Kaplan Flashcards
Metabolic state in Heart attack?
Mixed acidosis usu.Because you have lactic acidosis (metabolic), but you are also not breathing so you have respiratory acidosis.
Where do intraparenchymal hemorrhages from HTN usually occur?
Basal ganglia, internal capsule
Symptoms of Wilms TUmor? Treatment?
HTN, hematuria, palpable ab mass. Tx Vincristine - Actinomycin
Busulfan. Used for? Side effect?
CML - hyperpigmentation.
Difference between D-Dimer and Fibrin degradation products?
D-Dimeris ONLY from fibrin breakdown Fibrin Degradation products can be from EITHER fibrinogen (NORMAL in blood) or fibrin. Meanining D-Dimer is more specific for clot breakdown. Whereas Fibrin degradation products could be high in plasmin mediated breakdown of fibrinongen (DEC Anti-plasmin or Urokinase) without clots.
Where is the tubular fluid the most hypotonic (the least osmolality?
end of thick ascending loop and early DCT - macula densa is actually hypotonic!
Most common cause of nephrotic syndrome in US?
FSGS
Most common method of transmission of herpes from mom to kid?
During passage through birth canal.More rare is transplacental transmission.
What happens to the clearance of a secreted metabolite when the plasma concentration INC?
The clearance DEC due to saturation until it approaches inulin.
What drug is related to the induction and maintenance of REM sleep?
ACH
Gram negative rod with thick polysacch capsule in alcoholic?
Klebsiella
Treatment of delirium in pt w/ liver problems?
Benzo - Lorazapem specifically! Oxepam, Temazepam.LOT!Metabolized by phase 2 (conjucation) - effects liver less.
Mid humeral fracture = ?! WHich nerveWhich muscles effected/
Radial nerve. Also from saturday night palsy and axillary compression during crutches. Triceps, extensors of forearms, aand SUPINATOR!!
Where do UMN decussate?
In the pyrimidal decussation, which are in the medulla.
Why do you get retinopathy of immatuiry?
High levels of O2 cause VASOCONSTRICTION.THis leads to ischemic changes -> stmiulates VEGFRetinopathy due to INAPPROPRIATE VASCULAR PROLIFERATION. - > WHITE pupillary reflex in this case. (dont confuse w/ Rb)
Molecular problems inheritance of Duchennes and Beckers?
Duchenes - X linked FRAMESHIFTBecker - X linked POINT mutation.
Most common inherited neuropathy? What is the problem, how does it present? Most common nerve affected?
Charcot Marie Tooth - most common inherited neuropathy, mutation on genes encoding SCHWANN CELls -> demyelination of peripheral nerves. It is SENSORI-MOTOR. Usu AD . Often leads to foot drop and high arched feet. Most common nerve affected is deep peroneal nerve.
Pt w/ mutliple myeloma who has a bunch of white circles in plasma cells. What are these called and what are they made from?
Russell bodies - excess IgDistended endoplasmic reticulum
HCC associated hormone production?
EPO, insulin like growth factor (-> hypoglycemia), PTrP -> hypercalcemia
Most common food source of botulinum toxin?
Canned alkaline veges or preserved fish (preformed toxin in adults)Honey is spores in kids)
What to give prophylaxically to chemo pt to prevent uric acid stones?
Allopurinol. DEC Xanthide Oxidase - which in turn DEC uric acid production.
Dehydrated, super high ADH, where is majority of water reabs?
Still PCT. 65%..
Patient making up a story. Concern for?
Confabulation - chronic alcohol use - Wernicke Korsakoff
First like for acute glaucoma? When is latanoprost used? What is it?
Acetazolamide - reduces production of bicarb/aqeous humour. Latanoprost - Prostaglandin F2 - used in open angle glaucoma.
Which arches for internal carotid? For aorta and right subclavian?
Internal carotid - 3rd archAorta, right subclavian - 4th archARch 1- maxillary arteryArch 2 - stapedial artery
In retinal detachment or optic neuritis, what is the afferent/efferent problem? How does it present on swinging light.
Severe retinal damage/Retinal detachment/optic neuritis - Marcus Gunn pupil - afferent pupillary defect.So shining in normal eye would cause constriction of both.Shining in impaired eye would cause paradoxycal DILATION IN BOTH EYES (or at least DEC bilateral pupillary constriction) due to the impaired retina trying to take up as much light as possible. test performed is swinging light test
Crush injury - which diuretic should you give if pt is oligouric?
Pt prob has hyperkalemia from crush injury.Would want to give them something that gets rid of K.NOT SPARES IT - Dont give spironolactone or any other K/ H sparing drugs.
Head trauma - no signs on CTComes in 3 weeks later all disoriented and confused -what is this?
This is subdural. Would have had progressive decline. However look at TIMESCALE. Even tho epidural has lucid then crash, it would be within hours or days due to arterial pressure.Only subdural could be on a week timescale. Prompt did not say progressive loss of function.
Potters sequence often due to failure of what to form? Be specific.
Ureteric buds - ureter, renal pelvis, calyxes, collecting tubule.
Loud music damages what in ear? Where is it located.
Damages little hair cells - located on organ or corti. This rests against basilar membrane.
Most specific tests for cryptococcus diagnosis in CSF of HIV pt?
