Step 1 All content Flashcards
Sudan III staining
Checks the stool for presence of fat globules indicating steatorrhea
Prader willi genetic error that occurs
2 copies of a chromosome from the mother (fathers copy is lost) Pray for Willi he’s only 15 but short fat and dumb
ankylosing spondylitis HLA assoc
HLA-B27
Papillary Carcinoma of thyroid
P’s. Psamoma bodies, Prevalent, palpable nodes.
Also Orphan annie nuclei.
RET/PTC and BRAF mutations
Leuprolide and hormones as function of time
First stimulates GNRH but once chronically stimulated it actually therapeutically decreases FSH and LH
Zones of adrenal gland
G- aldosterone
F- cortisol
R- Androgens
medulla- chromaffin cells catecholamines
thrombo thrombocytopenic purpura symptom pentad and issue
fever, Microangiopathic hemolysis, neuro, thrombocytopenia and renal issues
can be older pt
ADAMS 13 a metalloprotease that usually degrades vWF
most common embryonic structure that leads to congenital diaphragmatic hernia
pleuroperitoneal folds
I cell Disease
bilateral, hip abnormalities, corneal clouding, course facial features. lysomal disease where an important phosphorylation enzyme (N-acetylglucosaminyl-1-phosphotransferase)
Kaposi Sarcoma
HSV 8 often GI bleeds or hematochezia involvement
measles distinguishing features
rash starts on the neck, koplik spots and conjunctivitis
Scurvy biochem issue
proline and lysine of collagen are not hydroxylated in the endoplasmic reticulum
Absolute risk
AR = a/(a+b) - c/(c+d)
Albinism biochem defect and embryologic issue
tyrosinase deficiency. melanocytes are derived from neural crest cells
Mechanism of isoniazid resistance
less KatG, so the catalase peroxidase enzymes need to activate drug are not expressed
receptor found on all T cells that is often targeted by anti rejection meds
CD3
CD16
natural killer cells
hemolytic anemia and gallstone type?
UNconjugated bilirubin stones. (liver overwhelmed)
ERBB2 (formerly HER2) drug
Trastuzumab, watch for cardiotoxicity
Thiazide diuretics common side effects
HyperGLUC (glucose, lipids, uric acid, calcium)
What does the axillary nerve branch from?
posterior cord
complication of tumor lysis syndrome
arrhythmia
Atypical cells in mono
CD8 T cells have abnormally abundant cytoplasm
RNA virus mnemonic
I went to a RETRO TOGA party, and drank FLAVored CORONA and ate CALIfornia PICkles. +reo virus which is only Ds RNA virus.
non-Enveloped viruses
DNA- PAPP
RNA- CPR + hepevirus
what neurotransmitter helps you sleep
acetylcholine in reticular formation
NF1 gene and symptoms
NF-1 tumor suppressor gene on chromosome 17q
cafe-au-lait, neurofibromas, lisch nodules. Autosomal dominant
NF2 gene
misprediction of the gene product merlin.
Schwannomas
mom introduces juice to infant then lethargy
aldolase B deficiency in fructose intolerance. fructose-1-phosphate inhibits gluconeogenesis leading to hypoglycemia (All die, more severe)
MEN syndromes inheritance
all are autosomal dominant
lead poisoning treatment
dimercaprol
krugenberg tumors
gastric tumors that met to the ovaries. associated with supraclavicular lymphadenopathy
what transports botulism towards cell center
dynein
polyarteritis nodosa path?
transmural inflammation and fibrinoid necrosis.
and beads on a string
yellow fever post mortem biopsy finding and symptoms
High AST, bloody emesis, jaundice Counselman bodies (they are degenerated eosinophils)
CML genetics
Philadelphia chromosome 9:22 translocation that turns on a tyrosine kinase
Ewing Sarcoma genetics
11:22 overactive transcription factor
Herpes zoster/CMV path
Cowdry A inclusion bodies
Call-exner bodies
granulosa cell tumors
Mallory bodies
alcoholic hepatitis. Damaged intermediate filaments
Reinke crystals and what are they
Leydig cell testicular cancer. Eosinic inclusions
G6PD inheritance
XR but can display lyonization
Horshoe kidney gets tuck on what
Inferior mesenteric
anaphylaxis immune elements
IgE with bound C3a C5a on mast cells causing histamine release
Signs of hydrops fetalis (Rh incompatibility)
purpura, thickened placenta, hepatosplenomegaly with ascites, dead baby
benzo overdose trx
flumazenil competitive inhibition so shifts benzo dose response curve right.
Distinguishing between Barter and Gitlemans
Calcium is high in Bartter and low in Gitelman
ethylene glycol overdose trx
fomepizole
Alport’s defect and inheritance
type 4 collagen. Cant hear cant see cant pee. x-linked dominant
Goodpasture
anti basement membranes specifically against alpha 3 chain of type 4 collagen. Cough hemoptysis and renal loss of proteins and red cells
cholinergic excess ( organophosphate poisoning ) trx
atropine in organophosphate poisoning
difference between repression and suppression
unaware of repression. Consciously suppress
Job syndrome
Defective helper T cells (Th17) cant make tnf-gamma to recruit neutrophils. recurrent staph accesses. retained teeth. High IGE and dermatologic issue.
Midline midbrain localization
Motor pathway (corticospinal) CL
Medial Lemniscus CL
MLF- IL
Motor nerve nucleus- IL 3,4,6,12
Lateral midbrain localization
Spinocerebellar IL
spinothalamic CL
Sensory of CN5 IL
Sympathetic IL
Diuretics in kidney stone Hx + HTN
Thiazides
really quick rhabdo and cramping with exercise in a young pt, biochem?
McArdle disease; myophosphorylase def occurs in cytosol
AML with Auer rods genetics
T (15;17) translocation
Hep C med with tons of side effects including depression
peginterferon alpha
how does hodgkin lymphoma evade immune system?
downregulates MHC1
Neuro reflex roots
Bicep- C5,C6 brachioradialis- C6 tricep- C7 Patellar- L2,4 ankle- S1 Cremasteric- L1, L2 Anal wink- S3, S4
how does exercise lower glucose?
increased expression and transport of glut 4 to the surface
Desmopressin hematological use
increases vwf and VIII (8) from Weibel Palade bodies
if a mixing study does not correct bleeding?
usually an antibody against something
Bernard Soulier vs Glanzman thrombasthenia
Bernard Soulier- low Gp1b, large platelets
Glanzman - no platlet clumbing low GPIIb/IIIa
T(12:21) and T(9:22)
ALL
T(12:21) Better prognosis most common
T(9:22) Worse prognosis. less common
CD20, CD23 and CD5 positive B cells
Chronic Lymphocytic Leukemia
Small Lymphocytic Lymphoma
TRAP positive and treatment
Hairy Cell Leukemia, Cladribine or pentostatin
what is APL?
AML t(15:17) translocation associated with auer rods and myeloperoxidase positive. Responds to Vit A and arsenic
t(9:22)
CML BCR-ABL
JaK2 mutations cancer?
Polycythemia vera
t(8:14)
bukitt (burk8) lymphoma: C-MYC overexpression (causes transcription factor overactivation
BCL2 and BCL6 mutations
Diffuse large cell B-cell lymphoma
t(14;18)
Follicular lymphoma. BCL-2 overexpression
t(11;18)
Marginal zone lymphoma assoc with chronic inflammation.. AYY (11) I’m Aching (18)
t(11:14) and cell cycle area
Mantel cell lymphoma. Increase in Cyclin D1 and skips G1-S checkpoint
Collagen types and associated diseases
type I: Osteogenesis imperfecta
type 3: Ehlers Danlos,
type 4: Alport, Goodpasture
heme synthesis what defects mitochondria vs cytoplasm
Mitochondria- sideroblastic anemia (X linked)
cytoplasm- porphyria’s
both- lead poisoning
vasculitis associated with Hep B and inflammation type?
polyarteritis nodosa. Transmural necrotizing inflammation
urine build up in porphyrias?
acute intermittent porphyria- protoporphyria
porphyria cUtanea tarda- Uroporphyria
MACROlides (azithromycin, erythromycin, ect.) adverse effects
Motility issues Arrhythmia (QT prolongation) Cholecystic hepatitis Rash eOsinophilia
also inhibit p450 enzymes
mumps complications
parotitis, pancreatitis, orchitis, meningitis, sub acute pan-sclerosing encephalitis
meniscus tears and rotation
medial- click on external rotation
lateral- click on internal rotation
lateral knee trauma’s unhappy triad
MCL, ACL, and medial meniscus tear.
Pathology of H-Pylori infection?
solitary lesions with underlying tissue replaced with chronic inflammatory cells
Ménétrier disease path?
Hyperplasia of surface mucosal cells with enlarged rugae . Atrophy of parietal cells and hypertrophy of mucosal cells
How do eosinophils attack parasites
antibody-dependent cell-mediated
parasite covered in IL-5 on eosinophils then attack. They also slowly induce a chornic type 1 hypersensitivity against the creature.
Courvoisier sign
painless jaundice, weight loss = pancreatic adenocarcinoma. most common risk factor is smoking
decreasing risk of hemorrhagic cystitis with Cyclophosphamide
mesna- binds toxic metabolites in urine
amifostine
prevents cisplatin induced nephrotoxicity
VACTERL
Vertebral, anal, cardiac, TE, Renal, Limb abnormalities
High drug metabolism what zone of liver
zone 3 furthest from triad
anesthetic that can cause seizures
enflurane
pain, stiff joints, hyperpigmentation of sclera or skin
homogentisic acid oxidase def resulting in an accumulation of homogentisic acid. Limit dietary tyrosine and L-phenylalanine
AAA repair common complication
Inferior mesenteric artery ischemia
Diuretics that can cause gout
Thiazides
Molar pregnancy gentics
full Mole. No fetal parts 46XX
Partial. fetal parts 69XXX
how does DCIS to IDC what mutation
metalloproteases to degrade basement membrane
Saliva ion concentrations and flow rate
Lower K, Higher Na Cl, and HCO3 secretion with higher flow rate
Infliximab vs Etanercept mech difference
Infliximab- binds soluble TNF-a
Etanercept- competitive inhibitor at TNF-a receptor
Symptomatic Pheochromocytoma two drugs for MM before surgery
Phenoxybenzamine- long acting for most symptoms Irreversible inhibitor
Phentolamine- SA, short word for acute hypertensive crisis. reversible inhibitor
both nonselective alpha blockers
achondroplasia
most common congenital dwarfism.
mut in fibroblast growth factor3 gene.
assoc with advanced paternal age.
CREST syndrome
calcinosis, Raynaud’s, esophageal dysmotility due to atrophy, sclerodactyly, telangiectasias
Rosacea vs pityriasis rosacea
Rosacea- face, sun bad, telangiectasias possible
pityriasis rosacea- back, herald patch, Christmas tree,
Maple Syrup Urine Disease
lethargy, seizures, early in life. Deficiency of branched chain α-keto acid dehydrogenase.
Limit “I love Vermont” I,L,V amino acids and give thiamine (B1) bc it is required by enzyme
zidovudine class and side effect
NRTI, anemia
HIV NRTI associated with hypersensitivity rxn
abacavir (atopic-avir)
Abx that bind 30s ribosome classes
Irreversible binding to 30s- aminoglycosides
reversible binding to 30s- tetracyclines
PDE-5 inhibitors mechanism to stop ED
increase cGMP
Desquamative interstitial pneumonia
middle age pt, hx of smoking, dry cough, SOB, hypoxia
ground glass opacities, low DCO. pigment laden macrophages
post strep glomerular nephritis
2 weeks after strep, hematuria. Low C3
LM: large hypercellular glomeruli
IF: granular appearance due to IgG and C3
EM: sub epithelial IC humps
Gq mnemonic
HAVe 1 M&M
activate phospholipase C and increase protein kinase C
antifungal that can increase skin pigmentation
ketoconazole
Gi mnemonic
people who are 2 MAD inhibit themselves
decrease cAMP production
SCC precursor lesion
actinic keratosis
GLP-1 mechanism
increase insulin via the incretin pathway
midline neck mass and embryologic remnant
thyroglossal duct cyst
foramen cecum
HNPCC (Hereditary nonpolyposis colorectal cancer or lynch) genetic issue
mismatch repair defect. Occurs during S phase
Ataxia telangiectasia genetic issue
Non homologous end joining (drunk strands are ataxic)
xeroderma pigmentosa genetic issue
Nucleotide excision repair defect. due to thymidine dimer accumulation
BRACA 1 and fanconi anemia genetic issue
homologous end joining (2 boobs are homologous)
homologous bloodlines are down
hormone that increases in starvation?
cortisol
constipation in a diabetic which nerve affected?
pelvic splanchnic
cleidocranial dysplasia
skull, teeth, bone abnormalities. Autosomal dominant affects osteoblast abnormalities
HLA inheritance in siblings
25% share all, 50% share some, 25% share nothing
Statin mechanism
Inhibit HmG CoA and increase LDL expression drawing cholesterol out of the serum
determining monoclonality of an endometrial Ca?
X linked isoenzymes
what does liver do in response to glucagon
Beta fatty acid oxidation to create energy for gluconeogenesis
most common urea cycle def?
ornithine transcarboxylase. Causes build up of ammonia. Emesis, refusal to feed, lethargy, comma
dont get enough protein what happens to nitrogen?
negative nitrogen balance, part of every amino acid.
cyclosporine moa?
decreases interleukin 2 signal via calcineurin inhibition
hypertrophic osteodystrophy
clubbing, arthritis, new bone formation. Usually due to bronchogenic carcinoma
Gardner’s syndrome
APC mutation
100% chance of colon Ca.
osteomas also common
Vit deficiency in carcinoid syndrome?
niacin bc more tryptophan converted to serotonin and not vit B3 (niacin)
heartburn med that causes constipation
aluminum hydroxide (aluminum binds phosphate and gets heavy and bound up)
rIbavIrIn mech?
antiviral Inhibits IMP dehydrogenase so it can’t be converted to GMP
Orotic aciduria?
megaloblastic anemia in child that is unresponsive to folate and B12. Treat with uridine, due to UMP synthase deficiency
endometrial carcinoma (endometrial type) risk & histology
risk: increased estrogen (especially obesity)
histology: glandular invasion of myometrium and disorganized tissue
Pancoast tumors cause horner’s how?
What damages each order neuron?
Horner’S (second order sympathetic neuron)
1st order is in spinal cord - spinal cord damage
3rd order goes back up anterior- carotid dissection
cells and signaling molecules GI?
Gastrin- G cells
Somatostatin- DIE!!! stops everything D cells
CholecystokInIn- I cells
Secretin- S cells
Gastrin inhibitory peptide- Kalk water is basic. K cells
6m baby low glucose, high lactic acid/uricemia, hepatomegaly?
Von Gierek a glycogen storage disease. Loss of G6P which breaks down. glycogen which builds up in liver.
Baby starves between feeds. sucrose and fructose makes it worse.
Immune thrombocytopenic purpura blood smear findings
increased megakaryocytes
topical abx that inhibits peptidoglycan wall synthesis
bacitracin. topical due to extreme nephrotoxicity
pharyngeal pouches mnemonic?
