Smart Book Flashcards
boggy, soft, raised, pruritic, erythematous lesions with wheal and flare eruptions
Type 1 hypersensitivity
Locations of RA
Small joints (PIP, MCP, MTP); and cervical spine
Influenza virus signs:
Acute fever, muscle pains, malaise, during winter
Carnitine deficiency
prevents fatty acids from being transported into the mitochondria for beta-oxidation
What happens in the maintenance stage of ATN?
Decreased urine output, fluid overload, increased creatinine/BUN, hyperkalemia
What type of diarrhea is present in cholera?
Mucous and some sloughed epithelial cells
hydroxycabalmin - use
cyanide poisoning
Common causes of noncaseating granulomas?`
Sarcoidosis, reaction to foreign material, beryllium exposure
Pindolol MoA?
Partial beta agonist; intrinsic sympathominetic activity (epinephrine-like activity)
Statin-MoA
Increased LDL receptor turnover
What does the radial nerve innervate?
Sensory-posterior arm, forearm, and dorsal lateral hand Motor- all extensor muscles to the upper limb, below the shoulder
beaded, branching filaments with ring-enhancing lesion
Norcardia
What cancers are EBV associated with?
Nasopharyngeal carcinoma, Burkitt’s, and Hodgkin’s
Pathognomionic for a large PDA complicated by Eisenmenger syndrome
Differential clubbing and cyanosis without blood pressure or pulse discrepancy
Reactive Arthritis
Conjunctivitis, Urethritis, oligoarthritis HLA-B27
Agartoban-MoA
Direct thrombin inhibitor (binds thrombin active site)
Dobutamine- receptor activation
B1> a1 + b2
Lambert-Eaton presentation
hyporeflexia or areflexia, autonomic symptoms, incremental response to repeated stimulation
What part of the heart is closest to the diaphragm? How does blood get there? Assume left dominant.
Left ventricle, Left coronary -> circumflex -> posterior interventricular (posterior descending)
snap, followed by a rumbling diastolic murmur hear over the cardiac apex
Mitral stenosis
Drug Induced Lupus: cause
slow liver acetylation
Steps to base excision repair?
glycoslase, endonuclease, lyase, polymerase, ligase
Emigrant from SE Asia presents with fever, night sweats and weight loss? Diagnosis? What factors helps for the characteristic lesion? Giant multinucleated cells?
TB, interferon-y -> activates macrophages.
Atropine: Role in Glaucoma
muscurinic receptor blockage -> mydriasis -> narrowing of anterior chamber angle -> diminished outflow
Atropine overdose - Tx
physostigmine
Response to smoking in the lungs…cilia? Macrophages? Mucous?
Cilia-down Macrophages/mucous - up
Cardiac problems with changes in vision….
Digoxin; look for elevated extracellular potassium
SERM used?
Inhibit the effect of estrogen in breast tissue; prevents gynocomastia
Dermatomyositis: Associations
paraneoplastic syndrome- ovarian, lung, colorectal, non-Hodgkin Lymphoma
Mental retardation, self-mutilation, nail biting, spasicity
Lesch-Nyhan Syndrome- HMGRT deficiency, leads to buildup or uric acid in the body, X-linked recessive
torticollis
uncontrollable contract of the SCM
What factors promote osteoclast activity -> bone resorption
interleukin-1 and TNF-alpha
Presentation to CD8+ cells is mediated through which pathway
Ubiquitin proteasome pathway
E6
gene product inhibits p53 syooressir gene
koilocyte
Sign of HPV, an immature squamous cell with dense irregularity in staining cytoplasm and perinuclear clearing, resulting in a halo
What is the MoA of Erythromycin?
Inhibit protein synthesis by blocking translocation; bind to 23S rRNA of the 50S ribosomal unit; bacteriostatic
Signs of ischemic colitis?
History of strokes indicitative of atherosclerosis, site of injury is located around watershed area
Low stage vs high stage
High-lymphadenopathy, mets, invasion low- lacks above
C. perfingens toxin
alpha toxin- Lecinthinase (Phospholipase C); phospholipid splitting
Zidovudine- Side effects
Bone Marrow suppression via inhibition of DNA polymerase (mammalian)
decubitus
laying down
Effects on an arteriovenous shunt
Acute- decreased TPR, -> increased CO/venous return Chronic- sympathetic compensation->dec. TPR, Inc. mean resistance pressure
How is cholesterol converted to estrogen?
LH stumulated Theca cells to synthesize androgens (progesterone leaves) and the androgens are processed to Estrogial by granulosa cells via aromatase
CEA
Colorectal
What is reverse T3?
inactive form that is generated entirely from peripheral conversion of T4
What is down syndrome associated with?
Early-onset Alz and ALL
Perinaud syndrome
limitation of upward gaze with a downward gaze preferential
Candidemia
systemic Candida infection, blood grows infection -results from low necrophilia counts
Undifferentiated somatoform disorder
Physical complaints for more than 6 months that cannot be contributed to a medical condition
How to calculate expected pCO2 compensation?
[pCO2] = 1.5*[HCO3-]
silver stain with slow growth on buffered charcoal extract medium (suplemented with L-cysteine and iron): organism?
Legionella pneumonia
How does an aneurysm of the PCA effect vision?
Applies pressure to CNIII (and sympathetic ganglion)
conjunctival injection
red eyes
Large cells with abundant basophilic cytoplasm?
Myelolasts- contain Auer rods Stain positive for peroxidase
Gluathione reduction: function?
catalyzes the reduction of oxidized glutathione.; Absence leads to the inability to reduce NADPH to reduce glutathione; similar to glucose-6-phosphotase
Hemolytic Uremic Syndrome: Signs:
Diarrhea illness (often bloody), hemolytic anemia with schistocytes, thrombocytopenia, acute kidney injury
Goodpasture Syndrome
Type II hypersensitivity, crescent moon shaped (fibrin and plasma proteins (c3b) with glomerular parietal cells, monocytes and macrophagesl antibodies specificially against GBM and alveolar basement membrane -> linear IF; Presents with hematureia/hemoptysis, Rx - emergent plasmapheresis
Most common cause of cancer death in men and wome?
Lung cancer
Chronic worry, feeling on edge, muscle tension, incomnia
generalized anxiety disorder
Fever and sore throat in a patient with hyperthyroidism
Thionamide-induced agranulocytosis
What enzyme is Vit K a cofactor for?
gamma-glutamyl carboxylase
Lung: wedge shaped hemorrhage: Diagnosis? Cause?
Pulmonary emboli, cause by tricuspid endocarditis
Thiazide- MoA
Inhibits Na-Cl transporter; leads to increased calcium resorption Hyper GLUC Glucose Lipidemia Urecemia Calcemia
Hereditary orotic aciduria: Signs,
Signs: physical and mental retardationm megaloblastic anemia, elevated urinary orotic acid levels
Clopidogrel - MoA
blocks P2Y12 component of ADP receptors
What is the role of Ghrelin?
Mediated hunger, decreases when food in consumed
Rhizomelia
proximal limb shortening
Cocaine MoA
Norepinephrine reuptake in the presynaptic terminals
Eisenmenger syndrome
Heart failure (shortness of breath, fatigability) and cyanosis -reversibility of a left to right shunt to right to left
Odds ratio
a*d/b*c
How would vitamin K deficiency present?
Intracranial, gastrointestinal , cutaneous, umbilical @ surgical site bleed
Cellular damage in Sarcoidosis is caused by
TH1 helped 2 cells
Signs of Acute inflammation
Neurophils and Monocytes
ST elevation in lead 1 and aVL?
Lateral limb leads MI and left circumflex
Marijuana signs:
Mild euphoria increase, inappropriate laughter, slowed reaction time,
Where is the cardia of the stomach location?
At the top of the stomach (by the gastroesophageal junction). It is next to the lesser omentum.
What is the most effective dietary changes to reduce someones risk of developing type II diabetes?
Reducing caloric intake
C5a: function
Neutrophil recruitment
Recurrent TB infections during childhood
Interferon-gamma signalling IL-12 (macrophages) -> activate T-cells -> secrete TNF-gamma-> Janus Kinase 1&2 -> STAT1 -> enhances intracellular killing
Blastomyces: Characteristics
Broad-based bud in yeast form branching hyphae in mold form
How does a protease affect HIV replication?
HIV will lack a mature core
Severe anemia following minor febrile illness?
Aplastic anemia
Action and lcation of loop diuretics
NA-K-2CL symporter in the think ascending limb of the loop of henle
Role of p53
Stops progression from G1 to S and induces apoptosis if there is a problem with the cell
Cyanide toxicity: Presentation?
altered mental status, seizures, CV collapse, lactic acidosis, bright red venous blood
Tumor staging
Stage A-confined to mucosa Stage B- enters muscularis Stage C- lymph node involvement
Role of IkB?
Dephosphorylated (inactivated) state limits access of NFkB into the nucleus
Atropine:
antimuscurinic- “Hot as a hare, red as a beat”
Calcitriol
Activated vitamin D- increases Ca2+ absorption
TCA overdose- signs
Mental status changes, sinus tachycardia, hypotension, dry mouth, blurred vision, urinary retention, arrhythmias
Acute hemolytic transfusion reaction
fever, chills, hypotension, chest/back pain; Complement mediated cell lysis
Classical galactosemia-inheritance pattern?
Autosomal recessive
how is glucose regenerated during fasting?
Malate -> oxaloacetate (Phosphoenolpyruvate carboxykinase) -> Phosphoenolpyruvate
What enzyme can covert a pro-carcinogen to a carcinogen?
