Incorrects Uworld Flashcards
Hematuria 3 days after a flu like illness (frequently)- Condition?
IgA Nephropathy (most common cause glomerulonephritis)
Histological finding of Abetapoproteinemia?
foam/clear cytoplasm at tip of jejunal villi
Cause and presentation of Pityriasis versicolor?
Hypopigment/hyperpigmented or erythematus macules/patches on upper body. Caused by Malasseiza species.
Number one lung cancer in nonsmokers and women
Adenocarcinoma
What happens to complement in SLE?
Goes down (eg c3 and c4) because it is being used
What causes triglyceride accumulation in hepatitic steatosis?
Decreased free fatty acid oxidation
What has antibodies to PLA2R?
Membranous nephropathy (these are found in podocytes)
Erythrocyte apperance in gray hepatiziation vs red hepatidization of lobar pneumonia?
Gray; broken down RBC, Red; alive rbc
What makes elastase in the lung? What can too much activity of it cause?
macrophages/neutrophils; emphysema (Too much protease activity aka elastase)
Painful thyroid; dx and histologic apperance?
Subacute granulomatus thyroiditis; mixed, cellular infiltration with occasional multinucleated giant cells
What can cause IgE independent mast cell degranulation (and anaphylaxis)?
Opoiods (including morphine), radiocontrast, some abx (eg vancomycin)
What do small cell lung cancers stain for?
Neuroendocrine markers (Neural Cell Adhesion molecule NCAM aka CD56, enolase, chromogranin, synaptophysin), also sometimes neurofilaments
Inheritance pattern of G6PD?
X linked recessive
Two vasculitises with Granulomas?
Giant Cell, Takaysu
Giant kidneys on CT in old man; method of inheritance?
autosomal dominant (polycystic kidney disease)
Most common complication of levothyroxine (or at least why you want to reduce dose if they are doing well)
Afib
Antibodies in Polymyositis?
Anti-jo (anti t-rna synthase)
Symptoms of Myotonic Dystrophy and inheritance?
autosomal dominant-increased trinucleotide repeats on myotonia-protein kinase gene. Sustained muscle contraction, weakness, atrophy, CATARACTS, BALDING, GONADAL ATROPHY
Sympathetic receptor that: increases insulin? Decreases insuilin?
Increases: Beta 2
decrease: alpha 2
How does ARDS work in sepsis?
Cytokines frmo infection-> activate pulm epithelium-> Cap damage/leakage-> Excess fluid in alveolar space.
Tx for psoriasis?
Calcipotrene (or other topical vit D analogs calcitrol, talcictol): bind to Vit D, less keratinocyte prolif, more keratinocyte differentiate
What enzyme inactivates the drug 6MP? What activates it?
Xanthine Oxidase. Activated by HGPRT
PAINFUL rash on face, groin, extremeties plus type 1 DM- what is diagnosis?
Glucagonoma (with necrolytic migratory erythema)
Cytogenic defect of APML? What gene is active?
t(15;17): activate retinoic acid receptor, PML/RARA fusion gene inhibits differention of myoblasts-> APML
Potential reaction to transmural necrosis/necrotic segment of myocardium 2-4 days after MI? Tx?
Pericardial inflammation to overlying necrotic segment of myocardium (Periciditis). Tx with aspirin therapy (leaves in 1-3 days)
Tyrosine kinase active in some breast cancer- what is it? Tx?
HER2 oncogene (increases prolif, less apop). Tx with Trastuzumab (antibody against HER2)
Why do you give people with SCID irridated RBCS in transfusion?
to prevent a reaction down the road (of the donor T cells against the host)
Someone is severely hypoglycemic; what do you give them?
glucagon
What symptoms do you get in a pineal gland tumor/Parinaud syndrome?
upward gaze palsy, absent pupillary light reflex, impaired convergence
What is McArdle Disease a defect in? (process and enzyme)
Glycogenolysis, Glycogen Phosphorylase
What ion is increased extracellurly in ischemia? Intracellularly?
extracell: K+
Intra: Na, Ca, HCO3
(increased intra ca is marker of ischemic injury)
Buttock mass that has scallopping on histology vs no scalloping?
Scallop: Liposarcoma
No Scallop: Lipoma
What process is absent in lactose deficiency?
Gene processing (and thus lactase deficiency)
What is Cyclosporines mechanism of action?
Inhibits calcineurin, decrease IL2 transcription in T lymphocytes
What causes tardive dyskinesia?
Upreguilation of dopamine receptors in response to long term dopamine blockade
Why would a woman display a X linked recessive trait when she is heterozygous?
skewed x linked inactivation
Spasming person, presence of eosinophilic round cytoplasmic inclusions in neurons-dx?
Rabies
Renal perfusion pressure falls; what goes up?
Filtration Fraction (GFR and RBF both go down, but GFR does down less due to autoregulation)
What receptor fires to maintain BP when going from sit-> stand?
Alpha 1 adrenergic
Old woman refuses to leave her house for whatever reason, gets a rash that is dry, cracked yellow, dx and tx?
Xerosis (water itch), apply moisturezer after bathing
Why would you give probenecid with penicillin?
Inhibit renal tubular secretion of penicillin
Findings in 17 alpha hydroxylase deficiency?
Mineralcorticoid excess, loss of cortisol and sex hormones. Hypertension, hypokalemia, amennorhea/lack of sex chararacs/feminization in men
Why would a coughing fit make you pass out?
Increased intrathoracic pressure decreases venous return to heart, decrease CO, decrease cererbral perfusion
Lymphoma associated with overexpression of Bcl-2 and translocation?