Ears, tonsils, bottom to top
- ears
- tonsils
- bottom of parathyroid
- thymus (3 and 4 are especially related)
- top of parathyroid
pharyngeal arches nerves mnemonic
At golden arches children first chew, then smile, then swallow stylishly - or simply swallow - then speak
ganciclovir toxicity and mech
nephrotoxicity and myelosuppression
Inhibition of the incorporation of dGTP by viral DNA polymerase
thiazolidinediones mechanism and major side effect
acts on peroxisome proliferator-activated receptors (PPARs) and sensitizes cell to insulin.
water retention “pioglitazone”
what is RA factor?
immunoglobulin M antibody against the Fc portion of immunoglobulin G
bifid testes embryologic issue?
malunion of the labioscrotal swellings
glactose vs fructose metabolism issues
galactose issues- start with breastfeeding, infantile cataracts
fructose- begin with introduction of fruit, juice, honey
mild: galactokinase def; essential fructosuria
severe: galactosemia (galactose 1-p UDIE transferase); hereditary fructose intolerance (All dielase B)
allergic (eosinophilic) granulomatosis and angiitis
symptoms and Dx
sinusitis, asthma, lung infiltrates, eosinophilia, vasculitis, neuropathy. Confirm with ANCA (anti neutrophil antibody)
What diuretics can make osteoporosis worse?
loop diuretics bc calcium is lost
abx that can cause nephrogenic DM
topical demeclocycline, used primarily for acne
Carnitine deficiencies vs medium chain acyl-coA dehydrogenase def
Both have hypoglycemic hypo ketosis
carintine def- cardiomyopathy
Acetoacetate formation is deficient
MCAD def- liver dysfunction and hyperammonemia
Pompe Disease?
enlarged muscles and heart. hypotonia, hepatomegaly secondary to HF. acid maltase deficiency. PAS positive glycogen accumulates in the lysosome
cori disease
limit dextrans accumulation. possible cardiomegaly. mild hypoglycemia. Due to debranching enzyme def
Filgrastim
recombinant GCSF cytokine. Helps with immunosuppression from ALL or cancer treatments
spike and dome on EM
membranous glomerulonephritis
Henoch-Schönlein purpura on IF
Large deposits of IgA in mesangium
lead poisoning mechanism
disrupts the incorporation by ferrochelatase of iron into protoporphyrin IX also disrupts ala (aminolevulnic acid)
rhomberg test positive, what structure is affected?
medial lemniscus
organic acidemia’s treatment mnemonic
Can’t convert proponyl CoA to methylmalonyl CoA
Limit VOMIT
valine, odd chain FA’s, methionine, isoleucine, threonine.
Presents at 1-2 weeks
CLL complication
warm and cold hemolytic anemias
Gynecomastia drugs mnemonic
Some Hormones Create Funny Knockers
spironolactone, Hormones, Cimetidine, Finasteride, Ketoconazole
Disulfiram like reaction drugs mnemonic
Sorry Pals Cant go Mingle
Sulfonylureas (first generation), Procarbazine, certain Cephalosporins, Griseofulvin, and Metronidazole
Placental abruption vs previa symptoms
abruption: painful, with contractions
previa: painless bleeding without contractions
Cremaster muscle comes from what muscle in development?
internal oblique
Juvenile Idiopathic Arthritis symptoms/ path
periodic temperatures associated with rash; enlarged lymph nodes, liver, and spleen;
RBC-laden macrophages with low hematocrit.
indinavir and side effects
protease inhibitor. thrombocytopenia and kidney stones
Raltegravir and side effects
integrase inhibitor can cause high CK and Rhabdo
laryngeal cancer greatest risk factor?
smoking
PTH main effects
increases calcium decreases phosphate in kidney and causes bone to resorb both by breaking down. Net effect ins more Ca and less Phosphate
Primary CNS lymphoma description
single ring-enhancing lesion with an angiocentric pattern of CD20+ cells
ALS affects what?
Anterior horn and corticospinal tracts
Anitschkow cells
Rheumatic fever
Di George embryology
3rd and 4th pharyngeal pouches don’t develop normally.
potter sequence embryology
failure of uretic bud to form properly
Vit E deficiency symp
ataxia and even hemolysis bc the red cell membranes get weak
midbrain vessel
PCA
Pons Vessel
Basilar- medial
AICA- lateral
Medulla Vessel
ASA- medial
Pica- PICA lateral
Wecners (granulomatosis with polyangiitis)
coughing blood chronic sinusitis cervical facial infection kidney C-anca Caseating granulomas cyclophosphamide and corticosteroids
churg strauss (eosinophic granulomatosis with polyangiitis)
asthma, sinusitis, eosinophilia
cardiac issues and purpura/nodules
pauchi immune glomerulonephritis
Trisomy 18 (edwards)
clenched fists with overlapping fingers
rocker bottom feet
low ears
micrograthia
Trisomy 13 (patau)
cleft lip holoproencephaly polydactyle aplasia cutis polycystic kidney disease
how does kidney reabsorb more HCO3
increased Na/H exchange in proximal tubule
where do sperm acquire motility?
spermatogenesis takes place in seminiferous ducts
but,
motility is acquired in the epididymis, which is lined with a layer of pseudostratified columnar epithelium with stereocilia
If you are putting a central line in the jugular where do you go?
within the carotid sheath lateral to the common carotid artery and anterior to the vagus nerve.
renal osteodystrophy physiology?
- Kidney sucks so phosphate increases
- phosphate blocks calcium in blood
- PTH responds to low calcium and bone is broken down
dantrolene mech
binds to ryanodine receptors and blocks calcium release from the sarcoplasmic reticulum.
RB mutation cancers?
Osteosarcomas, Bladder cancer, Retinoblastomas
ROB the RB gene
esmolol role in arrhythmia
See if the pt will tolerate a beta blocker with comorbidities. It only acts for 7mins so pt wont die if they become hemodynamically unstable
common finding in obstructive and restrictive pathology?
Decreased vital capacity and inspiratory reserve volume
HOT T-Bone stEAK
IL 1- Hot (fever)
IL 2- T (Stimulates T cells)
IL 3- Bone (bone growth)
IL 4- E (class switching to IgE and IgG)
IL 5- A (class switching to IgA) eosinophils asthma
IL 6- K (aKute phase reactants, megaKaryocytes) also increases plts as part of inflammation
Telling ANCA disorders and Goodpasture’s apart?
good pastures is usually a young male and will light up glomeruli on immunostaining
Hereditary hemochromatosis
AR. Dysregulated hepcin leading to increased iron absorption
Langerhans cell histiocytosis?
skin macrophages invade various organs Birbeck granules (look like tadpoles) on EM
bone tenderness
eczematous rash and spontaneously resolving brownish purple papular lesions.
How does Staph aureus TSS toxin work?
cross links MHC II
Most common genetic hyper coagulability?
Factor 5 Leiden (AD)
preventing protein C from degrading factor V
Vascular tumor growth is driven by what?
VEGF and FGF
Inability to fight mycobacterial infections and poor rxn to BCG vaccine?
IL-12 receptor deficiency
allelic heterogeneity?
different mutations in the same locus resulting in a similar phenotype.
jaw mneumonic
Remember “Lateral Lowers” and “M’s Munch”
Lateral pterygoids
Medial pterygoids, Masseter, teMporalis
Familial hyperlipidemia with high LDL who fail statin next step?
and ezetimibe or a psk9 inhibitor
BCL-2 function?
inhibits apoptosis
VWF deficiency
most common cause of increased bleeding
vwf acts as a ligand in plt adhesion
Trigeminal nerve exits V1, V2, V3
standing room only
Superior orbital fissure, foramen Rotundum, and foramen Ovale,
Norepi sympathetic mechanism
increased AV nodal conduction velocity via increased Ca2+ influx
methotrexate mech
inhibits dihydrofolate reductase.
drug metabolism and solubility
fat soluble- thoracic duct (no first pass)
water soluble- portal vein (first pass)
ports assoc with water
prostate cancer is found in what zone
peripheral zone
what artery supplies Merkle diverticulum
Superior mesenteric artery
Leukocyte adhesion deficiency molecular issue
loss of CD18 integrin
malignant PKU enzyme def.
dihydrobiopterin reductase
Steatorrhea kidney consequences
decreased oxalate/calcium complex exertion so more kidney stones
abciximab
Inhibits glycoprotein IIb/IIIa
low blood volume and afferent arteriole
High NE and Angiotensin II constricts but is counteracted by vasodilation on prostaglandins
Don’t give lots of NSAIDS to volume down pts
Bleomycin vs Busulfan pulmonary fibrosis?
Bleomycin- months to weeks post trx
Busulfan- years after trx
macrolides mechanism?
50S ribosome subunit
Aorta rupture from deceleration common location
aortic isthmus (right where it starts to go down after left subclavian)
Absolute contraindication with Cocaine MI
B blockers. Would lead to unopposed alpha leading to vascular constriction
polyarteritis nodosa hypersensitivity type
Type III
Hyper IgM syndrome molecular issue
Defective CD40L on T-helper cells doesn’t allow class switching
hepatorenal syndrome physiology
dilation of splanchnic vessels. constriction of renal vessels. causes pre-renal azotemia
pilocarpine and pupil
constricts pupil and decreases intraocular pressure via M3 agonism
ulnar nerve comes from what trunk?
lower
what cells produce androgen binding protein?
Sertoli cells
Muscular dystrophy inheritance
X-Linked recessive
Bleomycin mechanism
induces DNA strand breaks by producing superoxide and hydroxide free radicals that lead to DNA cleavage
IgA nephropathy vs PSGN?
both can be in kids
IgA- sore throat and hematuria at the same time. Mesangial deposits
PSGN- sore throat 3-6wks before hematuria. sub epithelial humps
Quinidine adverse effects?
Torsades and cinchonism, a syndrome that includes headaches and tinnitus
WPW blood flow issue
decreased filling of the ventricle during diastole due to early ventricular depolarization
Splenomegaly, burr cells, transfusion
pyruvate kinase deficiency
pancreatitis electrolyte complication
hypocalcemia
Trousseau syndrome and cause
pancreatic ca + migrating swelling and pain
thrombophlebitis from tissue factor liberating clotting factors.
Dubin Johnston
High direct bilirubin
black liver
Gram negative coccobacillus. Rapidly expanding infection post dog or cat bite
Pasteurella multocida
TB Ghon complex description?
caseating granulomas with multinucleated giant cells and epithelioid cells surrounding an area of central necrosis
eczema hypersensitivity type
type 1 Hypersensitivity
PHENYTOIN side effects
P450 induction Hirsutism Enlarged gums nystagmus Yellow Brown Skin Teratogen Osteopenia Inhibited Folate Neuropathy
Rarely SJS, DRESS and drug lupus
women hormone replacement therapy effect on thyroid
Increased TBG and total T3/T4 and normal everything else. No symptoms
Carbonic anhydrase inhibitor mechanism and changing urine effects
Increases HCO3 and volume losses alkalizing the urine
LH in PCOS?
High
What error type decreases with increased sample size?
Type II or missing the statistical significance
How does Warfrin work
suppresses carboxylation of precursor proteins that utilize vit K
Infusion rate formula
Drug clearance x Steady State Drug concentration plasma
How does Breast Ca mets get to vertebral column
intercostal veins
Glucosamine from F-6-P required cofactor
glutamine
eversion ankle sprain muscle that causes pain
Fibularis (peroneus) brevis
Jersey finger injury and innervation
flexor digitorum profundus (C8)
Autosomal trisomy with increased b-HCG
Trisomy-21
Autosomal Trisomy all values down
Trisomy 18. Inhibin may be normal or decreased
Nerves that may impair reinnervation peripherally
Schwann cells
What do 5-FU and capecitabine inhibit
thymidylate synthetase
What binds TATA box
RNA polymerase
Feathery appearance on contrast GI x-ray due to what
A lot of mucosal surface area
trx for child with severe diarrhea
sodium and glucose IV (or orally if worried in an office setting)
Interosseous muscle innervation
ulnar nerve
Plantar flexion nerve
tibial nerve
most common surgical injury during radical proctectomy
pelvic parasympathetic nerves
prostate cancer what type of lesions
osteoblastic lesion
nicotinic acid mechanism in cholesterol distribution
takes cholesterol from hepatocytes to VDRL in circulatory system
aspirin allergic pts should use what for headaches?
acetaminophen
Binding of prednisone?
Binds cytosol receptor with translocation into nucleus
Islets cells of pancreas comes from what cell type embryologically
Endoderm
In SCID due to adenosine deaminase def what enzyme is inhibited by high dATP levels?
Nucleoside monophosphate kinase
What lipid lowering agent increases muscle issues of statins?
Gemfibrozil
Respiratory compliance equation
Change in volume/ Change in pressure
Dicumarol?
Depletes Vit K just like Warfrin. Prolongs PT
Common secondary Ca from hodgkin lymphoma trx?
AML
What pharmacology value does not change with pt GFR function?
Loading dose
Chronic granulomatous disease susceptibility
Catalase positive organisms
S. Aureus, pseudomonas, serratia, nocardia, aspergillosis and candida
seizure with aura lobe of the brain?
Temporal lobe
stenting right kidney catheter advanced just beyond what artery
Right testicular is just below the renal access.
laxitive abuse electrolyte issue?
hypokalemia
First line for someone with recurrent pancreatitis or at high risk and has familial hypertriglyceridemia?
Niacin (works on VLDL) as fibrates are contraindicated
Major component of surfactant?
dipalmitoyl lecithin
diarrhea drug that has opiod properties at high doses
loperamide.
Foam cells in child?
Niemann-Pick composed of sphingomyelinase
Rheumatoid arthritis HLA assoc?
HLA DR4. 4 walled Rheum (room)
Thyroid hormone secreting ovarian tumor?
struma overii
tropic spastic paraparesis cause?
HTLV-1
amantadine
used to treat influenza, now used for parkinson thought to increase Dopamine release and inhibit degradation
Renal Cell Carcinoma
palpable mass, often spreads to lungs trx is recombinant IL-2 called aldesleukin
Osteopetrosis which cell has the issue?
dysfunctional osteoclasts. However normal osteoblast then make bone too thick after.
What is influenced by the disease prevalence in a population?
Positive predictive value
Chronic rejection (over 6m) of liver transplant what is damaged
small airways Bronchiolitis obliterans
lung changes with normal aging?
less compliance decreasing the FEV1 and increasing residual volume
Anesthesia that causes bronchodilation and is preferred in asthma?
halothane and sevoflurane
fluorinated anesthetics and the brain side effect?
Increase ICP and cerebral blood flow
Harnup disease
rash, ataxia and neutral amino acids in urine trx with niacin.
Most important immune component of lung abcess formation
Neutrophils releasing lysosomal contents
Subdural hematoma
crescent (crescent roll sub) bridging veins (slow decline bc venous)
Antiviral mechanism of interferon a and b?
Decreases protein synthesis in any cell with double stranded RNA due to viral infection
ragged red fibers on muscle biopsy, what type of diseses?
mitochondrial inheritance
amyl nitrate
cyanite tox antidote. coverts heme to methemoglobin which then binds cyanide keeping it in the blood so it cant poison mitochondria
locus ceruleus location and function
posterior rostral pons under floor of 4th ventricle. Secretes Norepinephrine for arousal
last cell type to disappear from bronchioles down to alveoli?
ciliated cells
toxo physical description?
intracellular and crescent shaped
how does insulin activate glycolysis?
activates PFK2 which produces fructose 1,6 bisphosphate
Anticholinergic toxicity (ex; jimson weed)
Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask, fast as a fiddle. Physostigmine
GI atresia embryologic issue
Duodenum- recanalization issue 8-10wks double bubble x-ray
Jejunum/ilium- vascular injury
Macrophage cell surface marker
CD14
Kozac consensus sequence?
Bunch of gcc’s before AUG that help initiate translation
sickle cell biochem?
mutated protein hydrophobic pocket allows for sickling
on release from SR calcium binds what in the muscle
Troponin C
Heparin overdose bleed trx
protamine sulfate
Nerve block for anything in medial leg
femoral block. Inject under inguinal ligament
achlasia electrophysiology
upper normal, esophagus low amplitude and Lower spincter is hyperexcited and does not relax
celcoxib?
(Selective cob b- or 2- inhibitor just what is sounds like
S 100 positive cancers?
neural crest derived cancers schwannoma and melanoma
Carpal tunnel ligament what structure traps median nerve?
Transverse carpal ligament (flexor riticulatum)
IL-10
released by macrophages. Anti inflammatory. Important in healing
primary hyperparathyroidism?
Common cause of isolated elevated Ca. Due to cortical reabsorption and sub periosteal erosions.
Class 1 antiarrhythmic mneumonic
A Queen’s Panini Doesn’t Beat Lidie’s Mexican Carne Fajitas Platter.
Deep brain simulation for Parkinson’s what area?
Gp internus or usually the subthalamic nucleus
knee flexion nerve
sciatic L4-S3
DMII drugs that increase insulin secretion via closing a K+ channel in B Cells of pancreas
Sulfonureas 1st gen- “amides” disulfiram rxns
Sulfonureas 2nd gen- “glipizide & glypuride”
Meglitinides- “glins”
Before alanine is converted to glucose in the liver who takes the amino group?
