Combank Flashcards
X linked recessive, a/w defect in BTK tyrosine kinase gene
dx?
what does this defect cause?
Bruton agammaglonulinemia
blocks maturation leading to a decrease in mature B cell, failure to generate plasma cells, and severely decreased production of all classes of immunoglobulins
insufficient opsonization of pathogens with IgG
a defect in the production of IFN-gammma describes a pt with…
what cells are responsible for this?
hyper-IgE syndrome aka Job syndrome
Helper T cells fail to produce or under-produce IFN-gamma
An OD of anticholinergic agents, such as atropine and ipratropium can be reversed with what drug?
What is the MOA?
physostigmine
AChE inhibitor
What is the reversal agent for heparin toxicity?
protamine
What is the antidote for iron toxicity?
What are ssx of iron toxicity?
What would be the cause of death if untreated?
deferoxamine
N/V d/t erosion of stomach lining
metabolic acidosis develops, along with liver and brain damage
death d/t hepatotoxicity
What is the antidote to ethylene glycol toxicity?
How does this work?
fomepizole or ethyl alcohol/ethanol
fomepizole inhibits alcohol dehydrogenase (metabolizes ethylene glycol and methanol)
Where are AT2-6 tender points located?
Where is AT2 specifically?
mid-line on sternum at the level of the corresponding rib
junction of manubrium and sternum (angle of Louis)
articulatory techniques are defined as…
low velocity, moderate to high amplitude where a joint is carried through FROM witht he goal of increased mobility
microdeletion on chromosome 7 specifically including deletion of elastin gene
William syndrome
elfin faced child
mental developmental delay
well-developed verbal skills
high calcium levels on labs bc of increased sensitivity to vitamin D
extreme friendliness toward strangers
DX?
William syndrome
microcephaly, mental developmental delay, high pitched cry or mewing in child
dx?
genetic abnormality?
Cri-du-chat
microdeletions of chromosome 5
rocker-bottom feet, microphthalmia, microcephaly, cleft-lip, holoprosencephaly, and polydactyly
dx?
genetic association?
Patau syndrome
trisomy 13
mental developmental delay, rocker-bottom feet, micrognathia, clenched hands, and congenital heart defects
Dx?
genetic abnl?
Edwards Syndrome
trisomy chromosome 18
What tender point is located in the superior aspect of the popliteal fossa either medial or lateral to the hamstring tendons?
ACL
MC type of short limb disproportionate dwarfism
what are the majority of cases due to?
achondroplasia
sporadic gene mutations and are a/w advance paternal age
What is the primary defect of achondroplasia?
involves consitutive activation of fibroblast growth factor receptor (FGFR3)
a cell-signaling receptor that normally has a negative regulatory effect on bone growth
A pt presents with a lateral strain pattern of the sphenobasilar synchondrosis (SBS). How would you describe the axis/axes present with this?
What will the shape of the head feel like?
two vertical axes
sphenoid and occiput rotate in the same direction around two vertical axes
parallelogram
What would skin biopsy under direct immunofluorescence reveal of bullous pemphigoid?
linear deposits of IgG and C3 located at the dermoepidermal junction
What is tx for cryptococcus infection?
What is its MOA?
What are major AEs?
amphotericin B, plus flucytosine for 2 weeks, followed by fluconazole for 8 weeks
amp B - fungicidal that binds to ergosterol in the fungal plasma membrane (increases permeability to protons and monovalent cations) forming pore
hypokalemia, hypomagnesemia, and renal impairments
What can reduce amphotericin B nephrotoxicity?
saline loading
fever, night sweats, weight loss, progressive cough and dysphagia for solids
dx?
What does this disease arise from?
Hodgkins lymphoma
germinal centers of B cells
What CD markers do Reed-Sternberg cells express?
What cells are they found on and what might they cause?
CD15 on neutrophils and is responsible for phagocytosis and chemotaxis of neutrophils
CD30 is a tumor necrosis factor receptor protein that leads to activation of NF-kappaB (prevents apoptosis and promotes cell proliferation)
Hodgkin’s lymphoma does not express what CD markers?
pan-B cell antigens CD 19 and CD20
pan-T cell antigens CD 3 and CD 7
For a pt with an abduction restriction at the ulnohumeral joint, how would you tx it?
hold arm in extension and supination and apply a medially directed thrust to the lateral elbow
What is the MC type of lung cancer a/w smoking, cavitations, and hypercalcemia?
squamous cell carcinoma
Where is the anterior Chapman’s point for the myocardium located?
