Quick Associations Flashcards
Best screening test for ACROMEGALY
Somatomedin-C (IGF-1)
Failure to appropriately concentrate the urine
DIABETES INSIPIDUS (inadequate ADH or failure of kidneys to respond to ADH)
Antimicrosomal and anti thyroglobulin antibodies
High in chronic lymphocytic thyroiditis (HASHIMOTOS)
Thyroid stimulating immunoglobulin (TSIG)
High in Graves’ disease
Labs in Graves’ disease (TSH , T4 level?)
Low TSH, HIGH T4 … And high TSIG
Autoimmune, PAINLESS thyroiditis
Chronic lymphocytic thyroiditis (ie: HASHIMOTOS)
Viral thyroiditis, very very PAINFUL , elevated ESR
Subacute granulomatous thyroiditis (de Quervains)
Elevated TSH is diagnostic for ——?
HYPOTHYROIDISM
Breast milk is low in what 2 vitamins?
D & K (breastfed babies need sunlight or vit D supplement ,,,and a vit K injection at birth)
An ovulated egg is arrested in what phase until fertilization?
Metaphase of Meiosis 2. (Until it “Met” a sperm)
What is the relationship btw confidence interval, RR and p- value?
RR> 1 means the exposure IS associated with the dz. A C.I. Of 95% – to be significant must NOT contain the null value of 1.0 When the 95% C.I. lacks 1.0 , this means that the p-value must be < 0.05 and the association is significant
Pregnant woman with low grade fever, maculopapular rash spreading from head to trunk and extremities, post-auricular lymphadenopathy….
Think MEASLES (rubeola), or GERMAN MEASLES (rubella) Rubella– particularly assoc with post-auricular lymph nodes Puts mom at risk for polyarthralgias and fetus at risk for deafness/ cataracts
What kind of epithelial lining do ovaries have?
Simple cuboidal (“germinal epithelium”)
The ovaries and testicles lymph drain to ——–??
Para- aortic lymph nodes
Lymph from the scrotum drains to the ——?
Superficial inguinal nodes
Purulent urethritis indicates chlamydia or N. gonorrhoeae and can ascend to cause PID–> what is the correct treatment?
Third gen cephalosporin + azithromycin or doxycycline (Treatment of gonorrhea always include tx for chlamydia too!)
What is 1st line tx for HTN in a pregnant woman?
Methyldopa
The only four situations where you can disclose patient information without their consent…?
1- when you suspect child or elder or spousal abuse 2- when the pt has had a gunshot or stabbing injury 3- when the pt has a reportable communicable disease 4- when a pt threatens to kill/ harm someone else and has means to do so
Marker for astrocytes
GFAP
CA-125 is a marker for—-?
Ovarian cancer ( but not very specific– it’s good for monitoring progression of the cancer, not screening for it)
Call-Exner bodies
Granulosa cell tumors (“Call your GRAN-E”)
Pt. with new onset achalasia, megacolon, megaureter… From Central or South America …
CHAGAS disease (Trypanosoma cruzi)
Child with fever, malaise, pharyngitis, generalized vesicular and pruritic rash, most lesions have crusted over within 6 days
Chicken pox (Varicella Zoster)
Children in daycare with dysuria, hematuria (UTI) ….most common viral cause ?
Adenovirus (Most common viral cause of acute hemorrhagic cystitis in kids)
Pt in septic shock from E.coli…. Which bacterial factor is responsible for the condition of the pt ?
Lipid A (the toxic component of LPS–> endotoxin) Lipid A causes activation of macrophages–> release of IL-1 and TNF-alpha–> signs of shock
Which cytokine (IL-?) is responsible for antibody isotype (class) switching??
IL-4
Which bacteria is the most common cause of osteomyelitis in pts with sickle cell disease??
Salmonella (These pts have functional asplenia, so are at risk to encapsulated bacteria)
Inflammatory arthritis after chlamydia infection…
Reiters syndrome
Hypokalemia can cause ——?
Muscle weakness
Right sided endocarditis
Typically IV DRUG users, caused by S. aureus
Most common type of collagen in the body, found in tendon, ligaments, bone, dentin, cornea, blood vessels, scar tissue…
TYPE 1 collagen
Type of collagen in basement membranes? Associate with what syndrome?
Type 4 Alport’s syndrome
Type of collagen associated with osteogenesis imperfecta and scar tissue long after a heart attack
Type 1
Type of collagen in cartilage, nucleus pulposus and vitreous humor
Type 2
Type of collagen associated with Ehlers Danlos syndrome And found in skin, lungs, intestines, blood vessels…
Type 3
Strep bovis septicemia or endocarditis, associated with??
COLON CANCER
Gray sub-retinal membranes, vision loss
Wet Age related Macular degeneration Wet= neovascularization / new blood vessels
Which vessels are most susceptible to the effects of Nitroglycerin?
The large veins
What substance would provide the fastest reversal of the effects of Warfarin?
