Quick Associations 2 Flashcards
A girl with Turner’s syndrome –> high or low gonadotropin levels (LH & FSH) ?
will have high LH & FSH but streak ovaries and therefore need donor oocytes to try to become pregnant
Catalase +, Coagulase negative bacteria that cause endocarditis on prosthetic valves
Staph. epidermidis (treat with Vanc)
Fat cells that contain multiple fat droplets and numerous mitochondria per cell, seen in babies
Brown fat – used for heat production! ((the ox phos and ETC in these cells is uncoupled so all energy produced is not made into ATP but instead dissipated as HEAT))
What protein is used in brown fat to uncouple the oxidative phos and ETC?
Thermogenin
Most carcinogens enter the body as pro-carcinogens and are converted to carcinogens by ________________
cytochrome P450 Monooxygenase enzymes
Why is someone on TPN who had a jejunal resection at increased risk for gallstones?
the lack of enteric stimulation –> decreased CCK secretion –> biliary stasis
________ in erythrocytes converts CO2 & water into bicarb
Carbonic anhydrase
temporal arteritis is characterized by what kind of inflammation
granulomatous of the media w/ fragmentation of the internal elastic lamina ((treat asap w/ steroids to prevent blindness!))
autosomal recessive disorder of tyrosine metabolism that results in a buildup of Homogentistic acid –which turns urine black after sitting out and attaches to collagen making the ears & nose appear blue/black
Alkaptonuria (defect of Homogentisate oxidase enzyme) –> in the tyrosine —> Fumarate pathway
a defect in phenylalanine –> tyrosine pathway
PKU (phe hydorxylase defect)
What is the mechanism of methicillin resistance? (ex: MRSA)
the bacteria alter the penicillin binding proteins (makes them resistant to all beta - lactams)
What is the mechanism of resistance of Staph aureus (non MRSA) to beta lactams?
produces beta-lactamase ( an enzyme that degrades the beta lactam ring)
Acanthosis nigricans assoc with?
Insulin resistance (DM, Obesity, acromegaly) and rarely GI malignancies
Why are pregnant women or women on OCP’s more likely to develop gallstones?
Estrogen –>increases cholesterol synth & secretion
Progesterone –> slows GB emptying & reduces bile acid secretion
CD3 is found on what cells?
T cells (needed for T cell receptors) –> anti CD3 antibody drugs can be used to inhibt T cells in acute rejection of kidneys, heart and liver transplants
older man who worked in a rubber/textile/ or leather plant for 30 years, now experiencing new onset gross hematuria, serum creatinine is normal
transitional cell carcinoma
HTN with low plasma renin activity and pt is feeling weakness / paresthesias
Primary hyperaldosteronism (normal Na levels due to “aldosterone escape”, low K+ , and high bicarb)
hypokalemia = weakness & paresthesias
Side effects of SSRI’s (sertraline, fluoxetine, citalopram, etc…)
Sexual dysfunction!
Pts with essential fructosuria cannot metabolize Fructose in the normal pathway (via Fructokinase) , but they can still put it into the glycolysis pathway via what enzyme?
Hexokinase
Pt with hx of hyperlipidemia has severe pain 40-60 minutes after eating, weight loss, pain not relieved by antacids
atherosclerosis of the mesenteric arteries –> they can’t dilate in response to incrs blood demand after meals, leading to intestinal ischemia & pain
Activation of which enzyme is primarily responsible for the damage done in acute pancreatitis?
Trypsin (once activated, it activates other pancreatic enzymes and can auto-activate more trypsin)
What is the most common and 2nd most common form of cancer in children?
1- Leukemia
2- Brain neoplasms (Pilocytic astrocytoma is most common, Medulloblastomas are 2nd most)
Most common location for Pilocytic Astrocytoma
mostly in the Cerebellum – looks like a cystic mass with a tumor nodule sticking off of it – pretty good prognosis
most common malignant brain tumor in kids, only in the cerebellum (mostly vermis) –> solid with sheets of small round blue cells – poor prognosis
Medulloblastoma
Anti-gliadin antibodies, loss of intestinal villi
Celiac dz
Aldolase B deficiency
causes life threatening hereditary fructose intolerance
Vitamin associated with maintaing specialized epithelium (acinar cells, etc…)
Vitamin A
Deficiency of this vitamin can cause infertility
Vitamin E
Treatment of acute Diphtheria infection
1- Diphtheria antitoxin (passive immunization)
2- Penicillin or Azithro
3- DPT vaccine
insomnia, agitation, dysphagia, headaches, coma after cave exploring
Rabies encephalitis
Stop codons
UAA, UGA, UAG
Type of diabetes associated with DKA
Type 1 (autoimmune)
Formula for Renal Plasma Flow (RPF)
Use the Clearance of PAH :
RPF = Urine PAH x Flow / Plasma PAH
Formula for Renal BLOOD Flow
RPF / (1 - Hematocrit)
Most fluids and solutes are reabsorbed in what part of the nephron?
