Mixto 2 Flashcards
Consider Antisocial personality disorder if
> 18 yo
Evidence of conduct disorder before 15yo
Testo, DHT and AMH effect on male genital formation
Testo-> Wolffian duct to int male genitalia development
DHT -> ext male genitalia devp
AMH-> suppresses int male geniatalia
Pt with cyanotic after Invasive vasc procedure (angiography), think of
Cholesterol (needle-shaped) containing debris that obstruct arteries
HLA class l vs ll (disease association)
HLA class ll -> RA, DM I, celiac disease
HLA class l-> Ankylosing spondylitis, reactive arthritis, arthritis with inflammatory bowel disease, and psoriatic arthritis
Leptin fx is
Decrease food intake
Gabapentin mec
Inh presynaptic Ca channels
First mediator to make effect in type l hypersensitivity
Histamine
CCK fx
Pancreatic secretion
Gallbladder contraction
Oddi sphincter relax
Decrease gastric emptying
Expected number of words by 18mo old
3 or more + dada and mama
Expected number of words by age 2
2 Word phrases
Wiskott-Aldrich sd features
Recurrent infections that worsen with age
Easy bleeding
Eczema
Chédiak-Higashi sd features
• Oculocutaneous albinism
• Pyogenic infections
• Progressive neurologic dysfunction
DiGeorge sd features
• Congenital heart disease
• Dysmorphic facies
・Hypocalcemia
Power formula
1 - Error type ll
Elastin properties are due to
Interchain cross-links involving lysine
Lamgerhans cells are
Dendritic cells, antigen presenting, interact with T cells. Have racquet shape and intracytoplasmic granules
HBeAg, anti-HBc mean
1)Increased replication and infectivity
2) no replication, low infectivity
HBsAg vs AntiHBsAg
1) first marker to appear after HBV inoculation
2) successful HBV vaccination
Isolated hand twitching that progressed to bilat tonic-clonic seizure is characteristic of ___ and it comes from ___
Focal-onset seizure
A single hemisphere
Polyarteritis nodosa key Words
Fibrinoid necrosis in medium-sized musc arteries (kidneys, skin, brain, gastrointestinal tract)
Presents with tissue ischemia/bleeding
Mucormycosis features
Caused by Mucor, Rhizopus and Absidia.
Associated to DKA, immunosuppressed.
Presents with paranasal sts (peri orbital pain, headache, discharge)
Nonseptate hyphae with 90 degrees branch
Chest XR findings in viral pericarditis
Enlarged globular cardiac silhouette with clear lung fields
M protein is a virulence factor that prevents ipsonization used by
Group A strep
Major virulence factor in gram-Neg rods
Lipopolysaccharide endotoxin
The use of fibrinolytic (thrombolytic) agents like alteplase, tenecteplase or streptokinase can cause
Reperfusion-related arrhythmia
Abdo Ao aneurysm vs Acute mesenteric ischemia
AAA: acute severe abdo pain, syncope, hypotension, shock. Smoking, male, >60yo
AMI: severe abdo pain but minimal tenderness, no shock/hypotension
Fibular neck fracture will likely cause
Common fibular nerve damage:
-unable to evert foot, loss of sensation on foot dorsum (superficial branch)
-unable to dorsiflex foot and toes (deep branch)
Opioid antagonists that doesn’t cause withdrawal sts
Methylnaltrexone
What’s Hawthorne effect in statistics?
tendency of study subjects to change their behavior as a result of their awareness (observer effect)
What’s Pygmalion effect in statistics?
researcher’s beliefs in the efficacy of treatment can potentially affect the outcome
What’s Berkson’s bias in statistics?
Selection bias
Why is there a relationship between sarcoidosis and kidney stones?
Increased alpha-1- hydroxylase activity -> increases 1-25 hydroxy Vit D
Meningococcemia main complications
Septic shock
DIC (petechial rash, mucous memb bleeding and venipunture bleeding)
Waterhouse-Friderichsen sd: Adrenal hemorrhage/ adrenal insufficiency
Facial nerve injury central vs peripheral
Peripheral affects forehead
Central (UMN) spares forehead musc
Facial nerve innervates
Face musc
Ant 2/3s taste of tongue
Parasympathetic innerv to lacrimal, submandibular and sublingual salivary glands
Stapedius musc in ear
Bell palsy is
Complete ipsilat facial nerve palsy
Rel to reactivation of HSV
Main features Yolk sac tumor
SAC:
Schiller Duval bodies (glomeruli-like figures)
Alpha-feto protein (AFP) increased
Children affected most commonly
From all germ cell tumors, which is not associated to high AFP or hCG
Teratoma
Dextromethorphan is a common ingredient of antitussives which blocks N-methyl-D-aspartate (NMDA) causing dissociation, which other substance is similar ?
Ketamine
In menopause, most common sts are ___ rather than ___
Vasomotor (hot flashes, night sweats) rather than mood or libido changes
Attention-deficit/hyperactivity disorder (ADHD) TTO
Hyperactivity predominance-> treat with dopamine
Inattention predominance -> treat with Norepinephrine
Ovarian hormone secreating tumor features
Granulosa tumor and Tecoma will secrete female hormones and alter menstrual cycle.