LATEX PARTICLE AGGLUTINATION - India ink is less specific (misses 50%)
pt w/ “peripheral blood smear showing punctate granulations in enlarged erythrocytes containing oval bodies - 2 episodes over the past 2 years.
Plasmodium vivax - even tho vivax/ovale is 48 hour cycle.the ability to remain dormant can be on the year time scale.
Huntington disease inheritance - initial presentation
AD - trinucleotide repeat = writhin movements, hyperreactive reflexes, aggression, depression, dementia, loss of volume in noestraitum/cortex
Location of hematopoeisis in infants. What time frames?
3rd week to 1 month = blood islands in yolk sac.Liver is 1 moht to 7th month.8th month - bone marrow. (other sites 2-4 months - spleen and lymph)
Pt w/ AL:L udnergoing chemo. What to give if NOT allopurinol?
Febuxostat - another xanthin oxidase inhibitor.Also vigorous hydration and diuresis.
What is Wilms tumor histo?
Islands of STROMAL AND EPITHELIAL - organize into recognizable glomerularl /TUBULAR structures”EPITHELIAL +STROMAL + TUBULAR STRUCTURE.
If GFR DEC,Dietary Na/K remain the same. If plasma conc is to remain the same - what happens?
Fractioanl excretion must INC because you are filtering less. In Chronic Kidney Disease - often see oliguria w/ hypernatremia/hyperkalemia
How does warfarin affect PT/PTT?
INC both. However, it should only INC PT above normal range. PTT should still be within normal range
What can goodpastures attack other than pulmonary and renal?
Lens.Also T4 collagen (anti Bm Ab)
Patient w/ pretty severe anemia - cardiac findings?
Widening pulse pressure.Due to INC sympathetic tone -> INC EF. Usu not cyanosis (blue coloration) because it requires 5 g of deox hemoglobin/100mL blood to create cyanosis. Anemic pt dont have enough Hb to have that much deox blodo.
What is the most common cause of staghorn canaliculus?
Proteus mirabilis
Child - pleomorphic tumor cells w/ necrosis and hemorrhage. What is this and hwere is it located?
GBM - can occur in children (rare) - occurs in brain stem (in cerebral cortex in adults - duh)
What is an encephalocele
When brain herniates through skull
Locked in syndrome can occur due to rapid correction of hyponatremia and?
Basilar artery infarction
In shock, constriction of what is most important in maintaining BP?
Venules and veins - NOT arteriolesThis is because majority of blood store is in veins - so it acts like a reservoir. Can accomodate up to 20% bloodloss w/o change. Constrictino of arteriole system has relatively little change since it has relatively little total blood.
Tumor in eye - rosettes composed of cuboidal to columnar cells surrounding central lumen
Wilms tumor - rosettes are Flexner Wintersteiner rosettes -
What is elevated right 1 hour after exercising?
VEGF. secreted not by endothelial cells usually, but cells around them that experience hypoxia. Adenosine also rises as it can vasodilate arterioles - but it has an incredibly short half life and would DEC right after exercising. Growth hormone also rises, but QUICKLY is metabolized.
What other presentation do you have in leukemias?
anemia (DEC RBC) infection (DEC mature WBC) hemorrhage (DEC platelets
What is buprenorphine?
partial agonist to the mu receptors. Naloxone is a better antagonist tho.
What is a renal side effect of coarctation of the aorta?
HTN - because there is not enough blood getting to the kidney -> INC renin
Which bug is otitis externa, which is otitis media?
Externa - pseudomonas - swimmers ear.media - strep, h flu and others.
Cause of meningitis or pneumonia in elderly?
Strep pneumo for both.
Exact name for PGE1s that keep PDA open?
Misoprostrol, alprostadil
Other name for hypertrophic cardiomytopathy?
IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS.
Most common site for PE origins?
Femoral vein.
Which muscarinic receptors (1,2,3) do what?
M1 - CNS, Enteric Nervous systemM2 - heartM3 - stomach - glands, ciliary muscle, sphincter muscle
When do rostral and caudal neuropores close?
25 days, then 28 days.
ostium primum type defect refers to?
Failure of endocardial cushion and septum primum fusion
Arnold Chiari 1 vs 2?
1 - mostly asymptomatic - tonsils herniation2 - tonsils and vermis - aqueductal stenosis and hydrocephalus usu - assoc w/ myelomeningocele.
What innervates Cricothyroid? What innervates everything else?
Cricothyroid: external laryngeal (suyperior laryngeal
Another name for Loeffler syndrome?
Endomyocardial fibrosis w/ hyperEosinophilia syndromefrom direct toxicity of heart by proteins (eosiniophil ribonucleas, and Eos Major BP)
Ristocetin test in Bernard Soulier? Glanzmann?
Ristocetin is an Antibiotic that cause vWF to bind to GP1b. Bernard Soulier - Abnormal Ristocetin - defected Gp1b problemGlanzmann - Normal Ristocetin agglutination - Gp2b/3a problm
Cells implicated in ARDS?
N! - diffuse injury to alveolar capillary barrier - N! release chemokines that attract histiocytes and produce free radicals, prostaglandins, and proteases. Formation of hyaline membrane is due to plasma fluuid extravasation and alveolar cell necrosis
What segment contributes the most to systemic circulation RESISTANCE?