Fresh frozen plasma (contains all coagulation factors) Vitamin K would also reverse warfarin effects, but slower, because it requires time for clotting factor resynthesis..
Frothy, foamy urine..
PROTEINURIA or bile salts in the urine
Treatment for systemic fungal infections …
Amphotericin B
Protein that is responsible for anterograde transport (moving intracellular vesicles and organelles toward the + end (rapidly growing end) of microtubules) — ie: away from the nucleus
Kinesin
Protein that is responsible for retrograde transport (moving items back toward the nucleus (- end of microtubules) )
Dynein
Lung abscess in an alcoholic patient Cause? Treatment?
Anaerobes, treat with Clindamycin
Pustules that spread and infect several hair follicles Cause? Treatment?
Skin infections are often caused by penicillinase producing S. aureus Treat with Nafcillin, Methicillin, or Oxacillin ((For MRSA use Vancomycin))
Nausea and vomiting 1 hour after a meal…. Cause & tx?
So soon after a meal suggests food poisoning from a pre-formed exotoxin, commonly the heat stable S. aureus Treat with fluids, supportive care (not ABX because it is toxin mediated illness))
Facial swelling and dark urine after a recent skin infection… Cause & tx?
Post-streptococcal glomerulonephritis after a streptococcal skin infection Tx is supportive, usually resolves on own
Long term effect of topical corticosteroid use on skin?
Decrs collagen production and glycosaminoglycans, leads to atrophy of the dermis w/ loss of collagen, drying, cracking, tightened skin Atrophic striae may also be found
Flat red skin lesion with central clearing …what bacteria?
Borrelia burgdorferi (cause Erythema Chronicum Migrans– the classic lesion of Lyme disease)
Pt with palmoplantar erythematous macular or petechial rash that spreads proximally to the trunk, with headache, fever, red eyes… Bacteria? Tratment?
Tick borne Rickettsia rickettsiae ( causing Rocky Mountain Spotted Fever) Treat with Doxycycline
Regional lymphadenopathy, malaise and fever after a cat scratch or bite…
Gram negative Bartonella henselae ( Cat Scratch Fever)
Hemorrhages, subperiosteal hemotomas, gingival swelling/ painful gums, hemarthralgias … What vitamin is likely deficient??
Ascorbic acid (vit C) – Scurvy Cannot be made in the body, must get from diet (Deficiencies common in the elderly, alcoholic, poor)
Autoantibodies to the hemidesmosomes along the basement membrane of the dermal/ epidermal junction
Bulbous pemphigoid
Pt with diffuse skin erythema, epidermis comes off easily with gentle pressure….cause? Endo or exotoxin?
Staph Scalded Skin Syndrome (SSSS) caused by the exfolatin exotoxin of certain Staph. species, mostly in infants and kids,( “Nikolsky’s sign” = sloughing of skin with gentle pressure)
What type of cells have intracytoplasmic granules that look like tennis raquets?
Langerhans cells - APCs of the skin and mucous membranes, derived from myeloid cell line, contain “Birbeck granules”
Warty papules on skin of middle aged person (any color) that look “stuck on” ( could be scraped off)
Seborrheic keratosis
Defective Intestinal and renal absorption of tryptophan— what is this disease and what causes it?
Hartnup Disease (defective absorption of tryp leads to Niacin (B3) deficiency and symptoms of Pellagra) -dementia/ ataxia - diarrhea - dermatitis
PABA esters protect skin from what kind of UV radiation?
UVB only
dimpling of the skin on the breast & nipple inversion – indicates ?
infiltration of the suspensory ligament (Cooper’s ligament)
peau d’ orange indicates___?
lymphatic obstruction – assoc with inflammatory breast cancer
ABX needed to treat beta-lactamase producing bacteria?
an antibiotic + a Beta-lactamase inhibitor (Tazobactam, Sulbactam or Clavulinic Acid)
What is the correct order of progression of mutations responsible for the development of colon adenocarcinoma? (the adenoma –> carcinoma sequence)?
APC tumor suppressor gene (dev of polyps) –> K-Ras mutation (polyp growth) –> p53 mutation (malignant transformation to carcinoma)
DNA methylation –> does what to transcription level?
Methylation is assoc with LOW TRANSCRIPTIONAL activity (heterochromatin)
Loop diuretics (like Furosemide) have what major side effects?
