Random Crap Flashcards

Question

HLA-DR3 and B8

Answer 1

``` Symptoms: A- cold Abscess B- baby teeth C- coarse facies D- derm problems E- hyper IgE F- fractures ```

Answer 2

if kid is less than 3-4 years then its normal | otherwise it has to last for at least 4 weeks

Answer 3

MVP (dec LV volume) with earlier midsystolic click Less blood coming into heart - easier to regurgitate back into LA HCM - Stiff hard ventricle which means lots of pressure. Small amount of blood will make a lot of sound whereas if a lot of blood is coming into the ventricle - blood will stretch out ventricle and normalize pressure. this is why HCM murmur is decreased with leg raise and squatting.

Answer 4

Purine analog - inhibits PRPP and inhibits purine synthesis

Answer 5

Vd = amount of drug in body / plasma drug concentration Low Vd - intravascular - plasma bound protein High Vd - all tissues like fat

Answer 6

Often idiopathic. Mostly females. can be from inactivating mutation BMPR2 that normally inhibits cell proliferation, Endothelial dysfxn which inc vasoconstriction. Drugs (amphetamines, cocaine)

Answer 7

``` Endothelin antagonists (bosentan) PDE-5 inhibitors (sildenafil) Prostacyclin analogs (epoprsotenol, iloprost) ```

Answer 8

PGI2 (prostacyclin) Epoprostenol, iloprost MOA: direct vasodilation and inhibits platelet aggregation. Inc cAMP Side effect: flushing, jaw pain

Answer 9

blocks leukotriene receptors (CysLT1). Specifically blocks LTC4, D4, E4. Especially good for aspirin and exercise induced asthma

Answer 10

5-lipooxygenase inhibitor. Decrease the conversion of arachidonic acid to leukotrienes. Inhibits bronchoconstriction! Hepatotoxicity

Answer 11

The drugs: Quinidine, Procainamide, Disopyramide MOA: moderate Na channel blocker, inc AP duration, inc QT interval Clinical Use: both atrial and ventricular arrhythmias Adverse Effect: cinchonism (quinidine), reversible SLE-like syndrome (procainamide), HF (disopyramide), thrombocytopenia, and torsades due to increased QT interval

Answer 12

The drugs: Quinidine, Procainamide, Disopyramide MOA: moderate Na channel blocker, inc AP duration, inc QT interval Clinical Use: both atrial and ventricular arrhythmias Adverse Effect: cinchonism (quinidine), reversible SLE-like syndrome (procainamide), HF (disopyramide), thrombocytopenia, and torsades due to increased QT interval

Answer 13

1. P wave. If present - sinus 2. R-R. Rhythym. + rate 3. QRS. (< 3 tiny boxes) 4. PR interval (< 1 box) 5. QT interval (less than 1/2 of the RR)

Answer 14

``` SICKFACES.COM RAG S- sodium valproate I- isoniazid C- cimetidine (H2 blocker) K- ketoconazole (-azoles) F- fluconazole A- acute alcohol C- chloremphenicol E- erythromycin (macrolides) S- sulfonamides C- ciprofloxacin (fluoro) O- omeprazole M- metronidazole ``` R-ritonavir A- amiodorone G- grapefruit

Answer 15

Bismuth binds to the base of an ulcer and allows for increased mucus production, can use as quadruple therapy for H.pylori Sucralfate requires an acidic environment so can NOT use with PPI

Answer 16

``` Used for atypical pneumonia (legionella, mycoplasma, chlamydia) Adverse Effects: MACRO M- motility problems A- arrythmias, QT prolongation C- cholestatic hepatitis R- rash O-eosinophilia ```

Answer 17

cyclophosphamide carbamazapine SSRIs

Answer 18

blood cancers and solid tumors, nephritic/nephrotic stuff MOA; DNA alkylating agent AE: hemorrhagic cystitis (prevent with MESNA), bladder transitional carcinoma

Answer 19

MC pre-excitation ventricular arrythmia There is an extra bundle of Kent AV node is bypassed Delta wave is present--> widened QRS and tiny PR interval treatment: procainamide

Answer 20

Lidocaine, Phenytoin, Mexiletine Na blockade especially ischemic tissue - binds to partially depolarized cardiac tissue

Answer 21

RALS Right artery is ANTERIOR to the right main bronchus Left artery is SUPERIOR to the left main bronchus

Answer 22

"eye stuff" (cataracts), "ear stuff" (deafness), and "heart stuff" (PDA) also can see blueberry muffin rash

Answer 23

Subclavian V. or | Internal Jugular V.

Answer 24

the internal laryngeal n. (travels through the piriform recess) the internal laryngeal n. is a branch of the superior laryngeal n. which is a part of the vagus nerve

Answer 25

FMR1 through methylation, which inactivates FMR1 and inhibits transcription

Answer 26

``` SADPUCKER S- (suprarenal) adrenal glands A- abdominal aorta & IVC D- duodenum (except 1st part) P- pancreas (only head and body) U- ureters C- colon (only ascending and descending) K- kidneys E- esophagus R- rectum (mid-distal) ```

Answer 27

helps with vocalization external branch of superior laryngeal n. ONLY the 4th arch pharyngeal constrictors and levator veli palitini

Answer 28

mainly sensory, supplies to vocal folds

Answer 29

ALL intrinsic muscles of the larynx EXCEPT cricothyroid m. 6th arch sensory function below the vocal folds

Answer 30

internal laryngeal n.

Answer 31

stimulates growth and differentiation of stem cells in the bone marrow

Answer 32

TNF-alpha, activated macrophages stimulate TNF-alpha to induce systemic inflammation via recruitment of additional leukocytes and increasing pro-inflammatory cytokine production (ex. IL-1 and IL-6)

Answer 33

lipoxin A and B are anti-inflammatory mediators that come from lipoxygenase

Answer 34

Langerhans cells | the tennis racquet granules are called Birbeck granules

Answer 35

location: glabrous (hairless) skin | used for light touch, low-frequency vibration

Answer 36

location: deep skin layers, ligaments, joints | used for high-frequency vibration, skin indentation

Answer 37

location: finger tips, superficial skin used for pressure, deep static touch (shapes, edges) rare: Merkel cell carcinoma, highly malignant

Answer 38

location: finger tips, joints | used for stretch and joint angle changes

Answer 39

harbored by white-tail deer in the US; transmitted to humans via tick bite. spreads to tissue that's rich in mononuclear cells (bone marrow, lymph nodes, liver, spleen) peripheral blood: MORULAE (intraleukocytic inclusions) that are mulberry-shaped

Answer 40

NON-MOTOR problems (autonomic dysfunction- constipation, vascular sympathetic nerves- orthostatic hypotension) because the motor problems (bradykinesia, cogweel rigidity, shuffling gate etc.) is driven by the loss of dopamine

Answer 41

Primary polydipsia is more psychological than pathological as the pt is simply consuming a lot of water. In primary polydipsia and DI the urine osmolality is dilute. Normal person - If a water deprivation test is done, this kicks in ADH activity. This should cause the serum osmolality to increase until it plateaus because all of the ADH receptors in the kidneys have been used. If exogenous vasopressin is then administered the graph should remain plateaued because all of the ADH receptors are used, it doesn't matter that you've given them more ADH. Primary polydipsia essentially looks exactly like a normal person except for the fact that initially their serum sodium levels will be lower than a normal person. If it was central DI, and a water deprivation test was done then the urine osmolality would increase slightly but not significantly because there is no ADH. So exogenous vasopressin administration would then cause a huge increase in urine osmolality.

Answer 42

relative risk is calculated usually in a cohort study. Ex. risk of people who have breast cancer due to daily alcohol consumption. to calculate: add all the people in the risk of an outcome(ex. breast cancer) to the exposure(ex. alcohol use) and divide that by the people in the risk of that same outcome without the exposure If RR= 1 (null value), there is no association If RR >1, exposure is associated with increased disease occurrence If RR<1, exposure is associated with decreased disease occurrence RR values are strengthened if the risk due to chance/probability is proven to be low. If there is a 95% CI and that interval does NOT include the null value (always 1.0), then this automatically means that the p-value will be <0.05. This means that the RR is statistically significant. Page 260 in FA

Answer 43

popping sound in alveoli due to heart failure

Answer 44

In a normal population: linkage equilibrium means that there is physical distance between two alleles so the chances of them being inherited together is smaller Linkage disequilibrium: tendency for certain alleles at 2 linked loci to occur together more or less often than expected by chance. Measured in a population, not in a family, and often varies in different populations. how to calculate the haplotype frequency of the alleles being linked: (frequency of first allele) x (frequency of second allele) If this calculated value is lower than the frequency of both alleles being inherited together (what they will give in the question), then the population is said to be in Linkage Disequilibrium

Answer 45

the occurrence of multiple phenotypic manifestations, often in different organ systems, which result from a mutation in a single gene

Answer 46

essential because B48 is placed onto chylomicrons; this is the only way chylomicrons can be secreted from the enterocyte

Answer 47

essential because B48 is placed onto chylomicrons; this is the only way chylomicrons can be secreted from the enterocyte

Answer 48

inhibit HMG CoA Reductase

Answer 49

