Smart Book 2 Flashcards
What causes polyhydramnios?
anencephaly and GI obstruction
oral macrocyclic antibioic that has becteriocidal activity and minimal absorption for C. Diff?
Fidaxomicin
Bacterial vaginosis diagnostic test?
KOH prep (whiff test)
Rifampin - MoA
inhibition of bacterial DNA-dependent RNA polymerase
How do alcohols act as disinfectants?
Disruption of cell membranes and protein denaturation
Probability that a female sibling of a male affected by an X-linked recessive disease will give birth to an affected child?
1/8
Factors required for osteoclast differentiation?
M-CSF and RANK-L (receptor for activated nuclear factor kappa B ligand), TGFbeta
Histone acetylase
Relaxes DNA coiling, allowing for transcription
“Histone acetylation makes DNA Active”
What are the adverse affects of Clozapine?
Agranulocytosis, neutropenia,
Most important thing for making a diagnosis of tetanus?
History and physical diagnosis, no toxoid screen is available
How does glucagon function?
stimulated G-protein on hepatocytes -> increased cAMP -> protein kinase A -> activates glycogen phosphorylase -> decreases fructose-2,6-bisphosphate levels
Intraductal papilloma- sign, cause
blood-tinged nipple discharge, caused by poliferation of papillary cells with a fibrotic core
Vertebral subluxation
vertebral malalignment -> can lead to paralysis with decreased or absent reflexes below the level of the compression
Galactokinase deficiency-
Cataracts, rarely pseudotumor cerebri
Side effects of Chloramphenicol during pregnancy?
“grey” baby syndrome
How to minimize type II errors?
Increased number, instrument sensitivity
What happens 2-4 weeks after infections with TB?
interferon secretion by activated T-lymphoctes
Painful ulcers on the tongue, gingiva, swollen gums, and certival lymphadenopathy
gingivostomatitis- primary infection if herpes simplex virus
Burkitt lymphoma translocation and function
t(8:14)
c-Myc a nuclear phosphoroprotein that functions as a transcription activator controlling cell proliferation, differentiation, and apoptosis
Leuprolide-MoA
Pulsitative? Constant?
gonadotropin-releasing hormone analog
Pulse-promoted LH and FSH
Chronic- reduces LH, FSH
How do alpha-1 blockers treat BPH
Promote smooth muscle relaxation -> increased urine flow through bladder, prostate
What organ produces EPO?
Liver
Function of helicase?
unwinds the double stranded DNA @ replication fork
Hemoglobin A2
alpha2, gamma 2
Shortness of breath soon after MI-pathology? Chronically?
Initially- tranudate accumulating in the alveolar lumen
Chronic- numerous hemosiderin-ladened macrophages in alveoli
Myelofibrosis
Replacement of the bone marrow by fibrosis -> causes Dacrocytes (abnormally shaped RBCs)
Beta-thalasemia minor vs major
Minor increased HbA2, lower Hb A
Major, no HbA, very high HbA2
What dopmine pathway supplies the pituitary?
Tuberoinfundibular
Drugs that will improve survival in patients with heart failure
Beta blockers (carvedilol, metropolol), ACE-I, ARBS, aldosterone antagonists
Confounding
exposure-disease relationship is muddled by the effect of an extaneous factor assoicated with both exposure and disease
“kids with bigger shoe sizes have higher IQ’s, however, it is a difference in age.
What other findings are associated with alchohol induced acute pancreatitis?
Mean corpuscular voluume of 108 fl, think folate deficiency
What are the retroperitoneal structures?
SAD PUCKER
Suprarenal
Aorta and IVC
Duedenum (except 1st part)
Pancreas (head and body)
Ureters
Colon (Ascending & descending)
Kidneys
Esophagus
Rectum (mid-distal)
Side affects of antidepressents?
induction of mania, especially if family history is positive
Etoposide-MoA
targets topoisomerase II, transient breaks in both strands (positive and negative supercoiling), vs, 1, which only nick single strand (negative supercoiling
Lysyl Oxidase
strengthens extracellular collagen fibers by mediating cross-link formation
What nerves can be affected by cerebellopontine angle schwannomas?
CN VII, CN V, CV VIII
How to hypertriglycerides cause acute pancreatitis?
Triglycerides > 1000 mg/dL exceeds binding capasity of albumin -> direct injury to pancreatic acinar cells
Permissiveness
One hormone allows another to exert its maximal effort
What affect do granulomatous diseases have on calcium?
Granulomatous disease increase PTH-conversion due to expression of 1-alpha-hydroxylase on activated marcophages
How do tumor cells develop resistance to chemotherapy?
multidrug resistance 1 gene- APT-dependent efflux pump
Budding yeast with thick capsule-systemic risk?
meningoencephalitis
Palpable gallbladder and extensive calcification? Risk?
Porcelain gallbladder, increased risk for chronic cholecystitis
Severe fatique, splenomegaly, bone marrow fibrosis? Receptor?
STAT/JAK2, primary myelofibrosis
McCune-Albright syndrome
GNAS gene encoding stimulatory alpha subunit og G protein, cafe-au-tait spots, endochrine abnormalities, fibrous dysphagia
Signs of hypercalcemia
mental status changes, muscle weakness, constipation, polyuria/polydipsia, and dehydration
optimal site for femoral nerve block?
Inguinal crease at the lateral border of the demoral artery
Signs of Bell’s palsy?
Sudden onset of unilateral facial paralysis (impaired eye closure, eyebrow sagging, inabilty to smile, disappearance of the nasolabial fold)
cause of calcium deposits in acute pancreatitis?
digestion of adipose cells by lipase -> fatty acids that bind calcium salts
What type of defect in pyloric stenosis?
Primary developmental defect
What cells are derived from neural crest cells?
MOTEL PASS
Malenocytes, odontoblasts, tracheal cartilage, enterochromaffin cells, laryngeal cartilage, parafollicular cells fo the thyroid, adrenal medulla and all ganglia, scwann cells, and spiral membrane
Exposure odds ratio
Compared odds of exposure of people with the disease to those without
Fever, cough, rhinorrhea, conjunctivitis in an unvaccinated child
Think measles, also develop a maculopapular exanthem (vesicular rash) that starts on face and spreads down
How can you reduce apoptosis due to folic acid deficiency?
supplement with thymidine, to increase dTMP production
Diffuse, medium-sized lymphocytes and a high poliferation index
EBV
Enlarged cells with intranuclear inclusion
CMV
Where does deep brain stimulation for parkinson’s disease work?
globus pallidus internus or subthalamic nuclei -> thalamo-cortical disinhibition
Myelinated myelinated afferents
Pain, temp, sensory
How to you treat mild hypoglycermia?
Seetened fruit juice
Clusters of gram-positive cocci on gram stain suggests?
Staphylococcal species
Enzymes inhibited by lead
Ferrochekatase and delta-aminolevulinic acid -> elevated zinc protoporphyrin
What enzyme inactivated 6-MP? activates?
Inactives- Xanthine Oxidase
Activates - HGPRT
How is glucose transported into cells?
Facilitated diffusion -> preferential for D-glucose
Acquired thrombocytopenia
epistaxis, ecchymoses, marked thrombocytopenia
Taxols-MoA
Hyperstabilize microtubules in M phase so miotic spindles cannot break down
Social anxiety disorder
marked anxiety about more than 1 situation for longer than six months
Fear of humiliation/embarrassment
Sociation situations are avoided, or endured with intense distress
Marked impairment
Tx-SSRI, SNRI, beta blocker (performance-only)
Signs of meurocysticercosis?
South and Central America
Presents with seizures
Diagnosis CT/MRI- cysts, scolex
Tx- albendazol
Signs of lead poisoning?
Long-standing behavioral problems, developemental delay/regression, financially-restricted in deteriorating human houses prior to 1978
tingling, difficulty concentrating, recurrent episodes of nonspecific abdominal pain? Cause? Treatment?
Acute intermittent porphyria, caused by porphobilinogen deaminase deficiency
Tx- infuse hemin, which downregulated hepatic aminolevulinate synthase or glucose
Keratoses- tranformation
Invasive squamous cell carcinoma
erythema, scaling, and subsequent hyperpigmentation
Xeroderma pigmentosum -cause by a decreased ability to repair DNA following damage by UV light
Risk with Familyial chylomicronemia syndrome (type 1)
Acute pancreatitis, lipemia retinalis, eruptive skin zanthomas, hepatosplenomegaly
Smooth muscle cells in the afferent renal flow
Guxtaglomerular apparatus cells (macula densa and JG cells)
Subacute sclerosing panencephalitis?
Cause by absent matrix protein, causes accumulation of viral nucleocapsid within neurons -> inflammation, gliosis
INF-gamma release assays?
Test for latent T-B infections by measure the tesponse to
Hyperplastic arteriolosclerosis
results from diastolic pressures > 120-130 mm Hg, presents as onion-like concentric thickening of the walls of the arterioles due to laminated smool muscles cells and reduplicated BM
Axonal reaction signs?
cellular edema (rounded cell), niddl substance becomes fine, granular and dispersed throughout cytoplasm
When someone has desires about a physician, what should you do?
Ask a chaperone to join them
How does right ventricular myocardial infarction present?
hypotension, elevated jugular venous pressure and clear lungs
When does aortic stenosis occur in patients with a bicuspid aortic valve?
> 50 years of age
Folinic acid, alternative name?
Leucovorin
Stem cells fo the lungs?
Type 2 pneumocytes
Phentolamine-MoA
Alpha receptor blocker, counteracts an alpha agonist
How does end-organ hypoperfusion lead to lactic acidosis?
decreased tissue oxygenation -> decrease oxidative hosphorylation -> increased NADH -> shunting of pyruvate to latate
hemiballism
flinging of the limbs
Mutation that causes paroxysmal nocturnal hemoglobinuria?
PIGA -> synthesize GPI anchor protein -> attach CD55, CD59
Cholchicine-MoA, SE
inhibits mucrotubular polymerization -> disrupts chemotaxis, phagocytosis, and degranulation
Also reduces the formation of leukotriene B4
SE- nausea, diarrhea
Concentric hypertrophy- sign? Cause?
Sign- increased wall thicknesss, myocardial mass, enlarged left atrium
Cause- long-standing hypertension
Polyarteritis nodosa-associations
Hepatitis B
Vsalproate - teratogenic affects
Neural tube defects
Capitation
A payor pays a fixed, predetermined fee to cover all the medical services required by a patient-similar to how a HMO works
Vesciculoulcerative lesions at the enterance to the vagina? Tx?
Herpes, tx- acyclovir
Echinocandins-examples, MoA, Use
“fungin”
Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan
Use: Invasive aspergillosis, Candida
antibodies that react with the alpha3 chain of collagen type IV? Clincal manifestations?
goodpasteur syndrome, hemoptysis, oliguria
What causes an increased ESR?
Acute phase proteins -> fibrinogen caues erythrocytes to form stacks (roueaux) that sediment at a faster rate than individual erythrocytes
Warfarin- teratogenic effects
nasal hypoplasiaa, stippled epiphysis
Vincristine, MoA
Disruption of neuronal microtubules -> stops organelle transport between body and axons (Acts in S phase)
Philadelphia chromosome
t(9:22) BCR-ABL (tyrosine kinase activity
how to ACE inhibtors cause hyperkalemia?
inhibition of angiotensin II -> decreased aldosterone secretion
Drugs that when combined with ACE-inhibitors can lead to hyperkalemia?
Amiloride, triamterene, spironolactone, or K+ supplementation
What can better transition a patient from hospital to home with improved adherence?
Checklist
Cushing’s ulcers
Elevated ICP -> increased direct vagus nerve stimulation -> Ach release )> hypersecretion of gastric acid
“clasp-knife” spasticity
Upper motor neuron lesion -> internal capsule damage (stroke)
Side effects of Statins?
