All Subjects Flashcards
1
Q
PSGN light microscopy
A
hypercellular glomeruli (leukocyte infiltration)
mesangial and endothelial cell proliferation
2
Q
PSGN immunofluorescence
A
granular deposits (IgG, IgM, C3) in BM and mesangium
“starry sky”
3
Q
PSGN EM
A
subepithelial humps
4
Q
PKU
A
AR deficiency of phenylalanine hydroxylase
fair complexion (excess phenylalanine inhibits tyrosinase necessary for production of melanin), intellectual disability, musty odor
pallor of substantia nigra, locus ceruleus, and vagal nucleus dorsalis
5
Q
Linkage disequillibrium
A
2 genetic locci and alleles inherited together more or less often than expected give allele fequencies
6
Q
Langerhans cell histology
A
stellar cells
intracytoplasmic granules that replicate tennis racquet (birbeck granule)
act as dendritic cells and present antigens to T cells
7
Q
Accumulation effect of studies
A
exposure to risk or risk modifiers must sometimes occur for long periods before clinically significant effect is detected
8
Q
ankle sprain
A
most likely damage to anterior talofibular ligament (pain on anterolateral aspect of ankle)
9
Q
Wilsons disease neuro changes
A
atrophy of basal ganglia after copper leaks from damaged hepatocytes
decreased ceruloplasmin
10
Q
Viral gastroenteritis outbreaks
A
most likely norovirus in developed countries
(rotavirus immunization)
Sx: vomiting and watery diarrhea
11
Q
CAAT and TATA
A
promoter of transcription in eukaryotic genome
12
Q
Enhancer sequences
A
bind activator proteins that facilitate bending of DNA
Silencers have opposite effect
13
Q
Effect of slow acetylators
A
slow metabolism of isoniazid, dapsone, hydralazine, and procainamide
14
Q
Prevalence
A
incidence * duration of disease
Prevalence is increased with factors that prolong disease duration (decreased mortality, higher quality of care, etc.)
15
Q
Risks associated with prostatectomy
A
injury to prostatic plexus can cause erectile dysfunction
16
Q
Cremasteric reflex
A
L1-L2 genitofemoral nerve
damage seen with testicular torsion
17
Q
Embryology of uteric bud
A
forms collecting system of kidney
- collecting tubules and ducts
- major and minor calyces
- renal pelvis
- ureters
18
Q
Embryology of metanephric mesoderm
A
- glomeruli
- bowman’s space
- proximal tubules
- loops of henle
- distal convoluted tubles
19
Q
Tamoxifen
A
SERM used in tx of estrogen receptor positive breast cancer
antagonist at breast, agonist at endometrium
prodrug metabolized by CYP2D to active metabolite, endoxifen
CYP polymorphisms change concentration of active metabolite in serum
20
Q
INH moa
A
activated by mycobacterial catalase peroxidase and requires specific protein sequence in enzyme target
resistance by non-expression of catalase-peroxidase enzyme or genetic modification of INH binding site on mycolic acid synthesis enzyme
21
Q
Analysis of variance
A
used to determine whether there are significant differences in the means of several independent groups
22
Q
Chi square tests
A
used to evaluate association between 2 categorical variables
23
Q
Multiple logistic regression
A
used to predict probability of binary outcome based one 1 or more independent variables
24
Q
Pearson correlation coefficient
A
measure of the strength and direction of linear relationship between 2 quantitative variables
25
CMV torches
```
chorioretinitis
sensorineural deafness
seizure
jaundice
hepatomegaly
splenomegaly
microcephaly
```
26
Surface marker of macrophages
CD14
27
Klinefelter Syndrome
Path: nondisjunction of sex chromosomes (47XXY)
Clinical: primary hypogonadism, tall, gynecomastia, mental retardation
Labs: low testosterone, high FSH, LH (loss of feedback inhibition), high estradiol
28
Gynecomastia with exogenous steroid use
increased androstenedione levels
Also see acne, male-pattern baldness, short stature, aggression
29
Triad of congenital rubella
1. congenital cataracts (white pupils)
2. Sensory-neural deafness
3. PDA
30
Bulimia
binge eating with compensatory behaviors to prevent weight gain (nl to high BMI)
vs. anorexia (significantly low BMI <18.5)
31
Major depressive disorder
>2 week
>5 SIGECAPS
No history of mania or hypomania
