General Flashcards
Why does carcinoid syndrome only occur after the carcinoid tumor has metastasized?
When localized to the GI system, the vasoactive substances released from the tumor are metabolized by the liver via the first pass effect.
When metastasized to the liver, the vasoactive substances produced enter directly into the systemic circulation resulting in the various symptoms.
Which hepatitis is able to integrate into the host genome and why?
Hepatitis B:
- DNA virus
- contains a reverse transcritpase
- integrates itself into the host genome and can remain latent in cells
How does therapeutic ionizing radiation work? (2 methods)
- Double stranded DNA breaks
- Free radical formation (ROS) that cause damage to cells and DNA
What does the HIV Env gene encode =
gp160 -> gp120 + gp41
mutations indicate that the HIV virus is resistant to certain anti-retroviral drugs
What does the HIV Pol gene encode =
reverse transcriptase, integrase, protease
mutations indicate that the HIV virus has developed resistance to anti-retroviral drugs (NNRTI, NRTI, protease inhibitors, integrase inhibitors)
What LN?
- skin from the umbilicus downwards,
- distal anus (below the pectinate line)
- distal vagina
- vulva
- scrotum
superficial inguinal nodes
Mechanism of warfarin induced skin necrosis?
Decreased production of protein C -> prothrombotic state -> increased thromboses in skin vessels -> ischemia -> necrosis
adult + pseudopallisading necrosis in the brain + intracranial mass =
Glioblastoma multiforme
Most common primary brain neoplasm in adults.
most commonly injured organ in “blunt abdominal trauma”
spleen rupture
proliferation fraction (Ki-67) indicates
mitotic index
What type of liver injury occurs with carbon tetrachloride exposure?
lipid peroxidation -> fatty change with hepatic necrosis
What does heterochromatin consist of? And what does it’s presence indicate about that piece of DNA?
- methylated DNA
- deacylated histones
if DNA is in this structure, it indicates there is a low transcription level.
Hypertrophy
increase in size
Hyperplasia
increase in number
Cyanosis + Chocolate colored blood + Decreased SaO2 + Normal PaO2
Methemoglobinemia (Fe2+ is oxidized to Fe3+ which cannot bind oxygen)
Hallmark of reversible cell injury
cellular swelling
Hallmark of irreversible cell injury
membrane damage
AL amyloid (Ig Light chain) =
primary systemic amyloidosis
AA amyloid (serum amyloid associated protein)
secondary systemic amyloidosis
non-mutated transthyretin =
senile cardiac amyloidosis
mutated transthyretin =
familiar amyloid cardiomyopathy -> restrictive cardiomyopathy
“tumor cells in an amyloid background” =
medullary carcinoma of the thyroid
beta-2 microglobulin deposition in joints =
dialysis-associated amyloidosis
Pain mediators = (2)
- Bradykinin
- PGE2
Neutrophil rolling is mediated via =
on endothelial cells =
- P selectin - from Weinel-Palade bodies mediated by histamine
- E selectin - induced by TNF and IL-1
on leukocytes =
-sialyl Lewis X
Neutrophil adhesion is mediated via =
on endothelial cells =
-ICAM and VCAM - induced by TNF and IL-1
on leukocytes =
-integrins - induced by C5a, LTB4
SCCID=
Selectins and Carbohydrates
Chemokines
Integrins
Diapodesis
1 gram of protein = ? Calories
4 Calories
Where on tRNA does the AA attach?
The 3’ end on the CCA tail
(CGG)n =
Fragile X Syndrome
(GAA)n =
Freidrich ataxia
(CAG)n =
Huntington Disease
(CTG)n =
Myotonic Dystrophy
Which creatine kinase is most specific for an MI
- CK-MM
- CK-MB
- CK-BB
CK-MB - only found in cardiac tissues
“cherry red mucous membranes”
carboxyhemoglobin accumulation
High Km = ? affinity
High Km = Low affinity
inverse relationship
Is DNA positively charged or negatively charged?
Negatively charged
Which nucleotides on the template strand are methylated in DNA replication? (2)
- Cytosine
- Adenine
Which nucleotide has a methyl group?