``` endocardium myocardium epicardium (visceral layer of serous pericardium) pericardial cavity parietal layer of serous pericardium fibrous pericardium ``` myocardium (wall pressures are the highest); area with the least amount of blood flow from coronary arteries during systole

Answer 50

``` COME LET'S GET SUN BURNED stratum corneum lucidum granulosum spinosum basale ```

Answer 51

Activation of T helper cells and proliferation of keratinocytes. Epidermal hyperplasia (acanthosis) produces erythematous plaques, hyperkeratosis and confluent parakeratosis of the stratum corneum producing the scaling. Can see pinpoint bleeding from dermal papillae exposure when scales are scraped off: Auspitz sign Parakeratosis: when keratinocytes still have their nucleus in the stratum corneum

Answer 52

``` MCD: most common nephropathy in kids 4 I's primarily IDIOPATHIC recent infection immunization immune stimulus ```

Answer 53

Deepest sleep. Sleep walking, night terrors, and bedwetting (Wee and Flee in N3) Delta waves (low freq, high amplitude)

Answer 54

Nonbenzos (Zolpidem, Zaleplom, Eszopliclone) dont affect sleep cycle as much as regular benzos

Answer 55

Second gen has less sedating effects because of decrease entry in CNS

Answer 56

``` COME LET'S GET SUN BURNED stratum corneum lucidum granulosum spinosum basale ```

Answer 57

first gen: Diphenhydramine (benadryl), dimenhydrinate, chlorpheniramine, doxylamine for allergy, motion sickness, vomiting in pregnancy, sleep second gen: Loratadine, Fexofenadine, desloratadine "adines" - used for allergy

Answer 58

H1 blockers have sedation and anti-muscarinic effects which help the muscle spasms and stiffness (also have a1 antagonism) Diphenhydramine and Benztropine are both used for acute dystonia

Answer 59

Activation of T helper cells and proliferation of keratinocytes. Epidermal hyperplasia (acanthosis) produces erythematous plaques, hyperkeratosis and confluent parakeratosis of the stratum corneum producing the scaling. Can see pinpoint bleeding from dermal papillae exposure when scales are scraped off: Auspitz sign Parakeratosis: when keratinocytes still have their nucleus in the stratum corneum

Answer 60

``` 4 I's primarily IDIOPATHIC recent infection immunization immune stimulus ```

Answer 61

beta-amyloid plaques (excess beta amyloid from insoluble fibrils that accumulate into extracellular amyloid plaques) AND neurofibrillary tangles (aggregates of hyperphosphorylated tau protein form intracellular tangled clumps)

Answer 62

Acid fast bacteria (Mycobacteria, Nocardia, Cryptosporidium)

Answer 63

Permethrin this drug is also used for scabies, which affects interdigital skin but presents with small papules, pustules, and burrows

Answer 64

portal hypertension left gastric vein

Answer 65

PSGN is a nephritic syndrome which means that the basement membrane is fucked up happens 2-4 weeks after a Group A Strep Infection in kids and in adults can also be caused by Staph LM- hypercellular glomeruli IF- granular (starry sky) appearance due to IgG, IgM, and C3 deposition along GBM and mesangium EM- subepithelial IC humps Acute Kidney Injury is common and therefore leads to fluid and salt retention resulting in edema and hypertension

Answer 66

vasodilators reduce systemic vascular resistance. Baroreceptors can sense this and cause reflex sympathetic activation: inc. heart rate, cardiac output, contractility AND RAAS is activated causing sodium and fluid retention

Answer 67

calculated as the proportion of subjects who truly have the disease among all those with a positive test result`

Answer 68

Bleomycin - radical formation - skin hyperpigmentation, pulm fibrosis Actinomycin D - intercalates into DNA - myelosuppression Anthracyclines (Doxorubicin, Daunorubicin) - does both of the above mechanisms - DILATED CARDIOMYOPATHY (prevent with dexrazoxane), alopecia

Answer 69

peripheral edema Ca2+ channel blocking occurs precapillary, so arteriolar dilation, this allows for increased blood flow which then increases capillary hydrostatic pressure and fluid extravasation into interstitium

Answer 70

nonsteroidal competitive inhibitors at androgen receptor (decreases steroid synthesis) use: prostate cancer

Answer 71

synthetic androgen that acts as partial agonist at androgen receptors. use: endometriosis, hereditary angioedema (the drug increases the amount of C1 esterase inhibitor)

Answer 72

5alpha-reductase inhibitor; decreases the amounts of DHT use: BPH and male-pattern baldness

Answer 73

Both: +ANA, inc CK, +anti-Jo, +antiSRP, +anti-Mi-2(helicase) Poly: Symmetrical shoulder weakness with ENDOmysial inflammation. CD8 Dermatomyositis: also has gottrons papules, heliotrope rash, "shawl and face rash". CD4. PERImysial and atrophy. For dermatomyositis look for occult malignancy

Answer 74

there is decreased LA pressure--> decreased LV preload and there is also an increase in LV afterload, this is because before, blood used to enter the aorta and then immediately be shunted to the pulmonary artery. Now, blood is flowing through the aorta to the rest of the system, so there will be an increase in BP and therefore an increase in LV afterload

Answer 75

anterior communicating artery aneurysm that bursts hemorrhage of bridging veins tearing of the middle meningeal artery

Answer 76

decreased outflow of aqueous humor or increased production | (from uveitis ,RBCs, retinal detachment) all can cause blockages

Answer 77

To increase trabecular outflow: (cholinomimetics) Muscarinic agonist Pilocarpine and Carbachol. both target M3 to contract ciliary muscle leading to pupil constriction. (dec pressure) To increase uveoscleral outflow: Prostaglandins Bimatoprost, Latanoprost. inc. outflow of humor via dec. resistance Side effect: darkens color of iris, eyelash growth To DEC. Aqueous humor inflow (Production) Beta (2) blockers: Timolol, betaxolol, carteolol Alpha agonist: Epinephrine (a1)(works via vasoconstriction of ciliary body), Brimonidine (a2) Diuretics: Acetazolamide via inhibition of carbonic anhydrase

Answer 78

progressive respiratory dysfunction due to the accumulation of surfactant debris within alveolar spaces. surfactant is a lipoproteinaceous material that appears pink with PAS staining. It forms lamellar bodies seen on electron microscopy. debris isn't being removed because there is impaired alveolar macrophage function. tx: inhaled GM-CSF replacement therapy

Answer 79

By ubiquitin-proteosome degradation (autophagy of cell components) and then apoptosis

Answer 80

Mediated by CASPASES (activated by many different ways) which then activate proteases and endonucleases Proteases break down cytoskeleton Endonucleases break down DNA

Answer 81

1. time frame: acute or within 3-5 days complication: papillary muscle rupture/dysfunction (usually due to RCA occlusion) findings: acute Mitral Regurg, leading to severe pulmonary edema 2. time frame: acute or within 3-5 days complication: interventricular septum rupture findings: chest pain, hypotension/cardiogenic shock, there will be inc. O2 saturation in Right Ventricle 3. time frame: within 5 days or up to 2 weeks complication: free wall rupture (usually due to LAD occlusion) findings: slit in the Left Ventricle that can lead to cardiac tamponade and sudden death previous MIs or LV hypertrophy is PROTECTS against rupture! 4. time frame: up to several months complication: left ventricular aneurysm findings: heart failure, angina, ventricular arrhythmias

Answer 82

Because the bacteria will develop rapid antibiotic resistance for example: Isoniazid monotherapy would cause 2 forms of gene mutations by the bacteria 1) the bacteria will decrease the amount of catalase-peroxidase enzymes which is what is needed to convert isoniazid to its active metabolite or 2) the bacteria will modify the protein binding site for isoniazid therefore, pair Isoniazid with streptomycin, ethambutol and/or pyrazinamide, basically use the RIPE drugs in combination

Answer 83

Because the bacteria will develop rapid antibiotic resistance for example: Isoniazid monotherapy would cause 2 forms of gene mutations by the bacteria 1) the bacteria will decrease the amount of catalase-peroxidase enzymes which is what isoniazid needs to kill the bacteria or 2) the bacteria will modify the protein binding site for isoniazid therefore, pair Isoniazid with streptomycin, ethambutol and/or pyrazinamide, basically use the RIPE drugs in combination

Answer 84

RNA Pol Inhibitor Ramps up P-450 Red/orange body fluids Rapid resistance if used alone!

