Mixto Flashcards
Menière disease features
-due to increased vol of endolymph in inner ear
-recurrent vertigo
-ear fullness/pain
Unilateral hearing loss/ tinnitus
Labyrinthitis presentation
Acute hearing loss (if not present, vestibular neuritis)
Nausea
Vomiting
Actin binds to which part of the sarcomere?
Z line
Myosin binds to which part of the sarcomere?
M line
What does CREST stand for in Sclerosis?
Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias.
What markers are useful in Sclerosis?
-Anti-centromere (CREST sd)
-Anti-DNA topoisometase l (Scl-70) (diffuse scleroderma)
Anti- histone (+) think of
Drug-induced lupus:
Procainamide, hydralazine, isoniazid, and D-penicillamine
Anti-SSA and SSB (+), think of
Sjögren (Ro and La are the same)
Hypersensitivity type lV
Occurs upon exposure to an antigen
-T cell and macrophages mediated
Ex: tuberculin, candida tests
Hypersensitivity type lll
Inmune complex mediated (ag-ab deposits in tissue)
Neutros recruited
Ex: Lupus, RA, PSG
Cystic fibrosis physiopathology
-Mut of CFTR transmemb prot that unables ATP attachment to Cl channels -> less Cl secretion -> Na reabs-> water reabs-> thick mucus production
-impaired post-translational processing
Cardiac hemochromatosis features
Excess of intestinal iron absorption
Hepatomegaly, non-tender
Darkly tanned looking skin
Sinus node dysfunction
Brown granular deposits in cells
CT scan showing ring-enhancing lesion, think of
Brain abscess
Anaphylactic rx elevates
Tryptase and histamine release (due to mast cell and basophil degranulation)
Hypersensitivity type l
Allergic rx
IgE ab bind to mast cells and basophils (receptor aggregation)
BCL-2 inhibitors increases the activation of
Caspases
Effect of progesterone withdrawal on endometrium
Uterine contractions
Constriction of spiral arteries
Apoptosis of cells in the stratum funcrionalis
Constrictive pericarditis signs
Increased JVP
Pulsus paradoxus
Kussmaul sign
Pericardial knock (before S3)
Ao regurgitation signs
-decrescendo murmur
-Rapid rise-rapid fall pulsation: “bumping” pulses: musset sign (head bobbing/pounding), pistol-shot femoral pulse, etc
-palpitations
Thoracocentesis must be performed on
-upper border of ribs to avoid hurting intercostal vessels
Untreated hypothyroidism in NB cause
Neurological deficits
Neurocognitive disfx
Propranolol in hyperthyroidism is used to
-decrease adrenergic effects
-block peripheral conversion of T4 into T3
Tto of patent ductus arteriosus
-inhibition of cliclooxigenase (NSAIDs) -> inhibition of PGE2 synthesis
Temporal arteritis/ giant cell vasculitis signs
Headache
Craneofacial pain
Sudden vision loss (feared complication)
Polymyalgia rheumatica ( neck, torso, shoulder pelvic girdle pain), morning stiffness
Horseshoe kidney is usually asymptomatic but can cause
Urinary infections and nephroliths
Spherocytosis features
RBC without central parlor (spherocytes)
Increase mean corpuscular Hb concentration MCHC
Malignant hyperthermia features
Post anesthetics
Excessive Ca+2 accumulation
Muscle contraction
Hyperthermia
Mitochondrial myopathy
Maternal inheritance
Muscle weakness
Neuropathy, seizures
Red, ragged cells on biopsy
Hepatic conversion of pyruvate into glucose requires activation of pyruvate carboxylase via
Acetyl-CoA
Why are lysene and leucine useful in pyruvate dehydrogenase deficiency?
They are exclusively ketogenic which helps decrease pyruvate production from glucose
McArdle disease features
Myophosphorylase deficiency
Poor excercise tolerance
Improves by consuming simple sugars
What’s the name for different codons producing the same amino acid ?
Wobble
Most abundant aa in collagen
Glycine
Which enzyme in DNA replication is made from RNA
Primase
Dichenne musc dystrophy is the result of
Deletion causing frameshift mut or nonsense mut
Aldolase B deficiency
Fructose-1,6-biph accumulation
Impaired gluconeogenesis
Severe hypoglycemia
Avoid fructose and sucrose
Li-Fraumeni sd affects a tumor suppressor gene on chromosome
17
Which biochemical processes take place in the cytoplasm
Glycolysis, fatty acids synthesis, pentose phosphate pathway
Which biochemical processes take place in the mitocondria?
Beta-oxidation of fatty acids, gluconeogenesis, creps cycle
Statins inhibit
HMG-CoA reductase
Which substances inhibit complex IV of the oxidative phosphorylation process?
CO
cyanide
Retonone (insecticide) inhibits oxidative phosphorylation by binding to
Complex l
Antimycin A and Oligomycin A inhibit oxidative phosphorylation by binding to
Complex III and V respectively
Most of the sts produced by heavy OH drinking are due to excess of
NADH
Northern blot transcription migration distance is due to
Alternative RNA Splicing
Homocystenirua is caused by
Cystathionine synthase -> cysteine cannot be produced so it becomes essential-> homocysteine accumulates (methionine cycle)
Genetic anticipation refers to
when a disease is more heavily expressed in a newer generation than the previous
Cystic fibrosis is produced due to a ____ mutation
Frameshift
Months old baby is recently introduced to solids (fruit) and presents with vomit and hypotension. Think of
Aldolase B def
Why does OH inhibit gluconeogenesis?
Not enough NAD req for gluconeogenesis due to excessive NADH
Transketolase participates in___ and deps on___
Pentose phosphate pathway
Thiamine (B1)
Phenylketonuria signs
Musty body odor
Eczema
Altered gait
Intellectual probs
Protein expression increased with normal mRNA concentration is likely a prob in
Ubiquinatination
Cataracts in children, think of
Classic Galactosemia
Pyruvate pathways
TCA cycle
Gluconeogenesis
Lactate formation
Alanine formation
High ATP levels ____ fructose-1,6 biphosphatase 1 and ____ phosphofuctokinase-1
Activate (gluconeo)
Deactivate (TCA)
High AMP levels _____ fructose-1,6 biphosphatase 1 and ____ phosphofuctokinase-1
Deactivate (gluconeo)
Activate (TCA)
High Frutose 2,6 biphosphate favors____ and low levels favor
Glycolysis
Gluconeo
Which cells are insulin independent?
Neurons
Beta-pancreatic cells
Hepatocytes
Enterocytes
Somatic sts disorder features and Tto
Multiple unexplained medical sts + excessive health care use
Schedule regular visits
Ant horn and Lat Corticoespinal tract injury have in common
Ipsilat motor sts
Ant horn (lower motor neuron) LCT (upper)
What type of collagen appears on myocardium after MI (on scars)
Type l
Which tissues have collagen type I
Skin, bone, ligaments, tendons, cornea, blood vessels and scar tissue
Osteogenesis imperfecta affects collagen type
I
Alpert sd affects basement mb, specifically collagen type
IV
Major copper excretion occurs via
Biliary excretion
Adjustment disorder has to last
Min 3 months
Max 6 months
Most important RF of Hepatitis B transmission
Injection drug use
Recovery from acute Hepatitis B infection will have
Anti-HBc IgG and anti-HBs antibodies
Chronic hepatitis B marker
HBsAg for more than 6 months
What’s a leading cause of early neonatal sepsis in women with not adequate prenatal care?
Group B streptococcus (S. agalactiae)
*key: narrow zone of clear hemolysis
COPs are the first line for treating hirsutism due to their effects
Decreasing androgen production
What arteries are located on the lesser stomach curvature?
Right and left gastric
What arteries are located on the greater stomach curvature?
Gastroepiploic (right and left)
Pituitary (ant vs post) derived from which embryologic derivates?
Ant: surface ectoderm (Rathke pouch)
Post: Neural tube
EBV/mono is associated to which malignancy ?
Burkitt lymphoma
Nasopharyngeal carcinoma
Scarlet fever is associated to ___ and main complication is
Pharyngitis
RA
Placenta previa refers to
Placenta covers internal cervical os
Placenta percreta refers to
Placental invasion of adjacent structures
*bladder has greatest risk
Besides SV/HR, what other formula can be used?
Rate of O2 consumption/ arteriovenous O2 content difference
Major adverse effects of clozapine
Neutropenia and agranulocytosis
Main cause of primary nocturnal enuresis
Brain maturation delay
*can’t have been previous continence and have to be 5 or more years old
Cryptococcus neoformans features
Budding Yeast with thick capsules
Tto for native vs prosthetic valse replacement
Native: naficilin or oxacilin
Prosthetic: vancomycin
Gynecological Laparoscopic procedures can harm which nerves
-iliohypogastric (loss of sensation on lat gluteal skin)
-ilioinguinal (loss of sensation on Mons pubis and medial thigh)
Acute retroviral sd refers to what and what are its markers?