2nd intercostal space, near the sternum
Where are the anterior Chapmans points for the upper lung and lower lung?
3rd and 4th intercostal space, near the sternum
The organ systems included in the 5th intercostal space as Chapman’s points midclavicular line include..
Then, at the 6th intercostal space midclavicular line, you could also include…
stomach (L) and liver (R)
gallbladder (R)
How does blood get to and from the placenta in regard to the fetus?
deoxygenated fetal blood travels to the placenta through two umbilical arteries that branch off the internal iliac arteries
oxygenated blood travels away from the placenta via one umbilical vein
What is associated with fixed splitting of the S2 that does not noticably change with inspiration or expiration?
How does this happen?
Atrial septal defect
closure of the pulmonic valve becomes delayed - the L to R atrial pressure gradient increases the R atrial volume and pressure, leading to increased R ventricular volume;
ejection of more volume by the right ventricle delays the closure of the pulmonary valve
What is typically a/w plateau-shaped holosystolic murmur that is harsh and loudest at the tricuspid listening position?
Why does this happen?
Ventricular septal defect
shape is the results of a relatively constant L to R pressure gradient as both ventricles eject during systole
How does a LBBB present audibly?
paradoxically split S2 because of a delay in ejection by the L ventricle
benign pediatric murmur that commonly presents in healthy children between 2 and 7 yo
how is it described?
Still murmur
midsystolic murmur more commonly heard at the L lower sternal border but may be heard throughout the precordium
infant with cyanosis, CHF, and growth retardation
parents give hx of poor skin color, inability to complete a feeding session, frequent pauses during feeding, and or anorexia
respiratory ssx of nasal flaring or muscle retractions
tricuspid atresia
pathology in the cardiac system can manifest as somatic changes at the corresponding spinal levels of…
What spot is relatively specific for an MI?
T1-T5
T2 most specific for MI
- foamy urine
- hematuria and proteinuria
- proliferation of mesangiala nd endothelial cells of the glomeruli and expansion of the mesangial matrix along with immune deposits
membranoproliferative GN
- genetic dz
- defects in one fo several subunits of type IV collagen, major component of basement membranes
- infiltration by lymphocytes and plasma cells with clusters of foam cells of uncertain origin
Alport syndrome
sensorineural hearing loss and hematuria
dx?
alport syndrome
IgA nephropathy is aka
Berger disease
C-ANCA directed against proteinase 3
wegners/ Granulomatosis with polyangitis
strong granular capillary wall staining for IgG, C3, and kappa and lambda light chains
dx?
target autoantigen identified in podocytes is…?
membranous glomerulonephritis
type M- phospholipase A2
urine dipstick positive for blood but no RBCs on UA
dx?
how is this possible?
rhabdomyolysis
dipstick checks for hemoglobin and myoglobin while UA will evaluate for the presence of RBCs
What drugs cause a risk of rhabdomyolysis?
statins
- bile acid resin to treat hypercholesterolemia
- AEs of this drug include GI upset, decreased fat-soluble vitamin absorption, and cholesterol gallstones
cholestyramine
GLP-1 analogue to tx DMTII
AEs include nausea, vomiting, and pancreatitis
exenatide
-atides
second gen sulfonylurea used to tx DMTII
AEs include hypoglycemia, lasting up to 24 hours
glipizide
What type of HS reactions consist of anaphylactic and atopic reactions that are a result of free antigen cross-links of IgE on presensitized mast cells and basophils?
Type I HSRxn
What type of HS reactions are antibody mediated and there are two classifications?
What are they?
Type II
- cytotoxic reactions occur when autoabs to human tissue bind and target the cells for destruction by immmune cells
- pernicious anemia, erythroblastosis fetalis, rheumatic fever, goodpastures
- noncytotoxic reaction occur when autoabs to human tissue bind and interfere with cellular function
- graves disease, myasthenia gravis, pemphigus vulgaris
What type of HS reaction is a delayed T cell mediated type?