Not due to another condition
32
Goodpastures Syndrome
anti-glomerular basement membrane (type Iv collagen) + and lung basement membrane
linear immuno
see glomerular crescents with proliferating parietal cells, monocytes, and macrophages on EM
33
JGA
Release renin in response to hypoperfusion of kidney
smooth muscle cells in afferent afteriole
34
Clasp knife spasticity
initial resistance to passive extension followed by sudden release
35
Internal capsule stroke
pure motor weakness of contralat arm, leg and lower face
36
Methionine cycle
methionine -> homocysteine -> cystein
37
Homocystinuria
cystathione synthase deficiency
Homocysteine is prothromtoic therefore see hypercoag, thromboembolic occlusion, ACS
ectopia lentis and intellectual disability can also be seen
38
2 year old speech development milestones
50-200 words
| 2 work phrases
39
inulin
compound with no tubular resorption, used to model the glucose clearance with inhibition of sodium-coupled transport of glucose
40
Paraaminohippuric acid (PHA)
clearance of PAH used to calculate renal plasma flow
amount excreted > filtered load
41
Pellagra
vitamin B3 (niacin) deficiency
photosensitive dermatitis, diarrhea, dementia
Important in citric acid cycle as cofactor
42
Cholesteatomas
collections of squamous cel debris behind tympanic membrane that form pearly mass
43
Primaquine
eradicates hynozoites (latent forms of malaria) to prevent disease relapse
44
Kiesselbach plexus
anastamoses and highly vascular mucosa in anterior nasal septum (common cause of nose bleeds)
1. Anterior ethmoidal
2. sphenopalatine
3. superior labial artery
all anastomose in this region
45
lead time bias
apparent increase in survival time among patients undergoing a screening when they have an unchanged prognosis
46
rituximab
monoclonal ab used in lymphoma immunotherapy that targets the CD20 surface IG
47
Infliximab
IgG1 monoclonal ab to TNFalpha
tx of RA, ankylosing spondylitis, and fistulizing crohn's disease
48
IL-2
cytokine that regulates activation and differentiation of t cells (tumor destruction)
used in tx of renal cell carcinoma and melanoma
49
Imatinib
inhibits BCR/ABL fusion gene
tx of CML
50
Abciximab
ab against GP IIb/IIIa receptor
blocks final step in platelet aggregation used to tx ACS
51
Odds ratio
measure of association
OR=odds of exposure in case/odds of exposure in controil
52
T cell ALL
fever, fatigue, pallor, petechia, bleeding, lymphadenopathy, HSM, bone pain
```
large anterior mediastinal mass that can compress superior vena cava (SVC syndrome) or compress the esophagus (dysphagia)
and trachea (dyspnea and stridor)
```
53
Churg-Strauss
Eosinophilic granulomatosis with polyangitis
small-med vessel vasculitis with asthma, rhinosinusitis, eosinophilia
asymmetric neuropathy (wrist drop)
anti neutrophil myeloperoxidise (p-ANCA)
54
Warfarin toxicity bleeding
Vit k (takes a few days)
FFP (immediately effective)
55
Heparin toxicity bleeding
protamine
heparin specific antidote
56
Acute dystonia
due to D2 antagnoism in nigrostriatal pathway
57
Patent urachus
straw colored urine discharge from umbilicus
58
Reverse t3
From peripheral conversion of T4
59
Axillary nerve
shoulder abduction (deltoid muscle)
sensory over upper lateral arm
60
Trousseau syndrome
migrating thrombophlebitis due to visceral cancer
adenocarcinoma produces thromboplastin like substance
61
Desmopressin (DDAVP)
1. hemophilia A and vWF disease: increases circulating factor VIII and endothelial secretion of vWF to stop bleeding
2. centrai DI: binds V2 receptors in renal tubular cells leading to increased aquaporin channels, increased water reabsorption and decreased urine output
62
Pleiotrophy
multiple, unrelated phenotypic manifestations as a result of a single gene defect
63
Transferance
unconscious shifting of emotions or desires from a person of the past to another person in the present
64
displacement
person expresses unacceptable feelings meant for someone in their present life toward a different, "safer" person
65
Projection
misattributing ones own unacceptable feelings to another person
66
Reaction formation