-early viral infection before serologic response
-HIV p24 antigen (+) and anti-HIV antibodies (-)
Focal seizure + awareness + auditory/olfatory hallucinations , think of
Temporal lobe epilepsy
Childhood febrile seizures are commonly associated to
Hippocampal sclerosis
hCG is most similar to
1.LH
1.FSH
3.TSH
Normal response to local alveolar hypoxia
Hypoxic pulmonary vasoconstriction (to limit blood flow to nonventilated alveoli)
Increased hemoglobin A2, think of
Beta thalassemia minor
What’s hemochromatosis?
Excessive intestinal iron absorption and deposition in various tissues (pancreas, heart, liver, joints)
Hemochromatosis causes
Hyperpigmentation
Arthritis
Liver damage
DM, hypopituitarism
Cardiomyopathy
Expected findings of Guarda lamblia under the mic
- ellipsoidal cysts with smooth, well-defined walls and 2+ nuclei or
- pear-shaped, flagellated trophozoites.
Giardia lambía features
-most common enteric parasite in the US and Canada.
-Chronic diarrhea, malabsorption, and flatulence.
-Hikers and campers drink contaminated water
MTZ can be used to treat which microorganisms?
Giardia lamblia
HP
E. Ameba
Trichomonas
Dextromethophan is a first-line cough suppressant bc ___ however it can cause ___ if OD or used with serotoninergic drugs
-similar to codeine but without opioid effects
-Serotonin sd
How does aging affect the resp system ?
-low PaO2 (+ dead space)
-microatelectasis -> shunting
-V/Q mismatch-> high A-a gradient
-PaCO2 does not really change (pathological if it does)
High lung compliance but total is low
Down sd is associated with what type of hernia?
Umbilical (due to incomplete closure of umbilical ring)
S4 suena como
S3 suena como
-una parranda
-una cojera
S3 and S4 are associated to
S3: eccentric hypertrophy in HF with reduced ejection fraction).
S4: normal if >70 but if <70, pathologic LV wall stiffening,
Organophosphate (pesticides) poisoning management
- Decontamination
- Atropine (reverses muscarinic effects via competitive inh)
3.Pralidoxime (reverses nicotinic and mucarinic sts)
Inhibition of the intrinsic coag pathway prolongs ___ whereas inhibition of the extrinsic
aPTT
PT
Which zona in the adrenal cortex produces mineralocorticoids?
Glomerulosa
Hereditary angiogram features
Children or teens
Deficiency is dysfunction of C1 inh-> + bradykinin (edema without itching) and - C4 levels
Malignant hyperthermia is due to
Abnormal Ryanodine receptors (RYR1) that increase Ca+2 influx
Rebound rhinorrhea is associated with the use of
Decongestants for 3 or more days
*stop decongestant
What’s the irrigation for the interior LV wall?
Right dominance (85%) : Right coronary artery -> post descending artery
Left dom: circumflex artery -> post descending artery
A right coronary artery occlusion only causing RV infarction can be explained by
Left dominance
SIBO risk factors
(-) Gastric acid, pancreaticobiliary secretions (PPI)
(-) Intestinal motility (DM, sclerosis)
lleocecal valve resection
Low Mucosal Immune response (igA)
Hungtington triad
Mov disorder
Behavior abnormalities
Dementia
Subacute thyroiditis markers
Elevated T4, suppressed TSH (hyperthyroid phase)
• Elevated serum thyroglobulin
• Elevated erythrocyte sedimentation rate
• Low radioiodine uptake
Black gallstones occur due to
High efflux of bilirrubin into bile
white pupillary reflex (leukocoria) in children <5 years old, think of
Retinoblastoma (most common occular childhood tumor)
Retinoblastoma is associated to
Sarcomas
Clinical trial phases
Preclinical: not in humans
I: pharmacokinetic, metab, dynamics ; adverse effects and max dosis. On a small and healthy group
Il: efficacy checking, affected subjects
lll: safety and effectiveness compared to placebo
IV: effect over time after being out in the market
Baby born from mother with untreated HPV will likely develop __ due to ___
Weak cry, hoarseness and stridor
Infection of true vocal cords (has stritified squamous epithelium)
Exceptional heat stroke is associated to
DIC (high fibrinolysis, thrombin and plasmin production )
Young man with hypertension, episodic headache, anxiety, and diaphoresis; and an adrenal mass on CT scan has
Pheochromocytoma
Lung abscess usually forms due to
the aspiration of oropharyngeal bacteria
RF for aspiration sd
• Periods of altered consciousness
• Impaired swallowing (eg, nasogastric tube, dysphagia)
• Periodontal disease (gingivitis)
The last structure to disappear in the respiratory epithelium is
Cilliated cells (until prox respiratory bronchioles
large hepatocytes filled with finely granular, homogeneous, pale pink cytoplasm. Think of
Hepatitis b
High Fructose 2.6-biphosphate ->high glycolysis and inh gluconeo->
less alanine to glucose
Insulin ___ fructose 2,6-biphosphate
Increase
patient developed localized erythema and vesicles 2 days after reexposure to a chemical on patch testing, think of
allergic contact dermatitis
Allergic contact dermatitis is a hypersensitivity type__, where there’s
IV
Migration of hapten(allergen)-activated Langerhans cells (dendritic cell) to regional lymph nodes
Impaired fibrillin synthesis, think of
Marcan sd
Impaired elastin degradation
Alpha-1 antitrypsin deficiency
The sciatic nerve is particularly susceptible to injury in patients with
femoral head dislocation, hip fracture, and/or arthroplasty
Polyarteritis modosa features
-weeks or months of constitutional sts and signs of organ ischemia
-biopsy: segmental, transmural inflammation with fibrinoid necrosis disruption of elastic laminae.
-rel to HBV
Horner syndrome classically presents with
hemifacial ptosis
miosis
anhydrosis
enophthalmos.
Bell palsy (CN Vll) presents with
-asymmetry of face when smiling
-effacement of nasolabial fold
-lips are drawn toward op side.
-Loss of taste from 2/3 ant tongue
-less tear production
Young woman with isolated thrombocytopenia and no other platelet abnormalities, think of
immune thrombocytopenic purpura
Red flags of drug-seeking behavior
-requesting a specific medication
-running out of medication
-claiming pain out of proportion to the physical examination
-Reporting lost or stolen medication
-obtaining multiple opioid prescriptions from different providers
What’s the initial approach for suspected drug-seeking behavior?
Clarify medication/prescription history
internal hemorrhoids drain into
superior rectal vein -> inferior mesenteric vein.
External hemorrhoids drain via
the inferior rectal vein -> internal pudendal vein -> internal iliac veins
Most carcinomas spread via
Lymphatics
The following CA spread hematogenously
Sarcomas
Renal cell carcinoma
Hepatocell carcinoma
These Ca spread perineurally
Pancreatic ductal adenocarcinoma
Prostate Ca
Most Ca spread via
Direct invasion
Formation of ketone bodies depends firstly on enzyme
Hormone-sensitive lipase
Cocaine-induced chest pain is treated with
Nitro (reduced preload) + BZD (reduces SNS response)
Young pt with MI signs, think of
Coronary artery vasoconstriction due to cocaine
Which technique is used for detecting large deletions or transloc of chromosomal segments?
Fluorescence in situ hybridization (FISH)
Key features of Coccidioides
Spherules full of sndospores
Endemic of southwest US (Arizona, New mex)
Turner sd is associated to which heart prob?
Bicuspid ao valve
Small linear splinter hermorrhages under nail (microemboli) suggest
Infectious endocarditis
Pte <40 yo with inflam back pain + tenderness at tendon insertion + forward flex reduced. Think of
Ankylosing spondylitis
Ankylosing spondylitis increased markers
HLA-B27
IL-17
TNF-alpha
Prostaglandins
Transposition of great arteries in NB causes reversed function of ventricules and arteries, in order to live, they need a
sx that widens foremen ovale or maintains ductus arteriosus to provide some oxygenated blood to the body
What anatomical landmark is used in a appendectomy?
Teniae coli
Ring-enhancing focal brain lesions on HIV patients. Consider ___ or ___
Toxoplasmosis
PCNSL (B cell lymphoma) by EBV
Class IA and III antiarrhythmics are associated to
acquired QT prolongation
Solatol and Ibutilide are class lll antiarrythmics that associate to
Torsades de pointes
Hemolytic disease of the NW features
Jaundice
Hepatomegaly
HypoHb
Direct Coombs (+)
Little to none prenatal care
Contralat complete sensory loss after signs of stroke, structure probably affected
Contralat Thalamus
Lacunar infarctions are believed to be primarily caused by
Lipohyalinosis and microatheromas
Elderly woman with rash around eye and nose + eye pain +decreased vision. Think of
Herpes zoster ophthalmicus
Anemia + High reticylocyte count suugests
Bleeding or hemolysis (intravascular or from splenic erythrocytes destruction)
Anemia + very low reticylocyte count (not normal response) suggests
Problema producing RBCib bone marrow.