Alphaketoglutarate which requires Vit B6 (thiamine)
accuracy of a screening test?
area under the curve
PCOS infertility trx if clomiphene fails?
Drugs that mimic FSH of LH surge near ovulation
post MI scarring involves what type of collagen?
Type 1
Central DI how do you know where it happened
Permanent: Hypothalamus
transient: posterior pituitary
Fenoldopam
D1 agonist with multiple positive effects in hypertensive emergency especially if there is kidney damage.
Sirolimus?
anti IL-2
ENaC inhibitors?
Amiloride and triamerene
Who is predisposed to Drug induced lupus
People who’s livers are slow acetylators
Halothane?
Inhaled anesthetic with MAJOR acute hepatocellular Liver injury causing the organ to shrink and increases LFTs and PTT
Oral HPV locations?
young pt. base of tongue or tonsils, keratized pearls.
methadone adverse effect?
QT prolongation
CAH 21 hydroxylase def treatment?
ACTH low doses therapy to provide negative feedback
Ankylosing spondylitis inflammatory molecules
IL-17 and TNF-Alpha
how does thiamine deficiency cause damage
low erythrocyte transketolase activity
Ectopic pregnancy description on histology?
Decidualized endometrium- dilated, coiled endometrial glands and vascular stroma
Diabetic cataracts biochemistry
glucose is converted to fructose but sorbitol and intermediate accumulates.
Ethosuximide (anti-epileptic) mechanism
Blocks thalamic T-type Ca channels
Major Biochemical rxns of the mitochondria?
TCA cycle, Beta-oxidation of FA’s, gluconeogenesis (carboxylation of pyruvate)
Major Biochemical rxns of the cytosol?
Glycolysis, Synthesis of FA’s, pentose phosphate pathway
Why is Amphotericin B so terrible (amphoterrible) ?
Renal damage that causes Low Mg and K via epithelial damage?
REID index?
comparison of mucus glands to area of between epithelium and basement membrane. High ratio indicates more severe chronic bronchitis/COPD
Enzyme produced by mast cells in response to anaphylaxis by mast cells
typtase
protoporphyria’s and symptoms relative to pathway
Early enzyme deficiencies- neuropsychiatric symptoms PBG def
Late enzyme deficiencies- sun sensitivities Uroporphyrinogen def
tissues that increase Glut 4 in response to insulin
Muscle cells and adipose
Rifaximin and Lactulose moa?
Rifaximin decreases gut flora’s ability to produce ammonia bc it is an abx
Lactulose lowers pH after conversion to short chain FA and increases conversion to ammonium in the gut
Mifepristone and misoprostol moa’s?
Mifepristone- progesterone’s stop (antagonism)
misoprostol- prostaglandin E1 agonist
enfuvirtide
stops gp41 conformational change inhibiting fusion of HIV virus to host cells
HIV integrase inhibitors drug name ending
“tegravir” all can cause elevated ck
what type of muscle does not rely of extracellular calcium to work?
skeletal muscle uses RyR channel to get Ca from SR instead
Lac operon 2 methods of regulation
- Positively- cAMP-CAP upstream of promoter
2. Negatively- repressor protein binding to operator locus
germinal centers of lympnode follicles B cell actions
Isotype switching and proliferation response to invader
what is in the lower leg anterior compartment?
Tibial artery/vein, deep peroneal nerve, foot extensor muscles
what immune cells cause inflammation in gout?
neutrophils
Metyraphone stimulation test physiology?
Negative feedback to HPA axis to decrease cortisol synthesis. Leads to reactive ACTH surge and build up of intermediates 11-deoxycortisol and 17-hydroxysteroid levels.
fixed dilated pupils
midbrain lesion
RNA interference?
Short double stranded RNA molecules block translation in ribosome
BPHP that responds to finasteride that has what cellular predominance?
Epithelial predominance. Non-responders usually have a smooth muscle and collagen predominant hyperplasia
How does gigantism result in big hands/feet/jaw
Excess GH stimulates liver to produce insulin like GF 1 which directly stimulates bone, soft tissue, cartilage
Bacterial and chemo agent resistance mut?
Multidrug resistance gene mutations result in a ATP dependent transporter that just pumps drugs out of the cell
Treatment of absence seizure + tonic clonic activity?
Valproic acid
Di George Embryologic issue
failure of III and IV pharyngeal pouch development
Stop codons
UAA, UGA, UAG
Linkage disequilibrium and calculation
Genes are inherited together more or less than expected. Just multiply frequency allele 1 x frequency allele 2
Postpartum thyroiditis cell type
Lymphocytic invasion with diffusely decreased R-iodine uptake. Similar to Hashimoto’s but occurs within 1 year of P and resolves
Initial drug for status epilepticus
IV Bezo’s
Cdiff treatment that inhibits RNA polymerase
Fidaxomicin (has less effect on good bacteria than vancomycin)
midline neck mass that moves
thyroglossal duct cyst
most common protein altered in familial dilated cardiomyopathy?
titin. Often Autosomal dominant with variable penetration
essential fructoseuria enzyme def and why is it so mild?
defect in fructokinase but hexokinase can still covert the fructose
what happens to pyruvate during hypoxic conditions?
NADH accumulation inhibits pyruvate dehydrogenase so production is shunted to lactate instead
testicular hydrocele what is the issue
tunica vaginalis
chronic diarrhea or illeostomy and stones?
pure uric acid stones due to low urine pH
when does expiratory stridor occur?
tracheomalacia
treatment for pressor leak that threatens to vasoconstrict a limb to death?
Phentolamine locally to antagonize a1 stimulation
nondisjunction in trisomy 21?
maternal nondisjunction during meiosis 1
Osteoclasts in paget’s disease of bone
numerous & large up to 100+ nuclei. Excess differentiation driven by M-CSF and Rank-L (aka nuclear factor kappa beta)
shortening of 4th toe and ephysial dysplasia
Refsum disease. Peroxisome issue phytanic acid build up
what happens if the midgut fails to rotate around the SMA?
fibrous band obstruction of duodenum and/or volvulus
murmur best heard with the pt sitting up and leaning forwards?
aortic regurgitation
excess raw egg white consumption decreases what vitamin?
B7 (Biotin)
Biochemical rxn that utilize vit B7?
Carboxylase enzymes
- Pyruvate to oxaloacetate (gluconeogenesis) pyruvate carboxylase
- Acetyl CoA to Malonyl CoA (FA synthesis) Acetyl CoA carboxylase
- Propionyl CoA to methylmalonyl CoA (FA oxidation) Propionyl CoA carboxylase
What meds should be avoided in HCM?
anything that drops preload is bad. Vasodialators and diuretics
Gerstman syndrome lesion location
angular gyrus of dominant parietal lobe
Embryonic origins of craniopharyngioma
Rathke’s pouch which forms anterior pituitary
skateboarding associations of distribution skew
Positive skew: Camel hump
Negative skew: ramp
named after the tail of data which pulls mean out
MEN mutations
Men 1: Menin (MEN1) 3P’s
Men 2A: Tyrosine kinase (RET) 2P’s & 1M
Men 2B: Tyrosine kinase (RET) 2M’s & 1P
Chronic glucocorticoids and liver enzymes
increased gluconeogenesis enzymes
Antibodies in thyroid diseases
TPO: Hashimoto’s, postpartum thyroiditis
TSH receptor: Graves
Nerve most commonly injured during thyroidectomy
external (recurrent) laryngeal nerve innervating the cricothyroid
Temporal lobe epilepsy path findings?
Temporal Astrocytic proliferation in response to hippocampal sclerosis/atrophy
Ulcer in the distal duodenum?
Zollinger Ellison syndrome
Secretin test and ZES?
paradoxical increase in gastrin due to abnormal adenyl cyclase activity
What is need to calculate CO from a Swan Ganz catheter?
rate of 02 consumption/ arteriovenus 02 content difference
Important gene in granulation tissue and vascularization?
VEGF can overproduce granulation tissue in secondary intent healing delaying recovery
gap junctions made of what protein?
connexins (connect/communication)
hemidesmosomes are made of what cell type?
integrins
Oxybutynin mechanism?
antagonizes M3 receptors to decrease detrusor contraction exact opposite of bethanechol
retroperitoneal hematoma can cause what neuropathy
femoral nerve (patella reflex and anterior thigh)
Nitric oxide is synthesized from what AA
arginine
PPI inhibitors and nutrient absorption
Increases: fat absorption
Decreases: calcium, iron, Mg, B12
Octreotide mech and indications?
somatostatin analog. acromegaly, carcinoid syndrome, variceal bleeding
Molecular motor proteins mneumonic?
REaDY AttacK
Retrograde- dynein
Anterograde- Kinesin
Interscalene block risk
also paralyzes unilateral diagram so avoid in pts with underlying lug dz
What major reactions is NADH used for?
cholesterol/FA synthesis and as a gluthione anti oxidant mechanism
Dark bit inside the nucleus what is it?
Nucleolus this is where RNA polymerase 1 transcribes ribosomal gene
Pulmonary Arteriole Hypertension signaling disfunction
Too many constrictors: Thromboxane and endothelin
Not enough dilators: NO and Prostacyclin
Heart failure cells in lung parenchyma?
hemosiderin laden macrophages described as “golden brown granules that turn blue with prussian stain”
Aortic notch artery branches right to left?
brachiocephalic, left common carotid, Left subclavian
most common part of the nephron obstructed by uric acid stones?
Collecting duct due to low pH causing precipitation
Epidermolysis bullosa and mutated protein
minor trauma = bullae. Keratin mutated
Angelman vs Williams syndrome
Angelman: inappropriate laughter chromosome 15 paternal silencing and maternal bit lost
Williams: Will Pharrell in elf. Friendly, elfin appearance chromosome 7
PSaMoMa bodies mneumonic
Papillary carcinoma of the thyroid
Serous cystadenocarcinoma of the ovary
Meningioma
Mesothelioma
B1 (thiamin) chemical reactions
Be APT (all dehydrogenase rxns)
- Branched-chain ketoacid dehydrogenase
- a-ketoglutarate dehydrogenase (TCA cycle)
- Pyruvate dehydrogenase (glycolysis and TCA cycle)
- Transketolase (HMP shunt)
Location of the parietal cells and chief cells in gastric mucosa
Top simple columnar cells
upper glandular layer- parietal cells
Lower glandular layer- chief and delta cells
Hennoch schonlein purpura other name
Ig A vasculitis
why does one get hypogonadism in hemochromatosis?
iron deposition in the pituitary gland
Staph aureus that causes tissue necrosis?
MRSA that gains leucocidin via a bacterial phage
when are monoclonals (cetuximab, panitumumab) against EGFR ineffective?
mutated KRAS
clasp knife spasticity location
internal capsule
what anesthetic are myasthenia gravis pts susceptible too?
vecuronium, but are resistant to succinylcholine
What is homocysteine normally converted too?
methionine (homo that does meth)
how does physiologic pleural fluid get there?
in from micro intercostal vessels out through parietal pleural lymphatics
in a pacemaker where is the LV pacing lead placed?
coronary sinus in the atrioventricular groove
Pip-Tazo antibiotic class
penicillin and a beta lactamase inhibitor
TRX for nephrogenic DI
Thiazide diuretics so more sodium and H2O is absorbed proximally
How many half lives to reach a steady state concentration?
4-5
cyclophosphamide mech and cell cycle area?
alkylates guanine. Cell cycle non-specific
didanosine mech and adverse effects
NRTI used in HIV. Hepatitis and pancreatitis
Protease inhibitor ending
“navir”
why is imipenem given with cilastatin?
cilastatin prevents its degradation by dhp-1 in the proximal tubule
single loud S2 in cyanotic baby?
transposition of the great vessles
Esophageal webs and iron def. anemia?
Plummer Vinson syndrome. Can be detected in middle age.
Common pathologic cause of bloody nipple discharge
papillary carcinoma described as epithelial cells lining fibrous core
p450 inducers mneumonic
Rif some Carbs, Barbs, and Herb and have a Phen Time!
p450 inhibitors mneumonic
Certain Silly Compounds Very Annoyingly Inhibit Enzymes, GRRR
Cipro, sulphonamide, cimitedine/omeprazole, valproate, antifungals/amiodarone, Isoniazid, Erythromycin, grapefruit juice
inhibin in males
produced by sertoli cells inhibits just FSH
Jaw jerk reflex what nerve
Trigeminal nerve in and out
Chromaffin cells appearance and what stimulates them
adrenal medulla is Blue on H&E
stimulated to produce catecholamines by acetylcholine
tap protein?
transports bacterial polypeptide fragments to b2-microglobulin and MHC1 in the ER for cell surface expression of pathogen
Disease causing pallor of catecholaminergic brain regions
PKU does this
Eosinophilic granulomatous polyangiitis
peripheral neuropathies, late onset asthma, eosinophilia, p-anca
CAH sheet rules
first #- mineral corticoid/BP Second #- sex hormones K is always opposite bp Cortisol always low, MSH always up 1 = up not 1= down
how do inflammatory molecules increase insulin resistance?
upregulate serine/threonine kinases
What’s a way to get Wallenburg syndrome following trauma?
vertebral artery dissection
pharmacologic permissiveness
when a hormone exerts no effect by itself but allows other hormones to exert their maximal effect
what drug class can mask the symptoms of hypoglycemia?
non-selective Beta Blockers
how can niacin be synthesized endogenously?
from tryptophan
uniform enlargement of uterus, heavy periods
adenomyosis. Endometrial glands and stroma in endometrium
common triggers for COPD exacerbations?
infections or air pollutions
celiac disease cancer association?
T-cell cancer
what happens to c peptide after insulin synthesis
secreted together in vesicles after being cut in the golgi.
calories and common molecules
1 gram carbs and protein- 4kcal
1 gram ethanol- 7kcal
1 gram fat-9kcal
TEE probe lies closest to what chamber and what is posterior
left atrium (anterior) descending aorta (posterior)
primary moa of 2’ed gen antipsychotics?
D2 and S2 receptor antagonism
1st gen only do D2 but more potent
HIV associated dementia description on path
microglia that form multinucleated giant cells
occurs bc HIV infects microglia which are immune like cells
Medullary Thyroid cancer path description
polygonal cells with congo-red positive deposits. calcitonin is a type of amyloid
In untreated MG what happens to acetylcholine receptors over time?
endocytosed and degraded due to lack of stimulation
common injury site of the common fibular (peroneal) nerve?
neck of fibula on knee injury remember PED (peroneal everts and dorsiflexes)
monotherapy for men with BPH and HTN?
non selective a1 blockers “azosin” such as prazosin.
Tamsulosin is uroselective so does not address HTN
Why do P women get constipated?
progesterone decreases colon smooth muscle activity
TMJ nerve?
Mandibular (V3) branch of trigeminal nerve
why doe RBC’s have a lot of chloride in the venous blood
it is exchanged in order to get rid of HCO3 produced by carbonic anhydrase
doxycycline mechanism?
inhibits protein synthesis by inhibiting 30s ribosome subunit
burning pain medial thigh/ anterior scrotum nerve?
ilioinguinal nerve
orbital floor fracture possible nerve damaged and symptoms
numbness in upper lip, cheek and gingiva infraorbital nerve (part of maxillary nerve)
HIV diarrhea associations
ulcers/owl eyes- CMV
nonulcerative inflammation- cryptosporidium
distortion of villi/ no inflammation- microsporidium
MAC- necrotizing and non-necrotizing granulomas
embryology of hypospadias
lack of urethral fold fusion
epithelial ovarian cancer tumor marker
Ca-125. Most common class of ovaria ca. can be serous or mucinous
osteogenesis imperfecta physiology
Osteoblast don’t make osteoid which in crucial in type 1 collagen.
naltrexone for ETOH withdraw mech?
block mu receptors useful to reward pathway
what cells produce aqueous humor?
epithelial cells of ciliary body
Umbilical cord vessles
1 vein: Oxygenated blood from mom
2 arteries: deoxygenated blood from fetus
pylocytic astrocytoma
children. well circumscribed with a cyst
pulsus paradoxus physiology during inspiration
drop in BP, bc with set cardiac volume due to tamponade
RV fills and septum moves toward LV so it cant fill as much and SV decreases
alkaptonuria
arthritis + urine turns dark
deficiency of homogentisic acid oxidase, an enzyme in the tyrosine degradation pathway, that converts homogentisic acid to maleylacetoacetic acid.
