10 Flashcards
Anti-thombin III deficiency (Bagel Lady)
AD
- Venous thrombosis
- Hypercoagulable state
“cotton candy” on pap smear; incidental finding in patient with intrauterine device
Actinomyces-like organisms
squamous cells covered with rods to obscure normal epithelial margins
Clue cells
Beta (1,3) glycan is a main component in
Candida and Aspergillus cells walls (Caspofungin)
Chronic Alcoholic and receptors (leads to tolerance)
UP-REGULATION of NMDA
DOWN-REGULATION of GABA
Most common INITIAL FINDING of alcohol withdraw
The shakes (tremors)
Fluctuating arousal levels are characteristic of delirium tremens. When do you see this?
48-96 hours of last drink
Kinda confusing but you are seeing hallucinations here too kinda seems like there is overlap in stages
Childhood to puberty…status of dat oocyte?
Meiosis I arrested in PROPHASE
Status of that oocyte after ovulation
Meiosis II arrested in metaphase
Why is prophase of meiosis II unique?
does not immediately follow a period of DNA synthesis; DNA was duplicated prior to prophase of meiosis I
How does metaphase of meiosis I different form metaphase of meiosis II and mitosis
Spindles not preparing to split the centromere
Tetrads instead lined up along the metaphase plate, and during anaphase the homologs separate from each other the the centromeres intact
Type of DNA cloning were signals nec. for transcription and translation are included in the cloned DNA. Allows for bacteria to be used to produce large amounts of proteins of interest
Expression cloning
TFs, thyroid proteins, steroids, Vit. D receptors, retinoic acid receptors, DNA transcription and replication proteins,
all bind DNA (good for plasmid vector shit)
Isotype switching is a process that occurs in naive B-lymphocytes on initial exposure to antigen. Walk me through how it happens
CD40 (on B-cell) binds CD40L on T-helper cells.
IL-4 secreted by TH cell = IgE switch
IL-5 secreted by TH cell = IgA swtich
Defect in CD18
LAD
Inherited defects involving the _______ signaling pathway result in disseminated mycobacterial disease in infancy or early childhood.
Interferon-gamma signaling
Fastest metabolism in glycolytic pathway?
Fructose=Fastest
Dietary fructose is phosphorylated in the liver to F1P and is rapidly metabolized because it bypasses _______, the major rate limiting enzyme of glycolysis
PFK-1
Obstructive hydrocephalus (aqueductal stenosis-> papilledema, HA, vomiting) and DORSAL MIDBRAIN (PARINAUD) SYNDROME
Pineal gland mass/tumor
DORAL MIDBRAIN (PARINAUD) SYNDROME
paralysis of upward gaze, ptosis, and pupillary abnormalities
due to direct compression of pretectal region of midbrain
(ex: pineal mass)
What is the most common pineal mass?
germinoma (a midline malignant tumor thought to arise from embryonic germ cells)
Germinoma also in suprasellar region (endocrinopathies) balls and mediastinum (young boys)
Damage, tumor, infact/hemorrhage of thalamus
Contralateral hemisensory loss, behavioral changes and language deficits
Gait and limb ataxia, intention tremor, and nystagmus in a child
Medulloblastoma (cerebellum)
Contralateral loss of pain and temp
Ipsilateral paralysis of CNs V, IX, X, and XI
Lateral Medullary (wallenberg syndrome)
Contralateral spastic paralysis, contralateral sensory loss of vibration and proprioception, and ipsilateral flaccid paralysis of the tongue (CNXII)
Medial Medullary syndrome
Rhizopus increased incidence in DKA is due to?
Rhizopus/Mucor has a ketone reducatase activity
Release of iron from binding proteins during DKA (facilitating growth)
Histologic examination is necessary for diagnosis of Rhizopus/Mucor. What is its shape?
broad ribbon-like nonseptate hyphae with right angle branching
Chorioretinitis and clustered pustular skin lesion
Candidemia
Recurrent fevers and bronchial obstuction in a patient with asthma
Thinkk ABPA (check IgE titers should be elevated) ABPA anti-bodies also present (duh)
Cholinomimetic are indicated for non-obstructive urinary retention, paralytic ileus and glaucoma. What are there ADRs?