Microsomal monooxygenase (Cytochrome p450 system)
Inhaled amyl nitrite- MoA
Oxidized Fe2+ to Fe3+ to generate methylhemaglobin to reduce cyanide binding to Cytochrome C oxidase
Pulsus paradoxus
> 10mm Hg drop in blood pressure during inspiration; difference between Korotokoff’s sounds during expiration and throughout respiration quantifies pulsus paradoxus
Pulsion diverticulum
increased luminal pressure created during strained bowel movements (chronic constipation)
Dopaminergic receptor signal transducers
d1 - Gs d2 - Gi
Polycystic Ovarian Disease-Hormoney levels
Inc. LSH, FS, Androgens Hyperinsulemia or insulin resistance
How does N. meningitis spread once infected?
Pharynx -> blood -> choroid plexus -> meninges
Cyanide toxicity: antidote
Sodium Thiosulfate -> provides sulfur groups for Rhonadese, to inc. cyanide detoxification Used in conjunction with hydroxocalbalamin and sodium nitrite
Pseudomonas- method of infection
water sources (hot tub folliculitis
nighttime dyspnea, family history of atopic dermatitis: Diagnosis?
Asthma
Draw the brachial plexus
Insert drawing here
Abciximab-Moa
Glycoprotein IIb/IIIa antagonist
Describe the characteristics of bacterial vaginosis?
Anaerobic, gram-variable rod
Isoniazid can lead to a deficiency of which vitamine?
B6, pyridoxine
Acute promyelocytic leukemia
Auer rods, t(15:17) translocation (RARalpha:PML); tx is all-trams retinoic acid
What causes milky opacity of the senses that is a glucose metabolite?
Sorbitol; formed froom glucose via aldose reductasel; aldose reductase is faster than sorbitol dehydrogenase with converts sorbitol to fructose
Arsenic- first line chelator
dimercaprol
Function of the proteosome
degrades damaged or ubiquitin-tagged proteins,
Camplobacter infection sources?
animals, undercooked food
Effect of metronidazole on Alcohol metabolism?
Inhibits acetaldehyde dehydrogenase (similar to bisulfram)
Tumor with augmentation of strength in repeated tests
Small cell Lung Cancer (lambert Eaton)
Decidua basalis
maternal blood flow in the lucanae; attached placenta to womb
What effect does long-term steroid have on the adrenal gland?
Long-term steroids can lead to bilateral cortical atrophy
What cell types for the aorticopulmonary septum and endocardial cushion?
Neural crest cells
Sporotrichosis..contraction?
fungus dound in natural environment (bank of trees, shrubs, etc.) enters the body through breaks in the skin (thorns, etc.) Common in gardeners
Auer rods
purple-red inclusion in blasts cells - think AML
Signs of Wegener’s?
Hematuria, RBC casts, mld proteinuria, oliguria, and hypertension
Small of absent lymph nodes
X-linked Agammaglobulinemia
Small intestinal bacterial overgrowth - signs
nausea, bloating, abdominal discomfort, absorption
What drugs should be avoided in hypertrophic cardiomyopathy?`
vasodilators, diuretics
What nerve is responsible for a winged scapula
Long Thoracic, c5,6,7, seratus anterior muscle
Antibiotic that binds to D-Alanine-D-Alanine? Method of Resistance?
Vancomycin Convert to D-Alanine-D-Lactate
Blunt abdominal trauma in a MVA, think?
Splenic repture; increased risk of encapsulated organs
PAS staining-detects
Live fungus
adenovirus Signs:
Conjunctivitis, fever, cough, congestion
Schistosomiasis damage
ulceration of scarring of the bowel and bladder/uterus and oeriportal “pipestem” fibrosis ) from eggs)
Bicornuate uteris characteristics? Cause?
Indentation in the center of the fundus, failed lateral fusion of the paramesonephric ducts
TRAP
Hairy Cell Leukemia
What artery runs on the posterior aspect of the duodenal bulb?
Gastrointestinal
Function of the superior gluteal nerve?
Innervated gluteus medius and minimus, tensor fasciae latae; trendelberg sign
Antithyroid drugs
methimazole, propylthiouracil
Teen male patient comes in with painless swelling of left breast for 1 month
Normal
Tricuspid regurgitation- murmur
Increases with inspiration best heart left 2nd and 3rd intercostal space
Affect on ventricular size with aging
decreased left ventricular chamber size, sigmoid shaped
Non-selective alpha and beta antagonists
Labetalol, Carvedilol
Cardiac conduction velocity
Fast > purkinje system > atrial muscle > ventricular muscle > AV node “Park at Venture Avenue”
Anti-centromere
Limited Scleroderma (CREST)
What is found in the Lymph node outer cortex?
B cells and T cells, diminished in agammaglobulinemia
Flunisolide
Inhaled glucocorticoid
Health maintenance organization: benefits
low monthly premium, low copayments, and deductibles, and low total cost for the patient
Prolonged QRS with little QT interval effects?
Class IC antiarrhythmics (Flecainide, propafenone)
ADHD tx
methylphenidate, amphetamines
Hepatitis Genome
Partially double stranded DNA
TMP/SMX-MoA
Inhibits tetrahydrofolic acid -> decreased synthesis of purines and pyrimadines
Lesch-Nyhan syndrome-inheritance
X-linked recessive
Most common cause of meningitis in children? 6-60? elderly?
S. Pneumoniae
How does an ectopic pregnancy look on histology?
dilated, coiled endometrial glands and vascularized edematous stroma
High levels of 5=ALA and porphobilinogen, deficiency?
Porphobilinogen deaminase
Nasal polyps
CF and Aspirin sensitivity
Temporal summation
Addition of multiple impulses over time; (ie, dendrites, cell body, axon hillock
Repeated splenic infarcts leads to
fibrosis and atrophy of the slpeen
Specific test for acute cholecystitis?
Failed visualization on radionuclide biliary scan
Eisenmenger syndrome
Reverse of left-to-right shunt due to pulmonary vascular sclerosis, resulting from chronic pulmonary hypertension
Signs of cardiomyopathy
Heart failure, S3 heart sound, enlarged heart, regurgitation sound
B2-adrenocrepectors functions
Smooth muscle relaxation in uterus, decreased GI motility, decreased bladder contraction, bronchi relaxation, increased blood profusion, insulin secretion, skeletal muscle tremor, contraction speed, glycogenolysis
Predominant hemoglobin form innewborn
Fetal hemoglobin (HbF and alpha2, gamma 2)
The paramesonephric ducts give risk to what?
Fallopian tube,s uterus, cervix, and upper vagina Also knows as the mullerian ducts
Contemplation
Acknowledge a problem, but not yet willing or able to commit
What is the start codon?
AUG
Edwards syndrome
Trisomy 18, fetal growth retartation, hypertonia, micrognathia, and conjenital heart defects, clenched hands with overlapping fingers, merkel’s diverticulum, and malrotation
Organisms that increase the risk of ectopic pregnancy?
Gonorrhea, Chlmydia
Chronic mesenteric ischemia
Atherosclerosis of the mesenteric arteries; presents with postprandial epigastric pain “intestinal angina”
Proteus Mirabilis
Urease positive, common cause of struvite stonesl classically results in staghorn calculi in renal calyces
What causes Polycythemia Vera
C617F mutation involving the JAK2 gene. This makes the hemotopoietic cells more sensitive to growth factors such as erythropoietin and thrymopoietin
Isolated Hypertension
systolic > 140 with diastolic
First order kinetics elimination
Constant percentage of drug is eliminated each time
Intussusception: presentation
intermittent severe colicky abdominal pain, “cureant jelly” stools, and sometimes a palpable mass in the right, lower quadrant
HFE mutation: MoA
reduced endocytosis of iron-tranferrin complex
Post-streptococcal glomerulonephritis- risk for poor long-term prognosis?
Increasing age
What is the rol eof fructose-6-phosphate?
control the balance between gluconeogenesis and glycolysis by activating PFK-1, which converts Fructose-6-phosphate to Fructose-2,6-bisphosphate
Lebes herditary optic neuropathy-inheritance
mitochondrial
myoclonic epilepsy with ragged -red fibers
myoclonic seizures with myopathy associated with red fibers with exercises Irregular shaped muscle fibers on biopsy
Midgut Volvulus: Cause
Mesentery twisting around the superior mesenteric artery
Celiac disease and multiple pneumonias. Diagnosis?
IgA deficiency
Small Cell Lung Cancer associations
SIADH, Lambert-Eaton,
Fabry Disease: Cause
-linked recessive lipid storage disorder alpha-galactosidase A deficiency (breakdown globotriaosylceramide)
Organophosphates-MoA
Acetylcholinesterase inhibitors- acts in the gap junction,
What is responsible for the green colored sputum in bacterial pneumonia infections?
myeloperoxidase from neutrophils
RBS with dark, intracellular inclusions that stain with supravital stain
Heinz bodies in G6PD
High fever, confusion, headache, watery diarrhea, mildly productive diarrhea: Diagnosis?
Legionella pneumoniaphilae
Where is the bladder located?
Extraperitoneal, touches the anterior abdominal wall when expanded
Budding + catheter think?
Candida Albicans
Cross-sectional study?
Data from a particular point in time. What is happening?
What can onddansetron treat?
Chemotherapy=induces emesis Also use, Granisetron
Prostate cancer is associated with what psychological condition?
Depression
Pannus
Proliferative granulation tissue –> observed in RA
Triad of congenital toxoplasmosis:
hydrocephalus, intracranial calcification, chorioretinitis
Enveloped viruses are inactivated by what?
Ether, organic solvents
craniopharyngeoma- large growth
Compresses stalk of pituitary stops hypothalamus dopamine from reaching the pituitary -> inc. prolactin secretion
Reyes Syndrome
hepatic encephalopathy, associated with viral infection (VZV and influenza B) that has been treated with aspirin
Wide, fixed splitting of S2
Atrial septal defect -> could potentially lead to pulmonary HTN is untreated
Thiamine is a necessary cofactor for which reactions in
pyruvate dehydrogenase, alpha-ketagluterate dehydrogenase
Inhibitor of fatty acid metabolism
Maloyl-CoA, which inhibits carnitine acyltransferase
c-Jun
nuclear binding factors; also c-FOS
Signs of neostigmine overdose
difficult breathing, severe muscle weakness; high doses cause desensitizing of nicotonic receptors Cholinesterage inhibitor
Hammer toes:
Friedreich Ataxia
What is increased in Lesch-Nyhan?