PCT (fluid is absorbed isosmotically in the PCT –> no concentration or dilution occurs)
In a dehydrated state the kidney will concentrate the urine to a max of ___mOsm/L — but it must put out at least .5 L / day to get rid of metabolic wastes (so will lead to death if you go to long without water)
1200 mOsm/L – does this via ADH acting on the collecting duct to cause water conservation
The ________ of the nephron is impermeable to water
Ascending limb of the loop of Henle & the early distal tubule
Pt will 2 month history of weight loss, polydipsia, fruity urine
DKA
low pH
low bicarb – anion gap metabolic acidosis
low PaCO2 – resp alkalosis (compensatory)
A substance that constricts the efferent arteriole in the glomerulus will have what effect on GFR and Filtration Fraction?
-efferents constricted will INCREASE GFR and decrease RPF therefore –>INCRS FF
FF = GFR / RPF
ex: Angiotensin II would do this
ADH acts on what part of the nephron specifically ?
the medullary portion of the collecting duct (it increases the permeability to water by adding porins to the CD)
Where is Renin made and secreted and under what circumstances?
the JG apparatus, in response to decreased renal arteriole pressure & increased renal sympathetic discharge (**there are Beta 1 receptors on the JG apparatus!)
Mechanism of loop diuretics
inhibit Na-K-2Cl symporters in the thick ascending loop of Henle (essentially cause the excretion of these)
Pt presents hyperventilating (resp alkalosis) and then later enters into an anion gap metabolic acidosis
Aspirin overdose – ASA directly stimulates the breathing center in the brain (low pCO2) and then hours later you get a metabolic acidosis due to the organic acid build up in the blood… (low bicarb)
Pt with a tear at the gastro-esophageal junction & history of alcoholism –> what kind of metabolic disturbance is going on?
Mallory-Weiss tears from vomiting –> loss of acid in vomit causes a metabolic alkalosis
This substance is filtered, secreted by the PCT, but not reabsorbed – so the concentration of it rises as it goes throughout the nephron
PAH
Which part of the nephron is the primary site of K+ regulation?
the Cortical Collecting Duct
Aldosterone acts on the _______ to cause reabsorption of ____ & _____ and loss of ____ & ______
reabsorbs Na+ and water at the expense of K+ and H+
ADH (vasopressin) causes an increase in water reabsorption and _____ reabsorption from the PCT
Urea
This substance is filtered only, NO reabsorption or secretion
Inulin – that’s why it’s used to measure GFR
The descending loop of Henle causes the urine to become ______
hyperosmotic (hypertonic) –> it is permeable to water but not solutes so as the loop moves down into the kidney medulla where the interstitium is more concentrated, water leaves the loop –> concentrating the urine
Selective proteinuria
Albumin loss without the loss of the ‘bulkier’ proteins like IgG and macroglobulins
(ex: Minimal change dz)
Filtration barrier in the glomerulus is made up of?
1- Fenestrated endothelium of arterioles
2- GBM
3- Epithelial cells (foot processes)
What is the main thing keeping Albumin from being filtered
The negative charge on the GBM and foot processes that repel the negatively charged Albumin ((not it’s size, it could fit through the slits))
Massive proteinuria (> 3.5 gm/day), edema, hyperlipidemia
Nephrotic syndrome
Cystic dilations of the medullary collecting ducts in the kidney
Medullary sponge kidney –> pretty benign, cause unknown, can develop hematuria or kidney stones
(stones are # 1 complication )
1 cause of Chronic Renal Failure
Diabetes
Hematuria, proteinuria, RBC casts and “hypercellular glomeruli” on microscopy
Post-strep glomerulonephritis
- will have high ASO titers and low C3
- subepithelial humps
- usually after throat or skin infection
Anti- GBM antibodies
Goodpastures syndrome –> renal failure, hemoptysis, crescents
Calcium oxalate crystals in the urine
Ethylene glycol ingestion (produces an anion gap metabolic acidosis)
Renal Clear cell carcinoma originates from what cell type
the PCT cells –> will appear golden/yellow grossly due to high fat content
When blood flow is compromised, what parts of the nephron are at most risk for low perfusion
Structures out in the medulla -> the PCT & thick ascending loop of Henle
Muddy brown casts in the urine
Acute Tubular Necrosis
bilateral flank masses (cysts) at birth or early in life, enlarged kidneys at birth
ARPKD
microscopic cysts in kidneys at birth that grow over time, can be clinically silent, some pts have flank pain, HTN, hematuria, renal failure slowly progresses over 10-20 yrs, also at risk for cerebral aneurysms
ADPKD
Most common nephrotic in white adults, assoc w/ Solid Tumors, hepatitis B or C, SLE or drugs, shows “spike & dome” appearance & capillary wall thickening
Membranous glomerulopathy – due to immune complex deposition (IgG)
Multiple Myeloma signs & symptoms
Constipation (hypercalcemia)
Renal failure
Anemia (fatigue)
Bone pain (usually back & ribs)
-**Bence-Jones (light chains) & Tamm Horsfall proteins show up as eosinophilic casts (pink on H&E, not eosinophils the cells..)
