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HIV gp120
attaches to CD4+ T cells
HIV gp40
fusion and entry
HIV pol
reverse transcriptase, aspartate protease, integrase
HIV gag (p24)
capsid protein
specificity
how many people without the disease test (-)
negative predictive value
how many of the (-) results are true (-)?
Rovsing sign indicates?
appendicitis (pressure in LLQ with quick release induces pain in the RLQ)
Projection
A man who wants to cheat on his wife is convinced his wife is cheating on him
Displacement
Mom yells and me, then I yell at Baxter
Transferance
father who was never there for his son, now the son is in therapy but when the therapist unexpectedly cancels the son says “you obviously can not make me a priority”
Kimmelstein Wilson nodules
diabetic nephropathy
schizophrenia
schizophreniform
schizophrenia: >6 months
schizophreniform: 1-6mo
brief psychotic disorder
<1 mo of schizo-like stuff
schizoaffective
> or = 2 weeks of stable mood with psychotic symptoms & also history of manic or depressive episodes
somatization disorder
need at least: 4pain complaints, 2 GI, 1 sexual, 1 neuro (8 total)
symptoms are not explained by medical work up
pt usually <30
exacerbated by anxiety/depression/relationship prob
factitious disorder
person totally faking it
hypochondriasm
preoccupation/fear of disease
> or = 6 months of this
person uses excessive remedies
believes their disease to be real
nephrotic
proteinuria (>3.5g/day) hypoalbumnemia (pitting edema) hypogammaglobulinemia hypercoaguable hyperlipidemia/hypercholesterolemia
nephritic
limited proteinuria (<3.5g/day) oliguria (not peeing a lot) azotemia (^ nitrogenous waste in the blood) salt retention periorbital edema HTN RBC casts and dysmorphic RBC in urine
SLE and nephritic
Diffuse Proliferative Glomerulonephritis
most often
SLE and nephrotic
Membranous Glomerulonephritis
t(9;22)
CML
philadelphia chromosome
Bcr-Abl hybrid formation; tyrosine kinase always on
tx: imatinib
t(8;14)
burkitt lymphoma cmyc activation (increased proliferation)
t(11;14)
Mantle Cell lymphoma
cyclin D activation (G1 –> S phase)
t(14;18)
Follicular cell lymphoma (aka Nonhodgkins) Bcl2 activation (no apoptosis, usually apoptosis is super active in the thyroid)
accurate
hit the bullseye (dead center) each time
precision
hit off center, but in the same location every time
t(11;22)
Ewing Sarcoma
Ashkenazi Jew (2)
Tay sachs (most commonly) Gauchers
Argyl Robertson pupil
syph
pupil constricts to accomidate but isnt reactive to light
Meig’s syndrome
triad: 1. ovarian fibroma
2. ascites
3. pleural effusion
high pitched, blowing diastolic murmur
Aortic Regurgitation
(head bobbing, wide pulse pressures
low, rumbling, diastolic murmur
Mitral Stenosis
radiates to carotids, pulsus parvus et tardus
Aortic Stenosis (systolic murmur)
post herpatic neuralgia
tx: amylitriptiline (this is a TCA)
famcyclovir can only be given early in shingles outbreak
phenylalanine –> tyrosine –> dopa –> xx –> xx -> xx
…dopa –> dopamine –> norepi –> epi
the 2 diastolic murmurs
Aortic regurg
mitral stenosis
Conversion disorder
sudden loss of sensory or motor function following an acute stressor
most often adolescent females
SNRIs
venlafaxine, duloxetine
case control study magic word
likelihood/likely
cohort study magic word
risk
cross-sectional study magic word
prevalence (this is the “snapshot” one)
leading cause of death in ppl >65
heart disease
leading cause of death in ppl 45-65
neoplasms
girl with unrelenting bleeding with menarche, only bleeding time is prolonged, normal blood count
vWF deficiency! “platelet adhesion deficiency”
(PTT may be slightly elevated)
tx: DESMOPRESSIN!!!! (cioc cards)
is it Autosomal Recessive?
Kartageners, Cystic Fibrosis, Crigler Najjar
is it Autosomal Dominant?
Achondroplasia’s Familial PKD met Marfans Tuberous Neurofibromatosis at MEN for hereditary huntingtons autosomal dominant von hippel landau
is it Xlinked Recessive?
Wiscott, Fabry, Lesch & Duchenne met a British Ornathine Hunter with occular Albanism& hemophilia at G6PD recessive x-ing
Beckwith Weidemann syndrome
WAGR wilms tumor (mesodermal origin) aniridia (no iris) GU malformation mental retardation
Combank also mentions: organomegaly, macroglossia, hypoglycemia (insulin resistance)
B1
thiamine (think alcoholics, mamillary body degeneration)
B2
riboflavin
B3
niacin
defic - pellegra (the 3 D’s: diarrhea, dementia, dermatitis)
B6
pyridoxine
B7
biotin (too much egg nog = defic)
B9
folic acid
B12
cobalamin
vitamins mnemonic
The rhythm nearly proved fatal
B1 B2 B3 B6 B9
Tamsulosin
BPH – relaxes smooth m
antagonist of alpha1 A/D Receptors
Terbutaline
keep baby in there
B2 AGonist- relaxes uterus
Teichoic acid?