PPRP- Phosphoribosyl phosphate phoshoriribosylransferase
Antisocial personality description:
repetitive and pervasive behavior that violated the baseic rights of others or social norms, destruction of property, aggression towards animals
Platelet aggregation in response to Ristocetin is normal in whhich deficiency?
Glycoprotein IIb-IIIa receptors
Hepatitis B liver slide
finely granular, homogeneous, dull eosinophilic inclusions (filled with hepatitis B surface antigen)
What effect does alcohol have on acetaminophen metabolism?
Alcohol induces CYP2E, which in turn metabolized increased amounts on acetaminophen to NAPQI, which is detoxified by GSH. Decreased levels of GSH increase the risk of ROS injury
Dihydroergotamine-dx and MoA
Dx- migraine headaches MoA- constrict blood vessels
Where in the kidney does lithium have an effect?
Collecting ducts.
Portion of the urethra most susceptible to damage
Membranous portion, just below prostate
Metanephric mesoderm: Forms?
AKA blastema- gives rise to the glomeruli, Bowman’s space, proximal tubule, loop of Henle, and distal convoluted tubules
Aplastic anemia
pancytopenia from toxins r t-cell issues
Anti-Jo-1
Polymyositis, dermamyositis
Acetazolamide MoA
carbonic anhydrase inhibitor: self-limited NaHCO3; diuresis, and decreases total body HCO3- stores; acts in the proximal tubule
Side effects pf Thiazide diuretics
hyponatremia, hypokalemia, hypercalcemia, hyperglycemia, hypercholesterolemia, hyperuricemia
What forms the superficial inguinal ring?
External oblique muscle aponeurosis
Dyspnea, bibasilar crackles and s3 heart sounds post-MI
Left ventricular heart failure -> dec. lung compliance
What valve is in danger after a myocardial infarct?
Mitral
4th aortic arch
Left- aortic arch Right- proximal right subclavian
Tuberculoid leprosy-test?
PPD, TH1 response is intact, allowing the recruitment o IL-2 and interferon-gamma to produce a reaction
parethesias and numbness in the dorsum of the right foot- nerve? and damage location?
Common peroneal nerve Fibular neck
Motor end plate potential- receptor effect
Increased receptor availability increases potential; decreased receptor availability decreases potential
Low grade vs. High grade
Low grade- well differentiated High grade- poorly differentiated
What is length constant?
aka-space constant How far along a nerve a signal can propigate
Mitral Stenosis-Left Atrium pressure changes
Increased left atrium pressure. Normal is the same as LVEDP
ADHD neurotransmitter deficiencies
Norepinephrine and dopamine
How is niacin synthesized
Primary- Nicotinamide (from diet) Secondary- Tryptophan -> Quinolinate -> Niacin or nicotininc acid minonucleotide (NAD)
Polycythemia Vera: Lab presentation
Increased RBC mass, plasma, platelet volume with low erythropoietin
Budding yeast with thick capsule?
Cryptococcus neoformans
Drug-induced lupus: anti-bodies
anti-ANA, anti-histone
TNF-alpha affect on insulin
Increases insulin resistance through the activation of serine kinase Catecholmines, glucagon, corticosteroids work in the same manner
germinoma
midline malignant tumor of embryonic germ origin of the pineal gland
What substances competitively inhibit iodine uptake in the thyroid?
perchlorate and pertechnetate; competitive inhibition
Nitrates MoA
Increased cGMP -> decreased intracellular Ca2+ -> decreased myosin light-chain kinase -> myosin light-chain dephosphorylation -> vascular smooth muscle relaxation
Fluoxetine-MoA
Selective Serotonin reuptake inhibitor
Cyt a + a3
Cytochrome C, AKA Complex IV of the electron transport chain
Protein M
Inhibits phagocytosis and the activation of complment
When the peak potassium permeance the greatest in nerve depolarization?
During repolarization
Blood gas coefficent
describes solubility of inhaled anesthetics in blood
Diffuse muscle cramps, especially after exercising?
Statin-induced myopathy
BNP signaling pathway
guanylyl cyclase converts GTP to cGMP; cGMP activated cGMP protein kinase
What is the active thyroid hotmone?
T3
pinpoint pupils and decreased respiration?
Opiods -> Ie. heroin
meromelia
failure on part of a limb to develop; thalidomide
Fibronectin: Used?
cell adhesion, growth, migration
Drugs that can cause drug induced lupus
Procainamine, Hydralazine, Isoniazid, Minocycline, quinidine
Where is ADH synthesized
paraventricular and supraoptic nuclei of the hypothalamus, eventually secreted by the posterior pituitary
You have to add primaquine to treat hypnozoites for which 2 species?
F. Vivax and Ovale
2nd aortic artch
Hyoid artery, stapedial artery
rivaroxban- MoA
Inhibits Factor Xa, used in venous thromboembolism and A. fib.
Cardiogenic shock signs:
Loss of consciousness, sudden and ongoing rapid heart beat, sweating, pale skin, weak pulse, rapid breathing, decreased or no urine output
Drug treatment for anaphylactic shock?
Epinephrine (alpha 1, beta 1) stimulation
Heroin withdrawal signs
hypersensitivity, increased sympathetic discharge
What does von Willibrand factor bind to?
Glycoprotein iB receptors, carried factor VIII Binds to exposed collagen underneath damaged endothelium
Polyarteritis Nodosa
Transmural wall inflammation of arterial wall with fibroid necrosis
Jugular Venous pressure tracing
Primary amenorrhea
absence of menses by age 15 in someone who has normal growth and secondary sex characteristics
Spherocytosis
AD hemolytic anemia -> look for spherical RBCs without a center pallor zone; Defect is in spectrin and ankyrin, a cytoskeletal protein
Treatment for COPD?
beta 2-agonists; activates Gs to increase cAMP concentration -> relaxation
Well differentiated, dysplastic columnar cells with growth along intact alveolar septae
Adenocarcinoma in Situ
Medulloblastoma: histology
Solid with tiny blue cells
Which drug lengths QT, but has a low incidence of torsades de pointes
Amiodarone
Calcium channel blocker- side effects
Constipation, edema, flushing, CV (HF, AV block sinus node depression)
Carbidopa-MoA
Stop peripheral degridation of L-Dopa reduces peripheral affects, however, does not stop neurological (anxiety, agitation)
Andrenergic receptor signal transducers
a1 - Gq a2 - Gi b1 - Gs b2 - Gs
Does not aggregate in the presence of ristocetin?
Von Willebrand factor
Filtered fraction equation
GFP/renal plasma flow rate
Terbinafine: MoA
inhibits synthesis of fungal membrane ergosterol via squalene epoxidase
Sensitive vs Specific
Sensitivity-rules out a disease Specificity- rules in a diease
Agitation, disorientation, pharyngospasm, photophobia leading to coma, death..
Rabies encephalitis
Method of resistance for fluoroquinones
DNA gyrase mutation
Polycystic Ovarian Syndrome presentation
amenorrhea/oligiomenorhea, hirsutism, acne, decreased fertility; associated with obesity
How does HbS cause symptoms?
Causes hydrophobic interactions among hemoglobin molecules
Lowest pH in the nephron
Distal tubules and collecting ducts
Where does thyroxine act?
Thryoxine binds to nuclear receptors
What drugs can help speed up the development of sulfactant pre-delivery?
Dexamethasone, bethamethasone
Liquifactive necrosis
Lysosomal digestion of the necrotic tissue in the brain
Varicocele
backup of blood into the testicular pampiniform plexus
Renal plasma flow rate calculate
RBF*(1-hematocrit)
Milrinone
phosphodiesterase 3 inhibitor; stops cAMP degradation, inc. heart contractility Also increases dilation in arteries, causes BP reduction
Tumor Homing
Recognition of “exit sites” on blood vessels in target tissues; i.e. breast cancer targets brain cells
DVT is pregnancy, treatment?
Low molecular weight heparin (enoxaparine
How to calculate maintenance dosage?
[Steady state concentration x clearance]/bioavailability
Treatment for PTSD
Cognitive therapy, SSRI
Sporotrichosis, organism?
Sporothrix schenckii
abrupt hemoturia with sickle cell disaese?
Acute tubular necrosis
Does the cerebellum control contralateral or ipsilater?
Ipsilateral
How is an aneurysm formed?
Transmural inflammation -> defredation of elestin and collagen by proteases -> loss of eslastin -> abnormal collagen remodeling -> weakening aortic wall
Placenta Accreta
Placenta attaches to myometrium without penetrating it
Holosystolic murmurs
tricuspid, mitral regurgitation; ventricular septal defect
Hemophilia B-inheritance/
X-linked recessive
Dobutamine- MoA
Gs -> increase cAMP, Ca2+ increase, increased contractility, and HR (inc. myocardial oxygen consumption)
Most common cause of UTI?
E. Coli
M. pneumoniae: additional risks
Hemolytic anemia from the cross-reaction of IgM with erythrocytes
What enzymes neutralize reactive oxygen species?
superoxide dismutase, peroxidase, catalase
anti-HBs
indicated resolution of acute infection or vaccination (negative HBsAg -confers long-term immunity
Radial traction
increased outward pulling, restrictive lung disease
Stain to turn fat black
Osmium tetroxide
Fasting leads to critically low glucose levels
defect in beta- oxidation in the mitochondria -> acyl-CoA dehydrogenase
Long slender microvilli containing tonofilaments
mesothelioma, tonofilaments are desmosomes
Organophosphate- Tx
Atropin, pralidoxine
Function of c3b
Opsonization and activation of the MAC complex works with IgG
Indirect inguinal Hernia: Site, lower, median border
Site: Deep inguinal ring lower- inguinal ligament medial - inferior epigastric vessels
parvovirus B19: characteristics
non-enveloped single-stranded DNA
Bambesin
Neuroectodem tumors (carotid body,)
What composes a splceosome?
snRNPs, proteins, pre-mRNA; removes introns
Acute Salicylate overdose
Respiratory alkylosis, followed by metabolic anion-gap acidosis
With abuse patients, what is the physicians primary goal?