Hepatotoxicity, muscle toxicity
What type of receptors are nicotininc receptor?
ligand-gated ion channels
Long-term effect of CKD?
increased phosphate, decreased calcium -> increase PTH -> osteodystrophy
Signs of tetenus?
paroxysmal involuntary muscle contractions involving jaw, neck, and trunk
Signs of esophagus squamous cell carcinoma? Prognosis?
dysphagia, fatique, retrosternal discomfort, weight loss
*look for keratin pearls
Prognosis? Poor
HIV-infected patient with sensory atacia and argyll-robertson pupils?
Tabes dorsalis, treponema pallidum
Mood symptoms in schizophrenia?
Absent
Physiological shunt
Area that is well perfused but underventilated
What is the role of CD40?
Allow for class switching
Where is the superior gluteal nerve located?
Uppermedial portion of butt
Arginase -
enzyme that produces urea and ornithine from arginine
Left-sided lesions vs right-sided lesions in the frontal lobe
Right- disinhibited behavior
left-executive function
Well-demarcated, scaly erythematous plaques involving extensory surface? Increased risk for?
Psoriasis
increased risk for psoriatic arthritis, Inc. risk with HLA-B27
Decreased potassium outflor and resultant prolongation of the action potential, risk of death?
Ventricular tachycardia and sudden death
How are triglycerides processed?
Colipase displaces bile salts from MiCells, pancreatic lipase attached to the surface and digests the Mucell
Foremen rotundum
Maxillary deivision fo the trigeminal nerve
Anti-cardiolipid antibodies
Antiphospholipid antibody syndrome -> recurrent venous thrombosis and/or pregnant loss
Can occur with SLE
Where are extended-spectrum beta-lactamase genes located? Alternative Tx?
Plasmids, treat with Carbapenems
Foscarnet
used for ganciclovir-resistent CMV, can chelate calcium, and renal wasting of magnesemia -> seizure risk
MoA- bind with viral-encoded enzymes: DNA polymerase, RNA polymerase, reverse transcriptase
How does a L-type calcium channel blocker affect skeletal muscle?
Extracellular channel is blocked, so no calcium influx into the cell. However, calium influx still occures becuase of the interaction between the l-type Ca2+ receptor and RYR1 receptor
Thus, no affect on skeletal muscle contraction
Cyanide poisoning cs Chronic Blood Loss?
Cyanide - normal Oxygen content
Anemia- low oxygen content
Complications of N meningitidis bacteremia?
Sepsis (sppoking fevers, chilld, arthralgias) and Waterhouse-Friderichsen syndrome (adrenal gland destruction, DIC, and shock)
Signs of iron deficiency?
Plumber-Vinson syndrome, dysphagia, iron deficiency anemia, koilonychia (spoon-shaped nails), shiny red tongie (papillae atrophy)
Hageman factor
Factor XII of the clotting cascade
How do you medically treat gallstones when surgery has been declined?
Hydrophilic bile acids
Agammaglobulinemia
B-cell defects that can manigfest with recurrent sinopulmonary bacterial infections -> no opportunistic infections
Epithelial ovarian cancer signs:
ascities, bowel obstruction, ovarian mass
What is the confirmatory test to diagnose Strongyloidiasis?
Rhaboitiform larvae in the stool
Effects of high levels of ammonia?
vomiting and confusion/coma
What defect allows acute bacterial access to the kidneys?
Vesicoureteral reflex
Treatment for restless leg syndrome
avoid aggravating factors (alcohol)
Support measures (leg massage
Dopamine agonists (pramipexole)
Signs of decompensated congestive heart failure
exertional dyspnea, orthopnea, bibasilar crackles, elevated JVP, lower extremity edema
Obsessive-compulsive disorder
Recyrrent, intrusive anxiety-provoking thoughts, urges, or images
time consuming
Where is type IV collagen found?
Basement membrane
non-rhythmic conjugate Opsoclonus-myoclonus conjugate eye movement
Neuroblastoma
Major depressive order- signs
>/= 2 weeks
Must have 5 of the following:
- Depressed mood, loss ofinterest of pleasure,
- changes in appetite or weight
- insomnia or hypersomnia
- pschomotor retardation
- low energy
- poor concentration
- thoughts of worthlessness
- recurrent thoughts of death of suicide
No history of mania or hypomania
Not due to substance or medical condition
Haptoglobin
binds free hemoglobin and reduced renal excretion of free hemoflobin preventing tubular injury
Which factors can activate complement?
IgM, IgG
Risks for transitional cell carcinoma of the bladder
smokers, occupation exposure to dyes, textiles, leather
Glucose urine dipstick
Uses glucose oxidase to ascertain the presence of urinary glucose, will not react to fructose or galactose
Where does reactived TB affec the lungs? Primary?
Upper lobes-2ndary
Lower lobes-1ary
Rb mutation risks?
osteosarcoma, other sarcomas (only if familial
What are the steps in repairng UV-associated damage to DNA?
Recognition (endonuclease), single stand cleavage, damaged DNA is discarded, DNA repair (polymerase), remaining gap sealed (ligase)
Determinant of symptom severity in Tetrology of Fallot?
Right ventricular outflow tract obstruction
DKA- signs
Kassmaul breathing, renal failure
Neuroblastoma-Characteristics
@ years of age,
solid sheets of small cells with dark nuclei and scant nuclei
Retroperitoneal mass
Dumbell tumor on mets
N-myc amplification
Allergic bronchopulmonary aspergillosis
hypersensitivity reaction to aspergillus, high serum IgE, and eosinophilia -> leads to bronchiectasis
pOLYARTHERITIS NEDOSA- signs?
Systemic, muscular, Gi symptoms, with biopsy showing transmural inflammation of the arterial wall with fibroid necrosis
Gram-positive cocci in chains after cystoscopy?
Enterococcus- gamma hemolysis of blood agar
What is effect modification
effect of an exposure on an outcome is modified by another variable
Pyridoxine deficiency
sideroblastic anemia, neurologic deficits, dermatitis, involved in the first step of heme synthesis
Sharp pain and bright red rectal bleeding on defectation? Location?
Anal fissure, occur distal to dentate line
How does bulimia nervosa affect bicarb?
Increases, along with pH,
Also see decreased K+, with normal anion gap
Finasteride-MoA, Tx
decreases conversion of peripheral testosterone to dihydrotestosterone via inhibition of 5-alpha-reductase Tx-BPH
Malingering
Falsification of exaggeration of symptoms to obtain external incentives (secondary gain)
What conversion pathway is deficientin alkaptouria?
Tyrosine to Fumarate
What are the class III antiarrhythmic drugs?
Amiodarone, sotalol, dofetilide, Ibutalide
How to calculate number needed to treat?
1/Attribultable risk (difference in percentage)
Drugs that cause pancytopenia
cabamazepine, chloramphenicol, suldonamides
Ethosucimide-MoA
T-type Ca2+ channel blocker
Incidence
Number of new cases divided by the populaton at risk
Reliability-definition
consistently provides the same value when measuring a fixed entity
What is the continued risk associated with a subarachnoid hemorrhage?
Vasospasm, rebleeding (lesser risk)
chalky white lesions in the mesentery with fat cell destruction and calcification?
Acute pancreatitis
Clinical signs of endometriosis?
Dysmenorrhea, pelvic pain, dyspareunia, ingertility
How to you treat severe hypoglucemia?
Intramuscular glucagon kits or byccal glucose paste (as last resort)
Signs of alcohol withdrawal? Tx?
tremulousness, agitation, elevated pulse and BP 48 hours following admission
Tx-long-acting Benzodiazapines (diazapam, chlordiazepoxide)
Straining on urination
Bladder outflow obstruction
What causes acute dystonic reactions?
D2 antagonism in the nigrostriatal pathway -> decreased dopamine with causes excess cholinergic activeity -> M1 activation
What does filtered fraction equal?
GFR/RPF
How can humans contract Bacillus anthracis?
Contact with infected animals
MAOI-names; MoA
Phenelzine, tranylcypromine, selegilinel used treatment-resistant depression
Multinucleated giant cells occur in
herpes infections (such as shingles)
Diagnosis of cardiac temponade?
ECG- low voltage QRS complexes
Chest x-ray- enlarged water-bottle-shaped heart
Signs of anaplastic tumors
loss of cell polarity, with disruption of normal architecture
Significant veriation in the shape and size of cells
Disproportionately large nuclei
Abnormal mitotic figures
Giant, multinucleated giant cells
Prolyl hydroxylase
hydroxylation of proline on procollagen chains,, forms stabilized collagen chain
Ulcerative Cholitis light microscopy findings:
Diffuse inflammation of the colon, limited to mucosa and submucosa, no granulomas
Signs of arginase deficiency? Treatment?
Spastic dipiegia, abnormal movements, growth delay, increased arginine levels
Tx- low protein diet
Polycystic ovary syndrome
Hirsutism, acne, androgenic alopecia, menstrual irregularities, polycystic ovaries, glucose intolerance, obesity
Cryptorchidism- hormone abnormalities?
Decreased inhibitin
What artery supplies the SA? AV?
Right coronary artery
Cause of unilateral fetal hydronephrosis?
Ureteropelvic junction -> palpable abdominal mass and enlarged kidney
How does tuberculoid leprosy present?
intact cell mediated immunity (Th1), mild skin plaques, hypopugmentation, hair follicle loss, and focally decreased sensation
Long-term risk of varicose veins?
Skin ulcerations
Pathological presentation of reye’s syndrome on the liver?
Microvescivular steatosis
Where are M2 receptors located?
Heart
Zero-order kinetics vs. First-order kinetics
Zero-order- same amount metabolized no matter the concentration
First-order- same proportion metabolized, no matter the amount
High potency first generation antipsycholitcs
Names: haloperidol, fluphenazino
AE- acute dystonia, asathisia, parkinsonism
Sentinel event
Enexpected occurrence involving death of serious physical inhury (suicide, full-term infant death)
Where are endotoxins location?
outer membrane of gram-negative bacteria, called LPS
Three regions- o-antigen, core polysaccharides, and Lipid A (toxic properties -> sepsis)
siderophages
hemosiderin laden macrophages
Junctional nevi
aggregated of nevus along the dermoepidermal junction (appear flat)
Saddle pulmonary embolus -> caused by hypercoagulable state
Bones of the wrist
So long to the pinky, Here Comes The Thumb
Polymyositis antibodies
ANA, anti-Jo-1 (histidyl-tRNA sunthetase)
Treatment for bipolar disorder?
Valproate, lithiu, . and quetiapine
Lamotrigine (prevents depression more than mania)
DiGeorge Syndrome- Cardiac Abnormalties
Tetralogy of Hallot, interrupted aortic arch
Adult-type coarctation of the aorta- risks
berry aneurysms, aortic arch hypertension
CD14 marker? Describe?
Monocyte/Macrophage, large cells with abundent pale cytoplasm
What can low testosterone cause?
Gynocomastia, ED
Lipid-lowering agent that prevents future CV events?
Statins
Stop the spread of methicillin-sensitive staphylococcus aureus?
Hand hygiene
What does the capsule do in E. Coli?
K-1 capsule -> Meningitis
Disease? Presentation?
Gaucher cell, Gaucher disease
Presentation: bone pain, easy bruising and bleeding, hepatosplenomegaly
Family history of a bleeding disorder?
von Willebrand disease
Cause of ecthyma gangrenosum?
P aeruginosa bacterium
Alpha fetoprotein is a common tumor marker for what cancers?
Hepatocellular carbinoma, Germ cell tumors
What cells are involved in Ulcerative Cholitis?
Th2 cells
Cause? Surgical risk?
Echinococcus granulosus-> rupture of cysts can cause anaphylaxis
Tuberous Sclerosis-Cardiac defects
Valvular obstruction due to cardiac rhabdomyomes
Flutamide-MoA
competitive testosterone receptor inhibitor
Ethosuximide-MoA
blocks T-type Ca2+ channels that trigger and sustain rhythmical burst discharges in thalamic neurons
What effect does a decreased IP3 have on later protein activation?