Sertoly and leydig tumor will have high Testosterone but no 17-ketosteroids (not adrenal related)
Maximal incidence of recurrent disease acceptable Formulation
(100 - Drug rate) x Standard rate
Acute vs delayed transfusion Rx
Acute: Rx against ABO products
Delayed: Rx against minor RBC antigens
Endurance training affects type ___ fibers which have a lot of ___
I
Mitochondria
Resistance training (weight lifting) amplifies type __ fibers which have low___
II
Mitochondria (glycolytic)
Obturator nerve damage impaires
Thigh adduction
Poxvirus features
Shiny round Papules on trunk and face (children) on genitals/groin (adults) and widespread (immunocompromised)
** microscopy: circles filled with pink litte balls (eosinophilic bodies)
Hardy-Weinberg equilibrium is about___ . Rules are
-Genetic variation remains consistent when there are no disturbing factors
-no mut, random mating, no migration, no natural selection, large population needed
Febrile gastroenteritis (watery diarrhea) and gram-positive rod, think of __. Major virulence factor
Listeria M
Cytotoxic created pores in phagosomes (reqs CD8 resp)
Pte with 1 or more maniac episodes are diagnosed with
Bipolar I disorder
Blood supply to ureters
Prox: renal artery
Distal: int iliac and sup vesical arteries
Decrease integrin expression (typical in malignancies ) will affect binding to ___
Fibronectin
Pearly mass behind tympanic mb, think of___. This is made of__
Cholestoma
Squamous cell debris
Neuraminidase inhibitor (oseltamivir) impair
Virion particle release
Pt with HiV and multiple nodules that bleed a lot when squeezed, HHV-8 is neg, think of
Bartonella h
Crossover studies
Subjects receive 2 or more sequence tto
If after vasopressin is administered, urine osmolality remains the same, think of
Primary polydipsia
Coag factor Vlll binds
Factor laxa and X to create factor Xa
Papillary thyroid carcinoma biopsy
Branching papillae
psammoma bodies (concentric calcifications)
Nuclei with dispersed chromatin
Nuclear grooves and intranuclear inclusions
Subacute granulomatous Thiroiditis (de quervain) features
Post infection
High T3 and T4
High TGb
Low iodine uptake
Mixed cell infiltrate + giant cells +disrupted follicles on biopsy
Graves’ disease biopsy
Follicular hyperplasia with tall cells projecting into follicular lumen
Hashimoto’s diseases biopsy
Lymphocytic infiltrate active with germinal centers
Most common cause of primary adrenal insufficiency
Autoimmune adrenalítis
Primary adrenal insufficiency key feature
Hyperpigmentation
(Not seen in 2ary due to tumor)
Glucokinase deficiency are one cause of__, characterized by
MODY
Mild hyperglycemia worsened by pregnancy-induced insulin resistance
Leuprolide mec
GnRH analogue that first stimulates and then down regulates production of LH
Permanent central Diabetes insipidues occurs as injury to
Hypothalamic nuclei
*damage to post pituitary is transient due to regeneration capacity
Deficiency of which enzyme is associated with abnormal male ext genitalia
5a-reductase
Which enzyme def is associated with female virilization
Aromatese (forms estrogens from androgens)
Rapid acting insulins are
Lispro and aspart
*postpandrial hyperglycemia
Long acting insulins are
Degludec
Detemir
Glargine
Weight loss hypoglycemics
GLP-1 agonists
SGLT-2 inhibitors
Pt with severe sistemic illness, low T3, normal/low TSH, normal thyroid physical exam, think of
Euthyroid sick sd
Boy with normal secundary characteristics but abnormal genitalia
5a-reductase def
Female looking male pt with abnormal genitalia (blind vagina)
17 a-hydroxylase def
If 2-6 fructose biphosphate is increased, ___ pathway will too because___
Glycolisis
It increases PFK-1
Thyroid peroxidase (TPO) fx
Iodide oxidation
TGb iodination
MIT-DIT DIT-DIT coupling
Glupizide is a __ which means it acts via __
Sulfonylurea
K channel inhibition -> depol-> Ca increases -> insulin secretion
PCSK9 inh like Evolocumab help statins via
Decrease of LDL-R degradation-> more LDL-R on cells -> more LDL uptake in liver
Menopause average age is __, confirmed with high levels of __
51
FSH
Urine turned black when left exposed to air, think of __ which affects conversion of __ into__
Alkaptonuria/homogentisic acid accumulation
Tyrosine into fumarate
Cushing sd + high/normal ACTH. Differential dg and tests
Pituitary adenoma: if ACTH is suppressed after high dose dexametasone.
Ectopic tumor: if still remains the same after dexametasone test
Effect of glucocorticoids on Graves ophthalmopathy
Anti-inflam
CF is associated to ___ due to pancreatic fibrosis
Diabetes
Aluminum hydroxide effects
pH increase
Constipation
Esophagus irrigation
Prox: thyroid artery
Mid: thoracic Ao branches
Distal: left gastric artery
Lynch sd features
Hereditary nonpolyposis colon cancer
Due to defective nucleotide mismatch repair system (mut genes MSH2 and MLH1)
Infant with descending weakness, absent gag reflex, history of honey consumption, think of __. *Mec__
Infant botulism by Clostridium b
*toxin blocks presynaptic ACh release.
Extensive noncaseating hepatic granulomas, think of
Hepatic sarcoidosis
Pseudomembranous colitis features
Adherent yellow pseudomemb
By C. difficile
Gilbert Sd features
Decrease UDP UGT activity but not absent
Mild jaundice
Provoked by stress
No tto needed
Increased and incomplete relaxation of LES, think of
LES
Hyperammonia effect on encephalopathy and key elevated molecule
Excess NH3 -> excess glutamine production to bind -> less glutamate synthesis-> disruption of excitatory conduction
Hepatic abscess in the USA are rare but when seen, they’re usually caused by
Bacterial infections
Acute viral hepatitis B histopathologic findings
Panlobular lymphocytic inflam
Cytotoxic T cells
Eosinophilic round bodies
Crohn disease is associated to gallstones because of
inflamof the terminal ileum causes decreased bile acid reabsorption -> bile acid wasting in feces.
Superficial inguinal nodes drain
Most cutaneous lymph from umbilicus down including anal orifice
Graft versus host disease is similar to primary biliary cholangitis because
It’s immune mediated
Destructs intrahepatic drugs after bone marrow transplant
Most specific ultrasound findings in cholecystitis__. If not clear, try___
-gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign.
-Failed gallbladder visualization on
radionuclide biliary scan
Vit K def impaires __
Gamma carboxylation of coag factors
Pancreatic ductal adenocacinoma is caused by a mut of
KRAS gene
Well demarcated liver mass, nodular with a central, gray-white, depressed stellate scar from which fibrous septa radiate to the periphery, think of
Focal modular hyperplasia (benign)
What happens when there’s testicular trauma?
Damage to blood-testis barrier (sertoli cells + tight junctions) -> antisperm antibodies
Homeobox gene (body pattering and positioning reg) mechanism
Coded transcription factors that bind regulatory regions on DNA
deficiency of IL-12 receptors on naive T cells prevents
differentiation into Th1 cells -> no IFN-gamma -> no macrophage and CD8 activation
IL-4 deficiency prevents
Formation of Th2 cells is-4 -> no B cell differentiation -> no production of immunoglobulins.