Why do pts with nephrotic syndrome also get hyperlipidemia?
The liver tries to compensate for the massive loss of albumin but can’t keep up so it ramps up production of other proteins too (including lipoproteins)
A baby born with no kidneys dies 12 hours after birth –> what is the cause of death?
Lung immaturity
-Potters syndrome from bilateral renal agenesis –> oligohydraminos –> no urine output, no lung development in utero
diffuse effacement of the foot processes of the glomerulus on EM
Minimal change dz –> treat with corticosteroids
linear deposits of IgG & C3 along the GBM
Goodpasture’s –> a form of RPGN, will see crescents
IgA mediated vasculitis in children after a URI –> abdominal pain, joint pain, palpable purpura, hematuria
Henoch-Schonlein Purpura
Types of Rapidly Progressive Glomerulonephritis (all are crescentic)
Type 1 - anti-GBM ab’s, (Goodpastures), linear deposits of IgG & C3
Type 2 - immune complex mediated, subepithelial humps (Post-strep glomerulonephritis, SLE, IgA nephropathy or Henoch Schonlein)
Type 3 - ‘pauci immune’ (no IgG or complement deposis), + ANCA (mostly Wegeners)
Patient with colon cancer and new endocarditis, what bacteria ?
Strep. bovis
Endocarditis that is culture-negative – which bacteria?
Haemophilus Actinobacillus Cardiobacterium Eikenella Kingella
“HACEK”
subacute bacterial endocarditis after dental work
S. viridans
Sudden cardiac death right after an MI is most likely caused by _____________
an arrhythmia (most likely V. fib)
Trousseau syndrome
migratory thrombophlebitis seen in patients with disseminated cancer (tumor releases pro-coagulants)
autosomal recessive long QT syndrome that is associated with neurosensory hearing loss - can lead to sudden death
Jervell & Lange-Nielsen syndrome – problem with the K+ channels in the ear and cardiac muscle
chest pain on exertion relieved by rest, how much of the artery is blocked by plaque?
at least 70% – stable angina happens when a vessel is > 70% clogged
Pt in a MVA with blunt trauma develops sever hypotension, JVD and his systolic BP falls 15 mmHg with each inspiration …
pulsus paradoxus, hypotension and JVD suggest something constricting the heart –> after a MVA, you should consider cardiac tamponade
young child with migratory arthritis 3 weeks after an untreated sore throat –> IF she were to die, what would be the most likely cause?
Myocarditis – the cause of death if you die from Acute Rheumatic Fever
- assoc with Aschoff bodies & “Anitschkow” cells (caterpillar cells)
yellow-brown pigment found in cells of older people, made from lipid peroxidation & free radical injury (common in the heart & liver of aging or sick / malnourished people)
Lipofuscin
STEMI in leads II, III & aVF –> which artery is probably occluded?
Right Coronary Artery — the posteroinferior wall of the heart is usually supplied by the posterior descending branch of the RCA
STEMI in leads V1 - V4 , what artery is most likely occluded?
the LAD (anterior /septal region)
STEMI in leads V5 - V6 & 1 & aVL, what artery occluded?
lateral circumflex (branch of the LCA)
STEMI in V1-V6 and 1 & aVL , which artery?
Left coronary artery (before it branches)
In older people (70’s & older), what predisposes the aortic valve to calcifications?
Necrosis of the tissue / cell injury (injury -> necrosis -> dystrophic calcifications)
congenital defect in the lower interatrial septum is associated mostly with what congenital dz?
Down Syndrome (endocardial suchion defects are common ((like ostium primum ASD))
cardiac anomalies associated with DiGeorge syndrome
Tetrology of Fallot or aortic arch defects
Hypertrophic cardiomyopathy is associated with a mutation affecting what structures?
the sarcomere proteins (myosin, troponin, etc…)
Dilated cardiomyopathies are assoc with mutations affecting what structures?
