUQ bleeding if hepatic bleeding persists after occlusion of the portal triad, the IVC or hepatic veins are likely to be injured.

multiple myeloma patients synthesize large amounts of monoclonal immunoglobulins or immunoglobulin fragments that are

susceptivle to proteasome inhibition due to large amount of proteins that they manufacture. results in accumulation of toxic intracellular and proapoptotic proteins increases cellular apoptosis.

multiple myeloma

suspected in elderly patients with any combination of hypercalcemia, normocytic anemia, bone pain, elevated gamma gap, or renal failure. renal failure is commonly caused by light chain cast nephropathy; large, waxy, eosinophilic casts composed of Bence Jones proteins are seen in the tubular lumen.

vertebral osteomyelitis

suspected with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially S. Aureus). it should also be suspected if there are new neurologic findings and fever with or without back pain. MRI of the spine is preferred for diagnosis.

contains the ovarian artery, vein, lymphatics, and nerves

suspensory ligament of the ovary ligate to prevent surgery

fatigue weakness headache irritability glossal pain dry mouth atrophy of tongue papillae alopecia pagophagia

symptoms of iron deficiency anemia

pseudogout

synovial fluid analysis showing rhomboid-shaped calcium pyrophosphate crystals. crystals are positively birefringent under polarized light. knee joint is involved in >50% of cases.

sarcoidosis

systemic inflammatory disorder characterized by noncaseating granulomas in a variety of tissues. most patients develop liver involvement, which typically manifests as asymptomatic hepatomegaly with mild liver function test abnormalities. liver biopsy frequently demonstrates scattered noncaseating granulomas. also have erythema nodosum and arthralgias.

statistical comparisons

t-test: means of 2 groups analysis of variance: means of 2 or more chi square: compare 2 categorical variables (vs. quantitative)

on jugular venous pressure tracings,

the first peak is the a wave which is generated by atrial contraction. this is absent in patients with atrial fibrillation.

at high altitude

the low partial pressure of inspired oxygen leads to hypoxemia with consequent hyperventilation and respiratory alkalosis. the hypoxemia and alkalemia can cause symptoms of altitude of sickness (egg, headache, fatigue, lightheadedness). the kidneys respond by creating a compensatory metabolic acidosis and by increasing erythropoietin secretion.

all hormone-containing contraceptives prevent pregnancy through the actions for progestins.

the main mechanism of contraceptive with systemically active progestins (eg, combined hormonal oral contraceptives) is inhibiting ovulation by decreasing FSH and LH synthesis in the anterior pituitary, by suppressing GnRH--inhibiting ovulation.

clear cell carcinoma

the most common subtype of renal cell carcinoma and is composed of large, rounded, or polygonal cells with clear cytoplasm. These tumors are often detected incidentally at an advanced stage; the lung is the most common site for metastasis, followed by osteolytic bone and liver.

several months to years after ischemic brain infarction

the necrotic area appears as a cystic cavity surrounded by a wall composed of dense fibers formed by astrocytic processes=glial scar.

ribosomal subunit maturation and assembly

the nucleolus is the site of ribosomal subunit maturation and assembly. RNA polymerase I functioins exclusively within the nucleolus to transcribe the 45S pre-rENA gene, which codes for most of the ribosomal RNA components (18S, 5.8S, and 28S rRNAs).

arteriovenous concentration gradient reflects

the overall tissue solubility of an anesthetic. anesthetics with high tissue solubility are characterized by large arteriovenous concentration gradients and slower onsets of action.

lacunar infarctions

the result of vessel occlusion (eg, due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures. uncontrolled hypertension and diabetes mellitus are major risk factors for this condition.

supplied by branch of celiac trunk

the spleen prone to rupture with blunt trauma derived from mesoderm (same as kidneys)

blunt trauma to the globe can cause orbital blowout fractures

these fractures most commonly involve the media or inferior orbital walls due to the thin bone bordering the ethmoid and maxillary sinuses.

hamartomas are the most common benign lung tumors.

they present as asymptomatic peripherally located 'coin lesion' in patients 50-60 years old. these tumors are composed of disorganized cartilage, fibrous and adipose tissue.