Follicular lymphoma, t(14;18)
What does high estrogen in cirrhotic patients cause?
spider angiomata, palmar erythema, gynecomastia, testiclar atrophy, Dupuyrten’s contractures, decreased body hair
What type of hypersensitivity is Hemolytic disease of the newborn, What can be done ot test for it?
Type II hypersensitivity (cytotoxic, IgG mediated), do Indirect coombs (looking for presence of circulating IgG anti-Rh
What would you look at in a partenity case?
allotype (amino acids genetically inherited)
What type of hypsensitivity is tested on a PPD?
Type IV, Looking at TH1+macrophages (CD4, CCD14 on macrophages, IFngamma)
What is the most common cause of SCID? other cuases?
Most commonly loss of IL2 gamma chain. Can also be adenosine deaminase, decrase MHCII
What controls the response to toxoplasmosis?
TH1 (its an intracell organism)
What causes HyperIgM?
no CD40L on T cells; so can’t bind B cells, no class switching
What infections are seen in CGD; why?
Repeat Aspergillus, Staph, Candida (all catalse positive), loss of NADPH oxidase mutaiton so they not kijlled by free radicals (can’t make myeloperoxidase)
What is the method of inheritance of CGD? What tests can you do for it (and what are their results)?
X Linked (at least usually), Nitro blue dx–is NEGATIVE (so will remain clear because no NADPH oxidase) OR DHR Flow Cytometry (will be less green, less DHR produced)
What type of hypersensitivity reaction is rheumatic fever?
Type II Hypsesnsitivity (it is molecular mimicry)
Main things for neutrophil chemotaxis
C5a, IL8
What might you see in IgA deficiency
Recurrent URIs and GI infection (bcause of weka mucosal surfaces), maybe increased IgE (more ectopic allergy)
What is the apperance of IgA?
dimeric immunoglobulin
What is the only interleukin that turns down immune response, what makes it
IL10 (made by TH2, turns down TH1)
What does the spleen reticuloendothelial system do?
Clears opsonized capsulated bacteria (via macrophages)
What can opsonize?
IgG and C3b( most important, classical complment pathway), CRP, mannose binding lectipthin
Wht is the main initial response to a capsule bacteria, what clears the infeciton?
Neutrophils; IgG and the opsonization pathway clear completely
What is Serum Sickness?
A type III hypersensitivity antigen-antibody mediated immune reaction; complxes lodge in kidney and lung-> (complements activate, lyse, call neutrophils like any type III rxn)
What causes serum sickness?
decreased c3 and C4 (often due to drugs: suilfonamdies, allopurinol, penicllin, cephalosporin, antivenin (Rattlesnake antivenom)
Name the markers on B cells
CD19, CD20, CD21, CD40
What infections will occur in a C5-C9 defiicency?
increased nesisseria infections (no MAC)
What immune repsonse is this descriping: cell surface bound antibody bridging by antigen
Type 1 hypersensitivity
What is a tx for severe allergic asthma when steroids aren’t getting it done (with SABA)?
Omalizumab; recombinant IgG antibody
What is the defect in Chediak-Higsahi? Inheritance? What might you see on light microscopy?
Defect in neutrophil phagosome lysosome fusion; AR’ see giant lysosomal inclusions
What infections will you get in Chediak Higashi–other signs?
Recurrent staph/strep infections—albinism (abnormal melanin storage), nystagmus, peripheral and cranial neuropathies
Describe Wiskott-Aldrich
Classic triade of thrombocytopenia, reduced B and T cells and eczema (so get petechaie, purpura, hematemesis, epistaxis fomr lack of platlets). Platlets are SMALL AND DEFORMED
What infecitons are people with Wiskott-Alrich vulnerable to? Mechanism of inheritance? when does it get worse
Opportunistic (PCP, etc from lack of T cells), Capsules (no b cells, no humoral immnuity), X linekd male, worse at 6 months (lose mom antibodies)
See some circles on a lymph node biopsy; what are they; what do they hold; what goes on there
Probably germinal centers; B cells do isotype switching (interacts with CD40L on T cells)
arise from follicle I Reckon
What disease will germinal centers not form in?
Bruton X linked Agammaglobulinemia
What do regular cells secrete to halt viral protein syntehsis; why does it not affect humans?
Secrete type 1 inferferons alpha and beta; only affects double stranded RNA
What is loaded onto the surface of APCs before T cell interactions
MHC class II
What would be the consequence if the lysosome wasn’t acidified? Where does htis occur too
No MHC II loading; so endosome-lysosome fusion fails. Fucks up immune response. Occurs in rough er.
What prevents superficial candida infection? What prevents systemic candida infection?
Superficial: T cells
Systemic: Neutrophils
What is the difference between an inactivated and a live attenuated vaccine (and an example)
Inactivated: Humoral only
Live attenuated: Cell mediated and humoral
EG Strep Pneumo (in kids do live attenuated, old people inactivated so IgM only)
What is the advantage of the oral polio vaccine?
get an IgA duodenual lumen immunity
What do PD1 cell receptors do? What are htey expressed in abnormally?
They baiscally bind to PDL1 and prevent immune response. Tumors and cancer do this to avoid death. So now it is a treatment.
What do Ubiquitin proteasesomes do?
Break down a cell/virus-> couple to MHC1 in ER, put on cel surface for CD8 cells
What does IL2 do?
made y T helper, increaes B and CD4 and CD8 T cells, activates NK and monocytes
What immune cells try to contain metastatic renal cell cancer and melanoma (I think)?
NK and T cells
What is the mechanism of peripheral tolerance for T cells?
Anergy; T cells need a costimulatory signal from CD28-B7 to activate; without it they will not work. EVEN IF THEY GET A SECOND SIGNAL-still do not work
What is central tolerance
thymic selection process (negaitve selection) to prevent self attack
What is wrong in Hyper IgE/Jobs syndrome?
