Factionless Flashcards
Why is Succinylcholine contraindicated in pts with burns, myopathies, crush injuries or denervating Dz
Can cause SIGNIFICANT K+ RELEASE –> VFIB in pts at high risk for Hyperkalemia
What is Priapism and which antiPsychotic is associated with it
Painful Long-Lasting Erections; Trazodone (TraZaBone)
What is Rxn Formation in Psychiatry
Reacting to an unacceptable situation by Forming a completely opposite response
covering fears of faling exam by being overly confident
Cocaine intoxication stimulates _____ [Miosis vs. Mydriasis]
Cocaine intoxication stimulates Mydriasis
Pupils Wide Open on Coke!
Pts who’ve had a major depressive episode in the past have to be screened for what before giving Antidepressants
Mania (rule out Bipolar DO)
Antidepressants are contraindicated in Bipolar pts since they precipitate mania
[ADHD medication] SE (2)
- DECREASED appetite
- Insomnia
These Drugs INC NorEpi & Dopamine in PreFrontal Cortex
What’s the most effective tx for Specific phobia?
CBT (Systematic Exposure)
Drug used for Tx-Resistant Schizophrenia
Clozapine
Tx for [Somatic Symptom DO]
Regularly scheduled Med visits (Goal: Improve functionality)
DO = preocupation with unexplained (but proven to be benign) medical sx
MOD for Death from TriCyclic Antidepressant OD
Blocks Fast Na+ in cardiomyocytes –> Prolonged QT/Arrhythmia
Is the EDV in Diastolic HF Elevated, Normal, or DEC?
NORMAL
Which Vitamins are intestinal bacteria known for producing? (2)
Vitamin K and [Folate B9]
Describe the histology for [lactase deficiency] pts and how you diagnose it?
Normal; STOOL pH less than 7
Tx for Hepatic Encephalopathy and their MOA (2)
- Lactulose (converts NH3 –> NH4+ in colon - but DOES CAUSE DIARRHEA)
- Rifaximin abx (⬇︎NH3 producing colonic bacteria)
Which parts of the GI tract are affected in Hirschsprung Dz? (2)
- RECTUM - always
- Sigmoid Colon sometimes
What is linkage disequilibrium
When a pair of alleles are inherited together in the same [gamete haplotype] more than would be expected by random chance
Can occur even if genes are on different chromosomes
What GI structure is used to identify the appendix during an appendectomy?
Teniae Coli
Teniae Coli travel outside colon and converge at root of appendix vermiform
Where would you find [Branched Tubular Submucosal glands] with alkaline secretions in the GI tract
[Brunner Submucosal glands] are found from the Pylorus all the way through [Duodenum 1st segment]
What’s the major immune mechanism against Giardia (2)
[CD4 Helper T] & IgA
Eosinophils can’t help against Giardia
Lymph drainage of [Rectum proximal to dentate] drains into the _____ lymph nodes (2)
*Inferior Mesenteric
*[Internal iLiac]
Lymph drainage of [Rectum Distal to dentate] drains into the _____ lymph nodes
Superficial Inguinal
Failure of the [Vitelline Omphalomesenteric Duct] to obliterate leads to what 2 things?
- Meckel Diverticula
- Enterocyst
Estrogen ____[INC/DEC] the level of TBG in the blood. How does this affect [Free thyroid hormone]? Explain
Estrogen INC TBG in blood –> INC binding sites available to carry thyroid hormone –> INC [TOTAL T4 (bound + free)] and [Total T3].
Free thyroid hormone levels are NOT affected
Identify sections of the Adrenal Gland
1 = Glomerulosa
2= Fasciculata
3= Reticularis
4 = Medulla chromaffin (stimulated by ACh)
How does Anorexia cause Amenorrhea?
Anorexia –> DEC GnRH from hypOthalamus
Which drug is used to control, [Graves Dz Ophthalmopathy] specifically and how does this help
Prednisone; DEC inflammation
Which layer of the stomach is Parietal cells found?
B; Upper Glandular Layer
Where, in the GI tract, is iron absorbed? (2)
Duodenum & Proximal Jejunum
What are the levels of Cholesterol, Phosphatidylcholine and Bile in pts with Gallstones?
INC Cholesterol
DEC Bile (since it’s saturated w/Cholesterol instead)
DEC Phosphatidylcholine
Bile & Phosphatidylcholine are protective against Gallstones
SCID MOD
auto recessive deficiency of Adenosine Deaminase (needed to eliminate excess adenosine inside cells)
What happens when SCID affects WBC
Adenosine accumulates in Lymphocytes –> Death –> Deficiency –> Multile Pathogen infections
NF-kB is most involved in what process
INFLAMMATION; allows Cytokine production
[Tracheoesophageal fistula w/esophageal atresia] results from what?
Failure of [PleuroPeritoneal membrane] to form completely
Describe the location of Femoral Hernias (3)
Inferior to Inguinal ligament
Lateral to Pubic Tubercle
Medial to Femoral Vein
Keep in mind: Incarceration/Stragulation is common
The Celiac trunk is the ___ main branch of the abd aorta. It provides oxygenated blood to which organs (6)
1st main branch of abd aorta = SPALDS
- Spleen
- Pancreas
- Abd Esophagus
- Liver (via Hepatic a. daughter branch)
- Duodenum
- Stomach
Out of the Retroperitoneal Organs, which is most commonly associated with Retroperitoneal Bleeding?
PANCREAS (body)
SAD PUCKER
Which Colon CA is the most common GI malignancy?
Colon ADC
Compare clinical manifestations between [R Colon ADC] and [L Colon ADC]
[R Colon ADC] = Bleeds / Iron deficiency anemia
vs.
[L Colon ADC] = Obstruction sx (altered bowel habits / NV)
Weakening of the ____ in ___ triangle causes Direct Inguinal hernia. They protrude only through the ______
Weakening of the Transversalis Fascia in Hesselbach’s triangle causes [Direct Inguinal Hernia]. They protrude only thorugh the EXTERNAL inguinal ring
How can we diagnose Tropheryma Whippelii with stains?
Cell Wall Glycoprotein in T.Whippelii stains magenta with PAS
Sucralfate MOA
Binds to [Mucosal Ulcer Base] and physically protects it against gastric acid –> Speeds up healing
Does NOT inhibit acid secretion
Which lab markers are the best indicators for Poor pgn in Cirrhosis pts? (3)
- Albumin
- Bilirubin
- ProThrombin Time
These Reflect Liver function in Cirrhotic pts
Function of Betalipoproteins
Component of [Chylomicrons and VLDL] that enables LDL small intestinal absorption
Abetalipoproteinemia = inhertied dz –> enterocytes accumulated with clear foamy cytoplasm from INC LDL
What are the most occuring CA amongst Women from greatest to least
Breast > Lung > colon
Breast = Most occuring
Why does [Hemolytic Dz of Newborn(Erythroblastosis Fetalis) ] occur more in [O- Mothers] and less in [A- or B- Mothers]?
[A- or B- Mothers] have mostly [anti-Rh IgM antibodies]–IgM does NOT cross placenta
- [TYPE O -MOTHERS] HAVE MOSTLY* [anti-Rh IgG antibodies] –IgG crosses placenta! –> HDNEF
Sickle cell anemia is ___(mode of inheritance) and should be diagnosed with what?
auto recessive; [HgB electrophoresis] determines carrier status
[GlutaMATE –> Valine @ 6th position]
[Wiskoff Aldrich Syndrome] Clinical Manifestation
“My Recessive-X WAS Bleeding, [always sick] and had Eczema!
- Bleeding (thrombocytopenia)
- always sick (recurrent infection)
- Eczema
X-linked recessive
[Ataxia Telangiectasia] MOD and clinical presentation
ATM gene defect –> Faulty DNA repair –> ROE
Recurrent Infection
Oculocutaneous telangiectasia
Early cerebellar ataxia
Where does complement bind on the Immunoglobulin
Heavy chain near the hinge point
Mode of Inheritance for [Hemophilia A vs. B]
Both are X-linked Recessive
What part of the Thymus/lymph node is underdeveloped in DiGeorge Syndrome? How does this affect function?
Paracortex; prevents 1° lymphoid follicles & germinal centers form forming in cortex
Identify which Knee this is (L vs. R) and the letters
RIGHT Knee
What should be monitored in pts with Ankylosing Spondylitis? Why?
Chest Wall Expansion; involvement of thoracic & costovertebral spine can limit chest wall expansion –> hypOventilation
After Clavicle Fracture, which muscle causes SUPERIOR displacement of the midshaft and which causes INFERIOR (2)
SUPERIOR = Sternocleidomastoid
inferior = PEC Major & arm weight
CLAVICLE = MOST FRACTURED BONE (especially in kids)
What type of Hypersensitivity is Myasthenia Gravis?
Type 2 (Ab-mediated)
Same as GoodPasture
Preferred Diagnostic tool for Vertebral Osteomyelitis
MRI
What 3 markers reflect Osteoclast activity
- Urine DeOxyPyridinoline (most specific)
- Urine HydroxyProline
- [Tartrate Resistant Acid Phosphatase]
MOD for [Giant Cell temporal Arteritis]
IL6 drives cell-mediated immunity against LARGE blood vessels
[Mccune Albright] Clinical Presentation (3)
- Unilateral Cafe Au Lait
- Endocrine Problems
- Polyostotic Fibrous Dysplasia
Lethal if onset b4 fertile but survivable in mosaicism pts
How are Contractures formed and what do they ultimately result in
comes from too much [matrix metalloproteinase activity + myofibroblast accumulation]. Contractures –> Wound deformitites
How does Anabolic Steroid misuse cause Acne?
Androgens stimulate follicular epidermal hyperproliferation and INC sebum –> Acne (inflammatory nodular eruptions)
Clinical Presentation for [Caudal Regression Syndrome] (2). What’s the major RF
- [LumboSacral AGENESIS NTD] –> [Flaccid LE + Urinary incontinence]
- Heart defects
Maternal DM = RF
Allopurinol (a ___ inhibitor) INC the concentration of what 2 drugs as a result?
Allopurinol = Xanthine Oxidase inhibitor –> INC
Azathioprine
6-MP
Sarcomere is defined as the distance between _____. [Actin Thin filaments] are bound & structurally supported by the _____
Sarcomere = Distance between Two Z Lines
[Actin Thin filaments] are bound & structurally supported by the [Z Lines] in the [I band]
Sarcomere is defined as the distance between _____. [Myosin THICK filaments] are bound & structurally supported by the _____
Sarcomere = Distance between Two Z Lines
[Myosin THICK filaments] are bound & structurally supported by the [M Lines] in the [A band]
In Lateral Epicondylitis, which tendon is often swollen and what function does it have?
[Extensor Carpi Radialis brevis]; Extends Wrist
What’s significant about Black women and Bone mass
Black women have Higher bone density and DEC risk of fractures
Lymph drainage of medial foot drains into the _____ lymph nodes. What part of the reproductive system also drains here?
Superficial Inguinal ; SCROTUM
Lymph drainage of Lateral foot drains into the _____ lymph nodes (2)
Superficial Inguinal AND Popliteal
Clinical Presentation for [Serum Sickness Type 3 Hypersensitivity] (5)
“Drugs can make ur Serum CAUFF”
- [C3 & C4 DEC]
- Arthralgia
- Urticaria
- Fibrinoid Vasculitits Necrosis
- Fever
What is [Serum Sickness Type 3 Hypersensitivity] mostly caused by?
Drugs acting as Haptens
(such as Infliximab :-) )
The Thymus and [inferior parathyroid] comes from the ___ pharyngeal pouch
3rd
Which pharyngeal arch does the [SUP parathyroid] come from?
4th
Which DO is characterized as [Endomysial CD8 inflammation + patchy necrosis] and what’s the MOD
Polymyositis; Ab against [Histidyl tRNA synthetase]
What ions contribute to the resting potential of a cell
[HIGH K+ conductance] AND [some Na+ conductance]
Tibial n. supplies sensory innervation to what part of the foot?
Plantar Foot
Falls onto an outstretched hand may dislocate the ____ bone, fracture the ____ bone –>which INC risk of developing _____. Fracture of the ____bone is in between which 2 tendons?
disLocate Lunate; [fracture Scaphoid–> Avascular Necrosis] found between extensor longus and brevis (snuff box)
Which drug DEC risk of both Breast CA and Bone Fractures in Women
Raloxifene SERM
Histology description for Osteoclast and list what 2 factors activate differentiation
multinucleated; [M-CSF and RANKL -both from OsteoBLast]
How does Omeprazole affect Skeleton system
long term use of PPI –> Osteoporosis
These CoAg Canners Obliterate SpongyBoneTrabeculae
Identify the finding
Clubbing (associated with prolonged hypoxia-typically from Lung Dz)
Difference between [Muscle Spindle system] and [Golgi Tendon system]
[Muscle Spindle system] = monitors muscle length
vs.
[Golgi Tendon system] monitors muscle force (associated with relaxation)
Defect in [PECAM1] –> No Neutrophil ____
Transmigration
Hematogenous Osteomyelitis is most common in ____ and usually affects the ____ of bone
Children; Metaphysis
Buttock injections to what quadrant(s) risk Sciatic n. injury
Superomedial, Inferomedial, InferoLateral
Butt injections to what quadrant(s) risk SUP Gluteal n. injury –> ___ Gait
Superomedial
Will cause Trendelenburg gait
COX __ is an inducible enzyme (by IL1) usually undetectable except during inflammation
COX2
Which musculoskeletal condition is associated with having an extra cervical rib?
Thoracic Outlet Syndrome –> UE paresthesias & weakness
Function of [Human Placental Lactogen] (2)
“HPL gives Mom Higher Plasma [Lipids & Glucose] for the baby”
[DEC Mom’s Fatty acid stores] and INC Mom’s Blood Glucose] for the baby
What would an US of the uterus in an ectopic pregnancy show?
Decidualized endometrium - Dilated, coiled endometrial glands & [vascularized edematous stroma] from progesterone preparation but no implant
Pelvic fractures are associated with injury to what Male GU structure?
[Posterior Urethra: Membranous segment]
- Cather placement is cx in Urethral injury*
- Prostatic segment is protected by Prostate*
Saddle injuries are associated with injury to what Male GU structure?
Anterior Urethra
Catheter placement is cx in Urethral injury
Between Epispadia and hypOspadia, which is associated with faulty positioning of the genital tubercle?
Epispadia
You PEE in ur Eye with Epispadia
Difference between [Androgen insensitivity Syndrome] and [Mullerian aplasia]
AIS have [NO Fallopian tube and Uterus (even rudimentary)] and [NO sexual hair] (2)
Saline Microscopy is AKA _____
WET MOUNT
think Trichomonas vaginalis
What is Cervical Cytology typically used for?
This is a PAP Smear ; HPV
Both [Indirect inguinal hernia] and [Communicating Hydroceles] are caused by what?