cytoskeletal proteins
most common cause of mitral stenosis
rheumatic heart dz ((usually starts as regurgitation and progresses to stenosis))
Kussmaul’s sign indicates
constrictive pericarditis (( an increase in JVP upon inspiration ))
vegetations on BOTH sides of a valve indicate
non-infectious “Libbman- Sacks” endocarditis –> assoc with Lupus
Painless, hemorrhagic macules on the soles & palms
Janeway lesions (septic microemboli assoc with bacterial endocarditis)
Painful red lesions on fingers & toes
Osler’s nodes (Osler = Ouch!) – also associated with bac endocarditis
chest pain that is reversible, relieved by nitro, and occurs at rest
UNstable angina (ST depression to just endocardial ischemia)
Angina that involves coronary vasospasm
Prinzmetal’s angina (ST elevation due to transmural ischemia)
mainstay of treatment fot heart failure
ACE inhibitors
heart defect associated with fetal alcohol syndrome
VSD
heart defect assoc with maternal diabetes
Transposition of the great arteries
caused by molecular mimicry of the bacterial M protein (which mimics a lot of human proteins)
Acute rheumatic fever
low voltage EKG with diminished QRS amplitude
Restrictive cardiomyopathy
most common adult primary heart tumor
Myxoma , “pedunculated mass” in the left atrium , benign
most common childhood primary heart tumor
Rhabdomyoma, benign hamartoma, assoc with Tuberous Sclerosis
prognosis of colorectal carcinoma is mainky determined by ___
stage (not grade)
benign hypopigmented patches caused by the fungus Malassezia furfur
Tinea versicolor – KOH prep reveals “spaghetti & meatballs” appearance on light microscopy
Homeobox genes (Hox genes) code for what kind of proteins ?
transcription factors – play a role in morphogenesis
apical displacement of the tricuspid valve, atrialization of the right ventricle and huge right atrium
Ebstein’s anomaly – assoc with Lithium use
child w/ fever, dysphagia, drooling, anxious, dyspnea , inspiratory stridor
Epiglottitis — could be prevented with the Haemophilis influenza type b vaccine
Hepatic encephalopathy will cause a decrease of _____ & ______ in the brain
alpha-ketoglutarate and glutamate , which inhibits the kreb cycle (glutamine accumulates causing astrocyte swelling)
Hand flapping in a pt with cirrhosis and testicular atrophy
asterixis
where are steroid hormones made (which organelle)?
Smooth ER
drug that inhibits the synthesis of guanine and is used for Hepatitis C and RSV
Ribavirin
defect in Fibroblast growth factor 3 (FGF3) will cause
achondroplastic dwarfism
secreted by parafollicular C-cells in the thyroid in response to high blood calcium
Calcitonin
what happens to c-peptide after it is cleaved from pro-insulin in the pancreatic B-cell golgi?
it is packaged in secretory granules and secreted in equimolor concentrations with insulin ((it is used to distinguish Type 1 from type 2 diabetes b/c it represents the amount of insulin you have))
In the migration of neural crest cells to the intestine, which segment will recieve innervation last in development?
the rectum ((the NCCs migrate caudally –> so the rectum is always the last to get them and is always involved if the baby has Hirschsprung’s))
African american female with hilar adenopathy, pulmonary infiltrates and non caseating granulomas
Sarcoidosis –driven by TH1 cells, IL-2 & IFN-gamma (which stimulate more TH1 and macrophages)
drug of choice for treating trigeminal neuralgia (tic douloureux)
Carbamazepine (reduces Na+ channel recovery and therby reduces neuronal firing)
child w/ large tonsils, cannot isotype switch antibodies
Hyper IgM syndrome
Fungal infection strongly assoc with DKA
Mucormycosis
Most dangerous side effect of Amphotericin B
Nephrotoxicity — decreases GFR and also directly toxic to tubules (can lead to hypokalemia and arrhythmias)– also look out for hypomagnesemia
Side effects of ACE inhibitors
Cough -- most common Angioedema -- life threatening* Proteinuria Taste changes HypOtension Fetal renal damage Rash incrs Renin Low AG II HypERkalemia
Type of bias that occurs when the investigator’s decision is affected by prior knowledge of the exposure status
Observer bias
Post-strep glomerulonephritis is an example of a Type ______ hypersensitivity reaction
Type III –Immune complex mediated
Side effects of Mannitol (an osmotic diuretic)
Pulmonary edema, dehydration
-pulmonary edema is caused by the rapid rise in plasma volume due to the drug pulling water out of cells and reducing intracranial pressure
IV acyclovir can cause crystalline nephropathy – but can be prevented by ____
adequate hydration (fluids!!)
Spironolactone can increase overall survival from CHF how??
antagonizes aldosterone and aldosterone is known to cause ventricular remodeling and cardiac fibrosis in CHF patients
Which population should receive reduced doses of renally cleared medications to prevent toxicity?
the elderly — there is a decrease in renal clearance / function as we age (be aware that there is not always a concomiant increase in Creatinine in elderly b/c as their renal function is decreasing , so is their muscle mass…)
the loss of E-cadherin is associated with ______
cancer metastasis —> E-cadherin helps cells stay together
what is Calcineurin?
a protein in T cells that is needed for the activation of IL-2 –> growth of T-cells
dz in which ceramide trihexoside accumulates in tissues–> leading to dark red rash btw umbilicus & knees (angiokeratomas), neuropathic pain & and renal failure
Fabry’s disease
man with recurrent kidney stones, besides hydration, what drug can help prevent recurrances?