N/V, ab cramps, diarrhea, dyspnea and increased secretions (sweating, LACRIMATION, and salivation)
Antibodies to GAS cross-react with host tissues due to molecular mimicry between M GAS antibodies (name them) and cardiac and CNS antigens (name them).
M protein (GAS) N-acetyl-beta-D-glucosamine (GAS)
Myosin in heart
Lysogangliosides (neuronal cell surface protein) CNS
Diffuse, erythematous, “sand-paper” textured rash most notable in skin folds. Caused by GAS
SCARLET FEVER
ERYTHROGENIC TOXIN
RVOT obstruction: Causes and murmer
Subvalvular, pulmonary valve stenosis or supravalvular narrowing in the main pulmonary artery
Murmor: harsh, systolic ejection murmur over the mid-to-left upper sternal border
How does squatting improve cyanosis in TOF
increases SVR (afterload) and decreases degree of right to left shunting across the VSD
Occurs when one hormone allows another hormone to exert its max effect ?
(ex: NE at max with cortisol due to cortisol upregulating alpha-1 on vascular smooth muscle cells. (thus in adrenal insufficiency low glucocorticoid levels can contribute to hypotensive crisis by decreasing vascular responsiveness to angiotensin II and NE)
Permissive effect
Combined effect of 2 drugs is equal to the sum of their individual effects
additive effect/response
combined effect of 2 drugs exceeds the sum of the individual drug effects
synergistic
Decreased drug responsiveness in a short period following one or more doses (rapidly develop tolerance).
Tachyphylaxis
Increases glucose release form liver in response to glucagon
Cortisol
ANP and BNP (systolic dysfunction)
Activate guanylate cyclase to increase intracellular cGMP
Decrease BP, vasodilate, diuresis/natriuresis
Counteract edothelin, sympathetics, and AngII
ENDORPHIN (morphine)
synthesized and released from corticotroph cells in anterior pituitary
Arrest of the cell cycle
promotion of angiogenesis (lead to tumor mets if they become resistant to cell cycle effect)
stimulation of fibroblasts to lay down ECM (implication in atherosclerosis and fibrotic disease)
TGF-B
hormone produced by the kidney in situation where the adrenergic and RAAS systems are stimulated.
Bradykinin (constricts veins and dilates arterioles to increase renal perfusion)
Endothelin (vasoconstrictor) release is mediated by
ANGII (thus ACEI are really good for HF)
BNP is elevated in people with heart failure
Used as test for CHF exacerbation
Decreased serotonin, NE, and Dopa
Depression (all depressed in depression)
Radial Nerves (superficial = sensory) deep branch (motor) pass through
supinator canal
Injury to radial nerve during it passage through supinator canal can be due to repetitive pronation and supination of forearm (frequent screw driver use), direct trauma, dislocation of radius)
Finger drop (can extend fingers or thumb) All else should be gucci
Choracobrachialis muscle lies deep to biceps brachii and is perforated and innervated by
Musculocutaneous nerve
Ulnar nerve passes between hook of hamate and pisiform bone in guyon’s cannal. Injury here =
weakness on finger abduction/adduction and clawing of the 4th and 5th digit
Loss of sensation in the lateral upper arm with weakness of the deltoid and teres minor
Axillary nerve fucked due to fracture of surgical neck of the humerus
odynophagia (pain with swallowing) or dysphagia (difficulty swallowing) with fever or burning chest pain…linear and shallow ulcers in esophagus
CMV
metaplastic gastic columnar epithelium in lower esophagus
Barrett
Inhaled amyl nitrate
Fe2+ to Fe3+ (methemoglobin) –> scaverngers up cyanide
TX for cyanide posioning
Hydroxycobalamin (B12 precursor) sodium thiosulfate are also antidotes for
cyanide poisoning
Lead posioning Tx
Dimercaprol or edetate disodium calcium (CaNA2EDTA)
The metabolism of ethanol by alcohol dehydrogenase and aldehyde dehydrogenase
Reduces NAD/NADH ratio
Increases NADH/NAD ratio
Inhibits pathways requiring NAD+
Agranulocytosis (fever and soar throat presentation in Grave’s patient)
Methimazole or propylthiouracil (anti-thyroid)
Stop drug and to WBC count
Treatment for serotonin storm
CYPROHEPTADINE (antihistamine with anti-serotonergic properties)
Benzos- can reduce agitation and mildy reduce HR and BP
Benign disorder of fructose metabolism. AR inheritance. Causes some fructose to be secreted unchanged into urine.