Answer 85

cyproheptadine fyi serotonin syndrome is AMS, neuromuscular excitation, autonomic hyperactivity

Answer 86

Hypoglycemia(no glycogenolysis) Bronchospasm (no bronchodil) Heart block hypotension (if overdose)

Answer 87

Hyperkalemia (blocking K from entering cells), "scooped" or depressed ST segments on ECG +Hypotension/bradycardia

Answer 88

Hyperglycemia (L type calcium channels are found in the pancreas, and blocking them inhibit release of insulin)

Answer 89

when 2 chromosomes exchange information via crossing over. Result is having progeny that have mixed traits from both parent viruses. ex.. developing resistance to a medication that one parent virus didn't have before but the other parent virus did. Its like a mom and a dad having a baby. Its a complete mix of genetic information and the baby will possess characteristics of both mom and dad. vs reassortment

Answer 90

When viruses with segmented genomes (influenza) exchanges genetic material Ex. a virus that usually infects animals and a virus that normally infects humans end up infecting a cell in a human. Their RNA segments mix together and form a COMPLETELY new virus w/ both RNA. This can lead to antigenic shift and cause pandemics (Spanish flu) Its like you, a human, mated with a dragon monster and the baby was a weird monster human that had full segments of RNA from you and the dragon monster.

Answer 91

Per protocol is when you remove patients from a study because they weren't complaint in taking the drug, etc. Reason why researchers want to do this sometimes is because it doesnt't reflect the rest of the experiment group who is actually complaint. BUT.. ITT is apparently the more fair and unbiased why to conduct research. This is when you dont exclude anyone and leave them in the group they were in. The idea why is that there was some reason why patients weren't complaint in the study and this needs to be accounted for.

Answer 92

Fetal thymus

Answer 93

Directive counseling is when you pretty much tell the patient what they need to do. This happens when there is ONLY 1 medically reasonable treatment option. Ex. Woman wants to keep pregnancy even though it is found to be an ectopic pregnancy and chance of rupture is high. You as physician have to say No because this fetus is sadly not viable and can kill the mother.

Answer 94

Lead I and II positive. (-30 to +90)

Answer 95

``` Hypocalcemia (Ca enters in phase 2 of A.P.. if no Ca then depolarization/repolarization are prolonged) Drugs (lots of antiarrythmics) Long QT syndrome Levofloxacin Haldol ```

Answer 96

Inherited mutation due to loss of function mutation of Na and K channels. Prolongs depolarization/repolarization and increases risk for ventricular tachyarrhythmias and sudden cardiac death. Romano-Ward syndrome - aut. dominant, purely cardiac (no deafness) Jervell and Lange-Nielson syndrome - aut. rec. sensorineural deafness Young pt. with recurrent seizures(not seizures, just passing out), w/ family history of Sudden cardiac death

Answer 97

First degree AV block: Prolonged PR interval (longer than one big box). Can occur with B-blocker use, Ca channel blocker use, and well-trained athletes tx: nothing Second degree AV block: Type 1 (wenckebach)--> progressive lengthening of PR interval until a beat is dropped (P wave not followed by QRS complex). There will also be a variable R-R interval because of this. tx: nothing Type 2--> dropped beats that are not preceded by a change in PR interval tx: pacemaker Third degree (complete) AV block: P waves and QRS complex are completely dissociated. Atria and ventricles beat independently of each other. May be caused by LYME DISEASE. tx: pacemaker

Answer 98

vancomycin, polymyxin (colistin), and nystatin

Answer 99

The patient will usually be a middle-aged man with no history of tobacco or alcohol use. The patient will present with diarrhea, malabsorption, weight loss, arthralgia, and in later stages even present with CNS problems (dementia) and heart problems (endocarditis). The bacteria causes Whipple disease. Basically the bacteria is engulfed by macrophages and then replicates within macrophages. This impairs antigen presentation. Buildup of infected macrophages blocks lymphatic channels which leads to malabsorption. There will be foamy macrophages that stain PAS (+). LOL "PAS the FOAMy WHIPped cream in a CAN" C-cardiac symptoms A-arthralgias N-neurologic symptoms

Answer 100

FF = GFR/RPF Filtration fraction refers to the amount of "things" that actually get filtered into the lumen from the plasma. So, how would efferent constriction affect FF? first the RPF decreases because if there's vasoconstriction then less amounts of blood plasma goes to the glomerulus in the first place. Then, there is an increase in GFR because pressure to filter the blood increases due to efferent constriction. So finally with an increase in GFR and decrease in RPF, the FF will increase overall.

Answer 101

Iron Deficiency Anemia: a microcytic and hypochromic anemia. Decrease in iron due to chronic bleeding, malnutrition, decrease absorption, GI surgery, or increased demand ex. pregnancy. Labs: decrease in iron, increase in TIBC, transferrin saturation will be low, decrease in ferritin (ferritin is the molecule that stores iron in cells) Symptoms: fatigue, conjunctival pallor, pica, koilonychia Anemia of Chronic Disease: a normocytic anemia. This is an anemia due to chronic inflammation (ex. increase in IL-6). This can be due to any chronic infection, neoplastic disorders, chronic kidney disease, and autoimmune diseases. Labs: decrease in iron because there is an increase in hepcidin (an inflammatory mediator released by liver, this will bind ferroportin on intestinal mucosal cells and macrophages thus inhibiting iron transport), decreased release of iron from macrophages decreased iron absorption from gut Symptoms: fatigue, mild pallor, prior/current autoimmune condition, etc.

Answer 102

ferritin: binds iron in cells transferrin: transports iron in plasma hepcidin: inflammatory mediator released by liver ferroportin: pore within macrophages and mucosal cells to secrete iron when they need to

Answer 103

motor: moves the diaphragm sensory: sensory fibers to the pericardium, mediastinal pleura, and diaphragmatic peritoneum

Answer 104

true negatives = (specificity) x (number of patients confirmed without the disease) false positives = (1-specificity) x (number of patients confirmed without the disease)

Answer 105

true positives = (sensitivity) x (number of patients confirmed with the disease) false negatives = (1-sensitivity) x (number of patients confirmed with the disease)

Answer 106

there are certain anatomic sites, eyes and testes, in which inflammation is inhibited to limit organ dysfunction. If there is significant injury to the eye or testes self-antigens from these areas may be released into the lymphatic system where self-reactive T cells (cells that escape negative selection in the thymus) will attack BOTH eyes and testes. that's why if there is significant damage to immune privilege organs they are usually removed completely. If it seems curable, then the patient will be started on aggressive steroids.

Answer 107

It is a type of Rapidly progressive (crescentic) glomerulonephritis (RPGN). there are autoantibodies to GBM and alveolar basement membrane, targeting type 4 collagen. It is a type 2 hypersensitivity reaction. LINEAR Immunofluoresence! symptoms: hematuria, hemoptysis

Answer 108

Patient will be easily fatigued, exertional dyspnea, gait is unstable, impaired vibratory sensation, pallor of conjunctivae, and nail beds and palms. 1) Vitamin B12 (AKA cobalamin) activates tetrahydrofolate (THF) by removing a methyl group from THF. That methyl group is then transferred onto homocysteine to make methionine. Methionine is used to build proteins and to also make glutathione which can modify DNA. THF is also used in DNA synthesis. SO, if there is a B12 deficiency then there will be increased amounts of homocysteine and low amounts of THF. 2) Vitamin B12 is also used as a cofactor to the enzyme methylmalonyl-CoA mutase. This enzyme converts methylmalonyl CoA to Succinyl CoA. Succinyl CoA is used for many things in our body, but more importantly if there is a B12 deficiency there will be a buildup of methylmalonyl CoA (methylmalonic acid) which impairs myelin synthesis. This leads to subacute combined degeneration of the dorsal columns and lateral corticospinal tract.

Answer 109

Sertoli cells: produce Anti-mullerian hormone (stops female internal genital organs) and Androgen binding protein (concentrates testosterone in the seminiferous tubules). Leydig cells: produce testosterone which stimulates the Wolffian ducts to develop into internal male genital organs. Testosterone is peripherally converted to DHT by 5alpha-reductase which develops external male genitalia.

Answer 110

Patient will probably be: diabetic and has impaired renin secretion in the setting of juxtaglomerular apparatus destruction from diabetic nephropathy. This means downstream decrease in aldosterone production. Decreased aldosterone means hyperkalemia and metabolic acidosis (NAGMA); more specifically type 4 RTA. Serum Sodium CONCENTRATION is unchanged because ADH is still able to function and maintains a normal serum sodium concentration! SO COOL

Answer 111

Pancreatic lipase This is why if patients have GERD and are on a PPI, it may help them to absorb dietary fats.

Answer 112

``` 5 P's: painful abdomen port-wine colored pee polyneuropathy psychological disturbances precipitated by factors that increase ALA synthase (CYP450 inducers) ``` tx: heme and glucose This happens because the mitochondrial enzyme ALA synthase, which is responsible for converting [succinyl coA and glycine --> ALA], is over active. Too much ALA is converted into the next intermediate, Porphobilinogen (PBG) and this is what causes the symptoms. Heme will negatively feedback onto ALA synthase decreasing its activity.