ARTERIOLES.Think.. wehre does the BP drop the most? Going through arterioles.R = P/Q (pressure over flow)Flow = P/R
HIT pt in need of anticoag?
Bival
PDA on imaging?Tetralogy on imaging?
PDA - Enlarged LV and LA, dilated aortaTetralogy - boot shaped heart
Apex of left ventricle bules otuward during contractionInward during diastole. What is this/due to?
“Paradoxical movement” - ventricular wall infarcted and cant contract. LAD infarct.
Red granules in enlarged young erythrocytes? Tx?
Malarai - these are SCHUFFNER DOTS (red granules) - indicative of malarial infection. Tx - NOT chloroquine (esp in south america) - most places resistance to chloroquine.atovaquone+ proguanil is good. OR Mefloquine soloFinally, Chloroquine can exacerbate psoriasis.
How do BPG levels change w/ hypoxia?
INC BPG levels w/ hypoxia.So mountain climbing -> INC BPG in order to DEC affinity - allows more oxygen to go the body. Also, always think to exericse. IN muscle, glyoclysis -> INC BPG
What vessels in kidney are occluded in sickle cell renal?
vasa recta - WHICH SUPPLY THE RENAL PAPILLARY! (cuz you get renal papillar ynecrosis in SS) - this is where the urine is most concentrated and most hypoxic/hyperosmotic.
Most common cause of viral meningitis? Viral encephalitis?Differentiation?
Meningitis: Enterovirus (Polio, echo, coxsackie, HAV)Encephalitis - herpes HSV1 Encehalitis has disorientation. It HSV1 (oral one) - Temporal lobe
Wheezing in infant - labored breathing, nasal secretions, tachypnea, tachycardia, . Bilateral wheezing! Tx?
RSV bronchiolitis. Ribavarin Also Palivizumab monoclonal ab agaisnt F protein prevents RSV in premature infants.
Describe negative strand Virus replication
Neg strands must carry RNA dependent RNA polymerase - It creates a complemetnary copy of its genome
MS progression histo?
Inflammation, myelin dreakdwon -> hyperplasia and hypertrophy of astrocytes -> plaque transprots into gliotic area.
Pancreas arterial supply Body, Head, Tail?
Head - SMABody, Head - Celiac
What does high pitched “tinkly” bowel sounds mean?
Small bowel obstruction - hernias, adhesions, tumor, foregin body, meckels, crohns, Ascaris, volvulus intussusception
Menetier disease histo?riSK ASSOC?
Enlarged rugal folds - hyperplasia of MUCOUS cells - hypersecretion of mucus - causes protein loss!! (PROTEIN LOSING AASTROENTEROPATHY - FROM inc MUCUS (PROTEIN IS NOT BROKEN DOWN? )THis is PRECANCEROUS! aLSO MAY SEE PARIETAL CELL ATROPHY.
How is ADH release regulated?
Based off of sensing of INC plasma osolarity/DEC extracellular fluid volume - sensed by hypothalaus
Histo description of alcoholic hepatitis? gross and microscopic? labs?
Swollen and necrotic hepatocytes, N! infilttrate, Mallory (hyaline eosinophilic) bodies, fatty change, Fibrosis around central vein. AST>ALT over 1.5
Heart sound w/ mitral regurg? Other than just the murmur?
May can Wide splitting of S2 as the aortic valve closes early (Due to blood leaving in a different direction). Of course also a systolic murmur
Berger disease
Mesangial prolif, w Immune complex deposits - IgA! based IC deposits in mesangium - seen w/ henoch schonlein purpura = may flare w/ URI or acute gastroenteritis.Episodic hematuria! w/ RBC casts.DO not confused w/ BUERGERS (smokers vasculitis .. is U! (ew))
Molecular problem w/ familiarl hypercholesterolemia?
AD - defective absent LDL receptor - cannot undergo apopoprotein B100 endocytosis (LDL) - CLATHRIN MEDIATED
Tx Crohns? Tx UC?
Crohns - Steroids, Azathioprine, MTX
Mallory Weiss vs Boerhaave?
Mallry - MUCOSAL linear tear from vomiting.Boerhaave - complete rupture (more than just mucosa) - - may show crepitus.
Where does foregut celiac supply end?
Includes stomach , first, and SECOND part of duodenum.
What are mallory bodies?
IntraCYTOPLASMIC eosinophilic inclusions - twisted PINK ROPES -(KERATIN) - Most common in ALCOHOLIC HEPATITIS - can be seen in alcoholic cirrhosis and wilsonsAlcoholic hepatitis has NEUTROPHILIC infiltrate s(and swollen/necrotitc hepatocytes) - tx w/ [prednisone
Primary biliary cirrhosisPrimary sclerosing cholangitisWho gets what, what are the problems, what are the histo, what are the lab findings, serologic findings, associations
Biliary cirrhosis - women - autoimmune - lymphoyitc infiltrates + granulomas. INTRALOBULAR destrcution. INFLAM conditino. Anti-mitochondrial Ab (IgM too), CREST, Sjogrens, RA, CeliacSclerosing cholangitis - MEN - olino skinning w/ beading - intra AND extrahepatic!! Fibrosis. Hypergammaglobulinemia (IgM!!) Ulcerative colitits, cholangiocarcinoma, P-ANCALabs - both have INC CB, INC cholesterol, INC ALP
Waht drains to thegastroepiploicinternal iliacsubpyloric nodes?
gastroepiploic - greater curvature of the stomachinternal iliac - bladder, male internal genitaliasubpyloric - distal stomach, pancreas, duodenum
Reflex - walk through the entire part from the tap.