T helpers can’t make IFN gamma; failed neutrophil chemotaxis. Get staph abscesses, pruritic eczema, eosinophilia, increased IgE. ALSO Th17 fails to make IL17; get “leather face (thick skin”) and extra rows of teeth
What is Hapten?
Hapten doesn’t do anytihng alone but whne it binsd to protein you get a immune response.
How can penicillin act like happen/ hypersensitivity type
Penicillin induced hemolytic anemia (type II); basically acts like hapten and binds to RBC-> antibodies recognize an dkill-> anemia
What is the biggest marker of leukocyte adhesion deficiency?
CD18 is absent (lack integrin), get neutropenia (make them, just can’t respond)
What viral infeciton are NK cells particualrly important in?
herpesviridae infecitons
What is Chornic Mucucutaneous candididas?
basically a t lymphocyte issue specific to candida
Describe Ataxia-Telangiectasea
Chromo11q22-23 DNA repair issue. Often get ITA deficiency with spider angiomata, cerebellar ataxia, xray hypersensitivity, ocular and cutaneous teleganectias, more cancer, more isnpulm infections
Describe Langerhans Cell Histiocytosis
“Tennis Racket” guy; get oral ulcers, rashes, LYTIC xray lesions, conjunctival pallor, raised tender spots
What are langerhans cells?
basically dendritic cells; bring immune repsonse to T cells
What does Daclizumab do
Binds to IL2 receptor; reduces T cell response
Alpha, beta chains in MHCII vs MHCI?
MHC II: 1 alpha, 1 beta
MHC 1: 3 alpha, 1 beta
What is the treatment for Bruton Agammaglobulinemia?
IV Immunglobin (bone marrow WONT DO SHIT–T cells are fine)
If you give someone antibody to toxin, what type of immunity is that?
passive immunity
What is the main treatment for diptheria?
give them antitoxin (also do other shit like vaccine and antibodies), basically passive immunity
Where do you see c-ANCA?
in neutrophils of Granulopolyangitis (Wegners)
How would an asplenic crisis cause sepsis?
So get abdominal trauma or sickle cell-> can’t clear capsule organisms-> sepsis
What makes sputum green?
myeloperoxidase
What would cause an intrapulmonary shunt?
Adequate perfusion, NOT ventilation
What is transformation?
Direct uptake of extracellular dna by a virus (so a killed virus+live for example)
What is transduction?
Need a phage for bacterial gene change
What is conjugation
Pilus mediated DNA exchange between viruses; transfer DNA via F factor (Fertility factor)
How do transposons act in viral DNA exchange
basically are mobile gnetic elemetns and can do like anything (move within a gene, transfer gene to gene gene to plasmid whatever)
What do you need to watch for in viral myocarditis
Decompensated heart falure
What happens to ventricular compliance in diastolic heart failure
Goes down
What would be the big problem with a fib in aortic stenosis
Well its a sudden loss of preload (doesnt contract), also emboli issue
Why would someone with SLE have cushings and what would happen to the adrenals?
Exogenous glucocorticoids traet SLE; so adrenals atrophy because of lack of use
What viruses can do reassorment? Recombination?
Reassortment is SEGMENTED viruses
Recombination is more nonsegmented I guess probably both
What is the toxoplasmosis TX
Pyramiethaine, Sulfadiazine
What is the big side effect for Amphotericin B?
Nephrotoxic due to its effect on cell membranes (so could lead to hypokalemia and arrhythmias)
What is the function of NFkB?
It is a transcription factor in infection; normally it is in the cyotosl bound to IkB–when IkB gets destoryed (Via cell signaling) it actiavtes and ramps up immune response
What pulls clavicle in superior/posteiror direciton after fracture (at least the medial portion)?
SCM
What pulls a clavical fraction inferior/anterior
Pec Major (I guess if its further along it could be more lateral and deltoid)
What is Spongiosis?
Seen in contact dermatitis; edema fluid in epidermis
What are risks of hereditary spherocyotsis?
Hemolytic anemia, splenomegaly, jaundice, INCREASED pigmented gallstones (breakdown and shit), Aplastic crisis from Parvovirus B19
Risks of Sickle Cell?
I mean theres the finger issue, autoinfarct of spleen and avasc necrosis of femur as well, ACUTE CHEST syndrome (basically vasoocclusive issues), osteomyelitis from salmonella
how do you calcualte ejection fraction
SV/EDV (so can do ESV-EDV/EDV)
What are the symptoms of alcohol withdrawal
Insomnia, tremulosness, anxiety, autonomic hyperactivity (variable BP, tachycardia, diaphroesis)
How do oyu calculate half life
(0.7*Vd)/CL
What is made first in the tyrosine pathway- Norepi or Epi- what does this
Norepi; PNMT dependent
What causes painless bleeidng in old people out the ass?
Diverticulosis; sigmoid bleeding, NOT ITIS
What causes wound contracture/scarring?
myofibroblasts
How can pseudomonas cause black gangrene?
Has ADP ribosylating factor E2
What is the telltale sign of Sturge Weber syndrome?
PORT WINE STAIN (baby with the red shit on the face), also leukocornia (NO RED REFLEX), increased risk of glaucoma, ID, seizure, phenocromocytomia, leptomeningeial angiomatas
How does the kidney response to ocarc of Aorta?
increases RAAS (lower perfusion pressure), further increases thoracic pressure (so fruther vent contractility?)
How does crohns cause kidney stones?
Impaired bile acid absorption; more calcium oxalate in kidney (agian terminal ileum is often affected)
IF trach pO2 is roughly equivalent to alevolar Po2, what is the problem? How can you se pCO2 here
its a perfusion issue PCO2 will be about 0, PO2 in alveoli will be equal to trachea (because the venous blood isn’t normalizing halfway between the two).
