March 23 Flashcards
Metanephric diverticulum = Ureteric Bud
collecting tubules, ducts, major and minor calyces, renal pelvis, ureters
Metanephric medoserm = Blastema
glomeruli, bowman’s space, proximal tubule, loops of Henle, distal convoluted tubule
increased TGF-beta
keloid scars
Polysachride vs Conjugate vaccine for Hib
Polysaccharide B-cell only no memory cells short immunity not immunogenic in infancy
Conjugate B-cell and T-cell yes memory cells long immunity immunogenic in infancy
most abundant amino acid in collagen
glycine
Glycine - X - Y - Gly - X- Y - Gly
What tissues cannot use ketones for energy
Liver and RBCs
Liver Produces Ketones
Muscle, Kidney, Brain - use Ketones
Heart failure med that prevents/improves ventricular remodeling
Mineralocoricoid receptor antagonists
spironolactone, eplerenone
contrainicated in pts with hyperK and renal failure
Noise induced hearing loss occurs due to damage of?
stereociliated hair cells on the Organ of Corti
high frequency sounds are lost first
Oppositional Defiant Disorder
argues
refuses to follow rules
deliberately annoys others
blames others
no serious violation of societal norms
Conduct Disorder
violates the basic rights of others or societal norms
criminal stuff
grow up to be Antisocial (Sociopath)
ADHD
onset before 12 years old
poor attention
hyperactivity
impulsivity
Internal Hemorrhoids venous drainage
Above pectinate line
middle rectal –> internal iliac
superior rectal –> inferior mesenteric –> liver
painless
External Hemorrhoids venous drainage
Below pectinate line
inferior rectal –> internal pudendal –> internal iliac –> caval system
pain via interior rectal branch of pudendal N.
Most common outcome of HBV infection
complete resolution (>95%)
NNRTI
Efavirenz = efaVIRenz Nevirapine = neVIRapine
allosteric RT inhibitors
NRTI
abacavir
tenofovir
emtricitabine
-VUDINEs
ADR: central fat deposition
PIs
daruNAVIR
ritoNAVIR
-NAVIRs
HEV
unenveloped RNA virus
fulminant hepatitis of pregnant women
fecal oral transmission
Stongyloides stercoralis
Rhabditiform larvae in the stool
infect via feet –> lungs –> GI
tx: ivermectin
Dihydropyridine calcium channel blockers
-dipines (amlodipine, nifedipine)
vasodilate vascular smooth muscle
non-DHPR calcium channel blockers
Verapamil>Diltiazem
reduce HR and contractility at cardiac muscle
Carcinoembryonic Antigen
elevated with pancreatic, gastric, breast, and colon cancers
also IBD, COPD, cirrhosis, pancreatitis, and smokers
used to monitor colorectal cancer (increased = worse prognosis, failure to normalize =persistent disease)
Tetrodotoxin
Fugu = Puffer fish
binds Na+ channels and prevents action potential.
Polymyalgia rheumatica
Pain and stiffness in hips and shoulders + fever, malaise, weight loss (NOT weakness)
associated with Giant Temporal Cell Arteritis
Primary Biliary Cholangitis
chronic autoimmune liver disease
+anti-mitochondrial antibodies
patchy lymphocytic inflammation with granulomatous destruction of intrahepatic bile ducts and necrosis
(similar histopath to graft-vs-host w/ lymphocytes in the liver)
Fat, Forty, Female, Fertile
Type I Muscle Fibers
@ postural skeletal muscle (paraspinal muscles)
slow twitch, red fibers
ATP from oxidative phosphorylation
Type II Muscle Fibers
IIa - fast twitch, aerobic oxidative phosphorylation
IIb - anaerobic glycogenolysis and glycolysis
biceps, deltoid, etc
rapid, forceful movements
Effects of ADH on the Medullary segment of the collecting duct?
increase urea and water reabsorption into the interstitium @ the medulla –> produce maximally concentrated urine
reabsorption of urea –> loop of Henle osmotic gradient!
Stress Ulcer
shock burn - Curling Ulcer sepsis severe trauma intracranial injury - Cushing Ulcer
Cushing ulcers due to vagus nerve stimulation from increased ICP –> increased ACh release –> hypersecretion of gastric acid
MLF Lesion
Dorsal Pons
Internuclear Ophthalmoplegia
ipsilateral eye unable to adduct
contralateral abducts with nystagmus
convergence and pupillary light reflex preserved
Mycobacterium leprae
tuberculoid = mild lepromatous = severe
tuberculoid –> strong TH1 response (IL-2, IFN-gamma, IL-12) –> macrophage response –> bacterial killing but also hypopigmented well demarcated plaques
Lepromatous –> TH2 (IL-4, IL-5, IL-10) –> more numerous and poorly demarcated lesions
positive lepromin skin test = Tuberculoid
When is beta-hCG first detectable in the serum?