Tap - stretches muscle.Spindle afferents detect tension in intrafusal fibers.Spindle afferents synapse w/ alpha motor neurons that innervate muscle.Initiates contraction.
WHAT IS THE FIRST!! STEP IN ATHEROSCLOERTIC DISEASE?!
Endothelial cell dysfunction or INJURY!Then you have monocytes etc.
in anemia, what happens to the size of the blood vessels?
Dilate in order to accomodate hypoxia. Anemia over time may lead to high output cardiac failure - blood trying to pump more (EF=65%) to provide more oxygenated blood to peripheral tissue
What is Werdnig Hoffmann due to? Inheritance?
due to abnormality in gene that TURNS OFF perinatal programmed cell death -> neuronal cell death keeps happening postnatally. - Disease of anterior horns. AR inheritance
How is prolactinoma gottedn to surgically through?
sphenoid sinus
PPARa vs PPARgamma
PPARa - FIBRATESPPARg - GLITAZONW?RZD
how do Cr and PAH compare to actual measures?
Cr - overestimates GFR due to SECRETIOnPAH - underestimages RPF - due to imperfect secretion
Nasal mucosa artery supply?
sphenopalatine artery from maxillary -> external carotid
What is a NSTEMI?
nonST elevated MI - aka UNSTABLE ANGINA - due to thrombiss w/ or w/o underlying atherosclerosis
DOC for klebsiellaPseudomonas?
Klebsiella - 3rd gen cephalosporins ( cefotaxime, cefriaxone, ceftazidimePseudomonas - AG + extended penicillin (aka 3rd cen cephalosporin/other things)
Causes of acute or chronic gastritis (what are the types)
Acute - NSAIDS, uremia, alcohol, othersChronicType A : autoimmune (parietal etc)Type B - H pylori related.
What are the findings in chronic gastritis w/ PENTAGASTRIN administration?
Chronic gastritis - does not produce as much acid due to chronic inflammationThis means that pentagastrin would lead to DEC gastric acid secretion as compared to normal.
When doy ou see nutmeg liver?
Chronic CHF. NOT acute right sided heart failure
What cause central scotomas? Location as well as disease
Destruction of Macula. (can be from ethambutol- optic neuropathy, color changes) - Also macular degen and MS.
Pressure findings and changes in coarctation?
INC pressure in aorta, LV hypertrophy.
Tumor marker in small cell lung CA? Where else can you see erb2?
L-mycerb2 - CA of breast, ovary, stomach
Pathway of CN3?
From interpeduncular fossa of midbrain -> passes between PCA and Superior cerebellar artery .
\Hives are what type of hypersensitivty rx?
T1!!n - anaphylaxis, allergy, atopic, (IgE ab to mast cell)T2 is ab mediated (autoimmune hemolytic anemia, pernicious anemia, idiopathic thrombocytopenic purpura, rheumatic fever, goodpastures, bullous pemphigoid, pemphigus vulgaris
TransformationConjugationTransposition Transduction
Transformation - taking up DNA from envt (“competence”Conjugation - f plasma sex piliTransposition - jumping w/ plasmids/transfersTransduction - viral lytic phage-generalized - packaging event-specialized - excision
Russell bodies?
Seen in Multiple myeloma (plasma cell)
What is important in clearing the following:NeisseriaChamydiaWhich is more comon?
Neisseria - ComplementChlamydia - TH1 (intracellular)CHLAMYDIA IS MORE COMMON. tHIS IS WHY YOU ALWAYS TREAT CLAMYDIA (when someone has gonorrhea)
Seminomas in male? Tumor marker? histo appearance.
PLAP (placental alkaline phosphatase) - w/ large neoplastic cells w/ consipicuous nuclei/nucleoli and clear cytoplasm mixed w/ lymphocytes
What to use in gallbladder surgery (cholecystectomy) prophylaxis?
wnat to broad spectrum GN anaerobes and some GP.so 3rd gen cephalosporin (cefotaxinme, ceftriaxone)
Genotype of complete vs partial mole?CA risk?
Complete - 46 XX or XY - no ovum, 1 egg that doubles or XY = 2 sperms. 2% riskIncompelte mole - 69 XXY - .2% risk
Who can fluorequinolone treat? Who can it not treat?
GN rods - GI GU (including pseudomonas, neisseria, some GP) - NOT effective for anaerobes! Clindamycin should be used for anaerobes - or metronidazle
Which bugs have phage packaged lysogenic toxins?
ShigABotulinumCholeraDiptheraiErythrogenic toxin of Strep Pyogenes
What has the fastest diffusion through membranes? why?
Carbon dioxide, then oxygen, then others tuff.CO2 has higher solubility = diffuses faster
Where does HIV hide out in the asymptomatic phase immediately after encounter?
Follicular dendritic cells - in the germinal centers of lymph nodes. - important reservoirs for HIV.