OTOTOXICITY (hearing loss) , HYPO-kalemia, -magnesia & -calcemia , decr GFR, volume depletion, hypotension..
what is most commonly injured when the humerus is dislocated anteriorly?
the axillary nerve –> resulting in deltoid paralysis and loss of sensory over the deltoid muscle , the shoulder will also appear flettened bc the humeral head has been displaced
what is the mechanism of Colchicine & what is it indicated for?
inhibition of microtubules –> binds to tubulin, impairs leukocyte (neutrophil) migration & phagocytosis –> reducing inflammation in ACUTE GOUTY ARTHRITIS ((diarrhea is a common side effect))
trabecular thinning with fewer interconnections
Osteoporosis
more metabolically active than long bones–osteoporosis typically involves this kind of bone
trabecular bone, aka spongy / cancellous bone, (makes up most of axial skeleton)
bone type that is very strong, serves as mechanical support and sites of muscle attachment , makes up most of the appendicular skeleton
cortical bone (long bones)
marked osteoclastic activity followed by osteoblastic activity –> net result is formation of abnormal bone (mosaic pattern of lamellar bone with the sections linked by cement lines)
Paget’s dz of the bone
Hyperparathyroidism causes osteoclasts to resorb bone –> primarily involves what type of bone?
Cortical bone (long bones)– classic is subperiosteal thinning of long bones
increased deposition of unmineralized osteoid – characteristic of ??
Vitamin D deficiency (b/c you need Vit D to absorb Calcium & Phos)
child with poor wound healing, late separation of the umbilical cord, recurrent skin infection with NO pus & gingivitis/periodontitis –> what is the diagnosis?
Leukocyte Adhesion Deficiency – autosomal recessive absence of CD18 –> can’t form INTEGRINS –> leukocytes cannot roll, adhere, or extravasate (hence NO pus)
late separation of the umbilical cord
Leukocyte adhesion deficiency (CD18 / Integrin defic)
this deficiency allows all bacteria to stay alive in phagocytes
Myeloperoxidase
this deficiency allows some organisms (catalase negative) to stay alive in phagocytes
NADPH oxidase deficiency –> causes Chronic granulomatous disease **Absence of NADPH oxidase = inability to form H2O2 so MPO has no substrate! (organisms that are catalase positive, however, make their own H2O2 and can be acted upon by MPO & killed)
Transcobalamin II is a carrier protein for —-?
B12 from the Ileum
Ceruloplasmin is a carrier protein for _______ & is low in ____________ disease
copper , Wilson’s dz
homeless/alcoholic with swollen gums, bruising, nosebleeds, hyperkeratosis, poor wound healing
SCURVY – vitamin C deficiency leads to inability to hydroxylate the proline & lysine residues of pro-collagen–> decr collagen = decr strength of blood vessel walls & other connective tissue ((even worse bleeding & bone deformities are seen in kids with Scurvy)
during skeletal muscle contraction, Calcium binds to ________?
Troponin C
pt with nodule containing long yellow crystals , neg birefringent under polarized light–> what are these crystals?
Monosodium Urate crystals (acute attack of Gout)
what kind of crystals are seen in pseudogout?
Calcium pyrophosphate – will appear as blue rhomboid crystals, positively birefringent, commonly affects the knee
young man with chronic low back pain, morning stiffness better with activity & HLA-B27 + , RF -
Ankylosing Spondylitis
sustained, involuntary muscle contractions
Dystonia (ex: Cervical dystonia is called Torticollis)
Which diuretic can also cause an INCREASE in calcium absorption at the DCT and therefore decr the risk of osteoporosis and renal stones ??
HCTZ (Thiazide diuretics) –((loop diuretics do the opposite and would increase the risk for osteoporosis))
RANK receptor / RANK ligand
assoc with osteoclasts, bone resorption (low estrogen states –> more RANK –> resorption of bone)
what ligament is affected in a radial head subluxation (yanking of a child’s arm)
annular ligament
diabetic pt with fever, flank pain, pain when walking –> pt lies supine in fetal position, resists extension of his leg
r/o Psoas Abscess (risk factors include DM, HIV, IV drug use, immunosuppressed)
“moldy” grains in China associated with G —> T mutations in p53 gene
Aflatoxin B1 from moldy peanuts, soy or corn –> highly associated with hepatocellular carcinoma
alveolar cells with ‘golden cytoplasmic granules’ that turn dark blue w/ Prussian blue staining –> what are the granules & what is the dz?
Hemosiderin (iron) , associated with Left sided heart failure macrophages eat the iron that is leaked out of congested capillaries (“heart failure cells”)
AST higher than ALT
alcoholic hepatitis
ALT >> AST
acute viral hepatitis
patient with bilateral femur fractures with acute onset hypoxemia, petichiae & confusion
fat emboli in the pulmonary microvasculature
male infertility, situs inversus, recurrent sinusitis & bronchiectasis
Kartagener’s syndrome (dynein defect)
peaked T waves on EKG
Hyperkalemia ( at risk for ventricular arrythmias)
virus associated with mono, nasopharyngeal carcinomas and Burkitt’s lymphoma
EBV
the main mechanism of excess copper removal from the body is ___________
hepatic excretion into bile
black pigment gallstones
chronic extravascular hemolysis (ie: sickle cell, B-thalassemia & spherocytosis)
keratin pearls
SCC
the most important environmental risk factor for pancreatic cancer
smoking!
acute onset heart failure after a viral infection
suspect viral myocarditis
enzyme that converts cholesterol to bile acids
7- alpha hydroxylase
bruising, bleeding, immature myeloid cells with Auer rods , t (15:17)
Acute Promyelocytic Leukemia (M3) AML –> treat with ATRA
what is deposited within Bowman’s space in RPGN?
