UWORLD

diabetic gastroparesis

Characterized by triad of postprandial symptoms: N/V/abdominal distension/early satiety due to uncoordinated peristalsis. Look for patient with DM and diabetic nephropathy and throwing up chunks of food (delayed gastric emptying due to damage to cells of cajal and impaired fundal relaxation due to loss of NO containing neurons)

Hypocalcemia w/blood transfusion

Citrate which is found in the blood will cause chelation of ca2+ leads to tenany, tingling sensation of fingers and toes, twitching and spasms

Difference between elastin and collagen

Collagen has hydroxylation and elastin does not The cross linking in elastin helps it have the stretchy property

Vitamin D (3 Ds)

D: distal tubule in renal (reabsorption) D: duodenum (absorbtion) D: destroy bone (activates osteoclasts)

Insulin and exercise

DM: you take an insulin shot and it releases insulin even when you are working out and glucose levels are getting low (get hypoglycemic) because body cant sense this Normal person: when the body starts to sense the low glucose levels it stops insulin release and changes it to make more glucose/limit uptake to maintain the levels

ACE inhibitors decrease aldosterone

DUH want to decrease the BP

Dressler's syndrome vs. Peri-infaraction pericarditis

Dressler's: autoimmune reaction = fibrinous pericarditis WEEKS after Peri-infaraction: inflammation overlying the necrotic part usually 2-4 days after

Iron Fist Bro

Duodenum: iron Jejunum: folate Ilium: b12

Mutation in what is seen in familial dilated cardiomyopathy and Duchenne and Becker?

Dystrophin

Mutation is what is seen in Marfans?

Fibrillin 1

Tuberus Sclerosis

HAMARTOMAS: Hamartomas in CNS and skin; Angiofibromas ; Mitral regurgitation; Ash-leaf spots ; cardiac Rhabdomyoma; Tuberous sclerosis; autosomal dOminant; Mental retardation (intellectual disability); renal Angiomyolipoma; Seizures, Shagreen patches.

Coccidioides immitis

ITS HUGE, see in the picture compared to the other background cells? Spherules containing endospores

Good Pasture syndrome

Ig's against alpha-3 chain of collagen 4 rapidly progressive glomerulonephritis - crescent formation (nephritic)

Henoch-Schonlein Purpura

IgA-anti-IgA immune complexes 1.palpable purpura on buttocks/legs 2.Abdominal pain (associated with intussusception) 3.arthritis

Type 1 hypersensitivity

IgE mediated and histamine is released first! This is because histamine is preformed in mast cells!

CCB in subarachnoid hemorrhage

Inhibits cerebral vasospasm 3-12 days after the incident to decrease ischemic deficits caused by the vasospasm (nimodipine)

Vitamin K (3 Ks)

K: "k"lotting factors K: gamma "k"arboxylation K: not made by "k"nipples BABIES NEED K SHOT CAUSE NOT IN BREAST MILK AND NOT IN GUT FLORA YET

Lateral geniculate nucleus (LGN)

Lateral for light (vision)

Homocystinuria

Lens subluxation (down and in), *thrombosis*, marfanoid habitus, intellectual disabiliity Tx: pyridoxine (B6)

What causes sickling?

Low o2 low pH high altitude = low o2

How to target protein to lysosome from golgi apparatus?

Mannose -6-phosphate Lysosome: organelle in the cytoplasm of eukaryotic cells containing degradative enzymes enclosed in a membrane

Medial geniculate nucleus (MGN)

Medial for music (hearing)

How does retinoblastoma protein work

Rb is aa tumor repressor gene Rb controls checkpoint G to S1 When Rb is phosphorylated it is INACTIVATED so a cell can go onto S1 phase (when its inactivated it releases E2F transcription factor, which allows the profession)

Chemoreceptors in the brain

Respond to Co2 Want to use this when there is increased ICP When there is high CO2 there is going to be vasodilation cause you want high O2, but if there is low CO2 you will get vasoconstriction = lower ICP So dilation occurs when O2 is low and CO2 is high Constriction occurs when O2 is high and CO2 is low

Vitamin B2

RiboFlavin: FAD, FMN 2 flavors of riboflavin -cheilosis (angular cheilosis) -corneal vasculazation

K+ channel congenital syndromes (prolonged QT = torsades)

Romano-Ward syndrome—autosomal dominant, pure cardiac phenotype (no deafness). Jervell and Lange-Nielsen syndrome— autosomal recessive, sensorineural deafness.