Incomplete obliteration of Processus Vaginalis –> connection between scrotum & Abd cavity
Most dangerous SE of Tamoxifen SERM
Although [E2 blocker @ Breast], it’s [E2 agnoist @ Endometrium] –> [Endometrioid Endometrial ADC]
What does pregnancy analytes show for [Down Syndrome] (4)
- INC inhibin A
- INC beta-HCG
- DEC AFP
- DEC Estriol
Bilateral ligation of which vessel resolves Postpartum Hemorrhage
Internal iLiac
Describe Septic Abortion and what causes it (2)
Seeding of Uterine cavity from instruments after having abortion –> Foul discharge + fever + abd pain
Staph Aureus & E.Coli cause it!
[Gestational Placental Choriocarcinoma] is usually preceded by _____ and causes ____ with ____. What happens if this metastasizes?
some form of pregnancy; [VERY HIGH bHCG + Vaginal Bleeding] ; Hematogeous spread –> Lungs–> Hemoptysis
Tx for PCOS (4)
Use a SOCK to treat PCOS
- Spironolactone -2ND LINE AND SHOULDN’T BE USED IN FERTILE PTS
- OCP - 1ST LINE
- Clomiphene
- Ketoconazole
Ovarian CA is usually diagnosed in _____. What are the CA marker? (2)
Postmenopausal women; [Epithelial = CA-125] but [Stromal/Granulosa = Estrogen]
Granulosa will have Call-Exner rosette & appear yellow from theca lipid
Which drug reduces the volume of the prostate in pts with BPH
Finasteride (5a-reductase inhibitors)
What’s the most common cause of [Blood Nipple Discharge] in women and describe its Histology
Intraductal Papilloma; [Papillary cells w/fibrovascular core] –> Unilateral bloody/serous discharge
1.5-2 risk of CA
What is a Cystic Hygroma and what pts have it?
Posterior neck mass made of cystic spaces separated by connective tissue; Turner Syndrome
Ovarian Torsion MOD
[SIPL - Suspensory InfundibuloPelvic Ligament] twist due to large adnexal mass –>arterial Occlusion—>Ovarian ischemia
[Kegel Pelvic floor strengthening] targets what muscle for [Stress Urinary Incontinence] tx
Levator Ani
Congenital Torticollis MOD
Malpositioning of Head in Utero vs. During birth –> constant contraction of SCM–>Lateral Neck swelling
Adenomyosis clinical presentation (3)
- Uniformly enlarged Uterus w/normal endometrial
- Menorrhagia
- Dysmenorrhea
MOD= endometrial glands within myometrium
Which thyroid tx contains Iodide and thus acts by competitively blocking
Perchlorate & PerTechnetate
Pt taking Hyperthyroid medication with [sudden fever & sore throat] should receive what test and why?
WBC w/ diff; Anti-Thyroid meds can –> Agranulocytosis
PTU also causes Liver Failure
What is the recommended regimen for Diabetics on Insulin
1 Long Acting (Glaaaaaaarrgine vs. Detmir)
+
1 short acting pre-meal (glulisine vs. aspart vs. lispro)
Between Glycogenolysis and Gluconeogenesis, which does EtOH inhibit in liver?
Gluconeogenesis
Which Lipid lowering drug actually INC HDL and TAG if used alone?
BABR (Bile Acid binding resin)
[Cholestyramine & Cole]
Type 2 DM pts mostly die from what?
MI
What are the 4 most common causes of Myopathy (elevated CK)
Statins Probably hurt Muscles
- Statins
- Polymyositis vs. Dermatomyositis (autoimmune)
- Muscular Dystrophy
- hypOthyroidism
Histology for Osteopetrosis (2)
Primary spongiosa in medullary cavity with no mature trabeculae + accumulated woven bone
Even though Prolactin INC during pregnancy, why is lactation actually inhibited?
Actual Lactogenesis (not Prolactin secretion) is inhibted by HIGH levels of E2 or Progesterone
Dopamine also bock Prolactin
Genetic causes for Down Syndrome (3)
- Meiotic Nondisjunction (most common)
- Mosaicism for a trisomy 21 cell line
- Robertsonian Translocation (14 –>21)
Why are pregnant pts (Fertile) at higher risk for Gallstones?
[E2 –> Cholesterol Hypersecretion] & [Progesterone–> Gallbladder hypOmotility]
Polyhydraminos (INC amniotic fluid) is caused by what? (2)
- Impaired fetal swallowing (Anencephaly, GI obstruction/atresia)
- Excessive amniotic production (high cardiac output, twin transfusion syndrome)
Renal Agenesis –> Oligohydraminos (not enough amniotic)
Define Pyknosis
Nuclear Shrinkage
Describe the process of EtOH breakdown to Acetic Acid and explain how Metronidazole disrupts this
Metronidazole has Disulfiram-like activity –> Acetaaldehyde accumulation –> Flushing/NV/Cramps after drinking
Testicular Torsion MOD
Twisting of Testes around spermatic cord which cuts off [testicular vein outflow] but still preserves [gonadal a. inflow (from Abd aorta)] –>Engorgement –>Hemorrhagic infarct
How does Testicular Torsion present? (2)
- High - riding Testis
- Absent Cremasteric reflex
What is Vaginal Adenosis and what demographic is it seen
Persistence of upper 2/3 [Glandular columnar]–> [Clear cell ADC]; DES daughters
[Prader Willi]
MOD (2)
&
Clinical Presentation (3)
[Paternal gene deletion] vs. [Maternally imprinted (silenced) gene disomy (receiving both genes from Mom)]
- [Short & Obese]
- hypOtonia
- Retarded
Which structures should be ligated during an oophorectomy and why?
[SIPL - Suspensory InfundibuloPelvic ligament] contains [ovarian NAVL(Nerve/Artery/Vein/Lymphatics)] ; prevents bleeding
What is Ebstein anomaly (3)? What medication is associated with it?
[Tricuspid displacement toward apex] + [DEC RV volume] + [atrialization of RV]
Lithium during pregnancy
Although the prostate drains into the ___ lymph nodes, how does osteoblastic metastasis to skeletal system occur?
[Prostate drains –>Internal iLiac Lymph nodes]
BUT
Bone metastasis from Pelvis spread via [Vertebral venous Plexus] (Prostatic venous plexus)
Where is the [Prostatic plexus] located and what does it innervate
[Inside Fascia surrounding Prostate]; innervates [Corpus Cavernosa –> Penile Erection]
Can be damaged during prostatectomy
Cystic Fibrosis and Kartagener (SIBS) present VERY similarly! What is the differentiating sign?
Cystic Fibrosis has [Bilateral Absence of Vas Deferens]! (This –> Infertility)
MiFepristone MOA
F this baby, smh
Progesterone R Blocker
Used for [1st trimester Abortion]
Misoprostol MOA
Prostaglandin E1 agonist; given with MiFepristone
[Sertoli Leydig ovarian tumors] come from ____ and secrete _____. Describe the Histo
[Sex Cord Stroma]; Testosterone; Round Sertoli surrounded by fibrous stroma w/ Reinke crystals]
What is Rheumatoid factor
IgM Ab that targets [host IgG Fc region]
What all conditions are associated with [HLA B27 Seronegative spondyloarthropathies] (4)? Which class of MHC do they belong to?
PAIR
Psoriatic Arthritis
Ankylosing Spondylitis
Inflammatory bowel Dz arthritis
[Reiters Reactive arthritis]
[MHC Class 1 = HLA A, B and C] (all else = MHC Class 2)
Latissimus Dorsi
A: Innervation
B: function (3)
C: Attachment (3)
A: Thoracodorsal n.
B: [Humerus: Extension / ADDuction / medial rotation]
C: iLiac crest –> [Spinous process of T7-12] and inserts at bicipital humerus groove
Describe the “Empty-Can” test and which muscle it test for?
[ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] –> Pain = [Supraspinatus Rotator cuff injury]
What are T-Tubules and what is their job?
[Invaginations of the Sarcolemma] that extend into each fiber; Coordinates contraction of myofibrils by transmiting depolarization to BOTH Sarcoplasmic Reticulum between 2 muscle fibers
What is Calcitriol
Vitamin D (1-25 Dihydroxycholecalciferol)
Where is Calcitonin produced and how does it DEC serum Ca+
[Thyroid parafollicular C-cells]; inhibits Osteoclast
Effect of T3 on bone
Activates Osteoclast (INC bone turnover) –> INC Ca+ and Phosphate
What biochemical change is exhibited in Myasthenia gravis on the motor end plate?
REDUCED MOTOR END PLATE POTENTIAL (from inability of ACh to stimulate opening of Na+ influx)
Which muscles allow you to sit up from supine position (3)
- [iLiopsoas Hip Flexors (iLiacus/Psoas Major & minor)]
- Rectus Abdominis
- External Oblique
Clinical Presentation for [DILE - Drug Induced Lupus Erythematosus] (3). Which drugs cause this (3)?
[Sudden FAP - Fever/Arthralgia/Pleuritis]; (Drugs linked to Liver Acetylation –>Procainamide/Hydralazine/INH)
SLOW ACETYLATORS = INC RISK!
Describe the [Psoas Sign] and what it indicates
Pain when Hip is extended; Psoas m. damage/abscess
Psoas and iLiopsoas m. are the major hip flexors
Which arteries are associated with the following nerves?
A: Long Thoracic
B: Axillary
C: Radial
D: Median
E: Tibial: Popliteal fossa
F: Tibial: posterior to medial malleolus
A: Long Thoracic = Lateral Thoracic artery
B: Axillary = POST Circumflex a.
C: Radial = DEEP Brachial a.
D: Median = Brachial a.
E: Tibial: Popliteal fossa = Popliteal a.
F: Tibial: posterior to medial malleolus = POST Tibial a.
Involuntary deviation of the Head to the R with neck muscle pain is an example of ___
DYSTONIA = abnormal (painful) movements or postures from sustained contraction
[Spasmodic Torticollis Cervical Dystonia] = most common
Hiccups and [Hypnic jerks seen when falling asleep] are an example of what?
Myoclonus = Sudden brief shock-like muscle contraction
A: List the n. roots associated with Obturator n.
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit
Obturator nerve
A: L2-4
B: Pelvic Surgery vs. ANT Hip Dislocation
C: medial thigh loss
D: No Thigh ADDuction
A: List the n. roots associated with Femoral n.
B: Associated Injury (2)
C: Sensory deficit
Femoral nerve
A: L3-4
B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]
C: [(AnteroMedial Thigh) & (Medial leg)]
List the n. roots associated with Common Peroneal n.
L4-S2
foot is dropPED (Peroneal Everts & Dorsiflexes)
List the n. roots associated with Tibial n.
L4-S3
can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)
A: List the n. roots associated with [SUP Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit (2)
[SUP Gluteal nerve]
A: L4-S1
B: [Superomedial Butt injection] vs. POST Hip dislocation
C: none :-)
D: [Trendelenburg gait] & [No Thigh ABduction]
A: List the n. roots associated with [inferior Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit (2)
[inferior Gluteal nerve]
A: L5-S2
B: Butt injection vs. POST Hip dislocation
C: none :-)
D: [No Thigh Extension]
What are the 3 drugs used for Acute Gout attack and which are first line?
GNC
Glucocorticoid/NSAIDs/Colchicine
Use NSAID 1st > Colchicine > Glucocorticoid
What is Dystrophin and in what dz is the gene for it deleted?
Protein allowing connection between [Extracell Conennective tissue] and [intramuscle cell contraction apparatus]; Duchenne Muscular Dystrophy (Gower sign)
Injury to the Femoral Neck can –> [Femoral head osteonecrosis] by damaging which artery
[Medial Femoral Circumflex] = perfuses Femoral Head & Neck
[Lateral Twisted Ankle sprain] is due to _________ and involves the ______ ligament
[Plantar flexed foot that’s forcefully inverted]; [ANT TaloFibular ligament]
Which drug is used for [rapid sequence intubation] and how does it affect the body longterm?
[Succinylcholine = fast acting depolarizing neuromuscular blocker]–> Phase 1 Neuromuscular blockade; Prolonged admin –> Phase 2 Neuromuscular blockade
Which cytokine plays the biggest role in IBD? What is its role and how does it do this? (3)
IL10; ANTI-inflammation;
- Inhibits TH1 cytokine release
- [DEC MHC Class 2 expression]
- [deactivates macrophages/dendritic cells]
Function of Enteropeptidase and where is it secreted?
Converts [inactive trypsinogen] –> [ACTIVE TRYPSIN]; Secreted from Jejunum
Which nerve enables visceral umbilicus pain during appendicitis?
What causes pain to shift from umbilicus to McBurney point? (2)
[T10 Afferent Pain fibers]; Irritation of Parietal peritoneum & Abd Wall shifts pain to McBurney
Which diagnostic is best to screen for malabsorption DO?
Sudan 3 Stain (test stool for fat)
Which 2 vitamins can Breast milk not provide for newborns?
Vitamin D and K
Annular Pancreas MOD
abnormal migration of [Pancreatic ventral bud] –> encircles the [descending 2ndpart duodenum] during 8th week gestation
Pancreas Divisum MOD
vusion incompletion of Ventral & Dorsal pancreatic buds –> Asx w/ no obstruction
Pancreatitis can cause blood clots in the ____ which affects the stomach how?
Pancreatitis can cause blood clots in the splenic vein –> INC pressure in [short gastric fundal veins] –> [short gastric fundal varices]
Identify
Which cytokines do TH1 produce to cause injury in Crohn’s IBD (3)
IF-gamma / IL2 / TNFa
Infliximab targets TNFa
Imaging characteristics of Cholecystitis (4)
- US Gallbladder wall thickening
- US Pericholecystic fluid
- Positive Sonographic Murphy sign
- Failed gallbaldder visualization on radionuclide scan
Describe the Histo (2) and Identify the GI lesion
Villous Adenoma
[Long glands + Villi projections from the surface]
Describe the Histo (2) and Identify the GI lesion
[Disorganized glands] + [smooth m. & tissue]
Hamartomatous polyps
What is Courvoisier sign and what is it associated with?
[Palpable BUT NONTENDER Gallbladder] = Pancreatic CA
- will be accompanied w/obstructive jaundice + CA sx*
- smoking = biggest risk factor for Pancreatic CA*
Identify
Describe [SUP Mesenteric Artery] Syndrome
Occurs when [Transverse Duodenum] becomes trapped between the SMA and aorta due to [DEC in the aortomesenteric angle] –> intestinal obstruction
What compounds are Absorbed EXCLUSIVELY in Duodenum only (4)
MIC + [Vitamin A]
What compounds are Absorbed EXCLUSIVELY in Jejunum only (6)
TEAM Water + [Vitamin DEK]
Dietary Lipids are Digested in the _____ but absorbed in the _____. How does reabsorption occur?
Lipids = Digested in Duodenum; Absorbed in Jejunum
Bile from Duodenum forms water-soluble micelles around [fatty acids] which are passively absorbed into the [Jejunum brush border enterocyte].