Fibrin
thyroid nodule with calcified structures & ground glass appearance
Papillary carcinoma (w/ Psammona bodies)
sudden cardiac death in a young athlete
hypertrophic cardiomyopathy
deficiency of CD 55 & 59 is diagnostic
Paroxysmal nocturnal hemoglobinuria (PNH) – can’t inactivate complement , recurrent thrombosis, hemolytic anemia, pancytopenia
antibodies against alpha3 chain of Type IV collagen _____ associated with ?
Goodpasture’s syndrome – anti-GBM antibodies –> develop RPGN and hemoptysis
child with retinoblastoma is at a great risk for what other type of neoplasm?
Osteosarcoma
ANP and sildenafil both act on what second messenger system?
cGMP
drug of choice for oropharyngeal candidiasis?
Nystatin (“swish & swallow” agent)
Pt with colicky abd pain, constipation, HA, impaired short term memory, wrist or foot drop, microcytic anemia with basophilic stippling
Lead poisoning
Mechanism by which cells become resistant to chemotherapy drugs?
ATP dependent transporter (they pump the drugs out of the cell)
drugs that block the Na-Cl symporters in the DCT causing more Na, Cl and water excretion, but can also cause incrs Calcium absorption & hyperuricemia
Thiazide diuretics
Carbonic anhydrase inhibitors work at what part of the nephron?
PCT (they incrs bicarb excretion)
side effects of Methotrexate?
stomatitis, hepatotoxicity (elevated LFTs) , myelosuppression (incrs risk for infection)
Spironolactone mechanism and side effects?
K+ sparing diuretic, causes gynecomastia and testicular atrophy in men (blocks androgen receptors) , may be used to treat Hirsutism in females
What is the recommendation for pregnant women who have positive Group B strep cultures from 35-37 wga?
intrapartum penicillin or ampicillin
Chronic lung transplant rejection (months to years later) affects what part of the lungs mainly?
inflammation of the small bronchioles (“bronchiolitis obliterans”) contrasts to chronic rejection of an abdominal organ which presents with vascular obliteration
hemolytic anemia, thrombocytopenia & acute renal failure (oliguria, hematuria) in a child
Hemolytic Uremic Syndrome (most cases due to E. coli or Shigella dysentery)
What are three most common causes of cancer in US women? What are the three most deadly cancers in US women in order?
Incidence: Breast, Lung, Colon Deaths: Lung, Breast, Colon
trachea deviated toward the opacified hemithorax on XRAY
lung volume loss / atelectasis ((ie: tumor blocking the main bronchus on that side))
trachea deviated away from the opacified lung on XRAY
large pleural effusion (something pushing the trachea away)
A child with a Strawberry Hemangioma – what do you tell the parents?
It is a benign congenital tumor made of capillaries, it will grow in proportion to the child for a few years and then regress (most gone by age 7)
early diastolic murmur heard at the left sternal border
Aortic regurgitation
(9:22) translocation leads to the ________ oncogene which codes for a fusion protein with constitutive _______ activity
BCR-ABL gene –> tyrosine kinase activity uncontrolled –> proliferation of granulocytic precursors –> CML
t (14:18)
follicular lymphoma , overexpression of the anti-apoptotic protein Bcl2
t( 11:14)
Mantle cell lymphoma, cyclin D1 overexpressed – promotes G1 –> S phase of cell cycles
What is on chromosome 14 that gets translocated in follicular , burkitt’s & mantle cell lymphomas??
the Immunoglobulin heavy chain
t (8:14)
Burkitt’s lymphoma – c-myc overexpression, activates transcription (fast growing tumors)
pt with hemoptysis, HTN, hematuria and a + c-ANCA , but absence of immune deposits
Wegener’s –a Rapidly progressive (crescentic) glomerulonephritis (absence of immune deposits r/o goodpastures)
EBV envelope glycoprotein gp350 binds to the complement receptor on ________ called _________
CD21 on B cells
Inflammatory bowel disease that can involve the entire GI tract from mouth to anus and commonly causes fistulas b/c it causes transmural (full thickness) inflammation
Crohn’s disease
lack of aldosterone and cortisol (upper 2 adrenal cortex layers) – what enzyme is lacking?
