* Second Pass Facts Flashcards
types of symptoms not improved with addition of carbidopa to levodopa
central (e.g. anxiety, behavioral)
actually worsen due to increased central avail of l-dopa
sorbitol to what in lens of healthy
Fructose
(by sorbitol dehydrogenase)
[glucose –> sorbitol by aldose reductase]
bounding pulses,
carotid pulsations,
head-bobbing
aortic regurgitation
Bcl-2
ANTI-apoptotic
increased in follicular cell lymph
loss of sensation of 5th digit;
nerve?
ulnar
sensation of medial 1/2 of hand
disaccharride containing fructose
sucrose
gait instability,
degen of posterior columns and spinocerebellar tracts
(gen and vit def)
Friedreich ataxia
Vitamin E deficiency
Cornybacterium get ability to make pseudomembrane via
phage conversion–>
exotoxin production
Rabies bind to which receptor
Ach (nicotinic)
- skin/resp infxs
- light skin/hair
- horiz nystag
- giant cytoplasmic granules in neutrophils/monocytes
Disorder?
Chediak-Higashi
psammoma bodies;
adult brain tumor
Meningioma
arise from arachnoid villi
decreases crystalization in urine
increased citrate
acidic ph - stone types
uric acid
cystine
calcium OXalate
type of necrosis in MI
coag necrosis
pneumonia agent that needs a complex acellular medium enriched with cholesterol in order to grow
mycoplasma pneumoniae
ApoE 3&4
Chylomicron and VLDL remnant uptake
ApoA-1
LCAT activation
ApoB-48
chylomicron assembly in intestine
ApoB-100
LDL particle uptake by EXTRAhepatic cells
ApoC-II
LPL activation
Oral bioavailability calculation
Area under oral curve DIVIDED by area under IV curve
curve of serum concentration after admin
common resp infx in CF
pseudomonas
bisphosphoglycerate mutase
makes 2,3 BPG in erythrocetes
lupus + false positive RPR/VDRL + increased aPTT
- recurrent miscarriages
- venous and arterial thromboembolism
(antiphospholipid Ab aka lupus anticoagulant –> HYPERcoaguable state in vivo)
sudden muscle relaxation reflex
golgi tendon
arranged in series
(very sensitive to tension, NOT to passive stretch)
1b sensory –> inhib interneuron
maintains muscle length
muscle spindles (intrafusal muscle fibers)
arranged in parallel
mediates stretch reflex–> causes cntx
1a sensory –> alpha motor neuron
myotatic reflex (aka deep tendon reflexes) mediated by…
muscle spindles
cause contraction
highest oral bioavail nitrate
isosorbide mononitrate
difference in effect of therapy/risk modifiers on based on time exposed due to…
latent period (initial steps of pathogenesis occur long before clinical manifestations)
HbF last until when
~6 months (gradual change)
non-typable Hflu cause…
otitis media
sinusitis
bronchitis
(part of normal upper resp tract)
nontypable = no capsule
cytokines released during tissue injury that DOWN-regulate infl
TGF-B
IL-10
Volatile anestetic effects
increase cerebral blood flow (increases ICP)
myocardial depression, hypotension, resp depression, decreased renal fx
malignant htn vessel process
onion-like concentric thickening of arteriolar walls
mucous secreting cauliflower-like mass in colon
villous adenoma
hiccups, shoulder pain -
which nerve roots
C3-C5
spleen of sickle cell firm and brown
vascular occlusions –> infarcts –> eventual autosplenectomy
IV MRSA abx –> muscle pains/increased CK
mech of drug?
maintenance of membrane potential (depolarization) and inhib DNA/RNA/protein synth
Daptomycin
Facial nerve (CN VII)sensory
somatic - pinna and external auditory canal
Facial nerve (CN VII) autonomic
parasymp to lacrimal, submandibular, and sublingual glands
mass in rt temportal lobe –> what visual defect?
contralateral SUPERIOR quadrantanopia
[ “Try the pie in the SKY” - Temporal = upper
“Leave the Poop on the GROUND” - Parietal = lower”]
holosystolic murmer that increases in intensity on inspiration
tricuspid regurg
sweat glands of axillae are what type of glands
apocrine
sweat secreted in membrane bound vesicles into hair follicles
length of phase 1 depolarizing blockade
of succinylcholine
20 mins (depends on metabolism)
enhanced by neostigmine in phase 1, counteracted in phase 2
histoplama histology
ovoid cells within macrophages
symptoms of septic shock
TNF- alpha
and IL 1 and IL 6
Toxic Shock - what cells?