Bilirubin conversion disorders
unconjugated: Crigler-Najjar (severe) gilberts (mild)
Conjugated/direct: Dubin Johnson (black liver/severe) and rotor (mild)
lacrimal glands M subtype
m3 uses Gq.
Hodgkin lymphoma treatment
1st line: ABVD
2nd Line: MOPP
DIC with leukemia?
PML likely M3 auer rod subtype T:15,17
Uvula deviation Cranial nerve
Vagus (X) contralateral to deviation direction
late catecholamine synthesis defects
dopamine β-hydroxylase deficiency: hypotension hypotonia (uses vit C)
catechol-O-methyltransferase: hypertension
indinavir side effects
crystal induced nephropathy, thrombocytopenia
Folate Vit B9 def biochemical issue
important in 1 carbon transfers and DNA/RNA synthesis
High AFP and acetylcholine esterase in amniotic fluid?
failure of neural tube to form bc neural plates do not come together
muscle that is under voluntary control that allows for defecation when relaxed?
puborectalis
where do bacteria from an aspiration abscess come from?
oral flora
Most common component of acute transplant rejection?
Type IV hypersensitivity. CD8 T-cells against recipient against graft MHC molecules
Voltage gated Na deadly poisons
Close- Pufferfish/ red tide blooms
open (persistent depolarization)- poison dart frogs (batrachotoxin)
Marfan’s biochemical issue?
Fibrillin-1 mutation. This normally forms a sheath around elastin
murmur in coarctation of the aorta?
flow through collateral blood vessels
receptors that decrease insulin secretion
Alpha 2 and somatostatin 2 (SomA(TWO)statIN)
Where do H-pylori reside?
gastric antrum
angiotensin II and GFR?
constricts efferent tubule increasing GFR
what happens after recovery from renal tubular necrosis?
Massive K drop. can be life threatening
Hypertrophic osteodystrophy
adenocarcinoma (usually of lung) causes AV shunting and megakaryocytes get into systemic circulation where they release PDGF and VGF in the distal bones causing new bone formation and digit pain
sensation of back of posterior tongue and mouth/tonsils and afferent branch of gag reflex?
Glossopharyngeal IX
Why can isoniazid cause a sideroblastic anemia?
inhibits pyridoxine phosphokinase which produces PLP a necessary cofactor of ala synthase
hypovolemic shock and urea reabsorption?
increased urea reabsorption in order to maximize the concentrating ability of the nephron and resorb more water
acute Aortic dissection med
IV esmolol
decreases contractility and heart rate to lessen further damage.
What anti arrythmics cause QT prolongation?
1A (Q,P,D) and class III (Amiodarone, ibutilide, dofetilide, sotalol)
A-galactosidase A deficiency
Fabry disease
neuropathic pain and decreased sweating
telangiectasia
death from CVA’s, cardiac dz, renal failure
what in the extracellular matrix does integrin often bind?
fibronectin
What enzyme does warfarin inhibit
epoxide reductase. Takes a while for previously made clotting factors to be cleared so bridge with heparin
symptoms of a subfalcine herniation
contralateral leg weakness
If the pringle maneuver does not stop bleeding where is the blood coming from?
hepatic veins or inferior vena cava
cell types female ovaries and hormone production
Theca cells: respond to LH produce progesterone and androgens in the interna
Granulosa: respond to FSH convert androgens to estrogen
CREST and diffuse scleroderma antibodies
CREST: anti-centromere
diffuse scleroderma: anti topoisomerase 1 (scl-70)
most common labs in people with renal stones
normal blood calcium
high urinary calcium exertion
why does a normal aortic valve calcify with age?
thought to include fibroblast differentiation to osteoblast like cells
Follicular lymphoma symptoms
Long indulgent waxing and waning course
painless lymph node involvement
t(14:18) blocks cell death
nodular pattern on x-ray
mixed connective tissue disease
features of lupus + other diseases like scleroderma
antibody against U1 ribonuclear protein
metformin mech
inhibits gluconeogenesis
Check Cr before starting
mech of fibrates for hypertriglyceridemia?
act on PaRR-a protein to increase transcription of lipases in endothelial cell targets of TAGs. This lowers hepatic VLDL production
DNA laddering?
process of apotosis wherein DNA is cut into 180 bp fragments as the cell degrades
atropine mech
Ach antagonist
germline mutations often affect what cells?
gametes and oocytes
calcium dependent intercellular connections?
cadherins form desmosomes and adherens junctions removing extracellular Ca causes dissociation
molluscum contagious on path?
caused by poxovirus
molluscum bodies. Eosinophilic inclusions
posterior dislocation of the tibia relative to the femur injured structure?
popliteal artery
sublimation?
mature defense mechanism. Channeling impulses to socially acceptable behaviors
in a healthy pt whith a nephrectomy what is the GFR eventually get too from the healthy kidney?
80%
PD5 inhibitors for erectile dysfunction moa?
increase cGMP in corpora cavernousa leading to relaxation
High flow in the pancreas due to what?
secretin causes a high HCO3 output and low chloride
false positive rate
1 - specificity
what do leukotrienes C,D,E promote in asthma?
bronchospasm and vessle permeability
nitrates and the heart
decrease preload and cause a reflex tachycardia
Albright hereditary osteodystrophy?
GNAS1 mut. short stature and fingers
Causes resistance to PTH so low Ca, high Phosporus and lots of PTH that cant act on receptor
what does a N terminal signal sequence addition signify?
bound to the ER so it can be inserted into membrane or secreted. If this is non functional the protein will accumulate in the cytosol
Infertility + Normal serum testosterone but low testosterone in the seminiferous tubules
Sertoli cell cell dysfunction causing a lack of androgen binding protein.
Pheo vs carcinoid breakdown products
Pheo- palpipations, sweating: Urine metanephrines
carcinoid- diarrhea, flushing, cardiac sclerosis: urine 5-HA
Activating tumor mutation that works by transfering signals to the nucleus via the MAPK pathway?
RAS
tumor that stains positive for chromogranin and synaptophysin
carcinoid tumor
alternate method of protein translation that takes place during apoptosis
translation via “internal ribosome entry sites” where it can begin in the middle of mRNA
osteomalacia what cant be formed?
Osteoid bone. Usually due to low Vit D, or calcium
what type of abnormal bone is formed in Paget’s?
lamellar
what muscles does the L. Recurrent laryngeal nerve innervate
L. recurrent laryngeal can be compressed by aortic dilation. Innervates multiple muscles ending in “arytenoid”
achalasia imaging and pathophysiology
“birds beak” loss of neurons in Auerbach’s plexus
examples of unmyelinated or type C fibers
pain, heat and autonomic postganglionic nerves
part of MHC II molecule that is digested during antigen processing?
invariant chain
what molecules determine cellular differentiation?
transcription factors
pernicious anemia
gastric mucosa attacked and parietal cells die. High gastin levels from G cells
type of nephrotic syndrome associated with sickle cell, HIV, and heroin addiction?
Focal segmental glomerulosclerosis
what section of muscle stretchers and lengthens during relaxation and contraction
I band (non overlapping portion beside z disk)
how does prostate ca. met to the spine?
Via prostatic venous plexus
Thiazolidinedione’s mech and effect
decrease insulin resistance by binding Parr-gamma a nuclear transcription factor
Lesch-Nyhan biochem
HGPRT defect so PRPP is able to compensate some with increased activity
Type 1 and II error mneumonic
Type I: I=P false positive
Type II: II=N false negative
apical wall thinning and dilated esophagus or colon +- dilated cardiomyopathy?
Chagas disease
Seronegative spondyloarthropathies HLA serotype?
HLA type 1. assoc with B27 HLA allele
erythromycin non-antibacterial indication?
motilin receptor agonist in gastroparesis
Metoclopramide mechanism and side effects
D 2 antagonist
dystonia and tardive dyskinesia
Benadryl can help motor symptoms
what types of receptors may have zinc finger nucleases?
intranuclear receptors may act as transcription factors (ex thyroid receptor)
where does a bladder rupture to cause intraperitoneal fluid?
bladder dome
what portion of the bowel is always involved in Hirschsprung disease
rectum
Do diuretics improve mortality in reduced EF HF?
No but ACE, ARB’s, NE-ARB’s, B-blockers, and mineralocorticoid receptor blockers do
new drug +/- fever with urinary eosinophils if urinary WBC’s are characterized
interstitial nephritis
Fasting and hormones
Glucagon and epi= transmembrane binding
prolonged fasting= cortisol binding intracellularly to alter transcription
Decerebrate (extensor) posturing. What is damaged?
Pons and/or midbrain below the red nucleus where the rubrospinal tracks feed
why does alveolar capillary blood have slightly higher O2 than systemic arteriolar circulation?
The blood used by bronchi and heart drain venous blood into arteriolar system
where does urethral injury from trauma often occur in males (assuming penis is not broken)
right below the prostate by the cowpers gland. Membranous portion of the urethra
Down and out eye. what nerve is still okay?
Abducens innervating the lateral rectus
and Trochlear innervating the superior oblique
most common early ETOH withdraw symptom
Tremors
Penicillin resemble what bacterial cell wall component?
D-ala D-ala
Where does phrenic nerve arrive from?
C3-C5 symp: hiccups and shoulder pain with diminished breath sounds on one side
Vit A toxicity symptoms
teratogenic, hepatosplenomegaly, Intracranial hypertension, skin changes
Pseudo allergic rxn with opiods
Histamine release no IGE component
how does radiation therapy damage cancer?
- Double stranded DNA breaks
2. Formation of free radicals
free fatty acids and DM?
Increase insulin resistance and increase hepatic gluconeogenesis
Heart pressures
RA: <5 RV: 25/5 PA: 25/10 PCWP: 4-12 LA: <12 LV: 130/10
SCC and ear pain?
nasopharyngeal SCC tumor obstructing the eustation tube outlet
What do ventral and dorsal portion of pancreas go on to form
Ventral: most of body
Dorsal: most of head and main pancreatic duct
Infection in pts receiving systemic chemo usually come from where?
endogenous flora penetrating mucosal barriers
male genitalia and lymph drainage
interior thigh/penis= superficial inguinal to deep
internal testes= para aortic
internal hemorrhoids veins
superior rectal originating for inferior mesenteric
what are the two major mechanisms of NAD+ regeneration?
arerobic- TCA cycle
anaerobic- lactate formation
How does Ventoclax (BCL2 inhibitor) help in CLL?
makes chemo more likely to induce apoptosis via caspases
GBM on stained brain biopsy
central area of necrosis surrounded by pseudo-palisading bodies + vascular proliferations
large difference between alveolar and pulmonary venous blood PaO2 but CO2 is normal. Why
indicates diffusion impairment. CO2 is normal bc it is 20x better at diffusing so is not as affected
NPH (Wet wacky wobbly) Why these symptoms?
Stretching of descending cortical fibers
Ovarian/ testicular Venus drainage
Left into Left Renal
Right goes ‘Right’ into the IVC
The endothelium secretes what in order to oppose Thromboxane A2?
prostacyclin (prostaglandin I2)
Ketamine moa?
NMDA antagonist that mimics catecholamine release. Improves bronchospasm. Increased HR and may cause higher ICP
What AA is important in renal ammonia genesis?
Glutamine. Helps acidify urine and provide bicarb for buffering the blood
Wilms tumor chromosome
Wilhelm is an 11 year old boy who is Wide (Beckwith Wideman)
Why does Rigor Mortis happen?
actin and myosin remain bound in the absence of ATP
Paget’s disease of breast path description
large cells and halo’s (Think nipples in the nipple)
What organ does polyarteritis classically spare?
lungs
VWF disease inheritance?
autosomal dominant
Hep B first line trx?
tenofovir disoproxil fumarate (Down to fuck)
embryologic origin of the pituitary
anterior: Rathke’s pouch, surface ectoderm
posterior: neural tube
sevelamir mech
binds phosphorus in intestine decreasing absorption
Vit E deficiency symptoms similar to what disease
Friedrich ataxia
Internal laryngeal nerve mech of injury and symptoms
purely sensory of mucosa above vocal cords.
Afferent limb of cough reflex.
Injured during food choking injuries and retrieval
unilateral swollen red arm and face what VEIN obstructed?
brachiocephalic
Bilateral would be superior vena cava
neurosarcoidosis most frequently associated with what tumor type
prolactinoma
Loading dose formula
Steady state conc x Volume distribution
maintenance dose formula
Steady state conc. x clearance x dose interval
BCL2 inhibits what
cell death cascade
Berylliosis vs silicosis on biopsy
Berylliosis- noncaseating granulomas
silicosis- birefringent particles, laden macrophages
Prokaryotic DNA Polymerase III function?
5 to 3 DNA synthesis. 3 to 5 exonuclease (mismatch repair) activity
(prokaryotic DNA polymerase I can do this + remove primers in 5 to 3 exonuclease fashion)
Desmopressin moa’s
Hemophillia A and vWF def= increases endothelial secretion of VIII and vWF
CDI and nocturnal enuresis- Binds V2 receptor and causes increased aquaporin expression and more water absorption
Thyroid treatments during P in mothers with Graves dz
Thyroid is developed by 12 in infants but if mother must be treated
1st trimester: PTU (not teratogenic but hepatotoxic)
2nd and 3rd trimester: methimazole which is less hepatotoxic
Why is blood venous oxygenation increased in septic shock?
The massive vasodilation and and increased HR causes blood to flow so fast the oxygen cant be properly extracted by the tissue
stimulant laxatives?
senna and Bisacodyl
VHL disease
AD tumor suppressor gene mutations
Pheochromocytoma, clear cell renal ca, cerebellar and retinal hemangioblastomas
physiology of diabetic neuropathy
- glycosylation leads to hyalinization of endoneurial arterioles
- sorbitol formation promotes oxidative stress
Kidney embryology
pronephros- regresses
mesonephros- males deferens and epidymis
mesonephros- females vestigial Gardner’s ducts
Metanephros- Glomeruli to the distal convoluted tubule
ureteric bud- collecting system and kidney
foscarnet side effects
chelates causing low Ca and Mg resulting in seizures
How does hypothyroidism cause high cholesterol?
Decreased LDL receptor gene transcription
Insulin special cell signaling
Receptor- Tyrosine kinase
Growth and division- RAS/MAPK
Glut4 translocation- PIK3 activates > protein phosphatase activates > glycogen synthase
midshaft humerus fracture
deep brachial and radial nerve
demyelination and electrophysical constants?
Time constant- increases bc takes longer
length constant- decreases bc ap travels less distance before needing a boost from ion channel depolarization
pembrolizumab mech?
Antibody against overexpressed Program death ligand 1. Causes CD8 T cell activation to fight cancer
gout crystals
needle shaped and negatively birefringent
GLP1 agonists
“tide” (tide of modern drugs)
weight loss, pancreatitis
delayed gastric emptying
more glucose dependent insulin, less glucagon
Ezetimibe moa
reduces cholesterol absorption at brush boarder via Nieman-pick like transporter protein
acute dystonic reactions caused by what
D2 antagonism in nigrostriatal pathway
what can be injured during c section when transecting abdominus rectus?
Inferior epigastric artery
Best indicator of the severity of a MR and M stenosis murmur?
MR: Presence of an S3
MS: A2 to opening snap time interval. shorter is worse
Ehlers Danlos physiology
Type III collagen C and N terminal cleavage issue
What is first line for HTN due to cyclosporine or tacrolimus?
Diltiazem
Only pathogenic fungus with polysaccharide capsule?
Cryptococcus neoformans. Lets it chill if phagocytosed
Barrett’s esophagus predisposes to what type of Ca?
adenocarcinoma
What muscle can compress the nerve in the sciatic foramen?
Piriformis
Motor innervation to muscles of mastication?
Trigeminal nerve V3 exits through foramen ovale
Malignancy in 3rd part of duodenum what is compressed?