If it was diffusion, PCO2 would be normal because it croses the alveoli really easily
What does sorbitol normally degrade into, when is tihs an issue?
Issue in diabetes, normally sorbitol degrades into fructose. Sorbitol is made frmo glucose (via aldose reductase). Sorbitol makes fructose via sorbitol dehydrogenase, but some tissues lack this (eyes, periph nerves), so whne you have excess glucose the extra sorbitol causes osmotic absorption
What is thoracic outlet syndrome, what cna cuse it?
Extra cervical rib; repetitive overhead movements/trauma, scalene muscle injury
Basically get compressed lower trunk bracihal plexus. Causes upper etremeity numbnes, tingling, weakness, can get pain (subclav art ocmpression)< swelling (subclav vein sompression)
What effect does Nitroprusside have on preload and faterload? What would od this to a pV diagram?
Decreases both; so both should move
What does decreased plasma oncotic pressure result in?
Edema (esp in proteinuria setting); increased net filtrate at capillaries-> edema
What virus has an owl eye apperane, when you might you see it in lungs, what is its apperance?
CMV; post lung transplant; enveloped double stranded DNA
What is a cholesteatoma?
a pearly mass of squamous cell debris that causes conductive hearing loss (behind tympanic membrnae).
Cancer on the other hand would be PAINFUL.
Name some DNA binding proteins
Transcription factors (Myc, CREB), steroid receptors (prgoest, aldost, cortisol, test, etc), thyroid hormone receptor (only one located on nucleus), fat soluble vitamines
What arre some protecitve virulence factors of H flu?
pRP (binds factor H, prevnets host from using C3b), polysach capsule
Distinguish effect modification vs confounding
Effect modification: Difference REMAINS or is ENHNACED when you take it into account (like you look at kids and adults and compare Reye syndrome rates)
Confounds will correct difference (thought alcohol showed a correlation, add smoking and its gone)
Who gets klbesiella pneumonia
Alcoholics (microaspriations), currant jelly sputum, lactose fermenter, encapsulated gram negative rod
What ultimately causes type II DM
A lot of it is increased fatty acids that leads to insulin resistance (more hepatic gluconeogenesis, less glucose insulin depennt uptake)
What is in the naming of NNRTIs, also what other thing doesnt need phosphorylation
—VIR—-, also foscarnet
Calcualte RPF (two differnet ways)
RPF=PAH Clerance= (urine pAH * urine flow rate)/ serum pAH
or RPF = RBF * (1- Hct)
Calcualte ifltration fraction
GFR/RPF
What is a pretty big give away of digoxin toxicity
color perception issues (hyperkalemia too of course)
What is the mitral valve prolapse murmur
late crescendo
What is the HCM murmur?
crescendo-descrescendo
What is deficiit in galactosemia (and so what builds up), what cna it cause
Galactose-1-PCT (so buildup of galactose 1 phosphate, cant make glucose 1 phosphate). Get ECOLI SEPSIS, Renal dysfunc (so hyperchoelmic metabolic acidsosi, jaundice, hepatomegaly, anemia, cataracts)
What is seen in renal failure, causes of the various types
Hypercholermic metabolic acidosis
type II (proximal): decreased bicarb reabsorb in PCT (tx with thiazide) hypokalemia start hi thne low urine ph
Type I (distal): defective hydrogen secretion (tx sodium bicarb) hypokalemia high urine ph
Type IV: hyperkalemia reuslts in reduced ammonium syntehsis (hypoaldost)
hyperkalemia low urine ph
What is PALPABLE PURPURA mean 100%?
Type III Hypernsensitivity rxn (small vessel vasculitis)
What are causes of oxygen issues in normal AA-gradient, high AA-graident
Normal: Diffuson is intact, so its an outside body isseu (eg high altitude, hypoventilation, not breathing like with opioids)
A-a is high: increased deadspace or shunting (shunt, V/Q mismatch, pulm fibrosis, pulm edema)
How do glucocorticoids act
Again they are like cortisol so steroid receptor-> bind on cyotplasm-> translocate to nucleus-> bind as trancsription factor
Difference between rectal cancer and an externa lhemorrhoid (just off hisotry)
rectal cancers will bleed and are ulcerated (look nasty)
External hemorrhoids hurt and may or may not bleed (could just be like a black blob)
Why would you give someone with sickle cell hydroxyurea
increases HbF
What does hdydorxyurea do, other uses
inhibits ribonucleotide redcutase (so decreases DNA syntheiss, s phase specific), cna use in melanoma, CML, sickle cell (increasing HbF)
What would you use imatinib in, what does it do
inhibits bcr-abl tyrosine kinase; tx for CML t(8;22), GI stormal tumors
How do you calculate Km from Vmax
At the point where 1/2 vmax is achieved—Km is the substrate amount
What is IL 12 deficiency, presentation
Basically have no IFN gamma; get recurrent hild hood non-TB mycobacter infections, salmonella, infection after BHCG vacine–could present in sepsis
Pharyngeal arches 1,2,3,6 what do they do
1: CNV2, V3, its chewing—if it was fucked up (like in Pierce Robin), small jaw and tongue falls into back of thraot, can’t breth
2 is facial rexpression
3 is glossopharyngeal
4/6 is swallowinga nd speaking (CN10)
What is the tratment for methanol toxiicity and MOA (there are 2)
1: Ethanol: competitive substrate for Alc dehydrogenase (lowers formaldehyde generation)
2: Fomepizole: inhibits alcohol dehydrogenase, going to ned dialysis
TB drugs and their mechanisms
R(ifampin): inhibit DNA depent RNA polymerase
I(sonazide): inhibit mycolic synthesis
Pyrazinamie (unclear)
Ethambutol (inhibit arabinsonyl trnasferase)
RIPE
big side effect rifampin
orange red body fluids, GI
big side effect isonazid
neurotoxicity/periph neuro issues (give B6/pyridoxine), hepatotoxic
big side effect pyrazinamide
hyperuricemia
big side effect Ethambutol
optic neuropathy
What happens to diffuson capcity for carbon monoxide (DLCo) in emphysema? Asthma?