Answer 113

-xaban drugs: MOA-> directly inhibits factor Xa used for-> treatment and prophylaxis for DVT and PE, stroke prophylaxis in patients with A fib cilostazol, dipyramidole drugs: MOA-> blocks phosphodiesterase, which decreases cAMP hydrolysis and increases cAMP within platelets leading to less platelet aggregation used for-> mainly peripheral vascular disease (claudication) -grel drugs + ticlopidine: MOA-> blocks ADP (PDY12) receptor which decreases ADP induced GP2b/3a expression used for-> same as aspirin use; dual antiplatelet therapy, angina, coronary diseases -parin drugs: MOA-> these are LMWH drugs that act mainly on factor Xa used for-> DVT and PE prophylaxis and MI eptifibatide, Abciximab, tirofiban drugs: MOA-> blocks Gp2b/3a (fibrinogen receptor) on activated platelets used for-> unstable angina, percutaneous coronary intervention naproxen: MOA-> NSAID, blocks COX1 and COX2 used for-> analgesic, antipyretic, anti-inflammatory warfarin: MOA-> inhibits VKOR enzyme, this inhibits Vitamin K dependent carboxylation of factors 2,7,9,10, protein C and S clinical use-> chronic anticoagulation, monitor PT/INR

Answer 114

PDE-3 inhibitor MOA: in cardiomyocytes-> increases cAMP and therefore increases Ca2+ influx, increase in inotropy and chronotropy In vascular smooth muscle-> increase in cAMP leads to MLCK inhibition, that leads to vasodilation and decrease in preload and afterload clinical use-> acute decompensated HF with cardiogenic shock (inotrope)

Answer 115

flumazenil

Answer 116

If there is a cholinergic excess causing excessive bradycardia, tachypnea, excess salivation, etc. AND there is weakness of muscles..... then the first thing to give is Atropine because we want to inhibit the Ach at the muscarinic receptors first. We can then give pralidoxime to inhibit the Ach excess at the nicotinic junction and this will help with the muscle weakness. Pralidoxime MOA: a cholinesterase-reactivating agent that treats both the muscarinic and nicotinic effects in ex. organophosphate poisoning

Answer 117

Neostigmine is used for myasthenia gravis, it is a acetylcholinesterase inhibitor

Answer 118

Clinical use-> used for muscle paralysis in surgery or mechanical ventilation. Selective for nicotinic receptors 1)depolarizing neuromuscular blocking drugs: Succhinylcholine - produces sustained depolarization and prevents muscle contraction 2)nondepolarizing blocking drugs (-cur drugs): ex. atracurium, pancuronium, vecuronium, etc. these are competitive Ach antagonists

Answer 119

hematoma or arrythmia!

Answer 120

nerves-> CNV3, chewing ``` muscles-> mastication (temporalis, masseter, lateral and medial pterygoids), mylohyoid, tensor tympani, anterior 2/3 of tongue, tensor veli palatini, anterior belly of digastric ``` ``` cartilage-> maxillary process (maxilla, zygomatic bone) mandibular process (meckel cartilage, mandible, malleus and incus, sphenomandibular ligament) ```

Answer 121

nerves-> CNVII, facial expression ``` muscles-> muscles of facial expression, stapedius, stylohyoid, platysma, posterior belly of digastric ``` ``` catilage-> Reichert cartilage (stapes, styloid process, lesser horn of hyoid, stylohyoid ligament) ```

Answer 122

nerves-> CNIX, swallow stylishly muscles-> stylopharyngeus cartilage-> greater horn of hyoid

Answer 123

central chemoreceptors sense CO2 levels whereas peripheral chemoreceptors sense PaO2(arterial oxygen)

Answer 124

1) this removes the RNA primers on both the leading and lagging strand 2) this is the inherent proofreading function by DNA polymerase, it allows DNA polymerase to go backwards to remove incorrect bases 3) lays down an RNA primer. This has to be done before DNA daughter strand synthesis 4) always in 5'-->3' direction

Answer 125

Fibrates are used to decrease the amount of TGs by fatty acid oxidation via upregulating lipoprotein lipase. Adverse effect of fibrates is gallstones because fibrates also inhibit the enzyme cholesterol 7alpha-hydroxylase. This enzyme is the rate-limiting step in the synthesis of bile acids.

Answer 126

A part of innate host defense, interferons interfere with both RNA and DNA viruses. Cells infected with a virus synthesize these glycoproteins which act on local cells by priming them for viral defense by down-regulating protein synthesis to resist potential viral replication (interferon alpha and beta) and by upregulating MHC expression to facilitate recognition of infected cells to improve the intracellular killing ability of macrophages (interferon gamma)

Answer 127

sweat ducts: normally body reabsorbs any NaCl that comes out with sweat, but since the Cl channel is messed up, Cl stays out and because of that even Na doesn't get reabsorbed leading to salty sweat airway: normally Cl channel allows for Cl to leave into the lumen of airway and this allows for Na and H20 to be reabsorbed. But in CF, the Cl channel is messed up so there are increased amounts of Cl in epithelial cells and this increases the osmolarity and pulls even more H20 and Na into the epithelium leaving a really sticky and thick mucus.

Answer 128

Dexrazoxane - an iron chelator

Answer 129

binds to GABA and HYPERpolarizes the cell membrane by allowing Cl- influx. this causes an increased threshold of the excitability

Answer 130

GABA A agonists - Phenobarbital, Topiramate, Benzos GABA reuptake inhibitor - Tigabine GABA transaminase inhibitor - Valproic acid, Vigabatrin

Answer 131

External intercostals: innervated by thoracic nerve roots T1-T11 Sternocleidomastoid: C1-C4 Scalenes: C4-C8