21-hydroxylase – most common form of CAH —-> ( or less commonly 11-beta hydroxylase)
lack of cortisol and androgens (lower 2 layers of adrenal cortex)
17- alpha hydroxylase – these have HTN and hypokalemia
fever, rash & oliguria 1-3 weeks after an B-lactam antibiotic (or sulfa, NSAID, rifampin or diuretics)
Drug induced acute interstitial nephritis
ascending muscle weakness after recovery from respiratory or GI infection (esp Campylobacter) or after immunization
Guillain-Barre syndrome – DTR disappear, ascending weakness
phospholipase C cleaves phospholipids to form ___ & ____
IP3 & DAG –> which causes Ca++ to increase in the cell & activates PkC
Left shift on an Oxygen dissociation curve?
increased pH (basic) , decr 2,3 DPG, or decreased temp (hypothermia) ((INCREASED AFFINITY of Hb for OX)) —-((LEFT = Hb releasing O2 more in the LUNGS))
Right shift on an Oxygen dissociation curve?
decreased pH, incrs 2,3 DPG, or increased temp (( Hb releasing O2 more in the tissues)) Decrs affinity for O2
Why is pus from a bacterial infection green?
MPO is a blue/green heme based pigmented molecule – so when it is breaking down all this bacteria and making pus
adult onset asthma, eosinophilia, mono or polyneuropathy, pulmonary infiltrates and paranasal sinus abnormalities
Churg-Strauss vasculitis
What is the afferent nerve at the carotid sinus baroreceptor ??
Herings nerve ( branch of Glossopharyngeal CN IX)
Overdose of the TCA Amytriptyline can cause symptoms similar to ____________
Atropine (( Anytriptyline blocks muscarinic receptors))
this drug inhibits the reuptake of Norepinephrine at the synaptic cleft
Cocaine or Tricyclic antidepressants
It is common for people over 70 or 80 to have HTN, especially high systolic pressure ((Isolated systolic HTN)) , why?
Loss of aortic compliance as you age (aortic stiffening)
Formula for Mean Arterial Pressure
MAP = CO x TPR
What is derived from the common cardinal veins?
SVC
Murmur with an ‘opening snap’ early in diastole
Mitral stenosis
a young woman with RVH – what is the most likely cause?
Primary pulmonary HTN –> idiopathic in young people, leads to cor pulmonale
How long after total ischemia do the myocytes stop contracting ?
about 60 seconds –> they run out of ATP & start to accumulate toxins (however, if ischemia is reversed within 30 mins, the function can be restored)
Exercising muscle releases adenosine, ATP, K+, CO2 & Lactate –> what do these all do?
Local Vasodilation –> to lower systemic resistance
A shortened PR interval could indicate ___?
the PR interval represent the conduction through the AV node –> if this is shorter than normal you could have an accessory conduction pathway that is bypassing the AV node & causing arrhythmias (ie: WPW syndrome)
characteristic EKG of a pt with WPW syndrome
Short PR interval, wide QRS, and a delta wave (early upslope of the QRS complex)
EKG with narrow QRS & no P waves
Atrial fibrillation (“irregularly irregular with no P waves”
How do you treat a-fib?
B-blockers, calcium channel blockers or digoxin AND warfarin (prevent clots!)
PR interval longer than 200 msec & otherwise asymptomatic
1st degree AV block
progressive lengthening of the PR interval until a beat is dropped (“going, going, gone”)
2nd degree – Mobitz Type 1 (Wenkebach) AV block
Normal PR intervals with random dropped QRS complexes
2nd degree block -Mobitz Type 2
In a patient with a-fib, what determines the rate of ventricular contraction??
the AV node refractory period ( the atrial myocytes are contracting wildly and on their own at a very fast rate…so the refractory period of the AV node is what determines how often one of the chaotic atrial contraction impulses is let through) – Most atrial impulses are actually not let through, or else the ventricular rate would be much higher!
Which has less oxygen content, the pulmonary artery or the coronary sinus?
The coronary sinus ( the cardiac muscle extracts 90- 100% of the O2 from coronary flow)`
Which part of the heart is most prone to ischemia?
the endocardium (force of contraction is highest here)
Why don’t calcium channel blocker drugs (verapamil) affect skeletal muscle too?
b.c skeletal muscle does not have to rely on extracellular calcium (it has calcium from the t-tubules and intracellular SR)
Three major causes of Aortic Stenosis
Bicuspid aortic valve, calcifications, or rheumatic heart disease
Wide splitting of S2 that does not vary with respirations
indicates a congenital ASD
early diastolic decrescendo murmur decreased by amyl nitrate
Aortic regurg
lat diastolic murmur eliminated by a-fib
Mitral / tricuspid stenosis
what ion is responsible for the slow phase 4 depolarization of the SA & AV node tissue
Na+ (inward sodium “funny” current)
in most people the SA & AV nodes are supplied by branches of what artery?
RCA (right coronary artery)
what is the most posterior chamber of the heart?
Left Atrium (enlargement can cause dysphagia or hoarseness)
a wide pulse pressure is indicative of _____?