What are examples?
type IV HSrxn
type I DM, MS, Hashimoto, graft v host, contact dermatitis including poison ivy and poison oak
What type of HS reaction is post-streptococcal glomerulonephritis?
type III HS reaction
What is a complication of PID when it ascends?
What is this syndrome called?
inflammation of the liver capsule
Fitz-Hugh-Curtis Syndrome
Where is Chapman’s point corresponding to the bladder?
periumbilical region
the ureters lie directly on what muscle?
What can be caused if there is stone formation?
psoas muscles
psoas syndrome - muscular imbalance, strain, spasm, tendonitis, or flexion contracture of the iliopsoas muscle
ureteral stones can cause a viscerosomatic reflex causing psoas syndrome
Where are Chapmans reflexes for the kidneys located?
anteriorly 1 inch superior and 1 inch lateral to the umbilicus
Why does horseshoe kidney occur?
due to fusion of teh inferior poles of the kidneys during fetal development
as the kidneys ascend from the pelvis, the horseshoe kidney becomes entrapped under the inferior mesenteric artery (IMA)
What syndrome has an increased association with horsehoe kidney development?
Turner syndrome
XO karotype
What is GINA?
Genetic Information Nondiscrimination Act of 2008 made it unlawful employment practice for an employer to discriminate based on genetic information or to request genetic information
What are major AEs of methotrexate?
hepatotoxicity, myelosuppression (reversible with folinic acid), mucositis, and teratogenicity, megaloblastic anemia (due to folic acid reduction)
CI in pregnancy
What DMARDs interfere with tumor necrosis factor?
etanercept and infliximab
What acid-base disturbance is associated with overuse of thiazide diuretics?
How?
metabolic alkalosis
- drug binds Na/Cl symporter and inhibits Na absorption causing excretion of water
- K goes with the water, increasing K excretion
- loss of Na and water activate RAAS - attempts to reabsorb some of the Na lost in the DCT by activating a Na/H transporter
- results in a loss of H and gain of bicarb that promotes an alkalotic state
- hypoK can exacerbate this by activation of aldosterone - which tries to increase K loss as Na is exchanged for K ions in the collecting duct
- body responds by exchanging extracellular H for intracellular K, resulting in a relative drop in serum H level and an increase in bicarb levels
What are the three main steps of BLT?
disengagement, exaggeration, and balance
What is used to tx Hep B/C?
IFN alpha
What is used to tx chronic granulomatous disease?
IFN gamma
What is used for immunosuppression after renal transplantation?
Muromonab-CD3 (OKT3)
What is used to tx HER-2 overexpressing breast cancer?
trastuzumab
What is relative risk formula?
RR = (probability of an outcome if a RF is present)/(the probability of an outcome if a risk factor is absent)
RR= (incidence of the exposed group)/(incidence of the unexposed group)
Tx for Clonorchis sinensis and other trematodes and cestodes?
MOA?
praziquantel
anti-helminthic agent that increases cell membrane permeability in helminths leading to disintegration of the parasite
What do you use to tx Chagas disease?
MOA?
Nifurtimox
interferes with reduction-oxidation reaction with molecular oxygen
What antihelminthic agent is used to treat filariasis, diseases caused by roundworms/nematodes?
MOA?
specifically what diseases does it tx?
diethylcarbamazine
inhibits arachidonic acid metabolism in microfilaria making them susceptible to the host’s immune system
Brugia malayi, Loa loa, and Wuchereria bancrofti
musty body odor, developmental delay, and growth retardation
dx?
caused by?
phenylketonuria
deficiency of phenylalanine hydroxylase
elevated hematocrit, leukocytosis, and thrombocytosis; often associated splenomegaly, generalized pruritis, increased thrombotic events, and erythromelalgia
dx?
polycythemia vera
The occipital-mastoid suture is between what bones?
What foramen does it create?
What nerves go through this?
occipital and temporal bones
come together to form the jugular foramen
with CN IX, X, and XI exiting the cranium
Two meds that improve mortality in HF pts?
What drug has been show to decrease hospital stay, but not decrease mortality in these patients? What is this drugs MOA?