T lymphocytes (--> IL2) Macrophages (--> IL1 and TNF)
pioglitazone mech
transcription modulation
increase adiponectin
nephrotic syndrome with underlying malignancy suggests…
membranous glomerulonephropathy
nephrotic syndrome with diffuse increased thickness of glomerular basement membrane w/o increased cellularity
membranous glomerulonephropathy
membranous glomerulopathy –> left vericocele
etio?
loss of antithrombin III –> hypercoag –> renal vein thrombosis
(flank pain, hematuria, vericocele)
MC lung cancer in
non smokers
women
adenocarcinoma
form glandular or papillary structures
lamellar bodies of type II pneumocytes
release pulmonary surfactant
maculopapular rash head–> trunk WITH postaruicular lymphadenopthy
Rubella
Toga Virus
IL2 –> what cells
- Th cells
- monocytes
- NK cells
- T cells (to make INF gamma)
- B cells (increase division)
ulcer through posterior wall of duodenal bulb - what vessel?
gastroduodenal
bias - know you’re being observed
Hawthorne
bias - only hosp pts
Berkson
selection bias
present in 90% of hashimoto’s pts
anti- thyroid peroxidase
lupus pt + cushinoid features… what do the adrenals look like?
bilateral cortical atrophy
taking exogenous glucocorticoids
NF 1 and NF 2 genetics/inheritance
Autosomal Dom
NF1 - 17
NF2 - 22
tx vasospasm 4-12 days post SAH
nimodipine
immunocompromised pt with skin lesions that are ulcerated in appearance w/ occasional necrotic center (looks kinda like kaposi) -
what bacteria
psuedomonas aeruginosa
neutropenia = at risk for what kind of bacteria
gram neg
opiods + biliary colic - mech?
contraction of smooth muscles in sphincter of oddi
glucocorticoids acutely increase what kind of cell in serum
neutrophils (demarginalization)
adult brain tumor with focal necrosis and hemorrhage
glioblastoma multiforme
- from astrocytes
- MC
adult brain tumor - well circumscribed gray mass, possibly with calcifications
oligodendrogiomas
excess copper - med?
penicillamine (chelator)
hypothalamic nuclei involved in circadian rhythm regulation
suprachiasmatic
ethambutol SE
optic neuritis –>
- color blindness
- central scotoma
- decreased visual acuity
Abs specific for SLE
anti-dsDNA (60% have)
anti-Smith/anti snRNP (20-30% have)
polyethylene glycol similar to what pathophys
lactase deficiency (osmotic laxative/osmotic diarrhea)
gray discoloration of macula w/adjacent hemorrhage
dx and tx target
age-related macular degeneration
(wet subtype)
tx: target VEGF
dry age related macular degen
gradual vision loss (difficulty driving/reading)
drussen depoits w/ pigment abnormalities on fundoscopy
recurrent severe nosebleeds +
telangectasias on oral/nasal mucosa, face, and arms (e.g.)
Osler-Weber-Rendu syndrome
AD - hereditary hemorrhagic telangiectasia
barroreceptor firing rate when high pressure
increases!
(ah! so high!!)
–> increases PARAsymp invluence on heart and vessels, prolongs AV node refractory period
side effects of thiazolidinediones (TXDs)
e.g. pioglitazone
fluid retention –> wt gain and edema
**can exacerbate underlying CHF
End-stage renal disease - metabolic derangement
renal osteodystrophy
- hypocalcemia via renal retention of phosphate and decreased renal synth of calcitriol
- hypocalcemia + resultant hyperPTH –> osteodystrophy
Left border of heart
LV forms apex and reaches as far as the 5th intercostal space at the left midclavicular line
(all other chambers to the rt of midclavic line)
stab through 5th intercostal space at midclav line - what hit?
lung
(overlies much of anterior heart)
- possibly LV if DEEP enough
XX ambig genitalia with hypokalemia and high BP
11-beta
markers indicative of small cell carcinoma (lung)
neuroendocrine markers (neurofilaments, neurosecretory granules)
tumor of neuroendocrine origin
env gene mt induced by
evasion of host neutralizing antibodies
pol gene mt induced by
anti-retroviral meds
small yellow retinal lesions in macula- expected visual defect?
central scotoma
positive “whiff” test
bacterial vaginosis
clue cells
yellow-green foamy foul-smelling discharge
trichomonas
failure of recanalization mechanism of atresia where in GI
duodenum only!