[Fatty acids] are then reconstructed and combined with apoprotein –> Chylomicron –> intestinal lymphatics
What compounds are Absorbed EXCLUSIVELY in iLeum only (3)
[Lynch HNPCC Hereditary CA] MOD
Which genes are implicated (3)
DNA mismatch repair –> microsatellite instability –> CRC
[MSH2 & 6 / MLH1 / PMS2]
Name the key differentiating factors for CRC from Ulcerative Colitis (vs. Lynch/Sporadic) (3)
CRC from UC are like MEN!
- Comes from [NON-Polyp dysplastic lesions]
- Multifocal
- [EARLY p53 but LATE APC] –> Higher Histological grade
Identify the Dz and describe its MOD
List 2 classic findings
Intussuception; Telescoping of proximal bowel into distal usually at iLeocecal junction; [Currant jelly stool + Bulls Eye US]
Anal fissures are ___ tears that come from ______. Where do they occur?
longitudinal; hard stools; [Distal to Dentate in the Posterior midline]
Identify
What do the Dorsal and Ventral Pancreatic buds each form?
Ventral = [Major pancreatic Duct of Wirsung], Uncinate, [posterior Head]
Dorsal = Everything Else
Which neonatal GI condition are Down syndrome pts most susceptible to? MOD? Name 2 other GI conditions
Umbilical Hernia;
Linea Alba defect –>incomplete umbilical ring closure –> [Reducible protrusion COVERED BY SKIN] that resolves spontaneously
Omphalocele = herniation within a thin membranous sac
Also susceptible to Duodenal Atresia, Hirschprung
Identify the key finding. What is this pt at risk of developing?
[Porcelain Gallbladder from Chronic Cholecystitis] –>Gallbladder ADC
Dystrophic intramural Ca+ deposition + chronic inflammation
Where is the Ligament of Treitz
lithium toxicity (LMNOP) can be precipitated by what? (4)
- Thiazides
- ACE inhibitors
- NSAIDs
- Volume Depletion
Which drugs cause Agranulocytosis? (6)
Gangs CCCrush Myeloblast & Promyelocytes
Ganciclovir
Clozapine
Carbamazepine
Colchicine
Methimazole(also Teratogenic–>Cutis Aplasia)
PTU
Which 4 conditions is Buproprion contraindicated in?
- SEIZURES hx
- Anorexia
- Bulimia
- Panic DO
Out of the anti-convulsants (Carbamazepine, Valproate & Lamotrigine), which is used for Seizure Px
Valproate
These are also used for Bipolar tx
Why is Antidepressant monotherapy contraindicated in Bipolar or person who may have Bipolar
Antidepressant monotherapy can INDUCE MANIA in Bipolar vs. [Unrecognized Bipolar DO]
Difference between Avoidant DO and SchizoiD DO
Avoidant DO = avoidance only due to fears of rejection or criticism (pts don’t want or like this)
vs.
SchizoiD DO = avoidance that these pts are perfectly content with
How do you differentiate [Bulimia Nervosa] from [Sjogren syndrome] (3)
Bulimia Nervosa will have
- Abnormal Electrolytes
- INCREASED Amylase and Lipase (Parotid swelling)
- [Russell Dorsal Hand Calluses]
Common characteristics of Cocaine Withdrawal (3)
- SEVERE ACUTE DEPRESSION (CRASH)
- Hyperphagia
- Hypersomnia w/vivid dreams
Phencyclidine (AKA ___) is a __(MOA)___ and main toxication sign is _____
PCP (Hallucinogen = [NMDA Glutamate Blocker])! ; [Vertical Nystagmus]
LSD main toxication sign is _____
Visual Hallucinations
Heroin main toxication sign is _____ (2)
- Miosis
- Respiratory Depression
What are the signs of Cocaine intoxication? - 3
- MyDriasis (Pupils Wide Open on coke!)
- Chest Pain
- Seizures
What is the primary SE of [SSRI AND SNRI] and which drug is an appropriate alternative
Sexual dysfunction; replace with Buproprion
Describe [Atypical Depression] (3)
Which drug is best for this type of Depression?
- Mood Reactivity (positive events brightens mood)
- Leaden Paralysis (extremities feel “heavy”)
- Rejection Sensitivity (super sensitive to criticism)
MAO inhibitors = tx resistant and atypical depression
Damage to what lobe of the brain results in [Apathy and organization impairment]?
R handed person
LEFT Frontal
Damage to what lobe of the brain results in Disinhibition?
R handed person
RIGHT Frontal
Difference between Tourette and [Chronic Tic DO]
Tourette = [Motor AND Vocal Tics both] for GOE 1 year
Which Benzodiazepines have short half life but can’t be used in Liver failure pts? Wh
Alprazolam & Clonazepam = intermediate] and [Triazolam & = short half life]
CAN NOT USE IN LIVER FAILURE PTS (they undergo hepatic metabolism) - LOT is preferred in liver failure pts [Lorazepam/Oxazepam/Temazepam]
Difference Between [Bulimia Nervosa] and Anorexia
pts with [Bulimia Nervosa] will NOT show signs of malnutrition because they still maintain body weight at or above minimal
Which function is dysfunctional in Xeroderma Pigmentosum and which enzyme is implicated
[Nucleotide Exicision Repair]; Endonuclease
These pts have hyperpigmentation in sun exposed areas and INC risk for Skin SQC
Explain how sun exposure causes skin DNA changes and how it’s repaired
UVB forms Pyrimidine dimers
Endonuclease nicks the damaged strand on both sides of the Pyrimidine dimer –> Excises it–>
Replacement by DNA polymerase
Acanthosis Nigricans is mostly associated with ____ but can also be tied to _____
mostly Insulin Resistance!; Gastric ADC
Terbinafine MOA
[Squalene Epoxidase] inhibitor
Accessory Nipples MOD
Failed regression of mammary ridge during utero –> Asx but sometimes tender (espeically during menses) mass in Teens
Which cells are responsible for the Type __ TB Skin Test reponse
Type 4; [CD4, CD8, macrophages]
CD4 & macrophages also keep TB in check with granuloma formation
Typically, Type 1 Hypersensitivity involves IgE-mediated mast cell stimulation
Which compounds do NOT need IgE to stimulate [Type 1 Hypersensitivity mast cell degranulation]? (3)
- Morphine (Opioids)
- Radiocontrast
- Vancomycin
Name the common causes of Erythema Multiforme (7)
“Only CHAMPPS can hit the Target!”
Cancer
HSV
Autoimmune
Mycoplasma Pneumoniae
PCN
Phenytoin
Sulfa abx
What is [Osgood Schlatter Dz]
Repetitive Quadricep contractions –> overuse injury of [2° ossification apophysis] of Tibial Tuberosity
Presents as pain at the Tibial Tubercle
The Piriformis muscle passes through the ____ foramen and functions to do what?
[Greater Sciatic Foramen] –>can compress Sciatic n. if injured; External Hip rotation
In psychiatry, what is splitting? Which demographic is commonly seen in
Splitting people into either all good, or all bad; Borderline PD
For Bipolar Mania dx, you need at least [__ sx +/- ___] that last for ___ duration. What are the sx? (7)
[3 sx +/- major depression]; 1 week duration;
BIPOLAR
Buying excessively (INC in pleasurable activity)
Inflated self-esteem
Psychomotor agitation (pacing)
wide awOke - won’t sleep
Lots of Language (talking a lot)
ADD-like distractability
Racing thoughts & Ideas
Cocaine MOA and toxicity signs (4)
[Presynaptic Reuptake inhibitor] of DNS [Dopamine/NorEpi/Serotonin]
- myDriasis responsive to light
- Tachycardia
- Agitation
- Vasoconstriction –> Myocardial ischemia (cp)
In Psychiatry, what is Displacement
Displacing feelings meant (but never given to) one person toward a “safer” person
In Psychiatry, what is Transference
Transfering unconscious emotions associated with a person in the past –> person in present
Pts abused as kids have difficult time seeking care in the future since they associate it with poor caretaking
In Insomnia tx, what is Stimulus Control
Eliminating stimulating bedroom activities and only getting in bed when sleepy
pt should leave bedroom if unable to fall asleep within 20 min
Buspirone MOA, indication and primary cons (2)
Buspirone = [5HT1a agonist]; GAD; [slow onset] and [lacks muscle relaxant/anticonvulsant properties]
In Psychiatry, what is Projection
Projecting your unaccetable feelings of something onto someone else (as if they have the feelings) so u don’t have to acknowledge ur own feelings
What is unique regarding frequency of Pheochromocytoma presentation
Sx may be Paroxysmal or Constant
Sx can resolve on their own sometimes
Ovarian vein thrombosis can extend to which vessels (L Ovarian vein vs. R Ovarian Vein)
[L Ovarian Vein] –> [L Renal Vein]
[R Ovarin Vein] –> IVC
List the peak times for
A: Glulisine/Aspart/Lispro
B: Regular insulin
C: NPH
D: Detemir
E: GLargine
Cinacalcet MOA
[Mimics Ca+] and allosterically sensitizes [Parathyroid CaSR] –> DEC PTH
Used for 1° or 2° HyperParathyroidism
Describe the Histo for [Hashimoto Autoimmune hypOthyroid] (3)
- [Hurthle Oncocytes] = pink cytoplasm from numerous mitochondria
- [Mononuclear parenchymal infiltration] +
- [Germinal centers]
[Primary Biliary Cirrhosis] MOD and marker
What other DO has similar findings?
Autoimmune Lymphocytic & Granulomatous destruction of intraHepatic AND interlobular Bile ducts
Marker = AntiMitochondrial Ab
This is all similar to [Graft vs. Host Dz]
What are the HLA associations for Type 1 DM (2)
HLA [DQ] and [DR3 & 4]
[INC ACTH + Hyperpigmentation] should make you suspicious for what dz
[Addison’s 1° Adrenal Insufficiency]
What’s the most serious complication of untreated Prolactinoma in women
Bone loss
The following histo from an Ovary likely indicates what dx?
Mature Teratoma
Describe how a female may end up with an indented uterus fundus
Incomplete lateral fusion of paramesonephric ducts –> Bicornuate uterus (indented uterus fundus)
Paramesonephreic ducts –> Fallopian/Uterus/Cervix/Upper Vagina
How does elevated Free Fatty acid contribute to Insulin resistance (2)
impairs [insulin-dependent] glucose uptake by Liver and INC liver gluconeogenesis
Sedentary Lifestyle & Obesity can also do this
Describe the Histo; Identify Dz
sample come from Breast Mass
[Fibrous myxoid stroma] that encircles [Glandular spaces]; Fibroadenoma
Describe the Histo; Identify Dz
sample come from Breast Mass
Cell proliferation surrounded by well preserved [Ductal basement membrane]; DCIS (Ductal Carcinoma In Situ)
Identify Dz and its MOD
sample come from Breast Mass
malignancy spreading from superficial DCIS –> nipple skin w/out crossing basement membrane –> Nipple Crust; [Paget Dz of Nipple]
What is an Imperforate Hymen and how does it present?
Incomplete degeneration of central fibrous tissue band connecting vaginal walls –>
Teen with 1°Amenorrhea, normal secondary sex characterisitcs but cyclical pelvic pain due to menstrual blood accumulation (hematocolpos)
During pregnancy, a mother who experiences [Maternal Virlization] probably has a fetus & placenta with what defective enzyme? Explain
Aromatase! (not 21aH) - the fetus and placenta will both have Aromatase deficeincy
In 21aH, placenta aromatase is still functional –> NO Maternal virilization during pregnancy
A: [Age related Macular Degeneration] MOD
B: Tx (2)
Retinal neovascularization from INC VEGF –> [Grayish subretinal membrane +/- hemorrhage]
B: [VEGF inhibitors(RaniBizumab)] & Smoking cessation
A: Glaucoma MOD
B: Tx approaches (3) and how specifically does B-blockers work?
INC intraocular pressure from [INC production vs. DEC outflow of Aqueous humor]
B:B-Blockers –> DEC Ciliary Epithelium Aqueous humor secretion!
Topical Prostaglandins = latanoprost (open angle glaucoma)
The testicles drain lymph into the ____ lymph nodes. Where do Glans Penis drain?
ParaAortic; Glans Penis–> [Deep inguinal nodes]
Identify Dz and its MOD
[CLOSED angle Glaucoma]; INC intraocular pressure from DEC aqueous humor drainage
Describe how Granulomas are formed
[CD4+ T] secrete IF-gamma –> activates macropages –> macrophages secrete TNFa –> further matures them and forms granuloma (walled off defense)
Common complications of Psoriasis (3)
- Psoriatic Arthritis (PAIR) -[Dactylitis Sausage fingers/Pencil in Cup]
- Nail pitting
- Uveitis
___ is the most common ocular childhood tumor. How does it present and what CA does it predispose them to?
Retinoblastoma (2 hit hypothesis); [Leukocoria White pupillary reflex] and may –> OsteoSarcoma
- Unilateral = sporadic*
- Bilateral = familial (worst pgn)*
Dz
[Retinal pale whitening] + [Cherry Red Macula] = [Central Retinal Artery Occlusion] –> Painless monocular blindness
Common characteristics of Down Syndrome pts - 7
the SHEEPPS of genetics
- Skin excessive at nape of the neck = nuchal skin
- HypOtonia w/ ⬇︎ Startle Moro reflex
- Epicanthal folds
- Ears that are small
- Protruding tongue w/flat face
- Palpebral fissures are upslanted
- Single palmar crease
In [Graft versus Host Dz] the transplant __ cells attack the Recipient. What are the manifestations? (4)
Which transplants are associated with GVHD? (2)
[Donor Tcells] proliferate in immunoCOMPRO recipient;
- Maculopapular Rash
- Jaundice
- Diarrhea
- Hepatosplenomegaly
Bone Marrow & Liver
Has similar Histo to Primary Biliary Cirrhosis
How can Testicular CA or [Gestational Trophoblastic Dz] cause Hyperthyroidism
Both of these secrete a lot of HCG, which is structurally similar to TSH –> INC T3/T4
Functions of TNFa (4)
WECS
WBC recruitment
Endothelium activation –> vascular leakage
CA Cachexia
Septic shock
Significant SE of Nitroprusside and reversal tx (3)
Cyanide toxicity –> seizures, bright red venous blood & lactic acidosis;
Antidote =
- Hydroxocobalamin (directly binds)
- Sodium Nitrite (induces methemoglobinemia)
- Sodium ThioSulfate (Sulfur donor)
Which layers of the Throat are passed when doing a Cricothyrotomy? (3)
[Superficial Cervical fascia], [Pretracheal fascia] & [Cricothyroid membrane]
Prolonged exposure to loud noises prediposes to damage of what part of the ear
[Organ of Corti: stereociliated hair cells]
Classic triad for ASA toxicity ; What acid-base state will these pts be in? (2)
ASA –> [Mixed Respiratory alkalosis + AG metabolic acidosis] (Normal pH/Low PCO2/Low HCO3)
[Air is Fast (Tachypnea)]
[Sound ringing (Tinnitus)]
[Air is Hot (Fever]
[Meniere TVS] Dz Sx Triad and MOD
[Meniere TVS]
INC endolymph volume in vestibular apparatus –> RECURRENT
Tinnitus
Vertigo
[Sensorineural hearing loss]
What is a Cholesteatoma?