8 days after fertilization
produced by syncytiotrophoblast
I-cell Disease
Inclusion cell Disease - Autosomal Reessive lysosomal storage disorder
defection phosphotransferase enzyme –> extracellular secretion of proteins that should be sent to lysosome and inclusion bodies = lysosomes full of cellular debris that can’t be broken down
due to inability of the cell to target proteins to the lysosome - deficient phosphorylation of mannose residues on glycoproteins in the Golgi
Essentail Fructosuria
Benign Fructokinase deficiency
hexokinase takes over the role of fructose metabolism and converts fructose –> fructose-6-phosphate
normally Fructose –> Fructose-1-phosphate via Fructokinase
fructose-1-phosphate then metabolized by Aldolase B
Second Generation Antipsychotics
Clozapine, Olanzapine -zapines
ADRS: weight gain, dyslipidemia, hyperglycemia, increased risk of DM
routine monitoring of: weight, waist circumference, BP, fasting glucose, lipid profile
monitor bone marrow clozely with clozapine
tx: Schizophrenia (also bipolar, OCD, anxiety)
Hyperacusis
increased sensitivity to sound
damage to Stapedius Nerve (branch of Facial Nerve CN VII) –> paralysis of the stapedius –> increased sensitivity to noise
Achilles reflex
S1
Pancreatic Beta Cell Function
Glucose –> GLUT2 channel –> TCA cycle –> increased ATP –> ATP binds K+ channel causing it to close –> depolarization –> calcium influx –> insulin release
K+ channles on beta cell regulated by ATP (which is produced from blood glucose)
T-test
T for 2
ANOVA
Analysis of Variance (3 words, 3 or more groups)
Theophylline
bronchodilator
PDEi –> increased cAMP –> bronchodilation
OD: seizures and tachyarrhythmias
Bacillus anthracis
only bacterium with polypeptide capsule - D-glutamate
no dorsal column involvement
ALS
anterior horn and lateral corticospinal tracts
Schwannoma
S-100 + (neural crest cell origin)
Bupropion
does not cause sexual side effects
does cause seizures in eating disorders and preexisting seizure conditions
MAOi
Tranylcypromine, Phenelzine, Selegiline, Isocarboxazid
for atypical depression
OD tx is phentolamine (after too much wine and cheese night)
Hyperplastic arteriolosclerosis
due to persistant diastolic BP > 120-130
onion-like concentric thickening of arteriolar walls
Edwards Syndrome
Trisomy 18
micrognathia, prominent occiput, low set ears, clenched fists with second and fifth digits on top of third and fourth, rocker-bottom feet
Capitation
pay a fixed amount for all medical services
underlying structure of an HMO
Hyperglycemia induced cataracts
accumulation of sorbitol in the lens –> water influx and osmotic cellular injury
glucose –> sorbitol –> fructose
Osler-Weber-Rendu Syndrome
hereditary hemorrhagic telangiectasia
telangiectasias in the skin, oronasopharynx, respiratory tract, GI, urinary tract
these can rupture and cause bleeding (epistaxis, GI bleeds, hematuria)
basophilic stippling
lead poisoning
Cryptococcus neoformans
budding yeast, round/oval encapsulated cells with narrow-based buds
virulence: thick polysaccharide capsule
meningoencephalitis is HIV+ pts
tx: Amphotericin B + flucytosine
Trichomoniasis
frothy yellow-green vaginal discharge
looks with saline microscopy
tx: metronidazole
Bacterial vaginosis
Gardnerella vaginalis
thin white/gray discharge with fishy odor (with KOH)
clue cells = epithelial cells with gram variable rods
tx: metronidazole or clindamycin
Candida vaginitis
thick “cottage cheese” discharge
pH (3.8 - 4.5)
tx: fluconazole
Cancer Drugs and Cell Cycles S G2 M G1/G0
S - antimetabolites (azathioprine, 6-mercaptopurine, hydroxyurea, 5-FU) block DNA synthesis
G2 - bleomycin
M - microtubule inhibitors (paclitaxel, vinblastine, vincristine)
cell cycle independent - alkylating agents ( cyclophosphamide) platinum agents (cisplatin)
Roseola
HHV6 and HHV7 - enveloped linear dsDNA
high fever +/- febrile seizure –> erythematous maculopapular rash that starts on trunk and spreads to face and arms/legs
kids <2y/o
thin stratum granulosum and prominent parakeratotic stratum corneum
psoriasis
presystolic sound that precedes first heart sound; is best heard at expiration in left lateral decubitus
S4 aka atrial gallop
heard immediately after atrial contraction as blood is forced into a stiff ventricle
Ventricular Hypertrophy
aortic stenosis
Herpes Encephalitis
prefers temporal lobes
D-xylose
monosaccharide that is absorbed directly, no need for pancreatic enzymes
decreased absorption with SIBO (small intestine bacterial overgrowth)
Production of ketones in a fasting person?
stress hormones (cortisol, glucagon, catecholamines) –> increased hormone sensitive lipase activity –> TG conversion to free fatty acids and glycerol –> glycerol uptake in the liver for gluconeogenesis
also
TGs –> Acetyl-CoA via beta-oxidation —> ketone bodies
Aortic Regurg
decrescendo diastolic murmur, high-pitched blowing, best heard white pt sits up and leans forward with breath held at end expiration
selective albuminuria
minimal change disease
First area of the brain to be damaged in global cerebral ischemia
hippocampus
What causes outflow obstruction in HCM
mitral valve leaflet and interventricular septum
don’t give them nitrates, we need to increase preload and prop the door open
Pulmonary vascular bed
hypoxia causes vasoconstriction (this is unique)
divert blood away from underventilated areas towards regions of better vent