peroxisome proliferator acitvated by

thiazolidinediones decrease insulin resistance

descending thoracic aorta lies posterior to the esophagus and the left atrium

this position permits clear visualization of the descending aorta by transesophageal echocardiography, allowing from the detection of abnormalities such as dissection or aneurysm.

hydroxylation of proline and lysine residues in collagen helps it attain its maximum tensile strength.

this process occurs in the rough endoplasmic reticulum and requires vitamin C as a cofactor. impaired collagen synthesis resulting from vitamin C deficiency (scurvy) can lead to fragile vessels, predisposing to gingival bleeding, ecchymosis, and petechia.

impaired function of vWF-cleaving protease: ADAMTS13

thrombotic thrombocytopenic purpura uncleaved vWF=more thrombotic>>diffuse microvascular thrombosis, microangiopathic hemolytic anemia, and thrombocytopenia

bypasses dTMP and reduce erythroid cell apoptosis due to defect DNA synthesis

thymidine supplementation due to folate deficiency

catalyzes oxidation of iodide to iodine, iodination of thyroglobulin tyrosine residues, and the iodotyrosine coupleing reaction to form T3 & T4

thyroid peroxidase

common cause of primary hypoparathyroidism and hypocalcemia

thyroid surgery muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability.

pseudomonas aeruginosa in burn patient treated with

ticarcillin, piperacillin ceftazidime, cefepime ciprofloxacin, levofloxacin imipenem, meropenem

psoriasis

tipical vitamin D analogs (calcipotrient, calcitriol, and tacalcitol) bind to the vitamin D receptor and inhibit keratinocyte proliferation and stimulate keratinocyte differentiation.

duodenal ulcers due to increased gastric acid production due

to H pylor destruction of somatostatin-secreting cells in the gastric antrum. h pylor in gastric body= gastric ulcers

base pairs that are shorter indicate base pair deletions due

to deletion/addition of number of bases that are not divisible by 3 in the coding region of a gene. cause a frameshift mutation

pulmonary diastolic pressure is slightly higher than right ventricle diastolic pressure due

to resistance to flow in the pulmonary circulation

top of foot going up the leg on the inside>> lateral leg going up the back of the leg>>

to uperolateral and superomedial nodes to deep inguinal and popliteal nodes

first line treatment for localized psoriasis

topical corticosteroids and vitamin D analogs

loss of cardiomyocyte contractility occurs within 60 seconds after

total ischemia (ATP depletion) <30 mins=reversible >30mins=irreversible

inactivates EF-2 via ribosylation and inhibit host cell protein synthesis

toxin produced by: C. diphtheriae pseudomonas A.

neonatal complications of diabetes during pregnancy

transient hypoglycemia macrosomia NARDS malformations prematurity polycythemia

beta thalassemia initiated by

translation of beta globin mRNA mutation leading to deficiency of beta globin chains required for normal hemoglobin synthesis

physostigmine

treat anticholinergic toxicity

muscarinic overstimulation

treat with antimuscarinic agent such as glycopyrrolate, hyoscyamine, or propantheline.

cholinesterase inhibitors may cause adverse effects related to muscarinic overstimulation

treat with antimuscarinic agent: glycopyrrolate hyoscyamine propantheline DUMBELLS: diarrhea urination miosis bronchospasm emesis lacrimination salivation

aspiration of aerobic and anaerobic flora leading to lung abscess in alcoholic patient

treat with clindamycin

permethrin

treatment for phthirus pubis: pubic louse blocks parasitic sodium ion conduction in nerve cell membrane channels and results in louse paralysis and death

congenital hyperplasia

treatment involves low doses of exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex.

hypoglycemia

tremor, diaphoresis, or confusion low blood glucose with symptom resolution with correction of blood glucose. elevated insulin and low C-peptide level= exogenous insulin injection elevated C-peptide suggest an insulin secretagogue or insulin-secreting tumor.

mental status changes, seizures, prolonged QRS duration, ventricular arrhythmias, and anticholinergic effects

tricyclic antidepressant overdose blockage of cardiac fast sodium channels and inhibition of muscarininc acetylcholine, histamine, and alpha-1 adrenergic receptors treat with: sodium bicarbonate