distal to duodenum= vascular accidents in utero
psoriasis med that activates nuclear transcription factor
topical vit D analogs –> inhibit keratinocyte prolif and stim differentiation
calcipotriene
calcitriol
tacalcitol
psoriasis med that blocks NFAT from entering nucleus –> decreases prod and release of IL2
cyclosporine
bisphosphonates are structural analogues of…
pyrophosphate
component of hydroxyapatite
PR interval
beginning of atrial depolarization to beginning of ventricular depolarization
chronic lymphedema = risk for…
angiosarcoma
(Stewart-Treves syndrome)
multiple firm violaceous nodules
Diffusion capacity in COPD
decreased (due to destruction of alveoli and adjoining capillary beds)
antiarrhythmic that increases AP duration and decreases phase 0 slope
Class 1A
Class of Type 1 antiarrhythmics that has strongest effect on phase 0
1C
class of type 1 that has weakest effect on phase 0
1B
where does V3 exit skull
foramen ovale
where does V2 exit skull
foramen rotundum
steroid use signs
- increased hematocrit
- soft small testes
- acne
- hepatic abnormalities
induces secretion of bicarb rich/chloide poor fluid from pancreas
secretin
from S endocrine cells in duodenum
biggest O2 difference from aorta
coronary sinus
When do microglia appear (post ischemia)
3-5 days
What cells form the glial scar post ischemic infarct
astrocytes
medullary thyroid cancer histo
nests of polygonal cells with congo red-positive deposits
extracellular deposits of amyloid formed by calcitonin
enzyme detected in inflammatory cells (e.g. machrophages) during inflammatory response but not detectable in most normal tissues
COX- 2
induces production of HbF
hydroxyurea
prevents efflux of K and water from cells, preventing dehydration of erythrocytes and reducing sickling
calcium dependent potassium (Gardos) channel blockers
incidence - when calculating don’t forget to account for what in the population
people who already have the disease (subtract from pop)
methotrexate leads to build of what
DIhydrofolate POLYGLUTAMATE
Amph B electrolyte disturbances and etio
hypoK
hypoMg
due to distal tubular membrane permeability (disfx)
Beta 2 microglobulin
MHC I
dobutamine
- mycardial O2
increases myocardial O2 consumption
increases HR, contractility, conduction velocity - beta1 agonist
apoptotic hepatocytes - histo
shrink
nuclear frag
intensely eosinophilic
“acidophil bodies”
“councilman bodies”
(due to acute viral hepatitis)
elastases produced from what cells; what inhibits
infiltrating neutrophils
- inhib by serum alpha-1 antitrypsin
and alveolar macrophages
- inhib by tissue inhibitors of metaloproteinases (TIMPs)
- can degrade eachother’s (not their own) inhibitors
prevent acidification of lysosomes in APC –> ?
impaired interaction w/ Tcells b/c low expression of MHC II
load antigen in endosome/lysosme or phagosome/lysosome fusion
where is MHC I loaded
RER
genetic defect in ataxia-telangiectasia
Auto Recessive
mt in ATM gene
(DNA break repair)
cortisol receptor location
intracellular
superficial inguinal lymph nodes drain…
all cutaneous lymph from umblilicus to feet
including external genitalia and anus to dentate
prostate drains to what lymph nodes
internal iliac
lymph from bladder…
superior –> external iliac
inferior –> internal iliac
charcot-bouchard aneurysm
- due to chronic hypertension
- deep brain structures (not lobar)
cerebral amyloid angiopathy
- beta amyloid deposition in walls of small/medium arteries –> weaken
MCC of spontaneous lobar hemorrhage in elderly (usu same protein as in alzh)
(not a/w systemic amyloidosis)
Lesch-Nyhan inheritance
XR
Classical galactosemia inheritance
AR
Rapid plasma decay of barbituate-like IV anesthetic (e.g. thiopental) due to
redistribution into other tissues throughout body
CD55
CD59
CD55 - accelerates complement decay
CD59 - inhibits MAC
(deficiency usually due to lack of GPI anchor)
kid w/ URI –> STRIDOR vs WHEEZING
Stridor
- croup (laryngotraceitis)
- parainfluenza virus (paramyxo)
Wheezing
- bronchiolitis
- RSV
poor feeding
hypotonia
cardiomegally
enlarged PAS+ lysosmes in muscle
acid alpha-glucosidase deficiency
Pompe disease
BRAF mt
melanoma
protein kinase
dilates veins
dilates arterioles
promotes diuresis
(endog)
BNP
both ANP and BNP activate Guanylate cyclase
bile acids reabsorbed from…
terminal illium
location of thyroid hormone receptors
intra-Nuclear
valproate teratogenic effects
neural tube defects
(valproate inhibits intestinal folic acid absorbtion)
e.g. - menigocele
ACL/PCL locations
APEX
-Anterior cruciate runs Posteriorly and inserts on EXternal femoral epicondyle
PAIN
- Posterior cruciate runs Anteriorly and inserts on INternal epicondyle
delusional d/o vs paranoid personality d/o
paranoid personality d/o = pervasive pattern of suspiciousness w/o clear delusions
(no clear delusions in personality d/o)
NB: delusional d/o must have delusions for at least 1 mo
(no clear bizarre behavior apart from delusion)
recurrant neiserria infx
complement def
drug that causes priaprism
not ED drug
trazodone
- for pts with depression and insomnia
(contraindicated in adolescent boys)
MC site of hematogenous osteomyelitis
(MC in children)
usually affects metaphysis of long bones
isoniazid SE
hepatoxicity
FIRST step in coronary disease involves what cells
endothelial
begins with endothelial dmg
location of atherosclerosis
large elastic arteris and large/medium muscular arteries
half life
t(1/2)= 0.7(Vd)/(Cl)
noncoronary atherosclerotic disease, DM, and CKD are at some risk for ______ as _____
CV events as pts with known coronary heart disease
MCC of death in DM
MI
coronary heart disease
choriocarcinoma (histo)
abnl prolif of both cyto and syncytiotrophoblasts
no villi
foot drop
common peroneal
order of enzymes in synth
17
21
11
17 - (over to cortisol/androgens)
21 - (down to pre aldo and pre cortisol)
11 - (down to aldo and cortisol)
Niacin antilipid action
inhibit VLDL production (liver)
- partially due to suppression of FFA release from periph tissue
used to increase HDL
Inulin estimates …
PAH estimates….