Porphyria is characterized for a deficiency of___
Porphobilinogen deminase
Porphyria is treated with heme infusion which downreg
Aminolevulinate synthase
When studying the difference of two groups, istatistically significant means that
The confidence interval doesn’t pass 0 (null value)
Statins mec
Inhibition of HMG-CoA reductase -> less cholesterol synthesis-> more LDL receptors-> more uptake of circulating LDL
Tetanus mec
Puncture wound-> presynaptic terminal lower motor neurons -> retrograde axonal transport-> ant horn -> toxin blocks inhibitory neurons -> spasmodic contractions
Only tissue where there increase in vasc resistance when O2 goes down ___. This prevents ___
Lungs (hypoxic vasoconstriction)
Perfusion wasting
Androgen insensitivity sd features
Androgen receptor dysfunction (high LH and testosterone, normal FSH)
Complete: female body and genitalia
Partial: undervirilization, gynecomastia, oligospermia
Pool/beach fungus
Malassezia versicolor (pityriasis)
Which adverse effect persist even after weeks of opioid tto ?
Constipation
Miosis
Amyloid seen under polarized light looks __ but in Alzheimer’s it looks
Apple-green
Yellow-green
Aggregates of tau protein in brain, think of
Pick bodies from frontotemporal dementia (Pick disease)
Huntington disease affects
Caudate nucleus
Intracel eosinophilic inclusions composed of alpha-synuclein (lewy bodies), think of
Párkinson
Xeroderma pigmentosum features
Failure to repair DNA damage by UV-rays (thymine dimers) via specific nuclease
Suspect Pancoast tumor when there is
Unilat upper limb pain (compression braquial plexus)
Areflexic weakness
Ipsilat ptosis/miosis (autonomic injury)
2 key factors for osteoclast differentiation un Paget’s disease
Macrophage colony-stimulating factor (M-CSF) and receptor for activated nuclear factor kappa-B ligand (RANK-L),
What can help with empyema after chest tube drainage
Fibrinolytic agent + deoxyribonuclease
Surgical drainage
Which Folate derívate is crucial for nucleic acid synthesis and to prevent apoptosis
Thymidine
Sporotricosis (rose disease) histopathologic finfings
Mixed granulomatous and neutrophilic inflammatory reaction
Sts in Myasthenia Gravis can be explained by
Reduced amplitude of motor end plate potential (post synaptic musc cell)
Drugs used in muscarinic toxicity
Glycopyrrolate
Hyoscyamine
Propanthrline
Mononucleosis (EBV) features
Fever + fatigue + lymphocytosis + splenomegaly
Transmitted via saliva (kiss disease)
Attention deficit medication
Stimulants: methylphenidate, amphetamines
Non-stimulants: atomoxetine**
Genetic features of down sd
Trisomy- meiotic non disjunction
Unbalanced translocations
Mosaicism (some cells have the trisomy, some others do not)
Pyridoxine (B6) is needed in
Transaminayion and decarboxylation of aa
Gluconeogenesis
NTs, heme and histamine synthesis
Biotin (B7) is a cofactor of
Carboxylase enzymes
*pyruvate (gluconeo)
*acetyl-CoA (fatty acid synthesis)
*propionyl-Coa (fatty acid oxidation)
Contact dermatitis features
Hair dye or other alkergenics
Type lV hypersensitivity
Phase 1/sensitization: langerhan cells take haptens and present them to naive T cells
Phase 2/ elicitation: CD8+ activate and release interferon gamma when happen is reexposed
2nd generation antipsychotics have less___ than high potency 1st generation (haloperidol)
Extrapyramidal sts
Pt with generalized rash + lymphadenopathy + corkscrew-shaped organism on dark microscopy, think of
Secondary syphilis
Penicillin in syphyliis mec
disrupts cell wall synthesis by inhibiting transpeptidase, necessary for cell wall cross-linking.
Salicylate toxicity is treated with HCO3 because
It converses it to lipophobic salicylate ion (Sal-) and traps it in the bloodstream
It increases its expretion in urine
Dopamine dose dep effect
Low dose: increases cardiac output and renal blood flow (beta 1adrenergic receptor stimulation)
High dose: opposite (alpha1 stimulation)
Opioid toxicity will occur if there is a problem with ___ elimination bc metabolites start to accumulate
Renal
(Metabolized in liver but excreted renally)
Niacin (B3) is req in reactions that use
NAD and NADP
Marker of monocyte-macrophages in TB granulomas
CD14
Branching, filamentous gram positive with similar TB presentation, think of
Nocardia
Nocardia key features
Branching filaments + my colic acid wall (partially acid-fast staining)
Embryologic development probs in Tetralogy of Fallot
Abnormal neural crest cell migration -> ant and cephalad deviation of the infundibular septum = malaligned ventral septal defect and overriding aorta.
Transpeptidases are
A type of PBP targeted by penicillins and cephalosporins
ATB that binds to cell wall glycoproteins
Vancomycin
ATB that interfere with DNA replication binding to ADN gyrase
Fluoroquinolones
Optimal site for femoral nerve block in case of quadricep injury
Right bellow inguinal ligament
Pudendal nerve block site for vaginal delivery
Ischial spine tip
Lung biopsy with large, rounded, well-circumscribed “cannonball” cell, probable metastasis from ___
Kidney
* Renal clear cell carcinoma
Long term OCPD complication
Secundary polycythemia (increasing EPO)
E.coli and Shigella have in common ___, capable of ___
Shiga Toxin
Ribosomal 60S subunit inactivation-> Protein synthesis inhibition
V. Cholerae infection mec
increases intracellular cAMP in intestinal mucosal cells -> decreased absorption and increased secretion of Na+, Cl- and water.
Pseudomonas infection mec
inhibition of elongation factor 2 -> no protein synthesis
Right ovarian vein drains into__
Left drains into__
Thrombosis is most common in__
IVC
Left renal vein
Right ovarian vein
Low cortisol, low ALD, high 17-hydroxyprogesterone, think of
Congenital adrenal hyperplasia (low 21-hydroxylase)
Recurrent Respiratory infections + congenital absence of vas deference, think of
Cystic fibrosis
Complicated delivery using vacuum assistance can cause__ due to damage to ___
Subgaleal hemorrhage
Emissary veins (hemorrhage between periosteum and galea aponeurosis)
Infantile hemangioma features
Common
Bright red plaque
Days or weeks after birth
Benign proliferation of endothelial cells
Increases its size and then regresses
Zoloidem and eszopiclone are
short-acting nonbenzodiazepine hypnotic agent.