Make sure they have a safe place to go
“bursts of coughing” with vomiting afterwards: suspect?
Pertussis, a gram negative coccobacillus
What is the role of negative selection?
Eliminate high affinity cell; reduce self-immune reactions
What structures drain into the IVC via the left renal vein?
Left testicular artery and renal vein
H. influenzae virulence factors?
Hib- polysaccharide capule: polyribosylribitol phosphate Prevents phagocytosis by inhibiting factor H
What test is used to monitor Warfarin
Prothrombin time
Where are parietal cells location
Upper glandular layer
In alcohol metabolism, what reaction consumes NAD+
alcohol dehydrogenase; increases NADH to NAD+ ratio
22q11 deletion: Dx name
DiGeorges Syndrome
Na, Cl, Ca storage
extracellular
What is Rheumatoid Factor and what does it target?
RF is an IgM autoantibody that targets the Fc portion of IgG
Most common cause of prostatitis?
E. coli
Patient with pneumonia receives blood transfusion and develops facial swelling, etc.? Diagnosis? Why?
IgA deficiency -> leads to over production of IgE that reacts with donor blood
B. fragilis- characteristics
gram negative, bacillus, anaerobic
Brown granular casts
Acute tubular necrosis;most common cause of acute kidney damage in hospitalized patients; usually resolves spontaneously; location: proximal convoluted tubule, ascending limb
Patau- cytogenetic studies
meiotic nondisjunction
Endothelial nitric oxide synthasis: Location and substrates
Location: vascular endothelial cells Substrates: arginine, O2, NADPH
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes
MELAS- stroke-like episodes with residual neurological deficit, muscle weakness, seizures
How do you evaluate the suseptability of Ankylosing Spondylitis?
Analysis of Class 1 MHC Allele expression
Cushing syndrome workup test
Dexanethasone suppression test
Natural Transformation
Uptake and incorporation of foreign DNA into a bacterium- requires the bacterium to become competent
Breast milk lacks what?
Vitamin D and K
What is the most effective preventive intervention to improve health outcomes?
Smoking cessation
Chronically ill individual with low hemoglobin/hemoatocrit. How to treat?
EPO
Alcohols effects of p450?
Induces it
What is contained in the paracortical lymph node?
T-lymphocytes and dendritic cells
Hypocretin-1 alternative name
Orexin-1
Treatment for DVT?
Warfarin
Define gastric erosions vs. gastric ulcer
Mucosal defects that do not extend fully into the muscularis mucosa vs. gastric ulcers that extend into the submucosa
Signs of a manic episode?
Distractibility Impulsivity/indiscretion Grandiosity Flight or fight activity increase Sleep decrease Talkativeness with/without dilusion Diagnosed as bipolar 1 disorder
Tumbling rods
Listeria
Congenital toxoplasmosis: infection route?
In utero infection; only if mother is affected during the first six months
What is at risk for damage in the 3rd part of the duodenum?
Superior mesenteric artery
Cutaneous neurofibromas
Early adolescence, multiple, raised fleshy tumors (
What factors use cAMP signaling?
FSH, LH, ACTH, CRH, hCG, ADH, MSH, PTH, calcitonin, GHRH, glucagon (FLAT ChAMP)
Cholchicine-MoA
second-line therapy; inhibition of microtubular formation
Acute Interstitial nephritis: Causes
Diuretics, NSAIDS, Penicillin and cephalosporins, proton pump inhibitors, and rifampin
Wiskott-Aldric
Thrombocytopenia, recurrent infections, eczemia
Acute Intermediate porphyria: Tx
Inhibit ALA synthase, glucose and heme Limit use of P450 induces
What type of epithelium is contained in the r eminent thyroid duct cysts?
Thyroid follicles
JAK2 signal type
tyrosine kinase
Fish oil -MoA
Decreases VLDL and triglycerides production via antagonism of receptors
Fabry Disease: Signs
neuropathic pain, hypohidrosis (dec. sweating), severe distal extremity pain, angiokertomas, and telangiectasis, proteinuria and polyuria (leading to renal failure)
Federoxamine
iron overload and overdose
Hemochromatosis: Effects
Dilated cardiomyopathy (reversible), hypogonadism, HCC (cause of death)
P450 inducers
Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
Function of the inferior gluteal nerve?
Gluteus maximus, extention and external rotation; trouble rising from a seated position and climbing stairs
Coffee ground emesis
peptic ulcer disease
What artery runs with the radial nerve at the mishaft of the humerus?
Deep brachial (AKA profundi brachii) after it branches from the brachial artery
Leukomoid Reaction
Increased white blood cell count, or leukocytosis, which is a physiological response to stress or infection
Pilocarpine-MoA
non-specific muscarinic receptor antagonist
What are the risks associated with congenital rubella?
sensorineural deafness, cataracts, and cardiac malformation (PDA_
-melia
limbs
Sumatriptan
Serotonin agonist; inhibits trigeminal nerve activation prevents vasoactive peptide release’ induce vasoconstriction; Rx- acute migraine, cluster headache attacks
How to calculate resistance in parallel?
1/R1 + 1/R2 + 1/Rn
Dermatomyositis
bilateral proximate muscle weakness violaceous eruption on eyelids and knuckles
Multiple myeloma- characterics
hyperCalcemia Renal failure Anemia Bone/Back pain
What are brown pigment stones characteristic of?
Infection-formed gallstones
Wants due to HPV?
Condyloma acuminata
Clavulanic acid
beta-lactimase inhibitor; expands antibiotic spectrum to include beta-lactamase synthesizing bacteria
“honeycomb uterus” “cluster of grapes”
Complete hydatidiform mole
Shiga toxin - MoA
Phage encoded -> inhibits 60s ribosomal subunit -> inhibition of protein synthesis -> cell death
Leading cause of death in women is
CVD
“serpentide” pattern in TB
Cord factor (virulence)
Scopolamine- side effects
anticholinergics, blurry vision, dry mouth, urinary retention,, constipation
What area of the lymph nodes do T-lymphocytes and dendritic cells populate?
paracortex
Zinc finger motif: function
Located with hormones that directly bind to DNA Steroids, thyroid and fat-soluble vitamins
Loading Dose Calculation
Volume of distribution X serum concentration X body weight
Transplant patient with pneumonia and intranuclear and cytoplasmic inclusions (owl’s eyes)
CMV- double stranded enveloped virus
What is a marker for testicular cancer?
b-HCG
Endoneural arterioe hylanization
Associated with DM (diabetic microangiopathy), distal symmetric peripheral polyneuropathy, starting in feet
What should be monitored with Lithium
BUN, Creatinine, thyroid function
Where does the trigeminal nerve exit the brainstem?
Lateral aspect of the mid-pons at the level of the middle cerebral peduncles
What does the 1st pharyngeal arch develop into?
maxillary processes, and mandibular processes, bones of the lower 2/3 of the face and jaw
Cytokeratins
keratin-containing intermediate filaments that make up the exoskeleton of almost all epithelial cells.
Early Signs of GVHD
maculopapular rash (palms and soles- desquamate (flaky) GI- diarrhea, intestinal bleeding, abdominal pain Transplanted organ remains unaffected
What organism is associated with gastric cancer?
H. pylori
Myasthenia Gravis- organ abnormalities
Thymoma, and other thymus disorders
E7
inhibits RB supression gene
HER2/ney oncogene encodes?
185-kD transmembrane glycoprotein that has tyrosine kinase activity
Fibromyalgia-signs
widespread musclulocutaneous pain with fatigue, impaired mental attention; multiple tender points in various locations
SLE signs? specific antibody?
skin rash, photosensitivity, arthraglia anti-dsDNA, anti-Smith
Schizophrenia signs? Tx?
social isolation, disorganized behavior, delusions, thoughts disorder Tx- atypical antipsychotic, Olanzapine
Acute Intermittent Porphyria: Signs
variable gastrointestinal and neurologic symptoms, reddish urine
Where is the pulmonary vascular resistance the lowest?
@ the functional residual capacity line (ending TV)
What is alpha?
The significant level, the likelihood of detecting something significant when it is not
Signs of hydronephrosis?
Increased volume in renal pelvis
How do atherosclerotic plaques grow?
release of PDGF -> smooth muscle cell migration from media to intima -> SMC proliferation
Pyrophosphate analog
bisphosphonates
Blood vessls involved with epistaxis
Anterior- Nasal Septum (Kiesselback plexus-anterior ethmoidal artery, sphenopalatine artery, superior labial artery) Posterior- Posterior Wall (Sphenopalatine artery)
Drugs to prolong mortality in HF patients
Spironolactone, eplerenone; any potassium sparing diuretics
Signs on neurosyphilis
headaches and memory loss
Where to colonic lymph nodes drain?
inferior mesenteric to internal iliac
Chlorpheniramine: side effects
Dizziness, drowsiness
Signs of femoral nerve injury
Inability to extend quadriceps muscle, loss of patella reflex, and loss of sensation of anterior and medial thigh and medial leg
Hodgkin’s lymphoma- signs
Reed Steinberg cells *large cells with 2 nuclei), non-tender lymphadenopathy
Atypical cells with abundant lacey cytoplasms in peripheral blood smear?
Reactive cytotoxic T-cells (reacting to EBV infected B-cells.