Emphysema goes down
asthma is high
Why might someone get a warfarin skin necrosis issue immediately?
Protein C or Protein S deficiencies (these are both Vit K dependent; protein C has a really short halflife, get hypercoagulable state)->microvasc oclcusion-> skin necrosis
tx for warfarin skin necrosisp
discontinue warfarin, protein c concentrate or FFP given
Varenicline use
partial agonist at nicotine receptor; quit smoking, reduce craving
What are signet ring cells; wher might you see them
abundunant mucin pushes nucleus to side, can see in gastric adenocarcinoma; diffuse involvement of stomach, due to cell adheison loss of E-Cadherin. Called “leather bottle stomach/linis plastica” due to plaque like diffuse involvmenet
Eggs on your butthole, tx
Pinworm (enterobiasis), tx is albendazole
If someone has a really low BMI and doesnt menstrate (is like a teenager), what is cause
hypothalamic suppression (low leptin-> low GnRH-> low everthing else)
ASD murmur
fixed split S2
What is the biggest concern in ASD
Pulmonary vascular sclerosis (so pulm vessels) and pulm HTN. This is eisenmeger syndrome.
Increased filtration of plasma proteins in kids?
minimal change disease
Erythematous papule with white scale on your skin, “sandpaper like”- dx and complication
Actinic keatosis- worry about skin cancer
Tissue Paper/sand paper macrophages
Gaucher disease
What is overactive in carcinoids that can induce cancer? (and makes them carcinoids)
Mirosomal monooxygenase (AKA CYP450 monooxygenase)
Men1A
MEN gene, Primary hyperparathyroid, pituitary tumor, pancreatic tumor (esp zollinger)
MEN2A
Ret, medullary thyroid cancer, pheochormocytoma, parathyroid hyperplasia
MEN2B
RET, Medullary thyroid, PHeochromocytoma, mucosal neuromas, marfinoid
EGFR treatment for cancer isntworking; what is the problem?
downstream KRAS mutation
Arteries most affect in atheroscleroesis
Abdominal > Coronary > Popliteal > Carotid (internal)> circle of wilis
tx for hypoglycemia
glucagon
aflatoxin increases risk of (And why)
p53 mutation; hepatocellualr carcinoma
What happens to oncotic pressure and lipid/protein synthesis in nephrotic snydrom
oncotic pressure down-> leads to higher lipid/liver protein syn (hyperlipedemia).
also because of pressure down get hypovolemia, increased aldost and ADH-> edema
Older woman, muscle pain ,headache, great response to steroids, what does she haev and apperance
Giant cell arteritis (Granulomatous inflammation of media), could also have jaw claudication, polymyalgia rheumatic (achy pain in hips and shoulders), also increase risk thoraic aneurysm
In a lymph node what is more concerning; abundunat mitotic figuers or monoclonal T cell receptor gene rearrangements
monoclonal rearrangements (looks like cancer), polyclonal is common/normal, monoclonal is not.
Apperance of hypoxic-ischemic encephalopathy vs cardiac embolism
Hypoxic-ischmeic: from cardiogenic shock, get BILATERAL wedge shaped infarcts in same areas
Cardiac embolism: different vascular territories, more random
Hepatocytes have finely granular, diffusely pink eosinophilic cytoplasm, dx?
Hep B; “ground glass” hepatocytes
What are the best markers for concern in cirrohiss
Prothrombin time, albumin levels, biirubin levels
What is wrong in osteogneeiss imperfecta
Type 1 collagen; normally what FORMS osteoid; so if its fucked up get blue sclera, small malformed teeth, hearing loss, flexibile joints
(type 1 ocllagen is in teeth, ligaments, skin, sclera)
In contrast, Vit D cant mineralize osteoid (but hte osteoid is fine)
Varicose veins (Venous stasis dermatitis); what is the issue?
incompetent venous valves
Concern with direct arteriolar vasodilators
Lower BP->sympathetic activaiton by RAAS. So get higher retained Sodium/fluid
Someone places some blood in an upright glass tube, the fuck are they doing and what affects it
Testing ESR: determined by iL-1, IL-6, TNFalpha
Your cerebellum is fucked (Purkinje cell degeneration)- what caused? What is this process?
AUTOIMMUNE. But its from cancer (small cell lung, breast, ovarian, uterine). Basically immune respones to tumor kills cerebellar cells (Anti-Yo, AntiP/Q, Anti-Hu)
What causes different rates of INH metabolism
variable acetylation in people
What are clavulanic acid, sulbactam and tazobactam- why add to a tx
Beta lactamse inhibitors. (so decrease drug cleavage by bacterial cells)
When is HBV likely to cause hepatocellular carcinoma
When it integrates into the host DNA
You give atenolol; what happens to cAMP in cardiacmyocytes, Juxtaglomerular cells, vasc smooth muscle
Well it is a beta 1 mostly; this isnt on vascular smooth muscle.
So decrease cardiac, decrease juxta
A woman’s neuro exam and strength exam is fine, but she has random spots of soft tissue pain, what is going on and what is treatment
Fibromyalgia (issue in central pain processing), aerobic exericse helps
Key differences in Lambert-Eaton MYasthenic syndrome (other than pathogenesis) from MG?
Heavily associated with small cell llung cancer.