Thymine
THYmine = meTHYl
Which AA are needed for purine synthesis? (3)
- Glycine
- Aspartate
- Glutamine
Child who is Hyperuricemic + has Gout + is Pissed off all the time + Retarded + dysTonic =
Lesch-Nyhan syndrome
HGPRT = enzyme deficiency HGPRT = symptoms
DNA topoisomerase VS Helicase
DNA topoisomerase = breaks the DNA double helix to relax the supercoils
Helicase = unwinds the DNA at the replication fork
Where is heme synthesized?
partly in mitochrondria and partly in the cytosol
Stop codons (3)
- UAA
- UAG
- UGA
2,3-bisphosphoglycerate does what to hemoglobin-oxygen relationship?
23BPG stabilizes the taut Hgb configuration therefore decreasing Hgb’s affinity for oxygen and making it easier for the oxygen to be delivered to the tissues.
increased 23BPG = O2 release off of Hgb = right shift = anoxia (decrease in oxygen on Hgb)
Is phosphorylated-glycogen synthase active? Or is de-phosphorylated-glycogen synthase active?
De-phosphorylated glycogen synthase is the active form.
Insulin -> Insulin R (tyrosine kinase R) on hepatocyte -> phosphorylation of Insulin R Substrate-I (IRS-1) -> (+)MAP Kinase pathway and (+)PI3K pathway
PI3K pathway = (+) protein phosphatase -> dephosphorylates glycogen synthase -> active glycogen synthase makes glycogen!
Cofactors for BCalphaKADH, PDH, and alpha-KGDH (5)
- thiamine pyrophosphate (B1)
- FAD (B2 - riboflavin)
- NAD (B3 - niacin)
- CoA (B5 - pantothenic acid)
- lipoate
Prokaryotic DNA Polymerase III actions (2)
- 5’->3’ DNA synthesis
- 3’->5’ exonuclease activity (proof reading)
Prokaryotic DNA Polymerase I actions (3)
- 5’->3’ DNA synthesis
- 3’->5’ exonuclease activity (proof reading)
- 5’->3’ exonuclease activity (removing primer)
Prokaryotic DNA Polymerase II actions (1)
-3’->5’ exonuclease activity (proof reading)
Northern blot is used to identify =
Type of probe used for Northern Blot technique =
specific RNA sequences
SS-DNA or SS-RNA
Southern blot is used to identify =
Type of probe used for Southern Blot technique =
specific DNA sequences
SS-DNA or SS-RNA
Western blot is used to identify =
Type of probe used for Western Blot technique =
proteins/antibodies
Antibody
Type of probe used for Southwestern Blot technique =
DS-DNA
uracil is found in DNA/RNA/Both?
RNA only
amatatoxins (found in poisonous mushrooms) inhibits what?
Eukaryotic RNA polymerase II -> decreases production of mRNA
Eukaryotic RNA polyermase I makes =
rRNA
Eukaryotic RNA polymerase II makes =
mRNA
Eukaryotic RNA polymerase III makes =
tRNA
Priority of surrogates (5)
spouse > adult children > parents > adult siblings > other relatives
APGAR Scores
Total =
Appearance, Pulse, Grimmace, Activity, Respiration
Total = 10 points (0,1,2 for each)
When are APGAR scores taken?
1 minute after birth
5 minutes after birth
Sensitivity =
a/(a+c)
Specificity =
d/(b+d)
PPV =
a/(a+b)
NPV =
d/(c+d)
95% CI =
mean +/- 1.96 SD/sqroot n
99% CI =
mean +/- 2.58 SD/sqroot n
_ is used to compare the exposure of people with the diseases to exposure of people without the disease
Odds Ratio - case control studies
68/95/99 rule of normal distribution
Under a normal distribution bell curve:
68% = 1 st dev
95% = 2 st dev
99% = 3 st dev
Competitive inhibitor (reversible) - what happens to Vmax and Km
- Vmax stays
- Km increases (therefor affinity decreases)
Noncompetitive inhibitor - what happens to Vmax and Km
- Vmax decreases
- Km stays
What order kinetics are Phenytoin, Ethanol, and Aspirin?