Mycobacterium tuberculosis

triggers CD4 lymphocytes to release interferon gamma leading to macrophage activation and differentiation into epithelial histiocytes. these along with langhans giant cells form granulomas. .

dihydrofolate reductase inhibitors

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

serotonin 5-HT1B/5-HT1D agonists inhibit vasoactive peptides> promote vasoconstriction/pain pathway blockage

triptans (sumatriptan)

pheochromocytoma

tumor arising from the chromaffin cells of the adrenal medulla characterized by excess production of catecholamines. causes episodic HTN, diaphoresis, and palpitations. microscopic examination shows electron dense membrane bound secretory granules, and immunohistochemistry is positive for synaptophysin, chromogranin, and neuron-specific enolase.

glomangioma

tumor of modified SM cells of glomus body involved in thermoregulation. shunting blood to/away from skin surface.

familial retinoblastoma

two Rb genes must be mutated increased risk for osteosarcomas

serum sickness

type III hypersensitivity reaction to nonhuman proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes. presents with fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels. histologic findings-small vessel vasculitis with fibrinoid necrosis and intense neutrophil infiltration. can be caused by: chimeric monoclonal antibodies or nonhuman immunoglobulins, and nonprotein drugs (penicillin, cefaclor, and trimethoprim-sulfamethoxazole)

absence seizures

type of generalized epilepsy characterized by brief staring spells with momentary loss of awareness followed by an abrupt return to full consciousness. a classic 3-Hz spike wave is seen on electroencephalogram; the treatment is ethosuximide.

HPV

types 16 and 18 are associated with anal and cervical squamous cell carcinoma. HIV infection increases the prevalence of HPV infection and the risk of anal carcinoma, this risk is further augmented in men who have sex with men.

resting membrane potential

typically about -70 mV high potassium efflux and some sodium influx are responsible for the value of the resting potential.

valvular aortic stenosis

typically an ejection or midsystolic murmur of crescendo-decrescendo configuration with maximum intensity over the right second interspace and radiation to the neck and carotid arteries. most common cause of aortic stenosis in elderly patients (age>70) is degenerative calcification of the aortic valve leaflets.

pulmonary infarcts

typically hemorrhagic (red) and wedge-shaped in the periphery of the lung. IVDU are at increased risk of tricuspid valve endocarditis, which can cause multiple septic pulmonary infarcts due to emobolization of tricuspid valve vegetation fragments.

congenital torticollis

typically noted by 2 to 4 weeks of age, after which the child prefers to hold the head tilted to one side. it is most commonly the result of malposition of the head in utero or birth trauma. most cases resolve with conservative therapy and stretching exercises.

transamination reactions

typically occur between an amino acid and an alpha-keto acid. the amino group from the amino acid is transferred to the alpha-keto acid, and the alpha-keto in turn becomes an amino acid. pyridoxal phosphate (active vitamin B6) serves as a cofactor in amino acid transamination and decarboxylation reactions.

invasive breast carcinoma

typically presents as an irregularly shaped adherent breast mass, most commonly in the upper outer quadrant. malignant infiltration of suspensory ligaments of the breast causes dimpling of the overlying skin. is spread through lactiferous sinuses, it may cause nipple discharge and superficial nipple changes.

cardiac tamponade

typically presents with hypotension with pulsus paradoxus, elevated JVD, and muffled heart sounds (Beck's triad). pulsus paradoxus refers to an abnormal exaggereated decrease in systolic blood pressure >10 mm Hg on inspiration, and is a common finding in patients with pericardial effusion with cardiac tamponade.

common peroneal (fibular) nerve injury

typically results from trauma to the leg near the head of the fibula. signs include 'foot drop' and a characteristic 'steppage gait'.

acute decompensated heart failure CXR

typically shows prominent pulmonary vessels, patchy, bilateral airspace opacification; and blunting of the costophrenic angles due to pleural effusions.

protein that undergoes ATP-dependent attachment to other proteins, labeling them for degradation

ubiquitin impaired: alzheimers parkinsons etc.

restless leg syndrome

uncomfortable sensation in the legs accompanied by an urge to move them. worse at rest and when falling asleep. Dopamine agonists are preferred for treatment (pramipexole, ropinirole)

transference

unconscious shifting of emotions associated with a significant person from one's past to a person in the present. project--misattributing one's own unacceptable feelings to another person.