Answer 132

``` Internal intercostals (T1-T11) Abdominal muscles (innervated by thoracic and lumbar nerve roots) ```

Answer 133

Inflammatory myopathies (polymyositis, dermato) Statin induced myopathy Hypothyroid myopathy

Answer 134

5 T's 1. Truncus Arteriosus 2. Transposition 3. Tricuspid atresia 4. Tetralogy of Fallot 5. TAPVR (total anomalous pulmonary venous return)

Answer 135

1. pulmonary artery stenosis (most important determinant for prognosis) 2. RVH 3. overriding aorta shifted to the right 4. VSD *the reason this is happening is because the embryologic tubular structure, infundibulum (gives rise to pulmonary artery), is displaced to the right. This allows for overriding of aorta and VSD formation. Because of the infundibular stenosis (pulmonic stenosis), the pressure is too high for blood to go from RV into Pulm. A., instead it uses the VSD to go into LV. This makes baby cyanotic. "tet" spells: mild obstruction of pulmonary artery L-> R shunt is beneficial to help oxygenate blood (PDA) systolic ejection murmur (crescendo-decrescendo), single S2 heard (if the pulmonic valve is diseased, no sound heard) squatting improves symptoms because this increases afterload/TPR and less blood is shunted from RV-> LV CXRAY: boot-shaped heart

Answer 136

VSD produces a holosystolic murmur that is only heard if the VSD is SMALL, the bigger the VSD the more inaudible it becomes

Answer 137

aorta is posterior to pulmonary artery

Answer 138

The aorta forms anterior and rightwards of the pulmonary artery, the aorta arises from the R ventricle while the Pulmonary artery arises from the L ventricle Problem: there are two separate circulations going on and therefore this is incompatible with life Fix: have to have a VSD or PDA so that there is at least some oxygenated blood going into circulation CXRAY: normal cardiac silhouette but a narrowed mediastinal shadow.

Answer 139

Schizophrenia is having at least 2 positive symptoms (delusions, hallucinations, disorganized speech) for greater than 6 months. schizophreniform disorder is having everything in schizophrenia but only lasting 1-6 months. brief psychotic disorder is at least 1 positive symptom lasting no more than 1 month, usually precipitated by stress. schizoaffective disorder has symptoms of both schizophrenia and mood disorders (MDD or bipolar disorder). Patient must have > 2 weeks of psychotic symptoms without a manic or depressive episode. bipolar disorder with psychotic features is either MDD or manic episodes with hallucinations or delusions. The psychotic features occur EXCLUSIVELY during a manic or MDD episode.

Answer 140

insert into greater trochanter, that's why if something hurts near the hip, it could be something to do with medius and minimus. these muscles do hip abduction and external rotation and internal rotation (if the hip is flexed)

Answer 141

describes the condition of having different mitochondrial genomes within a single cell. The severity of mitochondrial diseases is often directly related to the proportion of abnormal to normal mitochondria within a patient's cells.

Answer 142

VEGF and FGF (fibroblast growth factor)

Answer 143

on the heart AND juxtaglomerular cells of the kidney

Answer 144

this is an antiviral drug, inhibits IMP dehydrogenase so that GMP can not be made.

Answer 145

this is an immunosuppressant that inhibits IMP dehydrogenase

Answer 146

ApoE-2 Dec. risk of sporadic form ApoE-4 Inc. risk of sporadic form App, presenilin 1 and 2. Dec. ACh Widespread cortical atrophy especially hippocampus. , narrowing of gyri and widening of sulci. Senile plaques w/ B amyloid core. Neurofibrillary tangles (intracellular hyperphosphorylted tau proteins.) # of tangles correlates with severity Hirano bodies in hippocampus (intracellular eosinophilic proteinaceous rods)

Answer 147

Neurofibrillary tangles are hyperphosphorylated Tau proteins. Found in Alzheimers and Pick's

Answer 148

Arboviruses (west nile, St. louis virus, Eastern/western equine viruses) Must eliminate arthropods to stop outbreaks due to no vaccines available Sx: Confusion, tremors, focal deficits. Small viruses so might not be seen on gram stain Don't cause any lesions on brain scan

Answer 149

this is an antiviral drug, inhibits IMP dehydrogenase so that GMP can not be made.

Answer 150

this is an immunosuppressant that inhibits IMP dehydrogenase

Answer 151

mimics hypoxanthine and guanine, it gets incorporated during DNA synthesis but makes non-functioning "DNA" azathioprine is a prodrug that gets converted into 6-MP in the body

Answer 152

RUQ to determine if it is Intrahepatic or extrahepatic

Answer 153

Extra: Gallstones, pancreatic mass, biliary strictures Intra: Primary biliary cholangitis, Cholestasis of pregnancy, contraceptives, erythromycin

Answer 154

Parietal - upper glandular layer Delta/chief - Deeper aspect of gastric glands

Answer 155

Acute is from Burns,brain injury (cushing ulcer), NSAID use. | Chronic is from H. pylori (more common) or autoimmune (ab attacking parietal cells and intrinsic factor)

Answer 156

Chronic - from metaplasia

Answer 157

No fructokinase! so.. some fructose can be shunted over to glycolysis via hexokinase and it will turn to fructose 6 phosphate.yay.

Answer 158

Pts are stuck with fructose 1-phosphate which cant get shunted to anything to make energy. In addition, we have wasted a phosphate making fructose 1 phosphate so glycogenolysis and gluconeogenesis are inhibited. Presents in babies after weaning from breast milk. No sorbitol, sucrose, or fructose

Answer 159

DGI is one of the most common causes of septic arthritis in young, sexually active individuals. It is dues to the spread of N. gonorrhoeae from a (usually asymptomatic) genitourinary infection into systemic circulation. Patients will present with either purulent arthritis or the triad of polyarthralgia, dermatitis, and tenosynovitis.

Answer 160

happens with someone ruptures their flexor digitorum profundus tendon (FDP). This tendon originates from the FDP muscle in the forearm, travels through the carpal tunnel, palm, and flexor tendon sheath and then inserts onto the base of the distal phalynx. The tendon pops when someone hyperextends the DIP joint. Complete tendon rupture results in absent DIP flexion.

Answer 161

primary flexor of the wrist

Answer 162

step 1: ethanol is converted to acetaldehyde via [alcohol dehydrogenase]; this process simultaneously reduces NAD+ to NADH--> this all happens in the cytosol OR ethanol is converted to acetaldehyde via [catalase]; this process simultaneously converts H2O2 to H20--> this all happens in the peroxisome step 2: acetaldehyde is converted to acetate via [acetaldehyde dehydrogenase]; this process simultaneously reduces NAD+ to NADH--> this happens in the mitochondria

Answer 163

Hepatosteatosis! Excess NADH production inhibits free fatty acid oxidation and instead enhances fatty acid formation and increased triglycerides. It makes more triglycerides by converting DHAP to Glycerol-3-phosphate which requires NADH. Since there is excess NADH via alcohol metabolism, there will be increased Glycerol-3-phosphate. The glycerol-3-phosphate then accumulates to make triglycerides. lipids can be stained with oil red O or Sudan black

Answer 164

this is also called observer effect and is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied. This can impact the observed outcomes, thereby seriously affecting the validity of the study.

Answer 165

this is also called selection bias which is created by choosing certain people to be the control group

Answer 166

this describes the fact that a researcher's beliefs in the efficacy of treatment can potentially affect the outcome. classic example-> teacher is told that a set of students have a high IQ score (they actually don't). Teacher then has higher expectations for these students and teaches them in a way that facilitates their success. Because of this those students actually performed better.

Answer 167

Increase in Glomerular capillary hydrostatic pressure or increase in Bowman's space oncotic pressure INCREASES the GFR. Increase in Bowman's space hydrostatic pressure or Glomerular capillary oncotic pressure DECREASES the GFR.

Answer 168

Z line: actin filaments are bound to proteins at the Z line M line: myosin filaments are bound to proteins at the M line in the middle of the sarcomere. A band: corresponds to myosin filaments in the sarcomere. The size does not change. H band: region where myosin does not overlap with actin. This area gets smaller with contraction. I band: region where actin does not overlap with myosin. This area gets smaller with contraction.

Answer 169

Too much ammonia in the liver that can be converted to urea because of liver damage, cirrhosis, etc. Ammonia travels to brain where astrocytes convert ammonia to glutamine via glutamine synthetase. The glutamine is then passed into neurons where it uses glutaminase to turn glutamine into glutamate. This is how excitatory NT glutamate is released into the synapse. If there is too much ammonia, then there is increasing glutamine production in astrocytes. There is an increased intracellular osmolarity causing the astrocyte to swell up and is unable to release the glutamine. This disrupts excitatory neurotransmission. Hence, asterexis.

Answer 170

it gives off the short gastric artery and the left gastroepiploic artery. The short gastric goes to the stomach and has poor ansastamoses, so the tissue it supplies is vulnerable to ischemia. The tissue supplied by the L gastroepiploic artery can alternatively be supplied by the Right one.

Answer 171

it gives off the short gastric artery and the left gastroepiploic artery. The short gastric goes to the stomach and has poor ansastamoses, so the tissue it supplies is vulnerable to ischemia. The tissue supplied by the L gastroepiploic artery can alternatively be supplied by the Right one.

Answer 172

Sudden deceleration results in extreme stretching and injury to the aortic isthmus which is tethered by the ligamentum arteriosum. Widened mediastinum seen on chest x-ray

Answer 173

1) Ribose-5-P comes from HMP shunt and is converted to PRPP via [PRPP synthetase] 2) PRPP is converted to IMP 3) IMP is converted to either AMP or GMP via [IMP dehydrogenase] some facts that go with this process: - the nitrogenous base in IMP is hypoxanthine - AAs that donate nitrogens to make purines: glycine, aspartate, and glutamine - Carbon source to make purines: THF, glycine, CO2

Answer 174

We use the enzymes HPGRT (hypoxanthine-guanine phosphoribosyltransferase) and APRT (adenine phosphoribosyltranserase). Based on the name of the enzyme, we combine either Guanine (recycled)+ PRPP to make GMP OR hypoxanthine (recycled) + PRPP to make IMP OR using the enzyme APRT Adenine (recycled)+ PRPP to make AMP

Answer 175

Allopurinol and Febuxostat both inhibit Xanthine Oxidase to inhibit Uric Acid synthesis Rasburicase converts Uric Acid into Allantoin. Allantoin is a more easy metabolite to excrete.

Answer 176

1) glutamine + CO2 -> carbomyl phosphate via [carbomyl phosphate synthetase II] 2) carbamoyl phosphate + aspartate -> orotic acid 3) orotic acid + PRPP -> UMP via [UMP synthase] 4) UMP -> UDP 5) UDP is either converted to CTP OR is converted to dUDP via [ribonucleotide reductase] 6) dUDP -> dUMP 7) dUMP -> dTMP via [thymidylate synthase] *thymidylate synthase requires N5N10methylene THF as a cofactor

Answer 177

it means reactive neutrophilia the neutrophils will have toxic granulation, cytoplasmic vacuoles, and Dohle bodies (blue cytoplasmic inclusions of rough endoplasmic reticulum) there will be an increase in LAP (leukocyte alkaline phosphatase, this is an enzyme found in maturing neutrophils) Patient will be a normal person who suddenly gets very sick. They will have a fever, dyspnea, has an underlying infection like pneumonia. They will have increased neutrophils and bands.