SMA
OCD first line treatment?
SSRI
TMJ what muscles can spasm?
masseter and pterygoid
Fructose 2,6-Bisphosphate concentrations and rxns
High levels activate activate PFK-1 (glycolysis) and inhibit fructose-1,6 bisphosphatase (gluconeogenesis)
What anesthetic carries risk of large K increases?
succinylcholine can also have increased time of duration in pts with pseudocholinesterase mutations
Cleft lip and cleft palate
cleft lip: maxillary prominence and intermaxillary segment
Cleft palate: failure of palatine processes fusion
maraviroc moa
CCR5 inhibitor to stop macrophage entry
Lung cancer endocrine secretions
Small cell: Cushings (ACTH) and SIADH (ADH)
Squamous cell: hypercalcemia (PTHrP)
Graves opthalmopathy physiology?
Inflammatory expansion (due to fibroblast activation, causing glucosamine accumulation) of muscle and fat pushing eye out. Treatment is steroids
Middle meningeal artery is a branch of which artery?
maxillary artery
Cricothyroidotomy goes through what?
superficial cervical fascia and cricothyroid membrane
Ovarian torsion always includes rotation of what ligament which tracks with the blood supply
suspensory ligament of the ovary
infundibulopelvic ligament
What leads to nephrotic syndrome in minimal change disease
loss of anions in basement membrane allowing albumin into the urine usually due to autoimmune dysregulation
Where are VLCFA (very long chain fatty acids) degraded?
peroxisome
Sobosfuvir mech
Inhibits RNA dependent RNA polymerase in HepC
What structures are in cubital fossa? (front of elbow)
brachial artery and median nerve
Functional residual capacity in COPD?
Goes up due to expansion
high mitotic index (near 100%) is typical of what
Burkitt lymphoma
Why do you get panacinar emphysema in alpha 1 antitrypsin def?
elastases destroy interalveolar septa
Annular pancreas embryology
abnormal migration of the ventral bud
serum sickness rxns
7-14 days post exposure
fever, rash arthralgia
low complement and Ig deposition
Vessels have fibrinoid necrosis and neutrophil invasion
Celiac dz HLA assoc
HLA DQ2 and DQ8
What causes obstruction in HOCM?
mitral leaflet and intraventricular septum
Benzo mechanism
modulate GABA channel causing more Cl influx in the presence of GABA. Causes more hyperpolarization
Medical management of gallstones
ursodeoxycholic acid. basically a hydrophilic bile acid
Ghrelin and bariatric surgery
produced by stomach in response to fasting
Many ghrelin secreting cells are lost in procedure leading to less hunger
Common tamoxifen side effects
VTE, hot flashes, endometrial hyperplasia and Ca
Imiquimod moa
a topical agent that activates Toll like receptor 7 upregulating nf-kb and causes an immune response against abnormal/or proliferating cells in dermatologic conditions. Also increases apoptosis and inhibits angiogenesis
phenytoin moa
blocks Na in the motor cortex
Neural tube defects what week of development?
4th
parotitis serum marker
amylase
Ketogenic amino acids that will not be metabolized to pyruvate
Lysine and Leucine. can be protein supplement of ketogenic diet for pyruvate dehydrogenase deficiency
Pierre Robinson sequence first embryologic insult?
mandibular prominence misunion leading to micrognathia
peptide hormones effect on kidney (ANP and BNP)
dilate afferent, constrict efferent
Increase GFR, increase natriuresis and diuresis
decrease renin to lower volume status
Ortic aciduria vs Ornithine transcarboxylase def
Both have high orotic acid in urine
Ortic aciduria- presents at months old can be saved with uridine supplementation. No hyperammonia. megaloblastic anemia
Ornithine transcarboxylase def- presents within days or weeks. arginine supplementation helps minimally. no megaloblastic anemia
Low BMI what causes low estrogen state?
Low leptin inhibits GnRH pulsatile release and then LH and FSH are low as well
parvo virus genetics
nonenveloped single strand DNA virus
Multiple myeloma antibodies produced and renal obstruction cause?
mostly IgG.
The Kappa and lambda light chains cause renal obstructions
Organophosphate poisoning (farming or serine type gases)
Muscarinic: DUMBELS
diarrhea/diaphoresis, urination, miosis, bronchospasm/bradycardia, emesis, lacrimation, salivation
nicotinic: fasciculations/ paralysis
atropine and pralidoxime
Loud pulmonary component of S2
pulmonary HTN a condition assoc with BMPR2
where do lower rectal lymph nodes go to?
inguinal region
how are monoclonal antibody drugs cleared?
phagocytosis at the target or in the spleen
fibrates side effects
gallstones (block bile acid synthesis)
myalgias, not to be combined with statins
G6PD deficiency inheritance?
XR
Neurotoxic proteins in frontotemporal dementia
TAU (also in Alzheimer’s)
abnormally ubiquinated TDP-43 (also in ALS)
confidence interval equation
mean ± z score of confidence interval x (sd / (√n),
what promotes sickling
low O2, acidosis, dehydration
One kidney stenotic what happens in other kidney
decreases renin and excretes more sodium
Lack of gag reflex major insight
damaged medulla oblongota (brain death)
afferent- glossopharyngeal
efferent- vagus
cholestyramine
binds bile acids in bowel leading to their excretion. To compensate liver makes more cholesterol
what enzymes make fibro atheromatous caps unstable?
metalloproteases secreted by macrophages
bicornate uterus embryologic issue
lateral fusion of the paramesonephric duct
Other name for hereditary telangiectasia
Osler-Weber-Rendu
what is immune privledge?
organs (testes and eye) that are shielded from immune responses
young pt back injury with anterior disk displacement
spodylolysis (fracture of pars interarticularis)
bacteria produce which vitamins?
K and folic acid
Aortic Arches mneumonic
Medical Startup Conference at Science Park
- Maxillary
- Stapedial artery
- Common corticoid/ internal Carotid
- Aortic arch, rt Subclavian
- Pulmonary arteries, PDA
What underlies AAA
chronic transmural inflammation
how does pre-eclampsia damage organs?
widespread spasm
The liver requires expression of APOE3 and APOE4 to take up what?
chylomicrons and VLDL’s
AIRE deficiency
without air your body would char
chronic mucocutaneous candidiasis, hypoparathyroidism, adrenal insufficiency, recurrent candida infection
Wernicke’s aphasia what artery
Inferior MCA. Broca’s aphasia is superior MCA.
Asthma small molecule bronchoconstrictors in pathogenesis
LTB C4, LTD4, LTE4 CDE’s ends with e for eosinophils
Meniere’s disease triad
sensorineural hearing loss, vertigo, hearing loss.
Due to increased endolymph
pinworm trx
albendazole, mebendazole, or pyrantel pamoate. The latter should be used in pregnant women.
where does excess copper usually go?
bile
cAMP utilizing hormones cause what?
activate protein kinase A
immune cell types in COPD
macrophages, neutrophils, CD8 T cells
What predisposes to giardia infection
any condition with low IgA.
Giardia looks like horse shoe crabs on slide
Why do you have to take mefloquine for 4 weeks upon return from malaria endemic area?
Inactivated in the liver so cant fight schizonts in the liver
Cytokine important in Giant cell arteritis?
IL-6 (the giant of inflammation) can be targeted with tocilizumab
Raspuricase
Think Rasputin’s big penis
oxidizes uric acid so it can be excreted in the urine
Why are the acyclovir family of antivirals not universally effective?
many virus’s can’t convert the drugs to their active forms
True vs false diverticula?
True diverticula- Merkel’s all the layers
False diverticula- Zenker’s mucosa and submucosa only
Light’s criteria
Protein ratio over .5
LDH ratio over .6
Pleural/serum
postpartum pt with fecal incontinences nerve injured
pudendal
UV light convers what part of vit D pathway
first step: 7-dehydrocholesterol to vit D3 (cholecalciferol)
most deoxygenated blood in the body?
coronary sinus bc myocardial oxygen demand is so high
Dementia meds that can cause AV block/syncope?
acetylcholinesterase inhibitors Donepezil and rivastigmine
NRTI med specific mechanism
interfere with phosphodiester bond in growing strand
what are P bodies?
CYTOPLASMIC structures important in mRNA translation regulation and decay
most common cause of degenerative arthritis in back?
disk herniation, ligmentum flavum hypertrophy, and osteophyte formation
Thiamine (Vit B1) def. syndromes
Wernicke-Korsakoff
Wet/dry Beriberi
life threatening hemoptysis in chronic lung dz
usually due to blood leak from high pressure hypertrophied bronchial arteries.
Class III anti-arrhythmic drugs
AIDS Amiodarone (lipophilic class I,II,III activity) Ibutilide Dofetilide Sotalol
Exercise and paO2 paCO2 venus and arterial system
everything in the arteriole system remains relatively constant.
In the viens a lot more O2 is extracted and CO2 is produced
How is it easiest to hear an S3
end of expiration bc it brings the heart closer to the chest wall
Treatment for any generalized myoclonic or tonic clonic seizure?
Either Levetiracetam or valproic acid. Broad spectrum anticonvulsants.
most specific and sensitive test for c. diff toxic strains
NAAT only drawback is it may identify asymptomatic carriers. ELISA is more sensitive but cant destinguish toxic vs nontoxic
Regular rate tachycardia narrow QRS rhythm?
AVNRT. often affects young pts
common microbes in septic abortion?
Staph aureus and E coli
AA’s in collagen
Glycine X-Y
porcelain gallbladder assoc with what type of cancer?
gallbladder adenocarcinoma
what embryologic layer makes spleen and blood vessles/blood
mesoderm
what is a low volume of distribution and what does that mean
low is 3-5. Means the drug stays in the plasma well. This occurs if the drug has a high molecular weight, is highly charged, or binds to plasma proteins
what is in-between vagina and anus cut during episiotomy
perineal body
what is commonly affected in acute rhinositus?
the maxillary sinus gets all stuffed up bc it can’t drain into the middle nasal meatus
Didanosine side effect
DiDanosine causes pancreaDiDis
Niacin moa in hypercholesterolemia?
antagonizes VLDL cholesterol secretion
Family with righ Cholesterol, TG’s and cholesterol with eruptive/itchy xanthoma’s biochem issue?
Lipoprotein lipase or apoprotein C-II
CNS damage stages
12-48hrs red shrunken neurons
1-3 days neutrophils and liquefactive necrosis
3-5 days macrophages (microglia)
1-2 weeks reactive gliosis and vascular changes
2 wks + glial scar
Pie in the sky and pizza on the ground lobes
Pie in the sky is temporal lobe Meyers loop
pizza on the flor is parietal Baum’s loop
Genitalia and hormones male
Sertoli cells- anti-mullerian Hormone (no female internal)
Leydig cells- Testosterone (male internal)
5-alpha reductase- DHT (male external)
What are IL-2’s anti tumor effects in high doses ?
activates NK cells (and its T cell effects as well)
Propofol good and bad
Quick, decreases airway resistance
vasodilation, and increases TG’s and lipase
What do SLG2 inhibitors stop?
a glucose sodium symporter in the proximal tubule
What happens to urine gravity in proteinuria
Urine becomes super concentrated so high gravity all due to 3rd spacing will loss of protein to keep stuff in
Triad of botulism
dysphagia, diplopia, dysphonia (difficulty speaking)
angiogenesis substances
VEGF and Fibroblast growth factor
What muscles generate most intra-abdominal force during valsalva?
rectus muscles
What cells does RCC carcinoma usually come from?
Proximal tubules. Most important and can cause Ca.
what abducts arm over 100 degrees?
trap
what activates trypsin?
enteropeptidase in the brush border
Why fat in alcoholic liver dz?
lack of FA oxidation due to excess NADH
Effects of adrenergic agonists
a1= (midodrine, nor and phenyl ephrine, dopamine high dose) Vasoconstriction
B1: ( Dobuatmine) increased heartrate and output
B2: (albuterol) vasodilation, bronchodilation
D1= (fenoldopam, dopamine low dose) renal arteriolar vasodilation
Transplant rejection type most likely to make a macopapular rash?
Graft vs Host disease
Triglyceride breakdown 2 components
Glycerol: glycerol kinase (liver) can make substrates for gluconeogenesis
Fatty acids: beta oxidation or ketogenesis
Restless leg syndrome trx?
pramipexole a Dopamine agonist
Filtration fraction?
GFR (from creatine) /RPF (from PAH)
can use..
(urine conc x urine flow rate)/ plasma flow rate
for both substances if only give Cr and PAH
What drugs can be used if a cholinesterase inhibitor causes bad side effects? I.e treatment of MG
glycopyrrolate, hyoscyamine, propantheline
all selective muscarinic antagonists that don’t interfere with therapy
What part of Epinephrine synthesis requires cortisol/ACTH?
PNMT the final step to produce epinephrine from NorEpi
pseudogout crystal makeup
calcium pyrophosphate (calcium that burns)
cauda equina syndrome nerves?
S2-S4 pelvic splanchnic nerves. Parasympathetic
intrapleural pressure at resting equilibrium?
-5 cm H2O
what can be used as a marker of lung maturity in ammonitic fluid
Lecithin (phosphadylglycerol) increases
Sphingomyelin decreases
2:1 or higher ration of L/S shows maturity
Pigmented gallstone types
Black- hemolysis, enterohepatic bilirubin circulation
brown- chronic infection and microbial B-glucuronidase activity
Ace inhibitors and interactions
NSAIDS- renal failure due to lowering of GFR in pts with previously poor function
diuretics- first dose hypotension. So must start with low doses
PCP moa
NMDA receptor antagonism
What CN goes through the parotid gland?
Facial CNVII
Neurophysins?
carrier proteins for oxytocin and vasopressin
lower extremity lymph drainage
lateral- popliteal to superficial inguinal nodes (pop to the side)
medial- directly to superficial inguinal nodes
aldosterone normal function
increases Na/K ATPase pumps in collecting tube. promotes H+ and K secretion. Blocked by spironolactone
how do systemic contraceptives work?
decrease GnRH secretion
Where are anal fissures?
posterior midline distal to the dentate line. (line up with the butt crack)
trx for opioid induced constipation without precipitating withdraw symptoms
methylnaltrexone
best medical treatment for insomnia in older adults
Ramelteon a melatonin agonist
Physiology of Factor V leiden Def.
Thrombosis bc the mutated factor 5 does not get degraded by protein C.
What cells produce EPO?
Peritubular interstitial cells
Important cell types in granulomas
TH 1 and TH17
macrophages- become multinucleated giant cells
Addison’s disease (primary adrenal insufficiency)
low aldosterone- low BP, low Na and high K, skin pigmentation due to high ACTH production by pituitary
low cortisol- low glucose, eosinophilia, anemia
What does IgA protease do?
allows for attachment of bacteria to mucosal surfaces
paraneoplastic cerebellar degradation
truncal ataxia and visual disturbances with and a tumor usually small cell or breast ca. Assoc with anti yo/hu/pq antibodies
Ferguson bodies
asbestos particles
High altitude and 2,3 BPG ?
Goes up to facilitate unloading of oxygen at tissues
GI cancer genetic development sequence
APC mut- catenin accumulation. hyperplasia
KRAS mut- adenoma
p53- carcinoma
Antifungal that targets cell wall
Caspofungin
Antifungal that targets cell membrane
synthesis- azoles
binders- nystatin, Amphotericin B
antifungal that inhibits mitosis
Griseofulvin
hypocalcemia symptom
muscle twitching
Hairy cell leukemia vignette
MASSIVE splenomegaly, middle aged man, dry bone tap. TRAP
occular side effects of PD-5 inhibitors
blue vision, ischemic optic neuropathy
What cytokine is tied to neutrophil phagocytosis and pus formation
IL 8- (ate up the bacteria)
What activates Azithropine?
HGPRT turns it to active 6-MP
NF1 what are neurofibroma’s composed of?
Schwann cells which are neural crest origin
what does ureter obstruction do to GFR and FF?
Both decrease.
antiviral pyrophosphate analog that does not require intracellular activation
foscarnet
What nerves may be injured during lymph node removal for masectomy
intercostal brachial- pure sensory to medial upper arm
long thoracic- serratus anterior
thoracodorsal- latissimus dorsi
medial pectoral- minor and major pec muscle
How do Vit D analogues help in psoriasis?
activate a nuclear transcription factor resulting in decreased T cell and keratinocyte proliferation
What nerve innervates the proximal arm flexors?