Muscle ridgity with very high fever
Malignant hyperthermia, syccinylcholine
Intraductal papilloma vs pituitary adenoma
Intradutal piapilloma is unilateral, whereas pituitary adenoma is bilateral
What are the side effects of long-term alcohol abuse?
Thiamine deficiency -> Vermin degeneration -> Gait Ataxia
Phelan sign
Flexion of wrist reproduces carpel tunnel syndrome
Gower Sign
using hands to rise from a squat
What regulated the hypothalamus-pituitary-thyroid axis negative feedback?
T3
What is normagonadotrophic an-ovulation?
Normal cycle with normal levels of FHS and estrogen, associated with PCOS, treat with Clomiphene
Ecological study
Study of populations, not people (tropical studies)
How does estrogen effect the thyroid?
Increased estrogen = increased Tyroxine-bound globulin
Signs of cocaine withdrawal
depression, fatigue, hypersomnia, hyperphagia, vivid dreams Acute binge- severe depression with suicidal ideation, lassitude (lack of energy), and drug craving
Neurophysin
Carrier protein for oxytoxin and vasopressin
Opiod analgesics effects on the sphincter of Oddi
cause contraction via the activation of mu receptors; Tx- discontinue use
Treatment for bulimia?
Behavioral therapy, SSRI
Febrile illness in Massachusetts?
Ixodies; babesiosis
Atrial septal defect sound
wide and fixed splitting of s2 mild-systolic ejection murmur over left upper sternal border
Vincristine
Inhibit polymerization into microtubules
Polythycemia Vera: Presentation
piethoric, ruddy face and splenomegaly
Somatic symptom disorder: signs and tx
Sings: preoccupation with unexplained medical symptoms and excessive health case Tx: schedule regular outpatient visits
Impaired memory recall, area of brain affected?
Hippocampal area
Spindle cells with surrounding blood vessel proliferation?
Kaposi Sarcome
Signs of congenital hypothyroidism
lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, umbilical hernia, large fontanelles (soft spot) Symptoms starts week after birth (material T4)
Preferred benzodiazapines for people with impaired hepatic metabolism
“LOT” Lorazepam, Oxazepam, Temazepam
Golgi tendor reflex
receptors that measure stretch in tendons and muscles; protective mechanisms to stop overstretching a muscle
What should you limit use of alpha-1 decongestants?
Body compensated by reducing normally produced hormones to negate benefit.
Sexually active individuals - Hepatitis risk
Hep. B
Function of beta-glucuroidase
hydrolyzes bilirubin glucuronides and increases the amount of unconjugated bilirubin -> increasing stone formation
What occurs in the damaged portion of the brain after glios
Lysosomal digestion of the necrotic tissue
Organophosphate poisoning- signs
salvation, lacrimation, disphoresis, bradycardia, bronchospasm
Signs of West Nile Virus
febrile, rash, neurological manifestations (encephalitis, flaccid paralysis)
What codons code for “stop”
UAA, UAG , UGA
McArdles disease: Signs
Muscle cramps, myoglobinuria with strenuous exercise, Deficiency is Myophosphorylase
Zidovudine- MoA
competitively binds to reverse transciptase and is incorporated into the viral genome as a thymidine analog -prevents DNA chain elongation
T-cells that express neither CD4 or CD8 are?
Pre-B lymphocyte progenitors in bone marrow
Nitroprusside- effect
causes venous and arterial vasodilator causes decreased preload and afterload
Osteoclast Activation Factor
Alternative name for IL-l; overproduction leads to osteoporosis
In most individuals what vessels gives rise to the Posterior descending artery?
Right coronary-supplies posterior portion of right ventricle and 1/3 interventricular surface
Hemochromatosis: risk factors?
Hepatocellular carcinoma
Where are the myosin heads located in the sarcomere
A band
Thrombotic thrombocytopenic purpura: Signs? Defect?
hemolytic anemia, thrombocytopenia Defect: Dec. ADAMS13, large vWF monomers
Interleukin-1 inducible 1 enzyme that is highly expressed in inflamed tissue, but absent in normal
Celecoxib
Signs of succylcholine poisoning?
Severe Kyperkalemia, myopathies
What ligament contains the ovarian vessels?
Suspensory ligament; connects ovaries to lateral pelvic wall
Viridans streptococci: Characteristics
Found in the human mouse and contribute to dental cavities; synthesize dextrose from sucrose; attach to pre-damaged heart valves
Norepinephrine-MoA
a1 stimulation- inc. IP3 -> vasoconstriction in peripheral vessels b1 stimulation - inc. cAMP -> inc. contractility, conduction, HR (limited by baroreceptor response)
Recurrent sinopulmonary infections and congenital absence of the vas deferens
CF, also as obstruction of the pancreatic duct -> pancreatic insufficiency
Warfarin uses
DVT, A. fib., pulmonary thromboembolism
How to determine the number need to treat?
NNT = 1/absolute risk reduction Lower NNT is more beneficial
Acute Interstitial nephritis
Hapten induced hypersensitivity
Microfold cells
M-cells Base of the Peyer patch Site of entry for Shigella
Endomysial inflammatory disease
Polymyslitis; presents with proximal muscle weakness, no distal weakness
Signs of pituitary hemorrhage
Bilateral hemianopia, CV collapse, impaired CNIII
Polycystic astrocytoma: Imaging
Solid and cystic components on MRI
Causes of acute tubular necrosis?
Sickle cell disease, acute pyelonephritis, analgesics, diabetes mellitus
Clopidogrel-MoA
prevents platelet aggregation by blocking P2Y12 on platelet ADP receptors
What receptors does low dose dopamine target systemically?
b1- increased heart contractility D1- vasodilation of renal and mesenteric vessels **At high does, dopamine will induce vasoconstriction via alpha 1 receptors.
anti-cyclic citrulinated antibody
Rheumatoid arthritis
What forms from the 3rd aortic arch?
proximal internal carotid, common carotid and glossharyngeal nerve
What part of the ECG is affected by beta blockers?
increases PR interval by decreasing AV nodal conduction
C. perfringes can cause
Food poisoning (watery diarrhea and abdominal discomfort) and gas gangrene
normal phenylalanine and elevated prolactin? Co-factor?
tetrabihydrobiopterin (BH4) deficiency; co-factor for tyrosine hydroxylase and phenylalanine hydroxylase
Placental ALP
Seminoma
Function of primaquine?
Treat hypnozoites to stop disease relapse
P450 Inhibitors
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
Short stature, high arched palate, Tanner 1 breasts, and widely spaced nipples
Turner syndrome (45, XO)
Anicteric
subclinical (i.e. no clinical presentation)
How do you minimize wrong site errors in surgery?>
Dual identifiers
Heteroplasmy
Presence of both normal and abnormal mtDNA; results in variable expression in mitochondrially inherited disease
Sildenafil MoA
Phosphodiestease-5 Inhibitor; decreases degradation of cGMP
What enables “-rubicin” drugs to cause cardiotoxicity?
Generation of free radicals
What is the effect of a prolactinoma in men? in women?
Men- infertility, decreased libido, impotence Women-oligo/amenorrhea, galactorrhea, decreased bone density (estrogen suppression)
Function of S cells?
Secretion of secretin, inc. bicarbonate, dec. gastric acid secretion
Glioblastoma: Histological presentation
bizarre glial cells with multiple mitotic figures, pseudopalisading
Tacrolimus
calcineurin inhibitor, stops T-lymphocyte proliferation
What gastric vessels are supplied by the splenic artery?
Short gastric (no anastemosis), left gastroepiploic (anastemosis with right gastric)
Why is irradiate blood given to SCID patients?
To prevent GVHD later in life
Handgrip maneuver
Increases systemic resistance to increase afterload -> increases sounds of reverse blood flow (i.e. VSD)
Cholesterol granulomas
bluish-black gelatinous material behind the tympanic membrane
How is homocysteine processed? Cofactors?
metabolized to methionine via methionine synthase (Vit. B12, with folate) OR cystathionine via cystathionine synthase (B6)
How to treat hypertensive emergency with poor renal perfusion?
Fenoldopam
Systemic Mastocytosis
Mast cell proliferation (KIT receptor tyrosine kinase) in skin, bone marrow, and other organs. Causes excessive histamine release leading to flushing, syncope, hypotension, pruritis, and urticaria (hives). Inc. histamine stimulates gastric acid secretion -> gastric ulcer formation
Arsenic poisoning- signs
severe watery diarrhea, hypotension, QTc prolongation, garlic orod on breath or stool
metyrapone stimulation test
HPA integrity test -> blocks conversion of 11b-hydroxylase, which converts 11b-deoxycortisol to cortisol -> urinary excretion of 17b-hydroxycorticosteroid Failure to inc. signifies problem with HPA axis
Equation for flow rate:
Flow rate = area x volume
How does acute tubular necrosis present?
cell ballooning and vacuolar degeneration
What parts of the cortex are absent in agammaglobulinemia?
Primary lymphoid follicles and germinal centers
MEN1
Pancreas, pituitary, parathyroid
Thioamides - MoA
inhibits throid peroxidase
Hereditary orotic aciduria: Cause
uridine 5’-monophosphate synthase
Speed of movement on gel elecrophoresis?
Hemoglobin A > Hemoglobin S, Hemoglobin C
fever, bleeding gums, sore throat?
Acute myelogenous leukemia
Sign of marijuana infection?
conjunctival injection, tachycardia, increased appetite, dry mouth
Lupus signs:
Rash, arthritis, serositis,hematological disorders, oral.nasopharynx disorders, renal disease, photosensitivity, anti-ANA antibodies, neurologic disorders
Carbonic Anhydrase MoA
self-limited NaHCO3; diuresis, and decreases total body HCO3- stores; acts in the proximal tubule
Tigeminal neuralgia
sudden, severe pain in the distribution of CNV; treat with Carbamazapine
Where to muscles involved in hip adduction originate?