Aortic regurgitation (or decr compliance of the aorta)
S1 heart sound =
mitral & tricuspid valve closure
S2 heart sound =
aortic & pulmonic valve closure
S3 heart sound =
physiologic in young & pregnant –> pathologic in elderly –> associated with increased volume / filling pressure
S4 heart sound =
always pathologic –> “atrial kick” in late diastole, assoc with LVH , high atrial pressure against hypertrophic left ventricle wall
JVP waves : the “a wave” =
atrial contraction
JVP waves: the “c wave” =
RV contraction
Normal S2 splitting – why?
because the aortic valve closes before the pulmonic valve (inspiration increases the diference)
Wide S2 splitting cause
pulmonic stenosis or RBBB (takes longer than normal for the pulmonic valve to close)
Fixed S2 splitting (regardless of breathing)
associated with an ASD
Paradoxical splitting (pulmonic valve closes before aortic)
caused by anything that delays the aortic closure –> aortic stenosis, LBBB
Valsalva will increase your perception of which murmur?
Mitral Valve Prolapse (you are decreasing venous return, so most murmurs will actually decrease in intensity but MVP will be louder
Inspiration increases the intensity of sounds from which side of the heart?
Right side
Squatting / hand gripping increases the intensity of which murmur?
Mitral or tricuspid regurgitation (moves that increase TPR) – expiration will also increase intensity of all Left sided sounds
most frequent valvular lesion, late systolic crescendo murmur with a mid-systolic click
Mitral prolapse
high pitched, blowing diastolic murmur, wide pulse pressure, bounding pulses & head bobbing
Aortic regurgitation
opening snap, late diastolic rumbling
Mitral stenosis (assoc with rheumatic fever)
continuous machine like murmur
PDA
the plateau in cardiac myocyte AP is due to influx of _________
Calcium (phase 2 plateau) – allows for myocytes to contract at the same time
cardiac myocytes are electrically coupled by _______
gap junctions
U wave on an EKG
hypokalemia or bradycardia
treatment of Torsades de pointes
Magnesium Sulfate
Lyme disease can cause what type of heart block
3rd degree (complete) heart block
p waves & QRS complexes are present but they are completely dissociated
3rd degree heart block ( need a pacemaker)
What organ gets the largest share of Cardiac output?
LIVER
Pulmonary cap wedge pressure is a good measurement of which heart chamber?
Left Atrium
man with confusion, lethargy and an anion-gap metabolic acidosis
DKA – give insulin & normal saline
Which cells are responsible for stimulating the proliferation of an atherosclerotic plaque? (calling other cells to the scene?)
Platelets —> they respond to the endothelial cell injury and release PDGF & TGF-beta
List the cardiac tissues in order of fastest to slowest conduction velocity
Purkinjie –> Atrial muscle –> Ventricular muscle –> AV node
a decrease of systolic BP > 10mmHg upon inspirtaion
“pulsus paradoxus” –> indicates constrictive pericarditis, tamponade, restrictive cardiomyopathy …
triad of muffled heart sounds, elevated JVP & profound hypotension =
pericardial tamponade
What type of cell is directly responsible for the intimal thickening in people with atherosclerosis?
Smooth muscle cells
What are the possible causes of an anion-gap metabolic acidosis?
MUDPILES Methanol Uremia (renal failure) DKA Propylene glycol Isoniazid Lactic Acidosis Ethylene glycol Salicylates (Aspirin)
autosomal dominant condition with telangiectasias on the skin and mucous membranes & sometimes in the brain, liver, spleen –> predisposed to bleeding (epistaxis, GI bleeds, etc..)
Osler-Weber-Rendu Syndrome (“Hereditary Hemorrhagic Telangiectasis”)
0-4 hours post MI changes
minimal to no changes
4-24 hours post MI changes
coagulation necrosis, edema, hemorrhage, “wavy fibers”
1-5 days post MI changes
neutrophils infiltrate (inflammatory stage) –> biggest risk is fibrinous pericarditis at this stage
5-10 days post MI changes
Macrophages come in – phagocytize dead cells –> biggest risk is rupture of free wall or papillary muscles
10-14 days post MI changes
granulation tissue begins, neovascularization
1-2 months post MI changes
collagen deposition , scarring, fibrosis –> biggest risk is aneurysm, mural thrombus or Dressler syndrome at this point
Renal artery stenosis in an otherwise healthy 20-30 year old woman –> with “string of beads” renal artery
Fibromuscular dysplasia
Marked, one-sided kidney atrophy
renal artery stenosis (look for HTN & abd bruits)
a pt with prolonged QT interval is at risk for _________ & what is happening to their outward K+ current (phase 3 repol)
at risk for Torsades de pointes, their outward K+ current is slower / decreased, so that the repol phase is slower and prolonged (QT int)
tumor that is CD31 + and is associated with polyvinyl chloride, thorotrast & arsenic exposure
Liver angiosarcoma (rare, aggressive liver tumor) *CD31 is PECAM1 – functions in leukocyte migration thru endothelial cells
Most common congenital heart defect in Turner’s syndrome?