Decreased protein kinase C
Where are central lines inserted to? Derivation?
Into the superior vena cava; derived from the cardinal veins
kidney shaped organisms located in polymorphonuclear leukocytes?
N. Gonorrhoeae
Nonncleoside reverse transcriptase inhibitors Are they phosphorylated?
Nevirapine and Efacirenz Do not require activation via intracellular Phosphorylation
Organophosphate poisoning antidote?
Atropine, pralidoxime
Schizoid personality characteristics?
Prefers to be a loner, detached, unemotional
ACE-inhibitor, first dose hypotension
In patients taking diuretics, the addition of an ACE-I may lead to volume depletion from diuretics volume depletion and lack of PVR
How does glucose affect insulin release?
Glucose enters beta cells-> increased ATP -> closure of K+ channels -> depolarization of caclium channel -> increase in Calcium -> insulin release
Schitzotypal persaonality
Eccentric, odd thoughts, perceptions & behavior
Magical thinking (superstitiousness, clairvoyance)
Monospot test
agglutination on horse/sheep erythrocytes positive for EBV
Signs of embolism? Cause, post surgery?
blue toe, livedo reticularis, with normal peripheral pulses
Cause- atheroembolic disease -> cholesterol containing debris gets lodges in smaller vessels
In what order are vessels affected in atherosclerosis?
Abdominal, coronary, popliteal, internal carotids, circle of willis
Ecthyma Gangrenosum
How to communicate medicine delivery
Durg, dose, route
Uncontrolled diabetic mother, affect on child
Beta cell hyperplasia -> hyperinsulemia at birth
Where are M1 receptors located?
Brain
Signs of vWF disease?
increased bruisability and mucosal bleeding, due to inability to form initial platelet plug -> dental surgery
Dystonia
neurological movement disorder characterized by sustained involuntary muscle contractions
How do first generation antihistamines act?
Agonist at H1, antagonist at muscarinic 3 (m3_ receptors
Penetration through the fourth intercostal space (nipple) @ left sternal border?
Right ventricle myocardium
Turner syndrome: signs
Streak ovaries, bicuspid aortic valve, coarctation of the aorta, short stature, shield chest, webbed neck
What causes an umbilical hernia in an infant?
Incomplete closure of the umbilical ring
When does liquefaction occur?
Brain infarct, bacterial abscess
Jervell and Lange-Neilsen syndrome
AR, congenital QT prolongation with neurosensory deafness
Transpeptidases
Penicillin-binding protein that function to cross-link peptidoglycan in the bacterial cell wall
Diffuse fibrous thickening and distortion of the mitral valve leaflets?
Mitral stenosis, think Rheumatic fever
What does a deficiency in enteropeptidase cause?
Protein and fat malabsorption -> diarrhea, failure to thrive and edema
How does morphine act?
Stimulates G-protein receptors that activate potassium conductance -> hyperpolerization of cells, terminating pain signal
Also activate adenylyl cyclas, inhibt calcium conductanc, and inhiition of transmitter release
What is the karyotype of a complete mole?
46, XX
Dissociative amnesia
inability to recall important personal infomration (trauma); not explained by another disorder
Tumor, Correct statement
Cavernous Hemangioma- most common benign tumor
What is the most important risk for UTI with catheter insertion
Duration of catheterization
Whilms tumor
nephroblastoma, children 2-4, palpable flank mass
microscopic sample resembles primitive metanephric tissue
What enters the eye through the superior orbital fissure?
trochlear nerve (IV) abducens nerve (IV), and superior ophthalmic vein, CNIII
What does the vaccine target in H. influenze?
Hib capsid, not encapsulated can still be infected
Chronic granulomatous disease-most common infections
Catalase-positive organisms (S. Aureus, Burkholderia cepacia, Serratia marcescens, nocardia, aspergillus
Tx for combined tonic-clonic/absence seizures?
Valproate acid
Keratoses-light microscopy
hyperkeratosis, parakeratosis, atypical keratinocytes
Signet-ring carcinoma
cells that do not form glands, but contain abundant mucin and push the nucleus to one side, diffuse involvement, and a loss of E-cadherin
Phenotypic mixing
host cell is coinfected with 2 viral strains and the progeny contain unchanged parental genome from one strain and nucleocapsid for another. Next generation will revert.
Viral dependent nucleosides?
Acyclovir, calacyclovir, famciclovir, ganciclovir
Prevelence
Number of persons with a disease dividied by the total population at a specific time point
Antibody that causes tinnitus and hearing loss? MoA
Aminoglycosidse, also nephrotoxic
Irreversibly bind to 30s, causing genetic code misreading, and effects translocation
Dactylitis
Painful swelling of the hands and feet; common presentation of sickle cell disease in children
What type of damage does carbon tetrachloride cause?
free radical injury -> via free radical generation via lipid peroxidation
Dimished first heart sound with an apical holosystolic murmur radiating to the axilla? Treatment?
Mitral reguritation,
tx- reduce left ventricular afterload
Epithelial ovarian cancer- risk reduction
OTC, breastfeeding, tubal ligation
thick, brownish-yellow fluid rich in cholesterol in the brain? Derivation of?
Craniopharyngioma, arise from Rathke’s pouch (precursor to anterior pituitary
What type of receptors are muscarininc?
Second messenger (m1 + m1 are IP3, M2 is CAMP)
What hemoglobin has decreased interaction with 2,3-BPG?
fetal hemoglobin (hemoglobin F)
Signs of carcinoid syndrome?
Flushing, watery diarrhea, bronchospasm,valvular fibrous plaques
What canges does UV light introduce into the skin?
Pyrimidine-pyrimide dimers
Claudication ? Cause?
muscle pain with exercise that receeds when rested; caused by decreased blood flow due to artery constriction
cause: Atherosclosis of larger arteries (lipid filled intimal plaque)
Elderly patient with dementia and hemiparesis, think
Dysphagia -> aspiration pneumonia
How converts triglycerides in the fat into glycerol and fatty acids?
Hormone sensitive lipase
Side effects of COX 1 inhibition?
Gastric ulceration, increased beeding
How does human placental lactogen (somatomammotropin_ cause insulin resistance in a pregnant woman?
Secreted by synchrotrophoblast -> increased shunting of carbs to glucose, also stimulated pancreastic beta cell insulin production (when insufficient, this causes diabetes)
What is the first step in catecholamine synthesis?
Tyrosine to DOPA (via tyrosine hydroxylase)-rate limiting step
Pheneizine-MoA
monoamine ocidase inhibtor
How is glycogen broken down in muscles?
Hlycogen phosphorylase a, which is activated by phosphorylase kinase (PK). In skeletal muscle, calcium can activate PK -> glycogen breakdown
This is in contrast to the liver where epinepghrine and glucagon activate PK via increased cAMP
Physiological respose to pulmonary embolism?
Hyperventilation -> respiratory alkylosis, decreased Co2, but normal HCO3 until about 48 hours have passed
Elderly person with “intracytoplasmic granules that are tinged yellowish-brown”?
Lipofuscin, caused by lipid oxidation
Only product that is overexpressed in a hypothalamus lesion?
Prolactin
Treatment sfor bipolar disorder?
Lithiu, , valproate, and Lamotrigine
What cells are involved in the pathogenesis of Chron’s disese?
Th1 cells, which form granulomas
Cause of death in athletes under age 35? histology?
Cardiomyopathy (massive cardiac hypertrophy) -> ventricular fibrillation
Irregular shaped myocytes and arrangements
Lung mass, cerebellar symptoms and Purkinge cell degeneration
paraneoplastic cerebellar degeneration
How do the ovaries drain?
left ovarian -> left renal vein
right ovarian -> IVC
RNA polymerase I, II, III
I- ribosomal
II-messenger, snRNA
III-transfer, ssribosomal
Obsessive-compulsive personality disorder
lifelong pattern on insistence on control, orderliness and perfections and does not involve compulsions
Accuracy-definition
gives a measurement close to the actual value
How do activated macrophages cause increased calcium?
Secretion of 1-alpha-hydroxylase
Recurrent C. Diff infections and predisposed to reoccurances, tx? MoA?
Fidaxomicin (bacteriocidal, inhibits sigma subunit of RNA polymerase -> decreased protein synthesis and cell death
Where is type I collagen found?
Dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue
What biochemically occurs leading to DKA?
Triglycerides in adipose tissue are phosphorylated by glycerol-3-phosphate via glycerol kinase -> energy and glucose
Wernicke encephalopathy- damage
Hemorrhage and necrosis in the mammillary bodies and periaqueductal gray matter
What organ is least likely to infact?
Liver, dual supply of arteries (inferior phrenic, adrenal, intercostal arteries, etc.)
Bacteria that cause transient bacteremia after dental procedures? How do they binds to heart valves?
Strep Viridans, bind to fibrin and platelet aggregates on damages portions of valve
Histological findings for asporation pneumonia?
inglammation and a foreign body response with giant cells
Cause of Hepatocelluar carcinoma worldwide
Hepatitis B
Tetrology of Fallot-signs
VSDRight ventricular outflow tract obstruction, right ventricular hypertrophy
Galactose-1-phosphate uridyl transferase deficiency
Vomiting, feeding intolerance, neonatal jaundice, and death (if untreated) soon after breast feeding is intiated.
What is constant in ARDS?
Pulmonary capillary wedge pressure
Penetration at the left sternal border, 2nd intercostal space?
Pulmonary trunk
Primary biliary cholangitis- manifestations
fatigue, itching, and hepatomegaly ANA-titers are positive
Signs of septic shock
Fever, leukoctosis, hypotension, tachycardia
What else is derived from the same precursor at ACTH? parent protein?
beta-endorphin, derviced from proopiomelancortin (POMC)
What cells are present during chronic inflammation?
Macrophages/monocytes/lymphocytes/fibroblasts
Kappa receptor affects?
Miosis, dysphoria, sedation
Smith protein-function
complexes with small nuclear RNA in the cytoplasm -> forming small nuclear ribonucleoproteins
=> Removal of introns from RNA transcripts
Takayasu arteritis
< 4- years old, giant cell aortic lesions
Paraneoplastic cerebellar degeneration-cause
Cross reaction with purkinji neuron antigens, specifically anti-Y, P/Q, and Hu
How to treat hemophilia acutely?
Administration of thrombin, will lead to blood clotting
asymptomatic patient with a history o an inborn error of sugar metabolish?
essential fructosuria- fructokinase deficiency
What causes congenital torticollis?
breech delivery, malposition of the head in tero-caused by fibrosis of the SCM
What is HSP?
Boys 2-10, preceeded by viral/streptococcal URI
IgA-mediated leokocytoclastic vasculitis
Cause of Sepsis
TNF alpha -> activated marcophages
infant with lactic acidosis and neurological deficits, think? Tx?
Pyruvate dehydrogenase deficiency, tx. in a ketogenic diet
Lysine and leucine are strickly ketogenic and cannot be made into pyruvate, decreasing symptoms
Epicanthal folds, upslanting palpeebral fissures, protruding tongue and excessive skin at nape of neck?
Down syndrome
Describe a reticoulocytes?
Larger and bluer than a mature RBC, lacks nucleaus, but contains a mesh-like (reticular) network of residual ribosomal RNA, which appears aftee the wright stain
SCID signs
Failure of T-cell development, with B-cell dysfunction
Recurrent severe viral, fungal, opportunistic infections, failre to thrive, chronic diarrhea
Tx- stem cell xplant
Leukemoid Reaction
reactive increase in the white blood cell count, which can mimic leukemia; removal of the underlying cause will correct it
Where is the chemreceptor trigger zone located?
Doral surface of the medulla at the caudal end of the fourth ventricle
Test to determine if the means of two groups are equal?
Two-sample t test
Phenytoin- teratogenic effects?
Neural tube deefects, orofacial clefts, microcephaly, nail or digit hypoplasia
Pseudomonas aeruglinosa-Exotoxin A MoA
Inactivation of EF-2 via ribosylation -> inhibted host cell protein synthesis
Which cells in males produces testosterone?