uncomfortable feelings are transformed into their opposites
67
Tibial nerve
plantar flexion, inversion, toe flexion
sensory to plantar foot
68
Risk of second hand smoke exposure
1. prematurity, low birth weight
2. SIDS
3 middle ear infection
4. asthma
5. URI
69
PAH
Intimal hyperplasia, fibrosis, and medial hypertrophy with formation of capillary tufts
70
Hearing tests in conductive hearing loss
BC>AC in rinne test and weber test lateralizes to affected ear
71
Hearing tests in sensorineural hearing loss
AC>BC in rinee and weber test lateralizes to unaffected ear
72
Factitious disorder
intentional falsification or inducement of symptoms with goal to assume sick role
ex: deceptive reporting of symptoms, manipulating lab samples, ingesting substances, altering medical records, inducing illness
Malingering includes a secondary gain
73
Buspirone
partial agonist of 5HT receptor used for GAD
slow onset of action, no muscle relaxant or anticonvulsant properties
74
Hemolytic disease of the newborn
maternal anti-fetal erythrocyte antibodies cause a type II HSR
Maternal A and B antibodies are IgM and do not cross placenta and cause disease
maternal O ab are IgG and can cross the placental to cause fetal hemolysis
75
Lactotrophs
release prolactin
Prolactinomas present with hypogonadism, infertility, galactorrhea and amenorrhea
76
Corticotrophs
secrete ACTH
ACTH secreting tumors present with Cushing's disease
77
Somatotrophs
Secrete GH
tumor: acromegaly or gigantism
78
Thyrotrophs
secrete TSH
tumor: thyrotoxicosis
79
Gonadotrophs
secrete LH and FSH
tumor: hipopituitarism or mass effect
80
Selegiline
MAO B inhibitor
used to delay progression of parkinsons disease
81
Biotin as a cofactor
B7
```
1. Gluconeogenesis
pyruvate to oxaloacetate (pyruvate carboxylase)
2. FA syntehsis
Acetyl CoA to malonyl CoA (acetyl CoA carboxylase)
3. Fatty acid oxdation
propionyl Co-
A to methylmalonyl CoA
(propionyl CoA Carboxylase)
```
82
Biotin deficiency
rare
poor diet
excessive egg white consumption (biotin binding avidin)
congenital disorders
83
C peptide
measure of endogenous beta cell insulin secretion
Increased with sulfonylrueas and melitnides
84
Acarbose
inhibits alpha glucosidease in intestinal brush border and decreases postpradial glucose absorption
85
Thyroid dermopathy
stimulation of fibroblasts by TRAb and t cells leads to excess production of glycosaminoglycans and adipogenesis
induration and thickening of skin over shins (pretibial myxedema)
86
lipofuscin
yellow, brown finely granular perinuclear pigment
product of free radical injury and lipid perosidation
87
Anthracosis
carbon or coal dust taken up by macrophages within lung perenchyma
88
Fetal effects of maternal diabetes
congenital malformations (cardiac, ntd)
asphyxia
growth restriction
polycythemia
Increased fetal insulin (hyperplasia of beta cells):
macrosomia
hypertrophic cardiomyopathy
hypoglycermia after delivery
glucose can pass to fetus, but insulin is catabolized by placenta
89
Glucocorticoid induced myopathy
progressive proximal muscle weakness and atrophy WITHOUT pain
lower extremitys more invovled
normal creatinine kinase
90
Polymyalgia rheumatica
muscle pain and stiffness in shoulder, neck, and pelvic giirdle
worse in morning and with activity
normal creatinine kinase
91
Inflammatory myopathies
polymyositis and dermatomyositis
proximal muscle weakness, skin rash and inflammatory arthritis possible
high creatinine kinase
92
Statin-induced myopathy
proximal muscle weakness and pain weeks to months after starting a statin
increased creatinine kinase
93
Hypothyroid myopathy
muscle pain, crams and weakness in proximal muscles
delayed tendon reflexes and myoedema
increased CK
94
Features of cushings
```
central obesity
skin atrophy and purple stria
proximal muscle weakness
hypertension
glucose intolerance
skin hyperpigmentation (ACTH excess)
```
dg: 24 hour urinary cortisol, late night salivary cortisol, dexamethasone suppression test
95
Small intestinal bacterial overgrowth
overproduction of vitamin k and folate with nausea, bloating, abdominal discomfort, and malabsorption
96
Piriformis syndrome