What enzmye is ramped up in anaerobic metabolism?
Rate limititing step is PFK-1 for glycolysis.
Assoc of epispadia? hypospadia?
epispadia - bladder extrophyhypospadia - UTI
Tox ofCyclosporinTacrolimusSirolimus
Cyclosporin - neprhotox, hirsutism, gingival hyperplkasia, DMTacrolimus - nephrotox, DM, neural tube - Fecal excretionSirolimus - NO NEPRHOTOX - hyperlipidemia, pancytopenia
Two most common social phobias?
public speaking and restroom performance (shy bladder)This is not a specific phobia - because it is the presecen of others, not the act of speaking or the act of peeing that is “scary”
When do you see alone play? When do you see cooperative play?
Kids can paly in parallel (24-30 months) w/o real interactions.Cooperative play begins around 4 y.o
Two ways to detect chamydia trachomatis?
PCR (main)Pap speam - they are intracytoplasmic vacuoles.
neonate - conjuncivitis, cough, wheezing, eosinophilia, pneumo?
chlamydia (staccato cough)
How does the profile of secretion of hCG compare to hCS (somatomammotropin?) who secretes?
hCG - drops off after 10 weeks (first trimester)ish- keeps corpus luteum alive.hCS - INC throghout pregnancy - related to hormones from anterior pit (proalctin, GH)
Klinefelters hormone profile
INC FSH, LH.Impaired seminiferous and leydigDEC inhibit (INC FSH), DEC testosterone (INC LH), INC estrogen
Hpow to calculate confidence interval?
Mean +2 (SD/square of N)
hardy weinberg - how to calculate carrier risk of AR disease?
2pqP is basically 1so it’s 2q.Carrier! Not disease holder.
Cowdry inclusions seen in ?
herpes virus (alnog w/ tsank positive smear)
What is the relationship between Water under the bridge?
Water (ureterS)under the bridge (uterine artery, vas deferens)
Hypercalcemia causes?Hypocalcemia causes?
Hypercalcemia - Constipation (inability to contract)Hypocalcemia - Contracts (Chvostek’s sign)
Cancer markers inSmall cellSquamousAdenoBronchial Carcinoid
Small Cell - L-myc - neuroendocrine kulchitsky cellsSquamous - (hypercalcemia, cavitation) - keratin/bridgesAdeno - k-RAS, EGFR, ALK. Carcinoid - Neuroendocrine, ChromograninA+
Which brain hernia cause a blow ispi pupil CN3? And inpsilateral paralysis.
Uncal herniation.
Tophus - what and where?
Gout - Outer ear, forearm, elbows, knees, hands/feet,
Neuroblastoma - assoc? lab findings?
Firm irregular mass! that can corss the midline (BLASTS AROUND!) - w/ BOMBesin). Homovanillic acid INC.N-myc related. Opsoclonus myoclonus -
Where do you see Bombesin+
Neuroblastoma, Small cell ung CA, Gastric CA.
Relationship between Sensitivity, PPV and NPV?
Sensitivity is INVERSELY related to PPV,Sensitivity is proportional to NPV.
Arthroconida?Morulae?Sporangiospores?
Arthroconida - CoccidiodesMorulae - EhrlichiaSporangiospore - Fungi - mucor, rhinomyocis,s absidiomycosis, zygomycosis.
What Ulcerative colitis/Crohns drug has oligospermia and skin rx side effect?
Sulfasalazine - produg - metabolized by intestinal bacteria.Can tx Rheumatoid arthritis as well.
Relationship between PaCO2 and Alveolar ventilation (VA)
Inverely proportional.If alveolar Ventilation INC 4 fold, then PaCO2 is divided by 4.
If a pacemaker lead is dislodged, which coronary arteries does it damage?
if the lead perforates the cornoary sinus, may damage the CIRUCMFLEX artery
Signs of hypothyroidism besides cold and fatigued?
dry yellow skin (T4 related to converstion of carotene to VitA) - - INC carotene -> yellowsih skinBradycardiaHypoglycemia (low T4 DEC hepatic gluconeogenesis)Hypothyroidism DEC Hepattic LDL receptors -> HYPERCHOLESTEROLEMAI.
What to give pt w/ BPH and Parkinsons?
NOT benztropine - benztropine is antimuscarininc and cause cause further urinary retention - give them other stuff like bromocriptine.
CHild w/ mononucleosis like presentation that is monospot negative. What next?
EBV titer.Monospot is 90% + for adult cases, but false negatives can ccur in kids.Also, Monospot = heterophile. But do virus titers instead.
What are glucagon levels like in DM1?>
Actually INC.So you have hyperglyemic state, but since there is no insulin release (and thus no inhibitory response on alpha cells), you have GLUCAGON release! Would also have INC somatostatin as well as insulin also inhibits somatostatin.
What is agoraphobia?
Fear of situations in which easy space is not possible. Different from social phobia.
Buprenorphine mech of action? Use?
Meth, Methadone - long acting agonistNaloxone/Buprenorphine - partial agonistNaltrexone - long acting antagonist.
Treatment for Wolf Parkinson Wite?
DO NOT BLOCK AV NODE - If you block AV node, it will send signals through accessory path making it WORSE - Therefore try to block transmissino through abnormal pathways.Procainamide (Class1A drugs can do this) or Amiodarone.