How do you get euvolemia and hypoNa?

SIADH you will have more water retention which will increase extracellular fluid --> less aldosterone and more ANP --> ANP will cause Na+ excretion to try to decrease the volume Even a lower Na + (already was low cause so much fluid and it diluted the Na+ concentration)

Ventral Posterlateral nucleus

STT and DCML

Histoplasma capsulatum

See here, we see them inside the macrophages, thus very small

Cataracts

Seen in diabetics cause the glucose goes into an alternative pathway and accumulation of sorbitol occurs. The sorbitol accumulates in cell (cant leave) in a healthy person the sucrose is turned into fructose and can leave the cell

Putting Gram + bacteria in a hypotonic solution

So Gram + bacteria have a cell wall and cell membrane right? So if they were put into a hypotonic solution the bacteria wouldn't die because the wall helps hold the shape. If you introduce a cell wall antibiotic such as ceftriaxone (b-lactam antibiotic) you will destroy the cell wall = bacteria will die in hypotonic

Urea and hypotension/blood loss

There is more urea reabsorption in the kidney. Mediated by vasopressin Vasopression is high in hypotension to retain water. It also increases urea reabsorption in the inner medullary collecting duct = increases concentration gradient in the medulla= more water leaves in the descending limb to concentrate the urine

Craniopharyngioma

Tumor that arises from epithelial remnants of Rathke's pouch Suprasellar lesion Headaches, visual field defects, hypopituitarism, growth retardation , hyperprolactinmia

Famililal Hypercholesterolemia

Usually due to LDL receptor defect, the liver cannot uptake LDL/cholesterol

Thiamine

Vitamin B1 Alcoholics: B before G **You need to give B1/thiamine before you give glucose. WHY?? Ill tell you why When you give glucose you will increase in pyruvate. However, B1 is a cofactor for a-ketoglutarate dehydrogenase (TCA cycle). If there is high pyruvate and it can't go into the TCA cycle you will have a buildup which then will turn into lactic acid. BAD. Wernicke Syndrome: wacky and wobbly Korsakoff Syndrome: kant remember Dry beriberi: peripheral neuropathy Wet beriberi: peripheral neuropathy + dilated cardiomyopathy (CHF?)

Pyridoxine

Vitamin B6 Isoniazid Cant make heme: siderblastic anemia, neuropathy, irritability and GI upset

Scury

Vitamin C deficiency Gum bleeding, cork-screw hair, petechiae Need vitamin C for collegen production (vit c works in the ER)

Cortisol and its effect on NE

When ATCH is low there is low amount of cortisol made when then decrease the phenylethanolamine-n-methyltransferase enzyme (this decreases the conversion of NE-> E). Usually when cortisol is made it goes into the venous drainage and goes through the medulla, high concentrations of of cortisol then increases this enzyme to make more E. When you remove the pituitary gland, there is less ATCH thus less E made by the medulla.

Acute tubular necrosis

Will see muddy casts Usually due to toxic injury OR hypoxia to the PCT or thick ascending limb

ventromedial hypothalamus (VMH)

a brain region that depresses hunger when activated; when its defective you eat a lot more (get wider/medial)

Disruptive Mood Dysregulation Disorder

a childhood disorder marked by severe recurrent temper outbursts along with a persistent irritable or angry mood (BUT THIS IS <10 vs. intermittent explosive) constantly angry and irritable between outbursts

Vitamin E

antioxidant hemolytic anemia, muscle weakness, posterior column and spinocerebellar demyelination!! ataxia, loss of proprioception and vibratory sense

Vitamin E

antioxidant; mimics B12 deficiency without the megaloblastic anemia and hyperhsegmented PMNs will see, HEMOLYTIC ANEMIA AND LOSS OF PROPRIOCEPTION AND HYPO-REFLEXIA, ATAXIA