If only Hb low, think of pure red cell aplasia
Transient ischemic attack is characterized by
Focal neurological deficits (seems to be a stroke) but resolved without intervention
*due to transient brain ischemia
Transient ischemic attack management
Antiplatelets (aspirin+clopi)
Statin (HMG-CoA redactase inh)
Lifestyle modifications
Dog bite associated bacteria
Pasteurella multocida and Pasteurella canis
Capnocytophaga canimorsus
Cat bite associated bacteria
Pasteurella multocida
Bartonella henselae
Valproate is used as
Anticonvulsant and mood stabilizer
Anencephaly is caused by failure of ____ closure
Ant/rostral neuropore
What’s the best method for a pt with Turner sd to achieve pregnancy?
In vitro fermentation
Sporotricosis (rose disease) biopsy shows
Grandulomas and neutrophilic microabscesses
Pt with agitated delirium, sympathetic hyperactivity due to antiAcH toxidrome, give
Physostigmine
Pt with sedation/ slurred speech but normal vitals due to BZD OD, give
Flumazenil
Sedation with resp suppression + miosis due to opioid OD, give
Naloxone
Pt with altered mental status + mydriasis + sympathetic hyperactivity (serotonin sd) due to to SSRI/SNRIs OD, give
Cyproheptadine
Lung CA can cause epidural metastasis manifesting as___ and affecting__ nerve
Cauda equina sd
Sciatic and pelvic splanchnic
Pt unresponsive post partum with profuse bleeding and shock signs, think of
Amniotic fluid embolus sd
Amniotic fluid embolus sd hemodynamic effects
High PVR
High CVP -> high RVP
Low PCWP
25% pts with active TB show little to no resp to tuberculin skin test due to
Inadequate lymphocyte resp (T cell anergy)
Chronic granulomatous disease featured
Catalase (+) organisms recurrent infections
Normal igb levels, no leukopenia
*Impaired neutrophilic resp burst
MEN2B features
Medullary thyroid Ca signs (mass + high calcitonin
Mucosal neuromas
Marfanoid habitus
Pheochromocytoma
Pt with recent partum labor presents with fecal incontinence and loss of anal wink reflex. Nerve injured is
Pudendal
22q11 deletion sd features
Recurrent sinopulm infect
Craneofacial abnormalities
Congenital heart disease
Thymic hypoplasia
Where in the lymph node are T cells ?
Paracortex
Young woman with signs of internuclear ophthalmology, think of
Multiple sclerosis
Osmotic diuretics act on
Descending limb of henle loop and PT
Carbonic abhydrase inh (acetazolamide) used for angle closure glaucoma acts on
PT
Neonatal abstinance sd manifests as
NB with irritability, high-pitched cry, sleeping and feeding probs, autonomic disfx, tachypnea, diarrhea and vomiting
Anti-Smith ab relates to Smith prot, which is ____. This participates in
snRNA
RNA splicing removing introns via spliceosomes (which have snRNPs )
Peripheral artery disease management
Excersise + cilostazol
Acute management of variceal hemorrhage reqs
Somatostatin
Small gap near the tip of a long arm of the X chromosome , think of
fragile x sd
Fragile x sd features
Intelectual disability
Prominent forehead, chin
Long ears, long and narrow face
Macroorchidism
Elevated alpha fetoprotein is suggestive of ___ and represents failure of ____
Open neural tube defect -> hindbrain herniation
Primary neurulation
Primary neurulation process
Neural plate -> neural folds -> neural tube
Mediators of sepsis/syst inflam
TNF-a, Il-1, Il-6
Why are cholesterol gallstone produced ?
Not enough bile salts
Why are brown/pigmented gallstones produced?
Infection-> injured hepatocytes-> release beta glucuronidase-> Excess unconjugated bilirubin
Normal Anion gap value and formula
10-14
Na - (HCO3+ Cl)
Antipsychotics can produce acute dystonic Rx due to
Strong D2 inh in the nigrostriadal pathway -> excess AcH -> extrapiramidal sts
Proliferative phase of HBV express HBsAg and HBcAg + MHC on hepatocyte surface, this causes ___
CD8+ to attack hepatocytes but it’s not a direct citotoxic effect
HIV-2 features
West Africa
Low viral load
10-25 years to AIDS
Prot C is___. Its deficiency causes
Anticoag prot
Procoag state (DVT)
Factor Vlll deficiency causes
Hemophilia A
vWF fx
Binds Gplb (platelets glycoprot) to collagen
Protects factor Vlll carrier
Venous blanching + induration + pallor on site of norepi (extravasation), give
Phentolamine (op vasodilating effect)
During passive expiration, resp system compliance (chest wall vs lungs) reaches eq. That is at an intrapleural P of
-5 cm H2O
Sensitivity vs specificity
Positive truly have the disease (low rate of false neg)
Negative truly don’t have the disease (low rate of false positives)
Multiple sclerosis tremor is
Cerebellar
Action tremor
Ataxia rel
Mass in neck + ear effusion, suspect tumor in
Nasopharynx
Von Hippel-Lindau disease produces
-Cerebellar & retinal hemangioblastomas
-Pheochromocytoma
-Renal cell carcinoma (clear cell subtype)
Pt with episodes of irresistible need of sleep during day and inappropriate places, treat with
Modafinil (for Narcolepsy)
Alveolar ventilation is
Tidal vol - dead space vol
Cocaine withdrawal sts
Low mood, fatigue, hypersomnia, hyperphagia, and vivid dreams
Cannabis withdrawal sts
irritability, anxiety, depressed mood, and vivid dreams, insomnia and decreased appetite
Opiate withdrawal sts
abdominal cramps, nausea, vomiting, yawning, muscle aches, piloerection, lacrimation, and dilated pupils.
OH withdrawal sts
agitation, tremors, tachycardia, and hypertension
Pulm artery catheter/Swan-ganz reflects
left atrial and left ventricular end-diastolic pressures.
Pulm artery catheter/Swan-ganz go through
right atrium, right ventricle, and pulmonary artery
To reduce risk or treat estrogen tumors in post-meno women, give
Aromatase inhibitors (anastrozole, letrozole, exemestane)
Digital clobbing, think of
cardiopulmonary hypoxic disease
Pulm neoplasia
Chronic cardiopulmonary infection
Myotonic dystrophy type 1 features
CTG repeats
Attacks non-dividing cells: skeletal muscle, brain, myocardium
Sudden cardiac death due to MI usually causes
Malignant ventricular arrhythmia (ventricular fib)
Active infection of Strongyloides stercolaris is dg via
Rhabfitiform larvae in stool (noninfective)
*filariform larva in soil (infective)
To which antibody does Graves’ disease associate ?
Thyrotropin receptor
To which antibody does Hashimoto’s disease associate ?
Thyroid peroxidase
*thyroglobulin is more common in hypothyroidism
Physiological response to anaphylaxis
Antigent-igE contact-> igE ab receptor aggregation -> mast cell and basophil degranulation -> histamine and tryptase release.
Meckel diverticulum’s features
Persistent vitelline duct
Often by age two
Painless rectal bleeding
Sudden upward jerking (hanging from tree or kid pulled by the arm) may result in Klumpke palsy/ hand clumsiness because
It can injured of the inf trunk of brachial plexus -> median and ulnar N -> intrinsic hand musc
History of nasal wound or prolongs tampon + hypotension, rapid onset fever and diffuse erythematous rash, think of
Staphylococcal toxic shock sd (pyrogenic endotoxin superantigen)
Hartnup disease features
Deficiency of niacin due to mut of aa transporter (ex triptophan precursor of niacin)
Early childhood sts
Pellagran-like skin eruptions
Cerebellar ataxia
aa in urine
Predominant Hb before 8 weeks gestation?
Zeta or epsilon globins
Predominant Hb before 14 weeks gestation til first months of life ?
HbF (2 alpha, 2 gamma)
Chronic (>6mo) lung transplant rejection is marked by
submucosal lymphocytic inflammation in the walls of the small airways.
Acyclovir nephrotoxicity can be prevented wit
Adequate hydration
Twisting your ankle inward (lat ankle sprain) hurts ___
(Ant) talofibular ligament
Dg criteria for schizophrenia
continuous signs of disturbance for at least 6 months an at least 1 month of ≥2 of active or passive sts
EPO fx
In resp to hypoxia, it increases progenitor RBC differentiation and reduces apoptosis
Medicare covers
65 yo and older who have paid taxes, have residence and citizenship in US
Young ppl with disabilities, ESRD and ALS
Medicare covers
65 yo and older who have paid taxes, have residence and citizenship in US
Young ppl with disabilities, ESRD and ALS
Medicaid covers
Homeless
Undocumented immigrants
Pregnant women
Low-income families
Cleft lip is a result of failure in the fusion of
Maxillary prominence and intermaxillary segment
What test is useful to check if there’s sickle cell trait
Hb electrophoresis
Oligodendrocyte depletion, focal demyelination, T2 lesions on MRI, oligoclonal bands on CSF are typical of
Multiple sclerosis
Mass blocking ileocecal valve + air in biliary tree (pneumobilia), think of
Gallstone ileus
What type of genes are RET, TP53 and RB?
