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Random Facts 1 Flashcards

1
Q

Nerve affected:

  • Decreased sensation palm and 3rd digit
  • Weakness wrist and finger extension
  • Biceps and Brachioradialis DTR normal
  • Triceps reflex diminished
A

C7

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2
Q

Ligamentum Flavum

A

Runs inside spinal canal
Posterior (just under spinous process
Thickening can stenose spinal cord

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3
Q

Nerve that supplies sensation to TMJ

A

Mandibular Nerve (CN V3)
Also supplies floor of mouth, anterior tongue, lower face
Tensor Veli Palatini and Tensor Tympani (ear pain, muffled hearing)
Contraction of pterygoids (jaw pain)

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4
Q

1st Aortic Arch –> adult derivative

A

Part of maxillary Artery

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5
Q

2nd Aortic Arch –> Adult derivative

A

Hyoid Artery

Stapedial artery

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6
Q

3rd Aortic Arch –> Adult derivative

A

Common Carotid Artery

Proximal Internal Carotid Artery

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7
Q

4th Aortic Arch –> Adult derivative

A

On LEFT: Aortic Arch

On RIGHT: Proximal R Subclavian Artery

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8
Q

6th Aortic Arch –> Adult derivative

A

Proximal Pulmonary arteries

On LEFT: Ductus Arteriosus

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9
Q

Most likely site of obstruction in unilateral fetal hydronephrosis

A

Ureteropelvic junction

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10
Q

Confounding definition in regards to experiments

A

When a perceived assoc btw an exposure and an outcome is actually explained by a confounding variable assoc w both the exposure and the outcome

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11
Q

Polyhydramnios

A

Excessive accumulation of amniotic fluid
Increased abd circumference not matching age
Fetal GI obstruction or Anencephaly –> impaired swallowing
High fetal cardiac output –> Increased urination

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12
Q

Amyloid

A

B-pleated sheets
Congo red staining
Apple green birefringence in polarized light

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13
Q

Primary Amyloidosis

A

Systemic deposition
AL amyloid from Ig Light Chain
Assoc w plasma cell dyscarasias
Kidney most commonly involved organ

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14
Q

Secondary amyloidosis

A

Systemic deposition
AA amyloid from SAA (acute phase reactant)
Chronic inflammatory states

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15
Q

Familial Mediterranean Fever

A

Dysfunction of neutrophils
Autosomal recessive
Fever and inflammation –> SAA –> AA amyloid

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16
Q

Clinical presentation of amyloidosis

A 
Nephrotic syndrome (most common)
Restrictive cardiomyopathy
Arrhythmia
Tongue enlargement
Malabsorption
Hepatosplenomegaly
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17
Q