inulin - GFR
PAH - PLASMA renal flow
uses CD21 to invade cells
EBV
complement receptor
Lynch syndrome mech (mt)
Auto Dom
DNA mismatch repair defect
(hereditary nonpolyposis colon cancer)
nipple inversion
suspensory ligament infiltration by invasive breast cancer
OS on cath tracing of mitral stenosis
when ventricular pressure drops below atrial pressure (early diastole)
drug –> liver abnormalities and oral ulcers
methotrexate
possible sickle cell + gross hematuria
papillary necrosis
delayed separation of umbilical cord
defect in integrins
leukocyte adhesion deficiency
- Auto Recessive
- absence of CD18 –> inability to synthesize integrins
recurrent skin infections WITHOUT pus formation
leukocyte adhesion deficiency
AR mt-> absence of CD18 –> no integrins
high levels of prolactin –> what risk for women
osteoporosis
high PRL –> hypogonadism –> low estrogen –> accelerated bone loss
Why are Chlamydia trachomatis and Ureaplasma urealyticum (causes of NGU) not effectively treated by penicillins/cephalosporins?
Chlamydia lacks peptidoglycan w/in cell wall
Ureaplasma lacks cell wall entirely
DKA with normal CO2
respiratory failure
Apoliprotein E-4 increases risk for…
Alzheimer (late onset familial)
Risks for early onset Alzheimer
APP (ch 21) Presinillin 1 (ch 14) Presinillin 2 (ch 1)
budding yeast forms with thick capsules
cyrptoccocus
usu causes meningitis (dx w/india ink) but can also cause pneumonia (dx with mucicarmine staining)
(in immunocompromised)
fetal lung maturity ratio
Lecithin (phosphadidylcholine):
sphyingomyelin
L/S >= 2 (mature)
tx of toxo
pyrimethamine
sulfadiazine
(TMP-SMX)
(can sub clindamycin for sulfadizine if sulfa allergy)
Primary central nervous system lymphoma (cell origin/association)
B cell origin
EBV
similar lesions to toxo, but more commonly a single lesion (though can have multiple)
mifipristone
anti-progestin
hydrophobic (non-polar) amino acid residues
valine alanine isoluecine methionine phenylalanine
(typically in transmembrane domains of alpha helices)
pramipexole
stimulates dopamine receptors
classes of dopamine agonists
ergot:
- bromocriptine
- pergolide
non-ergot:
- pramipexole
- ropinirole
pt in adrenal crisis - tx
corticosteroids
response to vasopressors usually subobtimal
HbC more mild than HbS bc…
HbS allows hydrophobic interaction among hemoglobin molecules
(leads to polymerization)
Same in HbS, HbC, and HbA
binding affinity for O2 and 2,3 DPG
NB: does NOT result in significant change in folding
- skin anesthesia
- hypopigmentation
- bacterial invasion of Schwann cells
Mycobacterium leprae
d-xylose
monosaccharide
i.e. does not need enzymes to be absorbed but can be decreased in malabsorption (like celiac)
pt with aggetation/agression —> tx and cooperative —> high fever, confusion, muscle rigidity
neuroleptic malignant syndrome 2/2 tx w/ haloperidol
caclified cystic mass in young (is)
craniopharyngioma
cyst fluid rich in cholesterol
maximum stool osmolality
max approaches serum osmolality
normal stool osmolar gap = 50-100
accounts for non-electrolyte osms
Lactase-def labs after lactose challenge
- increased stool osmotic gap
- increased breath hydrogen content
- decreased stool pH
5-HIAA
5-hydroxyindoleacetic acid
serotonin metabolite
prevents renal impairment from tumor lysis syndrome (can happen during chemotherapy)
rasburicase
- urate oxidase
- uric acid –> allantoin (exreted in urine)
allopurinol
tumor lysis syndrome characterized by…
LOW calcium
HIGH phosphate
HIGH potassium
HIGH uric acid
fever
pharyngitis
rash (blanches?)