PEA = 0 = Zero order kinetics
reduction, oxidation, hydrolysis = what stage of metabolism?
Stage I
produces slightly polar, water soluble metabolites (still active)
What is Stage II of metabolism?
congugation (glucoronidation, acetylation, sulfation)
produces polar, inactive metabolites that are then excreted via the kidneys
Elderly patients rely on metabolism Stage I/II/both
II only
Organophosphate Poisoning
DUMBBELSS - Ach overload Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of CNS and muscles Lacrimation Salivation Sweating
What is the single most preventable cause of death?
Tobacco use
Probability of concluding there is no difference when there really is one =
Beta (Type II error)
Probability of concluding there is a difference when there really isn’t one =
Alpha (Type I error)
Treatment for a young sexually active person with STI type symptoms =
Treat for N gonococci and C trachomonous
Ceftriaxone (cefalosporin)
Azithromycin (macrolide) OR Doxycycline (tetracycline)
Epithelium of
- true vocal cords
- false vocal cords
- true vocal cords = stratified squamous ep
- false vocal cords = ciliated pseudostratified columnar ep
Clinical trials phases: Phase I= Phase II= Phase III= Phase IV=
Phase I = small number of healthy volunteers
Phase II = small number of patients with disease of interest
Phase III = Large number of patients randomly assigned to treatment or best available treatment (or placebo)
Phase IV = Post-marketing surveillance of patients. Drug is already approved.
Partial thromboplastin time =
PTT
Amyloid structure
beta-pleated sheets
Cardiomegaly + individual myofiber necrosis with mixed inflammatory infiltrate + travel to South America
T. cruzi
Gluconeogenesis locations (3)
Liver
Kidney
Intestinal epithelium
Why do some vaccines have the antigen conjugated with a carrier protein?
3 examples
The main antigen of encapsulated bacteria are their polysaccharide capsules. These polysaccharide antigens cannot be presented to T cells alone. They are conjugated with a carrier protein thereby enhancing their immunogenicity and activating T-cells
Examples:
- Pneumococcal (PCV) (the other pneumococcal vaccine (PPSV) is not conjugated with anything, therefore less effective)
- H. influenzae type B (conjugated with diphtheria toxoid)
- Meningococcal vaccine
Nerve that travels in the mandible
inferior alveolar nerve
Age (months) of standing alone with no support
10 months
Age (months) of first steps/cruising
12 months
Age (months) of parallel play
24-36 months
Age (months) of climbing stairs
18 months
Age (months) of drawing
4 years
Multiple seizures, pins and needles around mouth and hands and feet, random spasms leading to flexion of wrists, diffuse hyperreflexia - what serum electrolyte abnormality?
low calcium
Dermatome at the umbilicus
T10
BellybutTEN
Acute phase cytokines that are released during inflammation/help precipitate inflammation (3)
IL-1
IL-6
Tumor necrosis factor-alpha
In DIC is fibrinogen high or low
Fibrinogen is low because it is all used up in the clots
Function of TGF-beta in wound healing
Stimulates angiogenesis, fibrosis, cell cycle arrest
Inhibits inflammation
What stains blue on a Prussian blue stain?
Intracellular iron
Lipofuscin doesn’t stain
Branches of the external carotid artery (3)
External carotid ->
- Facial artery
- Occipital artery
- Maxillary artery
Injury of what cells release creatine kinase?
Cardiac, Brain, Skeletal muscle cells
What type of damage results in increased serum creatine kinase?
membrane damage, irreversible cell injury
Mechanism of ischemic cell swelling?
Ion pump failure due to lack of ATP -> intracellular accumulation of Na and Ca -> draws water into the cell -> swelling
Intercostal vein, nerve and artery lie in the subcostal groove on the upper/lower border of the rib?
Lower
That is why you insert chest tubes/needles on the upper border of the rib
Where do these things bifurcate?