Musculocutaneous nerve C5-7 innervates bicep, brachialis, and coracobrachialis (makes baseball throwing throw cocked position). also sensory for lateral forearm
Why do oral contraceptives and P make gallstones more likely?
Estrogen- cholesterol hypersecretion
Progesterone- gallbladder hypomobility
embryologic connection between bladder and belly button that may persist?
Urachus
If you cant use asprin for cardiovascular protection what is second line?
clopidogrel
Treatment for urea cycle disorders?
low protein diet
what other hormone can cause hyperthyroid symptoms by binding to the TSH receptor
When in huge excess (tumor) hCG can bind.
Possible adverse effects of aggressive osmotic diuretic therapy to treat cerebral edema
Increased hydrostatic pressure can worsen CHF or cause pulmonary edema in those who already have excess pulmonary fluid
prolonged exposure to loud noise damages what?
stereo ciliated hair cells of the organ of Corti
Tertiary amine acetylcholinesterase inhibitors that can cross the BBB
physostigmine, galantamine, donepezil and rivastigimine
ehrlichia on peripheral smear
morula (mulberry shaped intracytoplasmic inclusions in leukocytes)
P’s of Eosinophilic granulomatosis with Polyangiitis (churg-strauss)
Pale (atopic/ asthma) palpable purpura peripheral neuropathy Pauci immune glomerulonephritis p-ANCA/mPo-ANCA
granulomas
Probability of finding a difference if one exists (study power equation)
power= 1-B
power is usually around 80%
alpha/ beta errors
alpha risk-type 1 error = false positive
beta risk- type II error = false negative
ribosomes and location
free floating- cytosolic, mitochondrial, peroxisome, and nucleolus proteins
Rough ER associated- secreted proteins, membrane proteins and proteins within ER, Golgi and lysosome
Pagets disease
enlarged head, fractures, bone deformities, pain/ hot areas, radiculopathy, hearing loss, lytic sclerotic lesions
Only ALP is elevated
How long can sperm be viable after vasectomy?
3 months or 20 ejaculations
L5 radiculopathy symptoms
sensory lateral shin, dorsum of the foot
foot dorsiflexion, eversion, inversion, great toe extension
Viral recombination vs reassortment
recombination- 2 non-segmented virus genetic exchange via crossing over
reassortment- 2 segmented virus’s via segMENT swapping. BOAR
what causes zenker diverticulum?
cricopharyngeal muscle dysfunction (innervated by vagus nerve)
meds that can cause SIADH
Carbamazepine , SSRI’s , NSAID’s
Trochanteric bursitis (Greater trochanteric pain syndrome) occurs at insertion of what?
Gluteus minimums and Medius
G’s for greater trochanteric
What cells form the fibrous cap in atherosclerosis?
migrated smooth muscle cells that secrete extracellular matrix
Why hypotension in tension pneumothorax?
increased pressure causes vena cava to collapse
What vitamin is required for specialized epithelium differentiation?
Vitamin A
Drugs that target the PD-L on T cells to prevent T cell exhaustion and continued battle against cancer?
pembrolizumab, nivolumab, atezolizumab
Isoniazid side effects?
neuropathy, hepatotoxicity, drug induced lupus
POMC can form what hormones
endorphins, ACTH, MSH
what happens to phosphate during refeeding syndrome
increased insulin due to carbs causes phosphate to move into muscle and and the liver for ATP production
Niacin (B3) and biochemistry
Part of NAD/NADH needed in many dehydrogenase and redox enzymes.
Tons of dehydrogenase enzymes of the TCA cycle require this vitamin
what can chronic hemolysis do to the kidney
Hemosiderosis (iron deposition)
what enzyme in DNA synthesis catalyzes the formation of RNA strands
primase. remember uracil is only found in RNA
NK-1 antagonists
end in “pitant” used for chemo induced nausea. can cause neutropenia
phrenic nerve pain is referred where?
shoulder
Releasing factors?
recognize stop codons, UGA, UAA, UGA
Who is at high risk of vibrio vulnificus?
Iron overloaded pts or those with hepatic damage
arsenic poisoning
galicy breath, severe watery diarrhea. May be found in insecticides. Dimercaptol is firstline treatment
osteosarcoma
lytic lesion on x-ray. usually in metaphysis. bone, osteoid and spindle cells
What breaks down 6-MP?
Xanthine oxidase and thiopurine methyltransferase which is genetically depressed in up to 12% of the population
Why are old ppl bad at breathing in high altitude?
- decreased chest wall compliance
- decreased alveolar elastic recoil
- increased a-a gradient and v/q mismatching
primary hypothyroidism
TSH: High. telling to make more thyroid
T4: low. thyroid not working
T3: usually normal. small amount anyways and not made until at the tissue
ovarian tumor that secretes thyroid hormone?
struma ovarii. a germ cell tumor that causes hyperthyroidism symptoms
why do old people have yellow/brown intracellular spots on autopsy?
lipid peroxidation, especially those who are malnourished before death
Wecner’s polyangiitis path description?
necrotizing arteritis and epithelioid histocytes
eosinophilic polyangiitis path description
necrotizing granuloma’s with eosinophilic predominance
what vessels are most susceptible to atherosclerosis?
lower abdominal aorta and then coronary arteries
pulmonary alveolar proteinosis
macrophages cant clear surfactant. Surfactant goops up into lamellar bodies
Milrone
PDE 3 inhibitor used in refractory systolic HF
- positive inotrope
- vasodilation
which Histone molecule is on the outside of and packs in the wrapped DNA
H1
failed femoral catheterization above the inguinal ligament where does the blood go
retroperitoneal space
Trendelenburg gait after IM injection
superior gluteal nerve in superior medial quadrant of the buttock was injured
nerves of carotid sinus hypersensitivity
afferent- glossopharyngeal IX
efferent- Vagus X
propranolol and thyroid hormone
decreases adrenergic effects of thyroid hormone and decreases peripheral T4 to T3 conversion
Common Poisoning that causes oxalate crystals and AKI
ethylene glycol its metabolites include oxalate and other renal toxins. Fomepizole prevents degradation to toxic metabolites
common cause of multiple small hemorrhagic strokes in the elderly?
cerebral amyloid angiopathy
supracondylar humoral fracture potential injuries
If displaced portion moves laterally- radial nerve
If displaced portion moves medially- median nerve brachial artery
what happens to chest wall with pneumothorax?
springs outward as there is no longer negative pressure pulling it in
Specific B cell surface proteins
CD 19,20,21
treatment for age related macular degeneration?
VEGF inhibitors
metronidazole + alcohol
disulfiram like rxn
Testosterone receptor inhibitors
flutamide, cyproterone, spironolactone to some degree
MI and timeline of ischemia
takes only 60S for area of affected myocardium to stop beating. within 30+ minutes damage may be irreversible
proximal lymph drainage
internal Iliac nodes
HIV in CNS
preferentially replicates and infects macrophages
death cap mushroom mech
halts mRNA synthesis in the liver
where does coronary sinus drain?
right atrium
male androgen cells
Leydig (outside)- LH responsive makes Testostrone
Sertoli (inside tubule- FSH responsive makes androgen binding Hormone and inhibin B
how does hyper ammonia cause CNS symptoms?
increases glutamine which disrupts Glutamate release and disrupts excitatory neurotransmission
Isoniazid can deplete what hormone?
B6 (pyridoxine)
what vessel provides blood to the femoral head?
medial circumflex artery
Why wipe out CD3 + cells before a marrow transplant?
reduce graft vs host dz
ganciclovir side effects
can cause neutropenia, thrombocytopenia or anemia
G6PD converts what to what?
G-6-P to 6 phosphogluconate
Treatments for idiopathic pulmonary fibrosis?
Drugs that target growth factors
Hypothalamic nuclei
Ventromedial- satiety. VentromediFULL
Lateral- hunger, Fatterall
Anterior- heat dissipation. AC
posterior- heat conservation, your ‘posterior is hot’
arcuate- dopamine
medial preoptic- GnRH ‘gonads are modestly optical’
paraventricular- oxytocin PAIRaventricular
Supra optic- ADH look up to see water/rain
suprachiasmatic- sleep. Charismatic if you get enough sleep
Non sedating antihistamine agents?
loratadine, cetirizine. Use in the elderly
What comonent of FA synthesis inhibits beta oxidation?
malonyl coA
contrast induced nephropathy path findings?
proximal tubule necrosis. may have muddy casts
Breathing speed and obstructive/restrictive
obstructive- lowest work when breath slow
restrictive- lowest work when breathing fast
hemorrhagic pancreatitis on path description
chalky white fat necrosis with interspersed areas of hemorrhage
Large VSD cardiac pressures?
RA: unchanged
everything else increased due to intraventricular equalization and increased flow through pulmonary circulation
Xanthelasma
lesions around the eye filled with lipid laden macrophages . Signals high serum lipids possible biliary obstruction
exact missense error in sickle cell
normal GAG to a GTG switches glutamic acid to valine
what bacteria besides Pseudomonas and s. aureus are cystic fibrosis pts at risk for
non-typeable H-flu and Burkholderia
loss of vagus nerve gastric consequences?
low HCL and delayed gastric emptying/gastroparesis
Bluish lesion under nailbed differential
- Melanoma
2. glomus tumor (proliferation of small surface vessles important in thermo regulation)
first vs zero order kinetics
first order- same rate of metabolism with differing dose
zero order- diminishing rate of metabolism with higher doses
What innervates the tensor tympani
Mandibular nerve (V3 of trigeminal nerve) causes muffled hearing +/- ear pain in injured
Where do you sample to get a diagnostic biopsy of Hirshprung’s disease?
submucosa of the rectum
How does sodium bicarb infusion help in salicylic poisoning
reduces protonated form by lowering PH so it cant enter tissues and is excreted in the urine
low intravascular oncotic pressure does what to lipoproteins
increases lipoprotein production in the liver and decreased lipoprotein catabolism
Priapism medical treatment
a1 adrenergic agonist injection
lidocaine MOA
blocks voltage gated sodium channels from inside the neuron
What cells secrete hepcidin?
hepatic parenchymal cells
Distal Clavicle fracture why is it displaced
Distal fragment goes down due to pull of deltoid
proximal fragment goes up due to trap and sternocleidomastoid pull
Phenotypic mixing?
When a coinfected cell contains viruses that share surface protein but do no alter their genetics so viral progeny will not have mixed surface proteins.
what are the superficial and deep inguinal rings covered by?
superficial- external oblique aponeuroses
deep- transversalis fascia
Why do old people have poorer response to vaccines?
Less naïve T and B cells
What cells only go though glycolysis but sometimes produce no ATP?
erythrocytes can corm 2,3 BPG with intermediates instead of energy on some rounds of the rxn
pancreatic pseudocyst?
occurs weeks after pancreatitis. PSEUDOcyst bc it is lined by fibrous tissue rather than epithelial cells
Systemic mastocytosis ?
Monoclonal proliferation of mast cells. Histamine release = flushing, itching (especially after showers) and gastric acid secretion. assoc with KIT mutations. Kit Herron has rosy cheeks!
Charcot vs berry aneurysm?
charcot- intraventricular hemorrhage
Berry/saccular- subarachnoid hemorrhage
what opiod can precipitate withdraw symptoms in a chronic user?
buprenorphine
Cause of most isolated systolic htn
age related stiffness of arteries
What electrolyte is important in metabolic alkalosis
urinary Cl level because it can impair renal excretion of HCO3
C1 cleaves what?
C4 so these levels will be low inhibitor def
Subacute granulomatous thyroiditis (de quervian)
vs
Hashimoto’s thyroiditis
De quervian: transient hyperthyroid, follows infection, painful. macrophages and giant cells. high ESR/CRP
Hashimoto’s: autoimmune, painless, hypothyroid dominant. lymphocyte infiltrate with germinal centers. Hurthle (eosinophilic epithelial) cells
Henoch-Schonlein purpura (Ig A vasculitis) on biopsy
Ig A immune complex deposition with neutrophilic perivascular damage
What abx has MAOI activity and can cause serotonin syndrome
linezolid
What can cause opioid overdose in a methadone therapy pt?
any p450 inhibitor
What myopathy causes normal strength but delayed reflexes?
hypothyroid myopathy
What enzyme turns heme into biliverdin?
heme oxygenase
What kind of drugs are dose adjusted based on ‘ideal’ body weight?
Hydrophilic drugs that are limited to the extracellular fluid compartment
what causes strictures in crohn’s
thickened muscularis mucosa
which adrenergic receptors are found in eye and uterus?
eye- alpha 1
uterus- beta 2
What are the two most important buffers that the body uses to safely excrete H+
HPo4 and NH3
What features of a drug make it more likely to be hepatically cleared
Highly lipophilic drugs with high volumes of distribution
Phospholipase A2 antibodies?
assoc with membranous nephropathy
Hereditary hemorrhagic telangiectasia symptoms?
TGF-B signaling issue. Telangiectasia, nosebleeds, organ AVM’s. High output HF, pulmonary HTN, paradoxical emboli and Iron deficiency are complications
refractory urge incontinency treatment?
stimulation of S3
Vaptans?
Act on V2 and treat hyponatremia by causing water diuresis without affecting K or Na excretion
Klinefelter’s
XXY, long legs, gynecomastia, sparse facial hair. No sperm High FSH, LH tying to stimulate dysfunctional Sertoli and Leydig cells
What disease is assoc with renal angiomyolipomas?
Tuberous sclerosis
Homebox or Hox genes usually code for what?
transcription factors
Patiromer
Exchanges Ca to bind K in the intestine. A slow acting treatment for hyperkalemia
Why can ethanol consumption causes hypoglycemia
decreased pyruvate and oxaloacetate required for gluconeogenesis in the liver
FEV1/FVC ratio in COPD?
Decreased
Neutrophil invasion steps
Margination: improved contact with wall
Rolling: sialyl Lewis X on neutrophils and P/E selectins on wall
Activation: Integrins start to get expressed
Tight adhesion: CD18 integrins and ICAM
Transmigration: PECAM
Adenosine side effects
AV block
Flushing. hypotension
Bronchospasm
class of diuretics that can cause hearing loss
Hoop earings (loop)
What do you monitor in ankylosing splondylitis?
chest wall expansion
Granulosa cell tumor on histology?
Call-Exner bodies (Cuboidal cells in a rosette pattern with coffee bean nuclei)
Medulloblastoma vs pilocytic astrocytoma?
Both childhood tumors in cerebellum
Medulloblastoma- malignant, solid, small cells, cells surrounding neurophil
Pilocystic astrocytoma- cystic and solid components, GFAP +, eosinophilic cytoplasmic inclusions (rosenthal fibers)
3’ end of T-Rna molecule
CCA tail
T loop helps binding to ribosome
D loop helps proper tRNA synthetase recognition
What drug should be given to pts requiring chronic blood transfusions?
Deferoxamine. Helps bind iron to prevent CHF from iron overload
What test is more specific than karyotyping for the diagnosis of large duplications/ translocations or deletions?
FISH
Disease that involves loss of internal elastic lamina?
fibromuscular dysplasia
Ribs overlying spleen/liver and kidney
spleen/liver- 9-11th ribs
kidney- 12th rib
Myofibril layers
ZAM
Z line
Actin (light)
Myosin (heavy) middle darker
Leukoclastic vasculitis
neutrophil predominant vasculitis with purpura. Due to drug reaction. often abx or allopurinol
Retinitis pigmentosa?
genetic issue
First loss of rods- peripheral vision/night blindness
then loss of cones- central vision loss
What does chronic heavy use of NSAIDs do to kidney
Chronic interstitial nephritis- shriveled kidneys
and/or
papillary necrosis- infarcts
terbinafine antifungal mech?