Diabetic patient w/ orthostatic hypotensino, and nausea, postprandial fullness, constipation, recurrent diarrhea Tx?
Diabetic AUTONOMIC NEUROPATHY - Loss of autonomic innervation of lbood vessels leads to orthostatic hypotension.Tx w/ metoclopramide (dopaminergic blocker - facilitates gastric emptying, anti-emetic, tx nausea.tx Gastroparesis - symptomatic chronic - dleayed gastric emptyin gin ABSENCE of mechanical obsturction.PROKINETIC agent - metoclopramide. Also second line for GERD.
Most common side effect of metronidazole. Others?
GI distress. Also disulfiram, convulsions, insomnia, peripheral neuropathy, thrombophlebitis.
Smoker, drinker, bad hygiene - classic for?
Squamous cell CA of head and neck - vocal cords cna cause hoarseness. Present as white plaque lesions.
Band keratopathy a sing of?
hypercalcemic state. Hypercalcemia can also causelethary, depression, HTN!! SHORTENED qt INTERVAL.PEPTIC ULCERS, CONSTIPATION, PANCREATITIS.
Formula for mean arterial pressure?
MAP = CO x PVR
What is bumetanide?What is trimethaphan?
Bumetanide - More potent loop diuiretic (than furosemide) Trimephaphan - ganglionic blocker. BLocks ACh at nicotinic receptors. blocks uatonomic, sympathetic and parasympathetic. no depol, competitive antagonist. short acting.
If you penetrate through manubrium, what are you most likely to hit?
Brachiocephalic. vein
Signs of hypokalemia?
T wave inversions w/ U waves.
Decompensated CHF - how can you have edema but still be in prerenal azotemia (aka INC cr and Low excretion of Sodium?
Even though you have fluid overload, you are intravascularly dehydrated -> prerenal -> Kidney tries to resorb sodium. BAD - DECOMPENSATED.
ITP. Splenectomy. 4th moths after, thrombocytopenia recurs. Due to?
accessory spleen.Usual reason therapetuci splenectomy (and in some hemolytic anemia) doesnt always work.
TophusOsteophytesPannus
Tophus - goutOsteophyte - OsteoarthritisPannus - Rheumatoid Arthritis
Markers of NK cells?How can you have Ab bind without triggering crosslinking or agglutination?
CD16, 56Tx w/ PAPAIN - papain yields 2 monovalent Fab fragments and destroys Fc portion
Most common cause of preeclampsia (def)
preeclampsia - HTn w/ proteinuria, edemaMost commonly from hydatidiform mole (hCG over 100,000), may have hyperthyroid signs by crossrx
embryo derivatives of thyroid follicular?thyroid medullary/Calcitonin/parafollicular??
Thyroid follicular from ENDODERM of foramen cecum.Thyroid medullary from ULTIMOBRACHIAL BODY. Cacitonin producing cells (C cells) are in the parafollicular space. Medullarly CA is CA of the parafollicular C cells.
What is hidradenitis suppuravtive?
Blocking of apocrine sweat glands -0> obstruction and RUPTURE of ducts -0 often due to staph A.Tx - incision and drainage. Tend to recur and persist for decades.Often AXILLARY INVOLVEMENT - which is unusual for acne and carbuncles(which is face neck, back, upper chest)This can also occur at the perineum and inguinal folds. involves apocrine and sebacoeus glands.
Furuncle vs carbuncle?
Furuncle - single boilCarbuncle - multiple fused furuncles.
7-dehydrocholesterol - what is this?
precursos ro vit D - synth in skin when UV interacts. Levels are NOT dependent on PTH
AAAL
AA - chronic inflam (RA, TB, osteomyelitis, heroin use) -> Secondary amyloidosis. (from sAA, which is produced by liver). SAA are apoliporoteins secreted during acute phase of inflam. AL - primary amyoidosis (MM, Waldestrom, nonHodkin lymphoma)
When do you have INC HbA2?
Beta thalassemia (HbA2 is Alpha and delta)NOT Alpha thal (HbA2 is normal or slightly decreased due to improper Alpha chain)
Tx for rheumatic fever/GAS?
penicillinRF give penicillin and salycilates.
Diagnostic serum findings post MI? Time scale?
Troponin rises first ~4 hours - stays elevated.CKMB - rises at ~8-24 hoursAST - nonspecific
What does compensated HF mean?
Cardiac Output is NORMAL.BUT, INC preload (end diastolic volume) in part due to retntion of salt/water. COntractility is DEC. Compensated HF is on the lower curve.
DOC for endometriosis?
GnRH agonists - reduces gonadal steroids and enodmetrial growth.
What layers has to be pierced to get lfuid accumulation in costodiaphragmatic recess?
Parietal pleura - contains costal pluera and diaphgragmatic pleura
2 major ways to detect trinucleotide repeats (like fragile X)Prader Willi?Duchenes?
PCR or souther blot (DNA) PW - FISH - detects chromosomal abnormalities, translocation, ivnersions well. Duchenes MD can have diff mutations in large dystrophin gene - use multiple amplified probe hydrbidizatipon -sort of like qPCR.