- Common carotid
- Trachea
- Abdominal aorta
- Common carotid = C4
- Trachea = T4
- Abdominal aorta = L4
biFOURcates
55 yo man + yellow sputum + poor dentition with G carries and gingivitis + alcohol abuse + lung consolidation
Actinomyces with sulfur granules
Multiple telangiectasias in skin and mucous membranes + recurrent bleeds + skin discoloration + AD inheritance
Osler Weber Rendeu Syndrome
Hereditary Hemorrhagic Telangiectasia
Port wine stain on V1/V2 distribution + tram track calcification in the brain + intellectual disability + glaucoma + cerebral malformations =
Sturge Webber Syndrome (Encephalotrigeminal Angiomatosis)
cerebral malformations = leptomeningial angiomas
Hammartomas in CNS and skin + Cardiac rhambdomyomas + cutaneous angiofibromas + renal angiomyolipomas =
lots of tumors everywhere in a child
Tuberous Sclerosis
Cardiac rhabdomyomas = the only childhood heart tumor
Dopamine
low dose ->
medium dose ->
high dose ->
Low dose -> D1 = kidneys - increased GFR, increased RBF, increased sodium excretion
Medium dose -> beta1 = increased contractility, increased PP, increased systolic BP
High dose -> alpha1 = generalized systemic vasoconstriction
_ is given to prevent ischemic stroke in patients with TIA
low dose aspirin
Splinter hemorrhages suggest a problem with _
Cardiac/valve problem - infectious endocarditis
Congenital long QT syndrome is caused by a mutation in
ion channels (usually K channels)
Thromboxane A2 function (2)
- enhances platelet aggregation
- vasoconstriction
Prostacyclin function (5)
- inhibits platelet aggregation
- inhibits platelet adhesion to vascular endothelium
- vasodilation
- increases vascular permeability
- promotes leukocyte chemotaxis
Child + palpable purpura on buttocks and legs + GI issues + arthralgias + hematria =
Henoch-Schonlein Purpura
type of vasculitis
S3 =
volume overload
S4 =
pressure overload
chronic sinopulmonary infection + bilateral absent vas deferens =
Cystic fibrosis
Symptoms seem similar to Kartageer syndrome but the infertility here is due to a lack of a structure NOT a cilia issue
testicle lymph drainage ->
para-aortic LN
Scrotum lymph drainage ->
superficial inguinal LN
bug that is PYR positive
Strep pyogenes
L sided chest discomfort + burning pain + rash over the area that becomes vesicular =
Shingles - VZV reaction
Immunodeficiency disorder with partial albinism + giant cytoplasmic granules in neutrophils and monocytes + diagnosed in childhood =
Chediak-Higashi Syndrome
Inhibition of lysosomal trafficking -> microtubule dysfunction
lysosomal trafficking regular gene (LYST)
Started on a new drug, 10 days later the patient develops a rash, fever and joint pain. biopsy shows fibrinoid necrosis + neutrophilic infiltrate =
Serum sickness drug reaction - type III hypersensitivity
fever and muscle rigidity soon after surgery + cyanotic skin mottling + hypertension
Malignant hyperthermia
treatment = dantrolene - inhibits Ca release from Sarcoplasmic reticulum
NT inhibited in tetanus infection =
- GABA
- Glycine
Deficiency of Hypocretin-1 (Orexin-A) in CSF indicates =
Narcolepsy
hypocretin/orexin is produced in neurons in the hypothalamus
Dynein vs Kinesin
Dynein = retrograde transport down an axon
Kinesin = anterograde transport down an axon
Direct angiogenesis stimulators (2)
- VEGF
- FGF-2
BRCA gene function =
DNA repair gene
HER2 =
“human epidermal growth factor receptor 2”
tyrosine kinase
What 3 diseases drastically increase the risk for CAD related deaths?
- Non-coronary atherosclerosis
- Type 2 DM
- Chronic kidney disease
Acute hemolytic transfusion reaction is what type of hypersensitivity?