LPS?
techoic acid – gram +
LPS - gram -
increasing the threshold for a positive screening test (ie 120–> 130) will do what?
increase SPECIFICITY bc it decreases the number of fasle positives
pure sensory stroke?
ventral posterolateral thalamus
is it an exudate?
yes to at least 1:
ratio of pleural effusion protein: serum protein >0.5
ratio of pleural effusion LDH : serum LDH >0.6
pleural effusion LDH > upper 2/3 limit of normal serum LDH
causes of transudate? (3)
CHF
Cirrhosis
nephrotic syndrome
causes of exudate (4)
infection
PE
malignancy
collagen vascular disease
dorsal columns?
posterior columns
do vibe/discriminate touch/proprioception
pertussis toxin
inhibits Gi; get increased intracellular cAMP
cholera toxin
AB toxin
stimulates Gs (Ribosylates it)
adenylate cyclase on – ^cAMP
shiga toxin/ shiga-like toxin (EHEC)
inactivates 60S ribosome, decreasing host cell protein synthesis
M protein
Strep pyogenes virulence (does cellulitis, strep throat, just not scarlet fever)
Protein A
Staph aureus
binds Fc portion of IgG
Streptococcal pyogenic exotoxin
Strep pyogenese virulence for scarlet fever
leucovorin
folic acid analog
spiking fevers, hepatosplenomegaly, pancytopenia
Visceral Leishmaniasis (organism: Leishmania donovani)
Fever, headache, anemia, splenomegaly
Malaria
Fever and hemolytic anemia
Babesiosis
positive leukocyte esterase test
bacterial UTI
Positive Nitrite test
gram negative Bacterial UTI
Hepatosplenomegaly, jaundice, thrombocytopenia, and growth retardation
nonspecific signs of ToRCHeS infections
chromogranin positive
carcinoid tumor of the lung
most common tumor in male smokers
squamous cell carcinoma (produces PTHrP)
Kulchitsky cells
small cell carcinoma
too much aldosterone
Conns syndrome
too much copper
wilsons
tx: penacillamine
too much iron
hemochromotosis (root: heme)
eyes look toward lesion
Lesion in frontal eye fields
Eyes look away from side of lesion
lesion in paramedian pontine reticular formation
Nate’s old roommate was described as having Kluver-Bucy Syndrome where in the brain is the lesion? and was is the association?
Lesion in Amygdala
Association with HSV-1
pt is presenting as hyperorality, hypersexuality, and disinhibited behavior
Arylsulfatase A deficiency
Metachromatic leukodystrophy
Heart failure
Increase in capillary pressure
nephrotic syndrome/liver failure
decrease in plasma proteins
toxins, infections, burns
increase in capillary permeability
lymphatic blockage
increase in interstitial fluid colloid osmotic pressure
The difference between FAP and HNPCC??
FAP= 1000 polyps
HNPCC usually less than 100 polyps or no polyps
sickle cell anemia genetics
Chromosome 11–autosomal recessive
Chediak Higashi Syndrome
Recurrenty pyogenic infections (staph and strep)
partial albinism
Peripheral neuropathy
defect in lysosomal trafficking regulator gene (microtubule dysfunction in phagosome lysosome fusion)
Wiskott-Aldrich Syndrome
Thrombocytopenic purpura
Infections
Eczema
x-linked WASP gene on x chromosome–>Tcells unable to reorganize actin in cytoskeleton
Mental retardation, growth retardation, seizures, fair skin, eczema, musty body odor
Tyrosine is no essential
Phenylketonuria
d/t decrease in phenylalanine hydroxylase or decrease in tetrahydrobiopterin cofactor
Spherocytosis associated with???
Autoimmune hemolytic anemia (which is associated with CLL)
Hereditary spherocytosis
Overdose of Dextromethorphan (an antitussive)
Naloxone can be given for overdose
Polymyostis
symmetric proximal muscle weakness
endomysial inflammation with CD8+ T cells
Dermatomyositis
similar to polymyostis involves malar rash, heliotrope rash, “shawl and face rash”, “mechanic’s hands”
Perimysial inflammation and atrophy with CD4+Tcells
Mallory Bodies
aka eosinophilic hyaline inclusion bodies
Think Alcoholic hepatitis
levels that make up Median nerve
C5-T1
Levels that make up musculocutaneous nerve
C5-C7
levels that make up ulnar nerve
C7-T1
Wright’s test
neurovascular compromise under pectoralis minor muscle at the coracoid process.
Adson’s test
neurovascular bundle by tight scalene muscles