Squamous cell debris that form pearly masses behind tympanic membrane of middle ear
Which arteries anastomose at the [Kisselbach plexus] of the ANT nasal septum (3)
ANT Ethmoidal
Sphenopalatine
SUP labial
Sensation to the ear canal is NOT innervated by Vestibulocochlear n. What does innervate it? (2)
Vagus –> POST External Auditory canal
[CN5: B3] –> the rest
Which nerve is dangerously close to the inferior thyroid artery
[RIGHT Recurrent Laryngeal n.]–> [Raspy Vocal Cord Paralysis(same as L)]
Cleft LIP mechanism of formation.
Cleft palate mechanism of formation?
When does this occur
Cleft lip = [maxillary &
medial nasal processes (formation of 1° palate)] fail to fuse
Cleft palate— [the two lateral palatine shelves] vs. [lateral palatine shelf with median palatine shelf (or nasal septum) (formation of 2°
palate)] fail to fuse
5th-6th Week Embryo
MOA of Succinylcholine
ACh receptor agonist tht actually produces sustained depolarization and prevents
muscle contraction.
Describe Succinylcholine Phase 1 and its OD antidote
Phase I (prolonged depolarization)—no antidote. Block potentiated by cholinesterase inhibitors.
Describe Succinylcholine Phase 2 and its OD antidote
Phase 2 (repolarization finally starts but ACh R are still blocked since even tho they’re available, they’re desensitized)
antidote is cholinesterase inhibitors
How might a newborn suffering from Vitamin K deficiency present? (3)
Impaired clotting factor carboxylation
- Intracranial hemorrhage
- Bulging ANT Fontanelle
- [Eyes driven downward & unable to track up]
Clinical Presentation of Fanconi Anemia (3)
- Short stature
- Absent Thumbs
- INC CA Risk [Myelodysplastic syndrome and AML]
What is Fanconi Anemia
[Loss of DNA crosslink repair] –> Inherited Aplastic Anemia
Describe Pancytopenia (3)
Pan cytopenia : TAN
Thrombocytopenia (petechiae, hemorrhage)
Anemia (fatigue, pallor)
Neutropenia (opportunistic infection)
What’s the most important Pgn factor for [Bladder Urothelilal Transitional cell carcinoma]
Tumor Penetration into Bladder Wall
Chemotherapeutic (and toxic) effect of MTX can be overcome with what drug? Why does this help?
[Leucovorin THFolinic acid]; This is a reduced form of Folic Acid BUT doesn’t require DHF reductase like Folic Acid
MTX Indications (7)
- Brain Tumor - HIGH IV DOSES
- Meningitis (carcinomatous vs. lymphomatous)
- Leukemia
- Lymphoma
- Psoriasis
- RA
- Ectopic Pregnancy
[Tumor Lysis Syndrome] MOA and Clinical Presentation (4)
Develops during Chemo in CA with rapid turnover
HYPERKUP + [low Ca+]
- HYPERKalemia
- HYPERUricemia (tx: Rasburicase vs. Allopurinol)
- HYPERPhosphatemia
- hypOcalcemia
The MDR1 gene codes for the _____, which is a _____
MDR1 gene codes for [P-GlycoProtein Efflux Pump], which is an transmembrane ATP-dependent protein that effluxes hydrophobic protein out of the cell –> ChemoResistance
Hydroxyurea Indication (3)
- Sickle Cell Anemia (INC HbB Fetal synthesis)
- Rapidly DECREASES High [WBC Blast count] in pts with AML and [Chronic Granulocytic Leukemia w/blast crisis]
Inhibits [Ribonucleotide Reductase] –> inhibits [DNA thymine] synthesis
Multiple Myeloma [Tx and its MOA]
Crazy Ass BUMP
[Bortezomib Proteasome inhibitor] = Boronic acid-protein that inhibts breakdown of [Excess Proteins like (Monoclonal IgG)]–>intracell accumulation –> Plasma cell apoptosis
Also tx for Mantle Cell Lymphoma
Etoposide MOA
E2oposide: Topoisomerase 2 inhibitor –> Double stranded DNA breaks
Etoposide Indication (3)
- Testicular CA
- Lymphoma
- SOLC
Etoposide SE
Leukomogenic (Leukemia Promoter)
Function of Ristocetin
Activates [GP1B/2A Platelet R] –>INC availability for vWF adherence
Elderly who’ve received intubation or dehydrated are at risk for [Acute Staph Aureus ____] Dx? (2)
Acute Staph Auerus Parotitis; [Amylase & imaging]
Difference between Reassortment & Recombination
Reassortment (ex. influenza) = reassortment of [viral genome segments] within a host cell infected with 2 viruses
vs.
Recombination = gene exchange via crossing over of 2 double-stranded DNA molecules
How does LOE (LPS OuterMembrane Endotoxin) from [Gram negative bacteria] facilitate Gram negative sepsis
[LOE = LPS OuterMembrane Endotoxin]
LOE is passively released from Gram neg bacteria. LIPID A is the toxic component of LOE and activates macrophages –> IL1 and TNFa –> Sepsis
Is Angioedema Hereditary or Acquired? What enzyme deficiency INC the risk of Angioedema and why?
BOTH!; [Low C1 esterase inhibitor] activity –>INC bradykinin from the start –> INC risk of acquired Angioedema
ACEk2 inhibitors are contraindicated in these pts!
Describe the Monospot EBV test
Heterophile Ab that react with [Horse or Sheep RBC = EBV +]
[C1 esterase inhibitor deficiency] MOD (2) and presentation
What is the major virulence factor for [Group A Strep Pyogenes] and what does it do? (3)
M Protein
- Inhibits Phagocytosis
- Inhibits Complement
- Mediates Bacterial Adherence
Anaphylaxis (IgE) involves widespread mast & ___ degranulation. What is a specific marker for mast cell activation?
mast & basophil degranulation; Tryptase
Histamine & Heparin are also released
What is one of the more severe complications of [Reiters Reactive Arthritis]
SacroiLiitis
Also: RRA can also cause skin rash on palms & soles!
Formula for Drug Concentration
[Drug Dose (mg) / VD]
VD = Volume of Distribution (L)
Presbyopia and skin wrinkles are [Age related changes] (along with Macular degeneration)
Describe Presbyopia & how it’s related to skin wrinkles
[Denaturated Lens Hardening] –> DEC Lens elasticity–>inability to thicken
(In skin: DEC collagen & elastin –> wrinkles)
The following was obtained from a Liver biopsy. What’s the Dx, MOD
[Alpha 1 Antitrypsin deficiency];
No [Alpha 1 antitrypsin] –> INC [(macrophage tryptase)/(neutrophil elastase)] –> [Panacinar emphysema from alveolar wall destruction]
AND
Liver Cirrhosis from accumulation of malfolded [Alpha1AntiTrypsin] (seen in PAS+ image)
Name MOD and key findings for [Patau Trisomy __] (6)
[Patau Trisomy 13]; Prechordal mesoderm fusion –> midline defects
- aPlasia cutis
- holoProscencephaly (incomplete separation of prosencephalon forebrain - cerebral hemispheres)
- [Cleft Palate/Cleft Lip]
- Polydactyly
- [omPhalocele umbilical hernia]
- Rocker bottom feet
Describe [Acute Compartment Syndrome] and describe which vessels are impacted by
A: ANT Compartment (2)
B: Lateral (1)
C: Deep Posterior (3)
INC pressure within fascial compartments –> DEC perfusion
Explain the purpose of adding Primaquine to a Chloroquine regimen
Targets the [Plasmodium Vivax & Ovale] [intrahepatic hypnoZoite stage] –> DEC Relapses from these species
Difference in MOA between BetaLactams and Vancomycin
BetaLactams = bind to PBP (SUCH AS TRANSPEPTIDASE)–> DEC peptidoglycan cell wall cross-link
vs.
Vancomycin = BINDS DIRECTLY TO [Terminal D-alanine glycoproteins of cell wall itself] prevents [PBP Transpeptidases] from ever binding
Both bind irreversibly
Difference in MOA between [Echinocandin (i.e. Caspofungin)] and Azole antifungals
Azoles inhibit fungal [Ergosterol membrane synthesis]
vs.
[Echinocandin (Caspofungin) inhibits fungal [WALL synthesis]
N. meningitidits, gonorrhea, Strep Pneumo and H.Flu all have IgA Protease. What is its function?
Cleaves IgA at hinge region –> INC ability to bind to mucosal surfaces
Tx for [Gardnerella Bacterial Vaginosis] (2)
Metronidazole
Clindamycin
What’s unique about the Herpes virus membrane envelope?
Although most enveloped viruses get their [lipid bilayer envelope from host plasma membrane], Herpes family get theirs from host NUCLEAR membrane
Image showing HSV Tzanck Smear
Describe how Acyclovir is activated (3)
[Herpesfamily Thymidine Kinase] MUST first monophosphorylate Acyclovir –> intermediate –(host cell enzymes)–> [Active Triphosphate form]
Acyclovir = Guanosine analog
Organisms that are Indole positive means what
Can convert Tryptophan –> Indole
(Ex. E.Coli & Pasteurella)
[Cavernous Sinus Thrombosis] MOD and Presentation (3)
Infection of medial face sinuses or teeth spread thru facial venous –> cavernous sinus
- [CN3 / 4 / CN5B1 and B2 / 6] ipsilateral involvement
- Proptosis
- HA
[Facial CN7] exits the ____ foramen and courses through the ____ gland. Tumors of this gland cause what n. manifestation?
Stylomastoid; Parotid; [Ipsilateral Facial Droop]
What are the 2 immune defenses for Candida Albican infection
Local = T Cells (Reason HIV pts have local candida infections)
vs.
Systemic = neutrophils
Describe a Gumma and its Demographic
Cutaneous [Painless indurated granulomatous white-gray rubbery lesions]; [TERTIARY syphillis]
Name the cases in which [INH Monotherapy] can and can not be given
NEVER for ACTIVE TB
but [INH Monotherapy] can be given to pts with [Positive PPD but NEGATIVE CXR (Latent TB)
What is the main source of immunity against Influenza
Humoral Ab against Hemagglutinin prevents reinfection
Name the 2 common organisms that cause [Osteomyelitis in Sickle cell pts]
Salmonella & Staph Aureus
Sickle Cell = [GlutaMATE –> Valine @ 6th position]
What constitutes as a low Volume of Distribution and what drug characteristics cause this? (4)
low Vd = 3-5 L;
- Too much protein binding
- Too Hydrophilic
- Too Heavy (high molecular wt.)
- Too much charge
Describe the process of antigen presentation (starting with Ubiquitin ligases) (3)
Ubiquitin ligase recognize protein substrate and tags it –> [tagged complex is degraded by proteosome & coupled with MHC1 in ER]–>presented to CD8
This process is impaired in Parkinson’s & Alzheimer’s
Function of Northern, Southern, Western and Southwestern Blots
“No Man Steals Drugs With Pride”
Northern = mRNA detection: “Is gene being expressed?”
Southern = DNA detection
Western blots = Protein detection
Southwestern = [DNA-bound Protein] detection
All separated by size & charge on electrophoresis
Nucleosomes are made of ______. How does [H1 Histone] associate with Nucleosomes?
Nucleosomes = DNA wrapped around core of 8 histone proteins (2 each of H2A/H2B/H3/H4).
[H1 histone] is outside nucleosome core & compacts nucleosomes by linking DNA between adjacent nucleosomes
During continuous infusion, 1st order kinetic drugs reach steady state in how many half lives?
[1st order kinetic drugs] reach steady state in 4 half lives
Telomerase Function and [Locations (2)]
[Reverse Transcriptase Ribonucleoprotein] that adds TTAGGG to [3’ telomere region of chromosomes] –> lengthens Stem cell telomeres; Bone marrow & [Epidermis Stratum Basale]
Which molecules recognize stop codons and terminate protein synthesis
Releasing Factors
(these release the polypeptide chain from ribosome & disolve ribosome-mRNA complex)
What do Homeobox genes encode for
Transcription factors important in segmental organization of embryo along cranio-caudal axis
[Ragged Red Fibers on muscle biopsy] indicates what type of DO
Mitochondrial DO! (passed by Moms)
How are thyroid DO associated with depression
hypOthyroidism —> Depression
What type of receptors contain Zinc-finger domains
INTRAcellular receptors (steroid/thyroid/fat-solbule vitamins)
When is [Anti-Rh (D) IgG] given to Rh- Moms
1st: 28 weeks gestation
2nd time: Immediately postpartum
Describe [JAK-STAT] and list which ligands use it (6)
[Cytoplasmic (Not Receptor) Tyrosine Kinase]. STAT enters nucleus –> tx
PIGGLET
Prolactin
Immunomodulators (cytokines/IL)
GCSF
GH
Erythropoietin
Thrombopoietin
What 2nd messenger is used by [GPCR/cAMP pathway] and name the main hormones that use this (12)
PKA;
FLAT ChAMP Calls Girls Gluttunous
- FSH
- LH
- ACTH
- TSH
- CRH
- hCG
- ADH
- MSH
- PTH
- Calcitonin
- GHRH
- Glucagon
Pts with a hx of _____ are at risk for inaccurate pregnancy dating. Maternal serum quadruple screen is for identifying ____
Irregular menses; Congential Defects
Glucose is typically transported into cells via _____ from high to low concentrations. GLUT transporters prefer what isomer of glucose?
[Facilitated carrier mediated Diffusion]; D-Glucose
Lab findings for Absent Seizures (2)
- [3 Hz Spike EEG]
- Slow wave EEG
Gold standard for TIA px and what’s the MOA
ASA; COX inhibitor –> DEC [Thromboxane A2] –> DEC Platelet aggregation and vasoconstriction
Why is there actually an overall DECREASE in Mean Arterial pressure during exercise
Skeletal m. arterial Dilation from local [Adenosine/K+/Co2/lactate] —> [DECREASE overall systemic vascular resistance]
Characteristics for Carcinoid Syndrome (9)
How do ACEk2 inhibitors affect Bradykinin?
[ACEk2 inhbiitors] –> INCREASE Bradykinin
Kininase2 degrades Bradykinin
Difference between SchizoAffective and Schizophrenia
ShizoAffective = [Psychosis occurs WITHOUT mood DO] but [Mood DO can only occur with Psychosis]
Schizophrenia has NO significant mood sx
Pathognomonic presentation for [Large PDA –> Eisenmenger] (3)
[Clubbing hemipresent] + [Cyanosis hemipresent] + [NO BP or pulse discrepancy]
hemipresent = present in LE but not UE = differential
Hydralazine MOA and [SE (5)]
INC cGMP –> selective arteriole vasoDilation
Reflex Tachycardia + HALF
HA
Angina
Lupus syndrome
Fluid/Na+ retention
Cyanide poisoning MOD
Cyanide inhibits Fe3+ in the [mitochondrial cytochome c oxidase] –> DEC O2 cell consumption –> No change in Arterial O2 parameters but INC venous O2 content –> DEC AV O2 gradient
Which artery perfuses the inferior heart
PDA
Tx for Carcinoid Syndrome Sx
Octreotide
How does Opioid analgesics affect the Biliary system
Opioids can contract [Sphincter of Oddi smooth m.] –> INC pressure in common bile duct & gallbladder!