Type II hypersensitivity reaction - complement mediated cell lysis
Adult Polycystic Kidney Disease is associated with _ hemorrhage
Subarachnoid hemorrhage from a berry aneurysm
Anopheles mosquito
-Malaria
Aedes mosquito
- Dengue fever
- Chikungunya
- Yellow fever
“Ability to decompose hydrogen peroxide” =
Catalase positive
Contains the myeloperoxidase enzyme
“Possession of cytochrome oxidase” =
Oxidase positive
“Epithelial cells covered in gram variable rods”=
Gardnerella vaginalis - clue cells
“Multiple, painful, shallow ulcers on an erythematous base located on the labia + bilateral inguinal lymphadenopathy” =
HSV-2
What type of response is eosinophils attacking parasites?
Antibody Dependent Cell Mediated Cytotoxicity (ADCC)
Type II hypersensitivity
1) parasite invades
2) parasite coated with IgG and IgE
3) IgE binds to Fc receptor located on eosinophils
4) eosinophils degranulate and kill parasite
Compliment C1 deficiency predisposes to (2)
- Infection with encapsulated bacteria
- SLE
Defect in IL-2 =
SCID = opportunistic infections + diarrhea + failure to thrive
Defect in IL-12 R =
T cell disorder: decreased number of Th1 cells mature -> decreased amount of IFN-gamma released -> decreased amount of activated macrophages -> susceptible to mycobacterial infections
“Dysfunctional immunoglobulin gene rearrangement”
Hyper-IgM syndrome
- defective CD40L on Th cells therefore cannot class switch
- X linked recessive
Cytokine that mainly functions to support growth and differentiation of bone marrow stem cells?
IL-3 - secreted by all T cells
Nitroblue Tetrazolium (NBT) Test shows no color/no blue. Dihydrorhodamine (DHR) flow cytometry test shows no green fluorescence. What is the enzyme deficiency?
NADPH oxidase deficiency -> chronic granulomatous disease
If it was a myeloperoxidase deficiency, both of those tests would be opposite. NBT test would show blue coloration. DHR flow cytometry would show green fluorescence.
3 cytokines that mediate the systemic inflammatory response
- IL-1
- IL-6
- TNF-alpha
They all stimulate hepatic secretion of acute phase proteins
alpha and beta interferon
- secreted from?
- action?
secreted from:
-virally infected cells
actions: interact with neighboring virally infected cells and synthesize enzymes that halt viral protein synthesis and stimulate infected-cell apoptosis
How are herpes virus family envelopes different from other viral envelopes?
Obtained from host cell nuclear membranes instead of host cell plasma membranes
What is the toxic component of gram negative LPS?
Lipid A
8 yo boy + rapid and irregular movements of hands + unintentional “funny faces” + 102 degrees F + circular erythematous lesions on abdomen + new systolic murmur
Acute rheumatic fever post-streptococcal pharyngitis
JONES Criteria:
- Joins
- Carditis/murmur
- Nodules - subcutaneous
- Erythema marginatum
- Sydenham chorea
4 yo boy + fever + painful ulcers on tongue and gingiva + swollen gums + cervical lymphadenopathy
HSV-1
Increased work of breathing + wheezes/crackles/rales + rhinorrhea + congestion + 1 month old
RSV bronchiolitis
What vitamin deficiency can increase measles complications?
vitamin A
a are important in preventing superficial candida infections
b are important in preventing hematogenous spread of candida
a = T lymphocytes (T helper cells specifically)
b = neutrophils
What sjogren syndrome antibody has the ability to cross the placenta and cause neonatal lupus and congenital heart block?
SS-A antibody
Absence of CD18 =
Leukocyte adhesion deficiency
Unable to make integrins, therefore leukocytes/neutrophils cannot leave the blood
Patient’s serum + cardiolipin + lecithin + cholesterol
Nonspecific treponemal test/RPR test
Looking for coagulation -> positive
Then do antibody specific test
Polygenic inheritance (7)
- Androgenic alopecia
- Epilepsy
- Glaucoma
- HTN
- Ischemic HD
- Schizophrenia
- Type II DM
Antibody against proteinase-3 of neutrophils
Granulomatosis with polyangitis
c-ANCA
Antibody against myeloperoxidase of neutrophils
Microscopic polyangitis or Eosinophilic granulomatosis with polyagnitis
p-ANCA
Introns vs Exons - which ones stay and which ones go?