Senile Cardiac Amyloidosis

A

Non-mutated transthyretin deposits

Usually asymptomatic

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18
Q

Familial Amyloid Cardiomyopathy

A

Mutated transthyretin deposits
Restrictive cardiomyopathy
African americans

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19
Q

Dialysis assoc Amyloidosis

A

B2-microglobulin deposits in joints

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20
Q

Medullary carcinoma of thyroid

A

Calcitonin deposits within tumor

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21
Q

Acetoacetate can spontaneously convert to _____ causing a fruity breath

A

Acetone

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22
Q

ACTH is inhibited by

A

Cortisol

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23
Q

Antidote for Digoxin toxicity

A

Digoxin Ab Fragments

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24
Q

B-hCG expected to see an intrauterine pregnancy

A

1500

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25
Bacteria with Exotoxins
``` Corynebacterium diphtheria Pseudomonas aeruginosa Shigella E.coli Bacillus anthracis Vibrio cholera Clostridium Strep pyogenes Staph aureus ```
26
Carcinoid Syndrome Rule of Thirds
1/3 metastasize 1/3 present w secondary malignancy 1/3 are multiple
27
Causes of Restrictive Cardiomyopathy
``` Amyloidosis Sarcoidosis Hematochromatosis Lysosomal Storage diseases Myocardial Fibrosis (radiation, scleroderma) ```
28
Characteriatics of Exotoxins:
High virulence with Low concentration Induce high-titer antibodies (anti-toxins) Toxoids can be used as vaccines NOT heat stable
29
Characteristics of Endotoxins
``` Adverse effect intensity is low Clinical effects are fever, shock, DIC Heat stable (100 deg C for 1 hr) Induce TNF, IL-1, IL-6 NO vaccines available because poor antigenicity ```
30
Diagnosis of Prinzmetal Angina
CORONARY ARTEROGRAPHY - Recurrent CP at rest - Transient ST elevation on ECG - No high grade coronary artery stenosis on angiography * no coronary obstructions makes the diagnosis
31
Diagnostic for PID
Cervical motion tenderness (chandelier sign)
32
Ectopic Pregnancy risk factors
``` Previous ectopic History of infertility Previous tubal surgery PID Smoking Advanced maternal age IUD/ tubal ligation Hx ruptured appendix ```
33
Endometriosis
Responds to cyclic hormones Form chocolate cysts on ovaries Form catamenial pneumothorax in lungs
34
Vagus Nerve
- Swallowing - Elevates soft palate - Keeps uvula midline - Talking - Cough reflex - Parasympathetics to thoracoabdominal viscera - Monitoring aortic arch
35
Serum marker for Seminoma
Alk Phos
36
Screening test for Kartagener's Syndrome
Decreased Nasal Nitric Oxide
37
Reyes Syndrome is aka
Hepatoencephalopathy
38
Rate limiting enzyme of ketogenesis
HMG-CoA Synthase
39
Rate limiting enzyme in cholesterol synthesis
HMG-CoA Reductase | Inhibited by statins
40
Neuroendocrine tumor marker (Ex. carcinoid, insulinoma, gastrinoma...)
Chromogranin
41
Oxytocin is stored in the
Posterior pituitary
42
Oxytocin stimulates
``` Milk ejection (breast) Uterine contraction ```
43
Presentation of Prinzmetal Angina
Pain at rest Occurring at night Indistinguishable from classic angina
44
Symptoms of Carcinoid Syndrome
``` B-FDR Bronchospasm Flushing Diarrhea R valvular disease ```
45
Kidneys are located at spinal levels
T12-L3
46
Treatment for Carcinoid Syndrome
Surgical resection | Somatostatin Analog
47
Treatment for ruptured esophageal varicies
Octreotide (somatostatin analog, splanchnic vasoconstriction) Rubber band ligations (prevent bleeding)
48
TSH is inhibited by
Somatostatin | T3/T4
49
Tumor marker for Endodermal Sinus Tumor (Yolk Sac Tumor)
AFP
50
Urine Ketone test assesses
Acetoacetate | NOT B-hydroxybutarate
51
Kehr's Sign
Pain that radiates to shoulder | Sign of perotinitis
52
LH in women acts on _____ to produce _____
Theca lutein cells Produce estrogen and progesterone and stimulates ovulation, helps form corpus luteum
53
LH is inhibited by increased levels of
Progesterone (women) | Testosterone (men)
54
Main ketone bodies
Acetoacetate | B-hydroxybutarate
55
Major risk factor for Prinzmetal Angina
Smoking
56
Auditory sensation goes to which thalamic nuclei
Medial geniculate nucleus
57
Visual sensation goes to which thalamic nuclei
Lateral Geniculate Nucleus
58
Motor to the body goes to which thalamic nucleus
Ventral Lateral Nucleus
59
Facial sensation goes to which thalamic nuclei | Body sensation goes to which thalamic nuclei
Ventral Postermedial Nuclei
60
Iron Deficiency Anemia
``` Pica Hypovolemia (hemorrhoids) Brittle nails Angular cheilitis Microcytic Tx: Iron replacement, colonoscopy to r/o CA ```
61
Treatment for Tyl overdose or inhaled drug to loosen mucus plugs
N-acetylcysteine
62
Mechanism of Action of Benzos
Increased FREQ of GABAa receptor Cl channel opening
63
Mechanism of action of Barbiturates
Increased DURATION of GABAa receptor Cl channel opening CNS depression Resp depression CV depression
64
ACE inhibitors are contraindicated in pregnancy bc
``` Teratogenic Use Methyldopa (a2-agonist) instead ```
65
Syncope in positive G forces
4-6 G Forces pool blood in abd and legs Not returned to heart Hypoperfusion of brain
66
Dorsal Root Ganglia derive from ______ embryological tissue
Neural crest (from ectoderm)
67
Presentation of PCP intoxication
``` Sympathomimetic Psychosis Superhuman strength Hallucinations Vertical and Horizontal Nystagmus ```
68
Chemo agent responsible for restrictive lung disease
Bleomycin | Induces free radicals to interfere w DNA structure
69
Most common renal malignancy in adults
``` Renal Cell Carcinoma Deletion of genes on Ch 3 (assoc w VHL) -hematuria -flank pain -palpable flank mass -yellow tumor -clear cells *can be sporadic or hereditary ```
70
Mechanism of Factor V Leiden
Mutation produces Factor V that cannot be degraded by Protein C
71
Pulmonary diseases with increased Reid Index
COPD - Emphysema - Chronic Bronchitis
72
Neoplasm responsible for | ACTH --> Cushing's
Small Cell Lung CA
73
Neoplasm responsible for | PTH-related peptide --> Hypercalcemia
Squamous Cell Lung CA
74
Neoplasm responsible for | Erythropoietin --> Polycythemia
``` "possibly really high hematocrit" Pheochromocytoma Renal Cell Carcinoma Hepatocellular Carcinoma Hemangioblastoma ```
75
Neoplasm responsible for | ADH --> SIADH
Small Cell Lung CA | Intracranial CA
76
Viral illness assoc w Burkitt Lymphoma
EBV Neoplasm of mature B cells Starry Sky appearance
77
T cells are found in the _____ of the spleen
PALS and White Pulp
78
B cells are found in the _____ of the spleen
White Pulp
79
Compliment deficiency seen with | Frequent Neisseria infections
C5- C9
80
Compliment deficiency seen with - Frequent pyogenic RTIs - Increased frequency of type 3 hypersensitivity reaction
C3
81
Compliment deficiency seen with | Paroxysmal Nocturnal Hemoglobinuria
CD55, CD59 Prevents compliment from attacking RBCs DAF
82
Function of LH in men
Acts on leydig cells to produce testosterone
83
LH release is stimulated by
Pulsatile release of GnRH
84
Hydratidiform mole is the most common precursor of what malignancy
Choriocarcinoma High B-Hcg *make sure B-Hcg returns to zero bc any remaining mole could --> choriocarcinoma
85
Most common form of adrenal hyperplasia
21a-hydroxylase deficiency
86
Hormone levels altered in 21a-hydroxylase deficiency
Decreased aldosterone Decreased cortisol Increased sex hormones
87
Clinical manifestations of 21a-hydroxylase deficiency
Hypotension Volume depletion Hyperkalemia bc decreased aldosterone Masculinizing effects in fems bc increased androgens
88
Mechanism of Scopolamine
Anticholinergic | Antagonist of M1 muscarinics
89
Mechanism of Promethazine
Antagonist Histamine receptors | Antagonist D2 receptors
90
Mechanism of Prochlorperazine
D2 antagonist
91
Mechanism of Metocloparmide
D2 antagonist | Prokinetic in GI system
92
Mechanism of Ondansetron
5HT3 blocker
93
Mechanism of Methylphenidate
Indirect sympathomimetic | Releases stored catecholamines
94
1st line treatment for ADHD
Stimulants (methylphenidate, dextroamphetamine) SNRI (atomoxetine) If insomnia --> clonidine
95
Kid with | High fever --> Rash --> Fever resolves with appearance of rash
``` HHV-6 Roseola -lacy rash -rash spares face -Tx is supportive ```
96
Mechanism of Strichnine
Glycine Antagonist
97
Mechanism of Tetanus toxin
Binds Renshaw cells | Blocks inhibitory function of glycine and GABA
98
Mechanism of Black widow spider toxin
Excessive release of Ach
99
Mechanism of Botulinum toxin
Inhibits release of Ach
100
Oligohydramnios
Decreased amniotic fluid/ fetal urine production Placental insufficiency Bilat renal genesis Posterior urethral valves (males)
101
Polyhydramnios
Increased fetal urine/ amniotic fluid Decreased fetal swallowing GI obstruction Anencephaly
102
Potter Sequence
Bilateral Renal Agenesis Oligohydramnios Congenital Malformations POTTER: palm hypoplasia, oligohydramnios, twisted skin, twisted face, extremity deformity, renal agenesis
103
Risk factors for osteosarcoma
``` Bone infarcts Radiation Paget's disease Familial Retinoblastoma (mutated Rb gene) Male 10-20 yrs old ```
104
Efferent fibers that carry input from brain to influence outer hair cells of the cochlea
Olivocochlear Bundles Results in contraction of OHCs --> Stiffening of cochlear basilar membrane --> Sensitizes inner hair cells to particular frequency
105
Result of damaged Outer hair cells of the cochlea
Wide deflection of basilar membrane | Hearing loss
106
I Cell Disease
Defect in N-acetylglucosaminyl-1-phosphotransferase Mannose 6 is not phosphorylated Proteins are secreted extracellularly rather than to lysosomes -Coarse facial features -Failure to thrive -Cognitive impairment -Corneal clouding
107
Clathrin
Tag directing golgi --> plasma membrane or endosome
108
COPI
Tag directing golgi --> endoplasmic reticulum
109
COPII
Tag directing endoplasmic reticulum --> golgi
110
Zellweger Syndrome
Autosomal recessive Mutated PEX gene Defective peroxisome function Increased Very Long chain fatty acids (VLCFAs) Hypotonia, seizures, hepatomegaly, early death
111
Adrenoleukodystrophy
X-linked recessive Mutated ABCD1 gene No B-oxidation Impaired transport of VLCFAs to peroxisome Increased VLCFAs in brain, adrenals, testes -cognitive impairment -adrenal insufficiency
112
Ubiquitin
Tag for degradation in proteosomes
113
Kartagener's Syndrome
``` Autosomal recessive Defective dynein arm (retrograde axonal t/p) Immotile cilia Infertility/ ectopic Bronchiectasis Situs Inversus ```
114
Mannose 6 Phosphate
Golgi Tag for degradation in the lysosome
115
Desmin
Intermediate filament found in muscle cells --> rhabdomyosarcoma
116
Vimentin
Intermediate filament found in mesenchymal tissue --> sarcoma Secures organelles inside cytosol Provides resistance to mechanical stress
117
GFAP
Intermediate filament found in neuroglia --> astrocytoma
118
Scurvy
VitC deficiency Decreased collagen hydroxylation -swollen gums -poor wound healing
119
Osteogenesis Imperfecta
``` AutoDOM (COL1A1 and COL1A2) Decreased normal procollagen (type 1) -frequent fractures (weak bones) -blue sclera (translucent connective tissue, veins more prominent) -hearing loss (ossicles) -abn teeth ```
120
Ehlers-Danlos Syndrome
``` Procollagen peptidase (terminal cleavage) or Lysyl oxidase (cross-linking) deficiency Classic Type (stretchy skin, hyper mobile, easy bruising, Type V collagen affected) Vascular Type (aneurysms, muscle rupture, Type III collagen affected) ```
121
Menkes Disease
``` X-linked recessive Defective Menkes protein (ATP7A) Impaired Copper absorption Cu cofactor for lysol oxidase (last) step of collagen cross-linking -growth retardation -brittle hair (kinky hair) -hypotonia *ATP7B is Wilson Disease *no bone deformity *not hyper extensible *presents in infancy ```
122
Marfan Syndrome
Defective fibrillin-1 (FBN1) --> defective scaffolding for elastin synthesis Weak connective tissue Heart (cystic medial necrosis, MVP), cataracts, periosteum, pectus excavatum/ carinatum UPWARD subluxation of lens (down in homocystinuria)
123
Blotting techniques detect _____
``` SNoW DRoP Southern- DNA Northern- mRNA Western- Proteins Southwestern- DNA binding proteins ```
124
Antiviral Mechanism of Interferons
Induce viral defenses RNA protein kinase (degrades viral RNA) Trigger apoptosis Influence macrophages/ dendritic cells
125
Vanco is good for
Multidrug resistant organisms (MRSA, enterococci) | 2nd line for Diff (after metronidazole)
126
Mechanism of Vanco resistance
Vanco binds D-ala D-ala to inhibit cell wall synthesis When D-ala D-ala --> D-ala D-LAC Vanco cant bind
127
Gastrinoma + kidney stones + hypogonadism
Multiple Endocrine Neoplasia 1 (MEN1)
128
Clomiphene
Given for PCOS Induces ovulation Estrogen antagonist --> increases LH/ FSH
129
Bedbugs transmit what diseases
No transmission to humans | Local allergic reaction
130
ICAM-1
Receptor on vascular endothelials Binds neutrophil LFA-1 (integrin) Aids in extravasation
131
PECAM-1
Receptor on vascular endothelials | Aids in neutrophil/ monocyte/ platelet diapedesis from vascular compartment
132
Neutrophil chemotactic factors
C5a IL-8 (continued inflammation) LTB4 Kallikrein
133
_____ and _____ cannot use ketones
RBCs (lack mitochondria, no TCA) | Hepatocytes (produce the ketones)
134
Ketogenesis is unregulated during
Intense gluconeogenesis Oxaloacetate is depleted (1st step of TCA) Acetyl-CoA shunted to ketone formation Ex. type 1 dm
135
High _____ in alcohol intoxication inhibits conversion of Malate to _____
High NADH Inhibits Malate --> Oxaloactate Inhibits TCA cycle Accumulation of Acetyl-CoA --> ketone pathway
136
Zinc deficiency
``` Decrease in adult hair (pits, pubic, face) Immunesuppression Hypogonadism Dysguesia (distorted taste) Anosmia (loss of smell) Perioral and Buttock rash Predispose alcoholics to cirrhosis ```
137
Acrodermatitis enteropathica
Inherited zinc deficiency | Perioral and buttock rash
138
Vit B1 (thiamine)
Cofactor for dehydrogenases and transketolase
139
Vit B1 (thiamine) deficiency
Wernicke-Korsakoff syndrome Seen in alcoholism and malnutrition Oculomotor dysfunction, ataxia Chronic --> Korsakoff (amnesia, confabulation, apathy) Affects mammary Bodies (high metabolic demand)
140
Vit B2 (riboflavin)
Cofactor for dehydrogenases | Necessary for FAD synth
141
Vit B2 (riboflavin) deficiency
Cheilosis | Corneal vascularization
142
Vit B3 (niacin)
Cofactor for dehydrogenases Necessary for NAD synth Derived from tryptophan Assoc w Hartnup Disease
143
Vit B3 (niacin) deficiency
3 Ds of Pellagra Diarrhea Dermatitis Dementia
144
Vitamin B3 (niacin) toxicity
Facial flushing due to PGs
145
Vit B5 (pantothenic acid)
Cofactor for dehydrogenases
146
Hartnup Disease
Deficiency of neutral AA transporters (tryptophan) in kidney and sm intestine Elevated neutral AA levels in serum No Tryptophan --> No Niacin
147
``` Vit B5 (pantothenic acid) Vit B7 (biotin) deficiency ```
Dermatitis Alopecia Enteritis
148
Vit B6 (pyridoxine)
Cofactor for - transaminases - cystathionine synthase - DOPA decarboxylase - Serotonin synth - Niacin synth - GABA synth - heme synth
149
Vit B6 (pyridoxine) deficiency
Peripheral neuropathy | Isoniazid induces deficiency
150
Vit B7 (biotin)
Cofactor for carboxylases | Avidin in egg whites binds biotin
151
Vit B9 (folate)
Converted to Tetrahydrofolate | Found in green leafy veggies
152
Vit B9 (folate) deficiency
Megaloblastic anemia Increased homocysteine Normal methylmalonic acid levels