Leydig cells
Overdose of vitamin C
Galse-negative stool guaiac, diarrhea, abdominal bloating
What is your primary concern when an elderly patient comes in with exxhymoses in various stages of healing on the upper extremities?
Address their safety
What forms an AV shunt?
AV fistula 0> allows blood to directly enter the benous system
What direction of Hep C has no proof-reading?
3’-5’ exonuclease activity
What affect does cholestyramine have on hepatid cholesterol synthesis?
increases it
Crest components
Calcinosis, Raynaud phenomenon, esophageal dysmotility (fibrous replacement of the muscularis in the lower esopghagus), sclerodactyly, telangiectasia
Persistent hypotension despite rapid infusion
Cardiogenic shock
How long does it take for warfarin’s effect to kick in? Why?
Several days
Long half-life of facotr II (antithrombin)
New onset of anxiety with no prior psychiatric history and prominent physicial finding on examination suggets
Anxiety due to a general medical condition
Pneumocystic pneumonia and painful oral ulcers, think?
HIV
Hybernating myocardium
Chronic myocardial ischemia, -> decreased contractility and left ventricular dysfunction
Linear IgG and C3 deposits on immunoflourescent microscopy of the renal?
Goodpasteur
Lateral force leads to widening of the medial joint line?
MCL damage
Synaptophysin
transmembrane glycoprotein found int he presynaptic vescicles of neurons, neuroectodermal and neuroendocrine cells
Ciprofloxacin
fluoroquinolone class of antibiotics, interact with DNA gyrase
equation for sensitivity?
TP/(TP+FN_
Tamoxifen
Treatment for Er or PR tumor expression, a selective estrogen receptor modulator
What does the smooth ER do?
Synthesize steroids and phospholipid biosynthesis
Follicular lymphoma-translocation
t(14:18), BCL2
Diagnostic test for Trichomonas vaginalis?
Saline microscopy (wet mount)
VHL signs
capillary hemangioblastomas in the retina and/or cerebellum, congenital cysts and/or neoplasms in the kidney, liver, pancreas; increased risk for RCC
Bacterial resistance to cephalosporins?
Modification of PBP
TGF-beta -MoA
Promote the differentiation of fibroblasts into myofibroblasts
Large individual with chronic, mild dyspnea and fatique?
Chronic hypoventilation due to obesity
Rifaximin- MoA
nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of pneumonia
Increased blood ammonia and orotic acid excretion in urine. defect?
Ornithine transcarbamylase
What is required for the fusino and release of neurotransmitter vescibles into the synaptic cleft? Drug example?
Voltage-gated ion channels
Gabapentin
Homocystinuria-treatment
pyridoxine (B6) which is a cofactor for the deficient enzyme cystathioinine beta synthase
What is the only affect of Grrave’s disease not relieved by beta blockers?
Exophthalmos
What cell type produces interferon-gamma?
T-cells and NK cells
Nests of uniform round cells with inconspicuous nucleoli and few mitotic figures at the basal portion of the epi and upper dermis?
Compound melanocytic nevus
Ornithine transcarbamylase-action
catalyzes the combination of ornithine and carbamoyl to form citrulline in the urea cycle.
How to calculate total filration rate of a substance
Inulin clearance X ([plasma substance A])
History of prolonged bleeding following procedures and spontaneous hemorrhage into joints?
Hemophilia (related to either VIII or IX
Side effects of aminoglycosides during pregnancy?
Ototoxiicity, vestibulotoxicity
What type of receptors are hormone receptors?
G-protein activated
Cause of renal size differences in individuals at risk for athersclerosis?
Renal artery stenosis
What zone of the adrenal glands is affected in cushings?
Zone gasciculate
Where is type III collagen found?
skin, lungs, interstines, blood vessels, bone marrow, lymphatics, granulation tissue
What is a Ghon complex?
lower lung lobe lesion with ipsilateral hilar adenopathy, associated with primary TB
Stages of lobar pneumonia
- congestion - vasodilation, exudate contains bacteria
- red hepatization 0> exudate contains erythrocytes, neytrophils, fibrin
- grey hepatization -> exudate contains disintegrated RBC, neutrophils, fibrin
- Resultion - enzymatic digestion of exudate
Prazosin- MoA
alpha 1 adrenergic blocker causes vasodilation and reflexive tachycardia
What two things should you check when metabolic alkylosis is a concern?
Urine chloride, volume status
Effect of alpha1 -adrenergic agonist on the heart?
Increased vagal stimulation -> decreased pacemaker activity
Why are piperacillin and tazobactam linked?
stops pipercilin destruction via beta-lactamase
Ischemic preconditioning
Brief, repetitative episodes of myocardial ischemia followed by reperfusion protect the myocardium from prolonged episodes of ischemia
How to decreased renal plasma flow and increase filtration fraction?
Constriction of the efferent arteriole
Precision- definition
low level of variability when used to assess a fixed entity
What are the characteristics of S. Pneumoniae?
gram-positive, lancet-shaped cocci, bile soluble
Uncomplicated umbilical hernias are associated with?
Down Sydrome, hypothyroidism, Beckwith-Wedemann syndrome
Upper extremily numbness, tingling, and weakness with upper extermity edema
Thoratic outlet syndrome- salene triangle, cause by cervical rib or muscle deformity
Klinefelter syndrome
47, XXY- mental retardation, tall stature, gynecomastia, azoospermia
Actions of Cholinergic antagonists?
Increase GI smooth muscle tone -> nausea, vomitin, cramps, diarrhea, decrease heart rate, atopic baldder (non-obstructive urinary retention
Thyroid Peroxidase- function
Thyroglobulin iodination forms (T3/T4)
Depersonalization/derealization disorder
Feeling of detachment from or being on outside observer of one’s self
eperiencing surroundings as unreal
**Intact reality testing**
Sustained generalized tonic-clonic convulsions without fully regaining consciousness between episodes? Treatment? MoA?
Status epilepticus
Tx- intravenous benzodiazepam (lorazepam); Enhances post-synaptic chloride influx
First step in management of a request for opiod medication?
Confirmation of the patient’s prescription history
Epithelial ovarian cancer- marker
CA-125
Preferred vein for bypass grafting?
internal mammary artery
Sertoli-Leydig tumor
Ovarian tumor that presents with large adnexal mass with amenorrhea and virilization by a rare sex-stromal tumor
What causes anaphylactic reactions?
Mast cell and basophil degranulation -> histamine and tryptase release (mast cell specific)
Signs on heroin withdrawal
nausea, vomiting, abdominal cramping, muscle arches,
See dilated pupils, yawning, lacrimation on PE
Cardiac abnormalities in Marfan syndrome?
Cystic medial necrosis (aortic dissection & aneurysm) and Mitral valve prolapse
Transthyretin
Protein tetramer produced int eh liver to carrier thyroxine and retinol, mutations can lead to amyloid protein in the myocardium
Lesion at or above the red nucleus
Decorticate (flexor) posturing descending inhibition of th red nucleus
damage is @ pons
Cyclosorin-MoA
inhibts nuclear factor of activated T cells, blocking IL-2
Temporomandibular disorder?
unilateral jaw pain that worsens with jaw movement, headache, and derangement, pathologic contraction of the muscles of mastication, and/or hypersensitivity of the nerve that supply the jaw
Caused by mandibular devision of trigeminal nerve
Irregular spijkes protruding from the glomerular basement membrane in the kidney? Characteristics?
Membranous glomerulopathy
diffuse thickening of capillary wall on light microscopy wihtout an increase in cellularity
Subungual splinter hemorrhages?
Associated with microemboli, usually caused by subacute endocarditis
Homocystinuria-presentation
ectopia lentis, intellectual disability, marfanoid havitus
How do you stop increased HCL output from vagal, histamine and gastrin pathways?
Give them a proton pump inhibitor, H2 blockers only stop gastric acid secretion in histamine and gastrin, not vagal
Patient with history of rheumatic fever, nor presenting with exertional duspnea and diastolic murmer
Mitral stenosis (problem opening valve)
hypochromic, microcytic anemia, cause?
Iron deficiency
Dengue fever- mulitiple infections
Recovery from an infection leads to life-long immunity, however, secondary infection (with a different serotype can cause more severe illness
How does UV light lead to wrinkles?
decreased collagen fibril production -> upregulation of metalloproteinases
What x-ray signs would establish a cholecystoenteric histula?
Air in the biliary tree (pneumobilia) from interstinal gases
Where is collagen synthesized?
RER, hydroxylation in the cisternae of the RER
Trazodone - MoA and side effects
MoA- serotonin modulator (antagonized post-synaptic serotonin receptor and inhibits reuptake Side effects0 priapism (persistent erection > 4 hours
Effects of prolactinoma?
hypogonadism, anovlation, amenorrhea -> breast milk discharge
Suspect abuse in a patient, what is your top priority? Questions to ask?
interview alone to avoid intimidation
Questions: 1. Do you feel safe where you live?
- Who prepares your meals
- Who handles your checkbook
Sings of ARDS
Acute respiratory failure, bilateral opacities (hypoxemia, etc.)
Common cause of aspectic meningitis?
enterovisures (Echo, coxsachievirus, poliovirus
older child/ younger adult with edema, hematuria and proteinuria following skin or pharyngeal infection
post-streptococcus glomerulonephritis -> electon-dense deposits on the epithelial side of the basement membrane
What does a capsule do?
Protects the organisms from opsonization
What is another name for an anterior prolapse?
Cystocele
Vision problem, difficulty chewing, trouble speaking that are worse at the end of the day
Myasthenia gravis- Type II hypersensitivity
Test used to check ACTH response in adrenal glands?
Adrenocorticotropic hormone stimulation test
Sign of renal vein thrombosis?
membranous nephropathy, flank pain, hemoturia, right-sided varicocele
Selective arteriolar vasodilators: types, MoA
hydralazine, minoxidil MoA- reducing systemic vascular resistance -> baroreceptor stimulation leads to reflex sympathetic activation -> increased sodium and fluid retention
Cf-Most common cause of death
Pneumonia
Bile acid-binding resins- side effects
“chol-“ drugs, increase triglycerides by releasing of triglyceride heavy VLDL into circulation
Rapidly spreading pruritic rash with erythematous papules and excoriations on the extremities
Scabies or Sarcoptes Scabiei mites and eggs
Where does the left gastric artery run?
Along the lesser curvature of the stomach
What is the most important muscle involved in the Valsalva maneuver
Rectus Abdominalis
What is the important component of a newborn screening test?
High sensitivity- a negative diagnosis helps rule out the test- better to catch more false positives than have a false negative
What occupies the cavernous sinus?
Structures relating to eye movement
Electrolyte that can cause muscle weakness?
Hypokalcemia
Enzyme deficiency in porphyria cutanea tarda
Uroporphyrinogen decarboxylase
how does normal CSF flow?
choroid plexuss (lateral 3rd and 4th) -> lateral ventricles, interventricular foramen on monro -> third ventrical -> cerebral aquaduct -> fourth ventricle -> Luschka, magendie -> subarachnoid space -> arachnoid granulations -> Venous system
Isotretinoin-teratogenic effects
microcephaly, thymic hypoplasia, small ears, hydrocephalus
Ions permeable with a negative equilibrium?
Potassium, chloride
Effects of a noncompetitive inhibitor or irreversible competitive inhibitor on Vmax?
Reduces the maximum effect
Sign of secondary hyperaldosteronism
Increased Renin and Increased aldonsterone
Inspissated mass
dehydrated meconium
Cause of Annular pancreas
abnormal migration of the ventral pancreatic bud
Side effects of TCA
confusion, constipation, acute urinary retention
How much of a coronary artery lumen must be clocked for stable angina?
>750%
Parvovirus - in fetus
pleural effusions, pericardial effusions, ascites -> fetal hydrops
Hernia below the inguinal ligament?
Femoral hernia
Most common site of rupture in a blunt aortic injury?