Answer 178

Insulin travels in the blood and binds to insulin receptors on insulin-dependent tissue (muscle and fat). This leads to two different things-> -RAS/MAP kinase pathway which leads to cell growth and DNA synthesis OR -phosphoinositide-3 kinase pathway which ultimately will lead to increased GLUT-4 receptors on cell membrane

Answer 179

Glucose is the major regulator of insulin release. When glucose is present in the gut, incretins (GLIP-1 and GIP) are also released which increases B cell sensitivity to glucose. 1) Glucose will enter the B cell via GLUT2 receptor. * remember GLUT2 is BI-directional* 2) the glucose will undergo glycolysis and hence increase ATP 3) The increase in ATP, will CLOSE the K+ inward rectifying channels, and this keeps K+ within the B cell 4) increase K+ leads to depolarization 5) depolarization leads to increased Ca2+ influx 6) increased Ca2+ leads to exocytosis of insulin granules

Answer 180

1) Biguanides (Metformin) MOA: increases AMPK, and inhibits glycerol-3-phosphate dehydrogenase (mGPD) increases glycolysis, increases peripheral glucose uptake, inhibits hepatic gluconeogenesis and the action of glucagon--> all done to increase insulin sensitivity Adverse effects: lactic acidosis (decrease hepatic uptake of lactate) and B12 deficiency, weight loss (desired) 2) Thiazolidinediones (-glits, pioglitazone) MOA: Activates PPAR-y (nuclear receptor) which increases insulin sensitivity and levels of adiponectin Adverse effects: weight gain, edema (ENaC increased, leads to water absorption), HF, increase risk of fractures. there is a delay in onset of action (several weeks)

Answer 181

1) Sulfonylureas (-ides, tolbutamide, glyburide) MOA: closes the K+ channels in pancreatic B cells-> increased insulin release Adverse effects: hypoglycemia, weight gain 2) Meglitinides (-glins, nateglinide, repaglinide) MOA: same as sulfonylureas but act fast, shorter duration, bind on a different site on the K+ channel

Answer 182

1) GLP-1 analogs (-glutides, liraglutide, semaglutide, and exenatide) MOA: decrease glucagon release, decrease gastric emptying, increase glucose-dependent insulin release Adverse effects: nausea, vomiting, pancreatitis, weight loss, increased satiety 2) DPP-4 inhibitors (-gliptin, linagliptin, sitagliptin) MOA: inhibits DPP-4 enzyme that deactivates GLP-1, decrease glucagon release, decrease gastric emptying, increase glucose-dependent insulin release Adverse effects: respiratory and urinary infections, increased satiety

Answer 183

1) Sodium-glucose co-transporter 2 inhibitors (-gliflozin, dapagliflozin) MOA: blocks reabsorption of glucose in PCT Adverse Effects: glucosuria, UTIs, vulvovaginal candidiasis, weight loss, use with caution in renal problems like low GFR 2) alpha-glucosidase inhibitors (acarbose, miglitol) MOA: inhibit intestinal brush-border alpha-glucosidases, this delays carbohydrate hydrolysis and glucose absorption, decreases postprandial hyperglycemia Adverse Effects: bloating, whoo! LOL

Answer 184

amylin released with insulin from B-cells and inhibits glucagon release and decreases gastric emptying

Answer 185

MOA: decrease glucagon release, decrease gastric emptying Adverse Effect: hypoglycemia, increased satiety

Answer 186

1) propofol is a GABA agonist thats used for long-term sedation. Adverse effect is hypotension. 2) Etomidate is a GABA agonist that has the advantage of being the most hemodynamically neutral sedative. Adverse effect is decreased cortisol synthesis. Because of this, it is often avoided in patients with septic shock and should not be used as maintenance of sedation after induction. 3) Ketamine is an NMDA antagonist. This is a good sedative because it preserves the respiratory drive during induction of anesthesia AND it also provides an analgesic effect compared to etomidate and propofol. Ketamine stimulates release of catecholamines which can cause bronchodilation, but also increase HR, contractility of the heart, which potentially puts patients at risk for CV events.

Answer 187

1) Acute Dystonia: treat with benztropine and diphenhydramine 2) Akathisia: treat with benztropine, B-blocker, benzodiazepine 3) Parkinsonism: treat with benztropine, amantadine 4) tardive dyskinesia: treat with benzodiazepines, botulinum toxin injection, valbenazine (inhibits VMAT2), deutetrabenazine

Answer 188

1) Acute Dystonia: treat with benztropine and diphenhydramine 2) Akathisia: treat with benztropine, B-blocker, benzodiazepine 3) Parkinsonism: treat with benztropine, amantadine 4) tardive dyskinesia: treat with benzodiazepines, botulinum toxin injection, valbenazine, deutetrabenazine

Answer 189

Prostacyclin (PGI2) for PAH flushing, JAW pain

Answer 190

PGI2 (prostacyclin)- vasodilation, dec. platelet aggregation TXA2 (stored in platelets) - vasoconstriction, inc. platelet agg.

Answer 191

Elastic resistance - | Less work is required at low tidal volumes - so rapid, shallow breathing is used.

Answer 192

Airflow resistance - Work is minimized when these pts. have low respiratory rates with high tidal volumes (slow, deep breathing) Bc if fast breathing - worsens resistance.

Answer 193

Preload: passive leg raise and squatting Afterload: squatting and hand grip

Answer 194

UMP synthase Cant convert orotic acid to UMP. Children have FTT, developmental delay, megaloblastic anemia due to no folate or B12 being incorporated into thymidine. B12 nor folate helps symptoms! Treat the kids with Uridine Monophosphate (UMP) Aut. rec.

Answer 195

inhibits ribonucleotide reductase (converts UPD to dUDP) | Used in myoproliferaive disorders(CML, polycythemia vera) and sickle cell (inc. HbF)

Answer 196

It forms into fdUMP and inhibits thymidylate synthase | mimics uracil

Answer 197

Converts itself to 5-fluorouracil by cytosine deaminase . 5 fluorouracil pretends to be uracil and halts dna synthesis :) hehehehe

Answer 198

DHF ---- THF Methotrexate, TMP. Less dTMP bc folate is needed to convert dUMP to dTMP

Answer 199

Ornithine transcarbamylase deficiency - excess carbamyl phosphate is converted to orotic acid. Ammonium builds up bc halted urea cycle and child will have mental changes or coma.

Answer 200

Hyperthyroidism causes increased bone turnover with net bone loss. T3 stimulates osteoclast differentiation, increased bone resorption, and release of calcium. BUT, as calcium is released from bones into circulation, it suppresses PTH secretion, which leads to decreased reabsorption of calcium in the renal tubules and gut. SO, at the end this maintains a normal blood calcium level.

Answer 201

1. recurrent vertigo 2. ear fullness/pain 3. unilateral hearing loss and tinnitus caused by increase pressure and volume of endolymph in the inner ear

Answer 202

conductive hearing loss, no vertigo, mainly in middle aged people caused by sclerosis of ossicles particularly bony overgrowths of the footplate of the stapes

Answer 203

An atrial appendage is a small saclike structure that comes off of the atria (like Romeo's little ear pouch hehehe) These appendages are susceptible to thrombus formation. Approximately 90% of left atrial thrombi are found within the left atrial appendage in patients with nonvalvular atrial fibrillation..

Answer 204

acute atopic dermatitis: dermal perivascular lymphocytosis and epidermal intercellular edema (spongiosis) manifests clinically as small vesicles ``` chronic atopic dermatitis: epidermal hyperkeratosis (thickening of the stratum corneum) and epidermal hyperplasia (increased cellularity in the stratum spinosum) manifests clinically as lichenification and scales ```

Answer 205

1. Transcription of DNA into pre-mRNA within the nucleus 2. Posttransciptional modification (pre-mRNA processing), including splicing of introns and the addition of a 5' cap and poly-A tail 3. Translation of mRNA to protein at the ribosomes 4. Folding of the amino acid chain into a protein structure 5. Posttranslational modification and trafficking to the correct destinations

Answer 206

Usually occurs due to increase in intracranial pressure due to space-occupying lesions (ex. hemorrhage, hematoma) 1. hypertension 2. bradycardia 3. irregular respirations

Answer 207

Lesions in the temporal lobe! Symptoms: ipsilateral oculomotor nerve palsy with a fixed dilated pupil due to preganglionic parasympathetic nerve fiber damage

Answer 208

This kind of herniation will compress the cerebral peduncles, resulting in corticospinal tract injury with contralateral hemiparesis. Patients will have hyporeflexia and flaccid paralysis

Answer 209

lesions to the pons, medulla, or cerebellum due to disruption of vestibular pathways

Answer 210

Anything that causes compression of the dorsal midbrain (superior colliculus, pretectal area); usually occurs due to hydrocephalus and dilation of the third ventricle

Answer 211

Celiac disease is a chronic malabsorptive disorder caused by a hypersensitivity to gluten, a protein found in wheat, barley, and rye. Gliadin (a gluten component) triggers an immune-mediated reaction causing villous atrophy, crypt hyperplasia, and intraepithelial lymphocyte infiltration. Classic celiac disease presents after introduction of gluten into the diet (between 6-24 months old) with symptoms of malabsorption (ex. diarrhea, steatorrhea, flatulence, nutrient deficiencies, weight loss). Serology: elevated IgA anti-endomysial and anti-tissuetransglutaminase antibodies. Diagnosis is confirmed by endoscopic biopsy.

Answer 212

Strep Pyogens (GAS) Staph Aureus Clostridium perfringens Pathogenesis: bacteria spread rapidly through subcutaneous tissue and deep fascia, undermining the skin; most commonly involves the perineal region and extremities ``` Clinical Manifestations: erythema of overlying skin swelling and edema pain out of proportion to exam findings systemic symptoms (fever and hypotension) ``` Treatment: requires surgical debridement and broad-spectrum antibiotics

Answer 213

1. increased reticulocytes 2. spherocytes 3. nucleated erythrocytes reticulocytes are larger than mature RBCs, lack central pallor and have a bluish color (polychromatic RBCs) due to the presence of ribosomes which are NOT found in mature RBCs. spherocytes are erythrocytes with reduced cell membrane, which makes the cell spherical rather than biconcave. Spherocytes generally arise in the setting of immune mediated hemolytic anemia. IgG-coated erythrocytes are partially phagocytized by splenic macrophages, whcih reduces the surface area of the erythrocyte cell membrane, thereby causing the erythrocyte to assume.a spherical shape. nucleated erythrocytes are very immature RBCs. The presence of nucleated RBCs in the peripheral blood indicates a strong bone marrow response to compensate for the anemia

Answer 214

CD4 (CD8 cytotoxic T cells are involved in the hyperacute/ acute) Both cellular and humoral - Type II and IV

Answer 215

Celiac disease is a chronic malabsorptive disorder caused by a hypersensitivity to gluten, a protein found in wheat, barley, and rye. Gliadin (a gluten component) triggers an immune-mediated reaction causing villous atrophy, crypt hyperplasia, and intraepithelial lymphocyte infiltration. Classic celiac disease presents after introduction of gluten into the diet (between 6-24 months old) with symptoms of malabsorption (ex. diarrhea, steatorrhea, flatulence, nutrient deficiencies, weight loss). Serology: elevated IgA anti-endomysial and anti-tissuetransglutaminase antibodies. Diagnosis is confirmed by endoscopic biopsy.

Answer 216

Proliferation of vascular smooth muscle(arteriosclerosis), parenchymal atrophy, interstitial fibrosis.

Answer 217

Classically in chronic transplant rejection reaction. (from lung) Could be from virus, other etiologies not known. Fibrosis in small bronchioli

Answer 218