RET: protooncogene
TP53, RB: tumor suppressors
HPV oncoproteins (E6 and E7) affect
Tumor suppressors
E6-P53
E7-RB
*rel to head, neck, anal and penile Ca
Postpartum depression features
Up to a year
Depression sts
Guilt
Postpartum blues features
Resolves within 14 days
Mild depression
Tearfulness
Irritability
Postpartum psychosis features
Delusions, hallucinations, bizarre behavior
Old pt with Bradycardia + dropped p waves on EKG, think of
Sick sinus sd
Pt with depression and ongoing cellulitis is given atb then presents with seizures, what atb did he receive?
Linezolid
HSV-1 features
Gingivostomatitis
DNA virus
Ds
Enveloped
Randomization refers to
assignment of 2 groups with similar characteristics to prevent selection bias
Acute hemolytic transfusion reaction is caused by
Pt’s abs against blood product ABO-group antigen (ABO incompatibility)
Delayed hemolytic transfusion reaction occurs when
A pt was previously exposed (days to weeks before) to a foreign, minor RBC antigen
Dense lung opacity with air-fluid level in an alcoholic or drug user are consistent with
Lung abscess (due to aspiration during loss of consciousness)
Vaccine component of meningococcal meningitis
Capsular polysaccharide
Young adult with skin-colored, well-circumscribed plaque painless or without itching, think of
Verruca vulgaris by HPV
Histopathologic findings of HPV verruca
Epidermal hyperplasia
Hyperkeratosis
Cytoplasmic vacuolization
Multiple drug Tto is req for TB due to
Altered structure of bacterial ribosomal prots resistance pattern
Carcinoid sd dg
High 5-HIAA urinary excretion
Trauma to side of the face s and probable temporal bone fracture will affect which nerves ?
Facial and vestibulocochlear nerve
BRCA1/2 are responsible for
DNA repair
What can reverse MTX toxicity?
Folinic acid
Which antifungal drugs bind/inh incorporation of ergosterol into cell mb?
Amphotericin B
Nystatin
Which antifungal drugs inh ergosterol synthesis?
Azoles
The only immune cell that doesn’t go down with aging is
CD8+
Mycophenolate is the ideal drug for
helping prevent organ transplant rejection
Exercises of pelvic floor for helping with urinary Incontinence are aimed for which muscles?
Levator ani muscle complex
Why is profilactic penicillin important in S.pyogenes pharyngitis?
Prevention of acute rheumatic fever and rel cardiovascular disease
What type of edema does increased fluid extravasation and decreased oncotic pressure cause?
Pitting edema
Child with milky plasma + low lipase activity+ hypertriglyceridemia+ acute pancreatitis + Lipemia retinalis. Suspect
Fam chylomicronemia sd
Toxic shock sd toxin from SA features
Rel to tampons and nasal packing
Macrophages and T cells response
Detrusor musc contraction promotes
Urination (+ decrease int urinary sphincter tone )
Fatigue + depressed mood within 3 months of identifyable stressor
Adjustment disorder
Chronic depressed mood for more than 2 years
Persistent depressive disorder (disthymia)
Spironolactone causes gynecomastia bc
It blocks androgen receptor and decreases testosterone synthesis
TAP prot are needed in the immune system bc ___. TAP Mutations lead to
They present antigents to MHC l which then activate T cells
Ulcers and recurrent resp infections
Nitrates effects and adverse effects
Venodilation-> more blood remains in veins-> less EVDV -> less wall stress -> less O2 demand -> less pain
Headaches, hypotension, flushing
Greatest severity determinant in Tetralogy of Fallot
Degree of right ventricular outflow tract obstruction
Levothiroxyne absorption is decreased when taken with
Iron
Calcium
Antiacids
Night blindness + thickened skin are suggestive of
Vit A def
Causes of vit A, D, E, K def
Pancreatic insufficiency
Cholestasis/biliary obst
Short bowel sd
Hemophilia inheritance probability is
1/2 (being carrier) x 1/2 (passing affected chromosome) x 1/2 (having a boy) = 1/8
Which mood stabilizers are used for Manic features, manic + depressive, depressive
Valproate, carbamazepine
Lithium
Lamotrigine
Giant cytoplasmic granules inside neutrophils are pathognomonic of
Chédiak-Higashi sd (lysosomal trafficking impaired)
Tay-Sachs disease features
By age 6, developmental regression
Beta-hexosaminidase A deficiency High GM2 ganglioside
Cherry red spot on macula
Persistence of HBsAg for more than 6mo indicates
Chronic HBV infection
Anti-HBs in HBV represents
Long term immunity
Which organisms exacerbate COPD
Viral: rhinovirus, influenza, RSV
Bacterial: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae
The number needed to harm is
1/ ARI (prob of adverse effect in Tto group - prob of adverse in placebo group)
Resistance to Vanco is due to
replacement of the terminal D-alanine-D-alanine with D-alanine-D-lactate
Direct inguinal hernia features
Older men
Weakness of transversalis fascia
Medial to inf epigastric vessels
Hasselbach’s triangle
Indirect inguinal hernia features
Lat to inf epigastric vessels
In males: failure of processus vaginalis to obliterate
In females: failure of int inguinal ring to close
MAC (dep on C3, C5-9) is most important defense against
Encapsulated organisms
*MAC def displays low CH50 and AH50
Ras prot is activated when bound to
GTP
Mastocytosis is associated with KIT mut which causes
Excessive Histamine release -> gastric hypersecretion
From which vessel originate the hepatic arteries
Celiac trunk
Desmopressin lowers the clearance of
Urea
Pt with history of trauma presents with painful, firm, mobile mass on musc area, think of
Myositis ossificans
Mucosal bleeding and easy bruising that resp to desmopressin, think of
Von Willebrand disease
Paget disease profile
Old man
Multifocal bone pain (skull, vertebrae and extremities)
High alk phophatase, normal Ca, PTH and phosphorus
Thickening of cortical and trabecular bone
Possible spinal stenosis and nerve compression
A monocular upper left visual field defect is likely due to a lesion in
The lower right retina
What’s the most important measure to reduce risk of transmission in MRSA ?
Hand hygiene
Young pt with platypnea, pulmonary vasc disease signs and recurrent epistaxis
Hereditary hemorrhagic telangectasias
(Telangenctasias might not be mentioned)
infant with erythematous and pruritic patches on her cheeks, think of
has atopic dermatitis (eczema)
*high IgE, risk of other atopic diseases
Muddy brown granular casts in urine, think of
Acute tubular necrosis
Child with erythematous papules and pustules that later erupt, forming a honey/amber colored crusting, think of
Impetigo by SAu or SPiog
Beta blockers lower blood pressure via 2 mechanisms:
- Reducing myocardial contractility and HR
- Decreasing renin release by the kidney
Pemphigus vulgaris’ buzz words
Flaccid bullae -> easy eruption-> erosions
Desmosomes problem
Bullous pemphigoid’s buzz words
Solid bullae
Old people
Hemidesmosome problem
“Transforming unacceptable feeling or impulses into the opposite” refers to
Rx formation
Retinal cherry-red macular spot with white surrounding ring + hepatosplenomegaly + neuro degeneration, think of
Sphingomyelinase def
Thrush and Leukoplakia white-plaque like lesions on the tongue but only ____ can be scraped off
Thrush (C. albicans)
Congenital primary hypothyroidism, think of
Thyroid dysgenesis or TSH resistance
Which class lll antiarrhythmic has the least risk of producing Torsades de pointes
Amiodarone
“Sustained, involuntary, musc contractions that for body into abnormal and painful posture” refers to
Dystonia
For knowing the probability of not having a disease, use
Neg predictive value
Which cells and receptors participate in a tuberculin skin test Rx?