piriformis passes through greater sciatic foramen and is involved in external hip rotation
compression of sciatic nerve can cause piriformis syndrome (pain, tingling, and numbness in buttocks and posterior thigh)
97
High alpha fetaprotein
1. Ntd
2. ventral wall defects (omphalocele, gastroschisis)
3. multiple gestation
98
Down syndrome lab rsults
low AFP and low unconjugated estradiol
increased beta hcg and inhibin A
99
Incretins
GI hormones
glucagon like peptide 1 (GLP1)
Gastric inhibitory peptide (GIP)
stimulates pancreatic insulin secretion in response to ingestion of foods
why more insulin is released from oral than iv glucose
100
delta agent infeciton
Hep D infection
Can only occur with concominant hep B infection (encapsulated with HBsAg
101
Chronic lung rejection
bronchiolitis obliterans
obstructive lung disease with lymphocytic infiltration, and ultimately fibrosis scarring and obliteration of small airways
102
hepatic encephalopathy
increased levels of ammonia increase glutamine production and release disrupting excitatory neurotransmission
103
Genital lesions of syphillis
Primary: chancre
Secondary: Condyloma lata
tertiara: gumma
104
PAS stain
stains glycoprotein
used to diagnose trpheryma whippelii
105
Trypheryma Whipelli
gram positive actinomycete
abdominal discomfort, loose stool, weight loss
dg with PAS stain
106
Contact dermatitis
Type Iv HSR (t cell mediated)
characterized histologically by spongiosis (accumulation of edema fluid in intracellular spaces of epidermis) perivascular lymphocytes and eosinophils
107
Acyclovir nephrotoxicity
When acyclovir in collecting duct exceeds solubility, crystallization, and rental tubular damage can occur
Can be prevented (and treated) with adequate hydration and reduction in rate of drug infusion
108
Congenital Long QT syndrome
Mutation in K+ channels that decrease outward potassium flow and predispose to syncope, seizures, and sudden cardiac death due to arrhythmia (tDP)
109
Plegoticase
Urate oxidase that converts uric acid into soluble allantoin which promotes excretion
can cause hemolysis in G6PD deficiency (bit cells)
anaphylaxis
administered IV
110
Common medical conditions with polygenic inheritance
1. androgenic alopecia
2. epilepsy
3. glaucoma
4. hypertension
5. ischemic heart disease
6. schizophrenia
7. Type II DM
111
Causes of polyhydraminos
1. fetal GI obstruction
(esophageal, duodenal, intestinal atresia, enencephaly
2. high fetal cardiac output (alloimmunization, parvovirus infection, fetomaternal hemorrhage)
112
Abx against cell wall of bacteria
1. penicillins
2. cephalosporins
3. vancomycin
113
Step pyogenes M protein
alpha helical coiled protein
shares structural homology with tropomyosin and myosin
prevent phagocytosis by inhibiting complement binding, also aids in epithelial attachment
114
Scapular winging
due to long thoracic nerve damage and paralysis of serratus anterior muscle
common with axillary lymph node dissection
weakness in abduction above horizontal due to impaired rotation of scapula
115
Acute parotitis
RF: dehydration, intubation, decreased salivary flow (anticholinergics), salivary flow obstruction and recent teeth cleaning
often s. aureus
Ductal inflammation and abscess and elevated serum amylase without pancreatitis and normal serum lipase
116
Serum marker of osteoclast activity
1. tarate-resistant acid phosphatase
2. urinary hydroxyproline
3. urinary deoxypyridinoline (most reliable)
117
Streptomycin
binds 30s ribosomal subunit and prevents protein synthesis
118
perianal fistulas
Crohn disease
mouth to anus
spares rectum
full thickness inflammation
119
Suspensory ligament of ovary
contains ovarian artery
120
Transverse cervical ligament
Contains uterine artery
121
Carotid sinus reflex
afferent limb: baroreceptors to glossopharyngeal nerve
efferent limb: parasymp via vagus nerve
122
Virulence of diptheria
Exotoxin AB
acquired via phage mediated infection with Tox gene (lysogenization)
123
Tetralogy of Fallot
Anterior and cephalad deviation of infundibular septum during embryologic development
124
Pulsus paridoxus
measured via Korotkoff sounds