1) Name the disorder
2) Name the enzyme thats deficient
3) I wanna know the test for detecting fructose (remember it is a reducing sugar similar to glucose and galactose)
1) Essential Fructosuria
2) Fructokinase
3) Copper reduction test (nonspecific for reducing sugars)
urine dipstick uses glucose oxidase to detect
glucose and glucose only
would be negative in essential fructosuria (AR)
Infant with cardiomyopathy, muscle weakness and hypotonia, liver enlargment (due to heart failure), and an enlarged tonuge
Pompe Disease (type II glycogen storage disease)
No hypoglycemia like Von G b/c G-6-Pase is gucci
Pompe Disease enzyme deficient
Lyosomal acid maltase aka acid alpha glucosidase
accumulation of glycogen in lysosomes
inability to metabolize fructose-1-phosphate (a toxic intermediate that accumulates in cells and depletes intracellular phosphate)
Aldolase B deficiency
AR disorder caused by galactose-1-phosphate uridyl transferase (GALT) deficiency
Galactosemia
Galactose-1-phosphate accumulates in cells (galacticol too)
Galactosemia (AR)
- Failure to thrive (first few days of life)
- Liver failure (galacticol and Galactose-1-P accumulate)
- Hepatomegaly
- Failure to thrive
- GALT enzyme screening assay
CATARACTS IF UNTREATED
Galactosemia (AR)
Tx for galactosemia ?
- Elimination of all milk products (lactose = galactose + glucose)
- Soy based infant formula
pulmonary circulation vasoconstricts so that blood flow is diverted away from underventilated regions and towards more ventilated areas (decreases physiological shunting)
hypoxic vasoconstriction
Hypoxic vasoconstriction MOA
increase in pulmonary artery smooth muscle cytosolic Ca2+ due to hypoxia-induced modulation of K+ channels and or decreased production of ROS.
Vasodilation in ______ when PO2 falls below 50 mm hg
brain
In coronary vasculature subendocardial BF is mediated by:
PO2, adenosine, prostacylin and NO
decreased PO2 would cause vasodilation
Splanchnic blood flow to GI decreased during
exercise (sympathetics)
Small vessel leukocytoclastic angiitis associated with IgA and C3 deposition (esp. in small blood vessels of dermis and GI tract)
HSP
Purpuric rash (100%)..lower extremities at first, colicky abdominal pain (85%) and polyarthralgia (70%) in male child between 3-11 MC
HSP
mononeurtitis multiplex (seen in Churg-Strauss/eosinophilic granulomatosis with polyangitis)
asymmetric multifocal neuropathy due to vasculitis affecting the epineural vessels (wrist drop due to radial nerve involvment)
Late-onset asmtha, rhinosinusitis, eosinophilia (kindeys, heart and GI can be involved too)
Less common symptoms:
-skin nodules
-migratory/transient pulmonary infiltrates
-paranasal sinus issues
eosinophilic granulomatosis with polyangiitis
p-ANCA (neutrophilic myeloperoxidase) and esosinophilia
Anti-RNA III, Antitopoisomerase I (Scl-70), and anticentromere antibodies
Systemic sclerosis (scleroderma)
pulmonary parenchymal involvement by systemic sclerosis results in a chronic restrictive interstitial fibrosis
Sensory> motor initially (symptoms)
carpal tunnel
Enveloped viruses (acquired from host cell plasma or nuclear membranes) can be be inactivated by?
Ether and other organic solvent
Non-enveloped not phased by ether
Heating 50-60 C kills viral infectivity in most cases
cool
Dissolve lipid bilayer that makes up the outer viral envelope
ether
______ ______ ______ causes phosphorus retention. The excess serum phosphorus can cause hypocalcemia by combining with intravascular calcium
Chronic Renal Failure
Multiple blue-violet or brownish dermal plaques appear first on feet and legs before spreading proximally. Later stage to lung and GI
HHV-8 (kaposi)
Histo for HHV-8 (infects vascular and lymphatic endothelial cells) – mixed phenotype
spindle and endothelial cell proliferation, RBC extravasation and inflammation
CMV in HIV patient
esophagitis, colitis, and retinitis
Southern japanese immigrant. T-cell leukemia.
HTLV-1 (Retroviridae)