CD28-T cells
CD80- dedritic cells
Unilateral hearing loss, dg to consider
Perforation of tympanic mb
Vestibula schwannomas (acoustic neuroma)
Noise-induced hearing loss affects
Stereocilliated hair cells of organ of Corti
ARR = (Risk control - Risk treatment)
Absolute risk reduction
Most common reactivation sd in AIDs pt is from
CMV (herpesvirus family)
-navir antiretrovirals mec
Inh of HIV proteases -> not functional viral prots -> noninfectious virions
Elderly pt with lightheadedness and feeling of impending fainting when tightening tie, think of ___. EKG finding __
Carotid sinus hypersensitivity
Sinus pause
Tumor multidrug resistance mec
Increased expression of P-glycoprot-> ATP-dep efflux pump -> chemo agents expelled out of cell
Recovery complication after Acute tubular necrosis
Electrolyte wasting
Rectus femoris and sartorus hace in common ____ but differ in that
Hip flexion
R.F extends the knee and S flexes it
Pt with chronic pancreatitis, UTH and tortuous veins in gastric fundus. Think of
Splenic vein thrombosis (due to pancreatic inflammation)
Old male pt with back pain, suspect ___ bc it usually metastasizes to__
Prostatic CA
Bone (forms new bone via irreg glands)
Between 3 weeks and 2 years, a wound heals via
Matrix metalloproteinases which change type lll collagen for type l
Schizoid vs schizotypal
• Schizoid: prefers to be a loner, detached, unemotional
• Schizotypal: unusual thoughts, perceptions & behavior
Most common enteric parasite infection in US and Canada has
Giardia lambia
Light microscopy changes at days 1 to 3 after a MI
Coag necrosis
Prominent neutrophilic infiltrate (clusters of purple dots areas)
Light microscopy changes at days 10 to 14 after a MI
*Collagen depo and granulation tissue (white circles
Fibroblast prolif
*Neovasc (red dots)
Young pt with large mediastinal mass, MPO (-), TdT (+), think of
T-lymphoblastic leukemia if CD2-CD8 (+)
B-Lymphoblastic leukemia if CD10-CD79a (+)
Most potent chemotactic eicosanoid that causes rapid neutro locomotion is
Leukotriene B4
Which pathway can generate NADPH when cells are unable to do it directly form glucose ?
The pentose phosphate pathway (HMP shunt) via transketolase and transaldolase enzymes
A patent ductus arteriosus is a left-to-right shunt that allows continuous flow of oxygenated blood from ___ to___
Ao to Pulm artery (which leads to a higher PaO2 there)
Which drug can work as MTX toxicity rescue
Leucovorin (NS-formyl-tetrahydrofolate)
Exceptions to pt confidentiality
Suspected abuse
Knife or gunshot wounds
Diseases that most be reported
Threat to harm self or others
Pt with shortened vigina, rudimentary uterus, amenorrhea, rest of sexual features are normal, think of
Müllerian agenesis
Organism that usually causes pneumonia in OH use disorder
Klebsiella
Peniciline inh transpeptidases that target
D-alanine-D-alanine
In lymph nodes Cortez, B cells form___ where they undergo ____
Germinal centers
Isotype switching (other ig apart from IgM)
Beta Hb mut in Familial erythrocytosis produces poor binding of 2-3 BPG, which causes HbA to ___. This is similar to___.
Bind more O2.
HbF
Ureters are ant to ___ in the pelvic cavity
Int iliac artery
Which organism causes epiglottitis in children?
H.influenzae type b
Pt with harsh, holosystolic murmur along the lower left sternal border, think of ____, which is a _____ shunt
Ventricular septal defect
Left to right
Pt with Sickle cell disease taking Hydroxyurea presents with pancytopenia and macrocytosis, cause?
Medication-induced inhibition of a nucleic acid synthesis enzyme leading to DNA impaired synthesis
P- value is
probability of obtaining a sample value at least as large as the one observed when the population value claimed in H0 is assumed to be true.
rapid-onset muscle pain, fever, hemorrhagic bullae with dusky surrounding skin, and tissue edema/crepitus. Thinks of
Spontaneous gas gangrene by Clostridium septicum
Spontaneous gas gangrene by Clostridium septicum is associated with
Colonic malignancy
Gigantism is caused by hypersecretion of ___ mediated by ____
GH
Hepatic IGF-1
Pt requiring rapid blood transfusion but flow rate is not helping, you should
Double the diameter of the intravenous catheter
Pt with recurrent infections during childhood and absence of fluorescence in neutrophils during dihydrorhodamine flow cytometry, think of
Chronic granulomatous disease
Cause of recurrent infections in pt with cystic fibrosis
Development of bacterial macrocolonies
HBsAg HBeAg found in blood smear signifies
HBsAg: first marker of HBV infection, surface antigen, implies active infection acute or chronic
HBeAg: highly infectious if high, sts appear
Anti-HBc (antibody) in blood test implies
Positive in window period (helps when ab and ag may not be detectable )
Anti-HBe and Anti-HBs mean
Anti-HBe
Anti-HBs: person has recovered, seen in vaccinated people
Most common cause of complement deficiency is ___. Marked by___
Auto antibodies (IgG-ag complex formation)
Low C4, C3, CH50
Normal Factor B
Most common cause of bacterial vaginosis. Key finding is__
Anaerobic gram-variable Gardnerella vaginalis
Clue cells
Unilateral renal stenosis effects on non-stenotic kidney
small crowded glomeruli
Formula for calculating number needed to treat to prevent neg event in 1 person (NNT)
NNT: 1/ARR
ARR: control rate - tto rate
Control rate: n ppl with neg event/total in control
Tto rate: n ppl with neg event/total in tto
Why is beta-thalassemia a problem for prot translation initiation ?
It affects the Kozak consensus seq which identifies AUG codon
Insult to kinesin would
impair anterograde transport resulting in a deficiency of synaptic vesicles at the nerve terminal.
Gastric band must go through ___ to encircle the stomach
Lesser omentum
Testosterone replacement therapy adverse effects
Increased Prostate volume
Reduced erythrocytosis (must monitor)
Which organisms usually cause CF exacerbations
S. Aureus, H. Influenzae, P. Aeruginosa, Burkholderia capacia
From which aa does the eNOS make NO to cause vasodilation?
Arginine
What formula is used to know if an individual with a positive test truly has the disease ?
Positive predictive value (PPV)
PPV: TP/ (TP+FP)
** Do not confuse with sensibility
Cerebral palsy causes
Loss of descending inh control -> severe spasticity
Ankylosing spondylitis elevates production of
IL-17
TNF-a
Prostaglandins
Propionic acidemia is caused by ___
___ must be avoided
Deficiency of propionyl-CoA carboxylase.
Valine, isoleucine, methionine, and threonine (create more propionic acid)
Pt with chronic constipation and visible bulge protruding from vagina, Musc likely damaged?
Levator ani musc complex
Glycosylated HIV polyprot gp160 create gp120 and gp41 whose function is
Mediate viral attachment and viral fusion to host cell
Caspofungin blocks
Glucan synthesis needed for polysaccharide component of the fungal cell wall
ECO showing microbubles in left heart after peripheral vein injection, think of
Right-to-left intracardiac shunt (PFO or ASD)
Resting mb potential is formed with
High K and some Na conductance
Myocardial granuloma or Aschoff body are pathognomonic of
Acute rheumatic fever carditis
Shortened telomeres trigger
Permanent growth arrest
PCA strokes affect and cause
Occipital lobe -> Homonymous hemianopia (visual neglect), contralat to lesion: macula is spared.
Thalamus -> contralat hemisensory loss of the face, trunk, and limbs
If a pt is in denial about terminal illness but doesn’t interfere with medical care, pte
Should not be confronted. Doctor must be supportive of pt’s hopeful perspective
immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 on the GBM, think of
PSGN
NB wit Hb irritability, poor feeding and high pitch cry. Mom with poor prenatal care, think of
Heroin exposure during pregnancy
NB with growth def, smooth philtrum, palpebral fissures, thin upper lip and intellectual disability, think of
OH exposure during pregnancy
NB with jitteriness, excessive sucking, and a hyperactive Moro reflex, think of
Exposure to cocaine during pregnancy
Congenital Rubella sts
NB with cardiac defects, hearing loss and cataracts
Extended expectrum beta-lactamase bacteria (E.coli) inactivate penicilins and cephalosporins via
enzymes encoded in plasmids
Subclavian steal sd is recognized for
vertebral artery with retrograde (caudal) flow instead of normal antegrade
Pt with schizophrenia and poor response to 2 or more antipsychotics, treat with ____. Must monitor____.
Clozapine
Absolute neutrophil count (risk of agranulocytosis)
systolic ejection murmur that disappears during an episode of cyanosis is a characteristic of
Tetralogy of Fallot
systolic ejection murmur that disappears during an episode of cyanosis is a characteristic of
Tetralogy of Fallot
Drugs associated with SIADH
carbamazepine, cyclophosphamide, and selective serotonin reuptake inh
Medullary thyroid cancer features
Palpable neck nodule
High calcitonin
Spindle-shaped cells
RET mut
DM1 during early stages is characterized by
Islet leukocytic infiltration (insulitis). This is mainly due to destruction of beta cells through cell-mediated immunity.
Pt with recent head trauma, high serum Osm, ICF and ECF contraction, think of
Diabetes insipidus
Pulm Sarcoidosis features
-Dyspnea + cough +hilar adenopathy
-Pulm infiltrates: noncaseating granulomas, tightly clustered epitheloid macrophages.