Vitamin C

ascorbic acid collagen synthesis: hydroxylation of proline and lysine sCurvy: bleeding gums, wound healing issues, anemia, follicular hemorrhage/bleeding around hair, kinky/curly hair

Charcot-Bouchard microaneurysm

associated with chronic hypertension affects lenticulostriate arteries intracerebral hemorrhage of thalamus *will see fibrinoid necrosis remember?

pancreatitis

auto digestion of pancreas by pancreatic enzymes. causes: hyper Ca 2+, hyper TG, scorpion sting, gallstones, alcohol can use fibrates to decrease recurrence - work by increasing PARR-a and LPL ( there is more conversation of TG into FFA/Free Fatty Acids = less TG)

Aspiration if standing up

basal segment of the lower right lobe

hand sanitization

can be used to kill ENVELOPED viruses by dissolving their lipid bilayer membranes and then denaturing their proteins (can be used for influenza)

Endothelian 1

causes vasoconstriction (activated in RAAS) endothelial receptor blockers (Bosentan) used for pulmonary HTN

Thayer Martin medium

chocolate agar treated with antibiotics which inhibit normal flora but allow Neisseria growth; used to isolate Neisseria includes VPN (Vanco, nystatin, colistin and trimethoprim)

Rule of 2s for Neurofibromatosis type 2

chromosome 22 2 ears (acoustic neuroma), 2 eyes (juvenile cataracts) 2 parts of the brain

Aortic stenosis

crescendo-decrescendo systolic ejection murmur

Intermittent Explosive Disorder

disproportionate to the situation, impulse control disorder to be verbally or physically aggressive. the outburst may provide an immediate sense of relief that is usually followed by remorse.

tx for anaphylactic shock

epinephrine Sx: dyspnea, hypotension, tachycardia

PDGF

-Secreted by activated platelets and macrophages -Induces vascular remodeling and smooth muscle cell migration -Stimulates fibroblast growth for collagen synthesis IMPORTANT FOR ATHEROMA FORMATION

Vitame A (4 As)

A: antioxidant (used for tx of measles and retinitis pigmentosa) A: aura (used for vision)/lack of = night blindness A: activation (epithelial cell differentiation)/ lack of = keratomalacia and coral degeneration A: alopecia and abnormal pregnancy (if too much)

ACL and MCL

ACL (lateral to medial & posterior to anterior) MCL (medial to lateral & anterior to posterior)

Central Diabetes Insipidus

ADH deficiency due to hypothalamic or pituitary pathology If hypothalamic = persists for long time If posterior pituitary= transient D because the hypothalamic nuclei are intact and axons can regenerate

garlic breath? Bitter almonds?

ARSENIC poisoning = garlic (Tx with dimercaprol - same as MERcury) Bitter Almonds and cherry red skin is CYANIDE (Tx is hydroxocobalamin)

Psoriasis

Acanthosis: epidermal squamous hyperplasia Paracanthosis: retention of nuclei in the stratum corneum Nail pitting

PTSD by length of Sx

Acute stress <1m PTSD >1m

Generalized Anxiety Disorder

Adjustment <6m GAD >6m

What would you see with Waterhouse friderichsen syndrome?

Adrenal hemorrhage with hypoNa, kyperK, hypoGlycose

alpha, beta, gamma carboxylase

Alpha: incomplete hemolysis; green/brown Beta: complete, clear around it Gamma: none, nothing

HLA-B27

Ankylosing spondylitis Reactive arthritis (with uveitis) Ulcerative colitis Psoriatic arthritis

Gonadal arteries and veins

Arteries come off of the aorta Veins go into the IVC or renal vein (L)

Cobalamin

B12 rarely deficient in (from animal products- so I guess vegans can be) macrocytic, megaloblastic anemia high methylmalonic acid (v.s. folate deficiency where it is normal) Neurologic symptoms (need to make myelin) - effects adults Seen in pernicious anemia, spruse/enteritis, crohns (most common site is distal ilium-where b12 is absorbed)

Panthothenic Acid

B5 Component for CoA PoA is CoA

Biotin

B7 deficiency allopecia carboxylation reaction too much egg whites inhibits biotins

Folate

B9 Poor diet (from foliage/greens) Not taking prenatal vitamins (causes neural tube defect) - issue in babies not adults macrocytic, megloblastic anemia

Maltese cross

Babesia

Mitral stenosis

the earlier the opening snap the worse aka shorter time between S2 and opening snap this happens because as the mitral stenosis gets worse there is more pressure backup into the LA, more backup means that there will be more pressure to open the stenosed mitral valve sooner even though there is calcification

Hepatitis E Virus (HEV)

transmitted through contaminated food and water, PREGNANT WOMEN unenveloped/naked, single-stranded RNA (LIKE HAV)

Mutation in what is seen in HOCM?

