STEP 1 Week 2 Flashcards
Most hypotonic region of the renal tubule in setting of ADH and non-ADH
ADH - distal convoluted tubule (remains mostly impermeable to water)
Low ADH - collecting duct, no porins inserted so becomes less concentrated
What causes vasoconstriction and increased proliferation in the lunc
Thromboxane and endothelin
Treatment for Myasthenia gravis
Pyrostigmine - and AchE inhibitor
If too low - will respond to edrophonium test (aother AchE)
If too high - Desensitized muscles, wont respond to edrophonium (stop pyrostigmine temporarily)
How to measure severity of mitral stenosis
A2 to opening snap time interval
Shorter in more severe cases (the snap is when the mitral valve reaches its maximal diameter)
Symptoms and histo of hypersensitivity pneumonitis
Most common ligament injured in the ankle
Anterior talofibular ligament (lateral)
Function of fibroblast growth factor 23
Secreted by osteocytes in response to high phosphate levels
Inhibits synthesis of 1,25 hydroxyvitamin d in the kidney, so leads to a drop in calcium and phosphate absorbption in the kidney and intestine
Function of each of the rotator cuff muscles
Supraspinatus - abduction (first 15)
Infraspinatus - external rotation
Teres minor - external rotation and adduction
Subscapularis - internal rotation and adduction
What is stress hyperglycemia
In times of metabolic stress, the body releases chatecolamines, cortisol, and other inflammatory cytokines that increases hepatic gluconeogensis and glycogenolysis
High blood sugar with no diabetes
Function of type II pnuemocytes
Secerte surfactant
Regeneration of alveolar lining after damage
Can differentiate into type I pneumocytes
Histo of Lewy body dementia vs alzheimers vs frontotemporal dementia vs parkinsons
Lew body dementia - alpha synuclein
Alzheimers - Beta emyloid, presinilin, tau (tangles)
Frontotemporal - Tau protein inclusions, TDP-43
Parkinsons - Lewy bodies (alpha synuclein)
What is a cholesteotoma
A pearly mass of squamous cell debris in the middle ear behind the tympanic membrane, caused by chronic negative preasure
What causes dissemenated mycobacterium infections in childhood
Deficiency in the INF-gamme pathway (JAK-STAT)
Macrophages cant be activated appropriately - wont secrete IL-12 to induce phagolysosome killing and wont form granulomas
Methotrexate fetal effects
Cardiac, urinary, neural tube defects
Blocks dihydrofolate reductase
Treatement for acute gouty arthritis
NSAIDS (COX inhibitors)
Colchicine
Lymph drainage of the testes
Testes - para-aortic lymph nodes
Scrotum - superficial inguinal nodes
HIV/HSV drug that does not require phosphorylation
Foscarnet
Lesions of the macula cause:
Central scotoma
Like in macular degeneraion
Side effects of dopamine receptor blockers (metochlopramide)
Can cause dopamine blockade that can lead to cholinergic activity = extrapyramidal symptoms
Give with something with anticholinergic activity like diphenhydramine
What induces P and E selectins
P-selectins = weibel-palade bodies
E-selectins = Il-1 and TNF
Label the regions
Ach stimulates the medulla chromaffin cells
Side effects of amiodarone
Types of analysis to do based on type of independent and dependent variables (qualitative or quantitative)
Physical manifestations of cystic fibrosis
Nasal polyps, bronchiectasis, recurrent infections, digital clubbing
Pancreatic insufficiency, absence of vas deferens (inferitility), failure to thrive
CFTR gene helps developement of wolffian structures
Course of the great saphenous vein
Begins on the medial fit, courses up medial to medial melleolus then uo medial aspect of leg and thigh. Joins femoral vein in the femoral triangle (bounded by inguinal ligament, sartorius, adductor longus), inferior to pubic tubercle
Cancer and PD-1
Cancer cells often have mutations that make them express less PD-1, which would usually bind PD-L1 (programmed death ligand 1) on cytotixic T cells and cause lead to destruction
What cell surface signal is lacking in leukocyte adhesion deficiency
CD18 - see leukocytosis because neutrophils and macrophages cant enter tissues
Innervation of inner ear muscles
Tensor tympani - CN V3
Stapedius - CN VII
What will a mutated PRPP enzyme cause (phosohoribosyl pyrophosphate)
Gout due to increased purine synthesis
Causes of gongenital hypothyroidism (4) and hormone levels
Primary hypothyroidism
Thyroid hormone resistance
Central hypothyroidism
Transient due to maternal exposure
Normal pancreas development
Dorsal - tail, body, most of head, accessory duct
Ventral - Main duct, uncinate provess, part of head
Is pregnancy prothrombotic or antithrombotic? why?