-Immune resp: Th1, IL-2, interferon-y
Oculocutaneous albinism is a mut of
Tyrosinase
HIV fusions with host cell mb binding gp120 to CD4 and then
Chemokine receptor CCR5 -> gp41 -> viral fusion
pt with DM1 has postprandial nausea, vomiting of undigested food, bloating, and early satiety, think of ___.
Gastroparesis
B-hCG role is
Maintain the corpus luteum
Continue progesterone production
Risk of infection in systemic chemotherapy is higher due to
Mucositis -> damage to digestive tract epithelial cells -> endogenous bacteria enter bloodstream
Neutropenia
Drugs used to reverse anticholinergic toxicity
Tertiary amines: physostigmine, galantamine, donepezil, rivastigmine.
Neurologic sts on upper extremity in the setting of an extra rib, think of
Thoracic outlet sd -> compression of brachial plexus
Neurologic sts on upper extremity in the setting of an extra rib, think of
Thoracic outlet sd -> compression of brachial plexus
To treat atrial flutter, conduction block must be made through
Cavotricuspid isthmus (IVC-tricuspid valve)
Failure of post neuropore closure results in
Myelomeningocele (open spinal dysraphism)
Genetic shift and reassortment in viruses is responsible for epidemics thanks to their ____
Segmented genomes
Vesicoureteral reflux (retrograde flow urine) commonly occurs due to
Congenitallly shortened intravesical ureter
Key difference between acute stress disorder and PTSD
ASD lasts <1mo
PTSD lasts >1mo
Key Differences between Hirschsprung disease and intestinal atresia
HD: delayed passage meconium, obst sts. Small intestine unaffected (colon yes). Cellular migration failure.
IA: Small intestine affected (blind-ending, certain areas absent). Vasc occlusion prob.
MTX is a folate antagonist that causes ___ and ___ to accumulate intracel
Folic acid
DFH polyglumate
Most common benign liver tumor is___ and it’s recognized by___
Cavernous hemangioma
Cavernous, blood filled vasc spaces
Pt with acute dystonic Rx (eg torticollis) and history of recently diagnosed schizophrenia, probable cause
antipsychotic property of D2 antagonism in the nigrostriatal pathway. (Eg. haloperidol, fluphenazine)
False negative formula
FN= (1-sensitivity %) x (n of ppl with disease)
Isoproterenol is a ___ and ___ agonist
B1 and B2
Meckel diverticulum features
Failure of vitelline duct obliteration
Painless lower gastrointestinal bleeding and anemia
Dg with Tc-pertechnate scan
Usually by age 2
Allergic bronchopulmonary aspergillosis key features
Asthma exacerbation with proximal beonchiectasis
Organelle in charge of VLCFAs oxidation
Peroxisomes
BRCA1 and 2 muts produce
Defective DNA break repair
Block of C3-C7 will not only affect the brachial plexus but also cause
Phrenic nerve block -> ipsilat diaphragmatic paralysis
Allergic rhinitis immune response order
- Sensitization -> T cell induction/activarion, B cell maturation and IgE production
- Repeat exposure-> IgE cross-link on mast cells -> IgE receptor aggregation
outpouching from the ileum with a fibrous band connected to the umbilicus, think of
Meckel diverticulum
When do implantation, gastro latino, neurulation and neural crest cell migration occur?
Week 1
Week 3
Week 4
End of week 5
Blotchy red muscle fibers on Gomori trichrome stain are characteristic of
Mitochondrial myopathies
Causes of neonatal hyperbilirubinemia
-physiologic RBC lysis
-decreased UDP glucuronosyltransferase
-increase enterohepatic circulation with increased beta-glucuronidase activity
Which position helps relieve tetralogy of fallot and why?
Squatting -> increases SVR:PVR -> increases art [o2] -> relieves TET spell
Pts with medullary thyroid Ca should be screened for ___ prior to sx
Pheochromocytoma in adrenal medulla (considering MEN2)
Positive/negative sts favor prognosis in schizophrenia
Positive
most important limiting factor for left ventricular myocardial blood supply
Duration of diastole
Key feature of cardiac tamponade
Pulsus paradoxus: drop in pulse amplitude (SBP) during inspiration
Hyperacute transplant rejection hietologic findings
Mottling
Cyanosis
Arterial fibrinoid necrosis
Thrombotic occlusion
Acute transplant rejection hietologic findings
Lymphocytic interstitial infiltrate
C4d deposition
Neutro infiltrate
Necrotizing vasculitis
Chronic transplant rejection hietologic findings
Vasc wall thickening
Interstitial fibrosis
Atrophy
Main cause of SCD in young adults
HCM
HCM form of inheritance
Autosomal dom
Which Ca blocker do not affect cardiac musc (contractility, conduction)
Dihydropyridines
*will only cause vasodilation
Transposition of great arteries (pulm art behind Ao) is due to embryonic failure of
Spiraling of aopulm septum
How to treat beta blockers OD and mec
Glucagon -> Gprot-> cAMP increase -> Ca release-> HR, contractility and CO improvement
Peripheral neuropathy + HF (beriberi), think of
Thiamine (B1) def
Hemosiderin-laden macrophages (brown cells) are seen in the context of
Chronic passive lung congestion
*decrease LVS fx
Phenylephrine mec and use
a-1-agonist that increases peripheral vascular resistance but without direct effect on heart. VR increases and baroreceptors activate PSNS lowering HR
Septic shock
NB with cyanosis and narrow mediastinum, think of
Transposition of great arteries (parallel and systemic circuits)
Cryptogenic stroke features
Evaluated with ecocardio bubble study: microbubblea seen in left heart
Associated to PFO and ASD (septal probs)
What hemodinamic mec helps with forward flow in MR?
Decrease SVR
Vasospatic angina features
<50 yo without RF for CAD
Self-limited Chest pain after 10-15min
Due to Endothelial dysfunction
Smoking is main RF
Ascites as a result of RHF will have what portal capillaries parameters?
High hydrostatic P
Normal oncotic P
Normal capillary perm
Which factor stimulates fibrosis?
TGF-b
In the context of hipovolemia which lab findings are likely to increase
Hto
Alb serum
Uric acid serum
How does on recognize tRNA?
RNA 90 nucleotides long with high chemically modified bases and cloverleaf-like structure. CCA is 3’ end molecule
Proximal redial N injury will cause
Wrist drop (can’t extend wrist) and absent tricipital reflex
What drugs can cause aplastic anemia
Carbamazepine, valproic acid
Chemo
Immunosuppressants
Sulfonamides
Detrusor musc contraction causes ___ and its relaxation __
Urination
Urine retention
Midline neck mass that moves upward when swallowing or protruding the tongue, think of
Thryroglosal duct cyst (incomplete obliteration)
Acute facial flushing following accidental vitamin ingestion is highly suggestive of
Niacin (B3) toxicity. (Nicotinamide adenine precursor)
Best dg test for trichomonas
Wet mount saline microscopy
Lung vol changes in preterm NB with RDS
Low compliance
Low functional residual cap and total lung cap
High airway resistance (inflammation and edema from pneumocyte injury)
Genital ulcers diseases:
Single painless
Multiple painful vesicles
Deep purulent and painful
Painless, no lymphad, serpiginous
Syphilis
HSV
Chancroid (H. ducreyi)
Granuloma inguinale (donovanosis)
HSV tto
Valacyclovir indefinitely
Mania or major depressive sts + hallucinations/ delusions, think of
Schizoaffective disorder
Hospice care is provided to
Terminally ill pts with <6 mo prognosis
Tto is no longer beneficial/desired
Irreversible decline
Only opioid drug that is a partial opioid agonist but has very high affinity, Can end up acting as an antagonist and produce withdrawal sts
Buprenorphine
Pt who ate fava beans or took dapsone recently, presents with anemia, suspect___ and expect___ in blood work
G6PD def
High reticulocyte count, high lactate dehydrogenase, low haptoglobin, Heinz bodies (denature Hb)
Most common trigger in AFib
Pulm veins
Most common trigger in AFib
Pulm veins
What does positively skewed distribution mean?
Mean is greater than mean and mode
Gout producing conditions
Lympho/ Myeloproliferative
Tumor lysis
CKD
Diuretics
HVB carrier presents with rapidly progressive anorexia, nausea, abdo pain, jaundice, tender hepatomegaly, think of
HDV superinfection
Why does HDV need HBV to infect?
HDAg must be coated by external coat HBsAg
Unilateral bloody breast discharge, think of ____. Microscopy expected___
Intraductal papilloma
Epithelial cells lining fibrovasc cores
What organisms are cephalosporin resistant?
MRSA
Listeria
Enterococcus
Mycoplasma
Chlamydia
Baby with Failure to thrive + developmental delay + orotic acid crystals, think of __. Supplement with
Hereditary orotic aciduria.