Pubis and Ischium
Signs of an ectopic pregnancy
abdominal pain, bloody vaginal discharge, orthostatic hypotension
TCA overdose- Tx
sodium bicarbonate; if widened QRS and/or ventricular arrhythmias are present bicarb increases pH and extracellular sodium availability.
Ipratropium
anticholinergic agent and derivative of atropine
What is metanephrine? Where does it come from?
metabolite of epinephrine Medulla of the adrenal cortex (secretion of catecholamines)
Elastin: structure
interchain crosslinks involving Lycine
MEN 2B
Marfanoid, Mucosal Neuromas, and Medullary thyroid cancer, Pheochromocytomas
Budding yeasts that form germ tubes @37 degrees?
Candida Albicans
Where is the adenohyphysis derived from?
Surface ectoderm (Week 3, during gastrulation)
Jimsen Weed
Belladonna alkaloid toxin, strong anti-cholinergic effects
Dysostosis multiplex: description, cause
Course facial features, short stature, neurodegeneration, gait problem. Caused by abnormal targeting of enzymes to the lysosomes
What cells derive the digestive tract?
Endothelium
Lymph node cortex
site of B-cell proliferation during immune response (germinal centers) site of isotype switching (required CD40 receptor
What developmental milestones should be reached by age 2?
50+ word vocab, 2 word phrases, follow 2-step commands, parallel play, build six-bloack tower
Friedreich ataxia: problem
Absence of Schwann Cells
Rationalization- defense mechanism
Making excuses for unpleasant things or events
Signs of maternal rubella
low-grade fever, maculopapular rash (head to body) posterior auricular and suboccipital lymphadenopathy
SCID characteristics
Severe bacterial and viral infections in infancy chronic diarrhea mucocutaneous candidiasis
What is the initiation stage of tubular necrosis?
Ischemi injury to renal tubules, precipitated by hemorrhage, acute MI, sepsis, surgery, etc.
Carboxyhemoglobin
Form of hemoglobin bound with CO instead of O2. Causes decreased O2 binding capacity. Inhibits complex IV of the electron transport chain
Signs of chronic inflammation
Lymphocytic infiltration with collagen deposition
Acute intermittent porphyria: Cause
AD, disorder of the heme synthesis cause by porphobilinogen deaminase deficiency
Cromolyn sodium
inhibits mast cell degranulation and release of histamine
Gut bacteria can produce which vitamins?
Folate and vitamin K
Reaction formation
Responding in a manner opposite to one’s actual feelings
Sheets of granular cells embedded in a hyaline stroma?
Medullary
What is the physiological response to heart failure?
Heart failure -> reduced perfusion of tissue -> dec. renal blood flow -> inc. renin -> arteriolar constriction
Increased thirst and urinary frequency in a person with metabolic syndrome, think?
Diabetes Mellitus
What nerve passes through the interscalene shealth?
Phrenic nerve
Renal ammoniagenesis
metabolism of glutamine to ammonium in the PCT to connect sodium
Supinator Canal
Between superficial and deep parts of the supinator canal Cause by repetitive supination/protination; Presents with “finger drop”
Primary Carnitine deficiency signs
muscle weakness, cardiomyopathy, hypoketotic hypoglycemia, elevated muscle triglycerides
Ragged red fibers signify
mitochondrial dysfunction
1 aortic arch
Part of maxilaary artery
Myoglobin o2 saturation
single unit of globin (hemaglobin (hemaglobin = 4 subunits). Must stronger attraction to oxygen than hemaglobin; hyperbolic saturation curve
Bacterial toxin strongly associated with the development of sepsis?
LPS
Human recombinant form of BNP
Nesiritide
Signs of Neuroleptic Malignant Syndrome
hyperthermia, muscle rigidity (“lead-pipe”), altered mental status, autonomic instability
What type of receptors are baroreceptors?
stretch receptors, inactivated at lower BP
Hep A-clincal signs
fever, anorexia, dark-colored urine
Patau Signs
holoprosencephaly, microcephaly, microphthalmia, cleft lip.palate, and omphalocele
Glucagon 2nd messanger system?
Glucagon -> GTP -> cAMP -> protein kinase A -> serine-threonine residue phosphorylation and phosphorylation of proteins that bind regulatory genes on DNA
Medullary thyroid carcinoma: Gene mutation association
RET-activation mutation
Risk factors for pancreatic cancer?
smoking, chronic pancreatitis
anterolateral displacement of the proximal fracture fragment at supracondylar humerus? posterior displacement?
- Radial nerve injury 2. Ulnar
How is the Lac operon regulated?
Negatively by binding of the protein to the operator locus Positively by cAMP binding upstream from the promoter region
Primary Ciliary Dyskinesia: manifestations
Upper and Lower respiratory track infections, randomization of left-right body asymmetry, infertility
Methanol exposure signs
metabolic acidosis, opthamanologic, neurologic signs
Spinal muscular atrophy
SMN-1 mutation, with encodes snRNPs
Oeay d’orange define? association?
generalized erythematous rash that is often itche Skin texture is firm and course. The presence of breast edema is characteristic of inflammatory breast cancer Associated with lymphatic obliteration
Bosentan-MoA
Endothelin antagonist- used to treat pulmonary artery hypertension
What should be monitored with Olanzapine?
Dislipidemia, hyperglycemia Also, monitor them with Clozapine
Baclofen
GABA-B receptor agonist used to treat spasticity, secondary to brain and spinal cord lesions, in MS patients Also use Tizamide
Carple tunnel syndrome: signs and nerve
Palmer surface of first three digits, thenar weakness, tinel sign, Phelan sign Median nerve
Renal Cell Carcinoma-neoplastic syndomes
EPO, ACTH PHTrP
How does anxiety lead to “passing out”
Decreased pCO2 -> dizziness, weakness, blurred vision
Bacteriostatic drugs that inhibit binding of aminoacyl-tRNA to the 30s subunit
Tetracyclins
Peroxisomes-function
beta-oxidation of VLCFA, amino acids, etc.
Fluoxetine
selective serotonin reuptake inhibitor
Histopathological presentation of hepatitis B
accumulation of surface antigen within hepatocytes described at finely granular, pale pink cytoplasm with dull eosinophilic inclusion
Who does medicare cover?
65 year and older, disabled individuals, end-stage renal disease, or ALS
Most deoxygenated blood location?
Coronary sinus-> myocardial cells extract 60+75% of oxygen from blood
Bullous Pemphigoid antibody?
Hemidesmosomes; bullous pemphigoid antigen
Streptococcus Mitis:
Alpha-hemolytic organism living in the mouth
Where is airway resistance maximum?
Generations 2-5, including the segmental bronchi
Leydig cells
Male testes similar to the theca interna cells of the ovarian follicles -> secrete testosterone in response to LH
How does a PE affected V/Q
Areas of ventilation with areas of absent profusion
What joints are affected in RA?
Cervical spine, DIP, MCP, MTP
Role of the ventromedial nucleus?
mediated satiety, destruction leads to hyperphagia
Function of infraspinatus? teres minor?
infraspinatus- Laterally rotates arm Teres minor- adducts and laterally rotates arm
What binds to the platelet IIb/IIIa receptor?
Fibrinogen
What occurs in long-term topical corticosteroid use?
Dermal atrophy; loss of dermal collagen, cracking, drying, tightening, etc.
Absolute risk reduction
Control rate - Treatment rate (in percent)
Physical sings of bulimia nervosa?
Bilateral enlarged parotid glands, eroded enamel
What receptors does atropine target?
Muscarinic, do not affect nicotinic (GI tract)
Cerebral amyloid angiopathy
most common cause of lobar hemorrhage in the elderly, mostly in the occipital and parietal lobes
Bronze diabetes
late stage hemochromatosis; skin hyper pigmentation, diabetes mellitus, and pigment cirrhosis with hepatomegaly
Which cholesterol lowering agents cause gallstones?
Fibrates
What is the function of the spleen?
Remove abnormal RBCs Clearance of circulating bacteria Production of opsonizing antibodies which clear encapsulated organisms.
Scopolamine-MoA
muscuranic cholinesterase receptor antagonist
How does the esophagus present on a CT of the upper thorax?
Collapsed with no visible lumen
G to T mutation in p53
Hepatocellular carcinoma Aflatoxin-caused
colic
cramping stomach pain
Spongiosis
accumulation of edema fluid in the intercellular spaces of the epidermis
sella turcica
Sphenoid bone depression that contains the pituitary
Mucormycosis description?
90 Degree wide angle branching, nonseptate, proliferates in blood vessels, Diabetic Ketoacidosis, black escar (necrotic tissue); Rx- surgical debridement, amphotericine B
Cisplatin
MoA-cross-links DNA; Uses- testicular, bladder, ovary, lung carcinomas; AE- nethrotoxicity, peripheral neuropathy, ototoxicity; prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis
Tc-pertechnetate test
Merkels Diverticulum
signs of steroid abuse?
Inc. hematocrit, acne, testicular atrophy, gynocomastia, deepening of voice
Bulimia Nervosa-electorlyte abnormalities
hypokalemia, hypochloremia, metabolic alkylosis
Cholesteatomas
collection of squamous cell debris that form a round, pearly mass behind the tympanic membrane
NPH urinary incontinence: Cause
stretching of descending cortical fibers
Organism suspected in intraabdominal abcesses
Bacteoides fragilis E. Coli
What is the function of the seminal vescicles?
Alkaline fluid secretion that neutralized vaginal tract pH, contains enzymes, fructose, mucus, Vit. C. Fructose is important because it nourished the spermatozoa
E. Coli virulence factors
P-pili (cystitis and pyelonephritis) -> adhesion; K capsule (pneumonia, neonatal meningitis), LPS endotoxin - septic shock
Name the functions of IL-1-6
1- fever, 2-T-cells, 3-bone marrow, 4- IgE, 5- IgA, 6-Acute phase protein production
Low serum C1 esterase: diagnosis
hereditary angioedema; Avoid ACE inhibitors
Meglitenides- MoA
close ATP-dependent K+ channels-> opening L-type Ca2+ channel -> insulin release
Chronic transplant rejection MoA
CD4+ T-cells respond to APCs presenting donor peptides, secrete cytoKines -> activate complement
What gives rise to the collecting system of the kidney?