Explain how cells adere to Extracell Matrix starting with [ECM Collagen]
5a-reductase deficiency is ___(mode of inheritance)___ and presents with what? (3)
auto recessive;
- Feminized External genitalia (will masculinize @ puberty)
- small phallus
- hypOspadia
Adenosine [Indications (2)] and [major SE (3)]
Antiarrhythmic used for [PSVT and Chemical stress test] due to rapid 10 second half life
SE:
[Bronchospasm chest burn]
Flushing
High Grade BLOCK
Describe the Urease test used for H.Pylori Dx
[Pt Gastric mucosa] is added to [solution with pH indicator & urea].
If H.Pylori present, [bacterial urease] converts [Urea –> CO2 + NH3] –> INC pH –> COLOR CHANGe
[VPL thalamus] receives input from ____(2).
[VPM thalamus] receives input from _____
Damage to these result in ____(ipsilateral/contralateral) sensory loss
[Dorsal column & Spinothalamic] –> VPL
TrigeMinal —> VPM
Damage –> CONTRALATERAL sensory loss ( pure sensory stroke - Lacunar syndrome)
[MAC Mycobacterium Avium Complex] occurs in HIV+ pts with CD4 less than ___ and requires ____ px. List key characteristics (4)
50; Azithromycin
- Hepatosplenomegaly
- INC [ALP and lactate dehydrogenase]
- Can grow at HIGH temperatures (i.e. 41 C )
- [Fever/Wt loss / Diarrhea]
MAC is Acid Fast
Define Venous Capacitance
the AMOUNT of blood that can be held in the Veins
Ca+ sensing receptors are what type of receptors?
GPCR
Dynein is a microtubular motor protein used in ___ transport. Explain this directionality?
RETROgrade transport;
TOWARDS THE NUCLEUS! = Retrograde
Which Five Catalase + organisms are pts with [Chronic Granulomatous Dz] at risk for? (9)
“These cats [Need Big PLACESS] to kill”
- Nocardia
- Burkholderia
- Pseudomonas
- Listeria
- Aspergillus
- Candida
- E.Coli
- Serratia
- Staph
What causes bruises to turn green several days after injury
Heme oxygenase converts heme –> BiliVerdin (green color) — (BiliVerdin Reductase) —> UnConjugated Bilirubin –> Out into Blood
Terbutaline MOA and indication
B2 agonist that relaxes uterus and DEC contraction freq. during labor
What are the common areas of infection for HPV (3)
Cervix , Anus, [True Vocal Cords]
HPV likes Stratified Squamous epithelium
Why is Desmopressin used to treat [Von Willebrand Dz]
Desmopression stimulates endothelial release of vWF
Why do pts with Chronic hemolytic anemia (such as Sickle cell pts) develop folic acid deficiency?
Rapid INC RBC turnover –> depletes folic acid –> Macrocytic changes
Anesthetic [Blood Gas partition coefficient] is AKA ____
Anesthetic Solubility
Image: Drug A has HIGHER Solubility (reason it takes longer)
Name the factors that INC(2) and DEC(2) TPR on the [Cardiac & Vasulcar function Curve]
[Sympathetics / Vasopressors = INC TPR
vs.
Exercise /AV Shunt = DEC TPR
REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN’T CHANGE
Anaphylaxis would change what parameter of the [caridac output curve]
DEC Venous Return curve only
Name the factors that INC and DEC(3) Venous Return on the [Cardiac & Venous Return Curve]
[Fluid infusion = INC TPR]
vs.
[Spine anesthesia / Acute hemorrhage / Anaphylaxis] = DEC TPR
REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN’T CHANGE
[Drug-induced parkinsonism] is an EPS component caused by ____ blockers. ; What’s the antidote for it?-4
D2 blockers;
- Benztropine
- Trihexyphenidyl
- Propranolol
- Lorazepam
Why would damage to the POST Pit only produce TRANSIENT DI
ADH & Oxytocin are MADE in the hypothalamic nuclei and just secreted from POST Pit. Axonal regeneration would rebuild POST Pit
Only hypothalamic (paraventricular & supraoptic) n. damage –> permanent DI
Tx for [Maple Syrup Urine Dz] (2)
- Lifelong restriction of “I Love Vermont” = Isoleucine/Leucine/Valine
- Thiamine B1 (a-ketoacid dehydrogenase needs Thiamine B1)
How do macrophages play a role in atherosclerotic plaque stability?
inflammatory intraplaque macrophages secrete Metalloproteinases –> Degrade [ECM collagen] –> Plaque rupture
Which growth factors promote CA angiogenesis (4)
- VEGF
- [Fibroblast GF]
- [IL1 and IL-gamma –> INC VEGF]
Function of [2,3 BPG]
DECREASES Hgb O2 affinity (for unloading) by stabilizing the [Taut DeOxyHgB]
What is the major Cause of Death in Acute Rheumatic Fever
PANcarditis
Mitral Stenosis develops later down the line
What component of N.meningiditis actually causes the toxic effects
LOE
[LipoOligoSaccharide OuterMembrane Endotoxin]
Cirrhosis MOD for Asterixis neuro changes
Liver can’t metabolize nitrogenous waste and cant convert to Urea –>
- NH3 crosses Blood Brain Barrier –> [Astrocyte Glutamine & GABA Accumulation] –> Disrupts neurotransmission
- DEC BUN (since there’s no Urea conversion)
How does the sympathetic NS respond to HF
INC Afterload from vasoconstriction –> cardiac remodeling :-(
Renin pathway will also be activated
How does BNP respond to HF (2)
it helps!
BNP vasoDilates, stimulates diuresis –> DEC BP
Describe Streak Ovaries and what demographic they’re seen
Ovaries made of connective tissue with no follicles; Turner Syndrome
What is the difference between [Superior Vena Cava] and [Brachiocephalic vein] syndrome
Both have [Facial Edema] & [SubQ Vein engorgement]
BUT [SUPERIOR VENA CAVA] SYNDROME WILL BE BILATERAL
Homocystinuria MOD, Clinical presentation (3) and tx
[Cystathionine synthase] deficiency –> Thromboembolism
- Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis)
- Ectopia Lentis
- Retarded
tx = [Pyridoxine B6]
What type of pulmonary manifestations are seen in pts with [Diffuse or CREST Scleroderma]
[Pulmonary arteriole intimal thickening] –>Pulm HTN –> Cor Pulmonale
small arterioles & capillaries are affected first in this DO
Explain why [R Testicular Varicoceles] typically indicate ____ or ____ dx
[Renal Vein Thrombosis with spread to IVC] vs. Renal CA; [R Testicular vein] dumps directly into IVC. If IVC is occluded –> R Varicocele
- L Testicular Vein dumps into L renal vein*
- Renal Vein Thrombosis is a known complication of nephrOtic syndrome!*
SE for ACEk2 inhibitors (4)
- DEC GFR
- Hyperkalemia
- Cough
- Angioedema (rare)
How is [PRPP amidotransferase] related to Lesch Nyhan syndrome
Absence of HGPRT to ReConvert [hypOxanthine–> inosine monophosphate] and [Guanine –> Guanosine monophosphate] means INC degradation of these 2..-> INC de novo purine synthesis involving [PRPP synthetase & amidotransferase]
What does this lymph node biopsy indicate?
Follicular Lyphoma (t18 <—->14 BCL2)
[Anti-Apoptosis BCL2] overexpression
Where does isotype switching occur
[2°Follicle Germinal Center]
isotype switching = IgM –> IgG
Where does [VDJ/VJ Recombination] occur (2)
Bone marrow during B-cell maturation and then affinity maturation occurs in [2° follicle germinal centers]
Where does Negative selection/Tolerance occur?
Fetal Thymus: Medulla
Positive occurs in [Fetal Thymus: Cortex]
How does Acidemia affect the kidneys?
Tubular cells convert Glutamine –> GlutamATE –> [NH3(excreted) + HCO3(ReAbsorbed)]. This helps acidemia
Describe Delirum (4) and its tx
Acute confusion w/ agitation & possible psychosis
Tx = Haloperidol
Describe how Glucose stimulates Insulin release in Beta cells
Ammonia is made in the ___ from ____ and ____. How does GI Bleeds affect this?
Ammonia is made in the GI tract from [Glutamine Catabolism] and [Bacterial Protein Catabolism]. GI Bleeds allow more HgB to reach GI Tract –> INC Ammonia Absorption into blood –> Asterixis
How are Monosacchardies processed in the GI tract and role does the [D-xylose test] play in this?
Monosacchardies are absorbed directly w/ no need for amylases.
D-xylose = Differentiates between pancreatic insufficiency & physical malabsorption problem
Identify the Dz and describe the histo
Candida
Budding yeast w/[pseudohyphae germ tubes] (Germ Tube test @ 37 °C)
MOST COMMON OPPORTUNISTIC FUNGI
Amniocentesis showing [INC AChE & AFP] indicates ____
Neural Tube Defects
(Failure of Neural tube to fuse during 4th week gestation)
Identify and Note which part is involved in MVC
Rapid Deceleration while restrained/seatbelted (occurs in MVC) causes Aortic Isthmus to tear —> Aortic Rupture
[Cromolyn and Nedocromil] MOA
[Mast Cell Stabilizing agents] –> Inhibit Mast cell degranulation indepedent of stimuli.
BLOCKS D in image
Chronic Granulomatous Dz MOD and Dx (2)
[NADHPH oxidase (normally reduces O2 –> Superoxide ROS)] is deficient –> [Cat +infection]
Dx:
- [Nitroblue Tetrazolium] = absent dark blue precipitate
or
- [DHR flow cytometry] = absent green fluorescence
What are the main factors that INCREASE HgB Affinity for O2 (4)
“LAF & [DEC H2]O”
- DEC H+ and High Altitude
- DEC 2,3 BPG (2,3BPG increases at high altitude–>DEC affinity)
- cOld temp (DEC temp)
Leftward shift/Affinity INC/Fetal HgB
What would [Chronic high-altitude adaptation] do to HgB O2 affinity
“LAF & [DEC H2]O”
[Chronic high altitude adaptation] –> INC 2,3BPG –> DECREASES O2 HgB Affinity
Severe Anemia ALSO DEC O2 HgB Affinity
[Pericardial fluid accumulation with late diastolic collapse of the R atrium] describes ____ and occurs why?
Cardiac Tamponade; when ventricles relax they displace pericardial fluid –> collapses R atrium during diastole
Clinical findings for [Middle Cerebral Artery] occlusion
CTL [Face (no forehead)] & UE paralysis
+ [aphasia(if dominant hemisphere)] or [spatial Neglect (if Non-dominant hemisphere)]
Clinical findings for [Anterior Cerebral Artery] occlusion (unilateral vs. bilateral)
CTL LE paralysis
or
[Behavioral/Primitive Reflex/Urinary incontinence - if bilateral]
Severe Chronic Hemolytic Anemia (i.e. B-thalassemia) —> ______ hematopoiesis in the __ and ___. Seeing ____ precursors in these organs is a good sign.
Why does this happen?
Extramedullary Hematopoiesis in Liver & Spleen. [Clumps of Erythryoid Precursors in Liver & Spleen] is a good sign
EPO stimulates marrow cells to invade extramedullary organs if bone marrow isn’t sufficient –> Hepatosplenomegaly
2 most common bacterial isolates in intraabdominal infection
(B.Fragilis) & (E.Coli)
We all know Statins cause Muscle toxicity. What is another big SE?
LIVER toxicity
[Diffuse Esophageal Spasm] MOD
Loss of [MAP (Myenteric Auerbach Plexus) Inhbition] –> Periodic, simultaneous and Non-peristaltic LARGE contractions
Hepatitis E
A: Enveloped? Double vs. Single strand?
B: Transmission
C: Virulence
A: Naked single-RNA
B: Fecal Oral
C: Fulminant Hepatits in Pregnant Women
Etiology for Gallstones made of Calcium (2)
Which enzyme plays the biggest role & how?
[Liver fluke Clonorchis Sinensis] vs. bacteria infect biliary tract –> [CUPS (Ca+: UnConjugated bilirubin Pigment Stones]
[Beta Glucuronidase from injured hepatocytes] & Bacteria both hydrolyze bilirubin glucuronide –> INC UnConjugated bilirubin –> [CUPS (Ca+: Unconjugated bilirubin Pigment Stones]
What is Secondary Lactase deficiency
[Celiac inflammation] vs. [Infection] damage [small intestinal microvilli brush border] that carries lactase –> Lactose intolerance
1° Lactase deficiency occurs with age
Genetic Cause of Neurofibromatosis Type 1
[chromo 17 mutation]–> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein
Characteristics of Neurofibromatosis Type 1 (6)
CLAP ON type 1!”
- Neurofibroma PLEXIFORM
- Acoustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo)
- [Optic n. Glioma]
- Lisch nodules
- [Cafe Au Lait Spots]
- Pheochromocytoma
Neurofibromatosis Type 2 Genetic Cause
[chromo 22 tumor suppresor gene mutation–> (Merlin cytoskeletal protein)]
In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from _____. These pts may also have hyperpigmented spots known as ____
In NF1, Fleshy cutaneous neurofibromas are made of Schwann cells, which are embryologically from Neural Crest. May also have [Cafe Au Lait Spots (image)]
Image: Cutaneous Neurofibromas & Cafe Au Lait Spots
Dz
Constrictive Pericarditis (Pericardial Calcification)
A: Explain how Wallerian Degeneration works in the PNS.
B: Why doesn’t this work in the CNS?
C: What role do Astrocytes play
A: After axon damage, Schwann degrade myelin distal to injury and recruit macrophages to clear myelin debris –> allows axon regeneration
B: IN CNS: macrophages are recuirted slowly due to BBB AND Oligodendrocytes undergo apoptosis –> inhibits axon growth & allows persistent myelin debris to accumulate
C: Astrocytes proliferate weeks-months post injury and form glial scar –> also blocks axon regeneration
Why are ESRD Renal Failure pts at risk for bleeding? What type of coagulopathy will they have? Labs?
UREMIA in ESRD –> Qualitative Platelet dysfunction –> PRIMARY Hemostasis DO –> [ONLY INC BLEEDING TIME] (all other labs are normal)
Arsenic Poisoning Presentation(3), MOD and Tx
- Garlic breath!