Uridine
Wilson’s disease causes
Hepatic, neurological (slurred speech, altered gait) and psychiatric symptoms
ToF produces 4 defects, these are
• RVOT obstruction
• Ventricular septal defect
• Overriding aorta
• Concentric RVH
Hepatic Angiosarcoma is rare but it’s almost always associated to
Old man >60
Vynil chloride exposure
Hepatic Angiosarcoma is rare but it’s almost always associated to
Old man >60
Vynil chloride exposure
Graft-vs-host disease usually occur after__. Cells involved are__
Bone marrow transplant or lymphocyte-rich organs (liver) transplant
Graft T cells against Host MHC Ag
Absent Achilles reflex, nerve root affected is
S1
Absent Patellar reflex, nerve root affected is
L2-L4
HOX genes are in charge of coding prots that
Bind regulatory regions on DNA of target genes that participate in segmental org of the embryo
NB with cleft-palate, polydactylia, umbilical hernia , focal lesion on scalp, microophthalmia, think of
Patau sd (trisomy 13)
The metanephric blastema and diverticulum give rise to
-Glomeruli (all its parts), Bowman space.
-Major and minor calyces, collecting system, pelvis and ureters
Sickle cell trait (heterozygous) pte are different to homozygous sickle cell disease pte bc
HbA remains higher than HbS throughout life making the pt usually asymptomatic and normal RBC, Hb and reticulocyte count
Staph exotoxins produce a toxic shock sd due to
binding of toxins to large amounts of T-cells which release massive amounts of cytokines
Only cytokine with anti-inflammatory properties
IL-10 (protective in Crohn’s disease)
Narcolepsy key features
Cataplexy (loss of musc tone with strong emotions)
Low hypcretin-1 in CSF
Sleep paralysis and hallucinations
Which organism can produce a mono-like sd with a negative aglutination test (no heterophile Ab-horse erythrocyte aglutination)
Cytomegalovirus (immunocompetent)
HHV-6, toxoplasmosis
Which insurance option is preferable for paying low monthly premiums (payments) and copayments)
Health maintenance org
*con: no access to out-of-network providers
Pros and cons of “Preferred provider org” insurance
Pros: very flexible chioces for both in or out network providers
Cons: very high premiums and deductibles
Pros and cons of “Point of service” insurance plan
Pro: access to out of network providers
Cons: higher premiums than HMO and high prices if pt indeed goes to out-of-network providers
Coccidioides features
Southwestern US (Arizona, New Mexico,California, Texas)
Transmision by endospore inhalation
Acute pneumonia or flu-like sts + erythema nodosum
Meningitis
Niemann Pick disease buzz words
Ashkenazi Jews
Lysosomal storage disorder
Sphingomyelinase def->phospholipid accumulation-> hepatomegaly, splenomegaly, neuro sts, retinal opacification
Isolated mitral stenosis vs combined mitral and Ao valve disease
MS: Backward blood transmission-> pulm HT
MS/Ao: increased LVDP
Neuropathologic findings in frontotemp dementia ?
Tau prot inclusions
Neuropathologic findings in Lewy bodies dementia ?
Alpha synuclein
Integrase inh antivirals inhibit viral replication via
Preventing synthesis of mRNA
Mycobacterium T main virulence factor
Serpentin cord formation (prevents macrophage-med destruction and makes granulomas)
Supplement breast-feeded babies with
Vit D
Vit K
Iron (from 4mo until solid food introduction)
Lower cutoff in a quantitative dg means
More ppl with disease will test positive (high sensitivity, low specificity )
Small engagement ring inside RBC, think of
Plasmodium falciparum trophozoites
Best tto for malaria
Artemisinin
Specific marker for Primary biliary cholangitis
Antimitochondrial
Specific marker for autoimmune hepatitis
Anti smooth musc
Immuno def pt with necrotic ulcer and surrounding erythema, think of __ caused by__
Ecthyma gandrenosum by P. aeruginosa
When the inheritance expected freq < actually inherited freq, it is called
Linkage disequilibrium
Sulfonylureas mec
Stimulate endogenous pancreatic insulin secretions (elevate c-peptide level) indep of blood glucose levels
Pt with outpouching from lieum with a fibrous band connected to umbilicus, hematochezia and intestinal obst signs, suspect
Meckel diverticulum
Chronic lung transplant rejection is marked by submucosal lymphocytic inflammation in the
Walls of the small airways leading to bronchiolitis obliterans.
In order to be recognized, stop codons (UAA, UAG, UGA) must
Reléase factor 1
In order to release catecholamines, which NT is needed to activate chromaffin cells in the adrenal medulla?
ACh
Extrapulm features of cystic fibrosis ?
Pancreatic insufficiency
Azoospermia
Failure to thrive
Most common liver neoplasm in children
Hepatoblastoma
4 top metastasis places
Lymph nodes
Liver
Lungs
Bone
Why can fibrates produce gallstones ?
fibrates inhibit cholesterol 7a-hydroxylase which reduces bile acid production
Cholesterol synthesis deps on
Thiolase and HMG-CoA
Teenage girl with amenorrhea, normal secundary sexual features and cyclic abdominal pain, think of
Imperforate hymen -> blood obst -> hematocolpos (bulge in vagina, palpable ant to rectum)
Immunocompromised with Spherical yeast with thick capsule seen on India ink staining, think of
Cryptococcus
Esophagitis in immunocompromised features of Candida a, HSV, CMV
Ca: grey/white patches
HSV: small, punched-out (distinct) ulcers and intranuclear eosinophilic inclusions
CMV: large, linear ulcers
dihydrobiopteridine reductase deficiency affects
Catecholamine, tyrosine and serotonine production
Phenylalanine accumulation
N. gonorrheae reinfection main cause is
Antigenic variation
Cyclosporine and tacrolimus are the most common immunosuppressants used in transplantation. They act inhibiting
Calcineurin -> no NFAT actv-> no IL-2 -> no T cell stimulation
Which protein defect is associated with metastasis?
E-cadherin
Which papillary musc is more likely to become ischemic after a MI? Why
Postmedial
Deps on a single artery (posterior descending artery, a branch of the right coronary artery or left circumflex artery)
Consequence of excessive oxygen supplementation
Blood flow is redirected from well ventilated alveoli-> No CO2 exchange -> increasing dead space -> ventilation-perfusion -> Oxygen-induced hypercapnia
Blunt abdo trauma commonly involves
Liver and spleen
Less commonly kidneys
Assessment of pt’s decision making capability. Before discharge pt must be able to:
Communicate choice
Understand info
Appreciate consequences
Rationale (explain his decision)
Infective endocarditis pathogenesis (steps)
Disruption normal endocardial surface
at areas or max blood flow
Fibrin deposition/nidus
Microorg colonization of nidus
*staphylo can affect normal or previously damaged cells
Major depressive disorder sts are in SIGECAPS which mean
Lack of Sleep, interest, energy, concentration
Guilt
Appetite disturbances
Psychomotor retardation/agitation
Suicide ideation
Both Takayasu and temporal arteritis are large-vessel vasculitis. Key differences
Takayasu: Female, <40, Ao branches, constitutional sd, claudication, pulse discrepancies (weak pulses), bruits, myalgias, arthralgias
Temporal: ppl >50, carotid branches, visual probs, headache, jaw claudication
Histopathology of Takayasu arteritis
Granulomatous inflam of arterial media
Transmural fibrous thickening
Which org cause head and neck squamous cell carcinoma
EBV: Nasopharyngeal. Has neck mass + nasal obstr + unilat ear effusion
HPV (16 and 18): Oropharyngeal. Young. Persistent throat pain + tonsil lesion
Vasooclosive pain in sickle cell disease is due to
HbS allows hydrophobic interaction among hemoglobin molecules
a p value <0.05 is ___ and >0.05__
Statistically significant
Non-statistically significant
I’m cystic fibrosis mutations of CFTR causes
Abnormal prot folding
Urethral folds evolution in males and females
Males: ventral aspect of penis (failure creates hypospadias)
Females: labia minora
Epispadias vs hypospadia
Epi: faulty positioning of the genital tubercle
Hypo: faulty closure of urethral folds
Cryptorchidism
Descend failure of testis into scrotum
Multiple myeloma tto aims to ___ or ___
inhibit proteasome activity (bortezomib) or increase ubiquitination (lenalidomide)
Girl with hypotension and posterior loss of consciousness after vaccination, think of
Vasovagal syncope, induced cardioinhibitory and vasodepressor response.
Before operations, the following should be done
marking the operative site, independent verification of the patient, procedure, and site by 2 health care workers (a nurse and physician)
Which molecule has an important role in granuloma formation?
Interferon-gamma
Oppositional defiant disorder vs normal teen behavior
In ODD oppositional behavior is excessive in freq and duration (6mo or more)
Increase Pol gene mutations mean
Inconsistent use of antiretroviral therapy.