153
Vit B12 (cobalamin)
Cofactor for methionine synthase and Methylmalyonyl-CoA mutase Found in animal products
154
Vit B12 (cobalamin) deficiency
Megaloblastic anemia Increased homocysteine Increased methylmalonic acid Subacute combined degeneration
155
Vit A
``` Vision Differentiation of specialized epithelials Isotretinoin treats cystic acne All-trans retinoid acid treats APL Required for maturation of immune cells ```
156
Vit A deficiency
Night blindness Dry skin Metaplasia --> Thin squamous conjunctiva --> Keratomalacia Immune cells trapped in blast state --> Myelocytic Leukemia
157
Vit A toxicity
Increased ICP | Dry skin
158
Vit D
Ca and phosphate regulation | Formed in UV exposed epithelium
159
Vit D deficiency
Rickets Osteomalacia *defective mineralization of osteoid
160
Vit E
Protects RBCs from free radicals
161
Vit E deficiency
Anemia (not macrocytic, MCV <100) | Neurological deficits
162
Glycolysis
Glucose --> pyruvate Occurs in cytoplasm Generates ATP and NADH
163
Maturity Onset Diabetes of the Young | is a deficiency of _____ function
Glucokinase | No glycolysis
164
Post-Strep Glomerulonephritis
Coca-Cola colored urine Subepithelial humps (lumpy bumpy) + antiDNAase titer + streptolysin O titer
165
IgA GlomeruoNephropathy
``` After URI Purpura on buttock/ legs (henoch) aka Buerger disease Mesangial deposits of IgA RBC Casts ```
166
Alport Syndrome
``` Defect in type IV collagen X-linked inheritance Thinning and Splitting of BM Cataracts Isolated Hematuria High freq hearing loss "cant see, cant pee, cant hear a high c" ```
167
Granulomatosis w polyangitis
``` Nasal granulomas Pulmonary infultrates Hematuria + c-ANCA aka Wegners ```
168
Eosinophilic granulomatosis w polyangitis (Churg-Strauss)
Sm-Med Vessel Vasculitis Involves nasal passages Assoc w late-onset asthma, rhinosinusitis + p-ANCA Peripheral EOSINOPHILIA Mononeuritis multiplex due to epieneural vessels Biopsy: granulomas
169
Goodpasture's syndrome
Microscopic Hematuria Pulmonary infiltrates Type 2 Hypersensitivity + Anti-GBM Ab
170
Fetal Hb
2 a and 2 y | Does not bind well to 2,3 BPG
171
Myoglobin
Single peptide 1 heme High affinity for oxygen
172
Serotonin Syndrome presentation
3 As - increased neuromuscular Activity - Autonomic stimulation - Agitation
173
Treatment for Serotonin Syndrome
Cyproheptadine (5HT2 antagonist) Benzos (muscles, seizures, agitation) Fluids
174
Mechanism of Benzos and Barbiturates
Increase GABA Benzos: inc fred Barbs: inc duration
175
Presentation of Benzo or Barbiturate use
``` CNS depression Dizziness Slurred speech Resp depression Nystagmus ```
176
Reversal Agent for Benzos or Barbiturates
Flumazenil
177
Mechanism of LSD
Stimulates 5HT receptors
178
Mechanism of Cocaine
Inhibits catecholamine reuptake
179
Mechanism of amphetamines
Increases catecholamine release
180
Intrinsic Apoptotic Pathway
``` Increased BAX (pro-apoptotic) Decreased Bcl-2 (anti-apoptotic) Increase in mitochondrial permeability --> Cyt C release--> Activation of caspases *Bcl-2 is 4 letters = live *BAX is 3 letters = die ```
181
Extrinsic Apoptotic Pathway
``` Signal from outside cell TNF receptor - TNFa CD95 (FasR) - FasL Binding of TNFa/ FasL activate caspases Cytotoxic T cells release perforin (perforates) and granzyme B (activates caspases) ```
182
DiGeorge Syndrome
``` 22q11 micro deletion Affects 3rd and 4th pharyngeal pouches Abn face and cardiac Thymic aplasia (3rd pouch) T cell deficiency Parathyroid aplasia (hypoCa) Recurrent fungal infections ```
183
Which cranial nerve nuclei receives fibers from carotid baroreceptors?
Nucleus Tractus Solitarius- Caudal | thru glossalpharyngeal nerve
184
Popcorn-like calcifications on lung tumor
``` Hamartoma "popcorn is good" Benign Composed of fat, connective tissue, cartilage Well-circumscribed Peripherally located ```
185
Substrate for gluconeogenesis
Alanine
186
BCAA increased in maple syrup urine disease
Valine Leucine Isoleucine
187
Precursor of homocystene
Methionine | Assoc w endothelial damage and atherosclerosis
188
Precursor of serotonin, niacin, melatonin
Tryptophan
189
AAs that stimulate growth hormone and insulin
Arginine | Histidine
190
Precursor of NO
Arginine
191
Pediatric with Flank Mass
Wilm's Tumor (nephroblastoma)
192
WAGR
``` Deletion of WG-1 tumor suppressor gene W-wilms tumor A-aniridia G-genitourinary malformation R-mental/motor retardation ```
193
C3b
Opsonin
194
C5a
Neutrophil chemotaxis
195
Hereditary Spherocytosis
``` Defect in RBC cytoskeleton proteins Spectrin, Band 3, Pallidin, Ankyrin Dx: Osmotic fragility test Microcytic round RBCs NO CENTRAL PALOR Increased mean corpuscular Hb Increased RDW Extravascular hemolysis NEG Coombs Splenomegaly, Gallstones Aplastic Crisis ```
196
Urge Incontinence
Uninhibited bladder contraction | Detrusor overactivity
197
Stress incontinence
Involuntary leak of urine due to increased abd pressure | Decreased support and function of urinary sphincter
198
Overflow incontinence
Incomplete bladder emptying Bladder outlet obstruction Neurogenic bladder Impaired detrusor contractility
199
Organ failure after a transplant is a type _____ hypersensitivity
Type 4- delayed Chronic rejection T cell and Ab mediated vascular damage Obliterative vascular fibrosis
200
PPAR-y
Peroxisome Proliferator-activated Receptor-y Nuclear receptor and Transcription factor Found in adipose Role in adipocyte differentiation
201
Thiazolidinediones (TZDs)
Diabetes meds Bind PPAR-y Improve insulin sensitivity
202
MOA Disulfiram
Inhibits acetaldehyde dehydrogenase
203
Meds w disulfiram like effect
Metronidazole Certain cephalosporins Griseofulvin 1st Gen Sulfonylureas
204
Half lives to reach steady state
4-5
205
T 1/2 equation
0.7 x Vd ------------- CL
206
a1 antagonists can treat
HTN Urinary retention in BPH Ex. Terazosin, Prazosin, Doxazosin
207
Hansen Disease (Leprosy)
Mycobacterium Leprae Armadillos Coolest parts of body (Skin, Superficial nerves)
208
Obligate Anaerobes lack
``` Superoxide dismutase (oxygen radicals --> water and peroxide) Catalase (peroxide --> water and oxygen) ```
209
Bicornate uterus is due to
incomplete fusion of paramesonephric ducts (aka muellerian ducts)
210
Paramesonephric ducts (muellerian ducts) form
Fallopian tubes Uterus Upper vagina
211
Primary oocyte arrested in _____ until ovulation
PrOphase I until Ovulation
212
Primary oocyte arrested in _____ until fertilization
Metaphase II until fertilization
213
Kallmann Syndrome
Anosmia Hypogonadism -decreased GnRH in hypothalamus -no secondary sex characteristics
214
DiGeorge Syndrome
3rd and 4th branchial pouches fail to devo Aplasia of thymus and parathyroids 22q11 Deletion Cleft palate, Abn face, Heart and Great Vessel defects Tetany (no PTH --> hypoCa) Recurrent infections (no thymus --> no mature T cells)
215
Primary amenorrhea
Never menstruated - turner syndrome - imperforate hymen - androgen insensitivity - mullerian duct genesis - delayed puberty
216
Secondary amenorrhea
Menstruated previously then stopped
217
Post-Traumatic vulvar hematoma
Saddle trauma/ Sexual assault | Bulb of vestibule- highly vascular erectile tissue under labia majora
218
Amygdala receives inputs from
Limbic cortex Neocortex of parietal, temporal, occipital Auditory and Visual areas
219
Amygdala sends output to
Back to cortical areas that sent input Hippocampus (memory) Septum Thalamus and Hypothalamus
220
Stimulation of Amygdala
``` Memory and Emotion Arterial BP and HR GI motility and secretion Defecation or Micturition Pupillary dilation or constriction Piloerection Sexual Responses Secretion of Ant Pituitary hormones Licking, Chewing, Swallowing ```
221
What prevents mast cell degranulation
Cromolyn Sodium
222
Hypertrophic Cardiomyopathy
Genes encoding Sarcomere proteins AutoDOM Decreased compliance Affects LV --> diastolic dysfunction Decreased CO (decreased filling and compliance) Functional Aortic Stenosis (hypertrophic septum)
223
Notochord
Mesoderm | Stimulates neural tube development
224
Neural Tube
Ectoderm | Neural plate
225
Cell types that do NOT require insulin for glucose uptake
``` Neurons RBC Intestines Cornea Kidney Liver ```
226
VitD to active form
VitD --> Liver --> 25 D --> kidney --> 1,25 D
227
VitD helps prevent osteoporosis by
Stimulating Ca and phosphate absorption in gut
228
Von Gierke Disease
Glucose-6-Phosphatase deficiency Cannot break G6P from glycogen into glucose NO GLUCONEOGENESIS Glycogen accumulation
229
Presentation of Von Gierke Disease
``` Hypoglycemia Lactic acidosis Glycogen accumulation PAS + (stains glycogen) High triglycerides Hyperuricemia ```
230
Patients with Von Gierke Disease must avoid
Fructose and Galactose
231
Cori Disease
Glycogen debranching enzyme deficiency Breaks a-1,6 linkages Glycogen accumulates GLUCONEOGENESIS INTACT
232
Presentation of Cori Disease
Ketoacidosis Glycogen accumulates PAS + (stains glycogen)
233
Gaucher Disease
Lysosomal storage disease | Glucocerebrosidase deficiency
234
Tx of Gaucher
Recombinant Glucosecerebrosidase
235
Presentation of Gaucher Disease
Pancytopenia Lipid laden macrophages (crumpled tissue paper) Hepatosplenomegaly Bone disease
236
Krabbe Disease
Lysosomal storage disease Galactocerebrosidase deficiency Psychosine accumulation Globoid cells on nerve biopsy
237
Presentation of Krabbe Disease
Oligodendrocyte destruction Peripheral neuropathy Optic atrophy Developmental delay
238
Turner Syndrome
``` 45 XO genotype Ovarian dysgenesis Lymphatic blockage Bicuspid Aortic valve Aortic coarctation ```
239
Presentation of Turner Syndrome
``` Webbed neck Shield chest Swollen hands/feet Short stature Low estrogen High LH and FSH Horseshoe kidney ```
240
Patau Syndrome
Trisomy 13 | Meiotic non-disjunction
241
Presentation of Patau Syndrome
``` Cleft lip/palate Polydactyly Microcephaly Holoprosenencephaly (hemispheres don't separate) Cutis aplasia (skin or bone missing) Microphthalmia Polycystic kidney disease Rocker-bottom feet ```
242
Mother's labs in Patau Syndrome
1st trimester: low B-hcg | 2nd trimester: all normal
243
Rett Syndrome
``` X-linked Dominant (boys die in utero) MECP2 gene Regression of motor/ verbal abilities (age 1-4) Growth failure Seizures Stereotyped hand wringing ```
244
Cri-du-chat Syndrome
``` Deletion of short are of Ch 5 Microcephaly Epicanthal folds Intellectual disability Ventricular Septal Defect ```
245
Communicating Hydrocephalus
Arachnoid granulations do NOT absorb CSF properly Too much fluid Arachnoid scaring after meningitis Increased ICP, papilledema, herniation
246
Non-Communicating Hydrocephalus
Stenosis of aqueduct of Sylvius Colloid Cyst Tumor
247
Ex Vacuo Ventriculomegaly
``` Looks like increased CSF Brain tissue smaller than normal ICP normal Rest of NPH triad absent Seen in alzheimers, HIV, pick's, huntington's ```
248
Warthin's tumor
Benign Cystic salivary gland tumor Heterotopic lymphoid tissue inside gland tissue Can form germinal centers
249
Myotonic Muscular Dystrophy
``` AutoDOM CTG trinucleotide expansion DMPK gene Aches and weakness High arched palate Cognitive impairment Can have frontal balding, bilateral cataracts ```
250
Seborrheic Keratosis
Immature keratinocytes | Small keratin filled cysts
251
Resistance to fluoroquinolones
Mutation of DNA gyrase/ topoisomerase Decreased outer membrane permeability Increased expression of efflux pumps (plasmid)
252
Polycythemia Vera
Mutation JAK2 | uncontrolled EPO proliferation
253
Secondary Polycythemia
Due to hepatocellular carcinoma or exogenous EPO intake Increased EPO Increased RBC mass
254
Mutated Rb gene increases risk of
Osteosarcomas
255
Mechanism of Oxytocin
Activation of Phospholipase C | Treats post-partum hemorrhage
256
Mechanism of Darunavir Ritonavir
Inhibition of HIV enzyme protease
257
``` Osteitis deformans (Paget disease) ```
``` Idiopathic bone remodeling Overlying erythema Hearing loss (ossicles) Thick sclerotic bone Easily Fractures Mosaic patter of lamellar bone (unsealed cement lines) Bone pain Increased hat size Lion faces ```
258
Oxybutynin
Muscarinic antagonist Treats overactive bladder Adverse anticholinergic effects
259
Carcinoid Syndrome
``` Watery diarrhea Crampy abd pain Cutaneous flushing w eating or emotions Asthma attacks Tricuspid regurg ```
260
Carcinoid tumors puts patients at risk for
Pigmented dermatitis | Increased serotonin metabolism depletes tryptophan precursors of niacin
261
Lysyl oxidase uses _____ as a cofactor
Copper
262
Neuroleptic Malignant Syndrome is treated with
Dantrolene- Ryanodine receptor blocker Prevents rhabdo Benzos for agitation
263
If metabolic alkalosis, order _____ next
Urine Chloride
264
Bevacizumab
For Renal Cell Carcinoma For Neovascular macular degeneration Risk of GI bleed, HTN heart failure, thrombosis
265
Membranous Nephropathy
``` Caucasians Thick basement membrane on H/E Subepithelial Anti-PA2 Ab deposition Granular Immunofluorescence Spike and Dome on EM Assoc w HepB/HepC, solid tumors, lupus, drugs (NSAIDs, penicillamine) ```
266
Mechanism of Fibrates
``` Activate PPAR-a Increase LPL activity Increased TG clearance Increased HDL production Risk of gallstones ```
267
Live vaccines
Varicella Yellow fever MMR
268
Ranolazine
Increased cardiac oxygen efficiency Tx refractory angina Inhibits Na influx Inhibits FA degradation
269
Craniopharyngiomas
``` Benign tumors In sella turcica Arise from Rathke pouch Calcifications and Cystic Cholesterol crystals ```
270
Particles between ____ in size are most likely to be eliminated by the mucociliary escalator
> 2 micrometers | *< 2 micrometers cleared by alveolar macrophages (ex. asbestos bodies)
271
Lambert-Eaton Syndrome
Assoc w Small Cell Lung CA Auto Ab to VG Ca channels at NMJ Impairs Ach release Strength improves w exercise
272
Budd-Chiari Syndrome
Hepatic Vein Obstruction Hepatocellular hypoxia Nutmeg liver
273
Heme is synthesized in
Mitochondria
274
Cryptococcus
Sabouraud agar + latex agglutination India ink- clear halo Mucicarmine- red inner capsule
275
Uhthoff phenomenon
Tingling sensation Exacerbated by hot shower Seen in MS
276
CSF and MRI findings in Multiple Sclerosis (MS)
Ig bands on CSF immunofixation | Periventricular sclerotic plaques
277
Meningioma
``` From Arachnoid cells Benign Spindle-shaped Whorled pattern Compress structures ```
278
Phenoxybenzamine
Blocks a1 and a2 receptors
279
Lomustine
Alkylating chemo drug Nitrosourea Inhibits DNA replication Creates cross-links in DNA strands
280
Trigeminal N exits skull thru
Foramen ovale
281
Prolonged/ Rapid administration of Nitroprusside can cause
``` Cyanide poisoning (ams, abd pain, flushing) Tx Hydroxycobalamin ```
282
Wide split S2
Pulmonary hypertension | Hereditary form is from abn BMPR2 gene (predisposes endothelial and smooth muscle proliferation)
283
Mechanism of Metronidazole
Free radical metabolites damage bacterial DNA
284
Stim of B-1 receptors in JGA incudes
Renin release
285
Ribavirin
Tx HepC, RSV Nucleoside analog Acts on both RNA and DNA viruses For HepC always w other med
286
E.coli is heat _____
Labile
287
Refsum Disease
Autosomal Recessive No a-oxidation Phytanic Acid (BCFA) ----X----> Pristanic Acid Scaly skin, Ataxia, Short 4th toe Impaired vision (night blind) and hearing Peripheral neuropathy Epiphyseal dysplasia Tx: diet (no seafood, grass feeders or their milk), plasmaphoresis
288
Leuprolide
``` Long-acting GnRH agonist Tx androgen sensitive prostate CA Decreased GnRH receptor --> Decreased FSH/LH --> Initial transient increase testosterone ```
289
Trousseau Syndrome