strawberry tongue
scarlet fever
caused by pyrogenic exotoxins
which receptors prevent cerebral hypoperfusion upon standing
alpha 1
inhibition of saturation of long, branched lipids–> inhibits what bacteria
mycobacterium
mycolic acid= long branched saturated fatty acids
TB drug structurally similar to pyridoxine
isoniazid
transient tingling that fully resolves within minutes… tx
probably a TIA (if other things ruled out)
start with asprin (risk of GI bleeding)
HBV helps HBD with what
coating of viral particles –> allows it to infect hepatocytes
(coating done by HBsAg)
munro microabsesses
(in psoriasis)
spongiotic clusters in superficial dermis and parakeratotic stratum corneum
what complement protein is usually normal in PSGN
C4
decreased C3 and total compliment levels
recurrent mycobacterium infx
interferon gamma signalling pathway d/o
used post SAH
nimlodipine
(calcium channel blocker)
to prevent vasospasm
CMV esoph findings
linear ulceration
both intranuc and cytoplamic inclusions
ACA occlusion
contralateral motor and sensory deficits of LOWER extremities, behavioral changes, and urinary incont
glyburide
sulfonurea
- increases insulin secretion
no apparent liver disease w/ mild unconj hyperbilirubinemia when triggered by a stressor
Gilbert
pneumococcal vaccine type for old
outer polysacharide
H2O deprivation test cutoff to be considered “complete” central DI
> 50% increase in urine osm = complete central
> 10% increase in urine osmolarity after vasopressin suggests central DI
deposits in PSGN
C3
IgG
IgM
in mesangium and BM
“starry sky”
main virulence factor in shigella infx
invasion of mucosa
M cells that overlie Peyer’s patches
substances involved in path of asthma that have therapeutically beneficial pharm antagonists
LTC4
LTD4
LTE4
Ach
mech of increased expiratory flow rates in pulmonary fibrosis
(when corrected for low lung volume)
increased elastic recoil –> increased radial traction on airways –> decreased airflow resistance
P bodies
cytoplamic proteins that regulate mRNA translation and degredation
MC CV manifestation of SLE
pericarditis
enzyme that increases carcinogen’s effect
microsomal monooxygenase
*most carcinogens enter body in inactive state (pro-carcinogens) and are converted to active metabolite by cyp450 oxidase system
superior sulcus tumors (pancoast tumors) a/w
- rib destruction
- atrophy of hand muscles
- pain in C8, T1, and T2 nerve root dist
- edema of upper extremity (compr of subclavian)
- Horner
*severe pain in shoulder that radiates toward axilla and scapula is MC presenting symp
Remember DM and Beta blockers….
Non selective or B2 antag
- decrease
glucagon secretion –> may cause hypoglycemia in pts with DM
- beta blockers ALSO decrease/mask symptoms of hypocglycemia
Serum marker that increases risk of vertical transmission of Hep B
HBeAg
Meds with antimuscarinic (anticholinergic) effects:
atropine
TCAs (e.g. amitryityline)
H1 blockers (e.g.diphenhydramine)
neuroleptics
antiparkinson drugs
double vision while walking down stairs
trochlear nerve
vertical diplopia most noticable when affected eye looks toward nose - e.g. reading or walking down stairs
Histo for contact dermititis
spongiosis
fluid in intercellular spaces - blisters
pulsus paradoxus
decrease SBP >10 w/insp
increased RV volume pushes septum into LV b/c no room in pericardium to expand
a/w constrictive pericarditis, severe obstructive lung disease, restrictive cardiomyopathy, (acute cardiac tamponade)
black necrotic eschar in nasal cavity
mucor or rhyzopus
*esp in setting of DKA
age of aoritic stenosis symptom presentation
7th decade -
senile calcific aortic degen
6th decade -
congenital bicuspid valve
symptoms (SAD): exertional syncope, angina, dyspnea
Hflu vaccine type
cell wall polysacharide conjugated with protein toxoid from diptheria or tetanus
(can be given as early as 2mo)
tyrosine kinase receptor
fx (generally)
accelerate cell proliferation
responds to growth factors
IV acyclovir SE
crystalline nephropathy
need ensure adequate hydration
Dyspnea 2/2 HF caused by
general
decrease in lung compliance due to fluid accumulation in lung interstitium
Drugs with predominantly hepatic clearance (spare kindeys) tend to…
- be highly lipophilic
- high volume of distribution
Potency of inhaled anesthetic correlates to…
Minimal alveolar concentration
(inversely proportional)
(concentration that renders 50% of pts unresponsive to painful stimuli)
- dependent on body temperature
- decreases with increasing pt age
- UNrelated to sex, ht, wt of pt
hyperacusis nerve/muscle
stapedius muscle and nerve
(branch of facial)
?:
tensor typani
inserts on maleus (incrases tension on tympanic membrane)
- V3 (mandibular trigem)
How long from onset of total ischemia to loss of cardiomyocyte contractility
w/in 60 seconds
irreversible after about 30 mins
Cherry red macula symp in lysosomal storage disease
Tay-Sachs
(no hepatosplenomeg)
Niemann- Pick
- hepatoslenomeg
Langhans giant cell
(NOT langERhans)
activated macrophages (epitheliod cells) that have multiple nucelii organized peripherally in the shape of a horsoe
no specific finding in granulomatous conditions
Filtration fraction
FF= GFR/renal PLASMA flow
gene mt required for emergence of adenomatous polyps from normal mucosa
APC
- tumor suppressor
- regulates cell growth and CELL ADHESION
(K-ras –> unregulated proliferation)
Insulin triggers tyrosine kinase which triggers…
protein phosphatase
Preterm infants at life-threatining risk of what vit deficiency
Vit K
factor V Leiden
factor V resists cleavage by protein C
a/w risk of deep VENOUS (not arterial) thrombosis
i.e. not splenic infarcts
amyloid in old cardiac atria
ANP
- misfolded -> beta sheets
- senile cardiac amyloidosis –> may increase risk of aFib
- incidence >90% in 9th decade
neurologic symptoms that worsen with heat exposure
MS
pain shooting down posterior thigh/leg = what nerve root
S1
will also have diminished ankle jerk reflex
location of promoter
25-70 bp upstream
prevents dissemination of candida
neutrophils
T-cells for superficial
synaptophysin
protein in presynaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells
fexofenadine
2nd generation anti histamine
hydroxyzine
promethazine
chlorpheniramine
diphenhydramine
1st gen antihistamines
glomerular crescent = deposition of what
fibrin!