GABA A agonists
Used for sleeping problems
hemorrhage and necrosis in the mammillary bodies and periaqueductal gray matter, think of
Wernicke encephalopathy.
Thiamine (B1) is a cofactor of
Pyruvate DHG
Alpha-ketoglutarate DHG
Branched alpha ketoacid DHG (needed for aa)
Transketolase
Old age changes in respiratory system
Decreased chest wall compliance/mobility
Decreased alveolar elastic recoil
Increased alveolar-arterial O2 gradient
Increased dead space
Preeclampsia widespread endothelial dysfunction, vasospasm, microthrombi deposition can produce
Seizures
Renal insufficiency
DIC
FOXP3 function
Converts CD4 into regulatory T cells -> failure keeps immune activation going
Nitrates must be given in intervals throughout the day because of
Tolerance development
Opioid induced constipation can be treated with
Methylnaltrexone (does no cause withdrawal sts)
Bisacodyl and senna help with constipation vía
Enteric nerve stimulation-> increasing peristalsis
Why does preeclampsia cause vascular dysfunction?
early cytotrophoblast invasion is abnormal-> maternal spiral arteries underdeveloped-> not good perfusion to placenta -> low VEGF -> endothelial dysfunction
Tetanus vaccine mec
Humoral antibody response neutralizes bacterial products
Failed obliteration of allantois leads to
Patent urachus and urine leakage from umbilicus
N. meningitidis virulence factor responsable for severity (sepsis)
Lipo-oligosaccharide
Coxiella features
Q fever (lobar consolidation pneumonia is primary sign)
Animal waste inhalation
Severe debilitating retroorbital headaches
Most common cause of retina artery occlusion
Atherosclerosis in the internal carotid
Pseudogout key features
High WBC count with neutro predominance
Rhomboid shaped calcium pyrophosphate crystals
Blue when parallel, yellow when perpendicular
DNA mismatch repair defect is associated with
hereditary nonpolyposis colorectal cancer (HNPCC, or Lynch syndrome).
Nucleotide excision repair failure is associated with
Xeroderma pigmentosum
Inherited (not acquired) p53 mutations are associated with
Li-fraumeni sd
Superficial vs deep fibular nerve
Superficial everts the foot
Deep dorsiglexes foot and toes
Primary ciliary dyskinesia/Kartagener sd associated diseases
Respiratory infections, bronchiectasis (dilated bronchioles)
Infertility
Situs inversus (organs in opposite sites)
Listeria features
Flagellar tumbling motility
Reproduces in the cold
Transmuted by consumption of contaminated food
Medication induced esophagitis
Tetracyclines
Aspirin
NSAIDs
Biphosphonates
Protein A is a wall component of
Staph A
M Protein is a wall component of
Strepto pyogenes
Toxin A/lecithinase is a virulence factor of
Clostridium perfringens
Trehalose dimycolate is a major virulence factor of
M. tuberculosis
Locked-in sd is associated with
Osmotic desmyelination
Infarction
Class l antiarrythmic effect on Na and K channels
IA: blocks Na, blocks K (most extended)
IB: weak Na block, shortens repol (very short Na plateau, Thinnest curve)
IC: Strong block Na, very little effect on K.
Quinidine, procainamide and disppyramide are
Class IA antiarrythmics
Lidocaine and mexiletine are tú
Class lB antiarrythmics
Flecainide and propafenone are
Class lC antiarrythmics
Organophosphate toxicity or cholinesterase inhibitors toxicity can be treated with atropine. However, it has no effect on ___ meaning ___ can persist
Nicotinic receptors
Muscle paralysis, weakness and fasciculations
Pt with DM and overflow urinary incontinence. Cause?
loss of autonomic afferent innervation -> inability to sense a full bladder.
Loss of efferent fibers to the bladder -> incomplete emptying. (Increase postvoid residual volume test)
TTN gene mutation will likely cause impairs titin protein in charge of binding myosin to z discs. This will likely cause
Familial dilated cardiomyopathy
Dilated cardiomyopathy features
Heart failure sts
Due to direct insult (infection, toxicity or disease) to myocardium -> decreases ventricular contractility
SatO2 in right heart vs left heart
Right: 70% (SVC, RA, RV, Pulm a)
Left: 96% (LA,LV, Ao)
Higher SatO2 on right heart, think of__ likely due to ___ which produces___ , best heard in__
Left to right shunt
Ventricular septal defec
Holosystolic murmur
Lower left sternal border
Atrial septal defect
High SatO2 in SVC, RA and RV have the same Sat
Fixed splitting of S2
1 or 2 month old baby with dark urine, acholic stools, high direct bilirubin and GGT, hepatomegaly, think of
Biliary atresia/obstruction of extrahepatic bile ducts
Hirschprung disease features
NB with bilious emesis after feeding (failure to pass meconium)
Abdo distension with active bowel sound
**Forceful gas/stool expulsion, megacolon (main difference with other similar diseases)
Neural crest cell migration failure -> aganglionic rectosigmoid
Young woman with eye pain worsened by eye movement, decreased vision and optic disc swelling, think of ___. Suspect ___ as main origin of the disease.
Optic neuritis
Multiple sclerosis
Multiple sclerosis diagnosis
• Episodic/progressive symptoms disseminated over time & space
• Hyperintense lesions/ demyelinating periventricular plaques
• Oligoclonal IgG bands on cerebrospinal fluid analysis
Glucosuria begins with a serum glucose of ___
200 mg/dL
Diastolic blood pressure is directly related to ___. During exercise this goes down and so does DBP
Systemic vascular resistance
Piriform recess protects the internal laringeal nerve. Injury to this area will likely affect
Afferent limb of cough reflex
Low fecal elastase, Sudan staining (+), OH abuse, foul smelling stools, diarrhea, epigastric pain after eating, think of
Pancreatic insufficiency
Pterygoid musc innervation
Mandibular nerve (CN V3)
West Nile virus features
Replicates in birds, transmitted by mosquitoes
Flu-like sts, meningitis/encephalitis, asymmetric weakness
Cleft lip and palate is associated to recurrent otitis media due to
Levator or tensor of veli palatini dysfunction-> Eustachian tube dysfunction
Attention deficit desorder features
Innattention and or hyperactivity in 2 or more settings (school and home)
Sts before age 12
Drug induced parkisonism (antipsychotics or antiemetics) is best treated with
Central antiACh like benztropine or trihexyphenidyl
HSV-1 and 2 and VZV are susceptible to acyclovir because
They have viral phosphorylating enzyme which activates the drug
Fructokinase deficiency dg test
Glucose oxidase (-)
Copper reduction (+)
Fanconi sd affects
Proximal tubule
HBV like HIV has
Reverse transcriptase activity
Dengue shock sd is due to
Infection either different viral serotype
Anti-Rh (D) immunoglobulin is a product consists of
IgG
Pts with cryptorchidism have higher risk for which type of malignancy ?