Aortic isthmus (site where the ligamentus arteriosum is located
How long does a loss of contractility take during total ischemia
about 60 seconds
How to treat agitation and psychosis associated with delirium?
Haloperidol in low doses
Most common locations for breast cancer to spread?
Bone, brain, liver, lung
Persistent processus vaginalis-signs
outpouching of the peritoneum, leaving bowel contents in the inguinal canal
What proteins are involved with hemidesmosomes?
Integrins
Dopmine pathway for coordination of coluntary movement?
Nigrostriatal
Side effect of EPO stimulation?
Hypertension, due to increase blood viscosity from increased RBC and increased risk of thromboembolic events
Subclavian steal syndrome
Severe stenosis of the proximal subclavian artery -> reversal of contralateral vertebral artery to the ipsilateral side
Sides- exercise-induced fatique
Most usedul measure for assessing the defree of mitral stenosis?
A2 to opening snap interval (increase distance, decreased severity)
Basal cell carcinoma-Presentation
pearly papules with central depression of ulceration
Vitamin essential for transamination and decarboxylation of amino acids (ntrogen transfer)
Pyridoxine (anything with alpha-keto
What proteins are involved in tight junctions?
Claudins, occludin
What promotes the contraction of the gallbladder?
CCK from the small intestine
Inceased aldosterone syndrome name?
Conn’s Disease
ACE inhibitors - teratogenic effects
Renal dysgenesis, oligohydramnios
Schizophrenia vs schizophreniform-time frame
Schizophrenia- > 6 months
Schizophreniform >1 month to < 6 months
Spinal stenosis vs. disk herniation
Disk herniation will present with back pain, stenosis will not. L5-S1 stenosis affects L5, herniation affects S1
Wen taking a long-acting benzo ,what should be avoided?
1st generation antihistamined (chlorpheniramine). alcohol, barbs, and other CNS depressents
Pathogenesis of HIV-associated dementia?
Inflammatory activation of microglial cells -> form microglial nodules -> multinucleated giant cells-> cytokine excretion
Clinical manifestations of Factor I leiden
DVT, cerenral vein thrombosis,receurrent pregnancy loss
What vitamin is depleted in measles and should be supplemented?
Vitamin A -supplementation should be done to reduce comorbidities (ocular complications, diarrhea, pneymonia, recovery time and length of hospital stay
Oral vs rectal drug administration?
Increased bioavailability due to less first-pass metabolism rectally
CMV-related risks in infants exposed to the virus in utero
Chorioretinitis, sensorneural deafness, seizures, jaundice, hepatomegaly, microcephaly
Acute cerebellitis?
Post-viral cerebellar ataxia,
cause in children 2-3 weeks following varicella, measles, EPV
Drugs that interfere with cell membrane ergosterol incorporation
Amphotericin B, nystatin, azoles
What inhibits platelet aggregation and adhesion to the vascular endothelium?
Prostacyclins
Granulosa cell tumor- clinical features
inc. estrogen, inhibit with large, unilateral adnexal mass
Long term effect of diabetes on the gut?
Decreased motility
Risk in CD18 deficiency?
Persistent leukocytosis
Development of atherosclerotic plaque?
Endothelial damage -> macropage invasion -> platelet adhesion -> smooth mscle cell migation -> lipid debris
Pepsin- activitation and function
Activated in stomach -> starts the degredation of proteins for future digestion
Failure of prothrombin time to correct with vitamin K supplements?
Liver disease
Enkephalins, endorphins, dynorphins
Endogenous opiod peptides, part of the bodies natural opiod system
Side effects of Trimethoprim/sulfamethoxazole during pregnancy?
Neural tube defects
What parts of the spinal cord are affect in ALS?
Lateral corticospinal tract (spasticity and hyperreflexia) anterior horn -> flaccid paralysis, atrophy, fascivulation
Right-sided enlargement of the scrotum, with fluid collection?
Indirect inguinal hernia (through patent process vaginalis)
Physiological decor receptor for decreasing binding of RANK-L to RANK
Osteoprotegerin
Low-potency 1st generation antipsychotics
Names: chlorpromazine, thiondazine
AE- sedation, anticholinergic , orthostatic hypotension
What can be detected by a radiolabled DNA strand?
Things that bind (N-myc)
most common cause of bladder outflow obstruction?
BPH -> urine backup -> parenchymal pressure atrophy in the renals
Tzanck smear
genital herpes simplex virus
How to test concentration in an elderly individual
Reciting months of the year backwards
Negative agglutination twice spaced apart, think
CMV
High grade CIN
atypical cells have invaded beyond the lower one-third of the cervical epithelium
What proteins are involved in Gap junctions?
Connexins
What type of disturbances are seek in DKA?
Metabolic acidosis- low pH, low HCO3-
What happens during the first week after exposure to TB?
Intracellular bacterial proliferation
Signs of 17alpha-hydrozylase deficiency in males? Female?
Phenotypically female at birth, females develop normally; however puberty leads to the failure to develop secondary sex characteristics
Excessive mineralocorticoids by adrenals leads to hypertension
Progressive fatigue and heart palpitations, think
anemia
What type of receptors are in neurons?
voltage-gated
Signs of PKU
high phenylalanine -> disrupts neuronal and glial deelopment and lead to progressive neurological deterioration -> hpotonia, dystonia, seizures
Progressive ddyspnea and sudden death and atypical chest pain with ventricular hypertrophy
Pulmonary arterial hypertrophy
Methotrexate- teratogenic effects
lumb & craniofacial abnormalities, neural tube defects, abortion
Organism?
Coccidioides Immitis, endemic to the desert areas of the US and mexico
Culutre on Sabouraud media
Cause of non-bacterial thrombotic endocarditis?
Advanced Malignancy, chronic inflammatory disorders (SLE, etc.)
Where are normetanephrine and metanephrine created?
Chromaffin cells of the adrenal medulla
How does blood reach the retinal artery?
Internal carotid, ophthalmic arter-> retinal
How to calculate the positive predictive value?
TP/TP+FP)
What enzymes are found in the cytoplasm?
Glycolysis, fatty acid synthesisi, pentose phosphate pathway
How to detect fructose in the urine?
Copper reduction test
Where does most of the water get absorbed at in the nephron?
Proximal tubules
Statistical Power
(1-beta) study’s ability to detect a difference when one exists
Where does lithium affect the kidney?
Colelcting ducts
Antagonizes vasopressin (ADH)
What gets deposited in multiple myeloma?
Ig light chains (also known as amyloid type AL (primary)
Measles virus-description
enveloped, single stranded RNA virus, which encodes viral hemoagglutinin (cell surface adhesion) and matrix protein (assembly)
Paranoid personality disorder
Pervasive pattern of distrust, and suspiciousness, beginning in early adulthood
c-ANCA
cytoplasmic- antineutrophil cytoplasmic antibody
Patient wants to cancel the surgery after anesthesia, how to respond?
Ask and address the concerns
Inner necrosis, with pseudopalisading cells in the brain?
Glioblastomia multiforme
How does gluconeogenesis get generated during fasting?
Increased Acetyl-CoA inhibits pyruvate dehydrogenase and upregulates pyruvate carboxylase
What causes black stones?
Stone type?
Chronic hemolysis (sickle cell, spherocytoisi), or ileal diseas)
cause by increased enterohepatic cycling of bilirubin (unconjugated)
Calcium bilirubinate
INF-gamma function
Secreted by activated T-cells; recruits leokocytes and activates phagocytosis
What is the role of the pudendal nerve?
Innervation of the perineal region
arises from s2-s54 and controls the pelvic floor as well as external urethral and anal sphincter; can lead to fecal incontinence and urinary incontinence
Parinaud syndrome
Tumor of the pineal gland that causes the inability to look upwards
What do the vitelline veins form?
Portal system
Fungus branching at acute angles with septations
Aspergllus
Enzyme essential for the conversion of fructose-6-phosphate to ribose-5-phosphate?
Transketolase
Cause of maturity onset diabetes in the young?
Mutation in glucokinase
In patients that have a total gastrectomy, what needs to be supplemented?
B12, intrinsic factor can no longer be produced
Young man with dyspnea on exertion and decreased exercise tolerance and central obesity?
obesity-related restrictive lung disease
How does alcohol lead to hypoglycemia?
Ethanol processing -> increased NADH/NAD+ ratio -> shuts down gluconeogenesis -> hypoglycemia
Lack of anal sphincter contaction- nerve involvement?
S4
Patients receiving parenteral nutrition through catheter are at risk for? morphology?
Candida, pseudohyphae with blastoconidia
What are berry aneurysms associated with?
Ehlers-Danlos syndrome and ADPKD
What are the stop codors
UAA, UAG, UGA
How does the botulism toxin act?
Blocks release of Ach into the neuromuscular junction, toxin in heat tabile
Neurokinin 1 receptor antagonists?
Aprepitant, Fosaprepitant
Phenoxybenzamine
Alpha blocker
QT-interval prolongation in a young child
Congenital QT-interval prolonation-> mutations in potassium of sodium channels. Assocated with neurosensory deafness
Increased risk of Torades de Pointes
Buspirone
Non-benzo anxolytic used to treat GAD, slow onset of action, lacks muscle relaxant, or anticonvulsant properties and carries no risk of dependence
Dopamine receptor antagonists (antiemetic)
rochlorperazine, metaclopramide
Kallikrein
converts kininogen to bradykinin
What should all breast cancers be tested for?
HER2, associated with very aggressive forms
Function of Folic acid?
DNA single carbon donor required for purine and pyrimidine )Thymidine) bases incorporated into DNA
How to you culture H. Influenza?
Grow them around streaks of S. aureus, which provides NAD+ (factor V) and hematin (factor X) from the lysis of RBCs
DIC during pregnancy?
Cause by tissue factor (thromboplastic) found in the placental trophoblast -> released during placental injury -> activates complement cascade
What male cells secrete testosterone?
Leydig
Brown, firm colored spleen?
Remnants of autosplenectomy (hemosiderosis)
Cause by vascular occlusion
Respiratory signs characteristic of asthma
Normal chest x-ray, eosinophils in sputum, reduced FEV1
What sugar can bypass phosphofructokinase and undergo faster metabolism?
Fructose, doe snot have to meet PFK-1
Anemia with schistocytes, thrombocytopenia
Thrombotic thrombocytopenic purpura, decreased ADAMTs13 leading to large vWF multimers -> microvascular platelet-rich thrombi
Delusional disorder vs. paranoid personality disorder?
Delusion -> behavior not obviously bizarre, ability to function other than delision, not due to substance abuse
Paranoid- ppervasive pattern of suspiciousness or odd beliefs
Minimal change disease is what type of category?
Selective - certain size protein can get through
Diagnosis and microscopic characteristics?
Seborrheic Keratosis
Small cells resembling basal cells with variable pigmentation, hyperkeratosis, and keratin containing cysts
Best treatment for pulmonay infections and abscesses in an alcoholic?
Clindamycin
Mxogatous changes
weakening of connective tissue-> aortic dissections and aortic aneurysms
What is G6PD the rate limiting enzyme for?
Coversion to 6-phosphogluconate (first step in the pentose phosphate pathway
Norepinephrine extravasation
Interse alpha receptor mediated vasoconstriction which can lead to local tissue necrosis; counter acted by a alpha channel blocker, phentolamine
Foamy macrophages packed with both rod-shaped vacilli and PAS-positive diastase-resistant granules
Tropheryma whippelii
Closely packed, small, round, neoplastic cells in bone
Ewing Sarcoma
What proteins are involved with adherens junctions?
Cadherins
Light microscope findings in Chron’s disease?
Transmural inflammation and noncaseating granulomas
Hemosiderosis
complex of ferritin found within cells and is unavailable for acccess to the body
Latanoprost-MoA
prostaglandin for glaucoma -> increase outflow
Signs of vitamin A overdose?