- Prolonged QT
- Watery Diarrhea
Arsenic inhibits pyruvate dehydrogenase –> DEC Cellular respiration
Tx = Dimercaprol
BLack Gallstone etiology (2)
- HemoLysis Chronically–> INC UnConjugated bilirubin –> Ca+ bilirubinate precipitation–> BLACK [CUPS: Ca+ UnConjugated bilirubin Pigment Stones]
vs.
- Can also come from iLeal Dz that –> INC recycling of Bilirubin
Clinical signs for HyperCalcemia (3)
” Probably Mucho Ca+! “
- Muscle Weakness
- Constipation
- PolyUria –> Polydipsia
Which n. is associated with Piriform Recess damage and what is it responsible for?
Internal Laryngeal n.(CN10) = Cough Reflex
Describe the life cycle of Hepatitis B starting with entry
OLDER Pt with severe braydcardia is treated with Atropine but develops Severe Eye Pain. What happened?
Exacerbation of Closed angle Glaucoma!
ATROPINE IS CX IN GLAUCOMA PTS
Dz
[RSO-Reed Sternberg OwlEye] cells in Hodgkin Lymphoma
Describe [Bronchioalveolar ADC in situ]
Lung ADC subtype = [dysplastic columnar cells] which line alveolar septa and secrete mucus without invasion
Identify & Describe composition(2)
Benign Hamartoma (coin lesion on CXR!); [Disorganized Hyaline Cartilage + Fat]
A: Clinical Manifestations of DiGeorge Syndrome (5)
B: Genetic Cause
C: Embryologic cause
“CATCh 22 & Pa3”
Cardiac (Tetralogy of Fallot + Aortic Arch abnormalitites)
Abnormal face (Bifid Uvula/low set ears)
Thymus Aplasia (Thymic shadow in image) –> Virus/Fungal infection
Cleft Palate
[hypOcalcemia from PTH deficiency] may–> Carpopedal Spasms
22q.11.2 deletion
Pharyngeal arch - 3rd/4th both fail to develop
Describe the DDx for [Polycythemia Erythrocytosis]
IF-___ is important for mycobacterial infections. Explain how it helps to kill them
IF-GAMMA
Describe how Iron is Absorbed and stored
Which drug is used in Acute MI management but can also precipitate SOB in pts with COPD/asthma
[General B-blockers]
RA management centers around ____, which take ____ to onset. Name them (5)
DMARDS take weeks to onset
- MTX
- Hydroxychloroquine
- Sulfasalazine
- Minocycline
- TNFa inhibitors
In which cell does low O2 stimulate Glucose –> pyruvate but maybe no ATP, and why?
RBC; 2-3BPG INC when O2 is low but the ATP generating step is bypassed in order to make 2,3BPG
Isolated Systolic HTN (Sys>140 & Diastolic<90)
Age-Related Stiffness of aorta & arteries
Anatomically, During Thorancentesis how would you access:
A: [Lungs & Visceral Pleura] (3)
B: Which visceral structures are you attempting to Avoid by using these positions?? (2)
image
B:
- Abdominal Structures
- [Subcostal Neurovascular bundle]
* Paravertebral = [POST Scapular]*
Describe [Acidophilic Councilman bodies] and when you’d see them
Hepatocytes that have shrunk, undergone nc.fragmentation and become eosinophilic. ; Indicates Apoptosis
Kidney Embryo: What does the [Metanephric mesoderm blastema] give rise to? [Ureteric Bud]?
[Metanephric Mesoderm blastema] –> Internal Kidney structures
vs.
[Ureteric bud] –> Collecting system (CD, Calyces, Pelvis, Ureters)
Which joints are involved in RA (5)
- MCP & PIP
- Wrist
- Elbows
- Knees
- Cervical spine subluxation vs. cord compression
Sciatica MOD and Clinical Manifestation (3)
“Having Sciatica is like breaking LAWS”
- [Lower Back pain w/radiation down POST thigh –> lateral foot]
- Ankle jerk reflex ABSENT - (S1-S2 involvement)
- Weak Hip Extension-(S1-S2 involvement)
- [S1 n. posterolateral compression between L4-S3]
Which artery perfuses the Broca and Wernicke area?
MCA
A completely opacified hemithorax with tracheal deviation toward the opacification suggest _____. Explain
Mainstem Bronchus obstruction; Obstruction allows air distal to it to remain there and once pulm blood absorbs all of it, everything squishes together (opacification) and trachea moves toward the vacuum
Steps for converting Tyrosine –> Epinephrine (4)
Liver Dz Portacaval Venous Anastomses used during:
Esophageal Varices
[L Gastric] with [Esophageal]
Liver Dz Portacaval Venous Anastomses used during:
Rectal Hemorrhoids
[SUP Rectal] with [Mid & inf. rectal]
Liver Dz Portacaval Venous Anastomses used during:
Caput Medusae
Paraumbilical with [Superficial & inf. epigastric]
[T or F] DIC (elevated D-Dimer and low Fibrinogen) is associated with HUS-HAT
FALSE
only Unconjugated bilirubin & LDH will be INC
Lung Biopsy
[Sulfur Granules - Actinomyces Israelii]
Cystic Fibrosis MOD
Describe [Ladd’s Fibrous Bands]. What’s their MOD
Bands connecting RLQ to Retroperitoneum –> bilious emesis from duodenal compression;
Incomplete counterclockwise rotation –>midgut malrotation around SMA –> Volvulus and/or [Ladd’s Fibrous Bands]
What is the most common cause of DIC in Pregnant Women
Injured Placenta can release [Tissue factor Thromboplastin] in mom –> DEC platelet count from hyperactivation –> DIC
Which Fungus
Candida (oval yeast w/narrow base budding)
Which Fungus
Histoplasma Capsulatum
A pt taking Clindamycin (abx) who suddenly develops Intractable Watery Diarrhea + Leukocytosis probably has what? MOD?
C.Diff; Toxin A (and B) both disrupt actin cytoskeletal structure & intracell signal in GI tract
Contact Precautions = Germs N’ Hospitals! = [Gown/NonSterileGloves/HandWashing]
Which DO is associated with [KIT Receptor Tyrosine Kinase] mutation? Describe its presentation
Mastocytosis; Mast cell proliferation –> Excess Histamine release –> [INC gastric acid] & [pruritus post hot shower]
What are the 2 watershed areas of the colon
[Splenic Flexure] and [Rectosigmoid Junction]
Which mucous membranes are affected by OWR - Osler Weber Rendu syndrome
What’s the worst complication?
Telangiectasias on…
- Mucocutaneous (Lips, Skin)
- GI
- Respiratory
- Urinary
May rupture –> Bleeds
Clinical Presentation for [Type 1 Hypersensitivity IgE Mast cell response] (3)
PUB
Pruritus
Urticaria
Bronchospasm
Desrcribe the intracellular change AND clinical effect for each receptor
a1, a2, B1, B2
[Ehlers Danlos] MOD
Heritable Abnormal Collagen formation from [Procollagen Peptidase deficiency (impaired cleavage of N-terminal propeptides)] –>abnormal collagen
[MarFan Syndrome MOD].
Where is this protein found normally (3)
[Fibrillin1 defect (an extracellular scaffold for elastin)]
- Lens
- Periosteum
- Aortic Media –> Aortic Root Dilation –> Dissection
DDx breakdown for Gram negative bacteria
SE for HCTZ and Chlorthalidone (6)
- HyperGLUC (Glucose/Lipids/Uric/Ca+)
- [hypOkalemic metabolic alkalosis] (Aldosterone mediated)
- hypOnatremia
Describe the following
[Multinucleated Giant Cell] with epithelioid macrophages
This makes up a Granuloma
Sciatica MOD and Clinical Manifestation (3)
“Having Sciatica is like breaking LAWS”
- [Lower Back pain w/radiation down POST thigh –> lateral foot]
- Ankle jerk reflex ABSENT - (S1-S2 involvement)
- Weak Hip Extension-(S1-S2 involvement)
- [S1 n. posterolateral compression between L4-S3]
What are Contact Precautions (3)?
When should you use them(4)?
Germs N Hospitals!
Gown / NonSterileGloves / HandWashing
- MRSA
- C.Diff
- VRE
- Scabies
[Alcohol Hepatic Steatosis] MOD
[EtOH dehydrogenase] & [Acetealdehyde dehydrogenase] produces EXCESS NADH –> [DEC Free Fatty Acid oxidation] –> Fatty acummulation
Fill in the Blanks; Which is associated with [E.Coli Sepsis]
GALT deficiency –> E.Coli Sepsis
Hepatic biopsy showing [Spotty Necrosis + Ballooning Degeneration] indicates _____
Acute Viral Hepatitis
What type of Hypersensitivity is [Seronegative Spondyloarthropathy PAIR HLA-B27]
Type 3 (Immune Complex deposition)
What causes AAA (3)
- Transmural Aortic wall Inflammation
- Abnormal collage remodeling
- DEC Smooth m. & Elastin
All together –> Wall weakening
Renal failure Azotemia with [Large Eosinophilic Cast] in an elderly with fatigue likely indicates _____
[Bence Jones Proteinuria] in Multiple Myeloma
Why do VSD sometimes present after a neonate has already been discharged?
Neonatal VSD (most common congenital heart defect) presents AFTER [pulm vascular resistance] has DEC
Why do pts with Sepsis have [INC Anion Gap] (2)
Tissue hypOperfusion DEC Oxidative phosphorylation –> Forces Pyruvate to shunt into Lactate instead
+
Hepatic hypOperfusion –> Lactic Acid accumulation since Liver normally clears lactate
What are the most common aspiration sites when Supine (2)
Dense air space opacities
What are the most common aspiration sites when Upright
Dense air space opacities
Pts with hypersensitivity to [intradermal tobacco injections] probably have ____. Describe Histo
[Buerger’s Thromboangiitis Obliterans]; Thrombosing Segmental Vasculitis extending into contiguous veins & nerves
Neonate with Olive sized mass on deep palpation to RUQ indicates ____
Pyloric Stenosis from muscularis mucosae hypertrophy
CA Activating mutation of ____ can –> constant EGFR pathway stimulation —> Resistance to Anti-EGFR drugs
KRAS
[Creutzfeldt Jakob Dz] MOD
PrP (prion protein), normally in neurons as [a-helical structure] converts–> [INFECTIOUS Beta pleated sheets] –> Protease resistance –>
Vacuoles in [Gray Matter Neurons & Neutrophils] develop –> Cyst = [Spongiform Gray Matter]
What is Transthyretin
(Heriditary vs. Senile) [Primary AL Amyloidosis] deposition
[Familial hypOcalciuric Hypercalcemia]
Defective Parathyroid CaSR (Ca+ Sensing Receptors) –> INC PTH
[Thiamine B1] deficiency causes ____ and BeriBeri.
Describe BeriBeri (2)
What biochem rxn is [Thiamine B1] needed for?
[Wernicke Korsakoff Syndrome] and [BeriBeri]
BeriBeri (Wet vs. Dry vs. BOTH) is associated with…
- Heart involvement = WET
- Symmetrical Peripheral Neuropathy = DRY
[Thiamine B1] = Decarboxylation of a-ketoacids (carb metabolism)
What biochem rxn is [RiboFlavin B2] needed for(2)? What sx are present with deficiency(3)?
No RiboFlavin–>Problems with Flavor
FMN & FAD; [Glossitis/ Angular Stomatitis / Normocytic Anemia]
What biochem rxn is [Niacin B3] used in
Hydrogen acceptor (NAD / NADH)
Which DNA Polymerase has exonuclease activity and what is the exonuclease function (2)
[DNA Pol 3] = [3 —> 5 exonuclease activity] + [5–>3 Polymerase]
&
[DNA Pol 1]= [3 <<—>> 5 exonuclease acvitiy] + [5 —>3 Polymerase]
Exonuclease removes RNA primer and repairs DNA sequences
A: List the n. roots associated with Femoral n.
B: Associated Injury (2)
C: Motor Deficit (3)
Femoral nerve
A: L2-4
B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]
C:
1) [No Thigh Flexion]
2) [No Leg extension]
3) [Patellar Reflex loss]
In Pudendal n. blocks during labor, anesthesia is injected ____ medial to the _____ through the _____ —> ____ anesthesia
Anesthesia is injected intravaginally medial to Ischial Spine through the Sarcospinous Ligament = perineum anesthesia
Classic Presentation for [Renal Cell Carcinoma] (4)
RCC looks like HAWF!
[Hematuria PAINLESS (most common)] / [Abd Yellow Mass] / [Wt loss] / [Flank Pain]
L RCC in image
Fibrates MOA (2)
What other drug has similar MOA
Activates PPARa –> [INC LPL(TAG clearance)] AND [DEC Hepatic VLDL synthesis]
[Omega 3 Fish Oil] ALSO [DEC Hepatic VLDL synthesis] + [DEC apo B]
Glucagonoma Manifestation (4)
[Dermatitis (necrolytic migratory erythema)]
Depression
DVT
DM
comes from pancreatic alpha cells
Which CA cause [OsteoBlastic Sclerotic] Bone Metastasis (3)?Aggressive or indolent?
indolent
Which CA cause [Mixed] Bone Metastasis (2)?
Which CA cause [OsteoLytic Lucent] Bone Metastasis (5)?Aggressive or indolent?
AGGRESSIVE
Multiple Myeloma Presentation (10)
Crazy Ass BUMP
CR2AB - [HyperCalcemia/(Renal damage from Bence Jones prOteinuria) & (Rouleaux RBC stacking)/Anemia/(Bone Dark lytic lesions from IL6)]
AL amyloidosis
Back pain
Urine IgG
[Mott cell histo-full of Russel bodies - image]
[Protein M serum spike from monoclonal IgG]
Glioblastoma Histological Findings (5)
CREEPY
- Cystic Change
- Reddish brown hemorrhage
- Endothelial Cell Hyperplasia on Histo
- Pseudopalisading Necrosis on Histo - image
- Yellow necrosis
In [Wolff Parkinson White] an accessory AV conduction path can –> ______. What is the sx triad
PSVT
Recall the [PAm: PI3K AKT mTOR] pathway starting with Growth factor receptor binding
Describe [Hairy Cell Leukemia] (6)
“Hairy Men Make Dicks Penis Totally Freakin hard!”
- Mid Aged Men
- Massive Splenomegaly
- [Dry Tap from fibrosis 2° to (B-lymphocyte) infiltration & cytokines]
- [Pentostatin / 2CDA / Cladribine tx]
- TRAP dx - replaced with… Flow cytometry
- hypOcellular bone marrow (pancytopenia)
What is Chlordiazepoxide
ChlorDIAZEpoxide (like DIAZEpam)
Benzo (GABA - A allosteric modulator)
POMC is a polypeptide precursor cleaved into what 3 substances?
- ACTH
- MSH
- B-Endorphin
Explain difference between tumor Stage vs. Grade? Which is more important for Pgn?
Stage = Spread/expansion of Tumor = MOST IMPORTANT PGN FACTOR!
vs.