Recurrent DVT in different veins Simultaneous thrombophlebitis R/O Visceral malignancy (pancreatic) Due to production of procoagulants by malignant cells
290
Carcinoma in situ of skin
Irreversible nuclear changes in the stratum basale
291
Filariasis
``` Dx blood smear at night India Wuchereria bancrofti Thread-like larvae from female mosquito Tx diethylcarbamazine ```
292
MAP=
1/3 (sBP + (2 x dBP))
293
Cardiac Output (CO) =
=MAP/ SVR =SV x HR
294
End Diastolic Volume (EDV)=
SV + ESV
295
Ejection Fraction=
SV / EDV
296
Budesonide
Inhaled glucocorticoid | Tx asthma
297
Central Cord Syndrome
``` Cape-like distribution Absent temp sensation Normal fine touch Syringomyelia secondary to whiplash Risk of Horner Syndrome ```
298
Intervertebral disks derive from
Notochord
299
Phenylketonuria
``` Deficiency of phenlyalanine hydroxylase Cannot convert phenylalanine to tyrosine Pale skin Light blue eyes Eczematous extensors Intellectual disability Seizures Mousy/ Musty urine ```
300
Tuberous Sclerosis
``` Subependymal giant cell astrocytoma Shagreen patches Ash-leaf spots Benign cysts Renal cell carcinoma Angiofibromas around nose and cheeks ```
301
Lisch nodules
``` Ophthalmologic finding in Neurofibromatosis 1 Cafe au lait spots Neurofibromas Optic gliomas Seizures Cognitive deficits Soft tissue sarcomas ```
302
Vestibular Schwannoma
Brain tumor assoc w Neurofibromatosis 2 | Bilateral involvement
303
Peutz Jeghers syndrome
``` AutoDOM Hyperactive serine-threonine kinase Gain of function of STK11 on Ch19 Hamartomatous tumors Mucocutaneous hyperpigmentation ```
304
Peutz Jeghers Syndrome increases risk for _____
Cancers - Colorectal - Pancreatic - Ovarian - Breast
305
Machine-like murmur
``` Patent ductus arteriosis 6th embryonic aortic arch L --> R shunting Heard at L infraclavicular Tx: indomethacin (PGE2 inhibitor) ```
306
Alprostadil
Prostaglandin E1 | Congenital heart defects (PDA, transposition, tetralogy)
307
Aminoglycosides are inactivated by
Phosphorylation
308
Nerve that runs between superficial and deep flexor digitorum
Median
309
Pufferfish
Tetrodotoxin | Decrease permeability to Na ions
310
Phosphoenolpyruvate Carboxykinase (PEPCK)
Enzyme of gluconeogenesis
311
Least oxygenated blood in the body can be found in
Coronary Sinus | Cardiac myocytes pull O2 efficiently
312
NO release results in
Increased cGMP --> vasodilation
313
Adenosine
Vasodilator
314
Layer of cardium most susceptible to ischemia
Subendocardium | Vessels are outside the myocardium
315
Most effective lipid lowering drug for preventing future CV events
Statins
316
BPH _____ risk of prostate CA
Does NOT increase
317
Barrett's Esophagus
Reflux causes lower esophagus squamous --> Columnar non-ciliated mucinous Can progress to adenocarcinoma
318
Apocrine Metaplasia of Breast _____ risk of CA
Does NOT increase
319
t(15,17)
Mutated Retinoic Acid (VitA) receptor Immune cells trapped in blast state Myelocytic Leukemia Tx: Atrol (all trans retinoic acid)- binds mutated receptor
320
Myositis Ossificans
Muscle turns to bone during healing | Form of menenchymal metaplasia
321
Dilation Cardiomyopathy
``` All chambers dilated Systolic dysfunction Mitral/ Tricuspid Regurgitation (ring stretch) Arrhythmia (conduction system stretch) Tx: transplant ```
322
Loeffler Syndrome
Eosinophilic infiltrate w inflammation of heart walls Fibrosis of endo/myocardium Restrictive cardiomyopathy
323
Most common Primary Cardiac Tumor in adults
``` Myxoma Benign mesenchymal proliferation Gelatinous appearance Pedunculated mass in LA Causes syncope due to mitral valve obstruction ```
324
Most common Primary Cardiac Tumor in children
Rhabdomyoma Benign hamartoma of cardiac muscle Assoc w tuberous sclerosis Usually in ventricle
325
Metastisize to Heart
More common than primary of heart From breast, lung, melanoma, lymphoma Affects pericardium (effusion)
326
Carbon Monoxide poisoning
Cherry-picking red skin | Headache (early sign)
327
Methemoglobinemia
``` Fe in heme is oxidized to Fe 3+ Fe 3+ cannot bind O2 PaO2 normal SaO2 decreased Due to oxidant stress, newborns Cyanosis w chocolate colored blood ```
328
Treatment for Methemoglobinemia
IV methylene blue Reduces Fe 3+ to Fe 2+ Fe 2+ binds oxygen
329
Decreased ATP creates cellular injury
No Na/K pump Na retained --> hypertonic swelling No Ca pump (increased cytosolic Ca) Anaerobic glycolysis --> acidosis
330
Pyknosis
Cell shrinking
331
Karyorrhexis
Nucleus breaks into pieces
332
Karyolysis
Nuclear pieces broken into building blocks
333
Coagulative Necrosis
``` Remains firm Cell shape and organ structure preserved Nucleus disappears Ischemic infarcts (except brain) Infarct often wedge shaped and pale ```
334
Red infarction
When blood re-enters a loosely organized tissue that has experienced an ischemic infarct
335
Liquifactive Necrosis
Enzymatic lysis of cells/ proteins Complete removal of tissue w cystic cavity formed Release of lysosomal enzymes from damaged cells Brain infarctions (glial cells) Abscesses (PMNs) Pancreatitis (pancreatic enzymes)
336
Gangrenous Necrosis
Coagulative necrosis that resembles mummified (dry) tissue Ischemia of lower limb or GI If superimposed infection --> liquefactive --> wet gangrene
337
Caseous Necrosis
Cottage cheese appearance Coagulative and liquefactive necrosis Granulomatous inflammation (TB, fungal)
338
Fat Necrosis
Chalky white appearance (deposition of Ca) Saponification- released FAs bind Ca Due to trauma (breast), Pancreatic enzyme
339
Saponification
``` Dystrophic calcification Ca binds dying tissue Normal Serum Ca and Phosphate Psamomma bodies --> tumor cells outgrow blood supply and die Metastatic Ca ```
340
Fibrinoid necrosis
``` Damage to blood vessel wall Leak of proteins into wall Bright pink staining Malignant HTN or Vasculitis Young woman: Pre-eclampsia- placental vessels affected ```
341
Bacteria of Necrotizing Fasciitis
S.pyogenes (GAS) S.aureus C.perfringens Polymicrobial
342
Case Fatality Rate
Fatal cases / Total people w disease
343
Kinesin
Microtubule assoc motor protein Anterograde transport Required in reactivation of latent HSV to get viral particles from neurons to ganglia in skin and oral mucosa
344
Spectrin
Cytoskeletal protein along membrane Maintains shape of RBCs Defects --> elliptocytosis, spherocytosis
345
Lamin
Protein that forms fibrillar network lining inside of nuclear envelope Structural supporte Organize genome Regulate gene expression
346
Dynein
Microtubule motor protein Retrograde axonal transport Move organelles toward nucleus Allows latency of HSV (t/p to sensory ganglia)
347
What makes me think Lupus
Glomerulonephritis Photosensitive skin rash Arthralgias Young woman
348
Marker of Lupus
Anti-Phospholipid Ab Can cause PTT prolongation, false + RPR/VDRL Increased risk for thromboembolism and recurrent pregnancy loss
349
Heme synthesis occurs in
Mitochondria and Cytoplasm of RBCs
350
Edwards Syndrome
``` Trisomy 18 (meiotic non-disjunction) Growth retardation Micrognathia Prominent occiput Low ears Heart defects Renal deficits Limited hip abduction Clenched hands w overlapping fingers (hypertonia) Rocker-bottom feet ```
351
Methotrexate
DMARD for RA
352
Side effects of Methotrexate
Stomatitis Bone marrow suppression Liver function abnormalities
353
Hydroxychloroquine
``` For RA and Lupus Irreversible retinopathy (monitor during tx) ```
354
Superantigens bind to
MHC-II of APCs without processing | Nonspecifically activate T cells
355
Superior Mesenteric Artery Syndrome
Transverse duodenum trapped between SMA and aorta Partial intestinal obstruction Aortomesenteric angle decreases (fat, lordosis, surgical correction of scoliosis)
356
Hemolytic Uremic Syndrome (HUS)
AKI, Hemolytic Anemia, Thrombocytopenia Decreased Hb and platelets Increased bleeding time, LDH, bilirubin, BUN, Cr
357
Terbinafine
For dermatophytosis | Inhibits synthesis of fungal membrane ergosterol by suppressing SQUALENE EPOXIDASE
358
Drug concentration
Drug dose / Vd
359
Derivatives of Pharyngeal Arch 1
``` Muscles of mastication (master, temporalis, pterygoids) Maxilla Mandible Malleus and Incus Trigeminal Nerve ```
360
Derivatives of Pharyngeal Arch 2
``` Muscles of facial expression Styloid process Facial Nerve Stapes Lesser horn of hyoid ```
361
Derivatives of Pharyngeal Arch 3
Stylopharyngeus | Greater horn of hyoid
362
Derivatives of Pharyngeal Arches 4 and 6
Pharyngeal and Laryngeal muscles | Cricoid and Thyroid Cartilages
363
Treacher-Collins Syndrome
Impaired 1st and 2nd pharyngeal arch development | Hypoplasia of mandibular and zygomatic bones
364
Familial Hypocalciuric Hypercalcemia
Benign AutoDOM Defective Ca sensing receptors (GPCRs) in the parathyroid and kidneys Normal VitD
365
Primary site of ribosome synthesis and assembly
Nucleolus
366
Mitochondrial Dysfunction Symptoms
Myopathy Nervous system dysfunction Lactic acidosis RAGGED RED FIBERS on muscle biopsy
367
Where is the most highly oxygenated blood in the fetus
Umbilical vein --> ductus venous --> IVC
368
Gag reflex
CN 9-10 | Sensory fibers Pteragopalatine branch of Trigeminal
369
Corneal Reflex
No true blood supply Sensory- Nasociliary Nerve branch from CN V1 Motor- Facial Nerve to orbicularis oculi
370
Taste sensation to anterior 2/3
Chordae tympani branch of facial n
371
Muscles of mastication innervated by
motor branches of CN V3
372
Apo A-1
Activates LCAT
373
Apo B-48
Mediates chylomicron secretion from enterocytes
374
Apo B-100
Lipoproteins that come from liver
375
____ up-regulates HMG-CoA Reductase
Estrogen Increased cholesterol Gallstones
376
_____ is a complication of Parenteral Nutrition (TPN)
Gallstones (no fat to duodenum, no CCK, GB stasis)
377
Bile acids are reabsorbed in the _____
Terminal ileum | *affected by Crohn's
378
____ Km = _____ affinity
Low Km = High affinity for substrate | *and vice versa
379
Low Vmax of Hexokinase in skeletal muscle prevents
Cells from hoarding too much glucose
380
High Km of Glucokinase in liver
Low glucose utilization Glucose spared for tissues Wont bind glucose until levels very high
381
High Vmax of Glucokinase in liver
Faster processing of glucose --> g6p
382
Low Km of Hexokinase in skeletal muscle
Rapid glucose utilization for energy
383
Hexokinase
In most tissues (NOT pancreatic B cells) Inhibited by g6p NOT induced by insulin Low Km and Vmax
384
Glucokinase
In pancreatic B cells and liver NOT inhibited by g6p Induced by insulin High Km and Vmax
385
How glucokinase causes insulin release
``` Glucose --> g6p --> ATP ATP inhibits K channels Increased intracellular K --> cell depolarization Opens Ca channels --> Ca influx Ca dependent insulin release ```
386
Tetracyclines interact with _____ to form _____
Polyvalent cations (Fe, Ca, Al, Mg) Form chelate complexes in the GI tract --> decreased drug absorption *Fluoroquinolones and Thyroxine also susceptible to chelation
387
Vitamin B12 Deficiency presents with
``` Megaloblastic anemia (impaired DNA synth) Neuro deficits (impaired myelin synth) Degeneration of dorsal columns and LCST Elevated Methylmalonic Acid and Homocysteine ```
388
Vitamin B3 can be synthesized endogenously from _____
Tryptophan | VitB3 essential component of NAD and NADP
389
Low Dose Dopamine infusion
Stimulates D1 receptors in renal and mesenteric vasculature --> vasodilation
390
Increasing doses of Dopamine
Stimulate B1 and a1 receptors Increased cardiac output Elevated TPR Highest doses --> increased afterload can decreased cardiac output
391
Plasmodium infection
Malaria | RBCs w multiple small signet rings
392
_____ is required to kill Plasmodium vivax and Plasmodium ovale liver hypnozoites
Primaquine
393
Referred otalgia
CN 5, 7, 9, 10 Tumors in hypopharynx, larynx, base of tongue Sensory contributions from CN 9, 10
394
Osler-Weber-Rendu Syndrome (Hereditary Hemorrhagic Telangiectasia)
AutoDOM | Telangiectasias on skin and mucous membranes
395
UV-induced DNA Damage
Pyrimidine dimers | Recognized by endonuclease complex --> nicks damaged strand on both sides of dimer
396
Rapid infusion of Vanco can lead to
``` Direct activation of mast cells Massive release of histamine Red Man Syndrome Seconds- Minutes Not IgE mediated Tx: Resume Vanco infusion slower ```
397
Tibial Nerve functions
Weak plantarflexion, inversion, and toe flexion | Sensory of sole
398
Cross-Sectional Study
Snapshot (does NOT follow over time) Prevalence (NOT indigence) Correlation (NOT causation)
399
Cohort Study
2 groups followed over time (non-exposed control) Starting point = Exposure Measures Incidence --> determines Relative Risk Retrospective or Prospective
400
Case-Control Study
2 groups: cases and non-diseased controls Starting point = Diseased (cases) Non-diseased controls prevent confounding Who was exposed in both groups --> Odds Ratio
401
Randomized Controlled Trial
``` Studies disease treatment Random assortment to test or control group Single or Double blinding Identifies Causation Time-consuming and expensive ```
402
Crossover Study identifies
Causation
403
Substances that increase Surfactant Synth
Cortisol
404
Substances that Decrease Surfactant Synth
Insulin | *maternal DM --> fetal hyperglycemia --> increased insulin --> decreased surfactant --> NRDS
405
Lecithin : Sphingomyelin Ratio
Used to determine maturity of fetal lungs Lecithin and Sphingomyelin components of surfactant [Lecithin] increases w maturity [Sphingomyelin] stays constant Ratio > 2 = mature lungs Ratio < 2 = immature lungs
406
Testicular artery branches from _____ and supplies _____
From aorta | Supplies Testes
407
Pampiniform plexus drains into ____
``` Testicular veins (R to IVC, L to L Renal vein) Decreased drainage --> varicocele L Renal Cancer can cause L varicocele ```
408
Ovarian Arteries branch from ____
Aorta
409
Ovarian Veins drain into _____
R to IVC, L to L Renal vein | Septic Pelvic Thrombophlebitis --> ovarian vein thrombosis
410
JVP order of waves
``` A-wave C-wave X-wave V-wave Y-wave ```
411
JVP A-wave
Atrial contraction Absent in a-fib Peaked in pulmonary HTN or 3rd deg block
412
JVP C-wave
Tricuspid Closure
413
JVP X-wave
Atrial releaXation Increased in a-fib Increased in Tricuspid Regurg (IVDU, S.aureus)
414
JVP V-wave
``` Atrial Filling ("Villing") Followed by Tricuspid Opening ```
415
JVP Y-wave
Atrial emptYing Increased in pulmonary HTN or 3rd deg block Decreased in Tricuspid Regurg (IVDU, S.aureus)
416
Eyes point to _____ in Frontal Eye Field lesions
Ipsilateral side to lesion
417
Broca's Area
Motor Speech
418
Wernicke's Area
Sensory Speech
419
Functions of Angular Gyrus
Distinguishing L from R Identifying fingers on the hand Math Writing
420
Angular Gyrus lesion
Loss of function if dominant hemisphere (Gerstman's Syndrome) Hemispatial neglect if damaged in non-dominant hemisphere
421
Superior Temporal Gyrus contains
Primary auditory cortex | Wernicke's Area
422
Uncus
Assoc w seizures | Can compress CN 3 during uncal herniation
423
Fusiform Gyrus
In temporal lobe Btw hippocampus and Inferior temporal gyrus Facial recognition (prosopagnosia)
424
Internal Capsule contains
Axons from Primary Motor Cortex
425
Anterior 2/3 of Posterior Limb of Internal Capsule
Motor axons of Corticospinal Tract (CST)
426
Posterior 1/3 of Posterior Limb of Internal Capsule
Sensory fibers of Thalamocortical Tract
427
Genu of Internal Capsule
Motor fibers of Corticobulbar Tract
428
Corynebacterium Diphtheria
``` Resp infection Primary virulence: toxin (acts locally) Cervical lymphadenopathy Pharyngeal exudates Coalescing pseudomembrane Complications: myocarditis, neuro toxicity ```
