12 Flashcards
What do mesonephric ducts differentiate into ?
ductal stage
epididymis, ductus deferens, seminal vesicle
Mullerian (paramesonephric) give rise too?
ductal stage
uterine tubes, uterus, cervix and upper vagina under the maternal influence of estrogen
gives rise to glans penis in males and glans clitoris in females
genital tubercle
urogenital folds
ventral aspect of penis and the labia minora (chicks)
beomes scrotum in males and the labia majora in females
genital swellings
Urogenital sinus (males)
bladder urethra prostate and bulbourethral glands
Females urogenital sinus
bladder, urethra, lower vagina and Bartholin glands
DHT is adult male
secondary sexual characteristics
HIV DNA synthesis from the RNA template is impaired by reverse transcriptase inhibitors, which terminate viral DNA elongation by competitive or allosteric inhibition
NRTI: competitive nucleoside/tide RT inhibitor
NNRTI: Allosteric
Defect in the fusion of prechordal mesoderm- affects growth of midface, eyes and forebrain
Patau syndrome (13)
holoprosencephaly, microcephaly, microphthalmia, cleft lip, cleft palate, omphalocele
Patau syndrome (13)
Maturation of ovarian follicles, ovulation, and formation of corpus luteum
LH
Trophic to leydig cells in males and stimulates testosterone production
LH
Time Line of 4
4hours= Acute dystonia
4days= Akathisia
4weeks=bradykinisia
4months= tardive dyskinesia
Nasal flu vaccine
live attenuated
(MHC I and CD8+) Cell mediated
Injection flu vaccine
inactivated/killed
(induces neutralizing antibodies against HA) HUMORAL
who should be immunized for flu
everyone over 6mo old
Pericardial knock
earlier in diastole that S3
Constrictive pericarditis reduces ventricular compliance via an external force
A loud P2
Pulmonary hypertension
Restrictive pericarditis (positive Kussmal sign) why?
JVP should go down on inspiration but a fibrotic pericardium can not handle the increased VR so JVP pressure goes up.
CYP450 enzymes are heme containing proteins that are resposible for the majority of drug metabolism (mostly in liver). name the major subtypes
CYP3A, CYP2D, CYP2C
Prodrug metabolized by CYP2D to its active metabolite, endoxifen.
Tamoxifen
Woman with poor CYP2D on tamoxifen
exposed to decreased levels of drug’s active metabolite and have a higher risk of relapse
Downstream signal transducer that activates TFs to promote cell growth. Mutations associated with development of colorectal and lung cancers
KRAS
Decreased activity of hepatic N-acetyltransferase (wow)
decreased metabolism and increased toxicity of isoniazid and sulfonamides
Deficient thiopurine methyltransferase
6-MP cant be metabolized…becomes toxic
multidrug resistance in tumor cells
OVEREXPRESSION of P-glycoprotein (efflux)
Southwestern blots
identify and isolate proteins that bind DNA (ex: c-Jun and c-Fos, TFs, nucleases and histones)
S-100 ( neural crest marker)
homodimeric calcium-binding proteins (similar to calmodulin). Protein phosphorylation and cell growth and differentiation
cryptococcus neoformans
meningoencephalitis in HIV patient
Pneumonia is RARE
Autosomal recessive disorder of tyrosine metabolism
Alkaptonuria (tyrosine cant be turned into fumarate due to deficiency in homogentisic acid dioxygenase)
ochronosis
blue black pigment most evident in the ears, nose, and cheeks in alkaptonuria (AR) patients. (ochronotic arthopathy also a thing) ADULTHOOD manifestations usually
Inferior MI causes bradycardia…why?
RCA perfuses the SA and AV nodes
Blocks vagal influence on SA and AV nodes. Increases HR in patients with inferior MI
Atropine
People with disease of interest (cases) and people without the disease of interest (controls)
Case-control study
Median survival
calculated in cohort or clinical trials
compare median survival time in two or more groups of patients
LAD alone is occluded by atherosclerotic plaque
USE LEFT INTERNAL MAMMARY (thoracic) artery
*Superior patency rates
If multiple coronary arteries or vessels other than just LAD occluded
Use Great saphenous vein graft
Popliteal artery and vein course through popliteal fossa with tibial nerve. Common medical issues?
Popliteal artery aneurysms (majority of peripheral artery aneurysms.
Synovial (Baker’s) Cyst- associated with arthritis
Psychogenic or non-epileptic seizures can be seen in
conversion disorder
La belle indifference (incongruous lack of concern about symptoms) can be seen in
conversion disorder
Permanent CENTRAL DI
transient would be due to post. pituitary
Loss of hypothalamic vasopressinerginc neurons (supraoptic and paraventricular) due to trauma, surgery, or infiltrative disease (histiocytosis X) will lead to permanent DI
crescendo-decrsendo systolic ejection murmur at right sternal boarder.