HCTZ –thiazide diuretics decrease renal Calcium excretion
Calcineurin (T-cell) inhibitors used to prevent graft rejection
Cyclosporine & Tacrolimus
drug of choice for acute CHF – b/c they provide maximun diuresis in shortest amount of time
Loop diuretics
IBD that involves only the colon / rectum, has mucosal/submucosal inflammation, main symptom is bloody diarrhea
Ulcerative Colitis
Which vitamin has been shown to improve the outcome of measles?
Vitamin A
Bacteria that substitute D-lactate for D-alanine in the formation of the cell wall are resistant to ______
Vancomycin
Type II error (Beta)
saying that there is no difference when there really is one (Beta)
Power of a study
the probability of seeing the difference when one truly exists (Power = 1 - Beta)
findings of a subdural hematoma and bilateral retinal hemorrhages in a baby
Shaken baby syndrome –> report to state protective agency
damage to this nerve will result in the loss of the ‘knee jerk’ patellar reflex
Femoral (L2-4)
symptoms of a right sided colon mass
usually an exophytic mass –> anemia (from bleeding), fatigue/ pallor, anorexia, malaise, weight loss…
symptoms of a left sided colon mass
tend to infiltrate the wall –> obstruction, tenesmus, ribbon stools, N/V/Constipation..
Risk factors for Osteoporosis
Smoking Menopause Corticosteroids Physical Inactivity Caucasians Low body weight / BMI Alcohol use
The receptors for PTH are on _________
Osteoblasts –> which then turn on RANK –> activates osteoclasts to start resorbing bone and increasing serum calcium
patient who works around goat wool and develops hemoptysis, wide mediastinum..
Pulmonary Anthrax
gram + rods that form “medusa head” colonies and posses an antiphagocytic D-glutamate capsule
Bacillus anthracis
gram negative bacteria that have an IgA protease which helps them get into mucosal tissues
Neisseria gon. and menin.
Name 2 ANTI-inflammatory cytokines
TGF-beta and IL-10
What test differentiates Strep from Staph?
Catalase test (Strep = catalase negative) , (Staph = catalase +)
What is the ONLY coagulase + Staph species?
S. aureus
Pt has hypothyroidism (w/ low T4 and low TSH) – is this Primary or Secondary hypothyroidism?
Secondary –> problem is the pituitary
pt with schizophrenia – treatment ?
Olanzapine (or another antipsychotic)
Pt gets exposed to Radioactive iodide –> what can you give them to protect their thyroid ?
K+ iodide
Senile osteoporosis –> high or low turnover?
Low turnover
- Osteoblasts low
- Osteoclasts normal or high
Post-menopausal osteoporosis –> high or low turnover?
High turnover
- osteoblasts & clasts are high
- bone is lost b/c formation can’t keep up with absorption
What kind of receptors are the T3 & T4 hormone receptors?
nuclear / retinoid X binding to DNA
glycine & GABA are _____ neurotransmitters & glutamate is a _________ nt
inhibitory , excitatory
Diseases caused by S. aureus preformed EXOTOXIN
1- TSS
2- SSSS
3- Gastroenteritis (food poisoning)
1 gram protein or carbohydrate = ___ calories
1 gram fat = ___calories
1 gram ethanol = ___ calories
1 gram protein or carbs = 4 cals
1 gram fat = 9 cals
1 gram ethanol = 7 cals
_____________ has a very low infectious dose –> as few as 10 organisms can cause disease (although usually more)
Shigella
- other organisms that can infect at low #’s:
- Campylobacter (500 organisms)
- E. histolytica & Giardia (1 organism)
infant w/ vomiting, lethargy, jaundice shortly after beginning breastfeeding
Classic galactosemia (most common form)
- lack of galactose-1-phos uridyl transferase
hormone made by cells in the duodenum that increases bicarb secretion from the pancreas
Secretin
-stimulated by acidity (HCL)
pathogenic mechanism of Shigella
mucosal invasion
- invades M cells in peyers patches and causes bloody diarrhea
- also releases Shiga toxin –inhibits protein synthesis
the best way to determine if a certain gene is being expressed in tissue is to analyze the presence of ______________ by _______ blot
mRNA by Northern blot
(mRNA –> protein) = being expressed
What is the best way to destroy Hepatitis A on contaminated fomites or in water?