429
Lithium toxicity
``` Confusion, ataxia, neuromuscular excitability Due to volume depeletion Due to med interactions -Thiazides -ACE inhibitors -NSAIDs ```
430
Teriparatide
``` Recombinant PTH analog Increases osteoblast activity > osteoclasts Net increase in bone formation Increased bone resorption Increased serum Ca Increased URINE Phosphate EXCRETION ```
431
Ethosuximide
1st line for absence seizures | Prevents neuronal burst firing of Thalamic T-Ca channels
432
5 major causes of hypoxemia
``` Alveolar Hypoventilation Low partial pressure of inspired oxygen Ventilation-Perfusion Mismatch Diffusion Impairment R to L shunting ```
433
A-a gradient with: - Alveolar Hypoventilation - Low partial pressure of inspired oxygen
Normal
434
Most common primary bone tumor in children and young adults
``` Osteosarcoma Arises near metaphases of long bones Slowly worsening pain Soft tissue swelling Lytic bone lesions on XR Biopsy: spindle-shaped cells that generate osteoid, thin trabecular of neoplastic bone ```
435
Th2 cells release
``` IL-4 Induces T cells --> Th2 cells Promotes growth of B cells Promotes IgE --> IgG Aint Too (T cells) proud 2 (Th2) BEG (B, IgE, IgG) 4 (IL-4) work ```
436
Th1 Cells release
IFN-y Stimulates macrophages Inhibits differentiation of Th2 cells Activates NK cells
437
IL-5
From macrophages Promotes growth and diff of B cells Enhances switching to IgA Stimulates growth and diff of eosinophils
438
IL-2
Stimulates growth of Th cells and Cytotoxic T cells
439
IL-8
Main chemotactic factor for neutrophils | "clean up in aisle 8"
440
TNFa
Activates endothelium and vascular leak
441
IL-3
Supports growth and diff of stem cells in bone marrow
442
IL-12
Induces differentiation | Activates NK cells
443
IL-10
Modulates inflammatory response Decreases MHC class 2 and Th1 cytokines Inhibits macrophage and dendritic cells Secreted by T reg and Th2 cells
444
IL-1
Fever Acute inflammation Induces chemokine secretion
445
IL-6
Fever | Stimulates APPs
446
Arsenic poisoning
Garlic odor SCC of skin, lung CA, liver angiocarcinoma Tx: Dimercaprol
447
Micturition center of the brain
Medial Frontal | Supplied by Anterior Cerebral Artery
448
Must monitor _____ when treating a pt with Amiodarone
``` LFTs (hepatotoxicity) PFTs (pulmonary fibrosis) TFTs (thyroid dysfunction bc contains iodine) *other less common side effects: -Corneal deposits -Neuro probs -Constipation -Photosensitivity -Blue-Gray Skin (iodine accumulation) ```
449
Composition of bone
30% matrix (collagen, chondroitin sulfate, hyaluronic acid) 70% Crystalline salts (Ca, phosphate-hydroxyapatite) Ions and metals conjugated to hydroxyapatite
450
Potassium-Sparing Diuretics
``` "Potassium takes a SEAT" Spironolactone Eplerenone Amiloride Triamterene ```
451
Mechanism of Spironolactone Eplerenone
Aldosterone receptor antagonists in principle cells of collecting duct
452
Mechanism of Amiloride Triamterene
Block Na Channels in principle cells of collecting duct
453
Organization of Lateral CorticoSpinal Tract (LCST)
Arms are medial | Legs are lateral
454
MHC I molecules are found
all nucleated cells
455
MHC II molecules are found
only on APCs
456
Gower Sign
Using arms to stand up Proximal leg weakness Seen in Muscular Dystrophy
457
Cheyne-Stokes Respirations
Cycles of: - Apnea and hypercapnia - Hyperventilation and hypocapnia
458
Dressler Syndrome
Pericarditis 2-4 weeks after MI
459
Osmotic Demyelination Syndrome
Na corrected too quickly Diplopia Paralysis (locked-in syndrome)
460
Nutmeg Liver
Hepatic congestion - R sided HF - Budd Chiari
461
Prion Diseases
Crutzfeld-Jacob Disease Bovine Spongiform Encephalopathy (mad cow) Kuru
462
Oral antibiotic to treat MRSA or VRE instead of IV vancomycin
Linezolid
463
Beers Criteria
List of 50+ meds to avoid in geriatrics - Increased risk of side effects or - Decreased efficacy in elderly
464
Branchial Cleft Cysts
Lateral neck | Do NOT move w swallowing
465
Thyroglossal Duct Cysts
Midline Neck | MOVE w swallowing
466
Pyramidal Lobe of thyroid
Persistant thyroglossal duct
467
Chronic Granulomatous Disease
Poor O2 dependent killing Lack NADPH Oxidase Increased susceptibility to catalase + orgs (neutralize scrounged H2O2)
468
Auspitz Sign
Bleeding spots when scales are scraped off | Indicative of psoriasis
469
Lead poisoning
``` Basophilic stippling Wrist drop Confusion Blue gingiva Tx: EDTA or Succimer Tx kids w severe poisoning: Dimercaprol + Succimer ```
470
Hepatic Ito/ Stellate Cells
In space of disse Store fat, VitA Produce matrix Activated by damage to liver
471
Hepatic Zone 1
1st in blood flow | Most affected by viral hepatitis
472
Hepatic Zone 3
``` Last in blood flow Highest concentration of P450 enzymes Most affected by: -ischemia -toxic metabolites bc metabolized from zone 1-2 ```
473
Hepatic Zone 2
Most prone to damage from yellow fever
474
Hepatic blood flow
Zone 1-3
475
Hepatic Bile Flow
Zone 3-1
476
Spleen embryology
From dorsal mesentery of stomach From mesoderm Shares blood supply w stomach (endodermal)
477
Pancreas Embryology
Derived from endoderm Arises from Hepatic Diverticulum in ventral distal foregut Dorsal pancreatic bud on dorsal foregut (body and tail, accessory duct)
478
Hepatic Diverticulum gives rise to
Liver GB and biliary tree Ventral pancreatic bud --> head and main duct
479
Glossitis
Beefy red tongue | VitB12/ Fe deficiency
480
Vertical Nystagmus is specific to
Central vertigo | Vertical and horizontal together = PCP
481
Kidney converts Calcidiol to
Calcitriol In proximal tubule via 1-a-hydroxylase Stimulated by PTH
482
Dopamine in the Kidney
``` Secreted in PCT Promotes natriuresis Dilates arterioles Increases GFR *at high doses acts as vasoconstrictor ```
483
Side Effects of Loop Diuretics
``` OHH DAANG Ototoxicity (loop earrings hurt ears) Hypokalemia Hypomagnesemia Dehydration Allergy to sulfa Alkalosis (metabolic) Nephritis (interstitial) Gout ```
484
CD14
Present on macrophages Recognizes PAMPs Activation --> NF-kB
485
PGE2 mediates
FEEEver | Pain
486
LTB4 mediates
Chemotaxis of PMNs | Activation of PMNs
487
LTC4 LTD4 LTE4
Mediate: - vasoconstriction - bronchospasm - vascular permeability
488
Triggers of mast cell degranulation
C3a and C5a Trauma Cross-linking IgE surface Ag
489
Hageman Factor
Proinflammatory protein Made in liver Activated upon exposure to subendothelial/ tissue collagen Activates coagulation/ fibrinolytic systems, complement, Kinin system
490
Mechanism of fever
Macrophages release IL-1 and TNFa Increase COX activity in perivascular cells of hypothalamus PGE2 raises temp set point
491
Weibel-Palade Bodies
von Willebrand Factor P-selectin *mediated by histamine
492
E-selectins are mediated by
IL-1 | TNFa
493
Selectins bind
Sialyl Lewis X on leukocytes | Results in rolling of leukocytes
494
Leukocyte Adhesion Deficiency
Autosomal recessive | Defect of interns (CD18)
495
Leukocyte Adhesion Deficiency Presentation
Delayed separation of umbilical cord Increased circulating PMNs Recurrent bacterial infections that lack pus
496
Chediak-Higashi Syndrome
Autosomal recessive Mutated Lysosomal Trafficking Regulator (LYST) LYST required by granulocytes to make granules PROTEIN TRAFFICKING defect Microtubules not constructed properly Impaired phagolysosome movement
497
Chediak-Higashi Syndrome Presentation
``` Increased pyogenic infections Neutropenia Giant granules in leukocytes Defective hemostasis No melanin transport --> Albinism Peripheral neuropathy (no proteins to neurons) ```
498
Nitroblue Tetrazolium Test
Screen for CGD Blue: NADPH oxidase converts O2 Colorless: NADPH oxidase defect
499
MPO deficiency
Defective H2O2 --> HOCl Risk for Candida Normal NBT test
500
Defining characteristic of a granuloma
Epitheliod Histiocyte Accumulation (macrophages w abundant pink cytoplasm)
501
Caseating granulomas
TB (AFB stain) | Fungus (GMS silver stain)
502
Granuloma formation
Macrophages present MHC II to CD4 T cells Secrete IL-12 to diff Th1 Th1 secretes IFNy which converts macrophages to epithelioid histiocytes
503
Severe Combined Immunodeficiency (SCID)
Defective cell mediated and humoral immunity Defective: -Cytokine receptors -Adenosine Deaminase (accumulated products toxic to lymphocytes) -MHC II Recurrent infections (inc opportunistic)
504
SCID treatment
Sterile isolation Stem cell transplant Avoid live vaccines
505
X-linked (Bruton) Agammaglobulinemia
Complete lack of Ig Disordered B cell maturation Naive B cells do NOT mature to plasma cells Mutated Bruton Tyrosine Kinase
506
Presentation of | X-linked (Bruton) Agammaglobulinemia
After 6 mo of life Bacterial, Enterovirus, Giardia infection Avoid live vaccines
507
Common Variable Immunodeficiency (CVID)
Low Ig B cell/ Th cell defects Bacterial, Enterovirus, Giardia infections Occurs late in childhood Increased risk for autoimmunity and lymphoma
508
Hyper-IgM Syndrome
No CD40 2nd signal No cytokines produced for Ig class switch Low IgA, IgG, IgE Pyogenic and Mucosal infections
509
Wiskott-Aldrich Syndrome Triad
Thrombocytopenia (bleeding) Eczema Recurrent infections (defective humoral and cellular immunity)
510
Wiskott-Aldrich Syndrome Defect
Mutated WASP protein | X-linked
511
C5-C9 deficiency increases risk for
Neisseria infections
512
C1 inhibitor deficiency
Hereditary angioedema
513
SLE
``` Type II (cytotoxic) Type III (Ag-Ab complex) Death: Renal damage and infection Diffuse proliferative glomerulonephritis Cardiac, CNS, Joints, Blood cells, Rash ```
514
Libman-Sacks Endocarditis
Sterile Vegetations on both sides of valves Inflammatory activation in response to deposition Assoc w Lupus Result: mitral regurgitation
515
Diagnosis of Lupus
``` AntiNeutrophil Ab (ANA) Anti-dsDNA (highly specific) ```
516
Drug Induced Lupus
Anti-Histone Ab - Hydralazine - Procainamide - Isoniazid * remove drug cures
517
Antiphospholipid Syndrome
Assoc w lupus AutoAb against proteins bound to phospholipids Anticardiolipin (false VRDL) and Lupus Anticoagulant (false PTT elevation, hyper coagulable, lifelong anticoagulation) are most common
518
Sjogren Syndrome
Autoimmune destruction of lacrimal and salivary glands Type 4 hypersensitivity with fibrosis Dry eyes and mouth
519
Diagnosing Sjogren Syndrome
``` AntiNeutrophil Ab (ANA) ANITRIBONUCLEOPROTEIN Ab (Anti-SS-A, Anti-SS-B) ```
520
Sjogren Syndrome increases risk for
B cell Lymphoma | *unilateral enlargement of parotid late in disease
521
Scleroderma
Autoimmune tissue damage Activation of fibroblasts Deposition of collagen (fibrosis) Diffuse or localized
522
Diffuse Scleroderma
Skin and early visceral involvement Esophagus commonly affected ANA and Anti-DNA topoisomerase I (Scl-70) Ab
523
Localized Scleroderma
Skin and late visceral involvement | CREST Syndrome
524
CREST Syndrome
``` Calcinosis/ anti-Centromere Ab Raynaud Esophageal dysmotility Sclerodactyly Telangiectasias ```
525
Mixed Connective Tissue Disease
Lupus, Systemic Sclerosis, Polymyositis | Ab against U1 Ribonucleoprotein
526
Alkylating agents increase risk for
Leukemia/ Lymphoma | *side effect of chemotherapy
527
Nitrosamines increase risk of
Stomach carcinoma (intestinal) * smoked foods * Japan
528
Naphthlamine increases risk for
``` Urothelial carcinoma (bladder) *cigarette smoke ```
529
Vinyl Chloride increases risk for
``` Angiosarcoma of liver Occupational exposure (PVC) ```
530
Polycyclic hydrocarbons
In cigarette smoke | Highly carcinogenic
531
Oncogenic Viruses
EBV (nasopharyngeal, Burkett, CNS lymphoma) HHV-8 (kaposi) HBV and HCV HPV
532
Ionizing radiation
``` AML CML Papillary carcinoma of thyroid Generates hydroxyl free radicals *Nuclear reactors and radiotherapy ```
533
Non-ionizing radiation
``` UVB (most common) BCC SCC Melanoma Pyrimidine dimer nicks in DNA normally excised by endonuclease ```
534
PDGF-B over expression leads to
Astrocytoma
535
ERBB2 (HER2/ neu) receptor is blocked by
Trastuzumab Disrupts cell signaling and encourages apoptosis HER2 preserves cardiomyocytes Trastuzumab can be cardiotoxic
536
KIT Growth Factor receptor mutation leads to
GI stromal tumor
537
c-myc N-myc L-myc
Nuclear regulators of transcription
538
c-myc mutation
t(8,14) of Ig Heavy Chain c-myc overexpression (transcription activator) Burkitt lymphoma "starry sky" Aggressive
539
N-myc amplification mutation leads to
Neuroblastoma | *N = neuroblastoma
540
L-myc amplification leads to
Small cell lung carcinoma | *L = lung
541
Cyclin D is associated with
t(11,14) of Ig Heavy chain Overexpression allows unregulated progression G1 --> S Phase Mantle cell lymphoma (next to node follicle)
542
CDK4 amplification mutation is associated with
Melanoma
543
S-100 staining
Melanoma
544
Seeding of body cavities | "omental caking" is characteristic of
Ovarian Carcinoma
545
Vessel injury immediate response
Vasoconstriction Mediated by: -Endothelin -Nervous system
546
ITP
``` Autoimmune IgG against platelet Ag (GpIIb/IIIa) Ab produced by plasma cells in spleen Thrombocytopenia (platelets consumed) PT/PTT normal Increased magakaryocytes ```
547
Acute form ITP
In children After virus or immunization Self-limited
548
Chronic form ITP
Adults (women child bearing age) Thrombocytopenia in offspring Anti-platelet IgG crosses placenta Assoc w lupus
549
Treatment of ITP
``` Corticosteroids Children respond well Adults have early response and often relapse IVIg Splenectomy (source of Ab) ```
550
Labs of TTP and HUS
``` Thrombocytopenia Increased bleeding time Normal PT/PTT Anemia w Schistocytes Increased megakaryocytes ```
551
Treatment of TTP
Plasmaphoresis (remove auto-Ab) | Corticosteroids
552
Bernard-Soulier Syndrome
``` Genetic GP1b deficiency Impaired platelet adhesion to vWF Thrombocytopenia Enlarged platelets (immature) B.S = big suckers ```
553
Glanzmann Thrombasthenia
Genetic GIIb/IIIa deficiency Impaired platelet aggregation No fibrinogen linking
554
Uremia disrupts platelet function
Both adhesion and aggregation
555
Clinical features of Secondary Hemostasis Pathology
Deep tissue bleeding into muscles and joints | Rebleeding after surgical procedures
556
PT measures
Extrinsic and Common Pathways Coumadin/ Warfarin Effect Effect of liver failure on coagulation
557
PTT measures
Intrinsic and Common Pathways | Heparin effect
558
_____ activates factor 12
Subendothelial Collagen
559
_____ activates factor 7
Tissue Thromboplastin
560
Coagulation Factor Inhibitor Disorder
Ab against coagulation factor Anti-FVIII most common PTT does NOT correct w mixing study (w normal plasma, PTT will correct in hemophilia A) Ab binds added normal factor 8
561
Most common inherited coagulation disorder
Von Willebrand Deficiency | AutoDOM
562
Lab findings of vWF disorder
Increased bleeding time Increased PTT (vWF stabilizes factor 8, subclinical) Normal PT Abn ristocetin test
563
Treatment of vWF disease
Desmopressin | Increases vWF release from Weibel-Palade bodies
564
Vitamin K Deficiency
Disrupts y-carboxylation of factors 2, 7, 9, 10, C, and S Newborns Long-term ABX Malabsorption of fat soluble vits
565
Vitamin K is activated by
Epoxide Reductase (liver)
566
Mechanism of Coumadin/ Warfarin
Inhibition of epoxide reductase | No activation of Vitamin K
567
Heparin-Induced Thrombocytopenia (HIT)
Hep-PF4 Complex destroyed in spleen | Platelet fragments activate remaining platelets --> thrombosis
568
DIC
Inappropriate activation of coagulation cascade | Consumption of platelets and factors --> bleeding
569
Lab findings in DIC