Grade = differentiation (anaplastic vs. well-differentiated)
Why are Nitrates contraindicated in HOCM pts (2)
HOCM pts have LV outflow obstruction so if you DEC venous return or DEC total peripheral resistance you will worsen amount of blood getting through
[Thin curvilinear areas of lucency that parallel bowel lumen] indicates ______, often seen in _______. Causes(2)?
Pneumatosis Intestinalis(air in bowel wall); Necrotizing Enterocolitis
Caused by Prematurity vs. [Enteral feeding initiation]
Starting with [Day 0 Fertilization], describe the process of Implantation (9 steps)
In which parts of the TCA cycle do you get ___(x)___ and how many ATP do they give
A: NADH
B: GTP
C: FADH2
Can I Keep Selling Sex For Money, Officer?
A: NADH = 2.5 ATP each = (I-Keep) (Keep-Selling) (Money-Officer)
B: GTP = 1 ATP = (Selling - Sex) - used in Gluconeogenesis by PEP Carboxykinase to convert Oxaloacetate–>PEP
C: FADH2 = 1.5 ATP each = (Sex - For)
[Maturity onset Diabetes of the Young] MOD
Glucokinase mutation in the beta cells
Which nerve is classically affected by [L Atrial Enlargement] and how does it manifest
[LEFT Recurrent Laryngeal n.]–> [Raspy Vocal Cord Paralysis(same as R)]
Which 2 bedside maneuvers INC Intensity of the HOCM mumur?
“Val [Stood Up] to Hulk HOCM, the MVP, which INC anxiety”
Valsalva
[Standing Up]
(both DEC Preload AND Afterload)
Genetic cause for [Fragile X]
[CGG repeat] –>[FMR1 gene Methylation] on [X Chromo long arm] –>small gap near tip of [X Chromo long arm]
Huntington’s Dz MOD
[AUTO DOM [Chromo 4 CAG repeats]] —> Degeneration of (Caudate nc. inside the ((I)ndirect Striatum) –> [DEC GABA]
“Hunting 4 food is way too aggressive & dancey”
Huntington’s Dz Clinical Presentation (2)
“Hunting 4 food is way too aggressive & dancey”
1st: Aggressive Dementia w/ strange behavior
2nd: Dance-like Chorea mvmnts
Anatomically, what is the diff. between ulcers from [H.Pylori] and [Zollinger Ellison]?
[H.Pylori] = Antrum & Proximal Duodenum
vs.
Zollinger Ellison = DISTAL Duodenum
Vomiting is a reflex regulated by which receptors? (5)
5 Days of Having Nauseating Moomoo :-(
- 5HT3 (ondansentron tx) ****
- D2
- H1 Histamine
- [NK1 Neurokinin 1] ***
- M1 muscarinic
[Bruton X-linked aGammaglobulinemia] MOD.
What pathogens are these pts most susceptible to (2)?
[Bruton tyrosine kinase gene mutation] –> failure of [CD19 & 20 B cells] to mature –> NO B CELLS OR ANTIBODIES
- Giardia Lamblia
- [Encapsulated Pyogenic bacteria - sinopulmonary]
In a pt with an elevated ALP, how can you determine whether or not it’s bone origin and why?
Check GGT; GGT is found in Liver(just like ALP).. BUT NOT BONE, so if GGT also elevated –> indicates Liver pathology
How long does it take kidneys to INC HCO3 during respiratory acidosis? How is Heroin related to this?
Kidneys need 24 hours to activate [HCO3 compensation] during respiratory pH changes; Heroin –> cardiorespiratory depression –>might present as [Respiratory Acidosis w/normal HCO3] if <24 hours
Describe the process of Ca+ movement within the Sarcolemma starting with T-tubule
GI biopsy shows image. Identify cells and explain its association with appendicitis
Neuroendocrine cells(islands of uniform eosinophilic cells w/round nuclei) are in CARCINOID TUMORS
Appendiceal carcinoids may cause Appendcitis
CD15 is a marker for ____ and _____
Granulocytes & [Hodgkin RSO cells]
Label; Which rxn is associated with [Thiamine B1 deficiency]
RBC Transketolase requires [Thiamine B1]
Which step in the TCA cycle is [Thiamine B1] dependent and thus most affected by EtOH intoxication
Can I Keep Selling Sex For Money, Officer?
[Keep - Selling] (a-Ketogluarate –>SuccinylCoA)
Amatoxins are in ____ and inhibit _____. This stops ____ synthesis
[Death Cap mushrooms]; RNA Pol2 –> no mRNA synthesis
How is [Apolipoprotein E] related to Alzheimers
Apo E –> impaired synthesis and clearance of AB-amyloid —> INC risk for LATE onset Alzheimers
What are the n. roots for Bicep/Brachioradialis Reflex? What motor functions are involved(2)?
What are the n. roots for Tricep Reflex? What motor functions are involved(2)?
What are the n. roots for Finber ABduction?
Which part of the EKG is affected by [Phase 0 Fast Na+ influx]
QRS (will be widened)
An anti-arrhtymic that extends [Phase 3 K+ efflux] will change what on EKG
T Wave
Name the Psoriasis drugs that are Topical Vitamin D analogs and why they help (3)
Calcipotriene / Calcitriol / Tacalcitol
These bind to intranuclear Vitamin D R –> Inhibits Keritinocyte proliferation & differentiation
A: Common manifestations of Sarcoidosis (10)
B: Which demographic is most commonly affected
CD4 TH1 mediated
A: LAR CUBED
[Liver with scattered noncaseating granulomas around portal triad] + [Lymphadenopathy-Bilateral Hilar]
ACE elevation & [Asteroid vs. Schumann bodies]
Restrictive cardiomyopathy (RAMILIES)
Calcemia INC (hyperCalcemia)
Uveitis
Bell’s Palsy (Facial CN7)
Erythema Nodosum (SubQ Fat lesions)
Diffuse Intersitial Fibrosis (INC FEV1/FVC ratio)
B: AA Females
This Liver Biopsy indicates _____
Describe the MOD and it contraindications
Cavernous Hemangioma; MOST COMMON BENIGN LIVER TUMOR, made of cavernous blood filled vascular spaces
NO BIOPSY SINCE BIOPSY –> FATAL HEMORRHAGE
In Brain –> Intracerebral Hemorrhage + Seizures
List main functions of each hypOthalmic nuclei:
A: VentroMedial
B: ANT
C: POST
D: Lateral
A: VentroMedial = Satiety-Satisfied (full)
B: ANT = Lets Heat Go
C: [POST = Keeps you Pyogenic/warm]
D: [Lateral = Lots of food eating (INC Hunger)]
List main functions of each hypOthalmic nuclei:
A: Arcuate (3)
B: PVN (4)
C: SON (Supraoptic) (2)
D: SCN (Suprachiasmatic)
E: POA
A: Arcuate = GHRH & Dopamine(inhibits Prolactin) & GnRH
B: PVN = [AVP accessory], CRH, TRH, [AVP Main]
C: SON = [AVP Main] & Oxytocin
D: SCN = Circadian Rhythm
E: POA = [GnRH Main]
Describe the Difference between Gastric Ulcer and Erosion
Where are Gastric pits and glands in relation to this?
Ulcers make a deep U all the way into Muscularis Propria
vs.
erosions are mucosa only (Pits are invaginations of mucosa that articulate glands in the laminal propria of mucosa)
[Carpal Tunnel Syndrome] MOD
BILATERAL Median n. Compression from the [Flexor Retinacular Transverse carpal ligament] –> Peripheral mononeuropathy
[Flexor Retinacular Transverse Carpal ligament] can be surgically incised for relief
Purpose of the Smooth ER (2)
Where is it mostly found (3)
Steroid Synthesis & Drug Detox
Liver / Adrenal Cortex / Gonads
Mesothelioma Histology (3)
Cells with
[long slender microvilli]
[abundant tonofilaments]
[Pleural thickening]
Name the 3 mutations sites associated with EARLY Alzheimer
- Trisomy 21
- [Chromo 14 Presenilin 1]
- [Chromo 1 Presenilin 2]
Name the MAOIs (4)
MAO Takes Pride In Shanghai
Tranylcypromine
Phenelzine
Isocarboxazid
Selegiline (MAOB inhibitor)
Why does Iron supplementation –> Enlarged RBC with blue cytoplasm
INC bone marrow erythropoiesis initially –> accelerated release of [immature reticulocytes] which have blue cytoplasm from residual ribosomal RNA
What should make you suspect spinal metastasis? (4)
- [Back Pain WORST AT NIGHT - not relieved with rest]
- Older pt
- Systemic Sx
- [Hx of Infection or IV Drug use]
lead kettle (PB KTL) - Prostate/Breast/Kidney/Thyroid/Lung = most common
BRCA1 is responsible for _____ and most involved in what 2 CA?
DNA repair; Breast & Ovarian
A: Name the COX 1 inhibitors (2)
B: What do they inhibit
C: Function of what they inhibit (3)
C: SAR [Stomach protection/Aggregating Platelets/Renal Perfusion INC]
A: Name the COX 2 inhibitors (3)
B: What do they inhibit
C: Function of what they inhibit (5)
C: VIPR [VasoDilation/Inflammation-Pain/Renal Perfusion INC]
Describe the process by which Eosinophils attack parasites
[IgE dependent cell mediated cytotoxicity]
Intestinal Atresia MOD
SMA obstruction during utero –> [BlindEnd Proximal Jejunum], ABSENT BOWEL, and [terminal iLeum spiraled around iLeocolic vessel]
Most serious SE of Loop Diuretics (i.e.furosemide)
Ototoxicity
(especially in renal dz/rapid IV admin/other ototox agents/high doses)
What is [Brown Adipose tissue]
[Brown Adipocytes (1 cell with many fat vacuoles & many mitochondria)] = produces heat via [uncoupling oxidative phosphorylation] with thermogenin - in newborns/hibernating mammals
White Adipoctyes only have 1 intracytoplasmic fat droplet
Liver Angiosarcoma is associated with exposure to __(3)___. What’s the tumor marker?
[Vinyl Chloride / Arsenic / Thorotrast]
CD31
Milrinone MOA
PhosphodiesterAse inhibitor –> INC cAMP –> [INC contracility AND Arteriole Dilation] in HF pts
[Nesiritide BNP] MOA (3)
BNP analog that INC cGMP –>
- Natriuresis
- Arteriole Dilation (DEC Afterload)
- Venous Dilation (DEC preload)
Oligohydraminos –> ______. Describe this Sequence and Name the 3 most common causes of Oligohydraminos
Oligohydraminos –> POTTER Sequence
Pulm hypOplasia
Oligohydraminos(cause)
[Twisted Face & Extremities]
Twisted Skin
Ears set low
Renal Failure
What is the main MOA for pregnancy prevention in OCP
Progestins negatively feeds back on ANT Pit –> DEC FSH & LH
[Radial Head Subluxation Nursemaid’s Elbow] MOD and Demographic
[Sudden Traction/Hand pull] on [outstretched and pronated arm] –> Annular Ligament tear & subsequent displacement
Little kids
[Nucleotide Excision Repair] involves a damaged base
vs.
[Base Excision repair] which involves an Altered(deaminated/alkylated/oxidated)
Describe [Base Excision Repair]
Identify
Identify
Remember:
- [R middle Lung lobe] is adjacent to [R Atrium]
- R side of Heart of CXR is [R Atrium]
Glycolysis, Fatty Acid Synthesis and Pentose phosphate all occur in what part of the cell?
Cytosol
B-oxidation, TCA and Pyruvate Decarboxylation all occur in what part of the cell?
Mitochondria
[Toxic Shock Syndrome] MOD
[Staph TSS exotoxin] activates BOTH T-cells (leading to IL2 release) and APC MHC2
Pts with [Nausea from Acute Migraines] should have which nausea receptor blocked?
5 Days of Having Nauseating Moomoo :-(
D2 (central nausea)
Pts with [Nausea from GI irritation (gastroenteritis/chemo/anesthesia)] should have which nausea receptor blocked?
5 Days of Having Nauseating Moomoo :-(
5HT3
Pts with [Nausea from Vestibular/Motion Sickness] should have which nausea receptor blocked?
5 Days of Having Nauseating Moomoo :-(
H1 vs. M1
Difference between [Rheumatic Fever] and [Infective Endocarditis]
RF = [Fibrosis & Fusion of valves(mitral>aortic) and endocardium - Type 2 Hypersensitivity]
vs.
[Infective Endocarditis] = Vegetations on valve cusps –> destruction
HER2 is a ____ receptor
Tyrosine Kinase
[Allergic Atopic Asthma] is the most common and is treated with what 2 agents for acute relief?
- Leukotriene blockers ( -lukast )
- M3 blockers ( Ipratropium )
The Red dot represents ____ which indicates what for lung volume? What is the intrapleural pressure at this point?
FRC; resting state where airway pressure = zero;
[At FRC, intrapleural pressure = -5]
Vitamins A and D are both involved in epithelial regulation. What’s the difference?
Deficiency of which is liked to [Keratinizing squamous metaplasia]?