Testicular seminoma
Corynebacterium diphtheriae features
Gram positive
Bacillus
Diphtheria sd
Becomes toxigenic thanks to phage conversion (lysogenic bacteriophage)
AB toxins halt protein synthesis
Majority of anal fissure occur in
Posterior midline distal to dentate line
Pt recovering from sepsis can’t be disconnected from ventilator due to chest wall weakness, think of
Critical illness neuromuscular weakness due to peripheral axon degeneration and loss of myosin (atrophy)
Genitals effect due to complete androgen insensitivity sd
Internal genitals absent
Female external genitals
ANOVA/ analysis of variance is used in studies that
Compare 3 o more groups
Beta-2 agonists help with broncocontriction vía
Increasing cAMP-> smooth muscle relaxation
VPH virulence factor
Production of E6 (blocks p53) and E7 (blocks Rb) -> altogether inhibit cell cycle regulation
Plasmodium ovale and vivax req use of primaquine to prevent
Disease relapse during dormant phase within hepatocytes
Pharmacokinetic vs phamacodynamic tolerance
Kinetic: has to do with ADME: Absorption, distribution (plasma or fat) metabolism (P450c) or excretion problems
Dynamics: has to do with drug target problem (receptor or intracell signaling)
Kid with cognitive/behavioral problems + musc weakness + family member with musc weakness, think of
Myotonic dystrophy (trinucleotide repeat expansion)
What’s main risk factor for pelvic organ prolapse
Vaginal delivery-> injury to pundendal nerve -> no innervation to pelvic floor muscle
Pulm embolism causes what type of hypoxemia?
Ventilation/perfusion mismatch
*typically has respiratory alkalosis
Gastrojejunostomy will req __ supplementation
Iron
Tto of agitation and psychosis associated with delirium
Haloperidol
Neoplasm under nail, suspect ___ or ___
Melanoma (pigmentation rel)
Glomus tumor (thermoregulation rel)
Which parasites have Loos cycle
Strongyloides
Toxocara canis and gatis
Ascaris L
Ancylostoma
Trichuris trichuria
Benign paroxysmal positional vertigo is caused by
Debris in semicircular canals
Elevated endolymphatic pressure, think of
Ménière disease
Zero vs first order kinetics
Zero: constant amount of drug is metabolized and excreted (line)
First: Fixed proportion of drug is metabolized (curve)
Pt with clicking noise when chewing +headache +neck stiffness, think of ___ caused by__
Temporomanfibular joint sd by maser yet and pterygoid spasms
What’s 2nd leading cause of lung cancer in the US?
Radon found in contaminated groundwater affecting basements of houses
Montelukast (-lukasts) mec of action
Antagonist of leukotriene receptors
Pt with ptosis, dysphagia, dry mouth after tasting canned food, think of __ which impaires ___
Botulism
ACh release
H. influenzae features
Oxidase positive
Gram-negative coccobacillus
Some strains don’t have capsule -> cause otitis, sinusitis, bronchitis
Type b- has capsule -> causes epliglotitis
Only thiamine-dependent dehydrogenase in the TCA
Alpha-ketoglutarate
Elderly female, groin pain, one femur shorter than the other, leg laterally rotated, think of
Femoral neck fracture
Sciatic nerve function and mucs innervated
Extends the hip and Flexes the knee
Semimembranosus, semitendinosus and biceps femoralis (long and short head)
Elderly pt with shortened leg and medially rotated, think of
Posterior hip dislocation
Nerves responsable for wrist drop and foot drop respectively
Radial and common peroneal/fibular
What structures are affected in Trendelenburg gait ?
Superior gluteal nerve -> musc gluteus medius and minimus
Which nerve is affected in trendelenburg gait, the one on the dropping hip or the one on the rising hip ?
Rising hip
Physiologic response to altitude
Increased pulm arterial resistance
Increased cardiac output
Decreased plasma volume
Increased renal HCO3 synthesis
Resp alkalosis-> Hb curve to the left (increased O2 uptake)
Minutes following a burn, ___ is released from ___
Histamine
Mast cells
CD55 and CD59 deficiency is associated with
Paroxysmal nocturnal hemoglobinuria
E Coli virulence factors
Lipopolysaccharide -> sepsis
K1 capsule-> neonatal meningitis
Shiga toxin-> enterohemorrhagic
Heat-stable or labile toxins -> enteroroxigenic (cholera like)
P-fimbrias -> UTI
Which nerve is at risk of being injured during appendicectomy
Ant branch of illiohypogastric nerve
Alzheimers occurs due to decrease___ due to deficiency of___
ACh
Choline acetyltransferase
First line Tto for attention-deficit hyperactivity disorder ___. Most common adverse effects are
Methylphenidate and amphetamines (psycostimulants)
Less appetite, weight loss and insomnia
Diuretic that increases survival in HF
Spironolactone
*less effect from ALD -> improves ventricular remodeling
Which structure is responsible for sudden muscle relaxation ?
Golgi tendon organ
Excess varus laxity, think of ___ tear. This is in charge of preventing ___
LCL
Hyper adduction
__ prevents hyper abduction of leg at knee. If there is excess valgus laxity, suspect
MCL
MCL tear
Meniscus tear key words
Knee pain with locking specially when squatting or twisting.
Mcmurry test
Most common injured ligament in an ankle sprain
Ant inf talofibular ligament (inward sprain)
Which musc abducts the arm?
Supraspinatus
Which muscs adduct the arm ?