``` Rifampin - RNA polymerase inhibitor Ramps up CYP-450 (so use rifabutin if liver disease) Red/orange body fluids Rapid resistance if used alone ``` Isoniazid - inhibition of mycolic acid - neurotoxicity Pyrazinamide - MOA unclear (:)) hyperuricemia Ethambutol - blocks arabinosyl transferase (carb polymerization of cell wall) - optic neuropathy

Answer 219

A sequence occurs when a single developmental defect causes a cascade of additional malformations

Answer 220

Hypoplasia of the mandibular prominence leads to micrognathia. Severe micrognathia causes posterior displacement of the tongue (glossoptosis) and this then blocks fusion of the palatine shelves, resulting in a cleft palate that is characteristically U-shaped. tx: put patient in prone position because gravity pulls the tongue anteriorly, opening the airway

Answer 221

A collection of malformations that are often seen together and do not have a known, common cause ``` Ex. VACTERL association vertebral anomalies anal atresia cardiac defects tracheoesophageal fistula renal anomalies limb anomalies ```

Answer 222

Symptoms: pain and stiffness in proximal muscles (shoulders, hips), often with fever, malaise, weight loss. Does not cause muscular weakness. More common in females > 50 years old; associated with giant cell (temporal) arteritis (anterior ischemic optic neuropathy, AION) findings: increased ESR and CRP, normal CK Treatment: rapid response to glucocorticoids

Answer 223

due to longstanding HTN and diabetes mellitus near the subthalamic nucleus, causes damage at that area which results in contralateral hemiballism REVIEW the basal ganglia pathways! pg 516 in book

Answer 224

Wilson disease! The lentiform nucleus (globus pallidus and putamen) degenerate. Characterized by liver (hepatitis, cirrhosis), psychiatric (depression, personality changes), and neurologic abnormalities (dysarthria, movement disorders)

Answer 225

Mifepristone is a progesterone antagonist. When progesterone levels are high during pregnancy, it is used for medical abortion because it causes necrosis of the uterine decidua and stimulates uterine contractions. Progestins are used as oral contraceptives. They decrease LH secretion, thereby inhibiting ovulation and preventing pregnancy.

Answer 226

Pathogenesis: mutations in HFE protein; this protein interacts with the transferrin receptor complex that functions as a sensor of iron stores. If HFE is mutated, it becomes inactivated and causes enterocytes and hepatocytes to detect falsely low iron levels. Enterocytes respond by increasing apical expression of DMT1 increasing iron absorption Hepatocytes respond by decreasing hepcidin synthesis, so low hepcidin results in increased ferroportin expression on basolateral surface of enterocytes. This leads to increased iron secretion into circulation-> iron overload. *i've put a picture of this on our document* Symptoms: micronodular cirrhosis, diabetes mellitus, skin pigmentation (bronze diabetes). Patients at risk for hepatocellular carcinoma, heart failure, and testicular atrophy/hypogonadism.

Answer 227

Pathology: It is an inflammatory myopathy triggered by unknown, possibly viral, antigens. It likely represents a cell-mediated immune response against myocytes. Increased expression of MHC I antigens leads to presentation of autoantigens to CD8+ T cells that then initiate myocyte destruction. Infiltration of the ENDOMYSIAL by macrophages and CD8+ lymphocytes is typically seen. Labs: + ANA, increased CK, + anti-Jo-1, + anti-SRP, + anti-Mi-2 (helicase)

Answer 228

Similar to polymyositis, but also involves Gottron papules, photodistributed facial erythema (ex. heliotrope edema of the eyelids), "shawl and face" rash, hyperkeratosis of fingers "looks dirty/mechanical worker hands" PERIMYSIAL inflammation with CD4+ cells Labs: + ANA, increased CK, + anti-Jo-1, + anti-SRP, + anti-Mi-2 (helicase)

Answer 229

SNOW DROP Southern blot is for DNA Northern blot is for RNA OOOOOOOOOOOOOOO Western blot is for Protein

Answer 230

Equilibrium potentials of cellular ions reflect how they affect the membrane potential if the membrane were permeable solely for that ion.

Answer 231

IgG and C3b

Answer 232

middle geniculate artery

Answer 233

Symptoms: Cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), "magenta" tongue, corneal vascularization Riboflavin is used in the TCA cycle and ETC! SO, first riboflavin is phosphorylated to become flavin mononucleotide (FMN), which can then be further phosphorylated to flavin adenine dinucleotide (FAD). FMN and FAD participate in numerous red-ox reactions, and are also converted to energy carrying states like FADH2 or FMNH2. FAD is important for the enzyme Succinate Dehydrogenase in the TCA cycle. FMN serves as a component of Complex 1 in the ETC.

Answer 234

clindamycin (most important one imo) fluoroquinolones cephalasporins penicillins

Answer 235

Skin, Bone, tendons, ligaments, dentin, cornea, blood vessels, SCAR tissue

Answer 236

Symptoms: Cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), "magenta" tongue, corneal vascularization Riboflavin is used in the TCA cycle and ETC! SO, first riboflavin is phosphorylated to become flavin mononucleotide (FMN), which can then be further phosphorylated to flavin adenine dinucleotide (FAD). FMN and FAD participate in numerous red-ox reactions, and are also converted to energy carrying states like FADH2 or FMNH2. FAD is important for the enzyme Succinate Dehydrogenase in the TCA cycle. FMN serves as a component of Complex 1 in the ETC.