Ureteric bud
Enfuvirtide-MoA
Gp41- Stops viral entry into cells
Progesterone is increase when?
After ovulation remember pro-gestation
Chronic tic disorder
Either motor or vocal tic (but not both) for greater than 1 year
What affect does smoking have on the stomach?
dec. mucous production, inc. acid production (from nicotine), inc. risk of H. pylori infection
Signs of Hypothyroidism
Weight gain, irregular menstrual periods, fatigue, increased difficulty concentration, dry skin, memory loss
Cilostazol
Phosphodiesterase inhibitor that inhibits platelet affregation and causes direct arterial vasodilation. Treats PAD.
Serotonin sickness
nausea, vomiting, diarrhea, muscle hyperactivity (clonus, shivering, hyperreflexia)
Decreasing measurements does what to the SD?
Increase the width
What does hypocapnia imply?
alveolar hupercentilation
Fever, pruritic skin rash, joint pain, 7-14 days after antigen exposure
Serum sickness -> decreases serum C3, C4 levels Type III sensitivity Caused by nonhuman proteins
What passes inferior to the ovaries?
Ureter
Electrolyte abnormalities in patients with adrenal insufficiency?
hyponatremia, hyperkalemia, hypercholidemia, non-anion gap metabolic acidosis
5p deletion: Dx and Signs
Cri-Du-Chat Signs: cat-like cry, hypotonia, failure to thrive, microcephalt, low-set ears, hypertelorism, road nasal bridge
Signs of multiple myeloma?
bone pain, fatigue, anemia, kidney disease, and hypercalcemia
Suppression- defense mecahnism
mature, defensively puts aside unpleasant thoughts/feelings
What is Praziquartel?
Anthelmintic used for treatment of tapeworm and flukes; MoA increases permeability of membrane to calcium ions –> increasing contraction and resulting in paralysis in the contracted state
What nerve is responsible for lateral sensation of the arm and elbow flexion?
Musculocutaneous
Associatedion with Small Cell Lung Cancer
SIADH, Lambert-Eaton, Cushing, Amplification of Myc
Where is riboflavin used?
succinate dehyrdogenase (Complex II) (FAD) and complex I (FMN)
Side effects of statins
Myopathy, cholesterol gallstones
Shortened vaginal canal with rudimentary uterus
Mullerian syndrome (Mayer-Rokitansky syndrome)
Panic attack: pharmocotherap
SSRI
S-100
Neural Crest Tumors
Chorionic vili with focal edema and trophobastic prolieferation
Partial hydatidiform mole
Sotalol: MoA; side effects
K+ blocker; prolongs qt; beta-blocker Inc. risk for torsades de pointes; bradycardia
Trisomy 13
Patau syndrome- defect in the fusion of prechordal mesoderm -> severe midline defects
Anatomic location, AV node?
near septal leaflet of the tricuspid valve and the orifice of the coronary sinus
Myoedema
characteristic finding in hypothyroid myopathy due to slow reabsorption of Ca from the SR
Use for a southwestern blot?
DNA-binding proteins
What is serotonin derived from?
Tryptophan
Diphenoxyate-MoA
Opiod that targets mu receptors in the gut, slowing motility
What artery supplies the posterior wall of the right ventricle?
Right coronary artery
What protective immunity type is the diptheria vaccine?
Purified, inactivated toxin
Muddy brown casts
Acute tubular necrosis; due to decreased renal perfusion; proximal convoluted tubule (outer medulla)
Signs of botulism:
Diplipia, dysphagia, dysphonia “Three D’s”
Stains for Cry[tpcpccus neoformans
India ink-unstained zone macicarmine- stains red
Pharmacological treatment for Serotonin syndrome?
Cyproheptadine
anti-DNA topoisomerase 1
Diffuse Scleroderma -anti-SCL70
How is acetaminophen cleared by the liver?
NAPQI- with adequate glutathione (non-toxic metabolite
Signs of hypoglycemia:
sweating, disorientation, tremors, palpitations
Trichomonas vaginalis: Tx
Metronidizol
Signs of primary hyperaldosterism?
hypertension, hyperkalemic alkalosis, muscle weakness, and paresthesias
anti-muscarinic toxicity
dry and flushed skin, hyperthermia, mudriasis, cyclopplegia, bronchodilation, tachycardia,
Pericarditis that radiates to the neck?
Phrenic involvement (inferior portion of the heart
Preferred initial test for acute cholecystitis?
Ultrasonography
Tc- pertechnetate test
Merkel’s diverticulum
Aminoglycosides- method of resistance
additional of chemical groups (acetyl, etc) to the aminoglycoside antibiotic molecule outside of the bacterium -> decreasing the ability to bind to ribosomes
Lebes hereditary optic neuropathy
mitochondrial inheritance, leads to bilateral vision loss
Where does traffic flow to get to/from the Golgi
To Golgi-RER From Goli-Lysosome
hepatic encephalopathy- cause
Continual absorption of bacterial-produced ammonia without the ability of the liver to convert it to useful metabolites. Leads to increased inhibitory neurotransmitters and decreased excitation
Fibrates- MoA
PPAR-alpha receptor (peroxisome poliferator activated receotor alpha) -> dec. VLDL production and lipoprotein B, inc. lipoprotein lipase
What happens in central retinal artery occlusion
Destruction o fthe retinal ganglion cells in the left eye Painless vision loss
Major cause of duodenal peptic ulcer disease
H. Pylori
Primary ciliary dyskinesia
AR disease, caused by mutations in the genes responsible for normal flagella and ciliary function
Infection risk after clindamycin?
C. Diff
What is the most effective preventive intervention to improve health outcomes?
Smoking cessation
When should a physician intervene and request a court order?
When the children are placed at significant harm.
Red blood cell inclusions on Giemsa stain?
Malaria
peroxisome-proliferator activator receptor-gamms: Fucntion
decrease insulin resistance
VIPoma signs
watery diarrhea, hypokalemia, achlorhydra
Cholinergic receptor signal transducers
m1 - Gq m2 - Gi m3 - Gq
What factors drive angiogenesis
VEGF, fibroblast growth factor-2
What is wobble?
The first two nucleotide require tradition pairing, the third is a fudge factor
Shiga toxin - MoA
Phage encoded -> inhibits 60s ribosomal subunit -> inhibition of protein synthesis -> cell death
3rd aortic arch
Common carotid artery, proximal internal carotid artery
Secondary bacterial pneumonia are
S. pneumoniae, S. Aureus, H. Influenzae
Dupuytren’s contracture
slowly progressive fibroproliferative disease of the palmar fascia, nodules form eventually resulting in contractures that draw the fingers into the hands.
Type 1 Interferon
alpha and beta, secreted in response to viral infection, halts protein synthesis, only activated in the presence of dsRNA
Mitral regurgitation? What reflects severity?
holosystolic murmur best heart at the apex of the heart; radiated to the axilla; S3 sound intensity is a predictor of severity
Where are ketones utilized?
Mitochondria, hence RBC’s cannot use them
What receptors do the pupil dilator muscles of the eye respond to?
Alpha 1`
Hypochondriasis
Hypochondriasis is a hypochondriac (i.e. disproportionate fear of serious disease
Greatest risk factor for death in a patient with pericardial friction and quiet heart sounds
Pericarditis
sirenomelia
mermade syndrome
Large nucleated cells with scant cytoplasm think?
Blasts
Alternative name for the suspensory ligament of the overy?
infundibulopelvic ligament
What is the role of eosoniphils in parasitic infection?
Degranulation of Major Basic protein- antibody-dependent cytotoxicity
What happens in the recovery phase of ATN?
Gradual increase in urine output leading to high-volume diuresis Electrolyte abnormalities may include decreased concentration of K, MH, PO4, and Ca due to slowly recovering tubular function
What is population-based sampling?
Selection of participants based on national census data that is indicative of the national population
What enzyme processes methanol
Formaldehyde Dehydrogenase
vertebral osteomyelitis
bacterial infection of bone resulting from distal infection and spread via hematologic spread
What substance promoted the deamination of cytosine, adenine, and guanine to form?
dietary nitrites Form: uracil, hypoxanthine , xanthine
Condensed body composed on methylated DNA
Lyonization: inactivation of an X chromosome; called heterochromatin -> low transcription activity
Cryptococcus neoformans: typical infection target?
Immunocompromised pateints
Niemann-Pick disease
sphingomyelinase deficiency -> decreased lipid breakdown. spingomyeline accumulation within lysosomes leads to foamy and vacuolated electron microscope -> deposit in brain and liver -> mental regression and death by 3. Significant finds are a cherry-red macular spot
Parvo B19 anemia-
Erythrocytes only
what is dysdiadochokinasia?
impaired rapid alternating movements; cause by cerebellar lesions
CA 19-9
Pancreated Adenocarcinoma
Arsenic- MoA
Binds to sulfhydryl groups, impairing cellular respiration via inhibition of pyruvate dehydrogenase
Ladd’s bands
fibrous bands-connect RLQ retroperitoneum to the right cecum, cause cause duodenal obstruction when malrotate
Orlistat: side effects
Weight loss, decreases triglyceride absorption, LDL, cholesterol
Doxorubicin cardiotoxicity prevention
Dexrazoxane
Signs of riboflavin deficiency
angular stomatitis, cheilitis, flossitis, seborrheic dematitis, eye changes, anemia
Role of the Lateral nucleus?
Mediates hunger, destruction leads to anorexia
PAS stain- intense pink coloration
glycoprotein
Neimann-Pick Disease: Causes, sign
AR, sphingomyelinase deficiency neurodegeneration, hypotonia, hepatomegaly
What stage are oogonia arrested in before fertilization?