Vitamin A regulates [SPECIALIZED Columnar epithelia] and deficieny –> [Keratinizing Squamous metaplasia] of…
- Conjuntiva
- Respiratory tract
- Urinary Tract
- Pancreatic ducts
Explain the uniqueness of second infection with Dengue fever
Dengue has 4 serotypes
1st time infected w/1 serotype = asx vs. self-limited
2nd time infected w/diff. serotype = SEVERE pancytopenia + Elevated Liver Enzymes
Familial Chylomicronemia Syndrome
Sx (5)
HHALX
- Acute Pancreatitis - recurrent
- HyperTriGlyceridemia (especially Chylomicrons)–>creamy supernatant
- [Lipdemia Retinalis]= milky retinal vasculature
- [SKIN Xanthomas- eruptive= yellow erythematous papules on extensor surfaces]
- HepatoSplenomegaly
Familial HyperCholesterolemia would produce [Tendon Xanthomas and Xanthelasmas]
How are [PD1 and CTLA4 receptors] associated with CA
Somatomedin C is AKA ____
IGF1
Identify and describe the histology
[Contact Dermatitis Type 4 Hypersensitivity]; [Spongiosis (edema in the intercellular spaes of epidermis)
CD = Weeping, Erythematous, papulovesicular
Describe [Lipid PerOxidation]
Lipid degradation and H2O2 formation 2° to Free Radical damage –> [Fatty change and necrosis] ; Carbon Tetrachloride
Name the Vitamins and Enzymes inhibited by Excess EtOH (2)
- [Thiamine B1]
- [Folate B9]
In [Acute Calculous Cholecystitis], describe how Gallstone obstruction INITIATES the dz (3)
[Cystic Duct Obstruction] –>
- INC hydrolysis of lecithins into LysoLecithins–>
- DEC mucus layer –>allows Bile salt to irritate wall and cause Inflammation –>
- invasion by [KE3 - Kleb/E.Coli / Enterococcus / Enterobacter]—> Necrotic Gall bladder
Macrophage cell Marker
CD14
Describe [RNA Polymerase 1] (3)
Describe [RNA Polymerase 2] (3)
Describe [RNA Polymerase 3]
Name the mainstay Drugs for Staph Aureus (8)
i Love Crazy Crazy Deranged Boys N’ TV
- Linezolid
- Clindamycin
- [CefTaroline 5° generation]
- Daptomycin
- [Bactrim - Skin Infection]
- [Nafcillin - MSSA only]
- Tigecylcine
- Vancomycin
What is the [Colon Adenoma –> Carcinoma] Sequence (6)
AMCK - (DCC) - 53
Describe Chiari Malformation Type 2
Type 2 is TOO BAD:
Congenital Underdevelopment of [POST fossa] –> Cerebellum & Medulla herniation thru Foramen Magnum
Type 2 = SEVERE NEONATAL ONSET –> [MEDULLA COMPRESSION–>apnea] + [NON-COMMUNICATING HYDROCEPHALUS] + [LUMBAR MYELOMENINGOCELE]
Describe Friedreich Ataxia (8)
FriEdreich is Fratastic! He’s your fav., twisted frat iHouse brother, always studdering and falling, but has a sweet, big heart
FriEdreich = [Vitamin E Deficiency] mimics it
Fratastic has 9 letters = [Chromo 9 Auto Recessive]
twisted = Kyphoscoliosis @ childhood
frat = [frataxin (iron binding protein) defect]
iHouse = [(iron binding protein) defect]
studdering = Dysarthria
falling = [Falls + Gait Ataxia + (Pes Cavus High Foot Arch)]
sweet = DM
big heart = Hypertrophic Cardiomyopathy
Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]
Describe T-cell differentiation for TH1 and TH2
List the Arterial and Venous(3) supply for [ABOVE Pectinate Anus]
Arterial: [IMA: Sup Rectal]
Venous: [SUP Rectal] –> [inf. mesenteric] –> Portal
List the Arterial, Venous(5) and Nerve supply for [BELOW Pectinate Anus]
Arterial: [Internal Pudendal: inf rectal]
Venous: [inf rectal] –> [Internal Pudendal] –> [Internal iLiac] –> [Common iLiac] –> IVC
Nerve = [Pudendal: inf rectal]
MOD for [HFE mutation 1° Hemochromatosis]
HFE mutation –> Liver & Enterocytes falsely detecting low iron –> [1 and 2] –> [Liver Cirrhosis & HCC] AND BRONZED SKIN
- Liver DEC Hepcidin release —> [INC Ferroportin on Enterocytes basolaterally]–>INC iron absorption
- Enterocytes [INC Apical DMT1] –> ALSO INC iron absorption
Why does Diastolic HF –> Pulm HTN
[ST Elevations] or [Q waves] in these leads indicate INFARCT in which areas?
A: [V1 - V2]
B: [V3 - V4]
C: [V5 - V6]
D: [Lead 1 / aVL]
E: [Lead 2 / 3 / avF]
A: [(V1 - V2) = Anteroseptal - LAD]
B: [(V3 - V4) = Anteroapical - distal LAD]
C: [(V5 - V6) = AnteroLateral - LAD vs. LCX]
D: [Lead 1 / aVL] = [Lateral - LCX]
E: [Lead 2 / 3 / avF] = [InFerior - RCA] = R Vt
What is the [Cord Factor] in mycobacteria (3)
INC mycobacteria Virulence by enabling growth as [Serpentine Cords] –>
- inhibits neutrophils
- destroys MITOchondria
- releases TNFa
Classic Presentation for [Acute Viral Hepatitis (4)] and accompanying histo
- RUQ TTP
- Dark Urine
- Fever
- [Serum Sickness “like”(CAUFF) - Hep B]
Histo = Spotty Necrosis + Ballooning Degeneration
___(3)___ activate Guanylyl cyclase –> what? What other drug has a similar end-goal?
Sildenafil has similar end-goal
What [mini mental state exam] do you use to test for:
- Orientation
- Comprehension
- Concentration
- Short term memory
- Long Term memory
- Language
- Visual-Spatial
- Executive Function
What are the 2 biggest RF for Esophageal Squamous carcinoma?
Alcohol and Cigarettes
Fat / Barretts / GERD = Esophageal ADC
List and Describe the 5 causes of CRC
Describe the [pH / HCO3 / O2 / CO2] during PE < 24 hours
INC pH
Normal HCO3
low EE
Histology for [Acute Neuronal Injury] (AKA ___ _____) (4)
[Acute Neuronal Injury (AKA RED NEURON)]
- Cell Body Shrinks
- Nuclei Pyknosis
- Loss of Nissl substance
- Eosinophilic Cytoplasm
THIS IS IRREVERSIBLE INJURY that eventually –> Neuronal Degeneration!
Histology for [Chromatolysis Axonal Rxn (Loss of Axon)] (4)
[Chromatolysis Axonal Rxn (Loss of Axon)]
- Cell Body ENLARGES
- Nucleolus ENLARGES
- Eccentric nucleus
- Dispersion of Nissl substance
What are the Neuroendocrine markers (3)
- Chromogranin
- Neuron-specific enolase
- Synaptophysin
In [Renal Cell Carcinoma], what accumulation makes the cytoplasm clear? (2)
RCC looks like HAWF!
intracell Glycogen & Lipids
L RCC in image
What are the 7 P’s of [Congenital hypOthyroidism Cretinism]
- Poor Brain
- Protruding Fontanelle
- Puffy Face
- Protuberant Tongue
- Pot Belly
- Protruding Umbilicus
- [Can’t Plank = hypOtonia]
Usually Asx
[Eczema Atopic Dermatitis] MOD and its associations (2)
Type 1 Hypersensitivity –> skin inflammation triggered by environmental AND food antigens
associated with [allergic rhinitis] and asthma
Dz AND Describe the composition
[Signet Ring Gastric ADC]; NON-gland cells that ironically contain abundant Mucin & undergo [Stomach wall infiltration] –> [Leathery Linitis plastica]
[Burkitt Lymphoma - EBV] is associated with ___ translocation and overexpression of ____. Describe the Histo (3)
[8 14]; c-MYC overexpression (EBV INC B- cell proliferation–>INC translocation risk)
Histo = [Diffuse mid-sized lymphocytes with basophilic cytoplasm and high [Ki-67 fraction-proliferation index]
Which organisms cause [Liver Abscess via Biliary Tract ascension (4)]? Which cause [Liver Abscess via Hematogenous Seeding]?
[Biliary Tract ascension] = [KE3 - Kleb/E.Coli / Enterococcus /][Entamoeba: Colon–>Portal Vein]
Hematogenous = Staph A
What are the 2 best diagnositc labs for determining cause of [Metabolic ALKalosis]
[Urine Cl] and Volume Status
7 common causes of Dilated Cardiomyopathy
“the PIG PAID for Dilated Cardiomyopathy”
- Post Myocarditis from [Coxsackie B Enterovirus]
- Alcoholic Cardiomyopathy from long term EtOH usage (direct toxicity vs. nutritional deficiency)
- [Doxorubicin and Daunarubicin Chemotherapy]= dose-dependent
- Peripartum - (late in pregnancy vs. 5 mo. post partum)
- Genetic= affects cytoskeleton
- Iron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
-
Idiopathic
* MOST COMMON CARDIOMYOPATHY*
List the common causes of Restrictive Cardiomyopathy (8)
RAMILIES
- Radiation Fibrosis
- Amyloidosis (heterogenous misfolded proteins)
- Sarcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
- Metastatic Tumor
- Inborn metabolism errors
- Endomyocardial fibrosis= Common in [African/Tropic children]
- [Loeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
- Iron overload
[Fish oil Omega 3 FA] MOA (3)
- [DEC TAG by DEC VLDL and apoB]
- INC Gallbladder motility
- INC Bile Acid synthesis –> DEC Cholesterol saturation
Ribavirin MOA (4)
RIBA = RIMA
- RNA polymerase inhbitor
- IMPDH inhibitor –> GTP depletion
- Methylation of RNA
- Activates Immune system
Histo Description for VZV (2)
Multinucleated Giant Cells w/ Keratinocyte Intranuclear inclusions
Dermatitis Herpetiformis Histo
SubEpidermal blister with neutrophils in dermal papilla
Alzheimer’s Dz etx (3)
Alzheimers MOD = CHA
**Cleavage, Hemorrhage, ACh **
- Cleavage of [transmembrane amyloid precursor glycoprotein] –> Beta-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
- Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from Beta-amyloid starting to deposit in cerebral vessels
- ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 B-amyloid accumulation causing defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx
How do we acquire Schistosomiasis
Freshwater SNAILS infected with larvae
Why do Myocardial cells swell during transient ischemia (2)
Na+ accumulation (DEC Na/K ATP pump)
and
Ca+ accumulation (DEC [Sarcoplasmic Reticulum Ca+ ATPase])
What vessels are found within the [HepatoDuodenal Ligament] and how is this associated with RUQ Bleeding?
Portal Triad; If Pringle maneuver does NOT stop RUQ Bleeding, then source of bleeding = IVC vs. Hepatic veins
ESR is a non-specific marker for ____. What specifically causes INC ESR
Inflammation; [IL1 / 6 / TNFa] –> [Hepatic AKute phase proteins]–> INC Fibrinogen –> INC ESR
Diveritculosis MOD
INC [Pulsion Pressure] from strained BM–> [Mucosa & SubMucosa] herniation thru weak Muscularis = FALSE Diverticula
This is similar to Zenker
How are Blood transfusion related to hypOcalcemia?
[Giving GOE 6 L whole blood] can–> [INC SERUM CITRATE(typically added to stored blood)]–> Chelates Ca+ and Mg+ –> hypOcalcemia –> Paresthesia
Which 5 Drugs groups cause Osteoporosis?
These CoAg Canners Obliterate SpongyBoneTrabeculae
Thyroid meds
anti-Coagulants
anti-Convulsants(Phenytoin)
****Omeprazole****
Steroids - exogenous
Patellar fractures inhibit ____ (Flexion / Extension) of the Knee against gravity
EXTENSION
_____ is the most common cause of both kid and Adult Acute Gastroenteritis. Transmission (2)?
Campylobacter Jejuni;
- [Food: Contamined Poultry vs. Unpasteurized milk]
- [Domestic Animals: Dog / Cow / Chicken / Sheep]
Formula for Bioavailability
A: Dystrophic calcifcation is the Hallmark of _____ (3)
B: What is Plasma Ca+ in this DO?
A: [Dystrophic calcification] is the HALLMARK OF
- CELL INJURY
- CELL DEATH and
- Necrosis
B: Plasma Ca+ will be normal
This occurs naturally from aging
Main SE for Nitrates (3)
- HA
- Flushing
- hypOtension
Name the 2 opiate antidiarrheals
Loperamide & DiPhenOxylate
[Pure RBC Aplasia MOD] and dz’s its associated with (3)
Failure of marrow to produce only [RBC precursor elements];
Parvo B19
Lymphocytic Leukemia
Thymoma
The Trapezius muscle is innervated by the _____, found in the _______. Manifestation of injury to this? (3)
Spinal Accessory; POST Triangle
- Impaired ABduction past 90°
- Shoulder Droop
- Winged Scapula (also caused by Serratus ANT)
Clinical Manifestations for [Bells Palsy] (4)
Bells Palsy = Facial CN7 paralysis
Loss of F –> Unilateral Paralysis
Loss of A –> Hyperacusis
Loss of C–> DEC Eye lacrimation (tearing)
Loss of E –> Loss of ANT 2/3 Tongue Taste
FACE
- Facial Muscles
- Afferents(Somatic) from [Ear Pinna (Pain/Temp)] & [External Auditory Canal (stapedius m.)]
- Cry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
- Eat: Taste from ANT 2/3 Tongue
Describe [Intestinal Angina]
Postprandial epigastric pain from [Chronic Mesenteric ischemia 2° to Atherosclerosis]
A: Histology for [PNET - Primitive NeuroEctodermal Tumors] (MeDulloblastoma)
B: Pgn
A: Sheets of [small, primitive blue cells] + [abundant mitotic figures]
B: POOR! (PNET tumors are undifferentiated and aggressive)
A: Histology for [Pilocytic Astrocytoma] (3)
B: Pgn
A:
Pilocytic Astrocytes (spindle cells with hair-like glial processes)
+
Rosenthal Fibers
+
[Cerebellar Vermis Cyst]
B: (Better than MeDulloblastoma since it is well-differentiated)
Identify
LAD
[Leukocyte Adhesion Deficiency Type 1] MOD
Absence of [CD18 integrin] –> [No WBC Chemotaxis: Tight Binding w/ICAM1] but with persistent leukocytosis –> Mucocutaneous infections & [delayed umbilical cord separation]
What endothelial cell defect –> No Neutrophil Rolling
[L vs. (E / P)] Selectin defect
These can be upregulated by Cytokines and [SiaLyl selectin] is on the neutrophils
What target organ does the M3 Receptor work in (6)
“[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges”
“M3’s BEGS for Private Lounges”
Bladder(contraction) / Eyes / GI / Skin / [Peripheral Vasculature] / Lungs
A: Describe Histology (3)
B: Dz
C: What’s the primary leukocyte in the skin
A: image
-Solar Elastosis=Grayish-bluish color of the Dermis from sun damage
B: [Actinic Keratosis-PreMalignant]
C: Lymphocyte
A: Describe Histology (3)
B: Dz
A: image
B: Basal Cell Carcinoma
Identify
Malaria
Common causes of DIC (7)
STOP Making New Thrombi
Sepsis (gram-negative)
- *T**rauma
- *O**bstetric path
- *P**ancreatitis-Acute
- *M**alignancy
- *N**ephrOtic syndrome
- *T**ransfusion
What Pharyngeal functions are [Vagus CN10] responsible for? (4)
- Uvula (moves away from lesion in CN10 damage)
- Epiglottic Taste
- Swallowing
- Soft palate elevation
Which direction does the jaw point in [Trigeminal CN5] damage?
jaw points TOWARD lesion (since force from opposite pterygoid will be weak)
Loop Diuretics SE (6)
OH DANG
Ototoxicity
hypOkalemia
Dehydration
Allergy
Nephritis (intersitial)
Gout
What is the First sign of puberty in Males vs. Females
Males = Pubic Hair
Females = Breast Buds
Sensitivity
Formula(2) & meaning
SPecificity
Formula(2) & meaning
Recall the [2 x 2 Test vs. Disease] diagram
How many ATP are yielded in Aerobic vs. AnAerobic metabolism?
Aerobic = 32
AnAerobic = [2 + Lactate]
Define [p-value] and its relation to Null hypothesis
[p-value] = Chance that study results happened randomly
[p-value] < 0.05 means you can Reject Null hypothesis since it means there’s lil chance the results happened randomly
Difference between [Type 1 alpha] and [Type 2 Beta] error
[Type 1 alpha] = u sAw a difference that doesn’t exist (accepted Alternative hypothesis when you shouldn’t have)
vs.
[Type 2 Beta] = Blind to the Truth (accepted Null hypothesis when in actuality there was an effect)