Alopecia, dry skin, hyperlipidemia, hepatotoxicity, papilledema, visual difficulties
Signs of chronic gastritis
mucosal inflammation leading to atrophy, with hypergastrinemia
Gram-negative, pink-colored mucoid colonies on MacConkey’s agar
Klebsilla, E. Coli, Enterobacter
Signs of T. whippelii infection?
middle-aged caucasian males, presenting as malabsorption with diarrhea and weight loss
Reversal agent for Heparin?
Protamine
How do you diagnose thiamine deficiency?
baseline erythrocyte transketolase activity is low, but increases after the addition of thiamine
Where does the great saphenous vein located?
medial side of foot -> anterior to medial malleolus, and up the medial aspect of the leg, just inferolateral to the pubic tubercle in dives to join the femoral vein
Left vertebral artery- retrograde flow
blockage in the left subclavian
Bacterial recombination
gene exchange that occurs through crossing over of double stranded DNA molecules
Where is the caudate located?
Inferolateral walls of the anterior horns of the lateral ventricles
How does total parenteral nutrition cause gallstones?
lack of enteral passage of food into the duedenum fails to trigger release of cholecystokinin leading to contraction of the gallbladder -> niliary stasis
How does N. meningitidis spread?
Via respiratory droplets; where theyy invade the epithelium and gain access to the vasculature
VIPoma-signs
diarrhea (persists with fasting), achlorhydrai and hypokalemia
What infections are found in HIV patients with a T-cell count less than 50? Tx?
Mycobacterium avium complex; grows well at higher temperatures
Tx- Azithromycin
Where are M3 receptors located?
Peripheral vasculature, lung, bladder, eyes, gastrointerstinal , skin
Global payment
arrangement in which an insurer pays a provider a single payment to cover all expenses associated with an incident of care (think elective surgery, where pre- and post- op are also covered
How does fragile X cause symptoms?
>200 CGG repeats -> FMR1 hypermethylation -> inactivated FMR1 -> inhibits neural development
Factitious disorder
deliverate induction of infection without obvious external rewards
ARE AWARE OF THE SYMPTOMS
ulcerative mass on the anus?
Think cancer, specifically HPV
Precursor to Uroporphyrin?
Succinyl CoA
Chikungunya Fever? Vector?
Februile illness with flu-like symptoms, with prominent polyarthralgia/arthiritis and diffuse maculopapular rash.
Spread by Aedes Aegypti
Functions of protein A
virulence factor that forms part of the outer layer of S aureus, binds the Fc portion of IgG antibodies @ complement-binding site
Burkholderia cepacia
Aerobic gram-negative bacillus found in aquatic environments and colonized fluids in the hospital
catalase positive
Glanzmann thrombinasthenia
Fialure of platelet to platelet aggregation due to decreased Gp IIb/IIIa
aggregated with ristocetin
What clotting factors are produced in the liver?
2, 7 (shortest half-life), 9, 10
How to chronically elevated fatty acids lead to insulin resistance?
Impair insulin-dependent glucose uptake and increase hepatic gluconeogenesis
History of HIV, 2 ring-enhancing focal lesions (with mass effect), edema in right frontal lobe? Tx?
Toxoplasma gondii
Pyrimethamine and sulfadiazine
What is the normal lining of the bronchi?
Pseudostratified ciliated columnar
Canagliflozin-MoA, SE
MoA- SGLT2 inhibitor
SE-UTI and genital mycotic infections, symptomatic hypotension, renal impairment
Adherence to collagen?
S. Aureus virulence factor
In the setting of an infection-> hypotensino, tachycardia, tachypnea, and markedly elevated or decrease body temp
Septic shock
How to calculate bioavailability?
(Area under the oral curve X dose) divided by (area under the IV curve x Dose)
Cauda equina sundrome
Compression of spinal nerve roots
presents with severe bilateral radicular pain, saddle anesthesia and hyporeflexia
Metalloproteinases
Activated macrophages infiltrate atheroma, and cause the breakdown of extracellular matrix proteins (collagen), destabilizing the plaque
Potential complications of acute pancreatisit?
Leakage of pancreatic secretions into the peripancreatic space -> inflammatory reaction in the walls -> pseudocyst formation -> fibrous and granulation tissue
Where do H. pylori occupy?
Antrum of stomach (prepyloric area)
Atelectasis? Cause?
Complete of partial collapse of a lung
Contraction-secondary to radiation
lithium - teratogenic effects
Ebstain anomaly, nephrogenic diabetes insipidus, hypothyroidism
Six-sided crystals?
Citrate crystals -> Increased COLA amino acids in urine
What do the “-ravir” drugs for HAART therapy target?
messenger RNA transcriptoin (integrase inhibitor)
Signs of acute rheumatic fever
Migratory arthritis, pancarditis, sydenham chorea, erythema marginatym (JONES criteria)
What is stress-related mucosal disease?
Acute gastric mucosal defects that develop in response to severe physiological stress (shock burns, sepsis, etc.)
Laboratory finding of Sarcoidosis?
hypercalcemia/hypercalciuria, elevated ACE level
Side effects of SSRI?
sexual dysfunction
Does does eosinophil enter the bronchial wall in asthmatics?
Recruited by IL-5 released by allergen-activated Th2 cells
Acute symmetric arthralgia/arthritis with or without rash in adults working at a school?
Parvovirus
Signs of cocaine withdrawal?
intense psychomotor retardation, severe depression
Acanthosis nigricans
Bands in axilla, other skin folds suggesting insulin resistance - >
Latent period - studies?
timelapse from initial exposure to clinically apparent disease
Why is a two week window needed after MAOI dicontinuation?
Provide time to regenerate MAO A and B to normal levels
Treatment for chemotherapy, development of frequent urination, suprapublic pain, dysuria, progressive hematuria
Treated with cyclophosphamide (or analog) -> metabolized in the kidney to acrolein, which is topic to uroepithelial cells and cause cause death with long-term exposure
Signs of hyperaldosterism
hypertension, hypokalemia, metabolic alkalosis and decreased renin activity
Cardiac abnormalities in Tyrner syndrome?
Aortic coarctation, bicuspid aortic valve
Leukotrienev B4-moA
Metabolite of arachidonic acid -> stimulated neutrophil migration to the site of inflammation
Hypertrophic cardiomyopathy sound?
harsh crescendo-decreshendo murmur heard best at the apex and lower sternal border
What is the MoA of enoxaparin
Binds antithrombin III; then binds to factor Xa, stopping the convertion of prothrombin to thrombin
Morphology of Cryptococcus Neoformans?
Yeast only!
round or oval encapsulated cells with narrow-based buds
Organism associated with animal waste with severe headaches and pneumonia?
Q fever, coxiella burnetii
Side effects of Niacin?
decreased renal exceretion or urin acid -> acute gouty arthritis
Azoles- MoA, SE
MoA- supress the synthesis of ergosterol
SE- cytocrome p450 inhibitor
Long-term effects of hypogonadism?
Low estrogen -> vaginal dryness and low bone denisty
Alport Syndrome? Cause?
eye problems, sensorineural deafness, and nephritis
“can’t see, can’t pee, can’t hear a bee”\
Type IV collagen defect
Use for gamma-glutamyl transpeptidase?
Determine origin of elevated alkaline phosphatase (hepatic vs. bony)
GI abnormalities associated with Down syndrome
Duodenal Atresia
What proteins are involed with Desmosomes
Desmogleins, desmoplakin
Thickened heart valves, with multiple small vegetations on both surfaces, “wire-loop” structures in flomerular capillary
SLE, verrucous endocarditis (Libman-Sacks)
List anti-oncogenes? Functions?
Tumor supression, APC, BRCA1, RB, TP53
Warfarin interaction?
St. John’s wart -> decreased efficiency
What happens to Rb in order to progress from G1 to S?
Growth factors -> activation of cyclin D, cyclin E and cyclin kinase 0> RB hyperphosphorylation -> inactivation and release of E2F transcription factor
A. Globus Pallidus- basal ganglia
B. putame - medial to the insula and lateral to the globus pallidus and internal capsule
C. internal capsule
D. Caudate nucleus
E. Amygdala
Treatment for HER2-positive cancer?
Treastuzumab, a tryosine kinase, which downregulates cellular proliferation and promotes cellular apoptosis via binding to an extracellular domain on the HER2 receptor
HUS
microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency
What causes the outflow ventricular obstruction in interventricular hypertrophy?
Mitral valve leafnet and interventricular septum
Signs of noncommunicating hydrocephalus?
Headaches, increased ICP
How do loops cause hearing loss?
Inhibition of Na/K/2Cl transporters in the inner ear, usually at higher dosages with preexisting CKD, rapid intravenous administration, orwhen used in concert without agent that cause ototoxicity
How is epinephrine produced?
Norepinephrine in converted to epiinephrine via phenylethanolamine-N-methyltransferase (which is upregulated by cortisol
Legg-Calve-Perthes disease
young children isolated idiopathic osteonecrosis of the hip
What drugs are metabolized by jetatic N-acetyltransferase?
Isoniazid and sulonamides - increased toxicity
Myotonia?
abnormally slow relaxation of muscles (loosening one’s grip after shaking hands, inability to release a doorknob)
AD inheritance, CTG repeat for myotonia-protein kinase
Where are dietary lipids absorbed in the interstinal track?
jejunum via passive absorption
Complications of measles?
Encephalitis (days), acute disseminated encephalomyalitis (weeks), subacute sclerosis panencephalitis (years)
Bacterial vs virus meningitis?
Viral- WBC <500, normal glucose, protein < 150
Bacterial- WBC >1000, <45 glucose,
site effects of “navir” drugs?
metabolic complications (lipodystrophy, duslipidemia, insulin resistence
NNRTI- common side effects
abrupt-onset flu-like symptoms, abdominal pain, fever, hepatic failure
Uterine prolapse?
Uterus slips and enters the vagina
Disorders that can cause Xanthomas?
obstructive biliary lesions, primary biliary cirrhosis, primary or secondary hyperlipidemia
Fibrates-MoA
Upregulat lipoprotein lipase, and inhibit cholesterol 7alpha- hydroxylase
G-protein-dependent phospholipase C pathway?
GTP -> IP3 -> increased intracellular Ca2+
Cheyne-stokes breathing can be seek with which conditions?
CHF -> buildup of CO2 stimulated the breathng centers -> leads to overcorrect, stop breathing again
Anti-inflammatory agent that does not interfere with platelet aggregation?
Celecoxib (Cox 2 inhibitor)
Wernicke encephalopathy- signs?
Ophthalmoplegia, ataxia, and confusion -> coma -> death
Meniere Disease
unilateral hearing loss @ tinnitus cause by increased pressure and volume in endolymph
viral-independent viral nucleotides
Cidofovir, tenofovir
what is the function of enteropeptidase?
jejnal brush border enzymes responsible for the activation of trypsinogen to trypsin
Recombination
exchange of genes between 2 chromosomes by crossing over within homologous regions
Granulomatous inflammation of the media of a vessel
temporal arteritis
Signs of hereditary fructose deficiency? Cause?
vomiting and hypoglycermia 30 minutes after fructose ingestion (honey, fruits, vegetables), failure to thrive, hepatomegaly
Cause- Aldolase B deficiency
Hypoglycemia caused by intracellular accumulation of fructose-1-phosphate and depletion of inorganic phosphate
Side effects of tetracyclines during pregnancy?
Teeth staining
Where is PAH absorbed in the nephron?
It is not absorbed, concentration is lowest in Bowman’s space
Atypical depression
mood reactivity, leaden paralysis, rejection sensitivity, increase sleep and apetite
how do neural cells migrate in GI development?
Caudally, as such, rectum is ALWAYS involved
Buerger’s disease
AKA- thromboangitis vasculitis of medium and small-sized arteries- extends into contiguous veins and nerves
How does dehydration afffect the kidney filtration concentration
PCT will by isotonic (free flow)
Macula Densa - hypotonic (increased reabsorption of sodium with water)
Medullary CT- hypertonic (increased secretion of solutes to get more water)
How to calculate positive predictive value?