Symmetric pitting edema with frothy urine and history of NSAIDs use, think of
Nephrotic sd, membranous nephropathy
Competitive vs noncompetitive antagonists curve
C: E50 increases (curve moves to the right)
N: Emax decreases (curve is lower but doesn’t move)
Ao root dilation (ao aneurysm rel) is one of the most common causes of
Chronic Ao regurgitation
Blood-testis barrier is composed of
Sertoli cells joined by tight junctions
Antisperm bobies Can be the result of damage to the
Blood testis barrier (due to trauma or ischemia)
E. Coli virulence factor for UTI
P-fimbriae
E. Coli virulence factor for neonatal meningitis
Capsular polysaccharide
Virulence factor that plays major role in septic shock
Lipid A
Lack of thiamine B1 produces
Neuro sts (beriberi, wernicke-korsakoff)
Lack of thiamine B1 produces
Neuro sts (beriberi, wernicke-korsakoff)
Lack of Riboflavin B2, produces
Cheilosis, stomatitis, glossitis, normocytic anemia
Lack of Niacin B3, produces
Pellagra (3 d’s)
Lack of biotin B7, produces
Dermatitis, conjunctivitis, alopecia, neuro changes
Lack of Ascórbico acid Vit C, produces
Scurvy (gingivitis, petechiae, musc pain, hemorrhage due to impaired wound healing, corkscrew hairs)
What is transformation in bacteria?
Direct uptake of extracell DNA from a dying neighbor bacteria that allows them to gain virulence
Which bacteria can undergo transformation?
Haemophilus, Streptococcus, Bacillus, and Neisseria species.
Impaired ornithine transport affects hepatic urea cycle which causes ammonia to accumulate. Restriction of ___is the main Tto
Protein
Widely, fixed and split S2 + systolic ejection murmur at left upper sternal border, think of
Atrial septal defect
Pt with headache, diplopia, unable to move eye in any direction, fever , loss of upper facial sensation and corneal reflex. Think of
Cavernous sinus trombosis (usually by stapth)
*not brainstem infection cause there are no crossed signs, vertigo, ataxia
Vasovagal syncope pathophysiology
Increased PSNS tone
Transudative pleural effusion features
Low prot <0.5
Low LDH <0.5
Normal glucose
Common in HF, cirrhosis, nephrotic sd
Dog bite bacteria
Pasteurella multocida
Pasteurella canis
Capnocytophaga canimorsus
Cat bite bacteria
Pasteurella multocida
Bartonella henselae
Human bite bacteria
Eikenella corrodens
Group A Streptococcus
Which structure is commonly injured in thoracic and neck procedures?
Thoracic duct
Lung Mass + constitutional sd+ progre prox weakness (from legs to arms) + diminished reflexes, think of
Paraneoplastic Lamber-Eaton myasthenic sd
Lamber-Eaton myasthenic sd is produced by
antibodies against presynaptic voltage-gated calcium channels -> no Ca+2 influx -> less ACh released -> no musc contraction
Which myopathy is mostly associated to paraneoplastic sd
Dermatomyositos
*specially rel to adenocarcinoma
Which org reqs salt for growth, is oxidase (+), gram-neg and comma shaped
V. Cholerae
What enzyme makes the sputum green in bacterial infection?
Myeloperoxidase
Cross-species influenza infections deps on
Hemagglutinin, surface glycoprotein
Mitral regurgitation BP curve, describe
Left atrium curve peaks near mitral valve closing
Mitral stenosis BP curve, describe
LA curve makes “wave pattern” and moves upwards as a whole
Ao regurgitation BP curve, describe
Ao curve decreases prominently at valve opening and closing. Still peaks with LV curve tho.
Anticholinergic toxicity sts
Hot as a hare
Dry as bone
Red as beet
Blind as a bat
Mad as a hatter
Full as a flask
Fast as a fiddle l
Ao stenosis BP curve, describe
Ao curve does not peak with LV curve
Drug given to counteract antiACh toxicity
Physostigmine (cholinestease inh -> more ACh available)
CD40 fx
On activated CD4 T cell surface, key for signaling APCs( B cells make germinal center and switch class; Macrophages and dendritic make cytokines, MHCII and increase phagocytosis)
Colitis rel colorectal Ca vs sporadic colorectal carcinoma
Colitis rel Ca: <55 yo, nonpolypoid, prox>distal, multifocal, multiple mucinous, early p53 but late APC mutation
Sporadic: the opposite
Esophageal squamous cell carcinoma pt profile
Male, >50yo, smoking and OH use history and dysphagia
Which ribs are associated to the spleen and kidneys
Spleen: 9-10-11 (post sup portion of left abdominal cavity)
Kidneys: 11-12
While total serum AlkP levels may be unspecific, high serum levels indicate
High osteoblastic activity (promotes bone mineralization)
Cholecystokinin fx
Increase secretion pancreatic enzymes and HCO3
Pt with watery diarrhea, hypoK, achorhydria, what enzyme is prob def?
Vasoactive intestinal peptide (think of VIPoma)
Alanine transamination steps
- Amino group-> a-keroglutare-> Glutamate is formed
- Glutamate-> glutamate dehydrogenase-> ammonia
- Ammonia-> urea cycle-> urea
Neurologic disease rel to cystic degeneration of the putamen
Wilson’s disease
Structure affected by Hungtinto’s disease
Caudate nucleus
What’s used to prolong the duration of action of local anesthetics?
Epinephrine (vasoconstriction-> less blood flow -> more of the drug remains in place)
Niemann-Pick vs Tay-sachs disease
Common: Ashkenazi jews, cherry red macula, recessive
Pick: Sphingomyelonase def, areflexia, hepatosplienomegaly
Tay: B-hexosaminidase A def, huperreflex, normal abdo exam
Corneal reflex nerves
CN V1 with CN VII
Cough reflex nerves
CN X
Gag and carotid sinus reflexes nerves
CN IX and X
Jaw jerk reflex
CN V3
Granulosa cell tumor of ovary features
Unilat adnexal yellow mass in post-meno woman (>45yo)
Estrogen producer -> Post-meno bleeding
Cuboidal granulosa cells with eosinophilic material
Yolk sac ovarian tumor buzzwords
Schiller-duval bodies that resemble glomeruli
Young women
a-fetoprotein
Polysaccaride (capsule) vaccine vs Polysaccaride-prot conjugated vaccine
- Only B cell resp, for kids >2yo
2.B and T cell resp, kids <2yo (need extra help due to immature humoral immunity)
Amanita mushroom toxicity mec
mRNA synthesis inh
14 yo girl with external female genitals but int male ones, dg
5-a-reductase def
Immunocompromised with nucal regidity, CSF will most likely reveal___ typical of___
Lancet-shaped gram-positive cocci
Strepto pneumoniae
Bulimia Nervosa tto
CBT
Nutri rehab
Fluoxetine (SSRI)
Anorexia nervosa tto
CBT
Nutri rehab
Olazapine
Classic histopathological findings of Alzheimer’s
amyloid plaques and neurofibrillary tangles. Neuritic (senile) plaques in medial temporal lobes
Corkscrew hairs are seen in scurvy due to impaired ___ in ___
Collagen synthesis in RER (Vit c needed for hydroxylation of proline and lysine)
Hyper- igE sd features
-Auto dom
-Jak-stat defective -> less Th17-> reduced neutros
-Chronic eczema, recurrent non-inflam abscesses and sinopulm infections
-only igE is elevated, rest Igs ok
Subfalcine herniation features
Beneath falx recerebri
Contralat leg weakness
Uncal herniation features
Under tentorium cerebelli
Ipsilat dilated and fixed pupil
Hemiparesis
Miltinone is a selective PDE-3 inh that causes
Ca reputable and increases intracel influx -> positive inotropy and vasodilator
Which artery is anatomically related to the splenic artery?
Short gastric
In Klinefelter sd gynecomastia is produced due to
Lack of inh of LH/TSH due to defective Leydig cells and and low inhibin levels -> low testo
Months old baby girl with developmental regression and stereotypic hand movements, dg
Rett sd
Drooping of shoulder, no abduction pass 100 degrees, lat scapula displaced, musc hurt is
Trapezius
*Deltoid is pass 30 degrees
Improved ventilation in prone positioning occurs due to
Less compression from heart and other organs-> alveoli opened, ventilation is more evenly distributed
*Better V-P matching
Pt with history of caries or recent dental extraction, Indurated mass, no pain, think of ___. Main feature is
Actinomyces
Filamentous, branching, gram-positive bacilli
Fat embolism main RF
Long-bone fx
Pt with poor night vision, visual field loss, and funduscopic changes (pigment accumulation, optic disc pallor, retinal vessel attenuation) consistent with
retinitis pigmentosa, a genetic disease characterized by progressive dystrophy