Classic aortic stenosis
three major causes of valvular aortic stenosis
congenitally abnormal valve calcification (bicuspid valve)
calcified normal valve
RHD (MC in developing world…two above in US)
Marfan heart
aortic root disease that results in (aneurysmal dilation, aortic regurgitation (diastolic murmur), and aortic dissection)
where is aortic stenosis heard best?
right second intercostal space with radiation to the carotids
Primary biliary cholangitis
middle aged women and autoimmune diseases (sjogren and rheumatoid)
Ab in PBC
antimitochondrial
Granulomas and bile staining of hepatocytes (lymphocytic infiltration and intrahepatic bile duct destruction)
PBC
Most commonly affected organs in GVHD
Liver, GI, Skin
Post viral child with panlobular microvesicular steatosis
Reyes Syndrome
subepidermal, nonacantholytic blisters
Bullus Pemp (anti-hemidesmosomes)
Acute allergic contact dermatitis biopsy
spongiosis (abnormal accumulation of edema in fluid in the intercellular spaces between keratinocytes) and lymphocytic perivascular infiltrates
A competitive antagonist of endothelin receptors used for tx of idopathic pulmonary arterial HTN
Bosentan
Pulm HTN
medial hypertrophy (smooth muscle) intimal fibrosis Luminal narrowing Most severe: interlacing tufts of sm. vascular channels call plexiform lesions.
Inactivating mutation in pro-apoptotic BMPR2 gene–> increase endothelial and smooth muscle cell proliferation leading to vascular remodeling, elvevated pulm. vascular resistance and PTH
Familial PAH (primary pulmonary hypertension)
Family history w/ dyspnea and exercise intolerance in women 20-40
Familial PAH
red blood cells with small rings called trophozoites and BANANA-shaped gametocytes
P. Falciparum infection
Tx for ascariasis, trichuriasis, hookworm and pinworm
Mebendazole
Prophylaxis and tx for P. Jirvocecii in HIV patient. Also used in african sleeping sickness and leishmaniasis
Pentamidine
Require primaquine to treat liver hypnozoites
P. Vivax and P. Ovale
Forchheimer spots on soft palate
rubella
Unvaccinated close contacts of Hep A infection
immune globulin or vaccine
Hep A vaccine (inactivated) for high risk including…
living or travel to endemic areas, chronic liver disease or coag disorders, men having sex with men
Initiation of gene transcription: Binding of TFs to regulatory protein of the gene.
TF II D binds to TATA promotor sequence located about 25 BP upstream of coding region of the gene.
Transcription produced a pre-mRNA molecule containing introns and exons. Post-transcriptional modification in which INTRONS are removed via
snRNPs
Ciliated mucosal epithelium in lungs
trachea to proximal portions of respiratory bronchioles
Mucus-secreting cells are present to the level of the larger bronchioles, after which _______ cells become the prominent secretory cell type
Club
During thyroid surgery, nerve may be damaged do to close location of inferior thyroid artery
Recurrent laryngeal (branch of vagus)
unilateral: hoarseness
bilateral: inspiratory stridor and respiratory distress do to complete vocal cord paralysis
Foreign viral protein synthesis can be inhibited by __________, which induce synthesis of antiviral proteins that promote degradation of RNA and halt protein translation in virally infected cells only
alpha and beta interferon
Most common location of ectopic pregnancy (tubal ligation is actually a risk factor)
ampulla of fallopian tube (presents as adnexal mass on US)
Uterine specimen reveal decidualized endometrium only, dilated coiled endometrial glands and vascularized edematous stroma
ectopic pregnancy (absent chorionic villi)
molar prego or spontaneous abortion
Chorionic villi are enlarged and avascular edematous stroma
Inflammatory endometrial infiltrate (infection of decidua); Uterine tenderness, fever, tachycardia
endometritis
Straight short endometrial glands and compact stroma
proliferative phase (ex. day 7)
Gonorrhea Tx (FQNs no longer first line due to resistance)
3rd generation cephalosporin + azithromycin or doxycycline (cover chlamydia)
Drugs with high hepatic clearance have
HIGH LIPOPHILICITY and high volume of distribution
Low volume of distribution
good for excretion into urine unchanged and less hepatic metabolism
Supply the medial portion of the 2 hemispheres (frontal and parietal lobes)
Anterior cerebral artery (occlusion can cause contralateral motor and sensory deficits of lower extremities, behavior changes, and urinary incontinence)
First area to be damaged in global cerebral ischemia
Hippocampus
AIHA very similar to HS (indirect hyperbilirubinemia, elevated LDH, spherocytes) except
AIHA is not heritable, has positive direct coombs test, and propensity to develop other autoimmune diseases (SLE)
Complications of HS
pigmented gallstones and parvoB19 aplastic crisis
progressive HA with confusion
Hypertensive encephalopathy
Lacunar infarcts (small ischemic infarcts) are most commonly due to
hypertensive arteriolosclerosis of small, penetrating arteries
Hemosiderin-laden macrophages in pulmonary alveoli indicated chronic elevation of pulmonary capillary hydrostatic pressures most commonly due to
Left-sided heart failure