also glomerular parietal cells, monocytes, macrophages
Anticonvulsants + mood stabilizers
Valproate
Carbamazepine
Lamotrigine
(valproate is the MC used for seizure prophylaxis)
terbinifine
inhib squalene epoxidase
used for tx of dermatiphytosis
progressive supranuclear palsy
form of parkinsonism from degen of midbrain and frontal subcortical white matter
falls, exec function loss, vertical gaze palsy
abnormally phos tau
vit –> intracranial htn
Vit A
also –> hepatosplenomegaly and skin changes
nerves often affected by acoustic neuromas
(schwanomma that usu occurs at cerebellopontine angle b/w cerebellum and lateral pons and arises from CN VIII)
- CN VII (facial)
- CN V (trigem)
met process a/w drug induced lupus
liver acetylation (slow acetylators = higher risk)
cortical atrophy + enlarged vetricles
hydrocephalus ex vacuo
no increased ICP
blood gas in PE
LOW PaO2
LOW PaCO2
(norm?) HCO3
HIGH ph (respiratory alk)
testicular malignancy can also cause…
paraneoplastic hyperthyroidism
if secreting hCG –> similar to TSH
stool findings in secretory diarrhea
mucous and some shed epithelial cells
NO leukocytes/blood (inflammatory)
tx cryptococcal meningitis
amph B
Cl channel affected by benzos, barbituates, and etoh
GABA (A)
(inhibitory receptor)
benzos and zolpidem:
- allosterically binds
(others bind to different components)
tx of seratonin syndrome
cyproheptadine
antihistamine with ant-serotenergic properties
Wilsons
Kayser-Fleisher ring
Basal ganglia atrophy –> neuropsychiatric complications
damaged in chronic rejection of lungs
small airways
—> brochiolitis obliterans syndrome)
(vs vessels in acute rejection)
a/w nasopharyngeal carcinoma
EBV
weird looking lymphocytes w/ abundant blue cytoplasm w/ basophilic rim that’s indented by neighboring RBCs
EBV
(infectious mono)
***CD 8 T cells
(B cells small portion of smear)
abundant cytoplasm + lack of nuclear changes distinguish them from hematologic malig
candida skin test - what cells
CD4 T
CD8 T
NK cells
oculomotor findings w/ wern-kors
horizontal nystagmus
bilateral abducens palsy
diaphragmatic surface of heart supplied by…
Posterior descending artery
- 90% from RCA
(Inferior wall of left ventricle)
stop codons
UGA
UAA
UAG
N. meningitidis vaccine
capsular polysaccharides
tx of bradycardia –> eye pain
atropine
acute closed angle glaucoma
tx for giardia
metronidazole
acute leukemia that presents as anterior mediastinal mass
T-cell
ALL
(can cause resp symp, dysphagia, or SVC syndrome)
contain TdT
B and T cell
ALL
B cell markers
CD 10
CD 19
CD 20
T cell markers
CD 2 CD 3 CD 4 CD 5 CD 7 CD 8
chemo —> hemorrhagic cystitis
what drug/what prevention
cyclophosphamide
ifosfamide
—> toxic metabolite acrolein
prevent:
-mesna
(sulhydryl cmpd binds acrolein in urine)
- also aggressive hydration and bladder irrigation
Deficiency in:
C1 esterase inhibitor
Don’t give:
ACE inhib
-pril
high gastrin - which MEN
MEN 1
pancreatic gastrin secreting tumor
MEN 1
Parathyroid –> hypercalcemia
Pancreatic –> gastrin
Pituitary –> PRL, ACTH
MEN 2A
Parathyroid –> hypercalcemia
Pheochromocytoma
Medullary thyroid (calcitonin)
MEN 2B
Pheochromochytoma
Medullary thyroid
Mucosal neuromas (oral, etc)
Marfanoid habitus
Indicates irreversible myocardial cell injury
mitochodondrial vacuolization
(means they’re unable to make ATP_
c-myc
transcription activator
controls prolif, diff, apop
(overactivation –> high mitotic intex)
dmg to what structure will cause permenant central DI
hypothalamic nuclei
paraventricular and supraoptic
tibial nerve sensory
sole of foot
can’t stand on tip toes
tibial nerve
digital flexor os toes and flexors of lower leg
deletion of single nucleotide
frameshift
before giving entanercept
PPD skin test
mech of adenosine
(like ACh)
- acts on phase 4
- activates K+ channels and prolongs K+ flow –> membrane pot remains negative for longer period
- inhbits L-type Ca++hannels (longer to reach threshold)
- reduces rate of spontaneous depolarization
MCC of aseptic meningitis
enterovirus
