10 Flashcards by Keegan Sturgill

Anti-thombin III deficiency (Bagel Lady)

Venous thrombosis
Hypercoagulable state

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“cotton candy” on pap smear; incidental finding in patient with intrauterine device

Actinomyces-like organisms

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squamous cells covered with rods to obscure normal epithelial margins

Clue cells

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Beta (1,3) glycan is a main component in

Candida and Aspergillus cells walls (Caspofungin)

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Chronic Alcoholic and receptors (leads to tolerance)

UP-REGULATION of NMDA

DOWN-REGULATION of GABA

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Most common INITIAL FINDING of alcohol withdraw

The shakes (tremors)

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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

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Childhood to puberty…status of dat oocyte?

Meiosis I arrested in PROPHASE

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Status of that oocyte after ovulation

Meiosis II arrested in metaphase

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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

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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

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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

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TFs, thyroid proteins, steroids, Vit. D receptors, retinoic acid receptors, DNA transcription and replication proteins,

all bind DNA (good for plasmid vector shit)

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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

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Defect in CD18

LAD

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Inherited defects involving the _______ signaling pathway result in disseminated mycobacterial disease in infancy or early childhood.

Interferon-gamma signaling

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Fastest metabolism in glycolytic pathway?

Fructose=Fastest

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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

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Obstructive hydrocephalus (aqueductal stenosis-> papilledema, HA, vomiting) and DORSAL MIDBRAIN (PARINAUD) SYNDROME

Pineal gland mass/tumor

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DORAL MIDBRAIN (PARINAUD) SYNDROME

paralysis of upward gaze, ptosis, and pupillary abnormalities
due to direct compression of pretectal region of midbrain
(ex: pineal mass)

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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)

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Damage, tumor, infact/hemorrhage of thalamus

Contralateral hemisensory loss, behavioral changes and language deficits

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Gait and limb ataxia, intention tremor, and nystagmus in a child

Medulloblastoma (cerebellum)

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Contralateral loss of pain and temp

Ipsilateral paralysis of CNs V, IX, X, and XI

Lateral Medullary (wallenberg syndrome)

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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)