Beta myosin heavy chain (sarcomere protein)

How does digoxin work?

Blocks Na/K ATPase Build up of K inside the side Na leaves out of the cell with a Ca/Na cotransporter (Ca into and Na out)

Varicocele

usually left sided because the spermatic vein dumps into the left renal vein and LRV can get compressed by the superior mesenteric artery (LRV gets squished between SMA and Abdominal aorta)

Schizophrenia by length of Sx

Brief psychotic <1 m Schizophreniform 1-6 m Schizophrenia >6m

Hypotension in pregnancy

usually seen after 20 weeks and when laying supine or right lateral decubitus PUT THEM ON LEFT LATERAL DECUBITUS

Effect of HTN on vessels and glomeruli

vessels: fibrinoid necrosis glomeruli: hyperplastic arteriolosclerosis (onion skinning)

Which drugs cause heart blocks?

CCB B-blockers Digtoxin

When you have hemophilia A (no factor 8) you can use a drug that links what two factors?

9a and 10

avoidant personality disorder

A personality disorder characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation. BUT YOU WANT RELATIONSHIPS WITH OTHERS

Vitamin B3

Niacin: NAD+/NADP+ MADE FROM TRYPTOPHAN What a SIN to have 3 Ds diarrhea dementia dermatitis How you get B3 deficiency -Hartnup disease (less absorption of tryptophan) -Carcinoid syndrome (using up all the tryptophan to make serotonin) -Isoniazid use (need B6 to make B3)

Otitis Media and Otitis Externa Bug

OM: Strep pneumo, Hib OE: Pseudomonas

pyloric sphincter hypertrophy

ONLY IN CHILDREN

Oropharyngeal cancer vs. nasopharyngeal cancer viruses

Oropharyngeal: includes tonsil, base of tongue caused by HPV (usually HPV-16) Nasopharyngeal: EBV

Most common cause of nephritic syndrome in children?

PSGN

Sign for croup

Paramyxovirus Steeple sign

ACE inhibitors

increase creatine and work on the efferent arteriole to dilate it the reason why creatine increases is because when you dilate the efferent arteriole the GFR decreases leading to less creatinine being excreted

psuedotumor cerebri

increased ICP with no reason, seen in females that are obese will see papilladema, and headaches esp when bending over or valsava the increase in ICP will squeeze on the opic n. causing a defect in optic nerve axoplasmic flow

Muscles strengthen by Kegel excesses (pelvic floor)

levator ani group: iliococcygeus, pubococcygeus, puborectalis)

Trophozoite

motile feeding stage of PROTOZOA

Afib

no p waves, tachycardia, and irregularly spaced QRS complex rate is set by the AV node refractory period (when SA doesnt work the AV takes over)

Type 1 Familial hyperchylomicronemia

pancreatitis, creamy layer of supernatant (all the fat) on blood sample, xanthomas, no higher risk of atherosclerosis. Due to LPL deficiency

Aspiration if supine

posterior segment of the upper right lobe

Thyroidectomy complications

recurrent laryngeal nerve damage = hoarseness due to close proximity to inferior thyroid a.

Ventral posteromedial nucleus

relays sensory input from the face

Hepatic steatosis

short term change with mod alcohol intake; macrovesicular fatty change that may be reversible with alcohol cessation due to increased TG formation and decreased fatty acid oxidation

Damage to piriform recess leads to what nerve and ability

superior laryngeal n (CN 10) Loss of cough reflex

Minimal change disease

t-cell mediated injury to the podocyte only ALBUMIN loss (so minimal only loss of this) - leads to peri-orbital edema