Boiling for 1 minute
(Hep A is fecal-oral) – can also use UV light, bleach or chlorination
_______ is only capable of infecting when encapsulated with HBsAG
hepatitis D (delta agent)
a woman with HepB is most likely to pass it to her baby if she is _______ positive
HBeAg (the envelope)
-HBeAg is a marker of increased infectivity and replication
Which enzyme in the TCA cycle has Thiamine as a cofactor?
alpha-ketoglutarate DH
a-kg to succinyl coA
enzyme that is SPECIFIC to the liver that breaks down glycerol
Glycerol kinase
alpha- glucosidase deficiency in an infant
Pompe’s disease
-glycogen storage dz type 2
- cardiomegaly**
- hepatomegaly
- macroglossia, severe MR
- glycogen accumulates in lysosomes
glycogen phosphorylase deficiency in an infant
McArdle’s disease
-glycogen storage dz type V
- muscle glycogen phosphorylase defic
- weakness / fatigue when exercise **
- blood lactate levels don’t rise after exercise
deficiency in Glucose - 6 phosphatase in an infant
von Gierke’s disease
- most common glycogen storage dz (Type 1)
- hepatomegaly
- fasting hypoglycemia (seizures)
- hyperuricemia
- hyperlipidemia
glycogen debranching enzyme deficiency
Cori’s or “forbes’ disease
- glycogen storage dz type III
- hepatomegaly
- growth retardation**
- hypoglycemia
- hyperlipidemia
- muscle weakness
a tumor in the 3rd part of the duodenum is at risk for penetrating into what vessel?
the SMA
pt with severe hypoglycemia but high hepatic intracellular NADH —> where is the liver getting it’s energy?
hypoglycemia in the setting of high NADH = the liver is getting energy from something other than glucose
-Ethanol is an example (alcoholics)
What CANNOT use ketone bodies for energy?
RBC’s and Hepatocytes
LOCAL defense against candida is done by _____ and SYSTEMIC defense is done by ______
Local –> T-cells (ie: HIV pts usually have localized candida)
Systemic –> Neutrophils (neutropenic pts can have systemic)
a bleeding ulcer at the posterior duodenal bulb is most likely to penetrate what artery?
gastroduodenal artery
delta - aminolevulinic acid is elevated in patients with _______
lead poisoning
and Pyridoxal phosphate is a necessary cofactor for it so it also elevated
technitium -99 scan shows the presence of __________
ectopic gastric epithelium
will help identify Meckel’s diverticulum which often has ectopic gastric mucosa
which part of the intestine is the main site of Lipid absorption?
JEJUNUM
psoriasis can be associated with
deforming joint disease (psoriatic arthritis)
BRAF mutation (w/ Valine 600 replaced by glutamate) is seen in patients with ______
Melanoma
a chronic inflammatory skin condition associated w/ several environmental factors (foods, irritants..), intensely pruritic & associated with asthma & allergic rhinitis
Atopic Dermatitis (aka “Eczema’)
- cannot be diagnosed unless itchy!
- Eczema + Allergic Rhinitis + Asthma = the “Allergic Triad”
histological changes seen in Urticaria
dermal edema + dilated lymphatics (no changes in epidermis)
most common site for bullae of Pemphigus vulgaris
Mouth / mucosal surfaces
-Bullous pemphigoid spares the mouth/ mucosa
axillary lymph node dissection after mastectomy predisposes you to chronic lymphedema & development of ________
angiosarcoma (Stewart-Treves syndrome)
What is Vitiligo?
autoimmune destruction of melanocytes
Most common sites of fracture in osteoporosis
1- vertebral crush fractures
2-femoral neck
3- Colle’s fracture (distal radius)
Achondroplasia inheritance pattern
Autosomal dominant activating mutation of FGFR3 –(but most are sporadic mutations)
increased Alk phos in bone disease (ie: Paget’s) indicates_______
increased osteoblast activity
soap bubble tumor of the epiphysis
Giant Cell tumor (osteoclastoma) – benign
11:22 translocation
Ewing’s Sarcoma – small round blue cell tumors, in diaphysis of long bones, malignant
autoantibodies to ribonucleoproteins (SS-A and SS-B)
Sjogren’s syndrome
Anti-Jo-1 antibodies
Dermatomyositis / Polymyositis
drugs highly associated w/ SJS
Bactrim, Dilantin
‘sawtooth’ infiltrate of lymphocytes at the dermal/epidermal junction , this dz also highly assoc w/ Hep C
Lichen planus
S-100 tumor marker
Melanoma
drugs that end in ‘-dronate’
block osteoclasts
bisphosphonates used for Paget’s, osteoporosis, hypercalcemia
unique toxicity side effect of bisphosphonates
osteonecrosis of the jaw, and esophagitis
landmark for doing a pudendal nerve block
ischial spines
What can be used to treat the side effects of Myasthenia gravis drugs (like pyridostigmine)?
-diarrhea, nausea, sweating, cramping…
Pyridostigmine is a cholinesterase inhibitor (leading to increased Ach effects throughout the body)
-you can use an antimuscarinic agent like Scopolamine –> it treats only the side effects & doesn’t counter -stigmine’s effects on muscle b/c the muscle receptors are nicotinic cholinergic and Scopolomine blocks the muscarinic receptors only….
what nerve supplies the gluteus medius & minimus?