``` Decreased platelets (consumed) Increased PT/PTT Decreased fibrinogen (consumption) Microangiopathic hemolytic anemia Elevated d-dimer ```
570
Treatment of DIC
Treat underlying cause Blood products Cryoprecipitate
571
tPA converts
Plasminogen --> plasmin | Which then lyses fibrin and serum fibrinogen
572
Molecule that inactivates plasmin
a2-antiplasmin | *reduced production in cirrhosis
573
Complication of radical prostatectomy
Release of urokinase activates plasmin --> bleeding
574
Lab findings in disorders of Fibrinolysis
Increased bleeding time (plasmin inhibits aggregation) Normal platelet count (low in DIC) Increased PT/PTT (plasmin cleaves coag factors) Increased fibrin split products WITHOUT d-dimer (clot never formed)
575
Treatment of fibrinolysis disorders
Aminocaproic acid Blocks activation of plasminogen No plasmin formation
576
Cartilage is made of type _____ collagen
2
577
Rheumatoid Arthritis is associated with HLA_____
HLA-DR4 | *and IgM against Fc portion of IgG (RF)
578
Complication of Rheumatoid Arthritis
Secondary Amyloidosis | Chronic inflammation--> SAA --> AA
579
Ankylosing Spondyloarthritis
``` SI joints and spine Young males LBP Fusion of vertebrae (bamboo spine) Uveitis and Aortitis HLA-B27 ```
580
Reiter Syndrome
Arthritis, Urethritis, Conjunctivitis (see, pee, climb tree) Young males Weeks after GI or Chlamydia infection
581
Most common bugs of septic arthritis
N. gonorrhoeae | S.aureus
582
Glioblastoma
``` Aggressive brain tumor Gradual HA, seizure, neuro probs Assoc w mutated Epidermal Growth Factor CAN cross midline (butterfly glioma) Typically located in hemispheres ```
583
Lab findings in Lactose Intolerance
Increased breath hydrogen Reduced stool pH (acidic) Elevated stool osmolality
584
Treatment for Trigeminal Neuralgia
Carbamazepine
585
Pancreatic Islet Amyloid Deposition
T2DM HLA Class II Leukocyte infiltration of islet (insulitis) Ab against islet Ag in T1DM
586
Vitiligo
Loss of melanocytes Common w autoimmune disorders Patches of hypopigmentation
587
Mechanism of tocolysis (inhibition of uterine contraction) medications
B2 adrenergic stimulation
588
Mechanism of Methotrexate and 5-FU
Inhibition of thymidylate formation | *methotrexate is overcome by N-Formyl-THF supplement
589
Inhibin B is produced by
Granulosa cells
590
BRCA genes encode for
dsDNA repair proteins
591
Mechanism of Mifepristone
Inhibition of progesterone receptors
592
Aromatase
Expressed in granulosa cells | Converts things to estrogens
593
Mesonephric (Wolffian) Duct develops into
``` SEED Seminal vesicles Epididymis Ejaculatory duct Ductus deferens ```
594
PID complications
Ectopic | Fitz-Hugh-Curtis (liver capsule inflammation)
595
Choriocarcinoma
Cytotrophoblasts and syncytiotrophoblasts WITHOUT chorionic villi Develops after complete moles, abortion, pregnancy Highly vascular and invasive Round lung opacities + urine preg test
596
HPV infection --> E7 production --> Inhibited Rb -->
E2F transcription factors promote G1 --> S phase are inhibited by Rb Increasing G1 to S transition E6 binds and inactivates p53
597
Breastmilk becoming thinner and whiter after delivery is due to
Decreased progesterone
598
Adenomyosis
Endometrial tissue within uterine wall Menorrhagia and dysmenorrhea More common in multiparous women
599
Acute Stress Disorder | timeline
3 days to 1 month
600
Malignant Hyperthermia
``` Anesthetics (succs, gasses) Unregulated passage of Ca from SR into cell Sustained muscle contraction Hypercarbia Hyperthermia Acidosis ```
601
N. mengitidis vaccine
``` Ab against polysaccharide capsule Quadrivalent (ACYW) Recombinant proteins (B) ```
602
Elevated Alk Phos should be followed up by _____ test to determine if bone or biliary tract
y- glutamyl transferase (GGTP) | *not present in bone
603
Non-selective B-Blockers can exacerbate _____
Hypoglycemia | and mask hypoglycemic symptoms mediated by NE/Epi
604
Gloms Tumor (glomangioma)
Benign Small and tender Red-blue lesion under nail bed Originates from smooth muscle cells that control thermoregulatory functions of dermal gloms bodies
605
Adverse Effects of | Theophylline
Seizures (death) | Tachyarrhythmias
606
Mechanism of Etoposide
Chemotherapy Inhibits sealing activity of Topoisomerase II Chromosomal breaks accumulate in dividing cells
607
Alkaptonuria
Autosomal recessive Deficiency of homogentisic acid dioxygenase (tyrosine metabolism) Excess homogentisic acid Diffuse blue-black deposits in connective tissues Sclera and Ear Cartilage hyperpigmentation Osteoarthropathy of spine and Lg joints
608
Capecitabine
Metabolized to 5FU
609
Nucleus pulposus is rich in type _____ collagen
Type II collagen
610
The lens of the eye is rich in type _____ collagen
Type IV collagen
611
Reticular fibers (skin, vessels, uterus) are abundant in type _____ collagen
Type III collagen Produced by myofibroblasts Same cells responsible for wound contraction
612
Reportable Diseases
``` HepA / HepB Syphilis Gonorrhea MMR Tuberculosis Salmonellosis Shigellosis E.Coli (think food outbreaks) AIDS (not HIV) Varicella Meningitis ```
613
What classifies one as an emancipated minor?
``` Homeless Parent (i.e. 16yo mother) Married Military Finically independent High School Graduate ```
614
What medical circumstances do minor not need parental consent?
emergency care STIs substance abuse prenatal care
615
How long does a physician have to release records when requested by a patient?
30 days
616
Competency vs Capacity
Competency= legal definition Capacity= medical definition Both refer to ability to make decisions on their own
617
2 components of an advance directive
1. Living will | 2. Durable power of attorney
618
Power of attorney disagrees with the patients living will
Living will must ultimately be honored Meet with family and discuss Providing supportive care and review living will If conflicts arise consult ethics committee
619
Fidelity
Loyalty and/or promise-keeping | Duty to be loyal or keep promises
620
Vicarious liability | "respondeat superior"
Strict, secondary liability "respondeat superior" - the responsibility of the superior (or any 3rd party that has a duty to control) for the acts of their subordinate Employer responsible for employee actions
621
3 types of torts
- intentional torts - negligence - strict liability
622
EMTALA
Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay
623
Requirements of EMTALA
1. Examination and treatment cannot be denied or delayed to inquire about payment. Must post patient rights 2. If emergency exists, treatment must be provided until stabilized. 3. Hospitals with specialized capabilities are obligated to accept transfers from hospitals who lack the capability 4. Must report any time it has received an individual who has been transferred in an unstable emergency medical condition from another hospital violating EMTALA
624
ERISA
The Employee Retirement Income Security Act of 1974 | Protection for individuals within retirement and health plans
625
NMHPA
Newborns' and Mothers' Health Protection Act of 1996 Length of time a mother and newborn child are covered for a hospital stay in connection with childbirth No less than 48 hours following a vaginal delivery or 96 hours following a delivery by cesarean section
626
Res ipsa loquitur
"scalpel left behind" | No explanation required to show surgeon was negligent
627
Drug Trials
``` Phase I safety Phase II involves subjects with disease Phase III large scale testing Phase IV post release surveillance Phase V long term data ```
628
Healthcare Integrity and Protection Data Bank (HIPDB)
Government program that the collects and discloses users negative information on health care practitioners, including malpractice awards, loss of license or exclusion from participation in Medicare or Medicaid
629
Medicare Part A
Hospital Insurance Hospital, SNF, home health, hospice Free if paid SS for 10 yrs
630
Medicare Part B
Medical Insurance Doctors visits, Preventative, Equipment, Outpatient, Labs, XR, mental health, ambulance Monthly premium charged
631
Medicare Part C
Allows private health insurance companies to provide Medicare benefits Medicare Advantage plans
632
Medicare Part D
Outpatient Prescription Drug Coverage | Provided only through private insurance companies w government contracts
633
Informed consent
- Diagnosis - Risks and Benefits - Alternative Treatments
634
tort of negligence
4 D's - Duty owed - Duty Breached - Damage to patient - Direct causation
635
Fibromuscluar Dysplasia
``` Developmental defect of vessel wall Thickening of md-lg arteries (renal) Young females Fibromuscular webs Noninflammatory, Nonatherosclerotic Alternating luminal stenosis and aneurysmal dilation (string of beads) Loss of elastic lamina Resistant HTN Can involve CNS ```
636
Atherosclerosis
``` Intima affected Md-Lg vessels Plaque obstructs flow Necrotic lipid core Fibromuscluar cap Calcification ```
637
Arteriolosclerosis
Sm vessels Thickening of wall Hyperplastic or Hyaline
638
Monckeberg Medial Sclerosis
Calcification of the media Vascular pattern on XR Non-obstructive Subclinical
639
Typically require _____% blood vessel blockage before symptoms
70%
640
Hyaline ArterioloSclerosis is caused by
Benign HTN | Diabetes (NEG--> leakage of proteins)
641
Hyperplastic Arteriolosclerosis is caused by
Malignant HTN | Onion-skinning appearance
642
Most common complication of Aortic Dissection and cause of death
Pericardial Tamponade
643
Indicators of thrombus occurring before death
Lines of Zahn (RBC-fibrin-RBC-fibrin...) | Attachment to vessel wall
644
ATIII deficiency _____ cause a rise in PTT during Heparin administration
Will NOT Limited ATIII to activate Give coumadin to maintain anticoagulation
645
Caisson Disease
Chronic decompression sickness | Gas emboli causes multifocal ischemic necrosis of bone
646
Amniotic Fluid embolus can cause DIC
Amniotic fluid rich in thromboplastin Activates coagulation cascade Embolus contains fetal squamous cells and keratin debris
647
A-a Gradient
PAlveoli O2 - Parteries O2 | Normal 5-15 mmHg
648
Causes of Hypoxemia (low PaO2) without increased A-a Gradient
Hypoventilation | High Altitude
649
Right Shift of Hb Dissociation Curve
``` *need O2 now, taut form* Heat H+ CO2 High Altitude 2,3 BPG ```
650
Left Shift of Hb Dissociation Curve
``` *bind O2, relaxed form* Low CO2 Low H+ Cold temp Low 2,3 BPG ```
651
Inflammatory Bowel Disease (IBD)
Chronic, Relapsing Abn immune response to flora Bloody diarrhea Includes UC and Crohns
652
Ulcerative Colitis
``` Mucosal and submucosal ulcers Begins at rectum (LLQ) Extends to any level up to cecum CRYPT ABSCESSES Lead pipe appearance Toxic megacolon and Carcinoma *smoking protects against UC ```
653
Ulcerative Colitis is associated with
Primary Sclerosing Cholangitis and p-ANCA
654
Crohn's Disease
``` Full thickness inflammation Knife-like fissures Mouth to Anus Skip lesions Terminal ileum most common (RLQ) Rectum least common LYMPHOID GRANULOMAS Cobblestoning Creeping fat and Strictures (string sign) *smoking increases risk of Crohn's ```
655
Crohn's Disease is associated with
``` Malabsorption Ca Oxalate stones Fistulas Carcinoma (if colon involved) Ankylosing spondylitis Migratory polyarthritis Uveitis Erythema nodosum ```
656
0-4 hours after MI
No visible change
657
4-12 hours after MI
Wavy fibers | Narrow, Elongated myocytes
658
12-24 hours after MI
Myocyte hypereosinophilia w pyknotic (shrunken) nuclei
659
1-3 days after MI
``` Coagulation necrosis (loss of nuclei and striations) Prominent neutrophilic infiltrate ```
660
3-7 days after MI
Disintegration of dead neutrophils and myofibers | Macrophage infiltration at border
661
7-10 days after MI
Robust phagocytosis by macrophages | Beginning of granulation tissue at margins
662
10-14 days after MI
Well-developed granulation tissue w neovascularization
663
2 weeks - 2 months after MI
Progressive collagen deposition and scar formation
664
Mechanism of metformin
Inhibits mitochondrial glycerophosphate dehydrogenase and complex I Upregulates AMP-activated protein kinase
665
Effects of metformin
Decreased hepatic glucose production Decreased intestinal glucose absorption Increased peripheral glucose uptake Decreased lipogenesis
666
Side effects of Metformin
Diarrhea Lactic acidosis Vit B12 deficiency
667
Anticoagulation for Preggos
Heparins do NOT cross placenta | Enoxaparin (LMWH)
668
Treatment of Acute Simple Cystitis
Nitrofurantoin or | TMP-SMX
669
Warfarin blocks _____
Epoxide Reductase Lowers reduced VitK Prevents y-carboxylation of VitK dependent clotting (2, 7, 9, 10) Only blocks generation of new clotting factors Effect is delayed 3-5 days until existing clotting factors are consumed
670
Treatment for CMV Colitis and Retinitis
Ganciclovir Blocks viral DNA polymerase (lesser extent host too) Hematologic side effects (neutropenia, anemia, thrombocytopenia)
671
Whipple disease
Tropheryma whippelii Systemic illness involving Sm Intestine, Joints, CNS Enlarged, Foamy Macrophages packed w: -bacilli -PAS + -Diastase resistant granules *CAN of whipped cream: cardiac, arthopathy, neuro
672
_____ are earliest and most sensitive nutrient affected in malabsorption
Fats | Test w Assay of Stool w Sudan III Stain (IDs unabsorbed fat)
673
Pathogenesis of Wilson Disease
Autosomal recessive Mutated ATP7B Hepatic Cu accumulation leaks out Deposits in tissues
674
Diagnosis of Wilson Disease
Decreased Ceruloplasmin Increased urinary copper excretion Kayser Fleischer rings Increased Cu on liver biopsy
675
Treatment of Wilson Disease
Chelators (D-penicillamine, Trientine) | Zinc (interferes w copper absorption)
676
Microscope findings of Herpes Zoster (shingles)
Intranuclear inclusions in Keratinocytes | Multinucleated giant cells
677
Acute Myeloblastic Leukemia (AML) | Microscope findings and Mutation
``` Auer rods (eosinophilic intracytoplasm rods) t(15,17) ```
678
Hematologic malignancy or rapid cell turnover increases risk for _____ after cytotoxic chemotherapy
Electrolyte abnormalities - Hyperphosphatemia - Hyperkalemia - Elevated LDH
679
Mechanism of Digoxin
``` Rate control in Afib Positive Inotrope in Heart Failure Decreased AV node conduction Increases Vagal tone Inhibition of Na-K ATPase Pump ```
680
Eosinophilic Esophagitis
Chronic Th2 mediated d/o Triggered by food Ag Eosinophilic infiltration of esophageal mucosa M > f More common w hx of atopic conditions Dysphagia, Reflux, Vomiiting, Pain, Food Impaction
681
Streptococcus gallolyticus (S.bovis)
Endocarditis and Bacteremia Assoc w GI lesions (colon CA) If detected in blood culture, must workup for colon CA
682
Primary routes of elimination of | Senescent Ceruloplasmin and Unabsorbed Cu
Secreted into bile | Excreted in stool
683
Achondroplasia
``` Impaired cartilage proliferation at growth plate Activating mutation of FGFR3 AutoDOM or Adv paternal age Most commonly sporadic Short extremities Normal head and chest Dwarfism ```
684
Osteopetrosis
Thick heavy bone Inherited defective bone resorption Prone to fractures Poor osteoclast function Carbonic Anhydrase II mutation Lack of acidic environment for resorption Anemia, Thrombocytopenia, Leukocytopenia Extramedullary hematopoiesis Vision and Hearing impaired (compress CNs) Hydrocephalus Renal Tubular Acidosis (carbonic anhydrase deficiency)
685
Treatment for Osteopetrosis
Bone marrow transplant
686
Rickets
``` Defective osteoid mineralization Low VitD in children Pigeon Breast Deformity Frontal Bossing Leg bowing (w devo of walking) Rachitic Rosary (deposition of osteoid at costochondrial junction) ```