ACE-I and beta blockers
Digoxin, MOA: positive inotropic effect via inhibition of the Na-K ATPase in cardiac tissue
a form of systematic error, common in studies that use surveys or questionnaires asking participants to recollect previous events; differences of how study groups remember certain events
recall bias
information is gathered and analyzed at an inappropriate time; example includes using a survey to study a fatal disease - only the survivors will be able to answer, greatly affecting the outcome of the study
late-look bias
early detection of a disease is confused with increased survival rates of that disease
lead-time bias
abnormal plasma body cells accumulate in the bone marrow and produce abnormal antibodies that can cause kidney problems
multiple myeloma
elderly patient with hypercalcemia, anemia, fatigue, and bone pain - esp ribs and spine
what must be ruled out?
multiple myeloma
In multiple myeloma, what will show up in urine?
Bence Jones proteins - in 24 hour urine collection or protein:creatinine ratio would be elevated
monoclonal immunoglobulins lost in the urine
What will NSAID induced nephropathy generally cause?
How do they decrease renal blood flow?
chronic interstitial nephritis and papillary necrosis
inhibit PGE2 formation, which normally acts to dilate renal afferent arterioles leading to the glomeruli
If the 95% confidence interval of an odds ratio includes 1.0, the results are…
not statistically significant at the P,0.05 level of statistical significance
What deficiency causes Tay-Sachs disease?
hexosaminidase A deficiency
What level is the sympathetic viscerosomatic reflex for the adrenal glands at?
T8-T10
urge incontinence is also known as…
it is caused by…
detrusor instability
involuntary and uninhibited detrusor contractions during the filling phase of bladder functions
most of the time idiopathic
painless loss of monocular vision with associated pale retina with a cherry-red macula seen on funduscopic examination
dx?
retinal artery occlusion
Familial dysbetalipoproteinemia occurs due to a defect in…
What are the lipid levels like in this?
What will be a physical ssx?
Apolipoprotein E
elevated total cholesterol, elevated chylomicron remnants, VLDL, IDL, and LDL with normal HDL
cholesterol deposits in the dermis seen as yellow papules
What two things serve to allow the chylomicron remnants to be recognized by the LDL receptor of hepatocytes and taken into the liver for repackaging into VLDL?
apolipoprotein E
apo B48
found on HDL and chylomicrons, what serves as a cofactor for activation of Lecithin-cholesterol acyltransferase (LCAT), which serves in the formation of cholesterol esters?
Apo A1
What is found on VLDL, IDL, and LDL and is necessary for lipid recognition by the LDL receptor located on hepatocytes?
What hyperlipidemic state is due to a defect in this?
Apo B100
Type IIB familial hypercholesterolemia
defect in Apo CII
deficiency of LPL
abnormality in LPL
familial lipoprotein lipase deficiency, aka type I hyperlipidemia
rare genetic disorder characterized by abnormal cholesterol and bile acid metabolism and follows a progressive course that includes the development of xanthomas, cataracts, and pervasive neuro changes including dementia and seizures
dx?
genetic defect?
what happens?
tx?
cerebrotendinous xanthomatosis
cholesterol 7 alpha-hydroxylase (rate limiting step in bile synthesis)
accumulation of bile precursors, most notably cholestanol
exogenous bile acids (specifically chenodeoxycholic acid, CDCA) and statins
eruptive xanthomas result from …
while tuberous and planar xanthomas result from…
hypertriglyceridemia
hypercholesterolemia
What is the Fredrickson classification system?
Type I hyperlipidemia
Type IIA ..
Type IIB ..
Type III ..
Type IV ..
familail lipoprotein lipase deficiency
familial hypercholesterolemia due to LDL receptor defect
familial hypercholesterolemia due to a mutant apo B100
familial dysbetalipoproteinemia
familial hypertriglyceridemia
Thalamic nucleus relay station to the primary cortex for somatosensory info from the face
ventral posteromedial nucleus
thalamic relay for pathways including the basal nuclei and cerebellum related to control and coordination of movement
ventral lateral nucleus
thalamic relay to the primary somatosensory cortex for somatosensory info from the body
ventral posterolateral nucleus
What is different about the response of pulmonary tissues to hypoxia v most other tissues response to hypoxia?