- coxsackie
- echo
- polio
**Fecal/oral route
(but do not typically cause gastroenteritis)
what part of GI tract has ramified, tubular glands in submucosa that contain alkaline secretions (ph 9)
duodenum
Brunner’s glands
-submucosa of duodenum
Peyers patches
ilium
N-acetylcysteine use in CF
cleaves disulfide bonds w/in mucus glycoproteins
loosens thick sputum
Beta blockers and thyrotoxicosis
- decrease sympathetic adrenergic symptoms
- decrease rate of periferal conversion of T4 –> T3
decreased outward K and prolonged APs…. most likely to suffer what
torasades
and sudden death
CXR:
- unilateral pulmonary opacification
- deviation of mediastinum toward opacified lung
obstx in mainstem bronchus
–> lung collapse
% of coronary vessel obst –> symptoms
75%
increase insulin resistance in overweight pts
FFA
serum trigycerides
vitamin def associated with TB
pyridoxine (B6)
isoniazid similar and competes
PECAM (platelet endothelial cell adhesion molecule)
transmigration
rolling
L- selectin (neutrophils)
E/P selectin (endothelial cells)
(loose binding of sialated carb - e.g. sialyl lewis/PSGL)
expression greatly increased by cytokines
Tight adhesion/crawling
Integrins (neutrophils)
- CD18
ICAM (endothelial cells)
steps of getting leukocytes to tissue
marginalization rolling activation tight adhesion/crawling transmigration
musculocutaneous nerve
- flexion of arm at elbow
- supination
- lateral forarm (sensory)
directly behind esophagus
descending aorta
neurophysin
carrier molecule for posterior pituitary stuff from the hypothal
(oxytocin and ADH)
wet
wacky
wobbly
normal pressure hydroceph
non enveloped
single stranded
DNA
parvo
acute arthritis w/ opaque exudate high in neutrophils and intracellular organisms
(in sexually active young adults)
- bacterial/septic arthritis
- Niesseria gonorrhoeae
antiarrythmic sodium channel binding strength
1C > 1A > 1B
- 1C = most use dependance
1B has the least use dependence
i.e. the shorter binding means less time to accumullate effect
MCC of death in Marfans
after infancy
aortic dissection
cystic medial degeneration
blanching of tissue during norepi infusion - tx?
phentolamine
vessels spared in PAN
pulmonary
cystic tumor in cerbellum of child
- spindle cells
- hair-like glial processes
- ROSENTHAL FIBERS
- granular eosinophilic bodies
pilocytic astrocytoma
“holiday heart syndrome”
excessive etoh —> a fib
- irreg’ly irreg
- no P waves
- varying R-R intervals
anticonvulsant that can –> bone marrow suppression
carbamazepine
blood counts should be watched
check if suspect B12 def
serum methylmalonic acid
increased
tx of organophosphate poisoning with only atropine leaves pts at risk for..
muscle paralysis
*add pralidoxime
Granuloma formation (e.g. sarcoid) mediated by what cells/cell products
TH1
IL 2
INF gamma
genetic predisposition to hyperglycemia in pregnancy - mt in what enzyme
gluckokinase
(sensor w/in beta cells)
mt –> mild hyperglycemia that can be exacerbated during preg
withdrawl symptom:
yawining
opiods
heroin
fungal drug that inhibits CYP450 met of other drugs
azoles
- bilateral hearing loss
- bump on tibia
bx: cells with over 100 nuclei, tartrate-resistant acid phosphotase positive
Paget’s disease of the bone
huge cells with many many nuclei = overactive osteoclasts
NB: osteoclasts stim by M-CSF and RANK-L (from blasts)
Long QT interval (hereditary)
–> what else may pt also have
neurosensory deafness
- mutation in genes coding for potassium of sodium channels
Jervell and Lange-Nielsen syndromes
mech of glucagon reversal of beta-blockers
acts on g protein receptor
—>increases intracellular cAMP
—> increases release of intracellular calcium during muscle contraction
—-> increases HR and contractility
side effects of protease inhib
hyperglycemia
lipodystrophy
drug/drug interactions (inhib cyp450)
muscarinic receptors on endothelial cells
- promote release of NO (EDRF) —> activates g-cyclase –> decreases calcium concentration
midshaft humerus fractures - artery/nerve?