True positive/(True positive + false negative)
Mucosal tear without acute inflammation
Mallory Weiss, retching/vomiting
Harnup disease
Enterocyte apical transport proteins involved in the absorption of tryptophan is defective -> decreased niacin deficiency
Blepharosparm
involuntary forcible closure of the eyelids (starts with uncontrollable blinking)
Glisson’s capsule
Capsule of the liver, made from fibrin
Cause of atrialization of the right ventricle?
Lithium (ebstein abnormality)
Pulmonary hypertension-signs
Second heart sounds with right-sided heart failure due to cor pulmonale
Function of Sertoli cells
secrete mullerian-inhibiting factor -> absence leads to the development of female internal genitalia (paramesonephrid ducts develop)
Dermatitis herpetiformis-age?
4-5th decade of life on buttocks and extensor surface
Intranuclear acidophilic inclusion in the brain
HSV
What surfaces to streptococcus adhere to?
Heart valves with preexisting endothelial damage
How does SIADH affect the electrolytes?
hyponatremia, decreased plasma osmolarity, increased urine osmolarity, normal body fluid volume
46, XX t(14:21)
unbalanced Robertsonian translocation
hard nodules over the DIP bilaterally with moderate severe morning stiffness?
Osteoarthritis
Causes of acute pancreatitis?
- Recent ERCP
- Drugs
- Infections
- Hypertriglyceremia
- Structural abnormalities
- Surgery
- Hypercalcenua
Migratory throbophlebitis, concern?
visceral cancer -> paraneoplastic syndrome concern
Cause of keyloid scaring
Overexpression of TGF beta -> scar extends beyond borders -> raised, painful puritic lesions
How to approach an angry patient?
acknowledge the anger and defuse the situation
third heart sound and recent MI?
Decompensated heart failure
What are the tragets of HAART therapy?
Reverse transcriptase and protease
Possible cause of postprandial voluminous diarrhea and weight loss
Short bowel syndrome -> vitamin 12 deficiency
Pseudocholinesterase deficiency
Abnormally slow breaking down of anesthesia
Prolonged PTT, PT, normal thrombin time?
Aoixaban rivaroxaban
Schizoaffective disorder
Major depressive or manic episodes with concurrent symptoms of schizophrenia AND >/= 2 years of delusions of hallucinations in the absence of major depressive of manic episodes
What is tetrahydrobiopterin a cofactor for?
Synthesis of serotonin and DOPA
What causes the green color during the recovery from a hematoma?
Heme oxygenase (from macrophages) -> biliverdin (green pigment), carbon monoxide, and ferric iron
Biliverdin is reduced by biliverdin reductase to the yellow pigment, bilirubin, which is bound to albumin and transported to the liver
What pouch do the superior parathyroid glands come from?
4th pharyngeal pouch
Where does the fourth heart sound occur?
Prior to S1
How do TCA work? Risk of death?
inhibit the reuptake of NE and 5_HT via the inhibition of the fast sodium channel
Risk of death: cardiac arrhythmias -> death
Signs of B6 deficiency
anemia, peripheral neuropathy, dermatitis
Biotin deficiency: Enzymes
Pyruvate carboxylase - pyruvate to oxaloacetate
Acetyl-CoA carboxylase- Acetyl-CoA to malomyl-CoA
Propionul-CoA carboxylase - Propionul-CoA to methylmalonyl-CoA
What two effects does desmopressin therapy have?
Increases circulating factor VIII and vWF to stop bleeding (hemophilia A and Type 1 con willebrand disease) Binds V2 receptor in renal cells leading to increased aquaporin channels, increasing water reabsorption and decreasing urine output
Curling Ulcers
Ulcers arrising in proximal duodenim in association with severe trauma/burms
Pancreatic calcification, think?
Chronic alcohol abuse
Furosemide?
Loop diuretic, blacks Na-k-2Cl
elevated periosteum and sunburst pattern?
osteosarcoma- new women bone is being developed
Equation for specificity?
TN/(TN+FP)
Bipolar I versus Bipolar II
Bipolar I - manic episodes (severe, 1 week, marked impairment in social or occupational functioning, psychotic features)
Bipolar Type II (less sever, >/= 4 days, no psychotic conditions)
What forms the right-sided bulge in the chest on X-ray
Right atrium
Thromboxane A2-moA
vasoconstriction and platelet aggregation
What does glucose-6-phosphate dehydrogenase catalyze?
First step in the pentose-phosphate pathwa -> produces 2 NADPH while converting glucose-6-phosphate into ribulose-5-phosphate
Romano=Ward Syndrome
AD, QT prolongation without neural deafness
Myasthenia gravis antibodies?
antibodies against acetylcholine receptors
How do you treat pulmonary hypertension?
Bosartan (endothelian-1 antagonist)
How does alcohol kill viruses?
Disrupts viral envelope
How does precocious puberty affect children?
Lead to shorter height due to the action of sex steroids on the long bone epiphyseal plate
Where is type II collagen found?
Cartilage, vitreous humor, nucleus pulposus
Hydroxyurea- MoA
Increased fetal hemoglobin sunthesis -> protects against polymerization of sickle cells
What seizure types can use Valproic acid?
Tonic-clonic, myoclonic
What do diabetes “glit” drugs bind to?
PPAR-gamma, an intracellular nuclear receptor
Brain tumor iwth whirled pattern?
Meningioma
Delirium
Acute changes in cognition and behavior
What does the Meningitis vaccine contain?
Capsular polysaccharides
What does an increase in enzymes responsible for DNA synthesis signify?
Transition from G1 to S
Drugs that cause a decreased heart rate
Beta-blockers, non-dihydropyridine receptors, cardiac glycosides, amiodarone, sotatol, cholengeric antagonists
Where do dihydropyridines act?
Vascular smooth muscle, “-dipine” drugs
Where are cavernous hemangiomas located?
Brain parenchyma above the cerebellar tentorium
Dubin Johnson syndrome
detect in hepatic excretion of bilirubin glucuronides due to mutation in canalicular membrane transport protein
Labs: increased direct (conjugated) hyperbilirubinemia, other labs normal
Stress brings on jaundice
How do you calculate the probability of getting at least 1 positive test result in an experient
p = 1-(%of the time the test is negative) ^ (# of tests)
Chronic granulomatous disease-risks
recurrent bacterial and fungal infections due to impained NADPH oxidase
How does glactose-1-phosphate uridyl transferase deficiency present?
Jaundice, vomiting, hepatomegaly, renal dysfunction,
Treatment options available for Conn’s syndrome (hyperaldosterism)
spironolactone and Eplerenone
Bilateral knee swelling (as a child) with exertional dyspnea, think?
Rheumatic fever with mitral regurgitation
What infection can cause primary pericarditis?
Coxsackie
What are the clinical findings of preeclampsia?
New-onset elevated blood pressure at >/= 20 weeks, proteinuria (or signs of end organ damage)
Recurrent HSV infection treatment?
Calacyclovir
Haloperidol
1st generation antipsychotic and potent D2 blocker
Bluish lesion under the right index finer that is extremely painful to touch? origin?
Glomangioma-modified smooth muscle cells
Thermoregulation
Reducing nausea from gastrointestinal irritation? Vestibular?
5-HT receptor antagonists-GI
H1 receptor antagonists - Vestibular
Oxidase-positive colonies that do not germent lactose? tx?
Peudomonas aeruginosa
Tx: Cephalosporins (cefepime and ceftazidime)
Intradermal nevi
Epidermal nests have been lost, dermal nevus cells lose tyrosinase activity and produce little to no pigment
Bilobed nuclei with large eosinophilic granules
Eosinophils
Amniotic fluid embolism?
Caused by trauma, fluid containing arachidonic acid metabolites -> occlusion and vasospasm of the maternal pulmonary circulation -> left heart failure-> cardiopulmonary arrest
Foreman ovale
Mandibular branch of the trigeminal nerve
Where to external hemorrhoids drain?
Internal pudendal vein tributaries (inferior rectal veins)
Dissociated identity disorder
marked discontinuity in identy and loss of personal agency with fragmentation into more than 2 personality states
What causes granuloma formation?
CD4 T-lymphocyte reaction that causes damage and cavitation
VATER Syndrome
V- vertebrae
A- imperforate anus
TE - tracheoesphogeal fistula
R - Renal abnomalities
L - limb abnormalities
Eplerenone
aldosterone antagonist (similar to spironolactone)
What does C1 inhibitor deficiency cause?
Cleaving of C2 and C4 and inhibtion of kallikrein-induced convesion of kiniogen to bradykinin
What causes a mahority of overdoses in the US?
Opiods (including heroin)
What is placed on the 5’ cap on RNA stands?
methylguanosine triphosphate
vibrio vulnificus- characteristics
Gram negative, lactose fermenting organism
Where are cGMP-gated sodium channels used?
Vision
Effect of low-dose dexamethasone? High dose?
Does not change for any type of cushings, only ectopic,
High dose only supresses pituitary
Sudden onset of syncopal edisodes, think?
Cardiac arrhythmia, affected by K+ channels (genetically)
Organism causing pneumonia in alcoholics
Klebsiella
What structure lies anterior to the right renal artery?
IVC
How to test for malabsorption?
Sudan III stain- identifies unabsorbed fat and confirm malabsorption
Similar pathogenesis to Giant cell arteritis (temporal)?
Takaayasu arteritis, medial granulmoas
Headache, retro-orbital pain, high-frade feer and joint and muscle pain with skin rash, and thrombocytopenia after travel to Brazil?
Dengue fever
Most common cause of Osteomyelitis in children
S. aureus- hematological spread
What is the problem with Friedreich ataxia?
decreased FXN expression 0> decreased mitochondrial energy and increased oxidative stress, resulting in degeneration of neural tracts and peripheral nerves
Specifically, spinocerebellar and lateral corticospinal tracts (gait ataxia)
Ldegeneration of dorsal solumns and dorsal root ganglia (loss of position and vibration
Hypertrophic cardiomyopathy, and CHFF
Diabetes
cyanotic spells, improve with squatting, systolic murmur
Tetralogyof Fallot, caused by abnormal neural cell migration to anterior and cephalad deviation of the infundibular septum
What is responsible for a majority of drug metabolism?
Cytochrome P450 enzyme
Granulosa cell tumors
Yellow, lipid filled cells, in post menopausal women( Call-exner bodies) with coffee bean nuclei
Bacterial transformation-definition
uptake of naked DNA by a cell
Newer generation of antihistamines
Loratadine, cetirizine, do not cross blood-brain barrier
Denosumab- MoA
Inhibits the RANK/RANK-L interactions -> increased bone density
What is stimulus control for insomnia?
Usened only for sleep and sexual activity; leave bed when unable to sleep and go to another room, fixed wake-up times (including weekends)
Skin lesion on upper eyelid
Xanthelasma
Clomiphene- MoA
selective estrogen receptor modulator - Tx for PCOD
What is the function of the ulnar nerve?
Wrist adduction
Thyroid nodue containing clusters of overlapping cells with large nuclei containing sparse, finaly dispersed chromatin?
Papillary carcinoma (orphan annie eye)
What promotes the formation of gallstones?
High levels of cholesterol with decreased bile salts and phosphatidylcholine (which increase solubility of cholesterol)
How does hypertension arrive in a cresh patient?
sclerosis of everything -> sclerosis in the lungs -> pulmonary hypertension
Lung transplant with bronchial obstruction, dyspnea, dry cough?
Chronic rejection
Choline O-acetyltransferase
Synthesizes ACh
Cause of decerebrate posturing?
Extensor posturing- loss of descending excitation to the upper lumb flexors via the rubrospinal tract (at or below the red nucleus)
Damage is @ the pons
Spherocytes-MCHC
Increased, due to the smaller size
How long for a first-order kinetics drugs to reach steady state?
4-5 half-life
selective media containing vancomycin, collistin, nystatin, trimethoprim? Grows?