Superior gluteal n
test you must perform on your patient before starting them on any TNF-alpha inhibitors
PPD skin test (check for latent TB that could become reactivated)
- TNF-a inhibitors:
- etanercept, infliximab & adalimumab
what is the primary abnormality in Paget’s dz of the bone?
Osteoclasts– bone resorption
inheritance pattern of Osteogenesis imperfecta?
Autosomal dominant
plasma protein that binds free Hb to prevent it’s renal excretion
Haptoglobin
-decrs in hemolytic anemias
young african american child with bilateral swollen & painful hands & feet
Dactylitis (a result of of sickle cell disease seen in young children)
Hydralazine & Procainamide are metabolized in the liver by________
phase II - N acetylation
slow-acetylators develop Lupus like syndrome more often
anti-centromere antibodies are specific for
CREST syndrome
- Scl-70 AB’s are specific for systemic Scleroderma
drugs that are more __________ are preferentially processed in the liver (rather than kidney)
Lipophilic / good CNS penetration / high Vd
infant with testes but underdeveloped external male genetalia…which enzyme is deficient?
5-alpha-reductase
can’t convert testosterone —> DHT
man with tinnitus & vertigo is found to have bilateral acoustic schwannomas —> a mutation on chromosome ____ is likely
Auto. dom. mutation of NF-2 tumor suppressor gene on chromosome 22 (codes for ‘merlin’ protein)
-bilateral acoustic schwannomas are classic in NF-2 (Central neurofibromatosis)
renal cysts, hemangioblastomas of the cerebellum, bilateral renal cell carcinoma…
VHL – mutation on chromosome 3
prolactin is under tonic suppression by ______ from the ________
Dopamine from the hypothalamus
what is the best initial treatment for extreme hypoglycemia
IM shot of glucagon in an emergency
IV dextrose once you get to hospital
drug for isolated systolic HTN with main side effect of peripheral edema (ankle swelling) and flushing
Amlodipine
what does the mutation in CF actually do to the CFTR protein?
the Phe deletion causes abnormal post-translational processing so it never even gets to the cell surface – it gets degraded
Symptoms of Vitamin E deficiency
degeneration of dorsal columns, peripheral nerves, cerebellar tracts..
-mimics Friedrich ataxia
long-branched lipids that contain about 90 carbons— in a bacterial cell
Mycolic acid in Mycobacterium (what makes them “acid fast”)
rupture of a berry aneurysm causes a ___________ hemorrhage
subarachnoid hemorrhage
after starting this HTN drug, you can expect the patient’s serum creatinine to increase by up to 30%
ACE inhibitors – b/c they prevent AgII from constricting the efferent arteriole, therby decreasing GFR
serotonin releasing neurons are ONLY found in the ____________
Raphe nuclei of the brainstem (axons then project all over the CNS releasing Serotonin)
urine draining from the umbillicus of a neonate suggests persistant __________
patent urachus / allantois remnant
meconium draining from the umbillicus of a neonate indicates persistant ________
yolk sac / vitelline duct
Apolipoprotein E4 is associated with ______
late onset Alzheimer’s
mood stabilizers
Lithium, Valproate, Carbamazepine
the shortest acting benzodiazepine – to prevent excessive fatigue
Triazolam or alprazolam
failure of neural crest cells to migrate to the truncal and bulbar ridges of the truncus arteriosus and the bulbus cordis can lead to ____, _____ or _______
- Tetrology of Fallot
- Truncus Arteriosus
- Transposition of the Great Vessels
too rapid correction of hyponatremia can cause _________
osmotic demyelination syndrome (central pontine myelinolysis) –> spastic quadriplegia
if the sup. laryngeal nerve is damaged in thyroid surgery –> what muscle will lose innervation?
Cricothyroid muscle
recurrent laryngeal n. supplies all the other larynx muscles
drugs that are associated with fat redistribution from extremities to trunk
HIV protease inhibitors and long-term glucocorticoid use
a common complication of venous stasis/ varicose veins
venous stasis ulcers (usually on the medial malleolus)
a woman with significantly increased amniotic fluid –> baby is at risk for _____
anencephaly or GI obstruction (decrs fetal swallowing)
elevated acetylcholinesterase and AFP in amniotic fluid __________
neural tube defects
______ is believed to increase Insulin resistance in overweight people
increased Free fatty acids & Trigs
serous fluid collects within the tunica vaginalis
Hydrocele
most common cause of fetal hydronephrosis
inadequate recanalization of the ureteropelvic junction (junction of kidney & ureter)
this vitamin should NOT be taken by pt’s on Levodopa b/c it decreases it’s effectiveness
B6
drugs that can improve both the + and - symptoms of Schizophrenia
Second gen (Atypical) antipsychotics
-it’s not typical for “OLd CLOsets to QUietly RISPer from A to Z”
what is the RLS in the conversion of Acyclovir to it’s active triphosphate form
monophosphorylation by the viral Thymidine Kinase
best area on body to measure to get an idea of Insulin resistance
Waist-to-hip ratio (helps determine visceral fat)
mechanism of Mifepristone
anti-progestin drug (5X stronger affinity for progesterone receptor than progesterone)
mechanism of Phentolamine
alpha blocker
Which anti-fungal drugs act against the cell membrane (ergosterol)?