Hepatitis E virus

unenveloped and single stranded RNA virus spread though the fecal oral route. high mortality rate observed in infected pregnant women.

schizoaffective disorder vs. schizophrenia

unlike schizoaffective disorder, schizophrenia does not include prominent mood symptoms that meet criteria for manic and/or depressive episodes. psychotic episodes are experienced without mood episodes.

renal derivatives from embryology

ureteric bud ultimately gives rise to the collecting system of the kidney, including the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters. metanephric mesoderm (blastema) gives rise to the glomeruli, Bowman's space, proximal tubules, the loop of Henle, and distal convoluted tubules.

photosenstivity (vesicel and blister formation on sun exposed areas) due to enzyme deficiency in

uroporphyrinogen decarboxylase causes porphyria cutanea tarda

Sublingual nitroglycerin

used for rapid symptom relief in patients with stable angina. vendilation with a decrease in LVEDV and wall stress, resulting in decreased myocardial oxygen demand and relief of angina symptoms.

colchicine

used for treatment of acute gouty arthritis in patients who cannot take NSAID drugs. it inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization--disrupting chemotaxis, phagocytosis, and degranulation. significant side effects of colchicine include nausea and diarrhea.

digoxin

used for ventricular rate control in A. Fib. decreases AV nodal conduction by increased parasympathetic vagal tone. also used in heart failure due to its positive inotropic effect. these effects are accomplished via inhibition of the sodium-potassium ATPase pump.

base excision repair

used to correct single-base DNA defects induced spontaneously or by exogenous chemicals. glycosylases remove defect base, corresponding empty sugar-phosphate site is cleaved and removed by action of endonuclease and lyase. DNA polymerase then replaces the missing nucleotide, and ligase seals the final remaining nick.

southwestern blotting

used to detect DNA-binding proteins such as transcription factors, nucleases, and histones.

thayer-martin medium

used to isolate pathogenic Neisseria species. it is a chocolate sheep blood agar that contains vancomycin to inhibit the growth of gram-positive organisms; colistin and trimethoprim to inhibit gram-negative bacteria (other than pathogenic neisseria); and nystatin to inhibit yeasts.

erythropoiesis-stimulating agents

used to treat anemia of chronic kidney disease. increased risk of thromboembolic events due to increased blood viscosity. may also develop hypertension- maybe due to activation of erythropoietin receptors on vascular endothelial and smooth muscle cells.

glycerol kinase

uses glycerol from degradation of triglycerides in adipose tissue in liver and kidneys synthesizes glucose during gluconeogenesis

fick principle can be applied to calculate cardiac output

using the rate of oxygen consumption divided by the arteriovenous oxygen content difference.

selective IgA deficiency

usually asymptomatic recurrent sinopulmonary, gastrointestinal infections, autoimmune disease, anaphylaxis during transfusions.

congenital hypothyroidism

usually asymptomatic at birth. after maternal T4 wanes (two-ish months) infant develops constipation, lethargy, hypotonia, macroglossia, an umbililcal hernia, and a large anterior fontanelle.

skeletal system metastases

usually hematogenously. cancers of pelvis, including prostate, spread to lumbosacral spine via the vertebral venous plexus, which communicates with prostatic venous plexus.

nuclear factor kappa B

usually in the cytoplasm in inactive form= IkB lipopolysaccharide can initiate signal cascade that results of IkB and translocation of free NF-kB to the nucleus.

protective carrier protein for circulating factor VIII

vWF function as promoter of platelet adhesion at sites of vascular injury by binding platelet glycoproteins to subendothelial collagen on injured blood vessel walls.