Thayer-martin, grows N. Gonorrheae
Uticaria
“Hives” transient hypersensitivity, due to IgE-mediated degranulation -> causes edema of the superficial dermis
Acyclovir- MoA
Inhibits via reverse transcriptase via competing with deoxyguanosine triphosphate
Glioblastoma: characteristics
most common primary cerebral neoplasm in the cerebral hemisphere
large tumors causing mass effect, can see “butterfly glioma”
Necrosis and hemorrhage
Poor prognosis
Oral thrust, interstitial pneumonia, severe lymphopenia in first year of life
Vertical transmission of HIV-1, treat with prenatal antiretroviral therapy
In hypoxia conditions, what glycolysis component is shunted?
Pyruvate -> lactic acid inseat of Acetyl -CoA because of a build up of NADPH
Common asthma allergens
Animal dander, dust mites, cockroaches, pollens and molds
What does prussian blue stain detect?
Intracellular iron
Cyclothymic disorder
2 years of fluctuating, mild hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or major depressive
Signs of Dengue fever
Flu-like febrile illness with marked myalgias, retro-orbital pain, rash (white islands in a sea of red)
Travel to mexico/endemic area
Signs of syringomyelia?
Loss of upper extremilt pain and temperature sensation, and extremity weakness
c-ANCA is associated with what type of kidney formation?
Creascentic glomerulonephritis (rapidly progressing glomerular nephritis
Down syndrome- cardiac defects
Endocardial cushion defects
igE-independent mast cell degranulations?
Morphine, radiocontrast, etc.,
What should be removed in aldolase B deficiency?
Fructose and sucrose
What spinal tracts are affected in B12?
Dorsal columns, lateral corticospinal, axonal degeneration of peripheral nerves
Harsh ejection systemolic murmur at the base of the heart, radiating to the neck
Aortic valve stenosis
What are the functions of ACE-inhibitors?
Systemic vasodilation
Dilation of glomerular efferent arteriole (reduction in GFR, dec. perfusion with dilated vascular size)
Decreases adrenal aldosterone secretion
Webbed neck..association
Turner Syndrome - 46, XO
What connects the vagina to the anus?
Perineal body
Mu receptor effects?
Respiratory & cardiac depression
What type of transmembrane is CFTR?
ATP gated ion channel
Ducts distended by pleomorphic cells with prominent central necrosis without externtion beyond the ductal basement membrane
Ductal carcinoma in site (microcalcification are encountered on mammography)
Kawasaki disease? Risk for?
Medium sized arteries in young children of Asian ethnicity.
Fever for >/= 25 days plus 4 of the following
- bilateral conjunctival injection
- Cervical lymphadenopathy,
- mucositis (strawberry tongue)
- extremity changes
- rash
Increased risk for development of coronary artery aneurysm from inflammation
factors that can lead to vitamin B12 deficiency?
Long-tern vegan diet (years, not months)
What do proto-oncogenes do?
stimulate cell proliferation, and their over expression (activation) leads to increased cellular proliferation and neoplastic growth
Signs of scurvy
Gingival swelling and perifolllicular hemorrhages and coiled hairs
How to AV shunts affect preload and afterload?
Increase preload, decrease afterload
How to calculate RPF
PAH clearance - (urine [PAH] X urine flow rate)/ plasma (PAH)
Hashimoto thyroiditis-hormone changes
Increased TSH, Decreased T4, nomral T3(which is converted in peripheral tissues
What drug provides a signifiant reduction in triglycerides? Side effects?
Fibrates
Side effects: muscle toxicity, gallstones
MoA of calcipotriene
(topical vitamin D analog)m actuvate the vitamin D receptor (nuclear transcription factor) andd cause inhibition of keratinocyte proliferation
How to caoculate half-life
(0.7 x volume of distribution)/CL
How to revent hemorrhagic cystitis associated with nitrogen mustard-based chemotherapy?
Mesna and aggressive hydration
Hemorrhagic lymphocyte pleoctosis, increased protein, normal glucose?
Herpes simplex virus encephalitis
What nerve enters through the foramen rotundum?
CN V2 (maxillary
What type of immunity is antitoxin?
passive immunity
Signs of spinal stenosis? Cause?
bilateral pain provoked by walking, relieved by leading on something with normal strength
Cause- degeneration of spinal cord leading to ligamentum flavum hypertrophy
Ulcers in ZE?
extend beyond duodenal bulb and are refractory to therapy
Name some alpha-1 blockers
Doxazosin, Prazosin, Terazosin
What arteries supply the ureter -proximal? Distal?
Renal artery-proximal
Common iliac, internal iliac, and superior vesical artery-distal (not retained in X-plant
Hepatic changes in hepatitis?
Apoptosis of heratocytes, periportal inflammatory infiltration
Fatique, weakness, itching, cause?
uremia toxins secondary to progressive chronic kidney disease
Signs of HSP?
GI pain, hematemesis, IgA nephropathy, papable purpura in the buttocks and lower extremities, self-limited migratory arthalgias/arthritis
How do corticosteroids affect neutrophils?
Cause demargination removal of neutrophils from the edge of blood vessels and release them into circulation
Cause gram-positive bacteria to swell in hypotonic solutions
Interference with cell wall synthesis ->cephalosporins, vancomycin, penicillins
What can relieve carple tunnel syndrome?
Longitudinal incision through the transverse carpal ligament (flexor retinaculum)
Very large cells with over 100 nuclei?
Osteoclasts in Paget’s disease
How to diagnose type I diabetes?
Hemoglobin A1c > 6.5% or fasting glucose >/= 126
COX1 vs COX2 expression
Cox1 - norrmmal function tissues
COX2-expressed at sites of inflammation
Nigrostriatal degeneration in parkanson disease results in?
Excessive excitation of the globus pallidus interbus by the subthatamic nucleus, which causes excessive inhibition of the thalamus
Delta receptor use?
Antidepressant effects
Analgesia
Lambert-Eaton antibodies?
against pre-synaptic calcium channels
Folate deficiency, level of methylmalonic acid is?
normal
What does fluid infusion do the volume-pressure loop
Rightward extension of the filling portion, and increased maximal pressure
Immune complex vasculitis with igA and c3?
Henoch-Scholein purpura
Presents with purpuric rash, colicky abdominal pain and polyarthralgia
With a build u of 17-hydroxyprogesterone, where is the defect?
21-hydroxylase
What are the effects of exogenous steroids?
Decreased gonadotropin, leading to infertility
Signs of cardiac tamponade?
Jugular venous distention, hypotension, diminshed heart sounds, pulsus paradoxus
Schiztophrenia-characteristics
Fixed delusions, frank hallucinations
Name the potassium sparing diuretics.
Spironolactone and Eplerenone, Triamterene, Amiloride
Near-miss
medical error recognized before any harm has been done
What is associated with delirium?
Waxing and waning levels of consciousness, hallucinations
Heredity bleeding disorder
Von Willibrand Factor
How does long-term use of Levadopa affect movement?
Long-term use leads to On-Off phenomenon that causes fluctuations in movement ability over time, as the therapeutic windows narrows due to natural of levodopa-induced nigrostriatal degeneration
Types of lymphocytes
B-cells and T-cells, NK cells
What structure contains dihydrouridine, ribothymidine, pseudoridine?
tRNA, 3’ end has a CAA sequence used for recognition
What can a double blind study prevent?
Observer bias
Elderly person with hematuria suggests…
renal or urothelial neoplasm
Anaplasia of epithelial cells with invasion into the stroma
Epithelial ovarian cancer
Sertoli cells-function
Facilitate spermatogenesis Produce inhibit in response to FSH
Post-warfarin- reversal agent?
Protein C deficiency,
Warfarin initiation leads to a drop in factor VII and protein C
Tx- remove warfarin, and adminster fresh frozen plasma
Where does chromosome segregation occur during anaphase?
Primary spermatocyte
Function of BCL2
Cell death cascade
What receptors are involved in stimulating the vomiting reflex?
m, muscarinic, D, dopaminergic, h, histaminic (DHM)
When those do not work,neurokinin 1 receptor antagonists can work
Signs of tanstentorial herniation?
Ipsilateral oculomotor nerve compression - fixed and dilated pupil
Ipsilateral posterior cerebral artery compression (contralateral homonmous hemianopsia with macular sparing
Compression of contralateral corticospinal tracts
Brainstem hemorrhages (duret hemorrhage)- basilar artery
Postprandial rapid fluid shifts- cause? Signs?
Gastric bypass or damage to the pyloric sphincter
Postprandial nausea, voliting, cramps, viarrhea, and vasomotor symptoms (diaphoresis, flushihng)
Hear tfilaure in the setting of recent viral infection, think?
Dilated cardiomyopathy caused by viral myocarditis
Pathology of Raynaud phenomenon
increased deposition of collagen in tissues
Pulmonary hypertension: pathogenesis?
Passive increase in pulmonary capillary and arterial pressure caused by pulmonary venous congestion
Wheel-like shaped virus? Structure?
Rota virus
Hypertension in a women > 20 weeks pregnancy?
Pre-eclampsia
Highest incidence of cancer in woman?
breast
Drugs to manage drug-induced parkinsonism
Trihexyphenidyl, denztropine
KRAS
Proto-oncogene
What can reverse methotrexate toxicity?
Folininc Acid
Heparin-induced thrombocytopenia
iGG antibodies against heparin-bound platelet factor 4 _> activates platelets
Spinocerebellar tract?
Proprioception from the body to the cerebellum
What type of antibody is the anti-RH immune globulin?
IgG anti-D -> opsonize Rh+ fetal erythrocytes, administered @ 28 weeks
What is inhibited in drug-induced parkinsonism?
Nigrostriatal pathway (D2 blockade)
Mutations in CML?
CHr 9:22, which causes a tyrosine kinase activation (BCR-ABL)
Phenoxybenzamine-moA
irreversible alpha 1 and alpha 2 inhibitor
SIADH- effect?
Excessive water absorption by the kidneys, -> hypervolemia -> sodium loss by the kidneys
Poorly developed sexual characteristics, cannot smell? mutation?
Kallman syndrome, failure of GnRH-secreting neurons to migrate from origin in the olfactory to the hypothalamus
Muataion KAL-1, GFGR-1
Preventable adverse event?
harm to a patient via act of commission or omission, rather than from the underlying disease
Eczema after environmental exposure in a child?
Atopic dermatitis, seen with allergic rhinitis, asthma (allergic triad)
Pure red cell aplasia
hypoplasia of marrow erythroid elements due to inhibition of prythropoietic precursors by igG autoantibodies or cytotoxic T-lymphocytes
Associated with Thymomas and lymphocytic leukemias or parvo
Signs of hyperaldosterism, Na, K, H level?
normal Na reabsorption, increased K+, H+ exceretion,
How does digoxin slow ventricular rate?
enhances vagal tone -> slows AV node
What causes the removal of RNA primers and the replacement with DNA?
DNA polymerase I (5’-3’ exonuclease activity)
Sudden, involuntary contraction of a major muscle group
Acute dystonic reaction (4 hours-4 days after the initiation of antipsychotic medications)
PCA infarct on vision?
homonymous hemianopia (same side of both eyes)
Risks in pregnant mother with diabetes?
Transient hypoglycemia for the first several days
How to calculate the net excretion of a substance?
(Inulin clearance X Plasma [Substance A]) - (Tubular absorption of substance A)
Lepromatous leprosy-presentation
Weak cell mediated immunity (Th2), leads to myobacterium dissemination -> diffuse skin thickening, plaque-like hypopiigmentation, leonine facies, paresis, regional ansthesia,, testicular destruction, blindness
Small white spots with an erythematous base on buccal musosa?
Koplok spots (associated with measles)
Widespread narrowing of the renal arterioles with deposition of homogeneous, glassy material in the subendothelial space that stains pink with PAS?
Diabetes Mellitus
Bacterial DNA polymerase 1- unique features
5’-3’ exonuclease activity to remove the RNA primer created by RNA primase and repair DNA sequences