Prophase of meiosis 1
Carvello sign
Increased tricuspid valve murmur during inspiration
Tetrodotoxin
Pufferfish neurotoxin, functions by blocking voltage-gated sodium channels in nerve cell membranes.
What is the electrolyte that causes CF’s symptoms?
hyponatremia
How to strengthen bones and reduce fracture risk?
Weight bearing exercise
Incomplete penetrance
Clinical features are not always present in individuals who have the mutation
How to mitochondrial diseases spread?
maternal inheritance
Cardiac output (Fick principle)
rate of o2 consumption/arteriovenous o2 content difference
Phenytoin-MoA
reduces sodium channels ability to recover from inactivation
Affects on irregular pregnancies on dating?
Inaccurate prediction and tests at the wrong time
Germline mosaicism
more than one set of genetic information is found specificaly within the gametes
Growth factors activation cascade
Growth factor ->receptor tyrosine kinase -> autophosphorylation -> Ras-GDP-> Ras-GTP -> MAPK -> enters nucleus
Turner Syndrome: overies
dysgenesis; appear underdeveloped and strophic (“streak gonads”)
Follicular thyroid cancer- gene mutation
RAS
Diseases associated with HLA-B27?
Ankylosis spongyitis, psoriatic arthritics, IBS-arthritis, reactive (reiter’s arthritis). HLA-Class 1 associated
discharge from the umbilicus in a newborn, think?
patent urachus (allantoid remnant)
Phyostigmine:
Cholinesterase inhibitor; used for atropine poisoning (antimuscurinic antidote)
Signs of niacin deficiency?
Dermatitis (bilateral, sun exposed areas), diarrhea (atrophy of columnar cells), dementia - > pellagra
What percentage of students are within 1 SD unit? 2 SD? 3 SD?
1 SD - 68% 2 SD - 95% 3 SD - 99.7%
Infections with lytic bone lesions, think?
Mycobacterium species
Deficiency in LAD
Cells lack CD-18, essential for integrin formation; leukocytes are unable to adhere or migrate to sites of inflammation.
Disulfram effects on alcohol consumption
Abdominal cramps, nausea, headache Inc. alcohol dehydrogenase production
DiGeorges Syndrome
Congenital heart disease dysmorphic facies hypocalcemia
Grancyclovir- MoA
interferes with host cell DNA synthesis
How long does type 1 sensitivity take?
Hypertrophic cardiomyopathy: characteristics
Outflw tract obstruction and asymmetric septal hypertrophy, compared with progressive heart failure, which is symmetrical
open angle glaucome: Signs and Tx
peripheral vision loss, elevated intraocular pressure, Tx: Non-specific beta blockers- decrease aqueous humor secretion by the ciliary epitherlium
What cells deposit extracellular matrix and collagen matrix in atherosclerotic plaques
Smooth muscle cells
Direct Inguinal Hernia site, lower, median, lateral border
Hesselback triangle Inguinal ligament- lower Rectus abdominis - medial Inferior epigastric - lateral
What does relative risk mean?
Relative risk is equals risk exposure/risk without exposure; 1 is neutral, 1 increased risk of disease
Homogenistic Acid Dioxygenase deficiency
Alkaptouria; pigment deposits in connective tissues (sclera, ear cartilage), urine turns black after exposure to air “Al Kapone; everything turns black homo gentleman sex”
Common causes of caseating granulatomas?
TB and fungal infections
Pringle maneuver
occlusion of the portal triad
Flexible skin, multiple ecchymoses?
Ehlers-Danlos sydrome -> defective collagen synthesis caused by deficiency in pro-collagen petidase
Effect of oxytocin in pregnany?
Causes uterine contraction
binds fibrin and supports platelet aggregation?
glycoprotein IIb/IIIa
How to calculate michaelis constant Km?
1.2 maximum velocity -> concentration of substrate at that Km
What is the function of IL-1
Fever
What effects do loop diuretics have acid base?
Metabolic alkylosis, with volume contraction
Proton pump inhibitors- side effect`
decreased calcium absorption, Mg absorption, inc. C. diff infections
Proteasome, function?
Recycling center for proteins, breaking down misfolded, damaged and cytotoxic proteins for reuse Additionally, they regulate pro- and antiapoptotic prroteins, inhibition leads to acculumation of pro-apoptotic enzymes
CHF treatment
ACE/ARBs- improve blood flow and also inhibit chronic angiotensin II-mediated cardiac remodeling Significantly reduce mortality in systolic heart failure
Schwanoma: Histological presentation
biphasic with highly cellular areas with myxoid regions of less cellularity
Diastolic heart failure parameters
Increased LVED pressure with normal LVED volume, and ejection fraction
Warfarin-MoA
Inhibitor of vitamin K reductase
Thick, cottage-cheese vaginal discharge, organism? Cause
Organism- Candida Albicans Cause- decreased lactobacteria (gram-positive)
Hemangioma tissue derivation?
mesenchymal cells (blood vessels) are a part of the endothelium
Defects in patella fracture?
inability to extend the knee against gravity
MoA of nitroglycerin?
Venous dilatory, greatest affect on large veins; reduced pre-load
When flow decreases by a factor of 16, radius has decreased by?
2
Azathioprine - breakdown product
6-mp, acts on HGPRT (active metabolite) and TPMT (inactive metabolite); allopurinol blocks conversion to TPMT, increasing active metabolite
Causes of edema:
- Elevated Capillary hydrostatic pressure 2. Decreased plasma oncotic pressure 3. Sodium an water retention 4. ymphatic obstruction
Cause of hemolytic anemia after medication-induced oxidative stress?
Glucose-6-phosphate dehydrogenase deficiency
What arteries are at the greatest burden for developing atherosclerosis?
Coronary and abdominal aortic
Murmur best heart sitting up and leaning forward
Aortic regurgitation
Cataplexy
Conscious, brief episodes of sudden bilateral muscle tone
Most common childhood cause of epiglottitis?
Haemophilus influenzae b; cherry-red epiglottisis
Hemochromatosis: Cause and Signs
Cause: excess Iron absorption due to AR Ch6 mutation in HFE Signs: DM, cirrhosis, and hyperpigmentation of the skin
What is the most common amino acid in collagen?
Glycine, occupies ever third amino acid position in the alpha chain; Allows for the cross-linking helical structure
Marfanoid Habatus
Arm-span greater than height, long fingers, joint laxity
What happens as prevalence increases on PPV and NPV
PPV and NPV increase as prevalence increases
APO B100
Function- binds LDL receptor; deficiency leads to fast soluble metabolite deficiencies
Propranolo-Thyroid affects
decreases peripheral conversion of T4 to T3 (iodothyronine deionidase), and decreasing sensitivity to catecholamines
Dysthymic disorder
Mild, long-term form of despression
Freely mobile, soft, cystic mass with cutaneous surface opening
persistent cervical sinus; malformation; anterior to the SCM
Gardy-Weinberg Equations
p + q - 1 p^2 + 2pq + q^2 = 1 Sqrt(q^2) = q
Signs of Sarcoidosis
AA woman, cough, dyspnea, bilateral hilar lymphadenophathy, noncaseating granulomas.
Norepinephrine- autonomic function?
alpha 1 (increased dia/sys BP, vasoconstriction) > alpha 2 > beta 1 (increased heart rate);
beriberi
Thiamine- B1 deficiency; peripheral neuropathy, heart failure)
How does myasthenia gravis present?
Muscle weakness that progressively gets worse throughout the day
linkage disequilibrium
a pair of alleles are inherited together in the same gamete more or less often than would be expected by random chance
Where to B cells reside in the lymph node?
Germinal centers and lymphoid follicles
Patient presents with recurrent Neisseria infections defect?
Inability to form the MAC complex, c5b-9
Small Cell Carcinoma: neoplastic syndromes
ACTH, SIADH, Lambert-Eaton, Amplification of myc
Tinel sign
Tapping over the flexor surface of the wrist reproduces symptoms
What are the risk factors for cocaine use during pregnancy?
Prematurity
When is the sodium permeance the greatest in nerve depolarization?
At the peak of depolarization
Most common bacteremia-causing organisms in sickle cell patients?
S. pneumoniae, H. influenza
Kartagener Syndrome
Chronic upper/lower respiratory infections, immotile sperm, situs inversus on imaging, autosomal recessive ==> result from defective cilia motility
Phenytoin side effects
Gingival hyperplasia (PDGF activation -> gingival marcophages -> gingival cell and alveolar bone poliferation) coarsening of facial features, and hirsutism
Interstitial lung disease presentation?
progressive dyspnea, fine crackles, clubbing, and diffuse reticular opacities
6th aortic arch
Proximal pulmonary arteries Left-ductus arteriosus
What does treating Hodgkin’s lymphome increase the risk for?
secondary cancers
Portal Triad
hepatic artery, portal vein, common bile duct
Steps in wound repair
- inflammation-clot formation, vascular regeneration 2. Proliferation-collagen 3 deposition 3. Remodeling- Collagen 3 replaced with Collagen 1
Which hepatitis B antigen is the most infective
HBeAg
Nitrate MoA
Vasodilation of peripheral veins and arteries -> decreases preload (left end-diastolic volume and wall stress) modest reduction in afterload, some coronary dilation effects
When traveling to Africa, what shots should you receive?
Anti-malaria
Edwards Syndrome: Alt. name, signs
Trisomy 18, inherited as meitic nondisjunction\ Signs: rocker bottom feet, clenched hands, overlapping fingers, cardiac issues
hypotension, cool extremities, tachycardia
hypovolemic shock
Anaplastic thyroid cancer- gene mutation
p53
What hemotological signs are involved with lupus?
thrombocytopenia, or any other cytopenia
Adult rubella- complications
polyarthritis and polyarthralgia