In pulmonary tissues, hypoxia causes pulmonary vasoconstriction whereas with most other tissues, hypoxia will cause vasodilation
Why would a pt with squamous cell carcinoma have hypercalcemia and hypophosphatemia?
production of ectopic parathyroid-related protein (PTH-rp)
What neuroendocrine markers will be positive in small (oat) cell carcinoma?
enolase, chromogranin A, and synaptophysin
HBcAb IgM +
HBsAg +
HBeAg +
status?
window period of acute infection
What drug can be used to increase gastric motility in diabetics with gastroparesis, even though this is not the true indication for the drug?
erythromycin
tx of legionairres dz
first line is azithromycin
must use macrolide or fluoroquinolone for this atypical infection
presents in 4th decade of life with ataxia, dysarthria, dysmetria, nystagmus and peripheral neuropathy;
mutation is due to the production of an abnormal protein, ataxin-1, which caues symptoms
dx?
what genetics are associated with the mutation?
SCA-1 (spinocerebellar ataxia)
CAG repeat mutation on chromosome 6p and autosomal dominant
Where are sacral tenderpoints PS1-PS5?
- PS1 bilateral
- medial to PSIS at S1 level
- PS2, PS3, PS4 midline
- mid line on sacrum at corresponding level
- PS5 bilateral
- medial and superior to ILA
often fatal, this causes accumulation of unconjugated bilirubin in the brain (kernicterus) secondary to inherited or complete absence of UDP glucuronyl transferase activity in the liver
Crigler Najjar syndrome
defect in biliary excretion from the liver, inherited disorders causing conjugated bilirubin to accumulate
light therapy is not helpful
ddx?
Dubin-Johnson or Rotor syndrome
What causes physiologic jaundice?
mild, unconjugated hyperbilirubinemia caused by increased bilirubin production, decreased bilirubin clearance, and increased enterohepatic circulation
due to relative immaturity of the hepatic cells and gastrointestinal tract, inefficiency of hepatic excretion unconjugated bilirubin, and immaturity of enzymes (UDP glucuronyl transferase)
Where are the anterior lumbar tender points?
- L1 is medial to ASIS
- L2 is medial to AIIS
- L3 is lateral to AIIS
- L4 is inferior to AIIS
- L5 is on pubic ramus 1 cm lateral to the pubic symphysis
What occurs with false estimations of survival rates that are due to the disease being diagnosed at an earlier stage?
lead-time bias
What kind of heart disease can alcoholism lead to?
dilated cardiomyopathy, which may lead to CHF due primarily to systolic dysfunction
What are the 3 Cs of adverse effects of TCA toxicity?
- cardiotoxicity - EKG changes, wide QRS complexes
- anticholinergic - ‘being dry’ - urinary retention, anhidrosis, xerophthalmia; delirium; increased body temp; tachycardia
- convulsions
How do TCAs physiologically exert their toxic effects?
- inhibition of NE uptake at nerve terminals
- direct alpha adrenergic block causing hypotension
- anticholinergic action
- membrane stabilizing or quinidine-like effect on the myocardium by inhibtiing fast sodium channels, leading to prolongation of QRS complex with a predisposition to cardiac arrhythmias
How do you diagnose Whipple Disease?
endoscopic small bowel biopsy showing PAS positive macrophages in the lamina propria
triad of hypoxemia, neuro abnls, and petechial rash?
what are most common causes of this?
fat embolism syndrome
almost all cases due to long bone and pelvic fractures, because of high amounts of fat in bone marrow - fat globules enter pulmonary circulation
both the cerebral cortex and the epidermis are derived from…
ectoderm
Cardiogenic shock is a/w…
MI, high cardiac filling pressures, low cardiac index, increased peripheral resistance, and pulmonary edema, inadequate ventricular function
Giving what can decrease the severity of homocystinuria?