687
Osteomalacia
``` Defective osteoid mineralization Low VitD in adults Weak bone, Increased fractures Decreased Ca and Phosphate Increased PTH and Alk Phos ```
688
Alkaline Phosphatase is present whenever _____
There is activation of osteoBLASTS | Alkaline environment allows calcification of osteoid
689
Labs in Osteoporosis (Ca, Phosphate, PTH, AlkPhos)
All normal
690
Labs in Osteogenesis deformans (Paget Disease)
Isolated elevated AlkPhos
691
Treatment for Osteogenesis Deformans (Paget Disease)
Calcitonin (opposite of PTH) | Bisphosphonates
692
Complications of Osteogenesis Deformans (Paget Disease)
High Output Cardiac Failure (bone remodeling --> AV shunts --> increased work) Osteosarcoma
693
Osteomyelitis affects _____ in children
Metaphysis
694
Osteomyelitis affects _____ in adults
Epiphysis
695
Vaginal Adenosis
Persistence of columnar epithelium in upper 1/3 of vagina | In utero exposure to DES
696
Clear Cell Adenocarcinoma
Malignant proliferation of glands w clear cytoplasm | Complication of DES vag adenosis
697
Embryonal Rhabdomyosarcoma
Malignant proliferation of immature skeletal muscle | Grape-like mass protruding from vagina or penis
698
Microscopy of Embryonal Rhabdomyosarcoma
Rhabdomyoblasts have: - cytoplasmic cross striations - Positive staining for destin and myoglobin
699
MaLLory- Weiss
``` Longitudinal Lacerations of GE junction Alcoholics, Bulemics Failed relaxation of LES Caused by increased abd pressure Mucosa and submucosa only ```
700
PLUMmer-Vinson
PLUMber DIES Triad of Dysphagia, Iron deficiency anemia, Esophageal webs, increased risk Squamous cell carcinoma May be assoc w glossitis
701
Pancreatitis _____ levels of fecal elastase
Decreases
702
Ribosome biogenesis occurs within the _____
Nucleolus
703
Caseating granulomas of TB are almost always
Surrounded by Lg epithelioid macrophages Pale pink granular cytoplasm CD14 surface marker
704
Leptin
Produced by adipocytes (proportionally) Acts on arcuate nucleus of hypothalamus Inhibits Neuropeptide Y (decreases appetite) Stimulates a-MSH (increases satiety) Mutations result in hyperphagia and obesity
705
Most common cause of bloody nipple discharge
Intraductal Papilloma | Papillary cells w fibrovascular core
706
Most common side effects of ADHD meds
Decreased appetite | Insomnia
707
The _____ gives rise to the glomeruli, Bowman's space, proximal tubules, loop of Henle, and DCTs
Metanephros (metanephric blastema)
708
The ____ becomes the collecting system of the kidney, major and minor calyces, renal pelvis, and ureters
Ureteric Bud
709
Trichrome Stain identifies
Collagen
710
Chronic Kidney disease can cause hyperphosphatemia
Decreased renal excretion of phosphorus Dietary phosphorus restriction or Oral phosphate binders (Sevelamer)
711
Zinc-finger motifs
Chains of AA bound around Zn atom via linkages w Cysteine and Histidine Recognize DNA sequences Alter activity of target genes Affect Steroids, Thyroid hormone, Fat-Soluble Vits
712
Mechanism of ADHD meds
Stimulants | Increase availability of NE and DA in prefrontal cortex
713
Chvostek Sign
Facial muscle spasm | Indicates hypocalcemia
714
Trousseau sign
Carpopedal spasm | Indicates hypocalcemia
715
Iron absorption takes place in the
Duodenum and Proximal jejunum Gastric bypass can result in: -iron deficiency anemia -malabsorption of VitB12, folate, VitADEK, Ca
716
Function of Type II pneumocytes
Regeneration of alveolar lining following injury | Surfactant production
717
DNA binding proteins
Transcription factors (myc, CREB) Steroid receptors (cortisol, aldosterone, progesterone) Thyroid hormone receptor Fat-Soluble Vitamin receptors (VitD, retinoid acid) DNA transcription and replication proteins
718
Adverse Effects of Clomiphene
Hot flashes Ovarian enlargement Multiple pregnancy Visual disturbances
719
TamoxifEN
Estrogen antagonist at breast and uterus Agonist at bone Increased risk of T--> Thrombus, EN--> endometrial CA Prevents recurrence of ER/PR + BCA
720
Raloxifene
``` Estrogen antagonist at breast and uterus Agonist at bone Risk of thrombosis NO RISK of endometrial CA Treats osteoporosis ```
721
Pheochromocytoma
Tumor of adrenal medulla Derived from chromatin cells (neural crest) Secrete catecholamines and EPO Relapses and remits
722
Treatment for PHEochromocytoma
PHEnoxybenzamine Irreversible a-agonist first to avoid hypertensive crisis *follow w B-blockers
723
Diagnostic Features of subarachnoid bleed
Rupture of aneurysm | Bloody/ yellow LP
724
Straddle injury
``` Affects anterior (bulbar) urethra Blood in scrotum ```
725
Pelvic Fracture
Affects (membranous) urethra Blood in retropubic space and up abdomen Prostate pushed superiorly and feels boggy
726
_____ tend to be resistant to outliers
Modes
727
Acute Intermittent Porphyria
``` Defective Porphobilinogen Deaminase Abd pain, neuropathy, psych Increased Ur Porphobilinogen Defective heme synth Toxic heme precursors accumulate ```
728
Neruofibromatosis 1
``` Mutated NF1 (ch17) Neurofibromas Cafe-au-lait spots Pheochromocytomas Optic gliomas Pigmented iris hamartomas ```
729
Von Hippel Landeau Disease
``` Inactivation of VHL gene (ch3) Renal Cell Carcinomas AutoDOM Pheochromocytomas Hemangioblastomas (cerebellum) ```
730
Duchenne Muscular Dystrophy
``` X-linked recessive Mutated dystrophin Progressive weakness Low-Proximal to Upper-distal Dilated cardiomyopathy Elevated CK ```
731
Becker Muscular Dystrophy
``` X-linked Recessive Mutated dystrophin Progressive weakness Low-Proximal to Upper-distal Dilated cardiomyopathy Elevated CK ```
732
Dystrophin
Found in muscle | Anchors actin to ECM
733
Calf Pseudohypertrophy
Seen in dystrophies Connective and Adipose tissue replace muscle Enlarged appearing muscles
734
Cystic Fibrosis
``` Autosomal recessive Deletion of Phe508 Impaired glycosylation and folding of CFTR gene Mutated ATP gated Cl channel No Cl secreted in GI and lungs No Cl reabsorbed in sweat glands ```
735
Clearance Equation
C= UV/P ``` U= ur concentration V= ur volume/time P= plasma concentration ```
736
Renal Plasma Flow Equation
RPF = MAP / RVR or RPF = Cpah RVR= renal vascular resistance
737
MAP equation
MAP = CO x TPR
738
Cpah | Clearance of PAH
Upah x V / Ppah * approximates Renal Plasma Flow (RPF) * PAH is freely filtered, actively secreted, and NOT absorbed
739
Renal Blood Flow Equation
RBF = RPF / (1-hct)
740
GFR Equations
``` GFR= Uinulin x V / Pinulin GFR= Ucr x V / Pcr GFR= Kf [(Pgc-Pbs)-(OPgc-OPbs)] ``` * same as clearance equation * Inulin freely filtered, NOT secreted or absorbed * Creatinine less accurate but endogenous
741
Creatinine slightly _____ estimates GFR
Overestimates | *Small portion is secreted into nephron
742
Filtration Fraction Equation
FF= GFR/ RPF
743
Filtered Load or Filtration Rate Equation
FL= GFR x [plasma]
744
Excretion Rate Equation
Excretion= Filtered Load - Net Reabsorption Rate Net Reabsorption = Reabsorption - Secretion
745
Fractional Excretion Equation
FEna = Excreted/ Filtered
746
Henderson-Hasselbalch | Equation
pH= 6.1 + log [HCO3] / (0.03 x PCO2)
747
Anion Gap Equation
AG= Na - (Cl + HCO3)
748
Winters Formula
PCO2= 1.5 [HCO3] + 8 +/- 2
749
Renal Tubular Acidosis- | Type I
``` No Acid Secretion Defective a-intercalated cells in Collecting Duct Increased Ur pH (CaPO4 stones) Serum pH acidic HypoKalemia ```
750
Renal Tubular Acidosis- | Type II
No Basolateral Bicarb Reabsorption Acidic urine Serum pH acidic Caused by Fanconi or CA inhibitors
751
Renal Tubular Acidosis- | Type IV
Hypoaldosteronism/ Aldosterone Resistance HyperKalemia Serum pH acidic Ur pH acidic (decreased NH3 synth)
752
Fanconi Syndrome
Proximal Tubule doesn't reabsorb | Cause of Type II RTA
753
Lactate is essential for the regeneration of NAD+ for _____
glyceraldehyde-3-phosphate dehydrogenase Catalyzes glyceraldehyde-3-phosphate --> 1,3-bisphosphoglycerate
754
Atracurium is a unique anesthetic in that it _____
Has organ independent elimination | Primarily enzymatic hydrolysis
755
Hodgkin Lymphoma
Cervical LAD B-Symptoms HyperCa (paraneoplastic production of 1,25-VitD) CD15/CD30 + Reed-Sternberg Cells (owl eyes, bilobed nuclei)
756
Kawasaki Disease
``` Med vessel vasculitis (cardiac) CRASH and BURN (fever) Conjunctivitis Rash Adenopathy (cervical) Strawberry tongue Hands/Feet (desquamation) ```
757
Treatment of Kawasaki Disease
ASA (decrease clots, inflammation) | IVIG
758
Temporal Arteritis
Lg vessel vasculitis (temporal, ophthalmic) aka Giant Cell Arteritis Immune complex deposition Joint pains Headache and eye symptoms Biopsy: segmental damage, granulomas, fibrosis
759
Polyarteritis Nodosa
Med vessel vasculitis Cycle: Thrombosis --> Aneurysm --> rupture --> healing Biopsy: fibrinoid necrosis Beads on a string pattern Affects all organs Poly ARTERitis NOdosa- Pulmonary ARTERies NOT damaged
760
Treatment of Polyarteritis Nodosa
Steroids (inhibit inflammatory cytokines) | Cyclophosphamide (damages DNA, slows rapid division)
761
Thromboangiitis Obliterans
``` aka Buerger disease Sm and Med Vasculitis Assoc w smoking Claudication and Autoamputation Narrowing of blood vessels Increased sensitivity to cold ```
762
Henoch-Schonlein Purpura
``` Sm vessel Vasculitis IgA immune complex deposition Assoc w URIs Palpable leg and buttock purpura Joint pain, hematuria, hematochezia Most common vasculitis of children Tx steroids ```
763
Monoclonal Gammopathy of Undetermined Significance (MGUS)
``` Plasma Cell Dyscarasia Asymptomatic form of Multiple Myeloma Still producing other blood cells Can progress to Multiple Myeloma Extra proteins --> RF, anemia, thrombocytopenia, lytic lesions, hyperCa ```
764
Symptoms of Multiple Myeloma
``` CRAB HyperCa Renal Failure Anemia/ thrombocytopenia Bone lesions/ pain ```
765
Treatment for Influenza
NA inhibitors- block virion release | Ex. Oseltamivir, Zanamivir
766
Avoid the use of __(herbal supplement)___ with aspirin
``` Ginko Biloba Garlic Ginger Ginsing Turmeric Willow *antiplatelet properties ```
767
Tay-Sachs
``` Hexoseaminidase A deficiency --> GM2 Ganglioside in lysosomes --> neurodegeneration Autosomal recessive Ashkenazi Jews Cherry red spot on macula Lysosomes with "onion skin" NO HEPATOMEGALY (like niemann-pick) ```
768
Amaurosis Fugax
Sudden painless vision loss Spontaneous recovery (seconds to minutes) Occlusion of central retinal artery, carotid stenosis, temporal arteritis Self limiting
769
Pediculosis capitis
Head Lice Pruritis Tx: permethrin
770
Trichophyton Microsporum Epidermophyton
Dermatophytes Branching septet hyphae on KOH prep w blue stain Microsporum visualized w woods lamp Tx: azoles
771
Onychomycoses
Dermatophyte infection of the nails | Tx: terbinifine, griseofulvin
772
Side effects of Griseofulvin
GI
773
Increased dosing of anesthesia in alcoholics is due to
Ethanol oxidizing system (CYP450 2E1) or | cross-tolerance
774
Medications known to cause photosensitivity
``` Tetracyclines (DOXYCYCLINE) Thiazides Sulfonamides Amiodarone Fluoroquinolones Retinoids NSAIDs Griseofulvin Grazoprevir ```
775
Technetium-99m Scintigraphy
Radioactive substance injected | Shows metabolic activity
776
Corneal and Lacrimation reflexes are carried on nerves
Afferent: CN V1 (ophthalmic branch) Efferent: CN VII *loss of lacrimal reflex does not stop emotional tears
777
Tinea capitis causes alopecia via
Hair shaft breakage
778
Nominal Scale
names NOT numbers No order
779
Ordinal scale
Ranking | Ex. hot, hotter, hottest
780
Interval scale
Ordered numbers | Ex. temperature
781
Ratio scale
Ordered numbers | Zero is meaningful
782
Antiarrhythmic for Hyperthyroidism
Amiodarone | -K channel blocker
783
Childhood rash with lesions of different stages of healing
Varicella- Zoster (chickenpox)
784
Grave's Disease
Thyroid-stimulating Ig (IgG crosses placenta) Dermal fibroblasts (pretibial myxedema, GAGs) Orbital Fibroblasts Osmotic muscle swelling (GAGs) Assoc HLA DR3/ B8
785
Aortic stenosis is associated with _____ blood vessels
Torturous blood vessels | Angiodysplasia
786
Palmar erythema and Spider angiomas in the presence of cirrhosis are the direct result of
Increased estrogen
787
Gilbert Syndrome
``` Inherited hyperbilirubinemia Autosomal recessive Mutated UGT1A1 gene Decreased UDP-glucuronosyltransferase Increased unconjugated bilirubin Jaundice during stress ```
788
Caput Medusae is a dilation of _____
Superior Epigastric Veins
789
Alcohol damages _____ hepatocytes
Centrilobular | *contain highest concentration of CYP450 enzymes
790
Aflatoxin exposure leads to _____
Hepatocellular Carcinoma GC --> TA transversion on Codon 249 Interferes w transcription of p53
791
Pinealoma
Childhood tumor of dorsal midbrain Compresses pretectal region (vertical gaze palsy) Proximal to aquaduct (hydrocephalus) Most common type is germinoma (secreted hCG and testosterone)
792
Rb gene mutation increase risk for _____
Osteosarcomas
793
Focal Segmental GlomeruloSclerosis (FSGS)
``` Hispanics and African Americans Usually idiopathic Assoc w HIV, heroin, SCD Pink sclerosis on H/E Effacement of foot processes on EM No IC deposits (neg immunofluorescence) ```
794
_____ is the progression of Minimal Change Disease when it doesn't respond to Corticosteroids
Focal Segmental GlomeruloSclerosis (FSGS)
795
Focal Segmental GlomeruloSclerosis has a _____ response to steroids
Poor response to steroids | Progresses to CRF
796
Membranoproliferative Glomerulonephritis
``` Thick capillary membranes on H/E Tram-Track appearance IC deposition --> Granular Immunofluorescence 2 types based on location of deposits Nephrotic or Nephritic ```
797
Membranoproliferative Glomerulonephritis Type 1 Immune complex deposit location
Subendothelial Assoc w HepB/ HepC More often assoc w tram-tracks
798
Membranoproliferative Glomerulonephritis Type 2 Immune complex deposit location
Basement membrane | C3 Nephritic Factor (AutoAb, stabilizes C3 convertase, over-activation of compliment)
799
Diabetic Nephrotic Syndrome
Non-enzymatic Glycosylation of basement membrane Sclerosis of mesangium Kemmelstiel-Wilson Nodules Progression slowed by ACE inhibitors
800
Nephrotic vs Nephritis
``` Nephrotic - Proteinuria 3.5+ - Hyopalbuminemia - Hypercoagulable - Hyperlipid and hypercholesterol Nephritic - Proteinuria less than 3.5 - Inflammation and bleeding - Periorbital edema and HTN - RBC casts ```
801
Post Strep GlomeruloNephritis (PSGN)
``` Nephritic syndrome M protein virulence factor Hematuria (cola colored) IC deposits (granular immunofluorescence) Subepithelial "humps" on EM ```
802
Rapidly Progressive GlomeruloNephritis (RPGN)
Nephritic Syndrome Crescents in Bowmans space Crescent made of fibrin and macrophages IF helps resolve etiology
803
Linear Immunofluorescence of glomerulus
Ab to glomerular BM Goodpasture's syndrome Hematuria Hemoptysis
804
Negative Immunofluorescence of Glomerulus
Pauci-Immune Wegner Granulomatosis (c-ANCA, sinusitis) Microscopic polyangitis (p-ANCA) Churg-Strauss (p-ANCA, eosinophils, asthma) Test for ANCA
805
Granular Immunofluorescence glomerulus
PSGN Diffuse Proliferative GN Membranous GN Membranoproliferative GN
806
_____ increases the likelihood of angiomyolipoma, a hamartoma of blood vessels, sm muscle, and adipose
Tuberous Scleroses increases risk of antiomyolipoma
807
Most common malignant renal tumor in children
``` Wilms Tumor Composed of blastema, primitive glomeruli and tubules, and stroma Hematuria HTN (renin secretion) WT1 mutation (WAGR) ```
808
Beckwith-Weidemann Syndrome
Wilms tumor Neonatal Hypoglycemia Muscular hemihypertrophy Organomegaly (tongue)
809