Introns are removed
Exons are joined together and are translated
Spliceosomes remove introns containing _ _ @ the 5’ splice site and _ _ @ the 3’ splice site
5’ = G U
3’ = A G
CD16 or CD56 =
NK cells
What 5 cytokines activate NK cells?
- IFN-gamma
- IL-12
- IL-2
- IFN-alpha and beta (from virally-infected cells)
What type of receptors contain zinc fingers?
Intracellular receptors
Bind: steroids, thyroid hormone (T4/T3), fat soluble vitamins
The zinc finger part is the DNA binding domain
Where do repressor proteins bind?
Operator region
P27 has what action?
Cell cycle inhibitor
- Normal cells have high levels of p27
- Malignant cells have low levels of p27
Active Rb - hyperphosphorylated or hypophosphorylated?
Hypophosphorylated = Active
-Active -> binds to E2F transcription factor -> inhibits transcription of genes required to move from G1 to S -> stops the cell cycle
Inactive (Hyperphosphorylated) -> releases E2F transcription factor -> cells can continue from G1 to S without being checked
O2 -a-> O2 free radical -b-> H2O2 -c-> HOCl
a = NADPH oxidase b = superoxide dismutase c = myeloperoxidase
CD 14 or CD 40
Macrophages cell surface marker
Anergy
State during which a cell cannot be activated by exposure to its antigen. Mechanism of self tolerance.
Ex: T and B cells become anergic when exposed to their antigen without the appropriate costimulatory signal.
P-glycoprotein action?
pumps out toxins, including chemotherapeutic drugs
- ATP-dependent transporter
- often seen in adrenal cell carcinomas
- also called multidrug resistance protein 1 (MDR1)
CA 15-3/CA 27-29 = markers for?
Breast cancer
Caspase actions
Proteolytic enzyme that cleaves cellular proteins
Important in apoptosis
What class of MHC presents endogenous antigens to T cells?
MHC I
What class of MHC present exogenous antigens to T cells?
MHC II
After exposure to these toxins/viruses, IVIG should be given (5)
- Tetanus toxin
- Botulinum toxin
- HBV
- Varicella
- Rabies
Metastatic calcification locations?
- Kidney
- Lungs
- Gastric mucosa
The low pH in these environments favors calcium deposition
Carcinoma exceptions to the lymphatic spreading rule: (4)
- Renal cell carcinoma
- Hepatocellular carcinoma
- Follicular carcinoma of the thyroid
- Choriocarcinoma
These carcinomas spread via the blood instead of the “rule” that all carcinomas spread via lymphatics
Hyperkeratotic vesicles on palms and soles + reactive arthritis
Blennorrhagicum
The important distinguishing feature from other rashes on palms and soles is that these are vesicular
Eosinophilic casts (2)
Multiple myeloma
Chronic pyelonephritis
What happens when a stop codon is encountered in the ribosome?
Releasing factor proteins bind to the ribosome to facilitate release
Granulomas require what 3 cytokines?
IL12
IFN gamma
TNF alpha
Basophilic oval inclusions in mature neutrophils + increased LAP
Dohle bodies seen in neutrophils during a leukemoid reaction
Genetics of classic galactosemia?
AR
Deficiency of Galactose 1 phosphate uridyl transferase
Genetics of Hemophilia A, B, C?
A and B = X linked recessive
A = factor VIII deficiency
B = Factor IX deficiency
C = AR C = Factor XI deficiency
Genetics of Huntington’s disease
AD
CAG repeat
Anticipation more common if inherited from father
Genetics of Leber Hereditary Optic Neuropathy
mitochondrial
Order of mutations in colonic adenoma-carcinoma sequence (1, 2, 3)
1 = APC - loss of function, tumor suppressor gene 2 = KRAS - gain of function, oncogene 3 = p53, DCC - loss of function, tumor suppressor gene
Homeobox genes encode what proteins?
DNA binding transcription factors
Bind to regulatory regions on DNA and alter expression of genes involved in segmental organization of the fetus
Genetics of hypertrophic cardiomyopathy?
AD with variable expression
50% of cases are familial
Young boy with depression, gait disturbances, dysarthria, elevated transaminases. Cousin diagnosed with progressive neurologic disease.