Pyridoxine or vit B6
cofactor for cystathionine-beta-synthase
Asherman syndrome is the result of…
removal of the stratum basalis after too forceful or repetitive dilation and curettage procedures
intrauterine adhesions as an inflammatory response to damge of stratum basalis
What do I see on biopsy of the glomerulus in a diabetic pt?
basement membranes in the glomeruli become more permeable to protein (albuminuria). renal biopsy would display uniform thickening of basement membranes;
mesangial matrix may become more abundant and form distinctive mesangial nodules called Kimmelstiel-Wilson nodules
t(9:22)
Chronic myelogenous leukemia
Philadelphia chromosome
What is the gold standard dx criteria for CML and the tx?
either the demonstration of the Philadelphia chromosome [t(9:22) translocation] or the BCR-ABL1 fusion gene or mRNA product
imatinib
t(14:18)
what CD markers are positive and what CD markers are negative?
follicular lymphoma
CD 10+, CD 19+, CD20+
CD 5-, CD23-
t(15:17)
what is switched?
tx?
acute promyelocytic leukemia
alpha retinoic acid receptor gene (RARA) on 17 translocates with the PML gene on 15 => PML/RARA fusion gene
all-trans retinoic acid, which activates genes to lead to terminal differentiation of promyelocytes
APL is a/w what blood/bleeding disorder?
a/w what features histologically?
DIC
folded, bilobed nucleus within promyelocytes and coarse azurophilic granules and multiple Auer rods
Starling equation for net filtration
[Pcap(hydrostatic) - Pi(hydrostatic)] - [OcapP -OiP]
What is the pathology on the liver like in alcoholic cirrhosis?
all lobules are affected, so nodules tend to be uniform and thus small (micronodular)
fatty change may or may not be present, depends on recent intake
fibrosis is probably present
Kluver-Bucy syndrome
lesion in amygdala, characterized by a loss of fear, hyperorality, and hypersexuality
tx for acute gout attacks?
NSAIDs, colchicine, and glucocorticoids
colchicine MOA
disrupts cytoskeletal functions by inhibiting the polymerization of B-tubulin into microtubules, to prevent activation, degranulation, and migration of neutrophils
tx of DIC
coagulation factor replacement like FFP; if platelets <10k/uL, platelet transfusion should also be given
situs inversus, chronic sinusitis, and bronchiectasis
dx?
Kartagener syndrome
What type of casts are in advanced renal failure?
broad waxy casts
What casts are found in acute tubular necrosis?
brown muddy casts
What casts are considered normal or found with dehydration?
hyaline casts
What casts are found with glomerulonephritis?
RBC casts
What casts are found with acute pyelonephritis or acute tubulointerstitial nephritis?
white blood cell casts
diffuse swelling/anasarca is due to…
decreased plasma colloid oncotic pressure as the liver synthesis of albumin decreases
What nerve and nerve roots are associated with winged scapula?
long thoracic nerve C5-7
weakness of scapular traction is a lesion of what nerve/nerve roots?
dorsal scapular nerve
C5
C5-6 upper trunk brachial plexus lesion results in
Erb-Duchenne palsy
Middle and lower trunk brachial plexus C8-T1 lesion result in…
Klumpke palsy
What structures create the triangular interval in the shoulder?
What is within the triangular interval?
- teres major
- long head of triceps
- lateral humeral shaft
within: profunda brachii artery and radial nerve
triangular space has what boundaries and holds what structure within?
- teres minor
- teres major
- long head of triceps
holds circumflex scapular artery
What boundaries form the quadrangular space and what are its contents?
- teres minor
- teres major
- lateral humeral shaft
- long head of triceps
within it is the posterior circumflex humeral vessels and axillary nerve
When would sickle cell pts be at increased risk of having an aplastic crisis?
a/w parvovirus B19 infection, during which time erythropoiesis is suppressed
systemic vasculitis that affects medium arteries, affecting virtually any organ system but as a striking tendancy to spare the lungs
1/3 of these pts will has be found to have..
polyarteritis nodosa (PAN)
hepatitis B
young asian female (<40 yo), weak UE pulses
takayasu arteritis
Asian children, conjunctival injection, strawberry tongue, desquamating rash on hands and feet. acute MI
kawasaki disease
heavy smokers, amputation of digits, raynaud phenomenon
Thromboangiitis Obliterans
(Buerger disease)
hep C, low complement component 4
cryoglobulinemic vasculitis
describe the red cells in Fe deficiency anemia
microcytic and hypochromic
peripheral smear in iron deficiency anemia often shows some elongated red cells (pencil cells), and the central pallor in the erythrocytes is typically wider than the normnal one-third of the red cell diameter
increased serum and urine 5-HIAA levels; positive octreotide scan
dx?
carcinoid syndrome
Carcinoid syndrome may lead to deficiency of what B-vitamin? Why?
niacin
due to a relative deficiency of tryptophan, the precurose used for the production of both serotonin and niacin
most common type of leukemia in adults in Western countries?
what type of cells are malignant?
what are some features with this?
chronic lymphocytic leukemia
B lymphocytes
spherocytes on periph smear, elevated reticulocytes, reduced haptoglobin levels, and a positive direct Coombs test
Sensitivity and specificity equations
sensitivity = TP/ (TP+FN)
specificity = TN/ (TN+FP)
What maneuvers make mitroal valve prolapse murmurs better or worse?
