1. hepatic artery 2. Common Bile duct 3. Portal vein

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Sickle Cell Lab values

decrease Haptoglobin = intravascular hemolysis (responsible for preventing iron loss and renal damage – acts as an antioxidant)
Increased LDH = intravascular hemolysis
Increase unconjugated bilirubin = pigmented gallstones

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1-LP

2-LD b add V

3 is E

4 gets more

1-LP = AR type 1 Familial dyslipid-Chylomicron
decrease LPL (cofactor ApoC2) = increased TG = pancreatitis

2-LD b add V = AD type 2 Familial dyslipid-Cholesterol
decrease LDL receptors
b type = increased VLDL
increased cholesterol = xanthomas but in the achilles tendon
Atherosclerosis
corneal arcus

3 is E = AR type 3 Familial dyslipid-Lipoprotein
decrease ApoE = increase remnants in blood
increased cholesterol = xanthomas but in the palms

4 gets more
increased VLDL = increased TG = pancreatitis

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TP equation

1-a = CI

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a = significants or probability of making a type 1 error

increase a level = increase statistical significance = more likely to make a type 1 error

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1-b = power

increase w/ sample size = decrease likelihood of making a type 2 error

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MI =

decrease CO = increase EDV

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Most common cause of viral meningitis in all age groups

Enteroviruses =
1. echoviruses
2. coxsackieviruses

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reflex functions to maintain blood flow during changes in position (standing, supine, seated)

Baro + Stretch receptors = increase in Vagal stimulation

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accessory spleens = which origin

a thickening of the dorsal mesogastrium

occurs due to an incomplete fusion of mesenchymal buds

spleen initially forms near the urogenital ridge

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bilateral parotid gland swelling

fever

malaise

decreased appetite

Mumps

Transmission:
1. airborne droplets
2. contaminated saliva
3. respiratory secretions

Disseminates
1. Parotid glands then
2. lacrimal, thyroid, mammary glands, ovaries, testes, pancreas and/or central nervous system

invasion (e.g., facial nerve compression and palsy), systemic signs (e.g., weight loss, fatigue

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chronic myelogenous leukemia phil chromosome =

a non-receptor tyrosine kinase that has enhanced enzymatic activity =

inhibition of apoptosis
increased baseline mitotic activity
recombination of chromosomal regions between nonhomologous chromosome

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Portal triad

hepatic artery
Common Bile duct
Portal vein

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Pringle maneuver

compression of Hepatoduodenal ligament

control bleeding from hepatic inflow source

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Infusion rate =

Clearance x Steady state concentration

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Paracentric chromosomal inversions

two breaks in one chromosome to create an intervening segment

If a crossover event occurs within the loop formed, two disproportionate chromosomal segments are produced

a fetus is conceived with either of these two formed chromosomes = at risk for early spontaneous abortions

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Amphetamines cause these symptoms via

increased synaptic release

inhibited reuptake of biogenic amines (epinephrine, norepinephrine, serotonin, and dopamine)

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Major basic protein

is an eosinophilic protein = host defense against parasites

It is produced in response to IgE antibody-dependent cell-mediated cytotoxicity

Release leads to destruction of pathogens via cytotoxic mechanisms as well as the release of
1. histamine from mast cells + basophils
2. recruitment of neutrophils + macrophages

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Keratosis pilaris (KP)

keratinized hair follicles that are most commonly found on the extensor surfaces of the arms and thighs

nonpruritic and nonpainful erythematous bumps

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absolute polycythemia

appropriate increase in RBC mass due to increased EPO stimulation from chronic oxygen desaturation

ex: OSA

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lack of cardiac neural crest cell development

improper spiraling of the aorticopulmonary septum = persistent truncus arteriosus

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cystic artery is a terminal branch of the

right hepatic artery

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2 weeks of a generalized prodromal symptom complex, including
1. fever
2. exudative pharyngitis
3. tachycardia
4. hypotension
5. diffuse lymphadenopathy
6. Pancytopenia = anemia + leukopenia + thrombocytopenia

HIV

a mononucleosis-like syndrome

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exposure to naphthylamine (an antioxidant in the rubber industry)

urothelial (transitional cell) carcinoma

most common malignancy of the bladder, ureter, and renal pelvis

painless hematuria throughout micturition & flank pain

Adolescent F

Chest Pain post fever
SOB
Friction rub

Coxsackievirus B infection can cause pleurodynia (Bornholm’s disease, Devil’s grip)

fever + flu-like symptoms + painful spasms of the chest and upper abdominal quadrants due to pleural and muscular irritation