Have hyporeflexia or areflexia, autonomic symptoms (like erectile dysfunction), and classic incremental increase to stimuli
When does free wall rupture occur post MI
5-14 days
What is a symptom specific to Graves that distinguishes it frmo other hyperthyroidisms
Thyroid dermopathy (stim of fibroblasts-> excess glycosaminoglycans) Pretibial myxedema (and exopthalmos)
Location of hippocampus on CT
its like right before and slightly above hte cerebellum on nonmidbrain cuts
What is chronic lymphedema (from something like breast cancer axillary lymph node dissection) a risk factor for?
Cutaneous angiosarcoma (Stewart-Treves Syndrome).
Colchine mechanism of action?
again an acute gout tx; inhibit microtubule polymerizaiton (thus preventing chemotaxis)
How can you calculate winters formula, when is it useful?
Determine appropriate compensation (in stuff like DKA, so if it is too high and they are overcompensating, suggests they have respiratory alkalosis).
PaCO2= (1.5*HCO)+ 8 +/- 2
What is hydrocephalus ex vaco
basically hydrocephalus caused by cortical degeneration
Apperance of cocciodies imitis
spheruels packed with endospores
What is the abnormal bone pathology seen in CKD?
Renal osteodystrophy (hyperphosphatemia, hypocalcemia)
LVED pressure, LVED volume and filtration fraction in diastolic heart failure?
pressure is up ,other two are normal (this is LV hypertrophy)
major ganciclovir side effect
neutropenia
Pneumonia with Peptostreptococcus, Fusobacterium; cause?
aspiration (so could be like seizure or alcohol)- thsse are normally mouth flora
What treatment reduces prostate size in BPH?
5 alpha reductase inhibitors (finasteride, dutasteride)
Characteirstic cell of hodgkin lymphoma
reed sternberg cell
Rituximab
monoclonal antibody against CD20
Mutation in polycythemia vera
Tyrosine kinase (JAK2)
What vitamin deficiency is similar to freidrich ataxia
Vitamin E (due to degen of spirnocerebellar tracts, loss of position and vibration sense—degen dorsal columns, loss of deep tendon reflexes)
Tumor that causes SVC syndrome
Lung cancer or nonhodgkin lymphoma–MEDIASTINAL mass
tx trichamonas vaginalis
Metronidazole
What causes LV outflow obstruction in hypertrophic cardiomyopathy?
mitral vlave leafet and IV septum
Where does cryptococcus colonize. what stain do you use
Lungs, india ink
What can cause a primary spontaneous pneumothorax?
apical subpleural blebs (spontaneously rupture htrough visceral layer, can happen at rest)
Cause of spastic bladder in MS
Bladder hypertonia (can’t distend/relax properly)
What ahppens to serum haptoglobin in autoimmune hemolytic anemia
Goes down
area of blood in epidural hematoma
between bone and dura mater
Pleural thickening environment exposure?
asbestos
Most important mediator of Giant cell arteritis (and thus can be used for traetment)
IL-6, can block with Tocilizumab
Mechanism of diabetes nerve damage
endoneurial arteriole hylanization (basically vasular issue and sorbitol too)
Simple cuboidal cells are where in female GU
ovary
How can glucose be made in liver during DKA?
do triglyceride breakdown in adipose tissue; use GLYCEROL KINASE (use glycerol in liver and kidney) to make gluciose
What does vWF bind to
collagen and platelet GpIb
What does myoglobin look like on oxygen dissocaiton , how could it be “made” from hemoglobin (at least to look like this on the graph)
really steep curve, one subunit of hemoglobin would look like this
Flow is proprotional to resistance by what power
Flow = ____*r^4
What stage is an egg in that has been released in the cycle? (prior to fertilization)
Metaphase of meiosis II (in prophase I of meiosis before that)
Feature of primary hyperaldosteronism that you missed
paresthesias, muscle weakness due to electrolyte abnormalities
What would you give a patient with hemophilia when they cant clot
thrombin
Major clinical risk of Factor V deficiency
DVT—look up this disorder I kind fo forget it
Hemorrhages in occipital and parietal lobes in an elderly people
Cerebral amyloid angiopathy
What is the mechanism of Zenker Diverticulum formation
cricopharyngeal motor dysfunction (abnormal/diminished relaxation during swlalowing)
Complication fo various veins
skin ulcerationss
Diphenoxylate MOA
Opioid antidiarrheal agent (so affects motility)–binds to mu
What happens to MCHC n hereditary spherocytosis, haptoglobin?
goes up, haptoglobin goes down
dude with ulcerative colitis who doesnt take meds and has signs of shock, what imaging do you do/dx test
Do abdominal xray; may have toxic megacolon (colonoscopy is contraindicated)
Lymphoma where tumor increasees and decreasess in size and fluctuates
follicular lymphoma
Anastrozole MOA
Arommatase inhibitor
Foscarnet electrolyte side effects
hypomagnesia, hypocalcemia
How does digoxin affect A Fib
does rate control; increases parasympathetic tone
What does CEA (carcinoembryonigenic antigen assay) function as?
used to onitor colonic adenocarcinoma (esp for reoccurence)
Calcification of hilar nodes, bifringent particles surrounded by fibrous tissue—cause?