Wilson’s disease
-AR
Myopia
Increased axial length of the eye - image focuses in front of the retina
Most common predisposing condition for infective endocarditis in the developed world?
Mitral valve prolapse
Less common: valvular sclerosis, mechanical valve
46, XX t(14;21) in a newborn infant
Unbalanced robertsonian translocation Down Syndrome
Balanced translocations would not be symptomatic
13 yo boy, growth retardation, microcephaly, sun sensitive skin rash, recurrent infections, child of consanguineous marriage
Bloom Syndrome
- AR
- Mutation in BLM gene - DNA helicase does not form
Salicylate poisoning - which process comes first?
1) respiratory alkalosis
2) anion gap metabolic acidosis
Usually, the pH is close to normal
Prostatectomy can injure what nerve? What is the consequence?
Can transect the prostatic plexus
Contains the cavernous nerves that innervate the cavernous sinus. Without it, no penil erection
Micrognathia =
Hypoplasia of the mandible
Cytochrome oxidase =
Final component of the ETC
Turns O2 -> H2O
Cricothyrotomy incision passes through what 4 layers?
Skin
Superficial cervical fascia (includes subcutaneous fat and platysma muscle)
Deep cervical fascia (includes investing layer and paratracheal layers)
Cricothyroid membrane
Bilateral kidney tumors composed of fat, smooth muscle, and blood vessels? These are associated with?
Angiomyolipomas
- Diagnostic for Tuberous Sclerosis
- AD
Multiple phenotypic manifestations resulting from a single genetic mutation
Pleiotropy
Occurs in most genetic illnesses
Lacunar infarcts in the deep brain are caused by
Hypertensive arteriolosclerosis
Immediate CT imaging does not show the infarct because it is so small
A few weeks later, the necrotic tissue becomes a cystic space and can now be seen
Increased 5-hydroxyindoleacetic acid is an indicator of?
Increased serotonin
Elevated in carcinoid syndrome
Anaphylaxis results in increase in what 2 things
Histamine and Tryptase (specific for mast cell degranulation)
Anaphylaxis occurs due to mast cell and basophil degranulation
CA-125 is a marker for?
Epithelial ovarian tumors
What factor inhibits phagocytosis of group A streptococcus?
Protein M
Main virulence factor - inhibits phagocytosis, cytotoxic to neutrophils, mediator of bacterial attachment
Indole positive =
Can turn tryptophan into indole
Is pseudomonas motile
Yes - motile Oxidase positive Catalase positive Non-lactose fermenting Aerobic Encapsulated Type III secretion system
main virulence factor = Exotoxin A (ribosylates EF2), endotoxin (because its gram negative), phospholipase C, pyocyanin
How does CMV present in an immunocompetent person
Mononucleosis-like syndrome
Fever, malaise, myalgias, atypical lymphocytosis, elevated liver transaminases
Monospot negative (no heterophile antibodies)
Erythematous throat + gray-white tonsillar exudate + fever + chills + diffuse erythematous rash on chest and abdomen that blanches with pressure + tongue is bright red
Scarlet fever
- “Sandpaper rash”
- “Strawberry tongue”
Sequelae = acute rheumatic fever, glomerulonephritis
Only occurs in GAS strains that produce pyrogenic exotoxin/erythrogenic
The steady state concentration of a drug that is metabolized by first order kinetics is calculated how?
Half-life x 4
It takes 4-5 half-lives to get to a steady concentration
What is rebound rhinorrhea
Nasal congestion without a cough, post-nasal drip or sneezing
Caused by topical decongestant use for more than 3 days
Due to tachyphylaxis = decreased production of NE due to negative feedback -> vasodilation and continued nasal symptoms
Treatment = stop the decongestants
“Fungus spherules” =
Coccidioides
Main virulence factor in mycobacterium
Cord factor
Inhibits neutrophils, damages mitochondria
_ allows mycobacteria to persist inside of macrophages
Sulfatides
Inhibits fusion of lysosomes to phagosomes
Which E Coli causes bloody diarrhea?