What is the only other murmur to respond this way?
MVP murmur enhanced by Valsalva and decreased by squatting; this is because valsalva decreases the volume of the L ventricle, causing prolapse to occur sooner and more severely, whereas those that increase venous return and diastolic filling (squatting) and enhance ventricle volume, help to maintain tension along the chordae and to keep the valve shut
hypertrophic cardiomyopathy/ is the only other murmur to act this way
What is the antidote in TCA overdose with cardiac involvement?
sodium bicarbonate
defective Na-K-2Cl cotransporter
dx?
describe disease?
Bartter Syndrome
AR disorder of renal tubule which leads to salt wasting
this transporter fails to reabsorb chloride causing failure to reabsorb Na, resulting in excessive urinary loss of Na, Cl, K, and water
ssx: hypokalemia, hypochloremia, metabolic alkalosis, and hyperreninemia with normal BP
first line for sporothrix schenckii infection?
itraconazole
nephrolithiasis with a negative abdominal XR?
What imaging should be done?
uric acid stone
CT of abdomen and pelvis w/o contrast
Recurrent nephrolithiasis occurring at a young age is concerning for a genetic etiology, namely….
What test can evaluate for high levels of this?
cystinuria, rarest form of nephrolithiasis
cyanide-nitroprusside test evaluates for high urine cysteine levels
Paclitaxel MOA?
what are its indications for use?
microtubule inhibitor that causes a hyperstabilization of polymerized microtubules, thereby preventing the breakdown of mitotic spindle
used in breast and ovarian cancers
What drugs bind tubulin and block microtubule polymerization, thereby preventing formation of mitotic spindle?
What do these drugs treat?
vincristine and vinblastine
Hodgkins lymphoma and choriocarcinoma
Bleomycin and doxorubicin MOA and indications
anti-tumor abx that induce free radical formation, resulting in the breakage of DNA
Bleo txs testicular cancer and Hodgkins lymphoma
Doxo is for Hodgkins and solid tumors
poor wound healing, dermatitis, skin ulcers, alopecia, decreased taste and smell, depression and diarrhea
what is deficient?
zinc
connective tissue disorder that results in the thickening of the palmar fascia; MC symptom is the inability to extend the fourth and fifth digits as the fascia loses its elasticity
Dupuytren contracture
contracture of the first and third digits, injury to the ulnar collateral ligament is called what?
gamekeeper thumb
What cancer has virtually no chance of metastasis?
basal cell carcinoma
What organs are retroperitoneal?
- kidneys
- ureters
- abdominal aorta
- IVC
- duodenum (2,3,4 parts)
- ascending colon
- descending colon
- pancreas (except for tail)
alogia
absence of speech
avolition
apathy
anhedonia
inability to experience pleasure
haloperidol and other typical antipsychotic medications do not treat…
negative symptoms of psychosis well
What are MC lab findings in polycythemia vera?
What is tx?
JAK2 mutation and low serum EPO levels
phlebotomy and hydroxyurea
placenta accreta occurs when…
the placenta invades through the endometrial lining and attaches to the myometrium, preventing appropriate dettachment after birth leading to copious bleeding and retained placenta after delivery
secondary manifestation in children of primary infections with enterohemorrhagic E.coli, begins 5-10 days after a prodrome of abdominal pain, vomiting, and bloody diarrhea
dx?
triad that goes with?
Hemolytic uremic syndrome
hemolytic anemia, thrombocytopenia, and acute renal injury
digoxin toxicity is increased when what else is present?
hypercalcemia
hypomagnesemia
hypo/hyperkalemia
after taking an ACE-I and decreasing aldosterone present, the pt is at risk of what?
hyperkalemia
MC conditions that cause transudative effusions?