- deep brachial artery
- radial nerve
(supracondylar a/w brachial artery)
diabetic mononeuropathy of CN III
central ischemia
–> affects somatic nerve fibers but spares peripheral paraympathetic
= down and out gaze but normal light/ accommodation reflexes
aneurymal compression of CN III
affect superficial parasympathetic efferents first and spare deeper motor (extraocular mvmts)
early: dilated pupil and loss of accommodation
late; ptosis and opthalmoplegia
GTP formed in what stage of TCA
succinyl- CoA –> succinate
pure motor hemiparesis
location
posterior limb of internal capsule
or basal pons
pure sensory stroke
ventroposterolateral (VPL)
or
ventetroposteromedial (VPM)
thalmus
ataxia-hemiplegia syndrome
posterior limb of internal capsule
or basal pons
dysarthria - clumsy hadn syndrome
genu of the internal capsule
or basal pons
stage vs grade
stage - how much the tumor spreads
grade - degree of differentiation
duodenal ulcer - tx for long term relief
abx
colorectal carcinoma from IBD vs sporadic
IBD:
- multifocal
- younger
- from flat dysplasia
- mucinous/signet ring
- early p53/late APC
- proximal colon (esp chrohns or concurrent PSC)
NE–> what receptors
alpha 1/2
beta 1
**little on B2
(therefore only alpha on vessels)
calcineurin
essential protein in activation of IL-2
activation blocked by cyclosporine and tacrolimus
site of greatest degree of atrophy in Alzheimer’s
hippocampus
short term diabetic neuropathy tx that should be used with caution in pts with BPH
TCAs
(e.g. amitriptyline)
anticholinergic properties
low pitched holosystolic murmer that accentuates w/increased afterload (e.g. handgrip)
VSD
NB: ASD’s will NOT be holosystolic (may have midsystolic pulmonic ejection murmur)
myotonic dystrophy
AD d/o
- trinuclotide repeats in myotia-protein kinase gene
sustained muscle contraction + weakness/atrophy
cataracts, frontal balding, gonadal atrophy
CD14
macrophages
Catalase positive organisms (5)
[predom infx in chronic granulomatous disease)
- Staph aureus
- Burkholderia cepacia
- Serratia marcescens
- Nocardia
- Aspergillus
Most renal cell carcinomas from where
proximal tubule (epitheilial cells)
gross: golden yellow mass
induce EPO
renal cortical cells sense hypoxia and synth epo
predom cell in sarcoid granulomas
CD 4 T
supplies blood to upper ureter
prox 1/3
renal artery
pigment in dubin johnson
epinepherine metabolites
absence + tonic clonic
med
valproate
time minimum for persistent depressive disorder (dysthymia)
persistent depressed mood with >/= 2 depressive symptoms, lasting >/= 2 years
no symptom free periods > 2months
(1 yr in children/adolescents)
*specifiers : pure, w/ intermittent or persistent MD episodes
what is right beneath the 12th rib on the left
left kindey
sythetic T3’s effect on rT3
decreased
decreases T4 and synthetic can’t be coverted to rT3
patients with sarcoidosis or other granulomatous diseases are prone to hyper______
hypercalcemia
secondary to high levels of active vit D
(?why)
beta blockers tx glaucoma by
blocking production of aqeous humor from ciliary epithelium
hemibalism
subthalamic nucleus damage
contralateral
crescentic glomerulonephritis w/o immunoglobulin or complement
“pauci immune”
- ANCA
twinning timeline
0-4d = di/di
4-8d = mono/di
8-12 = mono/mono
(>13d = conjoined)
vomiting center
dorsal surface of medulla at caudal end of 4th ventricle
“area postrema” - gets blood from fenestrated vessesl
brain tumor - necrosis and vascular proliferation
glioblastoma
mech of non-bacterial thrombotic endocarditis (NBTE)
- often involves hypercoagulable state
- e.g. cancer (marantic endocarditis)
- patho ~Trousseau’s syndrome (migratory thrombophlebitis)
childhood osteomyelitis
staph aureus
Kid:
- non-rhythmic conjugate eye movements
- myoclonus
(opsoclonus-myoclonus syndrome)
neuroblastoma
*MC extracranial childhood cancer
adrenal medulla
N-myc (more copies)
small blue round cells
uniformly enlarged uterus with normal endometrial glands
adenomyosis
- endometrial glandular tissue in MYOmetrium