decrease in systolic blood pressure > 10 mmHg with inspiration
Cardiac tamponade, severe asthma, COPD, constrictive pericarditis
125
Treatment of COPD
Beta 2 agonist
Gs couples increase intracellular cAMP
126
Signs of constrictive pericarditis
1. increased JVP
2. Kussmaul sign (paradoxical rise in JVP with inspiration)
3. Pulsus paradoxus
4. pericardial knock
127
Kussmaul sign
rise in JVP with inspiration
seen in constrictive pericarditis
128
Third degree heart block
P and QRS are not related
SA node causes contraction of atria
AV node causes contraction of ventricles
129
Drugs that improve survival in systolic HF
1. ACE inhibitors
2. ARBs
3. aldosterone antagonists
4 beta blockers
130
Hyperplastic arteriolosclerosis
Diastolic pressures >130
onion-like concentric thickening of walls
Renal and ophthamologic symptoms
131
Osler Weber Rendu syndrome
hereditary hemorrhagic telangiectasia
132
Von ricklinhausen disease
NF1
neurofibromas, optic gliomas
lisch nodules
cafe au lait spots
133
NF2
b/l CN VIII schwanoma and meningioma
134
Strug Weber
cutaneous facial angiomas
leptomeningeal angioma
metal retardation
seizures
hemiplegia
skull radiopacities (tram track appearance)
135
Resistance to penicillins
Beta lacatamse
mutated PBP
mutated porin protein
136
Resistance to vancomycin
mutated cell wall
| impaired influx/increased efflux
137
Resistance to quinolones
mutated DNA gyrase
| impaired influx/ increased efflux
138
Resistance to aminoglycosides
mutated ribosomal subunit protein
mutated porin protein
aminoglycoside-modifying enzymes
139
Tetracyclines resistance
impaired influx/increased efflux
inactivated enzyme
140
Resistance to rifamycin
mutated RNA poll
141
PBP
transpeptidase
142
Thayer martin agar
chocolate sheep blood agar infused with vancomycin (inhibit gram positive bacteria), colistin and trimethoprim and nystatin (inhibits yeast growth)
143
C. perfringens
gas gangrene of penetration injuries (alpha toxin lecithinase)
late-onset food poisoning with transient watery diarrhea (toxin produced inside body,
144
Blunt aortic injury
most likely occurs at aortic isthmus (after subclavian artery branch)
145
Treatment of bacteroides infection
piperacillin (extended specturm penicillin)+Tazobactam (beta lactamase inhibitor)
146
pyrrolidonyl arylamindase test (PYR)
test to determine s. pyogenes
S pyogenes are PYR positive
147
Keloid
excess TGF beta leads to excess, disorganized collagen formation
148
Stop codons
UAG
UAA
UGA
149
Hypertrophic cardiomyopathy
AD
mut in beta-myosin heavy chain or myosin binding protein
c
150
Male embryonic sex development
MIF: regression of mullerian ducts that give rise to female internal genitalia
Testosterone: development of male internal genitalia
DHT: development of male external genitalia
151
Depersonalization/Derealization disorder
depersonalization(feelings of detachment from or being outside ones self)
derealization (experiencing surroundings as unreal)
intact reality testing
152
Dissociative amnesia
inability to recall important personal information (usually stressful nature)
not explained by other disorder
153
dissociative identity disorder
discontinuity in identity and loss of agency with fragmentation into >2 distinct personality states
(severe trauma/abuse)
154
Calcium sensing receptors
G protein coupled receptors that regulate secretion of PTH in response to changes in calcium concentration
155
Familial hypocalicuric hypercalcemia
AD
defect in CaSR i PTH and kidney
higher serum Ca levels required to suppress PTH secretion
Mild Asx hypercalcemia
Reduce urinary excretion of Ca
High PTH
156
Chronic interstitial nephritis
Chronic NSAID use
patchy inflammation and papillary necrosis with scarring
Calcium deposits
157
Gigantism
HyperGH secretion, secretion of IGF-1 from hepatocytes and activation of JAK-STAT pathway
158
G6PD
rate limiting step of pentose phosphate pathway
X linked recessive
Increased oxidative stress with animalarials and sulfonamides
159
Lateral epicondyltis
Tennis elbow
elbow pain worse with activity
attachment point of extensor carpi radialis brevis (wrist extension)
160
Who is eligible for medicare?