Inhibits Squalene epoxidase
McArdle dz
loss of myophosporylase and muscles cant break down glycogen
myoglobin in urine after exercise, muscle pain, cramping
Baby extracranial head bleeds
subgleal- crosses suture lines. BTW periostea and galea aponeuroses
cephalohematoma- btw skull and periosteum
polycistronic mRNA
one mRNA codes for multiple genes common in prokaryotes. ie lac operon is one such gene
vascular smooth muscle and phosphorylation
phosphorylated lc- contracted
dephosphorylated lc- relaxed
normal P with delivery then a mole. What happened?
proliferation of trophoblasts
What does pathology in brain look like in Rett syndrome
MECP2 gene. loss of brain development rather than signs of neuronal death
Feared cause of death in ALS
diaphragmatic atrophy
SIADH urine sodium?
becomes high as BNP and ANP ramp up to prevent frank volume overload
Whipple Dz
Loose stool, abd pain, weight loss. Gram + actinomycete PAS (visualizes cell gylcoproteins) + Diastase resistant Pass the foamy whipped cream CAN (cardiac, arthralgia, neuro)
Benign liver tumors
hepatic adenoma- can regress with contraceptive dc
hepatic cavernous hemangioma- most common. big caverns with vessles on histology
Barorecpetor reflex signaling
Usually M3 causes decreased cAMP in myocytes
decreased B1 and increased M2 cause decrease depolarizing Ca in SA node
all in response to increased BP
Hypothyroidism and galactorhea?
High TRH can stimulate lactotrophs
repetitive screwdriver use injury
radial nerve injury (usually finger extension without full wrist drop) due to repetitive contact with supinator muscle
What stimulates firs step of gluconeogenesis?
High Acetyl CoA tells rxn to make more glucose
water soluble drugs in neonates
need more of it to get same volume of distribution bc neonates have more relative total body water content.
cyanide tox treatments
- Sodium Thiosulfate- donates sulfur for detox
- Sodium nitrate- induces methemoglobin
- hydroxocolabumin- binds cyaninde ions
Opiod binding on mu receptor effects
Presynaptic CNS neuron- block Ca influx so no neurotransmitter release
postsynaptic spinal neurons- influx of K hyperpolarizing the cell
buserelin and bicalutamide dual therapy?
Buserelin- GnRH analogue
Bicalutamide- blocks initial GnRH surge
Homocysteinuria trx
High dose vit B6 (pyridoxine)
avoid methionine
Why is some proteinuria (<300mg/24h) normal in P
Increased GFR, decreased reabsorption and increased permeability
embyologic products of the vilintine veins and cardinal veins
villintine- portal system
cardinal- systemic venus system
Where does ablation for A-flutter target?
aria btw tricuspid valve and IVC in RA
Hawthorne effect
acting better bc you are being studied
What innervates posterior portion of external ear canal?
Vagus nerve
Cellular staging of oocytes
during childhood- arrested in Prophase of Meiosis 1
Menses- Some eggs complete Meiosis 1
Fertilized egg- arrested in metaphase of Meiosis 2 just before union with sperm
PURE red cell aplasia associations
- Parvovirus
2. systemic dz (often thymoma)
Trx for removal of parathyroid gland
oral calcium and calcitriol (active Vit D)
Hypersensitivity pneumonitis on biopsy
Poorly formed noncaseating granulomas, lymphocytes, septal fibrosis
Early CVD and tendon xanthomas/Xanthelasmas Defect?
LDL receptor or ApoB-100. elevated LDL in serum
Early CVD + Peripheral VD. Palmar Xanthomas. Defect?
APO E. elevated circulating VLDL and chylomicrons
Acute pancreatitis + itchy skin xanthomas, hepatosplenomegaly. Defect?
lipoprotein lipase or APO C. high chylomicrons
“Itchy pancreatitis due 2 lipase”
False negatives on urea breath test for H-Pylori
anything that suppresses growth but does not kill. abx, PPI’s or bismuth
Mid diastolic murmur + hemoptysis in immigrant
Mitral stenosis can cause hemoptysis via high pressure of bronchial veins
Histology difference btw lipoma and liposarcoma?
liposarcomas have scalloping/ indentations
Alcoholic cerebellar dysfunction vs. mamillary body damage
cerebellar vermis dysfunction- truncal instability, wide based gate +/- tremor
Mamillary body damage- Wernicke presents as triad of ataxia, encephalopathy, horizontal nystagmus
Calcineurin inhibitors side effects
Tacrolimus and cyclosporine can cause renal damage.. Decrease IL-2 gene transcription
In PCR what direction does Taq polymerase work?
5-3
where do intestinal epithelial stem cells reside?
crypts of Lieberkuhn
What cells are in cirrhotic nodules?
hepatocytes
stellate cells just make fibrosis (TGF-B)
What antibiotics bind the 23S pocket of the bacterial 50s ribosome subunit?
The clorox clean prince Linezolid of the macro 50s ribosome!
Macrolides and clindamycin specifically bind at the 23S pocket
cystic hygromas?
transilluminating cysts usually on left head or neck associated with trisomy’s and turner syndrome
why would a neuronal action potential that used to go to +40mv now only go to +10mv?
decreased sodium conc. outside the cell
what gland is particularly sensitive to radiation exposure?
Thyroid. Papillary and follicular cancers specifically. Give potassium Iodide prophylactically in case of significant radiation exposure
Why does tardive dyskinesia develop?
upregulation of dopamine receptors in respose to chronic antipsychotic use
What do cancer cells do in a petri dish
cover the whole thing then make mounds bc they lack catenin and cadherin mediated contact inhibition
midshaft humerous fracture. what nerve?
radial
Skewed X inactivation
refers to women who do not evenly inactivate X chromosomes across thier cells
Filtration fraction in a stenotic kidney?
Filtration fraction (GFR/RPF) increases bc GFR is saved (afferent dilates, efferent constricts) RPF is sacrificed. So FF is a higher number
Psoriasis pathology
hyperkeratosis and epidermal hyperplasia.
Due to DENDRITIC cells recruiting helper T-cells.
Venous drainage above the dentate line
Superior rectal > inferior mesenteric > portal venous system. This is why lesions above the dentate line often metastasize to the liver. Below the dentate line often metastasize to the lungs
trx for old people with dry skin in the winter
moisturize after bathing
why use probenecid with penicillin G?
increases concentrations by inhibiting renal tubular secretion. (can also be used to increase uric acid exertion)
tetracycline teratogenic effect
slow bone formation and destroy tooth enamel
mech of post cough or valsalva syncope?
decreased venous return to the heart due to increased intrathoracic pressure
bloom syndrome
DNA helicase issue.
Photosensitivity, short stature, telangiectasias. predisposed to lymphoma and GI ca.
complication of endometriosis?
infertility
In collagen synthesis hydroxylation and glycosylation is important for what step?
Triple helical procollagen formation
uncal (medial most segment of the temporal lobe) herniation sign?
CN III palsy making a ipsilateral fixed dilated pupil
microsatellite instability?
microsatellites are areas of repeated units. They are especially vulnerable if mismatch repair enzymes are not working as in lynch syndrome.
Dacubitrol valsartan therapy
neprilysin inhibitor increases ANP/BNP and blocks aldosterone production
ARB blocks remaining aldosterone at the receptor.
Angiotensin II is elevated but cant increase aldosterone
HLA subtypes that do not mount an effective IgG response? What happens
improper antigen presentation and no T cell response with is heavily dependent on IgG
ARDS physiology
fluid filled aveoli still get perfusion. Causes a V/Q mismatch and right to left physiologic shunting
Where does Kayser-Fleischer ring deposit in the eye?
Descemet membrane of the cornea
Dysplastic nevus syndrome genetics
9p21 chromosome. CDKN2A gene. predisposes to melanoma.
leucine zipper?
transcription factors that have two alpha helixes rich in leucine c-jun and c-fos are examples
How do G-protein coupled receptor work
PIP3 > DAG > protein kinase C > calcium release and protein phosphorylation
First step of purine synthesis?
Carbamoyl phosphate synthetase II combines CO2, glutamine and ATP in the cytosol
what does leg raise in appendicitis test?
peritoneal irritation against the psoas (on the groove of the vertebrae then goes toward groin)
How do retinoids work for acne
- Decreased epithelial cohesiveness.
- increased turnover,
- normalizes keratinization
What enzyme is def in a normal weight/ young pt with elevated blood glucose level (mild DMII)
glucokinase in the pancreas leading to higher setpoint before insulin is released.
Pontine hemorrhages
fixed pinpoint pupils loss of horizontal gaze, decerebrate (extensor posturing) death in hours
the brain: cytotoxic edema vs vasogenic edema
cytotoxic- usually ischemia (due to ATP dependent pumps malfunctioning)
vasogenic- often tumors
reactive arthritis triad
cant see, cant pee, cant bend my knee
types of cells in cervical transitional zone?
simple columnar epithelium and simple stratified squamous epithelium
Sleep Stages
BATS Drink Blood
B- Awake
A- Awake eyes open
T- Theta N1 light sleep
Spindles/ K complex N2, bruxism
Delta- bedwetting night terrors, sleepwalking
Beta- REM sleep, erections, dreams/nightmares, muscle paralysis
What becomes an essential AA in PKU?
Tyrosine
Hallmark of TB meningitis on autopsy?
Thick grey exudate on base of brain. Usually subacute, includes vasculitis
Is diabetic diarrhea a thing?
Yes. Secritory Persists with fasting (even at night) due to autonomic bowel dysmotility.
How do stimulants work?
Block NE and D reuptake
What combats hyperphosphatemia and too much vit D?
Fibroblast growth factor 23 for when your GRF is 23!!! Released by osteocytes
what cells produce elastase?
alveolar macrophages
What nerves can be injured during prostatectomy?
prostatic plexus (inferior hypogastric nerves and + pelvic and splanchnic nerves) This contains nerves that innervate the corpus leading to erectile disfunction
Injury location of median nerve signs + whole lateral palm is numb
proximal to palmar branch of median nerve often compression by the pronator teres
2 associations of non-bacterial endocarditis
technically any hypercoagulable state but especially Lupus and Advanced malignancy
Klienfelters hormones
Low Testosterone, high estradiol
High FSH and LH due to lack of negative feedback
Why is sputum green with pneumonia?
neutrophils releasing myeloperoxidase turns it green
What antiemetics are used in motion sickness nausea
anticholinergics (scopolamine) anti histamines (promethazine is clutch in hyperemesis gravidarum)
acetazolamide and urine K
Promotes excretion of potassium
Where are B1 receptors found?
juxtaglomerular cells (this is why B blockers decreases renin) and cardiac muscle. Not in the vasculature
What drugs is HIV 2 immune too naturally
NNRTI’s, fusion inhibitors
Cells important in Sarcoidosis
Macrophages (convert active vit D and secrete Ace)
CD 4+ T cells (secrete TNF-a / INFN Gamma to activate macrophages)
Why don’t selective arteriolar vasodialators work as longterm monotherapy for HTN?
hydralazine and minoxidil dont work alone bc
- sympathetic reflex tachycardia
- RAS activation making them bad longterm
alcoholic + chelitis, glossitis what is deficient
Vit B2 (riboflavin) FAD is needed for succinyl dehydrogenase in the TCA cycle
humoral neck fracture complication
Avascular Necrosis
chronic alcohol use and receptors
less GABA more glutamate NMDA receptors. The latter is responsible for excitatory symptoms of withdraw
duodenal ulcer posterior wall can erode into what?
gastroduodenal artery
what is analogous to EC50 for inhaled anesthetics. measure of potency
MAC. Mean alveolar concentration. lower is more potent
Spermatic cord mnemonic
ICE TIE
Internal s. fascia- transversalis fascia
Cremasteric muscle & fascia- internal oblique
External spermatic fascia- external oblique
(Orchiplexy for non descended testicle pulls it through this)
Diabetic most common mononeuropathy
CNIII ischemic
Over 24hrs without food how does glucose stay steady?
Gluconeogenesis utilizing glucogenic AA’s to make oxaloacetate and convert it to posphopenyl pyruvate
Normal cardiac changes with aging
lipofuscin, shortened length, decreased ventricular cavity size, sigmoid septum, dilated aortic root
Chikungya fever
southern hemisphere, severe arthralgia/arthritis, lymphopenia, alpha virus, transmitted by Aedes mosquito (same as zika)
Crohn’s or UC which has granulomas?
Crohn’s has granulomas
elevation of testicle feels better for what dz?
epididymitis
ichthyoses vulgaris
“fish scale disease” due to filaggrin mutation. ineffective desquamation
Tongue sensation
anterior sensation 2/3 Trigeminal V3 mandibular
anterior taste 2/3 Facial nerve
posterior sensation + taste 1/3 glossopharyngeal
mixture of normal and abnormal cells what kind of mosaicism?
somatic mosaicism
Fas ligand?
Helps self reactive T cells undergo apoptosis
drunk colleague working?
contact supervisor ASAP
RAS active state vs inactive
GDP inactive
GTP active
Right sided ascending
vs
Left sided descending colon cancers
RT-ascending (larger), occult fatigue, iron deficiency
LT- descending (smaller) constipation obstruction
rectal- tenesmus, small caliber stools
Best drug for bulimia nervosa?
fluoxetine
Why are immature RBC’s blue after Wright Giemsa stain?
Residual ribosomal RNA
Why give ACE inhibitors after MI?
prevents left ventricular chamber dilation
Mechanism of duloxetine, nortriptyline for neuropathic pain?
decreased serotonin and NE release
Haldane and Bohr effect of Hgb?
Haldane- to accept more oxygen heme releases H+ and CO2. In lungs
Bohr- to accept CO2 more H+ is created and oxygen is released. In tissue
Golgi Tendon organ?
negative feedback to prevent muscles from exerting too much force
Why do we get wrinkles?
Decreased collagen fibril production and up regulated metalloproteases
leishmania
intracellular parasite transmitted by sand fleas. Are oval and have a rod shaped kinoplast.
Theophylline intoxication
seizures and tachy arrhythmias. TRx usually includes benzos or barbiturates
cholangiocarcinoma on biopsy
adenocarcinoma with mucin production and desmoplastic response
What vitamin is a cofactor in AA transamination and decarboxylation reactions?
B6 (pyridoxine)
cystic fibrosis restrictive or obstructive?
obstructive due to a mutated ATP activated chloride channel
Acute intermittent porphyria treatment
Heme infusion, decreases ALA accumulation and so porphobilinogen accumulation is not enough to cause attacks and symptoms are controlled
mech of hydrocephalus in sub arachnoid hemorrhage?
blood blocks CSF absorption
reactive neutrophils on blood smear?
Dohle bodies (peripheral tiny blue cytoplasmic inclusions
interstitial nephritis vs tubular necrosis
white blood cell casts vs granular “muddy” casts
what vessles may bleed in diverticulosis?
vasa recta
oral pharyngeal cancer and nerve compression?
base of tongue- glossopharyngeal
back of throat- vagus
geneticly inherited RB mutation cancers
retinoblastoma and osteosarcoma
The worst retinal and bone cancers
Glaucoma meds and inflow/ outflow
less inflow: beta blockers, alpha 2 agonists, carbonic anhydrase inhibitors
more outflow: prostaglandin agonists, muscarinic agonists
Why is Hep B genetically unstable?
lacks 3-5 exonuclease proofreading
B-thalassemia genetic issue?
abnormal transcription or translation of mRNA
abciximab
blocks platelet IIb/IIIa binding to fibrin.
Glucagonoma
Often affects insulin resistant/ DM.
migratory necrolytic erythema and tons of skin symptoms. often affect groin, face or extremities
Cremasteric and anal wink reflex roots
L1, L2 testicles move
S3, S4 winks galore
risk of longterm TMP-SMX therapy
hyperkalemia
global brain ischemia most vulnerable regions
hippocampus > purkinje cells
Treatment for prolactinoma?
dopamine agonist cabergoline
Why do Cystic fibrosis pts get so many infections
mucus cant be cleared allowing for bacterial macrocolonies and protective biofilms
communicating hydrocephalus
symmetric enlargement of ventricles. due to disruption of arachnoid granulations
where does reactivation TB take place?
upper lungs
late phase of a type 1 hypersensitivity rxn?
eosinophil recruitment and release of tissue damaging major basic protein
PCL vs ACL on MRI?
PCL connects toward side with fibula (small bone)
ACL connects toward side with tibula (big bone)
What abx can decrease metabolism of statins and cause myopathy?