Enterohemorrhagic E Coli (EHEC)
Which E Coli causes watery diarrhea?
Enterotoxigenic E Coli (ETEC)
- heat labile (LT) = increases cAMP (eL Agua)
- heat stable (ST) = increases cGMP (San Gabriel)
4 bacteria that can take up naked DNA from the environment
- Streptococcus
- Haemophilus
- Neisseria
- Bacillus
Transformation
DNAse - degrades naked DNA and can inhibit transformation
Methenamine silver stain is used to identify _
fungus
Window period of HBV
positive for: HBcAb and HBeAb
negative for: HBsAg and HBsAb
HBcAg is detectable when?
Rises before the patient becomes symptomatic and stays elevate throughout the infection (whether in window period or not)
What Ab should be measured to test if an infant has been infected with Toxo in utero?
IgM - first Ab produced when B cells are stimulated
IgG levels would indicate passive immunization from mother
What 2 things increase precision and what 1 thing decreases precision?
increases precision:
- decreased standard deviation
- increased power (1-beta)
decreases precision:
-random error
What 1 thing decreases accuracy?
decreases accuracy:
-systematic error
how to decrease the chance of making a type II error? (4)
increase power -> decreases beta
how to increase power?
- increase sample size
- increase expected effect size
- increase precision of measurement
Medicare is for _
- elderly (>65 yo)
- certain disabilities
- ESRD
Medicaid is for _
-very low income
Matching strategy helps overcome what bias?
Confounding bias
Randomization helps overcome what bias?
Selection bias
Types of selection bias:
- Berkson bias
- Healthy worker effect
- Non-response bias/Attrition bias
What type of bias?
A screening test preferentially identifies less aggressive forms of a disease and therefore increases the apparent survival time
Length time bias
Drugs with high intrinsic hepatic clearance have _ lipophilicity and _ Vd
- high lipophilicity
- high Vd
16 year old boy + chewing plant seeds + progressive confusion + agitation + feeling like bugs crawling on skin + trouble seeing + very thirsty =
Atropine poisoning
What type of mosaicism - genetic mutation is seen in offspring but not in parents
Germline mosaicism
Can somatic mutations be passed to offspring?
No
They are acquired/spontaneous alterations of somatic cells
What cell produces IL-2
Antigen stimulated T cells -> (+) stimulates growth of all lymphocytes (T, B, NK) and monocytes
What cells produce IL-1?
monocytes/macrophages
Angry at being abused a child so the person joins a rugby team where he is known for playing really hard
Sublimation
Chronic nasal congestion + occasional headaches + atrophic nasal mucosa + thinned nasal septum + small septal perforation + been taking oral loratadine with no help of symptoms
Nasal cocaine abuse
Variable phenotype in patients with the same genetic mutation. Example: Marfan syndrome, NF1
Variable expressivity
One genotype presents with many problems in multiple systems. Example: PKU
Pleiotropy
Different mutations at the same locus causing a similar phenotype. Example: beta thalassemia, Duchenne vs Becker muscular dystrophy
Allelic heterogeneity
Defect in intracellular messenger in a CD19 cell leading to multiple infections in an infant
Bruton agammaglobulinemia
CD19 = B cells
Defect in tyrosine kinase gene (BTK)
If the hydrophobic N-terminal sequence of preproinsulin is cleaved off, where would the peptide accumulate?
In the cytosol
The N-terminal sequence is what directs the preproinsulin towards the rER where it gets cleaved to proinsulin
Ablation of a can be used to treat severe axillary hyperhidrosis.
Ablation of b can be used to treat severe facial hyperhidrosis.
a=Thoracic sympathetic trunk
b=Superior cervical ganglion
Sweating is controlled via the cholinergic postganglionic sympathetic fibers
Cellular differentiation and dedifferentiation is controlled by _
Transcription factors
Sudden appearance of acanthosis nigricans + anemia =
Indicates a GI malignancy or lung malignancy
The anemia indicates blood loss, leaning towards a GI malignancy with occult blood loss
Hypoplastic first digits + mullerian fusion abnormalities + genetic
Hand-foot-genital syndrome
- AD
- Mutated HOXA13 gene