Teres minor
Subscapularis
Which musc externally rotate the arm
Infraspinatus (mainly in adduction)
Teres minor (mainly in abduction)
*one compensate the other if one fails
The external auditory canal is innervated by ___ with the exception of the posterior part innervated by__
Auriculotemporal branch of the Trigeminal
Vagus nerve (only part of the ear that causes vasovagal response)
What part of the ear does the facial nerve innervate?
Stapedius
Which musc are responsible for closing and opening the jaw?
Lat pterygoid muscs
Pathway for a cardiac catheterization
Femoral a -> external illiac-> common illiac -> Ao
Puncture above inguinal ligament increases the risk of hemorrhage in___
Retroperitoneal space
Decreased blood flow in spermatic cord is likely due to a problem with the Gonadal arteries, which arises from___.
Abdo Ao
Lateral leads (l and aVL) ST elevations, think of ___ occlusion which originates from__
Left circumflex artery
Left main coronary artery
Ant chest lead (V1-V4) correspond to __ artery which supplies to
Left ant descending
Ant ventricle and interventricular septum
Inferior chest leads (ll, lll, aVF) correspond to __ artery which supplies___
Right coronary artery
Right ventricle and inf left ventricle
Severe constipation + occasional fecal incontinence and history of vehicle collision, think of
Conus medularis (sacral spinal cord injury)
Pt with involuntary,large amplitude movement of arm and history of HTN, DM. Think of __ due to ___ in ___
Hemiballism
Lacunar stroke
Subthalamic nucleus (inh nucleus Pallidus Inter is -> no inhibition of Thalamus-> excess mov)
In the absence of findings upper UTI signs but presence of gross hematuria, think of
Renal papillary necrosis
Obstruction of which vein will cause face, neck and arm swelling? brachiocephalic vein or subclavian or axillary vein will cause
Brachiocephalic. The other two do not affect the face
Glossopharyngeal
Elevate larynx during swallowing (stylopharyngeus musc)
Taste and sensory fx on post 1/3 tongue
Tonsils sensory fx
Afferent portion gag reflex
Parotid gland secretion
incision at the 5th intercostal space in the midaxillary line could injure __ musc
Serratus ant
Most common compression of median nerve Is between ___. The other possible compression is between __\
Two heads of pronator teres muscle (due to excess pronation. Ex: playing tenis)
Flexor digitorum superf and profundus
Wound in 4th intercostal space, next to sternal border will hurt __
Right ventricle
*left ventricle is midclavicular
Pt with head trauma + talk and die phenomena, think of ___ due to___ located in __
Epidural hematoma
Middle meningeal artery (comes from maxillary that comes from ext carotid)
Foramen spinosum
Pt with shear injury (shaken baby sd) + crescent shaped mass on MRI, think of ___ due to__
Subdural hematomas
Tearing of bridging veins
Pt with Marfan sd or ADPKD , altered mental status, parenchymal bleed, MRI shows blood following sulci and gyri, think of___ due to ___
Subarachnoid hemorrhage
Rupture of berry aneurysm (in any communicating/ Willis polygon)
Contact lenses nerve injury__ and common infection organism __
Ophthalmic branch of the Trigeminal (V2)
Pseudomonas
Pharyngeal arch associated to CN Vll
2nd pharyngeal arch
Pharyngeal arch associated to CN V
1st pharyngeal arch
Bell palsy associated organisms?
Hiking history: Borrelia B/ Lyme disease (intracel spirochete)
No hiking history: HSV
Pharyngeal arch associated to CN lX
3rd pharyngeal arch
Jugular foramen craneal nerves
IX, X, Xl
40-50 year old pt with aggressive behavior + writhing body movements + flailing arms + intermitent smile + similar family history, think of
Huntington’s
*trinucleotide repeat is CAG, anticipates with every new generation (anticipation)
15 yo male with broad-based gait, diabetes, scoliosis, loss of sensation in his feet and HCM, think of
Friedrich’a ataxia
*trinucleotide repeat is GAA
30 year old male is off-balance + hair loss + failure to relax after shaking Dr. hand, think of
Myotonic Dystrophy
*trinucleotide repeat is CTG
A patient with intellectual disability. Big ears + gonadal enlargement. Think of
Fragile X
*trinucleotide repeat is a CGG
Dopamine pathways disease association
Mesolimbic-> Reg behavior-> schizophrenia, psychosis
Nigrostriatal-> coordinated movement-> Parkinson, Wilson’s, Lewy body dementia
Tuberoinfundibular -> D2 inhibition of prolactin -> antipsychotics (risperidom), metoclopramide
Young female with focal neurological deficit, think of __ and if on top of that she has eye problems, consider
Multiple sclerosis
Optic neuritis (if Afferent pupillary light reflex defect) or intranuclear ophthalmoplegia (if inability to look medially upon contralat gaze)
Port-wine stain on face in trigéminas distribution + tram-track calcifications
Sturge Weber
Ataxia telangectasia mec
Defective dsDNA break repair
Brain tumors in children vs adults
Adults: supratentorial.
1.metastasis, 2. gioblastoma, 3. meningioma, 4. schwanomma.
Children: infratentorial
1. Astrocytoma, 2. medulloblastoma, 3. ependymoma
Brain mass crossing mid-line + pseudo-palisading tumor. Think of
Glioblastoma multiforme
Loss of pain and temperature Ipsilat in face and contralat in body, think of __ or __ stroke.
PICA (has dysphagia, hoarseness or decreases gag, affects lat medulla) o
AICA (has facial droop, affects lat pons)
Pernatal HBV infection high risk marker
HBeAg (high viral replication and infectivity)
Middle age man with steatorrhea, abdo pain + arthralgias + dementia + macrophages filled with inclusions positive for acid-schiff stain, think of
Whipple disease by Tropheryma whipplei
Cyanide disrupts which part of the electron transporter chain?