individuals >65 and older who have a work history and younger individuals with disbilities
161
Frameshift mutations
deletion or insertion of bases not divisible by 3
162
Conduct disorder
1. aggression towards people or animals
2. destruction of property
3. serious violation of rules
4. decietfulness of theft
163
Cleft lip
failed fusion of intermaxillary segment and maxillary prominence
164
Cleft palate
palatine shelves fail to fuse with each other or primary palate
165
Factor V leiden mutation
inherited coagulability
Factor Va resistance to inactivation by protein C
166
BRCA
Tumor suppressor gene
in charge of DNA repair genes
167
Suicide risk factors
1. previous attempts
2. psych disorder
3. single
4. live alone
5. elderly white man
6. unemployed or unskilled
7. physical illness
8. family history
9. access to firearms
10. substance abuse
168
Polycythemia Vera
uncontrolled erythrocyte production
mutation in JAK2 cytoplasmic tyrosin kinase associated with erythropoietin receptor
169
Hypercalcemia
1. Exogenous Vit D excess
2. granulomatous disease (sarcoid, TB
3. hodgkin and non-hodgkin lymphoma
170
Attrition bias
form of selection bias in which loss to follow up occurs disproportionately to expose and unexposed groups
171
PCOS
Androgen excess
ovarian dysfunction
insulin resistance
obesity
Increased risk of endometrial carcinoma
increased activity of 17alpha hydroxylase, 17,20 lyase and 3 beta hydroxysteroid dehydrogenase
172
Morphological characteristics of osteoporosis
Trabecular thinning and perforation with loss of interconnecting bridges
173
Thiazolidinediones (TZD)
bind PPAR gamma
Upregulate
GLUT4 (insulin responsive glucose transporter on adipocytes and muscles)
Upregulates adiponectin (cytokine secreted by fat and increases number of insulin-responsive adipocytes and regulates FA oxidation)
174
Diseases transmitted via direct contact
1. mono
2. lymphogranuloma venereum
3. RSV, rhinovirus, norwalk virus
175
Diseases transmitted via Droplet
1. influenza
2. meningococcus
3. andenovirus, pertussis
176
Diseases transmitted via airborn
1. TB
2. Measels
3. chicken pox
4. small pox
N95 mask!!
177
Diseases transmitted via mosquito
1. malaria
2. dengue fever
3. chikungunya
178
Diseases tranmitted via ticks
1. lime disease
2. Rickettsia
3. Babesiosus
179
Glucagon
increases hepatic glucose production via glycogenolysis and gluconeogenesis
stimulate G proteins receptors on hepatocytes increasing cAMP and activating protein kinase A
180
Tetracycline effect on fetus during pregnancy
Stained teeth
181
Chloramphenicol effect on fetus during pregnancy
"gray baby" syndrome
182
Trimethoprim/sulfa effect on fetus during pregnancy
NTD
183
Aminoglycosides effect on fetus during pregnancy
ototoxicity, vestibulotoxicity
184
Rheumatoid Arthritis
1. pain and swelling
2. morning stiffness
3. small joints (spares DIP)
4. fever, weight loss, anemia
5. cervical spin involvement
labs:
1: RF
Anti CCP antibodies
(Anti-cyclic citrullinated peptide )
2. C reactive protein and ESR
XRay: soft tissue swelling, joint space narrowing, bony erosions
185
Granuloma formation
Macrophages release TNF alpha and pro-inflamm cytokines (IL6, IL1, IL12) that promotoe macrophage and Th1 cell differentiation
Th1 produce IL2 and IFN gamma to promote further inflammation
186
Fetal Hydronephrosis
most common site of obstruction is ureteropelvic junction
newborns with palpable abdominal mass and enlarged kidney
187
Prophyria cutanea tarda
uroporphyringoen decarboxylase deficiency (UROD) of porphyrin synthesis
causes photosensitivity due to accumulation of porphyrinogens that react with oxygen on excitation by UV light
188
Labs in Klinefelters syndrome
Increase LH and FSH
| decreased testosterone
189
LH and FSH in male
LH -> test
FSH -> inhibin
190
Turner Syndrome
1 coarctation of aorta
2. bicuspid aortic valve
3. horseshoe kidney
4. streak ovary
```
narrow, high arched palate
low hairline
webbed neck
broad chest/widely spread nipples
cubitus valgus
short stature
```
191
piriformis recess
superior laryngeal nerve damage (cough reflex)
192
Acute hemolytic tranfusion reaction
Type II HSR against pre-existing anti-ABO abs
Complement reaction that causes erythrocyte lysis, vasodilation and shock
193
IL4
produced by TH2
facilitates b cells and Th2
abs isotype switching to IgE
194
paranoid personality
suspicious, distrustful, hypervigilant
195
Schizoid personality
prefers to be alone, detatched, unemotional