- Amphotericin B
- Nystatin
- Azoles
inheritance pattern of G6PD deficiency
X-linked recessive
FTA-ABS test is specific for _________
Syphilis
Polycythemia vera is associated with a mutation in ______________
Jak 2 - NON receptor tyrosine kinase
pt with sickle cell & gross hematuria
renal papillary necrosis
paralysis of upward gaze (parinaud syndrome) is characteristic of a _______________ lesion
dorsal midbrain around the pineal gland
this drug act to prolong both the PT & PTT time
FondaparinuX
-direct factor Xa inhibitor
(remember b/c factor X is the intersection of the intrinsic & extrinsic pathways so this drug will prolong BOTH PT & PTT)
best diet alteration for diabetes improvement
low-calorie (better than low carb)
most important risk factor for gastric adenocarcinoma
diet (smoked foods, nitrosamines), blood type A, H. pylori or autoimmune gastritis
(NOT SMOKING)
when you have a mitochondrial disease, why are there varying presentations?
Heteroplasmy :a mixture of more than one type of an organellar genome within a cell or individual.
pt with MR, night blindness, chronic diarrhea, weakness, ataxia, steatorrhea…
Abetalipoproteinemia
-lack of ApoB-100 & B-48 = can’t absorb fat or fat soluble vitamins and all the consequences from that
Mechanism of Macrolide antibiotics
(ie: Erythromycin)
blocks translocation of the amino acid chain on the 50s subunit rRNA (“macroSLIDES”)
pathogenesis of sickle cell anemia
HbS point mutation in Beta chain (glutamic acid –> valine), low O2 state or dehydration precipitates sickling –the deoxy Hb polymerizes to make sickle shape)
what is the function of the poly-A tail
protects the mRNA strand until it gets out of the cell (gets degraded from the poly-A tail and up)
function of peptidyl transferase
making the covalent peptide bonds btw amino acids on a growing peptide
causes your body to absorb too much iron from the food you eat
Hereditary hemochromatosis
drug therapy that you can use for Hepatic encephalopathy
Lactulose
-b/c it renders the ammonia inabsorbable by converting it to ammonium (NH4), and increase transit of bowel content through the gut.
ligament that attaches to the cervix and then goes posteriorly
Uterosacral ligament
effect of Cushing’s ACTH on the adrenal cortex
hyperplasia
which structure assists in producing new bone after a fracture (ex: clavicle fx)
The periosteum
-contains the progenitor cells for osteoblasts, chondroblasts and fibroblasts
“Hot T-Bone stEAk”
IL-1 --- fever IL-2 -- stimulates T cells IL-3 -- stimulates bone marrow IL-4 -- stimulates IgE IL-5 -- stimulates IgA
IL-8 – recruits neutrophils (clean up on ‘aisle 8’)
What is the most likely explanation for prolonged, ABX resistant colonization of a CF patient w/ Pseudomonas
the Pyocyanin toxin made by Pseudomonas…
virulence factor of N. gonorrhea
pili, opa proteins
function of Neuraminidase inhibitors
block the function of the viral neuraminidase protein, thus preventing the virus from reproducing by budding from the host cell.
which interleukin is also called ‘osteoclast activating factor’ and is involved in bone resorption
IL-1
Bence-Jones proteins
multiple myeloma
most grave effect of Metformin overdose
Lactic acidosis
which tissue proliferates in a hydatidaform mole?
trophoblastic tissue (what would have become the placenta)
What is the most commonly used drug for infertility?
also used for PCOS
Clomiphene
(SERM) that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus.
True or False – regular menses means regular ovulation
FALSE
-women undergoing anovulation still have (more or less) regular periods. In general, patients only notice that there is a problem once they have started trying to conceive.
Effects of a Beta-2 agonist
Smooth muscle relaxation (bronchial dilation, uterine dilation, relaxes GI tract & relaxes detrusor)
child dies from mycobacterial infection, had brother who also died from this… what is missing?
INF-gamma receptors (can’t call macrophages)
mechanism of Cisplatin
crosslinks DNS
very effective at treating testicular CA
child dies from mycobacterial infection, had brother who also died from this… what is missing?
INF-gamma receptors (can’t call macrophages)
child dies from mycobacterial infection, had brother who also died from this… what is missing?
INF-gamma receptors (can’t call macrophages)
mechanism of Cisplatin
crosslinks DNS
very effective at treating testicular CA
mechanism of Cisplatin
crosslinks DNS
very effective at treating testicular CA