Silicosis exposure (inhaling mineral dusts like sand blasting)
What mediates the development of lung abscesses?
lysosomal enzyme release from macrophages and neutrophils
Mechanism of polycythemia vera
increased sensitivity of bone marrow to growth factors; namely JAK2 gene (V617)-replaces valine with phenylalaine
Why would a hypothyroid patient present with a muscle mass and elevated CK?
myoedema; (hypothyroid myopathy), get myalgia, proximal muscle weakness, cramping. Basically slow calcium reabsorption by SR
Why do you need to dose oral nitroglycerin much higher than sublingual?
high first pass metabolism
What disease gives you a dry tap
hairy cell leukemia (can also see it in via TRAP tartrate resistant acid phosphatase), will have pancytopenia
What disease is associated with renal angiomyolipomas
TUberous sclerosis (also has brain hamartomas, ash leaf skin pathces, cardiac rhabdomyomas, facial angiofibromas for example)
side effect of erythropoetic stimulating agents (and names)
Erythropoetin, Darbepoetin alpha, increased risk of worsening hypertension and thromboembolic events
Ribavirin mechanism of action and use
used in hep c (with inferferon alpha); induces lethal hypermutation, inhibit RNA polymerase, deplete GTP, defective 5’ cap formation, modulate effective immune response (basically interefere with viral rpelication of genetic material)
Mechanism of aciton of timolol in open angle glaucoma (and similar drugs)
nonselective beta blocker that diminishes secretion of aqueous humor by ciliary epithelium. Acetolzamide does same
MOA of prostaglandin F2alpha (lansoprost, travoprost) and cholinomemietcs (pilocarbine, carbachol) in open angle glaucoma
decrease IOP by increasing outflow of aqueosu humor at trabechualr meshwork (muscarinic), uveosecral (prostaglandins).
Cholinergic guys actually do a lot more because oculomotor neuron uses ACh for parasymp; promote ciliary muscle contraction, contract iris sphincter
Adverse effects of theophyelline (meaning toxicity)
seizures ,tachyarrhytmias—can treat with barbs and benzos
What causes nitrates to give chest pain relief?
decreasing preload/myocardial oxygen demand (so less LV outflow)
What is the result of most acute tubular necrosis
recovery and tubular reepitheliziation
Where would you see “apparent euvolemia”
in conditions with excess ADH (so SIADH and small cell lung cancer) means you don’t get edema or inccreased JVD, ascities or anything like that
What cells are primarily involved in COPD development (immune cels)
neutrophils, macrophages, CD8 t cells
Kidney failure with narrowing of renal arterioles with deposition of homogenous glassy material in subendothelial space that stains pink with Periodic Acid Schiff stain (PAS) cause?
diabetes mellitus (this ishyaline arteriolosclerosis)
What is mutated in duchennes (and its function)
Dystrophin protein on X chromosome; frameshift mutation (its a deletion). Dystrophin normally provides mechanical stability to sarcolemma; links cytoskeleton (actin) to transmembrane proteins on ECM (alpha and beta dystrophdigoglyacans).
So it is a mutation in sarcolemma-skeleton linker protein
What is the genetic difference between Duchenes and Beckers that makes Becker midler
Becker is a three gene deletion so you don’t get a frame shift
What happens to hte heart as you age (normally)
decreased LV chamber size, increased interstital connective tissue (collagen deposition), accumulation of brown lipofusin pigment, SIGMOID shape of ventricualr septum
Which fungi: double refractiel wall with single broad based bud (in body), branching in cold
Blastomyces dermatitidis
body: large yeast cell with single bud
cold: mold with branching hyphae
What is defective in kallman syndrome (name some conditions as well)
Failure of GnRH secreting neurons to migrate from olfactory placode to hypothalamus. (Kal-1 mutation or fibroblsast growth factor 1 gene mutation)
Central hypogonadism, LOSS OF SMELL (ansomia), may get cleft lip/palate
Ovarian tumor “small cuboidal cell growing in cords or sheets, forming a rosette, with a gland like apperance and a pink eosinophilic center with a coffee bean nuclei”
Name of this condition, the histological shape, what it secretes
Granulosa cell tumor, “Call Exner Body”, estrogen, inhibin
remember COFFEE BEAN NUCELI
What nerve lies between the palmaris longus and the flexor carpi radialis and what cords of brachial plexus does it arise frmo
Median nerve; lateral and medial cords
What is a Barr body
the inactivation of one X chromosome that happens in females
what aspect of medicare handles physician visits and testing?
Medicare B
when the elbow is dislocated posteriorly, what nerve is damaged (and name two structures it runs by)
Ulnar nerve; cubital tunnel and the medial epicondyl
you get posterior dislocation with either posterior ulna or anterior humerus
What is most common source for hospital acquired infecitons?
Central lines
What is Lynch syndrome, what does it lead to
AUTOSOMAL DOMIANNT DNA repair defect of MLH1, MSH2, MSH6, PMS2 or EPCAM. Get Endometrial and all GI cancers
Congenital CMV presentation
Triad: CUtaneous hemorrhages (blueberry), sensorineural deafness, periventricular CNS calcifications
Congenital Syphilis presentation
notched teeth, long bone deformations, bronzing rash, maculopapular rash, perforated palate
Congenital Rubella presentation
ID ,PDA , pulm stenosis, blindness, encephalitis, motor abnormalities, cataractes, deafness. NO CNS calcifications
Congenital Parvovirus B19
can get hydrops fetalis
Congenital Herpes Simplex
encephalitis, conjunctivits, keratoconjunctivitis, thormbocytopenia, elevated liver enzymes
How do methampheatmine and amphetamine act
increase NE and dopamine release (dopamine causes reward activaiton)
what recpetor has the biggest stimulatory effect on smooth muscle
alpha1 (via gq, Ip3/DAG)
what is an OSHA guideline for gas anesthetic use
proper ventilation (can leak out, bad news)
name two things that increase in restrictive lugn disease
elastic recoil (elasticity, sorta opposite compliance) and work of breathing
Treatments for pyelonephritis if bacteremia is present
start on a fluroquinolone or ceftriaxone
What is a sentinel event
event in a healthcare setting that lead to death or serious physical or psychological injury (do a root cause analysis to look at retrospective causes)
what nerve supplies afferent baroreceptor reflex, what ahppens if you cut it
this is glossopharyngeal; will increase sympathetic activity (again no parasymp) so hypertension with tachycardia
Layers of anterior abdominal wall from superficial to deep
Skin-Camper Fascia->Scarpa fascia->External oblique/aponeurosis->interal oblique/aponeurosis ->transversus abdominus->transversalis fascia->parietal peritoneum
Enlarged left atrium, left ventricular myocardial mass and left ventricular wall thickness is increased- cause?