Risk Factors for urothelial tumors
Cigarette smoking Naphthylamine Azo dyes Long term Cyclophosphamide or Phenacetin
810
Urothelial Carcinoma
``` Painless hematuria Flat initiation (early p53 mutations, high grade --> invasion) Papillary initiation (low grade --> high --> invasion) Often recur (field defect) ```
811
Risk factors for Squamous Cell Carcinoma of bladder
Must first develop metaplasia of squamous cells Chronic cystitis Schistosoma hematobium Prolonged nephrolithiasis
812
Risk factors for Adenocarcinoma of the bladder
Urachal remnant (bladder dome) Cystitis glandularis Exstrophy
813
Most common cause of endocarditis
Strep viridans Low Virulence Only infects damaged valves Vegetations do NOT destroy valve
814
Most common cause of endocarditis in IVDU
Staph aureus High virulence Infects normal Tricuspid Lg Vegetations destroy valve
815
Most common cause of endocarditis in prosthetic valves
Staph epidermiditis
816
Most common cause of endocarditis with colorectal carcinoma
Strep bovis
817
HACEK Organisms
Endocarditis w NEG cultures - Hemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella
818
Drugs that cause AIN
5 Ps - Pee (diuretics) - Pain (NSAIDs) - PCNs and CePhalosporins - PPIs - RifamPin
819
Reticular Activating System (RAS)
``` Reticualr formation (alertness) Locus cerulean (NE) Raphe nuclei (serotonin) ```
820
Elevated AFP seen in
Neural tube defect | Anterior abd wall defect
821
The presence of _____ distinguishes nephritic from nephrotic syndrome
Hematuria (present in nephritis) | Suggests glomerular inflammation and injury
822
_____ accelerates atherosclerosis
Smoking Stimulates vasoconstriction Induces prothrombotic state *most important intervention to lower risk of MI
823
Vena Cava opening in diaphragm
T10 | Contains IVC
824
Aortic hiatus in diaphragm
Contains: - aorta - thoracic duct - azygos vein
825
Esophageal hiatus in diaphragm
Contains: - esophagus - anterior and posterior trunks of Vagus Nerve
826
Elastin is fond in
``` Skin Lungs Lg arteries Elastic ligaments Ligamenta flava Vocal cords ```
827
Elastin = _____ + _____
Tropoelastin + Fibrillin Rich in NON-HYDROXYLATED proline, glycine and lysine residues
828
Elastin changes with aging
Decreased dermal collagen and elastin Decreased synth of collagen fibrils CROSSLINKING REMAINS NORMAL
829
Buspirone
``` Non-benzodiazepine anxiolytic For generalized anxiety disorder Slow onset of action Lacks muscle relaxant and anticonvulsant properties No risk of dependence ```
830
Hydralazine | Mechanism of Action
Direct peripheral vasodilator Prefers arteriolar smooth muscle Increases intracellular cGMP Decreases afterload and BP
831
Side effects | Hydralazine
Headache (vasodilation) Tachycardia (reflex sympathetics) Peripheral edema (hydrostatic presssure, Na retention, fluid extravasation) *reduced by administering w B-blocker and/or diuretic
832
Absent vas deferens
Cystic fibrosis | *results in azoospermia and infertility
833
Octreotide
Somatostatin analog Inhibits release of GH Tx for acromegaly (or hypophysectomy)
834
Treatment for acromegaly
Octreotide (somatostatin analog, inhibits GH) Cabergoline (DA agonist) Pegvisomant (GH receptor antagonist)
835
Pleomorphic cells forming psuedopalisades
Glioblastoma multiforme * malignant brain tumor from astrocytes * pseudopalisades migrate away from central necrosis
836
Butorphanol | Pentazocine
Synthetic opioid agonist Partial agonist at mu receptors Can precipitate opioid withdrawal in heavy opioid users
837
Lymphogranuloma Venereum
Necrotizing granulomatous inflammation of inguinal lymphatics and nodes STD (chlamydia L1-L3) Heals w fibrosis Perianal involvement --> rectal strictures
838
Precursor lesions for penile SCC
``` Bowen Disease (shaft) Erythroplasia of Queyrat (glans) Bowenoid Papulosis (reddish papules) ```
839
Bowens Disease
Precursor lesion for penile SCC Leukoplakia Basement membrane NOT invaded
840
Erythroplasia of Queyrat
Precursor lesion for penile SCC Erythroplakia On glans penis
841
Bowenoid Papulosis
Precursor lesion for penile SCC | Like Bowen but does NOT progress to invasion
842
Mumps can cause
Parotiditis Meningitis Pancreatitis Orichitis
843
Granulomatous Orichitis
Necrotizing? Think TB | NonNecrotizing? Think autoimmune
844
Testicular varicocele
More common Left Assoc w L Renal Cell Carcinoma (blocks spermatic vein) Accumulation of warm blood --> infertility
845
Hydrocele
Fluid in tunica vaginalis In infants --> impaired closure (processus vaginalis) In adults --> blocked lymph drainage
846
IVDU infective endocarditis affects tricuspid valve which leads to _____
PE
847
Spinal Stenosis
Lumbar most common Posture dependent LE pain, numbness, weakness Most common cause is degeneration of spine Leads to: Canal narrowing (disc herniation, ligament flavor hypertrophy, osteophytes)
848
Vomiting Reflex
CRTZ in Area Postrema and Nucleus Tractus Solitarious Both located in Dorsal Medulla at Caudal end of 4th Ventricle
849
Area Postrema has a weak BBB
Activated directly by toxins | Activated indirectly by ascending afferents from bowel wall (chemo release of 5HT)
850
Antipsychotics block D2 receptors in _____ pathway
Mesolimbic
851
D2 Block in Tuberoinfundibular pathyway
Galactorrhea | Amenorrhea
852
Only nerve thru obturator foramen
Obturator Nerve Adduction Sensory to distal medial thigh
853
ACL damaged by _____ or _____
Internal rotation or Valgus Stress | Leads to rapid hemarthrosis
854
VPL receives information from _____ and sends information to the cortex
Spinal Thalamic Tract | Dorsal Columns
855
VPM receives information from _____ and sends information to the cortex
Trigeminal pathway
856
Lacunar Infarcts
Lenticulostriate Arteries (of MCA) Sm vessel occlusion due to lipohyalinosis and microatheromas Risks: DM and HTN
857
Location of most gastric ulcers
Lesser curve | BTW body and antrum
858
Pudendal nerve
Stretched during labor (stress on pelvic floor) --> Weakness of perineal muscles --> Fecal/ Urinary incontinence, pain, sexual dysfunction
859
_____ sense RNA viruses bring along all of their own RNA polymerases
Negative Sense RNA | All single stranded (except reoviruses)
860
Esophageal webs increase risk for
Esophageal SCC
861
_____ free radical is the most damaging
OH
862
Free radicals cause damage by
``` Peroxiding lipids (membranes) Oxidizing DNA and proteins ```
863
Most common cause of unilateral fetal hydronephros
Uteropelvic junction
864
_____ in case-control studies controls confounding
Matching
865
Local defense against Candida
T cells (common in HIV because decreased T cells)
866
Systemic defense against Candida
Neutrophils (common in neutropenic)
867
X-inactivation
Barr Body --> Heavy methylation/ deacetylated histones --> Low transcription activity
868
CGD patients at risk for _____ organisms
Catalase +
869
SRY gene codes for _____
Testes Determining Factor
870
Sertoli Cells produce
Anti-mullerian Hormone
871
Leydig Cells produce testosterone which _____
differentiates Wolfian ducts
872
DHT differentiates _____
External genitals (male)
873
Adenomyosis
Glandular tissue in myometrium Enlarged uterus Normal endometrium
874
Gene enhancers (bind activators) and silencers (bind repressors) are located
anywhere within the gene
875
Promoters are located
25 -75 bases upstream Required for transcription Examples: CAAT, TATA, pribnow Rich in Adenine and Thiamine
876
Hereditary Fructose Intolerance
Aldolase B deficiency
877
Classic Galactosemia
Galactose 1 Phosphate Uridyl transferase deficiency
878
Essential Fructosuria
Fructokinase deficiency Asymptomatic, Benign Glucosuria (reducing sugar and unmetabolized fructose)
879
A-flutter
Reentrant circuit Cavotricuspid Isthmus of R atrium Between Tricuspid and IVC
880
Reactive (Atypical) Lymphocytes
Activated in intracellular infection Lg scalloped abundant cytoplasm Diagnostic of mono Granules contain perforins
881
Failed closure of Omphalomesenteric (Vitelline) duct
Normally closes 7th week | Causes enterocysts and Meckel Diverticula
882
MAC
Minimal alveolar concentration Measure of anesthetic potency (1 / MAC) Concentration at which 50% unresponsive (ED50)
883
_____ encode DNA binding transcription factors that have role in segmental organization of embryo along craniocaudal axis
HOX genes
884
If HbA cannot bind 2,3 BPG for O2 unloading
It resembles HbF (inability to bind 2,3 BPG)
885
Neprilysin
Breaks down ANP and BNP
886
Transcatheter Aoritic Valve Implant
Treats Aortic Stenosis | Complication: Aortic Regurgitation (poor seal of prosthetic valve to annulus)
887
Uterine proliferation but no embryonic/ trophoblastic tissue (villi)
Ectopic pregnancy
888
_____ artery supplies AV node
Dominant Coronary artery
889
p53 induces _____ which then inactivate _____
p53 incudes p21 ---> inactivates CDKs
890
Rb mutations cause
Osteosarcoma and Retinoblastoma
891
Cyclin _____ + CDK _____ phosphorylate Rb
Cyclin D + CDK 4 Releasing it from E2F Unbound E2F allows progression thru S phase
892
Cyclin _____ + CKD _____ allow progression thru S phase
Cyclin E + CDK 2
893
Limiting reagent in alcohol metabolism
NAD +
894
NAD regeneration
Pyruvate --> Lactate (glycolysis) Oxaloacetate --> Malate (TCA, when no gluconeogenesis) *can cause hypoglycemia
895
Increased NADH promotes
Dihydroxyacetone Phosphate --> Glycerol 3 Phosphate --> Glycerol 3 Phosphate + FAs --> Triglycerides
896
Increased NADH downregulates
TCA cycle --> | Aceytl-CoA shunted to ketones
897
Depression Symptoms
``` DIGS CAPES (5/9 for 2+ weeks) Depressed mood Interests Guild Sleep disturbance Concentration Appetite changes Psychomotor agitation Energy fatigue Suicidal ```
898
Persistent Depressive Disorder
2 symptoms 2+ years No less than 2 months
899
Treatment of DVT
Unfractionated/ LMW Heparin Coumadin after a few days or Factor Xa medication (rivoroxiban, apixaban, dabgatron)
900
MEN 1
Menin Gene Pituitary adenoma Parathyroid hyperplasia Pancreatic Tumors
901
MEN 2a
RET gene Parathyroid hyperplasia Medullary Thyroid Carcinoma Pheochromocytoma
902
MEN 2b
``` RET gene Mucosal Neuromas Marfanoid habitus Medullary Thyroid Carcinoma Pheochromocytoma ```
903
Enzyme elimination of free radicals
O2 --- superoxide dismutase ---> O2- --- catalase ---> H2O2 --- glutathione perosidase ---> OH ---> H2O
904
CCl4
``` Cause of free radical injury Dry cleaning industry Converted to CCl3 in p450 system Hepatocellular damage --> decreased apolipoproteins Fat gets in liver, cant get out Fatty Changes ```
905
Reperfusion Injury
Cause of free radical injury | Reperfusion inflammatory cells + dead tissue + O2 = free radicals
906
Biliary Atresia
Failure to form Obstruction in 1st 3 months Jaundice, Cirrhosis, Conjugated Bilirubin
907
Cholelithiasis
``` Supersaturation of cholesterol/ bilirubin or Decreased phospholipids/ bile acids or Stasis (increases risk of bacteria) ``` Ex. Cholestyramine binds bile acids (risk for stone)
908
Cholesterol Gall Stones
``` Radiolucent Yellow Risks: -age, estrogens -increased HMG-CoA Reductase -Crohn's (decreased salt/ acid reuptake) -Cirrhosis (decreased bile salts) -Clofibrate (increased HMG) -Native american ```
909
Bilirubin Stones
``` Radio-opaque Black Risks: -Extravascular hymolysis -Biliary infection --> deconjugates bilirubin ```
910
Chronic Cholecystitis
Rokitansky-Ascholff Sinus formation GB mucosa dives down into smooth muscle Porcelain GB (calcification) --> cancer Tx: remove it
911
Elderly woman w new onset cholecystitis
Think GB adenocarcinoma
912
Bilirubin is metabolized by
Macrophages of reticuloendothelial system
913
Urobilinogen
Conj Bilirubin in bile --> intestines --> urobilinogen Makes stool brown Reabsorbed into blood Filtered by kidney --> yellow urine
914
Pigmented gallstones
Increased conjugated bilirubin in bile
915
Dark urine
Due to urobilinogen Not unconjugated bilirubin Unconjugated bilirubin is NOT water soluble
916
Jaundice of newborn
``` Decreased UGT --> Increased unconjugated bilirubin --> Fat soluble Deposits in basal ganglia (kernicterus) Tx: phototherapy (does NOT conjugate, makes unconjugated bilirubin soluble) ```
917
Crigler-Najjar Syndrome
Absence of UGT Increased unconjugated bilirubin Kernicterus
918
Dubin-Johnson
``` No bilirubin canicular transport protein Autosomal recessive Increased CONJUGATED bilirubin DARK LIVER (epinephrine metabolites) Rotor syndrome (no dark urine/ liver) ```
919
Drugs that target Microtubules
``` "Microtubules Get Constructed Very Poorly" Mebendazole Griseofulvin Colchicine Vincristine Paclitaxel ```
920
Dynein moves _____ | Kinesin moves _____
Dynein: Retrograde, + ---> - Kinesin: Anterograde, - ---> + "kin go out, dying to come back home" * Negative Near Nucleus * Positive end Points to Periphery
921
Lesch-Nyhan Syndrome
``` X-linked recessive Absent HGPRT Defective purine salvage Orange sand in urine HGPRT acronym: -Hyperurecemia, Gout -Pissed off (aggressive, self-mutilation) -Retardation -dysTonia ```
922
Genetic code is Unambiguous
Each codon = 1 AA
923
Genetic code is Degenerate/ Redundant
Each AA = multiple codons
924
Wobble Position
3rd in codon 1st in anticodon doesn't change anything
925
Bloom Syndrome
Deficient Helicase BLM gene mutation Autosomal recessive Growth retardation, immunodeficient, photosensitive
926
TATA Boxes are found in _____
Promoters and | Origins of Replication
927
Mechanism of: Irinotectan Topotectan
Inhibit topoisomerase I in eukaryotes "I can = IrinoteCtAN"
928
Mechanism of: Etoposide Teniposide
Inhibit topoisomerase II in eukaryotes "side" "2 sides to everything"
929
Mechanism of Floroquinolones
Inhibit topoisomerase II (DNA gyrase) and topoisomerase 4 in prokaryotes "4-oquinolones)
930
DNA polymerase 3
Prokaryotes only Elongates 5' --> 3' 3' --> 5' exonuclease activity
931
Labs in DKA _____ Glucose _____ K _____ Sodium
High glucose High K Low Sodium
932
Side effect of Cisplatin
Ototoxicity to hair cells in labyrinth
933
Cardiovascular effects of Nitroglycerin administration _____ HR _____ EDV
``` Increased HR Decreased EDV (ventilation) ```
934
Allelic Heterogeneity
Different mutation of same gene locus cause similar phenotypes
935
En-FU-virtide
HIV drug Inhibits gp41 (no entry) Inhibits FUsion
936
Cold dry air in asthmatics
Triggers inflammation Mast cells/ Eosinophils --> Cysteinly containing LTs --> Bronchospasm, secretion, edema
937
Leukast medication mechanism
Cysteinyl Leukotriene Antagonists
938
Maravi-ROC
HIV drug Binds CCR5 Inhibits DOC-king
939
"MDs fix complaints" --> | "MGs fix complaints"
IgM and IgG fix complement
940
Pompe
1st and 4th letters are P a-1,4-glucosidase NO hypoglycemia
941
Lactulose
Tx for hepatic encephalopathy | Converts ammonia --> ammonium
942
Rifaximin
Tx for hepatic encephalopathy | Decreases intraluminal ammonia production
943
Branches of Celiac Trunk
L gastric artery Splenic artery Common Hepatic artery
944
Prevalence
Number of people with disease ---------------------------------------- Total population
945
Incidence
Number of people with disease --------------------------------------- Those at risk
946
Relative Risk
A/(A+B) ------------ C/(C+D) *in very low prevalence RR = OR
947
Odds Ratio
A/B ------- C/D *in very low prevalence RR = OR
948
Attributable Risk
A C ---- - ------ (A+B) (C+D) *incidence of exposed - incidence of unexposed
949
Absolute Risk Reduction
C A ----- - ------ (C+D) (A+B) *Have disease but no intervention (risk in control) MINUS have disease and received intervention (risk in experimental group)

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