Complex IV (cytochrome c oxidase)
Blood type A or B develope ___ antibodies, AB develops ___ and O develops ___
A : antiB (IgM)
B: antiA (igM)
AB: none
O: antiA and antiB (IgM and IgG)
Pt with neurological st not explained pathophysiologically or without anatomical correlation, think of
Conversion disorder/ functional neurological st disorder
Baby boy with thickened bladder wall, vesicoureteral reflux and hydronephrosis, this is likely do to___
persistent urogenital mb (common cause is post urethral valve)
Primary Tto for acute opioid intoxication is ___ however it reqs redosing because___
Naloxone
It’s a short acting opioid antagonist and most opioid take long to be cleared out
Rate-limiting enzyme in de novo fatty acid synthesis
Acetyl-CoA carboxylase
Late complication of radiation
Fibrosis
TRH effect on prolactin
Increase its secretion
Chronic Oh use leads to ___ and ___ receptors
Downregulation of GABA A
Upregulation of NMDA
Pt with hypoxemia, increased A-a gradient, no response to 100% O2, think of ___. Best Tto is
Intrapulm shunt
Positive end expiratory pressure (PEEP)
Child with arm trauma after being pulled by the arm. Think of ___ ligament tear. Make ___ or ___ maneuver to correct
Annular
Hyperpronation or
flexion and supination
Loperamide mec of action
Binds to mu receptors and inhibits ACh release from myenteric plexus -> slows peristalsis
Glucocorticoids inhibits
Nuclear factor kappa B (NF-kB)
-xaban anticoagulants affect the conversion of ___ to ___ by blocking ___
Prothrombin to thrombin
Xa
Mutation order in colorectal adenoma to carcinoma formation
1.APC inactivation
2. Methylation abnormalities
3.COX2 overexpression
4.KRAS activation
5.DCC inactivation
6.p53 inactivation
HIV pt with ascites and large mass in small intestine, think of which organism?
EBV (Burkitt lymphoma affects gastrointestinal track)
Which chemotherapy agent is associated with causing cancer?
Cyclophosphamide (bladder ca)
In metabolic alkalosis HCO3 is __ because ___
High because Cl depletion impairs HCO3 excretion
Which antihistaminics have antiACh side effects
1st generation
Which abdominal pathology is associated with acute respiratory syndrome (ARDS)
Pancreatitis (enzymes released-> neutros infiltration->edema, inflam and fibrin deposits in alveolar mb)
Pt on antipsychotics (haloperidol,sertralin) develops fever, confusion and diffuse rigidity without clonus. Think of
Neuroleptic malignant sd
Baby boby with hyperuricemia + self mutilating behavior. Think of__ . Hyoeruricemia is due to ___. This is compensated by __ enzyme
Lesch Nyhan sd
Mutation of Hypoxanthine-guanine PRT
Phosphoribosyl pyrophosphate amidotransferase
Complications of Primary cytomegalovirus in babies
chorioretinitis , sensorineural deafness, seizures, jaundice, hepatomegaly, splenomegaly, and microcephaly.
Fragile X sd occurs due to expansion of a repetitive sequence in __ gene
FMR1
Treat severe or refractory Neuroleptic malignant (antipsychotics OD) sd with __. Mec is ___
Dantrolene
Inhibits Ca+2 release from sarcoplasmic reticulum via antagonism of ryanodine
Avoiding using trailing zeros (decimals) and abbreviations helps reducing
Transcription errors
Pts with DM and painful neuropathy can be treated with
Gabapentinoid (gabapentina, pregabalina)
SNRI (duloxetina, venlafaxina)
Antidepresivos (tricyclics)
Pharyngeal pouches structures associated
1st: ear and mastoid air cells
2nd: tonsil
3rd: inf parathyroid and thymus
4th: sup parathyroid and thyroid
Retinopathy of prematurity (abnormal retinal vascularization) can be exacerbated if
NB is exposed to O2 supplementation
ACh colinesterase (donepezil or rivastagmine) are associated with __ because they enhance ___
Vasovagal syncope, bradycardia and AV block
Parasympathetic tone
Bromocriotine and pramipexole are both___. Levodopa on the other hand ___
Dopamine agonists (directly stimulate dopamine receptors).
Replaces dopamine depletion
UMN lesion sts
Increased deep tendon reflexes (3+)
Increased tone
Babinski (+)
Spastic paresis
Clasp knife spasticity
**everything is UP in upper motor neuron problems
LMN lesion sts
Fasciculations
Atrophy
Flaccid paralysis
**everything is LOW in lower motor neuron problems
Opsonings responsable for e inflam and edema
C5a and C3a
Pt with soft mobile nontender subcutaneous mass/masses, stable or slow growth, think of ___ made of
Lipoma
Mature adipocytes arranged in lobules and separated by fibrous septa
Fetal Hb is made of 2 alpha chains and two __ chains
Gamma
Which hormones are mediated by JAK/STAT pathway
EPO, prolactin, GH, theombopoietin
Hypertrophic cardiomyopathy is product of a mut that affects __ and ___
Beta-myosin heavy chain
Myosin-binding prot C
H. pylori virulence factor
Urease splits gastric urea into ammonia (NH3) and CO2 -> pH increase -> survives
Tumors marking positive for cytokeratin, desmin and vimentin have origins from
Epithelial cells
Muscle cells
Mesenchymal
S100 (+) think of
Melanocytic neoplasms
Medication that promotes hyperthermia
Anticholinergics (amitriptyline)
Sympathomimetics (cocaine, amphetamines)
D2 antag (haloperidol, chlorpromazine)
Diuretics
Northerm blot vs western vs southern
N: detects mRNA
W: detects proteins
Southern: detects DNA
Female pt with 20-40 years old with severe RV hypertrophy, progressive dysnea and sudden death, think of
Pulmonary arterial hypertension
NB with deep sacral pit and hair tuft over midline lumbosacral region, think of ___ which is caused by__
Spina bífida occulta
Failure of vertebral arch fusion
Thick-walled spherules packed with endospores (balls filled with little balls) + pt has hilar adenopathy and lung infiltrate, think of
Coccidioides
Rotavirus features
Age<5 yo
Abrupt onset vomiting
Watery diarrhea
Blunting of the villi in the duodenum and prox jejunum
Fluoroquinolones mec of action
Inhibit bacterial DNA topoisomerase and gyrase
Doxycycline mec of action
Disrupts 30S ribosomal subunit
Azothromycin and chloramphenicol mec of action
Inhibit 50S ribosomal subunit
Small cell cancer (from lung, breast, ovary,utero) is associated with __ , this is due to __
paraneoplastic cerebellar degeneration (ataxia, dysarthria, visual problems)
Immune response
All patients with major depressive episode should be screened for ___ before tto
History of mania
ATBs that target cell wall of bacteria are
Penicillins, vancomycin, cephalosporins, carbapenems
Penicillins, vancomycin, cephalosporins, carbapenems are not useful on Mycoplasma because ___. Must treat with __
They lack cell wall
Bacterial ribosomal blockers (macrolides and tetracyclines)
Crucial component for peptidoglycan synthesis in bacteria
Glycosytransferase
Fat redistribution is a common side effect of
Antiretroviral therapy
Tto for pulmonary arterial hypertension
Bosentan (endothelin antagonist)
Baby with Triad (cataracts + sensorineural hearing loss + patent ductus arteriosus) think of ___. Prevent with
Congenital rubella
Live attenuated vaccine prior to conception
Monoamine oxidase inhibitor/MAOis (phenelzine or tranylcypromine) are reserved for___
Tto resistant major depressive disorder or with atypical features like mood reactivity, leaden paralysis, rejection sensitivity or increase sleep and appetite
Urease positive organisms like ___ or ____ , ___ pH,
H.pilory
Proteus
Increase
Most common UTI agents and their key difference
E.Coli does not produce nitrites, E faecalis does.