Long standing hypertension. Concentric LV hypertrophy
NF1 features
autosomal dominant chromo17; cafe au lait spots, neurofibromas (the nasty ass peduncles), lisch nodules (on eyes), pseudoarthritis, various brain tumors
Signs of increased intracranial pressure in an infant
altereed mental status, enlarging head circumference, bulging fontanelle, downward driven eyes
Values of PTH, Urinary Calcium, 1-25 Vit D and PTHrP in multiple myeloma-why?
Down PTH, Up Urinary Calcium, Down 1-25 Vit D, normal PTHrP…well PTH drives reabsorption of calcium at the DCT, so without it it’ll get excreted in the urine. The other guys are because tthe PTH axis is intact, bone is just getting destoryed
What are amatoxins/amanita phallodies; what do they cause?
Mushroom poisoning (death cap). absorbed and transferred to liver, sodium taurochlorate co transport (NCTP) and organic anion trtansporting polypeptide (OATP) concentrate toxin in liver cells; BIND TO DNA DEPENDENT RNA POLYMERASE II SO CANT MAKE mRNA
Main inhibitor of Beta oxidation (and what enzyme normally starts it)
Malonyl-CoA inhibits; (by inhibiting the starting enzyme, carnitine acetyltransferase)
What is transthyrein; what can it do to heart?
protein tetramer in the lvier that normally acts as a carrier of retniol and thyroxine. When mutated, gets misfolding-> produce amyloid->infiltrative caridomyopathy (diastolic heart failure aka hypertorphic guy)
What controls fibroblast proliferation and migration during wound healing?
TGF-Beta (transforming growth factor beta) and PDGF (platelt derived growth factor)
Where does carcinoid syndrome cause endocarditis
Usually right side of heart
What does carbon tetrachloride do to the liver
free radical damage
Tx for Staph Epidermidis
Vanc
What causes the cutaneous flushing, warm and itching with niacin administration? How can you prevent?
Prostaglandins. Can prevent by giving aspirin
What COX inhibitor does not affect platelet aggregation and why
Cecloxib; this is a selective COX2 inhibitor, and COX1 is what drives platlet aggregation and many more normal tissue functions. COX2 is pretty selective for inflammation
What is a good drug for improving PAD symptoms and what is its moa
Cilostazol; vasodilates reduces platelt activation via platlet phosphodiesterase inhibition (which normally breaks down cAMP). IMPROVES PAD SYMPTOMS LIKE CLAUDICATION
What is CREST Syndrome, how might it present
Calcionsis Raynaud Phenom Esophageal dysmotility Sclerodactyl Teleangetasias
Its systemic sclerosis variant; have chronic autoimmune stuff going on and vascular endothelial injury/chronic ischemic tissue damage, excessive fibroblast activation
so you get fingertip ulcers, as well as GERD because the esophagus gets atrophied and gets fibrous replacement (so increased irsk for Barretts and Cancer too from GERD, as well as just general stricture and dysphagia)
What aspects of Wernicke encephaloapthy are not reversible?
The korsakoff syndromes (so chronic memory loss and confabulations) from anterior and dorsomedial thalamic nuclei
Describe Chanchroid
genital lesion caused by Hamephilius Ducreyi (gram negative bacteria, STD). DEEP PAINFUL ULCERS (one or more), RAGGED BORDERS, can get GRAY EXUDATE AND INGUINAL LYMPHADENOPATHY, gram stain the bacteria will clump
How does penile squamous cell carcinoma present
lumps or ulcers sometimes with adenopathy; PAINLESS (average age of presentation is 50)
What kind of virus would have a phospholipid viral partical surface really simila rto that of a cell nuclear membrane?
Herpeviridae; they get their envelope from budding out and getting lipid bilayer from host cell nuclear membrane (so CMV wold be an example)
In situations of starvation, which hormone binds to an intracelluialr receptor to maintain blood glucose?
cortsiol; alters gene trnascription to enhance glucose production, limit peripheral glucose utilzation (can maintain normal blood glucose)
Lab values in salicylic acid poisoning?
starts with a priamry resp alkalosis then a mixed resp alkalosis and anion gap metaoblic acidosis
What cells secrete bicarb in the GI tract
made by S cells (produce secretin) that increaess bicarb
signs of pancreatic adenocarcinoma and risk factor?
progressive weight loss, painless enlarged gall bladder, jaundice (risk is smoking)
Tx for restless leg syndrome?
dopamine agonists(ropinrole, pramipexole)
How do BNP and ANP act
like nitric oxide; active guanyl cyclase and increase cGMP (relax vasc smooth muscle and vasodilation)
Vit E deficiency signs
ataxia, impaired proprioception and vibratory sensation, hemolytic anemia—-neuronal and erythrocyte membranes are sensitive to oxidative stress. can happen in CF (impaired fat malabsorption)
who can havei ssues with posterior urethral valves
men only (its a malformaiton of wolffian duct)
What are signs of antiphospholipid antibody syndrome
Occurs ins tuff like lupus.
Hypercoagulable state.
increased VTES/embolus, adverse preg outcomes (multiple losses)
get prolonged PTT
get anticardolipin antibody
antibeta-2glycoproteinI antibody