Answer 237

clindamycin (most important one imo) fluoroquinolones cephalasporins penicillins

Answer 238

Babies will present with signs of heart failure (poor feeding, sweating/tachypnea with feeds) and failure to thrive due to left-sided volume overload with inability to maintain adequate cardiac output. cardiac exam: holosystolic murmur at the left lower sternal border; a palpable thrill might also be present at the left sternal border

Answer 239

CATCH-22 Conotruncal abnormalities (tetralogy of fallot, truncus arteriosus, interrupted aortic arch) abnormal facies thymic hypoplasia/aplasia (T-cell deficiency) craniofacial deformities (cleft palate) hypocalcemia/hypoparathyroidism

Answer 240

Thrombolytics are drugs that lyse a clot by converting plasminogen to plasmin, which cleaves thrombin and fibrin clots. These are the drugs that they call tPA activators which are: alteplase, reteplase, streptokinase, tenecteplase To reverse the effects of thrombolytics, give antifibrinolytics. Which are: aminocaproic acid and tranexamic acid

Answer 241

1. Several medications are given to protect heart and relieve pain - beta blocker - nitroglycerin - morphine - aspirin tablet to chew 2. PCI (percutaneous coronary intervention) is the first choice for the treatment of STEMI. The goal is to open the artery within 90 minutes of the patient receiving care. 3. If the hospital doesn't have a PCI program, transfer the patient to the nearest PCI hospital. This should be done within 2 hours of the patient first receiving care. 4. IF options 2 and 3 are NOT possible, that's when fibrinolytics/thrombolytics are give. The goal is to infuse clot-busting medications within 30 minutes of a patient's arrival at the hospital.

Answer 242

Intracerebral hemorrhage

Answer 243

Valacyclovir (prodrug) that gets converted to acyclovir. MOA: guanosine analogs that are monophosphorylated by the viral thymidine kinase. The virus then tries to incorporate these guanosine analogs during DNA replication. BUT, DNA replication is terminated! YAY!

Answer 244

famciclovir | same MOA as valacyclovir/acyclovir

Answer 245

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral ulcerations (apthous stomatitis), arthritis (peripheral, spondylitis)

Answer 246

Valacyclovir (prodrug) that gets converted to acyclovir. MOA: guanosine analogs that are monophosphorylated by the viral thymidine kinase. The virus then tries to incorporate these guanosine analogs during DNA replication. BUT, DNA replication is terminated! YAY!

Answer 247

famciclovir

Answer 248

Recall bias results from inaccurate recall of past exposure and many times occurs in RETROspective case control studies. People who have experienced something bad are more likely to remember what happened years ago. Minimize it by performing a prospective study (begin study by taking exposed and unexposed ppl)

Answer 249

Hydralazine dilates arteries and Nitrates dilate veins. Hydralazine is for Hypertensive emergencies, HF Nitrates is for angina, pulm edema. it decreases preload and lets the heart relax :)

Answer 250

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral ulcerations (apthous stomatitis), arthritis (peripheral, spondylitis)

Answer 251

noncaseating granulomas and lymphoid aggregates. Th1 mediated.

Answer 252

crypt abscesses and ulcers, bleeding, no granulomas. Th2 mediated.

Answer 253

Carvedilol Labetalol a1 - so DECREASED systemic vascular resistance rather than it just being evened out bc blocking B2

Answer 254

Latissimus dorsi C6-8 extension, adduction. internal rotation of humerus

Answer 255

ototoxicity, sulfa allergy, metabolic alkalosis (loss of K+), gout (because diuretic competes with uric acid transporter leading to increased uric acid in blood)

Answer 256

ethacrynic acid, BUT has more ototoxicity compared to regular loops

Answer 257

hypokalemia (metabolic alkalosis), hyperuricemia (gout), hypercalcemia, sulfa allergy

Answer 258

Natalizumab(a4 integrin blocker), rituximab(CD20)

Answer 259

Called McArdle disease. Deficient enzyme: skeletal muscle glycogen phosphorylase Findings: increase glycogen in muscle, but muscle can't break it down, leads to painful muscle cramps, myoglobinuria (red urine) with strenuous exercise, and arrhythmia from electrolyte abnormalities.

Answer 260

Called Andersen disease. Deficient enzyme: branching enzyme Findings: most commonly presents with hepatosplenomegaly and failure to thrive in early infancy. Other findings include infantile cirrhosis, muscular weakness, hypotonia, cardiomyopathy early childhood death.

Answer 261

Called Cori disease. Deficient enzyme: Debranching enzymes (alpha-1,6-glucosidase and 4-alpha-glucotransferase) Findings: similar to von Gierke but milder symptoms and normal blood lactate levels. Can lead to cardiomyopathy. Limit dextrin-like structures accumulate in cytosol. Gluconeogenesis is intact.

Answer 262

Called Pompe disease. Deficient enzyme: lysosomal acid 1,4- glucosidase (acid maltase) with alpha-1,6-glucosidase activity Features:cardiomyopathy, hypotonia, exercise intolerance, and systemic findings lead to early death.

Answer 263

Called Von Gierke disease. Deficient enzyme: glucose-6-phosphatase Features: severe fasting hypoglycemia, increased glycogen in liver and kidneys, increase in blood lactate, increased TG, increase in uric acid (Gout), and hepatomegaly, renomegaly. The liver DOES NOT regulate blood glucose. Impaired gluconeogenesis and glycogenolysis. tx: frequent oral glucose/cornstarch; avoid fructose and galactose

Answer 264

Invades common bile duct, therefore increased amounts of conjugated bilirubin in blood, increased Alk Phos, acholic stools mutation: KRAS-activating mutation other cancers with KRAS: colorectal and non-small cell lung cancers

Answer 265

germline mutations in APC tumor suppressor gene

Answer 266

malignant melanoma

Answer 267

c-MYC protooncogene overexpression is in Burkitt lymphoma, which presents as a facial mass (endemic African form) or with ascites and multi-organ involvement (sporadic form)

Answer 268

patients do not pass meconium by 48 hrs of life, poor feeding, bilious vomiting, abdominal distension, forceful expulsion of gas and/or stool with a digital rectal exam, and megacolon in the aganglionic segment

Answer 269

von Willebrand disease. Presentation: prolonged mucosal bleeding, easy bruising * vWF carries factor 8 with it, so we would measure bleeding times with PTT* tx: Desmopressin, apparently this releases vWF from endothelial cells and then would also simultaneously release factor 8

Answer 270

conjunctival injection (red eyes), tachycardia, increased appetite, and dry mouth

Answer 271

``` This is what is used to deliver serious news. S-> set the stage P-> perception I-> invitation K-> knowledge E-> empathy S-> summary and strategy ```

Answer 272

The skin will turn white. The drug is working YAY. Melanoma uses the PD-1 inhibitor, ex. pembrolizumab

Answer 273

PAI most commonly results from autoimmune destruction of bilateral adrenal cortex and often occurs in patients with a preexisting history of autoimmune disease (hypothyroidism, T1DM) Patients will present with salt wasting and hypovolemia and orthostasis (decrease in aldosterone) and hypoglycemia, normocytic anemia, and eosinophilia (decrease in cortisol)

Answer 274

EEG- theta waves (4-7.9 Hz) | characteristics- easy to wake; wakefulness-sleep transition

Answer 275

EEG- theta waves (4-7.9 Hz) and K complexes and sleep spindles characteristics- largest percentage of sleep

Answer 276

EEG- delta waves (<4 Hz) | characteristics- prominent 1st half of night, difficult to wake, sleepwalking and night terrors

Answer 277

EEG- resembles wakefulness, occasional sawtooth waves characteristics- prominent 2nd half of night, dreams, REMs, muscle atonia, REM sleep behavior disorder and nightmare disorder

Answer 278

premotor cortex- selection of motor plans for voluntary movements motor cortex- actually executes the voluntary movements

Answer 279

Hypermetabolic state! increased temperature, hypertension, tachycardia, perisistent hyperglycemia this is likely triggered by the profound release of inflammatory mediators from damaged tissue which leads to increased levels of catecholamines and glucocorticoids tx: testosterone analog (oxandrolone), this decreases muscle wasting and enhances protein synthesis

Answer 280

[Rcontrol - Rtreatment]/Rcontrol OR RRR= 1- RR (relative risk-> Rtreatment/Rcontrol)

Answer 281

Semantic memory refers to memory made from general knowledge (words, pictures, objects). This information is stored in the anterior temporal lobe.

Answer 282

Initial therapy- amphotericin B and flucytosine | Long-term maintenance- fluconazole

Answer 283

occurs when an unaffected parent has gametes with a mutated allele that is passed to offspring; it is typically suspected when multiple siblings have an autosomal dominant disorder with phenotypically normal parents

Answer 284

describes different genetic mutations causing the same disease, so same symptoms/manifestations

Answer 285

1. Legal or situational emanicpation (ex. parent, married) 2. Emergency care in which delay of care could result in significant harm to life or limb 3. Specific conditions (ex. STI, pregnancy, substance abuse) that are potentially serious, sensitive, or stigmatizing

Answer 286

Bcl-2 is an apoptosis inhibitor. When Bcl-2 is overexpressed, cell death is delayed and an accumulation of indolent malignant cells occurs.

Answer 287

Morphine is cleared by kidneys, if there is a problem with the kidneys and they can't undergo renal clearance, monitor carefully. Morphine metabolites that are made from hepatic glucuronidation are ACTIVE metabolites.

Answer 288

Macrophage Fc receptor CD16