What can old expired tetracyclines or aminoglycosides (new), cisplatin, 6MP, valproic acid, tenofovir use cause?
Wfanconin syndrome - failure to reabsorb anything in PCT including HCO3 (excretion - acidosis)
What does dyspnea, pulmonary edema suggest (cardio wise?)
Left heart failure,not right heart! right heart = jvp and HM.
Small cell lung CAvis Carcinoid histo?
Both are neuroendocrine!Small cell - Kulchitsky - small dark blue cells . ACth, ADh, Lambert EATON. L-myc! Carcinoid - “nests” of neuroendocrine, chromogranin A+ (polyp like mass in bronchus)
Where does Hpylori reside? IN which layers of stomach?
Antral stomach In MUCUS layers on surface of MUCOSA and within lumina of gastric glands. “eat holes in the mucus”H pylori do NOT invade mucosa
Which two diuretics are SYNERGICIST (meaning together they do more then both of them combined separately?Synergistic! NOT additive.
Synergistic - loop and thiazide
What is IGFBP3?
Insulinlieke growth factor binding protein 3. Liver secretes IGF1 and IGFBP3 in parallel in repsonse to GH.GH is pulsatile, so 24 hours measurements required.IGF1/IGFBP3 are easier to measure - and are analogous in clinical findings.
leading cuase of death in black men 25-34 y.o?
Accidents.15-24 is homicide.
DOC for raynauds?What is contraindicated?
Caqlcium channel blcokers - nifedipine and nicardipine.Ergot alkaloids - dihydroergotamine - contraindicated because they can cause intense vasoconstriction. These can be used to tx migrains tho.
Which diabetic drug amy exacerbate CHF by causing Edema?
Glitazones.
Hallmark of Menieres disease?
Menieries - tinnitus and fullness in ear. + vertigo, hearing loss, .Endolymphatic hydrops - too much fluid/rpessure -> nerve damage. Can damage CN8 -> tinnitius and hearing lo0ss and vertigo.Migraines, TIA, Herpes encepahlitis can cause vertigo BUT NOT tinnitus.Menieres symptoms can be recreated by having pt hyperextend neck and turn head from side to side.Can lead to permanent hearing loss - esp. transiet LOW FREQUENCY -> permanent.
Pt is resistant to lifestyle/.dietary changes. What to do next?
Give small stepwise changes - “shaping” Rather than large changes.
What nerve can be damaged in posterior dislocation?What also passes through the same foramen as the aforementioned nerve?
Sciatic nerve.Also can get it during pregnancy. Superior gluteal nerve also exists greater sicatic foramen w/ sciatic nerve. However, not likley comrpessed w/ hip dislocation.
Secretin? What does it do in normal pt?What does it do in Zollinger Ellison?
Secretin - inbhitis gastrin release froma ntrum normally.Secretin STIMULATES gastrin secretion from gastrinoma (ZE)
Preesntation difference between stone in common bile duct vs cystic duct?:
Common bile duct - would get jaunidceCystic duct - would not necessarily get jaundice.But can have AST, ALT slight elevations. Both have pain radiating to shoulder. Basically common bile duct affects LIVER more.
Which of the local anesthetics can cause allergy?
Ester type - aka ONE i. - due to being PABA derivatives.
What are side effects of thiazides?
Normal: hyponatremai, hypercalcemia, hyperuircemia.ALSOHyperglycemia, hyperlipidemia. + sulfa allergy
Di George immunoglobulin lelvels6 months gestation. after 6 months?
6 months - normal - due to getting moms IgG (placental transfer) and IgA (breastmilk -> can go on longer 10 days to 7.5 months)After 6 months, predominanntly IgM.
Tx options for prostatic adenoCA?Which is the only one to cause initial “flare” that gets worse then better.
Flutamide - tx prostate CA - androgen receptor antagonistLeuprolide (GnRH analog) - this has flare - initially gets worse - then gets better as it becomes inhibitorry. not commonly used for postate CA as the above 2 are better -Finasteride (5a reductase inhibitor)Stilll have hestosterone. More used for tx of male pattern baldness.
Which part of hypoglycemia would not be masked by beta blocker?
sweating - sympathetic - but ACh and Muscarining (not adrenergic receptor)Gluconeogenesis, glycognenolysis, palipitations and tremors are all masked (or exacerbated)
What HLAs has a relation to Goodpastures? Which is the strongest?
Goodpastures - HLA -DRB1 (and 2) are strongest)DR4 comes in after.
Most common thyroid CA?
Papillary 80-%Follicluar 10%Rest
Cause of tinea pedis? Be specificTInea capitis?
Pedis - mentagrophytes (metaphalanges!) mneumoniccapitis - tonsurans, violaceum
What is alginate? What bacteira hs it? This bacteria also has GLYCOCLAYX!
Alginate is exopolysach capsule - inhibits ciliary clearance, allows adhesion of bactera to each other - prevents phagocytosis - High level of Ab to alginate in pt who have CF. ->glycocalyx causes bacterial slime layer on culture.
What is hypersensitivity (gold allergy, poison ivy, hair dy,e, contact hypersenetivity a few days later caused by)
HSR4 - TH1 and M! TH1 sensitized to hapten carrier complex - mediated by IFNgamma, IL2,
What is the major cause of death in post-heart transplantation - what is seen on histo?