196
Schitzotypal personality
eccentric, odd thoughts, perceptions, behavior
197
Antisocial personality
disregard and violation of others
198
Borderline personality
chaotic relationships, sensitivity to abandonment, labile mood, impulsie, inner emptiness, self harm
199
histrionic personality
dramatic, superficial, attention seeking
200
narcissistic personality
grandiosity, entitlement, lack of empathy
201
avoidant personality
avoidance due to fears of criticism and rejection
202
dependent personality
submissive, clingy, needs to be taken care of
203
Rett syndrome
normal development until 5-18 months then loss of motor and language skills, stereotypic hand movements, deceleration of head growth
de novo mut in x linked MECP2 gene
204
pramipexole
direct dopamine agonist
205
APL
Auer rods
| 15;17
206
tubular fluid with low ADH
highest osm: bottom of loop of henle
207
Vasopressin
increases water permeability within cortical and medullary collecting duct
activates urea transporters in medullary collecting duct increasing urea reabsorption
208
Cyanide poisoning
Inhibits cytochrome c. oxidase in mitochondria
red skin, tachypnea, headache, tachy, n/v, confusion
tx: inhaled amyl nitrite oxidizes Fe2+ to Fe3+ with greater affinity for cyanide (sequesters cyanide and keeps it from binding cytochome oxidase)
209
G6PD
increased oxidative stress due to lack of NADPH
210
Glutathion reductase
uses NADPH to reduce glutathione
211
Prognosis of PSGN
poor: age, pre-existing kidney disease
212
PSGN tx
anithypertensives, salt/water restriction, diuretic
213
Metabolic alkalosis diganosis
Need urine chloride
214
hemochromatosis
HFE (hepatocytes and enterocytes)mutation interacts with transferrin receptor
decreased hepcidin and DMT1 leads to iron overload
increased risk for cirrhosis and hepatocellular carcinoma
215
Gonadal arteries
arise from abdominal aorta
torsion can lead to ischmia
216
Osteoblastic bone metastasis
1. prostate
2. small cell lung
3. hodgkin lymphoma
217
Osteolytic bone metastasis
1. multiple myeloma
2. non small cell
3. non hodkin
4. renal cell carcinoma
5. melanoma
218
Cavernous Hemangioma
most common benign liver tumor
cavernous blood filled vascular spaces of variable size lined by single epithelial layer
219
Gram negative sepsis
LPS release from cell during division of lysis
Lipid A activates Macrophages leading to widespread release of IL-1 and TNR alpha leading to septic shock
220
Methotrexate
Dihydrofolate reductase inhibitor
death of all rapidly dividing cells (GI, bone marrow)
tx of toxicity: folinic acid
221
Radial nerve injury
hyperextension injury (supracondylar humerus fracture with anterolateral displacement)
wrist drop and loss of sensory of posterior forearm/dorsolateral hand
222
radial nerve
hand/finger extensor
sensory to posterior forearm and dorsolat hand
223
Ulnar nerve injuries
hyperflexion injuries (falling on fixed elbow) posterior displacement of proximal humerus or fracture of medial epicondyle
sensory loss over medial 1.5 digits and weaness of flexion of 4th and 5th digits and wrist
224
ulnar nerve
wrist flexion and 4th and 5th finger flexion
225
Mature mRNA
1. 5' cap (7-methyl-guanosine)
2. poly-A tail at 3' end
3. Splicing (GU at 5' and AG at 3' splice site
226
Cyclosporine
inhibits calineurin activation (necessary for activation of IL-2, which promotes growth and differentiation of T cells
227
Tacrolimus
inhibits calcineurin activation
228
Which part of kidney is most susceptible to ischemic injury
Renal medulla (esp proximal tubule and thick ascending lim of henle) due to active transport (ATP) depending of ions
229
Acute Tubular Necrosis
decreased renal perfusion
increased creatinine and BUN with normal BUN/cr ration and oliguria
Histo: flattening of proximal tubular epithelial cells with loss of brush border, and cell necrosis of basement membrane
Muddy brown casts
230
Muddy Brown Casts
ATN
231
Uric acid kidney stones
often occur in distal tubules or collecting duct due to low pH
(tumor lysis syndrome)
232
Etoposide
chemotherapy agent that inhibits sealing of topoisomerase II
double stranded DNA breaks seen
233
Smooth ER
Detox
Steroid hormone synthesis
lipid synthesis
carb metabolism
234
Latanoprost
topical prostaglandin used in tx of closed angle glaucoma
increase outflow of aqueous humor
235
HER2
transmembrane glycoprotein with intrinsic tyrosine kinase activity (eGFR)
236
ER and PR
intracellular receptors