Macrolides (azithro, clarithro, erythro)
Athletes can have what type of physiologic murmur
pulmonic flow murmur due to increased stroke volume
muscle that can cause both hip and knee problems
rectus femoris
NNRTI’s
Do not require phosphorylation to be active.
Elephants never delay
Efavirenz, nevirapine, delavirdine
During pregnancy what hormone suppresses lactation
progesterone secreted by the placenta
What is a sign of MILD mitral stenosis
Loud S1
Why do you get myocyte swelling in transient ischemia?
ATP pump failure in sarcoplasmic and cell membrane leading to increased intracellular Ca and Na that draws water in
Cystic Fibrosis + hyponatremia?
Salt wasting in the sweat
obturator nerve
thigh adduction and medial thigh sensation
hematologic consequences of uricemia ?
impairs platelet function. Causes prolonged bleeding time
Lower extremity cyanosis and clubbing
PDA
panic disorder pharmacotherapy
SSRI
Miosis vs mydriasis
Miosis- constriction, short ciliary nerve
MyDriasis- Dilation, long ciliary nerve
Topoisomerase drugs mnemonic
Tucan- Kaitlyn’s #1 favorite animal. Topoisomerase 1. Irinotecan, topotecan
both sides- poside. Topoisomerase 2. Etoposide, teniposide
ecological study
uses population level data
acute intermittent porphyria
wine colored urine, abdominal pain, +/- neuro symptoms PBG/ALA in urine.. Dextrose may help
nerve injured during appendectomy sensation to suprapubic region
illiohypogastric nerve L1
HAART and fat??
HAART is associated with body fat redistribution towards more truncal obesity
Glioblastomas staining?
EGFR
Infective endocarditis and renal issues and presenting signs
abcess/emboli- flank pain
complex deposition- proteinuria/hematuria.
posterior hip dislocation nerve injury?
Sciatic nerve
candida skin test
Used as a cheap way to test for T cell function. Induces a type IV hypersensitivity response where CD4 + T cells, macrophages and later CD8+ T cells respond.
Neuroblastoma
in children, catecholamines, Homer Wright rossettes. neural crest origin. may cause opsoclonus-myoclonus syndrome. N-myc
Near sighted and far sighted
myopia- near sighted focuses too far anterior of eye that is too long. Kaitlyn near sighted and very long
hyperopia- far sighted. Focuses too far behind retina. eye is too short.
What anti-emetic is good for people with GI infections
5-HT antagonists
most commonly affected nerve route in cervical spondylosis
C7
what type of collagen is scar tissue?
type 1. Granulation tissue is type 3
Types of eukaryote RNA polymerase
RNA polymerase I: in nucleolus. Makes most of ribosome
RNA polymerase II: mRNA, snRNA, Micro RNA
RNA polymerase III: TRNA, small component of 60s subunit
Dermatome that goes over the kneecap
L4
hemodynamically neutral anesthesia induction?
Etomidate
Central vs peripheral chemoreceptors and breathing
peripheral (carotid) sense oxygen levels
central (medulla) sense CO2
intermediate acting benzos
COLA
clonazepam, oxazepam, lorazepam, alprazolam
Difference between HLA 1 and HLA 2?
HLA 1: aka HLA B27 Present to CD 8+ T cells. Spondylonegative arthropathies
HLA 2: DR and DQ alleles. Present to CD 4+ T cells. RA, celiac dz, type I DM
Action sports and sympathometics :)
Action junkies do EPIc DOPe shit! ^CO/BP
Epic cousins (Nor & Pheny) are pressing action sport progression! ^BP -CO
Petrol and butane cars are going faster than ever! ^CO Lower BP
Liddle syndrome
Ameliorate a little HTN.
Collecting duct. Causes HTN via Na resorption. treat with amiloride.
Explain how translation of stop codons works?
The anticodon of the trinucleotide before the stop codon will be the last to code in a 5-3 direction
mamillary body on MRI
Bird’s beak
RTA’s
Type 2: Proxitwo. loose acid and K in urine
Type 1: The distal one. loose K and HCO3 in urine. Ca stones. assoc with calcium stones and AI conditions
Type 4: loss of aldosterone. high K assoc with DM and ACE/ARB. TRX fluticortisone
chronic diarrhea or ileostomy and pH
less bowel HCO3 resorption so constant metabolic acidosis. predisposes to uric acid stones
Osteoporosis vs Primary Hyperparathyroidism
osteoporosis- trabecular thinning
primary hyperparathyroidism- subperiosteal bone resorption with cortical thinning. High Ca. Possible low phosphate
prostacyclin and platelets
inhibits platelet binding
Parathyroid blood supply
inferior thyroid artery a branch of thyrocervical trunk
case series
pts have disease and there is no control group
What makes up the starry sky in Burkitt lymphoma?
macrophages and apoptosis of cells
what lymph node would cancer on the tounge metastasize to first?
submental
Primary adrenal insufficiency weird symptoms
eosinophilia, anemia, hypoglycemia
What is sorbitol usually converted into?
Fructose
In MCAD and carnitine deficiency what is the major downstream molecule that can’t be formed?
Acetyl-CoA- which is used for ketone formation and the TCA cycle
Triamterene and amiloride moa?
Inhibit ENAC sodium channel
Fetal hemoglobin greek letters
alpha 2 gamma 2
G6PD causes a failure to produce what?
NADPH , which is also used in FA and cholesterol synthesis
Major cytokine in eosinophil recruitment
IL-5
What muscle protein is dephosphorylated to cause muscle contraction in both smooth and skeletal muscle
myosin
Arginase deficiency
Can’t make Urea (CH4N2O) from arginine. Arginine builds up (treatment is to avoid this). spastic diplegia and abnormal movements
what class of HIV drugs can cause metabolic like syndrome
protease inhibitors
tubocurarine moa?
competitive ACh antagonist
Cardiac node blood supply
SA node- RCA
AV node- Depends on dominance
Ehlers Danlos issue in collagen synthesis
cleavage of N and C terminal ends in extracellular space by procollagen peptidases
ankylosing spodylitis immunogenetic associations
HLA 1. B 27 and T helper 17 cells + TNF alpha
calculating renal perfusion flow?
Renal blood flow x (1 - hematocrit)
cholesterol meds that should be avoided in cholecystic dz
fibrates
Thalamic vs pons vs putamen intracerebral hemorrhage eye findings
Thalamus- unequal pupils
pons- small word pinpoint pupils
putamen- dilated pupils
vWF deficiency and ristocetin test
abnormal (poor plt agglutination)
Strongest to weakest binding of Class 1 antiarrythmics
Top (strongest) to bottom (Weakest) C.A.B
MecA bacterial gene
codes for a PBP with low affinity to beta lactam antibiotics.
baroreceptor reflex nerve roots
afferent- glossopharyngeal
efferent- vagus
MacConkey agar
turns pink for lactose fermenters
stress hyperglycemia?
extremely ill/stressed pts will have more gluconeogenesis due to catecholamine increase
What constitutes active RAS in the MAP K pathway?
RAS is activated when bound to GTP
Nitrates moa
vasodilation in large veins to reduce preload is the major effect.
Where is vit D3 produced?
calciTRIol or D3. Tri to make D 3 in the PCT
Pseudo and Pseudopseudo hypoparathyroidism
Both have Albright hereditary osteodystrophy- Short 4th and 5th digits, short stature, subcutaneous calcification)
Pseudo- PTH resistance bc receptor signaling fails
pseudopseudo- PTH works fine bc maternal allele rescues signaling
Type 1 DM pathophysiology
T cell mediated B-islet destruction. May have glutamic acid decarboxylase antibodies that prime T cells
Vaptans
Block V2 used in SIADH
Anal cancer proximal to dentate lymph mets
first to internal illiac lymph nodes
Phenoxybenzamine vs phentolamine
Phenoxybenzamine- irreversible a1 and 2 antagonist
Phentolamine- reversible a1 and 2 antagonist. so it can be overcome by high doses
Consequences of midgut malrotations
- obstruction by ladds bands (connect retroperitoneum to colon/cecum) wraps around SMA
OR - volvulus
zero order kinetics vs first order kinetics
zero order- constant amount of drug eliminated
First order- constant Fraction of drug eliminated
anaphylactic shock what happens to the vasculature?
massive vasodilation
Carbon monoxide binding to heme
competitive. that’s why High flow O2 can knock some of it off
Maraviroc vs Enfuvirtide
Maraviroc- inhibits CCR5 gp120 interaction needed for Macrophage infection (120 is macro than 41)
Enfuvirtide- binds gp41 inhibiting entry
Basophilic stippling what is it comprised of?
ribosomal RNA makes the RBC inclusions.
Happens in Lead poisoning, or sideroblastic anemia
LEAD poisoning mneumonic
L- lead lines on bones metaphysis
E- encephalopathy, erythrocyte stippling
A- abdominal pain/anemia
D- wrist/ foot drop. Dimercaprol, eDta, succimer
Peripartum cardiomyopathy type?
Dilated with increased compliance
IL-8
attracts neutrophils
what hormones inhibits lactation during P despite high prolactin
progesterone
primary aldosterone’s serum Na, Serum K, and HCO3
Normal Na due to aldosterone escape
Serum K low due to excretion
HCO3 high due to metabolic alkalosis
What can be used to check for hyperthyroidism during P
Free T4
Explain pathophys of Sheehan’s syndrome
Pit enlarges during P. But blood supply does not increase proportionally, and with excessive blood loss ischemic necrosis can occur
Other name for Tau
microtubule associated protein
How is salmonella typhus typically transmitted
fecal oral, typically contaminated food or water in other countries
Consequence of bad BPH on kidney
bowmans capsule pressure increases, paranchymal hydrostatic damage, hydronephrosis
What major abdominal organ has dual blood supply?
Liver. So it is less affected by infarcts from atrial clots. Blood can go into the portal system retrograde from accessory intercostal and phrenic arteriole vessles. In a transplanted liver these accessories are no longer a backup option
Cystinuria
COLA (Cysteine, ornithine, lysine, arginine) in urine. Risk of SIXtine kidney stones. May be dx by cyanide-nitroprusside test
Differential cyanosis arms vs legs + signs of a PDA
It is a reverse shunt through the PDA (right to left) usually due to left outflow obstruction or persistent pulmonary hypertension of the newborn
Which HLA’s are related to MHC 1 vs 2
MHC 1- All only have 1 letter (A,B,C)
MHC 2- All have 2 letters (DQ, ect)
Myenteric (Aurbach’s plexus)
In the submucosa. Damage causes dilation via chaga’s or Hirsprungs.
Aldosterone’s main effects in the serum
Increases Na
Decreases K and CL
creates a Metabolic alkalosis H loss and HCO3 gain
Drugs that have zero order elimination (constant amount/time)
PEA’s are shaped like a Zero
Phenytoin, Ethanol, Aspirin
Midodrine
When your old and in the doldrums you need some midodrine to keep you up (a1 used for postural hypotension)
What Beta blockers help in HF
B-blockers Curb Mortality
Bisoprolol, carvedilol, metoprolol
excessive internal rotation or quick direction change + hemarthrosis knee injury
ACL
ABPA signs/symptoms
Hx of asthma or CF.
eosinophilia/ IgE
fleeting infiltrates/bronchiectasis
positive aspergillus skin test
What type of cell releases renin?
juxtaglomerular cell of the afferent arteriole which is a modified smooth muscle cell
TB locations
primary infection: upper portion of lower lobe
reactivation: Upper lobes
Valgus and varus stress and knee injury
Gus is a guy his legs are together. Us is a girl spreads legs apart
valgus- forced stress inward breaks MCL
Varus- forced stress outward breaks LCL (less common)
How do you treat Hartnup dz
High Niacin diet
Supplementation of normal infants
Vit D, especialy if in north or dark skin
Iron after 4months of age until substantial eating of solid foods. Or earlier if preterm
Vit K at birth
Atrial Septal Defect murmur
wide fixed split S2
Histology of late stage radiation dermatitis
telangiectasia, fibroblast proliferation, homogenization of dermal collagen (mediated by TGF-B)
A fib and cauterization
recurrent- destroy origin near pulmonary veins
permanent- destroy AV node near the coronary sinus
Fixed dilated pupils what is injured
midbrain containing the Pretectal and EdingerWestphal nuclei
external hemorrhoid pain mediated by what nerve?
pudendal
bowel and bladder control nerve and root
pelvic splanchnic nerve part of cauda equina or tumor met injury S2-S4 relaxes muscles allowing for defecation
Femoral hernia comes out where
Below inguinal ligament just medial to femoral Vein
Why is elastin so stretchy
lots of nonpolar AA’s and lysine residue crosslinking
What does RT-PCR detect in a sample
m-RNA
2, 3 bpg and sickle cell
High levels promote sickling
Enzyme deficiency similar to G6PD
gluthione reductase
Homocysteinuria nutritional treatment
Avoid methionine and add B6 (pyridoxine)
Intravaginal block numbs what nerve?
pudendal
Muscles in sitting up from laying down without hands
illiopsoas, rectus abdominus and external oblique
abulia
lack of will usually damage to cingulate gyrus
Ovary, Uterus, Cervix, Vagina, vulva lymph drainage
Ovary- para aortic Uterus- external Iliac Cervix- internal iliac Vagina- proximal to internal iliac; distal to inguinal Vulva- inguinal
Hip fracture direction and injury
posterior dislocation- sciatic nerve anterior dislocation (rare)- femoral artery
lacunate injury can compress what?
median nerve similar to carpal tunnel
Niacin is synthesized from what AA?
tryptophan
How do fibrates cause gallstones?
Blocking cholesterol 7-hydroxylase
Left upper sternal border vs Upper sternal border
LUSB- pulmonic murmurs and PDA
LSB- Aortic regurgitation and HCM
What cells release Interferon gamma?
T cells
What types of malaria have a form that is dormant in the liver
Vivax and Ovale. These must be treated with primaquine in addition to chloroquine
What anesthesia med may help in bronchospasm?
Ketamine bc it is a sympathomimetic
What do integrase inhibitors stop
production of viral MRNA by incorporation into host genome
What pump is important in taking drugs out of CNS that may be inhibited to improve penetration of some drugs like HAART
P-glycoprotein efflux pump
Histology of a liver infected with Hep B vs Hep C vs Hep A?
Hep A: Spotty necrosis, ballooning, Counselman bodies
Hep B: Ground glass, pale eosinophilic hepatocytes
Hep C: lymphoid aggregates and steatotosis
Hardy Weinberg secret/ meaning of equations
p^2 + q^2 = 1 Refers to Population alleles
p^2 + 2pq + q^2 = 1 Refers to individuals
FBPase-2 and PFK-2
Fasting: FBPase-2 is activated (more glucagon and cAMP)
Fed state: PFK-2 is activated (more insulin and less cAMP)
Fructose 2,6 bisphosphate
More F 2,6p gluconeogenesis sinks
activates glycolysis
Urine sodium in hyperaldosteronism and SIADH
High
Due to aldosterone escape in hyperaldosteronism and downregulated renin in SIADH
50S ribosome inhibitors mnemonic
The Clorox clean prince Linezolid of the macro 50s ribosome.
Macrolides are azithro, clarithro, erythro
abx class that does not work against anaerobes?
Aminoglycosides
Mean (amino) GNATS cannot kill anaerobes.
Bind irreversibly to the 30s ribosome
lactase def stool findings
low pH
Why are most monoclonal therapies just fragments?
better tissue penetration
What disorders are REM sleep changes associated with in the elderly?
alpha-synuclein diseases especially Parkinson’s
Contact dermatitis immunology
sensitization: Langerhans cells
Reaction: CD8 cells and Tnf gamma
Frontotemporal dementia molecular issue
Tau neurofibulary tangles creating Pick bodies
TDP-43 inclusion bodies
pathophysiology of diaper rash
spares skin folds.
poop urease producing bacteria increase the local skin pH producing irritation
club foot anomaly type
deformation
TOF murmur and severity
pulmonic stenosis murmur that gets worse with increased preload causing right blood to go to left circulation without going through the lungs and LA during episodes.
Homocysteinuria what do you supplement
cysteine