difference in phenotype observed in those with same genetic mutation

variable expressivity dependent on multiple interacting genetic and environmental factors

dilations of the spermatic vein pampiniform plexus enlarge with standing and regress with lying down

varicoceles some asymptomatic others experience: aching pain that is relieved with recumbency, testicular arophy, or reduced fertility

phenylephrine

vasoconstriction, SVR increase, afterload increase, and decrease CO

lymphatic drainage proximal to the anal dentate line occurs

via inferior mesenteric and internal iliac lymph nodes distal: inguinal nodes

insulin resistance

visceral obesity measured by wait circumference or wait-to-hip ratio is an important predictor of insulin resistance.

breast milk content is insufficient in

vitamin D and K K is given parenterally to all newborns at birth to prevent hemorrhagic disease of the newborn. exclusively breastfed infants require vitamin D supplementation due to lack of sunlight exposure and to prevent rickets.

vitamin deficiency mimic friedreich ataxia

vitamin E deficiency antioxidative properties ataxia, loss of position and vibration sense, and loss of deep tendon reflexes

enteric bacteria produce

vitamin K and folate inhibit proliferation of surrounding pathogenic bacteria, and digest unabsorbed dietary sugars and convert them to fatty acids. small intestinal bacterial overgrowth: deficiency: B12, A, D, E, iron

renal blood flow

volume of blood that flows through the kidney per unit time and can be calculated by dividing the renal plasma flow by (1-hematocrit). plasma flow=PAH clearance times urine flow rate.

VIP persists with fasting, achlorhydria, and hypokalemia

vs. gastrinoma ZES: ulcer!, diarrhea, abdominal pain/acid reflux

PT/INR used to monitor

warfarin vs. aPTT used for monitoring unfractionated heparin

adenocarcinoma in situ

well differentiated, dysplastic columnar cells that line the alveolar septa without vascular or stromal invasion. tendency to undergo spread and can progress to invasive disease if not resected.

lead time bias

when new test diagnoses condition earlier than conventional studies, causing apparent increase in survival time despite no improvement in overall mortality.

lactic acidosis in septic shock results from tissue hypoxia

which impairs oxidative phosphorylation and causes shunting of pyruvate to lactate following glycolysis

chronic inflammation is associated with increased circulating pro-inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis factor -alpha)

which stimulates the liver to release acute-phase reactants (eg, C-reactive protein, fibrinogen). the presence of acute-phase reactants increases the erythrocyte sedimentation rate, a nonspecific marker for inflammation.

sensory ataxia

wide based gait, positive romberg sign. evident in tabes dorasalis along with loss of proprioception and vibratory sensation, severe lancinating pains

probability of child of parents from 2 populations with different mutant allele carrier frequencies

will inherit an autosomal recessive disease is 25% multiplied by the carrier frequencies.

widening of pressure volume loop

with a shift in the isovolumic relaxation line to the left (indicating less residual blood volume in the ventricle at end-systole). an increase in effective stroke volume or ejection fraction is depicted on the left ventricular pressure-volume relationship.

fragile X syndrome

x-linked disorder that presents with a long, narrow face, a prominent chin and forehead, and large testes. patients have developmental delay and neuropsychiatric findings that overlap with anxiety disorders, autism, and ADHD.

lesch-nyhan syndrome

x-linked recessive disorder caused by deect in hypoxanthine-guanine phosphoribosyltransferase (HGPRT). this results in failure of the purine salvage pathway, leading to increased degradation of hypoxanthine and guanine to uric acid. de novo purine synthesis must increase to replace the lost bases, necessitating an increase in phosphoribosyl pyrophosphate (PRPP) amidotransferase activity.

DMD

x-linked recessive myopathy that manifests with proximal muscle weakness and enlargement of the calf muscles in boys ages 2-5. deletions affecting the dystrophin gene. this gene stabilized sarcolemma and the intracellular contraction apparatus, and disruption of the protein results in membrane damage and myonecrosis.

allopurinal and azathioprine

xanthine oxidase catalyze 1 of 2 major inactivating pathways. allopurinal competitively inhibits XO, resulting in increased conversion of azathioprine to its active metabolite.

metalloproteinases

zinc containing enzymes that degrade the extracellular matrix participate in normal tissue remodeling and in tumor invasion through the basement membrane and connective tissue.