Bicuspid aortic valve
Drug used to close a PDA
Indomethacin (an NSAID, inhibits PGE2)
PDA is most closely associated with what illness?
Congenital Rubella or prematurity
Most common form of cardiomyopathy
dilated cardiomyopathy
Causes of Dilated cardiomyopathy
-genetic (AD) -myocarditis (Coxsackie A or B) -alcohol abuse -cocaine or other drugs -pregnancy
Asymmetrical septal hypertrophy and dynamic ventricular outflow tract obstruction are characteristic of ______
Hypertrophic cardiomyopathy (common cause of sudden death in young athletes –> the huge septum and the mitral valve leaflets block the left ventricular outlfow)
what is Kussmaul’s sign?
a paradoxical increase in JVP when the patient breaths in (it should usually decrease upon inspiration) –> this indicates constrictive pericarditis
What drugs can cause a “lupus like syndrome” – ie: drug induced lupus?
it’s not “HIPP” to have lupus Hydralazine Isoniazid Procainamide Phenytoin
new onset lupus symptoms + anti-histone antibodies
Drug induced lupus (Hydralazine & Procainamide have highest risk)
Common side effects of all nitrates
Headache, flushing (due to the vasodilatory effects)
Drugs that slow AV nodal conduction
Ca+ channel blockers (verap & diltiazem), Beta blockers & Digoxin) – can all cause slower heart rate
Which test should you routinely monitor for a patient on Warfarin?
Prothrombin (PT) time (extrinsic path)
Which test should you monitor for a person on unfractionated Heparin?
PTT ((“Hep = PTT”)) – intrinsic path
Vitamin K dep clotting factors
Factors II, VII, IX and X and protein C & S
combined use of a beta blocker & a non-dihydropyridine Ca++ channel blocker (verapamil or diltiazem) can have what effect??
Additive neg chronotropic effect –> severe bradycardia and hypotension
What is the drug of choice for beta-blocker overdose?
Glucagon –> it increases cAMP and increases the Ca++ release in the cell –> increasing HR & contraction
Why does amenorrhea occur in women who are anorexic?
loss of GnRH pulses from the hypothalamus after the body fat falls below a certain critical level
unable to release handshake easily, cataracts, & frontal baldness
Myotonic Dystrophy
inheritance pattern of Myotonic dystrophy
Autosomal dominant, CTG repeats
hearing loss from loud noises is a result of damage to the ___________
hair cells of the Organ of Corti —-(shearing forces of the tectorial membrane damage the hair cells)
What should you do 1st for a child with hyperpyrexia (ie: 107 degrees)
1- cool with cold blankets, cool saline bags, cold water enemas 2- Acetaminophen
Subdural hematoma is a rupture of the _______ , classically in the elderly after minor trauma
bridging cortical veins
in DCIS, the _________ layer of the duct is uninvolved
basal, myoepithelial layer
serum ______ should be monitored in a pt at incrs risk for Choriocarcinoma
B-hCG
bilateral absence of the vas deferens in a young male
Cystic Fibrosis
B12 deficiency effects on spinal cord —(“Subacute Combined Degeneration”)
1- Dorsal Column degeneration 2- Lateral Corticospinal Tract degeneration 3- Degen of peripheral nerves causes…. 1- loss of sensory 2- UMN signs (spastic paresis, hyperreflexia) 3- Numbness / paresthesias -Called “combined” b/c it effects both ascending & descending tracts!
deficiency of Arylsulfatase A–> leading to accumulation of cerebroside sulfate
Metachromatic leukodystrophy
Middle meningeal artery is a branch of the :
Maxillary artery (which is a branch of the External carotid)
understimulation of ______ receptors causes orthostatic hypotension
alpha-1 (a1 vasoconstriction prevents cerebral hypoperfusion upon standing)
pt. nasal ulcers and renal failure – has antibodies against ________
neutrophils! (Wegener’s has a + C- ANCA)
IL-12 deficiency
can’t differentiate T cells into Th1 –> can’t fight off MYCOBACTERIA
what is a Choriocarcinoma made up of – histologically
proliferation of both cytotrophoblasts and syncytiotrophoblasts (no villi )
Neurons with rounded cell bodies, nuclei & nissl substance displaced peripherally
“Axonal reaction” – the axon has been severed & the cell body is reorganizing to try to regenerate the axon
Polyarteritis nodosa is associated with a _________ infection in 10-30% of the cases
Hepatitis B
Pt with symptoms of mono, but the patient’s serum fails to agglutinate sheep erythrocytes ..what is causal agent?
CMV -negative Monospot test
a stroke at the VPL or VPM of the thalamus would produce pure _______ symptoms
Sensory only
stroke at the posterior limb of the internal capsule
only motor hemiparesis
nerve that supplies innervation to the lacrimal glands
CN VII
brain tumor with psammoma bodies
Meningioma
What (besides hydration) can help prevent kidney stones?