CHF, cirrhosis, and nephrotic syndrome
While the list for exudative effusion causes is longer than transudative, exudative causes include…
lung infections, malignancy, pulmonary embolism, and collagen vascular disease
unexplained weight gain in a patient diagnosesd with cancer should raise suspiscion for…
paraneoplastic syndrome such as the syndrome of ectopic ACTH secretion
a decrease in the synthesis of beta globin chains of hemoglobin results in…
What are ssx of this?
beta thalassemia
- Mediterranean or AA ethnicity
- beta thala major - severe microcytic and hemolytic anemia
- hepatosplenomegaly and jaundice
- on smear hypochromic microcytic RBCs, increased retic ct, and target cells
- not seen in consecutive generations bc it is AR
- aka Cooley’s anemia
a deficiency in cytochrome b5 protein is seen in…
what are ssx?
methhemoglobinemia, an AR disorder
hypoxic, cyanotic face, nails and lips, blood has muddy appearance
defect in nucleotide excision repair (involved in removing a group of damaged bases)
dx?
what does this defect result in?
xeroderma pigmentosum
a deficiency of endonuclease activity that prevents repair of thymine dimers
What are ssx of xeroderma pigmentosum?
skin changes in sun-exposed areas by 6 months of age and are at increased risk for skin cancers due to UV light, including basal cell carcinoma, squamous cell carcinoma, and melanoma
What is an autosomal dominant disorder of DNA mismatch repair genes which cause an error in nucleotide pairing?
what might this lead to?
hereditary nonpolyposis colorectal cancer (HNPCC/Lynch syndrome)
commonly leading to colorectal cancer in 80% of pts
a branch of the superior mesenteric artery, this branch travels inside the transverse mesocolon/mesentery to supply the transverse colon
middle colic artery
What is the treatment for serotonin syndrome?
What is the treatment for neuroleptic malignant syndrome?
- cyproheptadine and benzodiazepines
- bromocriptine and dantrolene
Where are melatonin receptors MT1 and MT2 located?
suprachiasmatic nucleus
What structures go through the superior orbital fissure?
CN III, IV, V1, and VI
What structures go through foramen rotundum?
CN V2
What structure goes through foramen ovale?
CN V3
What structures go through the jugular foramen?
CN IX, X, XI and jugular vein
What structures go through foramen magnum?
brainstem, spinal root of CN XI, vertebral arteries
If you suspect a subarachnoid hemorrhage but you are not seeing blood on CT, what should you do next?
get an LP and look for xanthochromia or blood in CSF
Any INR above the normal range should be treated in an intracranial hemorrhage. The tx is to..
administer FFP, which replaces the clotting factors that were not produced durign warfarin therapy, restoring the function of the clotting cascade
What type of cells secrete cholecystokinin?
I cells in the duodenum and jejunum in response to the presence of amino acids and fatty acids
Glucagon-like peptide (GLP-1) is released primarily by …
intestinal L cells in response to carbohydrates and proteins
Vasoactive intestinal peptide (VIP) is secreted by….
what does it do?
parasympathetic ganglia located throughout the GI tract
increases water and electrolyte secretion by the intestines
VIPoma can lead to chronic diarrhea and hypokalemia due to increased losses in GI tract
Secretin is released by what cells?
what does it do?
what can exogenous secretin help with clinically?
S cells in the duodenum in response to the presence of acid and fatty acids
acts as an antacid by increasing bicarb excretion by the pancreas and decreasing gastric acid secretion
dx ectopic gastrin production, as in a gastrinoma; if gastrin levels fail to decrease after injection of secretin, it is indicative of ectopic gastrin production
Overproduction of gastrin by gastrinomas in MEN-1 causes…
increased acid secretion by G cells, leading to peptic ulcers
Where do most breast malignancies occur?
upper outer quadrant of breast
unilateral nipple discharge (serous or bloody); lobulated, soft, tan mass lying in a cystic cavity; located under the areola
dx?
tx?
intraductal papilloma
benign tumor that grows in the lactiferous ducts of the breast;
slight risk of cystic lesions harboring areas of atypia or ductal carcinoma in situ; recommend excision whenever they are dx’d by core needle biopsy