Dx = viral culture or PCR and serological testing

pericarditis w/ the development of a pleural friction rub

ACEi effects to kidney

Increase RBF = decreased blood pressure due to decreased vasoconstrictive effects of ATII decrease GFR decrease PCT pressure

ambiguous genitalia increased 17-hydroxyprogesterone 46, XX karyotype

21-hydroxylase deficiency = congenital adrenal hyperplasia

ambiguous genitalia HTN 46, XX karyotype

11b-hydroxylase deficiency

Factor V Leiden

Mutation where Protein C can't do its job --> clots more common than Protein C deficiency tx: tPA

When will you see deficiency in Protein S

Prego OCPs

Increase in Va & VIIIa post warfarin

Tranisently at the start of warfarin tx pt are at a hypercoagualative state due to a decrease in Protein C/S

recurrent episodes of muscle weakness that typically develop after certain triggers 1.strenuous exercise (e.g., football) 2. alcohol ingestion 3. dietary changes 4. medication use 5. stress

autosomal dominant disorder mutations in sodium and calcium channel genes = intracellular shifting of serum K+ --> muscular paralysis/weakness

symptomatic syringomyelia, we should screen for

TRAUMA

Tanner Stage 1

no hair flat chest raised nipple

Tanner Stage 2

8+ Pubarche = pubic hair BOYS: testicular enlargement GIRLS: Thelarche = breast buds mount forms

Tanner Stage 3

12+ Coarsen pubic hair Increase penis size/length Breast enlarges

Tanner Stage 4

Spares thigh Penis width/glands increase Breast enlarges areola, mound on mound

Tanner Stage 5

hair on thigh penis + testis enlarge breast contour areola flattens

Biopsy reveals diffuse epidermal keratinocyte necrosis with minimal lymphocytic infiltration in the dermis

Stevens-Johnson syndrome (SJS) toxic epidermal necrolysis (TEN)

Jarisch-Herxheimer rxn

acute, systemic rxn response (shock sx) to release of bacterial endotoxin-like substance release after initiation of abx spirochete infections 1. Borrelia = Lyme 2. Treponema 3. Leptospira

veins within the portal venous system

1. left gastric --> esophageal 2. paraumbilical --> small gastric 3. superior rectal --> middle/inferior rectal 4. Splenic IVC is outside PLEASE DO NOT GET THIS WRONG AGAIN

A major risk factor for bone loss and the development of osteoporosis is

1. Smoking 2. malabsorption 3. malnutrition 4. anorexia 5. Rx = anticonvulsants + corticosteroids + PPIs + anticoagulants

In a kid knee pain (referred) reduced hip range of motion on IR + abduction + flexion anterior hip tenderness

slipped capital femoral epiphysis (SCFE) risk factor = obesity

postpartum thyroiditis

follicular cell damage with lymphocytic infiltration, leading to the release of preformed thyroid hormone

Hamartomatous polyps

Sx: 1. mild anemia 2. occult blood in his stool Dx: Biopsy normal findings for location on histopathologic analysis 1. smooth muscle hyperplasia (bands of light pink cells) 2. glandular hypertrophy w/o distorted architecture Association: 1. Juvenile polyposis syndrome 2. Peutz-Jeghers syndrome 3. Cowden syndrome

Hyperplasia of glands = serrated appearance on microscopy left colon = rectosigmoid

Hyperplastic polyps

neoplastic proliferation of glands

Adenomatous polyps

Osteoid osteoma

Cortex of long bones (femur) resolves w/ aspirin radiolucent core (osteoid)

Osteoblastoma

arises in vertebra DOES NOT respond to aspirin

Osteochondroma

EXT1/2 mutation Cartilage cap affects growth plate (metaphysis)

Osteosarcoma

associations: Rb + Pagets + radiation exposure Destructive mass = sunburst appearance + lifting periosteum (Codman triangle)

Giant cell tumor

multinucleated giant cells + stromal cells epiphysis of long bones soap bubble appearance

Ewing Sarcoma

poorly differentiated neuroectoderm (PNET) Onion skin appearance small, round blue cells = resemble lymphocytes (PAS+) 11;22 translocation

Chondroma

radiodense core medulla of small bones of hands + feet

Chondrosarcoma

medulla = pelvis or central skeleton Cartilage-forming tumor

Incomplete penetrances

Trait or condition is SOMETIMES produced Ex: mainly found in autosomal dominant disorders i.e.: Rb + Osteogenesis imperfecta + BRAC1