Secrete a secretory protein and surfactant components and also help to detoxify inhaled substances (smoke) by CYP450 mechanism
Club cells (Clara)
Incomplete fusion of urethral folds and presents as a ventrally located urethra (bottom)
Hypospadias
Rotation of testicals around spermatic cord
testicular torsion
Trauma or congenitally horizontal positioning of testes (bell clapper deformity)
Facilitates torsion
Wall thickening, pericholecystic fluid on US
acute cholecystitis (mc due to gallstones obstructing the cystic duct)
Cholescintigraphy
can be used to assess cystic duct patency and make diagnosis when US for acute cholecystitis is unclear
HCM (large transverse diameter of myocytes and haphazardly arranged myocytes)
AD mutations in sarcomere proteins (thick and thin filament components) MC = beta-myosin heavy chain
Chronic anemia
dilated cardiomyopathy
Hypersensitivity myocarditis
drugs caused, mononuclear infiltrate and eosinophils
Contact dermatitis, granulomatous inflammation, PPD skin test, and candida extract skin rx are examples of
type four hypersensitivity (occur 48-72 hours after antigen exposure) this is why you wait to read PPD
Exclusively ketogenic AAs
Lysine and leucine (great for pyruvate dehydrogenase deficiency)
Heberden and bouchard nodes w/ joint pain peeking in afternoon or evening after activity
Osteoarthritis (fingers, knees, hips, and spine MC)
Combo of genetic, metabolic and mechanical factors that result in defects in articular cartilage
osteoarthritis
Reactive arthritis bugs
salmonella, shigella, campy, chlamydia
involvement of lower extrimity joints accompanied by enthesitis (infammation at insertion of tendons)
Reactive arthritis
Blue black deposits in cartilage. Adults have sclerae and ear cartilage hyperpigmentation along with osteoarthropathy of large joints and spine
Alkaptonuria (AR)
Neucloside monophosphate (ie nucleotide) that requires only cellular kinases for activation. great for HIV patient with mutated viral thymidine kinase HSV infection
Cidofovir
Treatment of friends and family should be limited to
emergency situations when no other physician is available
Gold standard for diagnosing Hirschsprung disease (congenital aganglionic megacolon)
Rectal suction biopsy
Hydrogen breath test
used to diagnose lactose intolerance
Annovulation (ex: PCOD) is a common cause of infertility. how do you treat this infertility?
Menotropin (human menopausal gonadotropin) acts like FSH and triggers formation of dominant follicle. Ovulation can then be induced by admin of beta-HCG which mimics LH surge via its similar alpha subunit
Paraventricular tumors (ex: floor of fourth ventricle) w/ perivascular rosettes
Ependymomas
Hypercellular areas of atypical astrocytes bordering regions of necrosis (pseuodo-palisading)
GBM
benign tumors that involve cerebellum of children and young adults). Esosinophillic granular bodies and elongated hairlike processes (rosenthal fibers)
Pilocytic astrocytomas
Spindle cells with palisading nuclei arranged around verocay bodies composed of eosinophilic cores (Antoni A pattern)
Schwannomas
pregnancy and oral contraceptives predispose to
gallstone formation (female fat forty fertile)
Reduces bile acid secretion and slows gallbladder emptying
progesterone
Estrogen induced hypersecretion of cholesterol and progesterone-induced gallbladder hypomobility are responsible for
cholelithiasis (gallstones) in women who are pregnant or using oral contraceptives
Over-expression of this oncogene leads to increased sensitivity of of cells to mitogenic stimuli
Ras (signal transducer for MAP-kinase pathway)
Erb-B2 gene (proto-oncogene) overexpression =breast and ovarian cancer
Tyrosine Kinase activity related to epidermal growth factor receptor
Hyperplastic arteriolosclerosis (onion-like concentric thickening)
laminated SMCs and reduplicated basement membranes
homogeneous deposition of hyaline material in the intima and media of small arteries and arterioles (acellular thickening of arteriolar walls)
HTN (lower levels than hyperplastic)
Trigeminal neuralgia (tic douloureux)
electric-shock like or stabbing pain in V2 and V3 distrubution. Carbamazepine = DOC (monitor CBC due to risk of aplastic anemia)
saline microscopy
wet mount
Inhibits phagocytosis and compliment activation, mediates bacterial adherence and is the target of type-specific humoral immunity to S. pyogenes
M protein
Bortezomib (binds and inhibits 26S proteasome). USE?
In multiple myeloma it can facilitate apoptosis of neoplastic cells by preventing degradation of pro-apoptotic factors
46 XY adolescent who appears phenotypically female but has primary amenorrhea due to the absence of an internal female reproductive tract and the presence of cryptochid testes
Androgen Insensitivity Syndrome
The platelet function analyzer (PFA-100) test is abnormal in
NSAID use
Thrombocytopenia
Von Williebrand disease
CALMs in MAS vs CALMS NF1
NF1= smaller bilateral and smooth boarder (coast of cali) MAS= large unilateral with an irregular boarder (Coast of Maine)
MAS triad
CALMs (first)
Fibrous dysplasia of bone
Endocrine abnormalities
results from an activating mutation in the G protein/CAMP/AC signaling pathway
MAS (mosaic somatic mutation)