Major mec for Shigella ATB resistance
Conjugation
Asplenic pts must vaccinate against ___ because
Encapsulated bacteria (Strep pneumo, H. influenzae, N. meningitidis)
They can only be cleared by the spleen
Organism associated to cat scratch vs cat feces contact
Bartonella
Toxoplasma
Acyclovir mec of action
Competes for viral DNA polymerase
Viral proteases inhibitors are important in
HIV and HCV
Pelvic inflam disease is associated to which organism?
Chlamydia
N. gonorrhoeae
Ectopic pregnancy main risk factor is __ caused by __
Tubal scarring
N. gonorrhoeae or Chlamydia t
To prevent tetanus in neonate __
Vaccinate mom with inactivated vaccine
Pt with groin pain, not painful ulcers and intracytoplasmic inclusion bodies, think of
Chlamydia
Enterococcus features
Gram +
Catalase negative
Gamma hemolytic (no hemolysis)
Grows in saline and bile
Most common gram + UTI cystoscopy can cause enterococcal endocarditis
Ring shaped intraerytrhocytic parasite
Babesia (Protozoa)
Mulberry-shaped, intracytoplasmic inclusions or morulae in monocytes, think ok
Ehrlichia
Corynebacterium features
Diphtheriae
Gram +
No capsule
AB exotoxin (B affects prot synthesis)
Sore throat, fever, pharyngeal exudates
Brain and heart main complications
Profilaxis for close contacts in Meningitis
Rifampin, ceftriaxone and criprofloxacine
Cryptococcus n and cryptosporidium are usually associated with
Meningoencephalitis in AIDS
High volume diarrhea and biliary disease in AIDS
Pt with sickled-shaped RBC in blood smear + fever, chills and leukocytosis. Think of
Encapsulated organism (due to possible asplenia due to sickle cell anemia)
Painless genital ulcer, think of
Syphilis by treponema p
Granuloma inhíbame by Klebsiella
Lymphogranuloma v by Chlamydia
Which virus has the capacity of inducing indefinite proliferation of B cells ? Which test is dg?
EBV
Heterophile antibodies
P. Falciparum has more parasitemia and therefore more severe than ovale, malariae or vivax because
It affects RBC of all ages while malariae affects only old RBC and the other 2 affect only young and large RBC
Pt with fever, just returned from Africa or south America and has positive Giemsa stained. Think of
Malaria
Pt with hemorrhagic bullae ,Gram (-) and history of being in recent contact with salt water (ocean) or ingestion of raw oysters.Think of ___. Pts with ___ have higher risk
Vibrio vulnificus
Liver diseñas or iron overload
Parvovirus key words
“Slapped-cheek” flushed, red.
sDNA
Replication in erythrocyte precursor in bone marrow
Pt with minor laceration on the skin, inflam sts, gram (+) and PYR (+) but coagulase and catalase (-). Think of ___ infecting via
Strepto pyogenes (necrotizing fasciitis)
Hyaluronidase and streptokinase production
Most common congenital heart defect is ___. It’s main risk in adulthood is ___
Bicuspid aortic valve
Ao stenosis
Pt with recurrent sinopulm infections + failure to thrive and low immunoglobulin levels (all types). Think of ___ which affects__
X-linked agammaglobulinemia
Maturation of B cells (look for CD19, 20, 21 absence in cells)
Low total thyroxine but normal free T4, think of
TBG deficiency
Antipsychotic most important side effects
Extrapiramidal
Tardive dyskinesia
Nueroleptic malignant sd
Omeprazol blocks what type of transport ?
Primary active transport (H-K bomb used atp)
Cimetidine is a ___ which acts decreasing ___
H2 antagonist
intracell cAMP
Soldenefil is used for __ and __ whose mec of action is
Penile disfunction
Pulmonary hypertension
Upregulation of cGMP
Direct vs indirect inguinal hernia location
Direct -> into ext ingunal ring -> abdo
Indirect-> into int inguinal ring -> scrotum
Which pneumoconioses is very similar to sarcoidosis?
Berylliosis (both have noncaseating granulomas)
Stellae shaped granulomas, think of
Cat-scratch disease by Bartonella
Ovoidal or spherical nodules in the peripheral mesangium. Think of
Diabetes Mellitus
*Kimmelstiel-Wilson nodules in nodular glomerulosclerosis
Medullary tumors origen depending on location
-Intramedullary: primary tumors
-Intramural extramedullary: meningiomas, schwannomas, neurofibromas.
-extradural: metastases
Carbonic anhydrase inhibitors (ex acetazolamide) mec
Block NaHCO3 reabsorption in proximal tubule -> increased urinary HCO3 excretion
6-18 month old baby girl who initially had normal development and then regressed (can’t talk, can’t walk, has microcephaly) think of
Arrested brain sd (Rett sd) by MECP2 mut
Microcytic anemia + High HbA2 + target and hypochromic RBCs, think of __. It occurs due to __
Beta thalassemia trait
Point mut -> faulty mRNA or early translation termination
Biopsy findings in poststrepto glomerulo nephritis
IgG and C3 granular deposits
Minimal change glomerulonephriris biopsy
Podocyte effacement
Several fleshy, raised, soft cutaneous tumors + pigmented spots on trunk. Think of ___ which derived from __ cells
Cutaneous neurofibromas
Schwann
Which anti epileptic is used to prevent seizure recurrence
Na channel inhibitor, Phenytoin