increase cellular proliferation
237
Papillary muscle rupture
anterolat papillar muscle: LAD
Posteriomed pap muscle: posterior descending
238
Follicular lymphoma
non-Hodgkin lymphoma
t(14;18) Bcl2 over expression
anti-apoptotic effects
239
Ataxia Telagiectasia
1. Ataxia
2. Telangiectasias
3. Sinopulmonary infections
240
Chediak-Higashi Syndrome
1. Oculocutaneous albinism
2. pyogenic infections
3. Progressive neurologic dysfunction
241
Chronic granulomatous disease
1. severe bacterial and fungal infections
| 2. granuloma formation
242
DiGeorge Syndrome
1. Congenital Heart Disease
2. Dysmorphic facies
3. hypocalcemia
4. hypoplastic thymus
5. hypoplastic parathyroid causing hypocalcemia
Complete DGS is a type of SCID
243
SCID
1. severe bacterial and viral infections in infancy
2. Chronic diarrhea
3. Mucocutaneous candidiasis
thymic aplasia
244
Terminal complement deficiency (MAC)
Recurrent Neisseria infections
245
Wiskott-Aldrich syndrome
1. Recurrent infections that worse with age
2. Easy bleeding (thrombocytopenia)
3. eczema
246
Common variable immunodeficiency
B and T cell dysfunction
hypogammaglobulinemia
recurrent infections in children and adults
cell mediated immunity is not as impaired
247
X-linked agammaglobulinemia
insufficient mature B cells
2. infection with encapsulated pyogenic bacteria
248
Patau Syndrome
Trisomy 13
```
Microcephaly
cutis aplasia
micrphthalmia
cleft lip/palate
umbilical hernia/omphalocele
rocker bottom feet
renal defects
cardiac defects
polydactyly
```
impaired fusion of prichordal mesoderm
249
Edward's Syndrome
Trisomy 18
```
fetal growth retardation
hypertonia
micrognathia
congential heart defects
clenched hands with overlapping fingers
Meckel's diverticulum
malrotation
```
250
Idiopathic intracranial hypertenison
Young obese women
H/A
Papilledema
transient visual disturbances worse with valsava
251
TX of BPH
1. alpha antagonsits (terazosin, tamsulosin
2. 5-alpha-reductase inhibitor (finasteride, dutasteride)
3. antimuscarinic (tolterodine)
252
finasteride
inhibits conversion of testosterone to dihydrotestosterone
reduces prostate gland size
SE: decreased libido, ED
253
Tumor suppressors
1. APC
2. BRCA1
3. RB
4. TP53
254
APC
tumor suppressor in Adenomatous polyposis syndrome
colon cancer
255
BRCA1
TS responsible for dna repair
breast and ovarian cancers
256
RB
Tumor suppressor that regulates transition from G1 to S
257
TP53
Tumor supressor gene
p53 inhibits proliferation of cells with genetic abnormalities
258
Sickle cell
Substitution of valine (hydrophobic) for glutamic acid (hydophilic)
259
Nitroprusside toxicity
Cyanide toxicity
```
tx: sodium nitrate (methemoglobin formation),
sodium thiosulfate (sulfur donor), hydroxocobalamin (cobalt binds cyanide)
```
260
Burkitt Lymphoma
Associated with EBV
t(8;14)
cmyc (transcription activatior)
261
Mantle cell LYmphioma
t(11;14) cyclin D1
promoter of g1 to S transition
262
CML
BCR-ABL (9;22)
inhibits apoptosis and promotes mitogenesis and increased tyr kinase activity
263
Alkaptonuria
AR disorder of tyrosine metabolism
urine turns black
black pigment in ears, nose and cheeks
264
Akathisia
Subjective restlessness and inability to sit still
symptom of antipsychotics (Extrapyramidal)
265
IgA Nephropathy
Painless hematuria 5-7 days after URI
Mesangial hypercellularity and IgA deposits
With extra renal symtpoms AKA Henoch Schonlein purpura
266
Alport syndrome
Defective type IV collagen
Lamellated appearance of BM
267
Recombination
gene exchange that occurs through crossing over of 2 double stranded DNA molecules
268
Reassortment
Mixing of genome segments in segmented viruses that infect same host cell
269
DNA Pol III
5'-3' DNA synthesis and 3'-5' exonuclease (proofreading)
270
DNA pol 1
Same as pol III
also removed RNa primer (5'-3' exonuclease)
271
Granulosa Cell Tumor of Ovary
1. increase in estrogen (endometrial hyperplasia, precocious puberty)
2 Increased inhibin
Call exner bodies (cuboidal granulosa cells in rosette pattern with coffee bean nuclei)
Yellow theca cells with lipid
272
DIC in pregnancy
due to release of tissue factor from placental trophoblasts following placental injury
273
Multiple myeloma
Bone marrow with >30% plasma cells
1. normocytic normochromic anemia
2. Bone resorption due to Il-1 and IL-6 activation of osteoclasts
3. hypercalcemia
4. increases susceptibility to infection
5. al amyloid in kidneys, heart, tongue and CNS
6. Rena fialure