Potassium Citrate solution (citrate binds to the free ionized calcium, preventing precipitation)
Neuraminidase inhibitors (Oseltamivir) prevent the virus from ____________
exiting the host cell and releasing virions
a small blue tumor under the fingernail is derived from what kind of tissue ?
Glomus tumor --> from the modified smooth m. cells (“Glomus bodies”) that control **thermoregulation in the tips of fingers, toes & ears **
recurrent small “lobar” hemorrhagic strokes in different lobes of the brain – usually a result of ___________
Amyloid Angiopathy (in elderly with beta amyloid deposits)
-(more benign than the larger hemorrhagic strokes from HTN)
low levels of the stimulatory neurotransmitter Orexin (hypocretin) causes _________
Narcolepsy
1st line tx for Narcolepsy
Modafinil
- non amphetamine stimulant
Pt with recurrent renal stones, addition of sodium cyanide & sodium nitroprusside to his urine turns the urine red/purple….
**Cystinuria **
- the pt has an inborn error of metabolism (Cystinuria)
- hexagonal crystals in urinalysis
- tx = Alkalinize the urine
Treatment for TCA side effects (Convulsions, Coma, Cardiac arrythmias)
Sodium Bicarb
loss of neurons in the anterior horn –> UMN or LMN lesion?
**LMN **
- the cell bodies of the anterior horn cells are LMNs
What feature of Methadone warrants using it for Heroin addiction treatment?
It has a long half-life –> prolonged effects that help prevent withdrawal symptoms in heroin dep patients
The low-affinity nature of __________ is what allows the characteristic “rolling” action attributed to leukocytes
Selectins
A person with this pneumonia probably lacks _____ immunity
- CMV pneumonia (note the nuclear AND cytoplasmic inclusions)
- lack of T-cells / cell mediated immunity
A person in a deep coma will have a high or low Glasgow Coma Scale # ??
The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).
which “- encephalon” structure does the Cerebellum and 4th ventricle develop from? (Malformed in Dandy Walker syndrome)
Metencephalon
Two main things that aid Diphtheria toxin in attcking the host
1- low extracellular **iron **
2- Lysogenic phage that encodes the toxin **
Fiber type grouping indicates ________
Muscle fiber type grouping occurs following denervation and reinnervation, the muscle fiber assumes the type determined by its new motor neuron
Phosphorylation usually occurs on _______________________residues
serine, threonine, tyrosine and histidine residues
When is the maximun flow through the coronary arteries?
EARLY DIASTOLE
Thyroid nodule with + **calcitonin **
Medulllary thyroid cancer
Mechanism of Botulism toxin
gets into nerve terminal, cleaves SNARE proteins, prevenst Ach vesicles from being secreted
a Low Fecal Elastase test indicates _____________
pancreatic insufficiency
function of IL-10
ANTI-inflammatory cytokine
-downregs MHC II, Th1 and macrophages
rash on palms and feet, vomiting and liver damage in a child (after a viral illness)
**Reye’s Syndrome **
- parent’s may have given ASA
- causes Fatty damage to the liver
mechanism of nicotine
- binds to nicotinic acetylcholine receptors (esp in brain)
- increases the levels of several neurotransmitters
- increased levels of dopamine in the reward circuits of the brain are responsible for the apparent euphoria and relaxation, and addiction caused by nicotine consumption
screening test for Chronic Granulomatous Dz
Nitroblue tetrazolium test
- abnormal : does not turn blue
What structures run through the Cavernous Sinus?
- Internal Carotid artery
- CN II, IV, V1, V2, and VI
Symptoms of Kawasaki Dz
- fever
- strawberry tongue
- swelling of hands & feet
- desquamation of finger tips
- rash / erythema all over / red conjunctiva
- coronary aneurysms *
loss of E-cadherin would allow _________
cancer to invade the basement membrane (mets)
elevated AFP can indicate what kind of cancers?
hepatocellular carcinoma OR germ cell (nonseminoma) testicular carcinoma
enzyme that removes Thymine dimers after UV damage
**UV- Endonuclease **
(defective NER is seen in Xeroderma pigmentosum)
conversion of NE —–> EPI occurs in adrenal medulla by the enzyme ____________
Phenylethanolamine-N-methyltransferase (PNMT)
Amatoxins (found in Death cap mushrooms) effect what cell enzyme & product?
RNA pol II –> mRNA synthesis
the RLS of the Urea cycle is activated by ________
N-acetylglutamate (NAG)
- activates CPS I
why do you get wrinkles as you age?
decreased synthesis of collagen and elastin (despite a good diet w/ all the vitamins!)
“FABGUT”
-what are the life threatening enzyme deficiencies for Fructose & Glucose pathways
life threatening Fructose pathway defect –> Aldolase B
life threatening Glucose pathway defect –> **galactose 1- uridyl transferase **
How can TNF-alpha cause Insulin resistance?
it phosphyrylates Serine residues –> inhibits Insulin from phosphorylating Tyrosine …