Concentric intimal thickening - most significant limituing factor to long term success of heart tx - seen w/in first year -> leads to progressive occlusion of Cornoary arteries -> MI. Form of chronic rejection.
What vertebral level is the renal vein located?
L1 L2 Celiac -T12, Hepatic portain vein/pancreas - T12/L1. Horizontal duodenum - L3 vertebra.
Which polyp disease gives you higehr risk of CA elsewhere (ovarian, endometrial etc) What cell cycle phase is this a problem?
HNPCCG2 problem!Synthesis and endonucleases is in S2 but mismatch proofreading errors are in G2.
What is Low Vit D, INC PT time, INC conjugated bili, and Hypercholesterolemia due to?
Extrahepatic cholestatis.Can get bile out - cant absorb vit D, K (hypocoagulable). since cant get out bile and bile is backed up, bile synth turned off, choelsterol conc INC, and also DEC expression of heaptic LDL receptors.
Abnormal behavior, fever, pain for more than 2 years in FARMER
Brucella - chronic - can last for a looong time. assoc w/ cattle. Undulating fever. From unpsteurized dairy.
Recurrent branch of median nerve innervates what?What would defect have?
Inneravtes thenar eminance - opposition Recurrent does not have cutaneous sensation - just muscle
DOC for immediate tx for anaphylactic shock?
epneprhineCortisol, and other stuff used later. or in conjunction.Epi tx the hyptension that is life threatening
Most likley long term cause of chronic ureteral reflux?
CHF and secondary HTN.Not UTI and abnemia. BECAUSE MOST REFLEX SPONTANEOUSLY RESOLVE - so give ab therapy to prevent UTi until reflux subsides.
Dermatomyositis targets what type of muscles? wehre woudl this effect the esophagus?
Targets striated muscles - upper 3rd of esophagus
Which of the IBD causes fistulas?
Crohns - needs fissues and total wall inflam.UC does not do this - does nto cause fissues or fistulas.
2 Noncurare (tubocurarine) nodepol of Nicotinic receptor?
TrimethaphanHexamethonium Stops autonomic and muscular
Composition of histo findings in AlzheimersPicks?
Alzhemiemrs - B-amyloid (amyloid A4)Picks - alpha -synuclean
What gene does HFR conguation begin and end on?
Begins on oriT, ends on Tra if possible.
Blood supply of body/tail of pancreas and head of pancreas?
Body/tail - spenic artery branchesHead - superior and inferior pancreaticoduodenal branches of GDA and SMA.
Most common site of rupture post MI?
Anterior wall of LV - most commote site of rupture post MI.Prob because this ist he site of MI - necrosis -> weakened wall -> rupture. Occurs during first week, when tehre is necrosis and softening, but no fibroblastic scar yet.
When do CK-MB levels return to normal?
By 6 days.Troponin returns around 7 to 10 days later to normal.
What would an month or so spontaneously aborted fetus/placenta have
Villous structure containing nucleated eryhtrocytesVillous = chorion. Nucleated erythrocytes are produced by developing fetus.
Mexico - watery diarrhea. What is this?
E Coli.ETEC - Heat Lable (AMP)Stable (GMP)
What pt is sumatriptin contraindicated in?
prinzmental or coronary artery disease - would cause constriction.That is how it tx migranes (via constriction)
Tx for PV? Early and alte
Early - serial phlebotomy and sapiring.Hydroxyurea later if needed.
CLeaning agent for naked virus?
NOT ETOHfor example norwalk virus - clea w/ bleach (soidum HYPOCHLORITE.
Treatment for end stage reanl hyperparthyroidism?
Hyperparathyroidism in this case is due to inability to excrete P. The INC P binds to Ca and DEC Ca.So you need to give Cinacalcet - which INC sensitivty of parathyroid Calcium sensing receptors. This would reduce PTH, so you dont have all this lytic bone crap while actually having high levels of Ca which are masked by high levels of P/.
General profile wise, how do epi and norepi differ?
Epi is B>ANorEpi is a>B2 This is why you would give Epi in anaphylactic.And Norepi to maintain bblood pressure.An dobutamine for heart failure shock etc B>1>B2>a
What cells kill Malaria cells?
Not T cytotoxic.RBC do NOT have MHC1. Which is need for Cytotoxic T.So it is NK cells that kill RBC.
Pertussus - what is the mech of toxin - how does it present?
ADP riboslyates Gi - inbhitis inhibitor - INC cAMPLymphocytosis promotionBlocks immune cellsINC histamine sensitivity! (coughs)HYPOGLYCEMIA
Face motor knock out - where is the lesion in lower face, total face?
Lower face only CONTRALATERAL upper motorEntire face - ipsilateral lower M
Types of GLUTAMATE RECEPTORS?
Both ligand gate and voltage gated.predominantely Ligand Gated (NMDA) - which is actually both. W/ sufficient depot - MG plug is released.
Where is C4 complement needed?
For CLASSICl PATHWAY - INVOLVES c1 c4, c2 FOR SPLITTING OF C3. Once you are past splitting of C3, C4 not needed.
Kernicterus in baby can be due to which 2 antibiotics in mom?
CHloramphemical - grey baby.TMP-SMX - kernicterus