Prothrombotic
- Increased clotting factors - like fibrinogen
- Decreased anti-clotting factors - like protein S
- Less fibrinolysis
Levels of the sciatic nerve
L4-S3
What muscles does the median nerve course between
Humoral and ulnar heads of the pronator teres
flexor digitorum superficialis and flexor digitorum profundus
Inhibitory checks on trypsin activity
Trypsin inhibitors (encoded by SPINK 1 gene) are released in the pancreas
Tryspin also can cleave another molecule of trypsin at a second site different from activation that inactivates it - stops excessive cascade
Main cause of epiglottitis vs steeple sign
Haemophilus influenza type B = epiglottitis
Croup = steeple sign
Nondisjunction in meiosis I vs meisosis II
What blood changes would be seen after several days at high altitude
Slightly high pH, low O2, low CO2, low bicarb
Low O2 in air increases respiration (chemoreceptors) that leads to loss of CO2 and resp alkalosis. This leads to loss of bicarb in kidneys
Effects of fetal hyperglycemia (from uncontroled maternal diabetes)
Lots of glucose crosses to placenta so big baby (macrosomia)
Leads to increase in fetal insulin and beta cell hyperplasia - after birth see hypoglycemia so have to give glucose
APC vs KRAS vs TP53
APC - progression from normal mucosa to polyp (B catenin accumulation)
KRAS - Increase size of adenoma
TP53 - malignant transformation
Most likely cause of fatigue, fever, and new heart murmur
Infective endocarditis
proliferative glomerulonephritis can be secondary (nephritic syndrome)
Cause of fetal midgut atresia
Vascular injury
Hematologic cancers associated with downs syndrome
Acute lymphoblastic leukemia
Acute megakaryoblastic anemia
Effects of raloxifene in different areas of the body
Estrogen agonist in bone (good for osteoporosis)
Estrogen antagonist in the breast and uterus
What increases urea reabsorption and where
Vasopressin (ADH) in collecting tubule
Function of calcium in neuronal transmission
Triggers fusion and release of neurotransmitter vesicles
Nerve most at risk during ablations involving the right atrium
The right phrenic nerve
Why are ischemic occlusions rare in the lung
Dual blood suply bc anastamoses between bronchial and pulmonary arteries. Broncial arteries can continue to supply nutrients
How is blastomyces described histologically
Branching hyphae
large round yeast with doubly retractile walls and a single broad based bud
Is cystic fibrosis obstructive or restrictive
Obstructive - progressive bronchiectasis, mucus plugging
Effect of acetazolamide on Na and K in urine
In the proximal tubule, it blocks reabsorption of Na.
But later in the collecting duct, Na is reabsorbed in exchange for K leading to an overall increase in K in the urine
Pathophys of high altitude pulmonary edema
Drop in O2 leads to vasoconstriction. If this is uneven, can lead to increase in pulmonary arterial pressure and perfusion in a certain area that can cause capillary membrane disruption and lead to edema
Pathophys of a staghorn calculus
Urease producing organisms (proteus, klebsiella) cause an increase in urea that is converted to ammonia in the urine. This alkalinizes the urine and causes precipitation of struvite crystals
Continuous urea production makes stones grow very rapidly, can lead to renal atrophy
Pathophys of cachexia
TNF-alpha is produced by macrophages and some neoplastic cells
Decreases appetite due to affect on hypothalamus and increases basic metabolic rate = musle wasting
Histology of mesothilioma
Flattened cells or spindle cells
Immunohistochemistry: cytokeratins, abundant tonofilaments
Effect of ATP on muscle contraction
ATP binds to myosin light chain and causes a releases from actin = relaxation
A - caudate
B - internal capsule
D- putamen
E - globus pallidus
Muscle that takes up most of the sciatic foramen and can compress the sciatic nerve
Piriformis - external rotation
Changes in the endometrial tissue throughout menstruation
Where is most water absorbed in the tubule
THE PROXIMAL TUBULE
>60% regardless of hydration status
Potency of neuromuscular blocking agents in myasthenia gravis
Nondepolarizing (rocuronium, vecuronium) - more potent because fewer receptors that they compete for
Polarizing (succinylcholine) - less potent, fewer receptors so cant produce same effect
Fungal infection most associated with central venous catheter
Candida - pseudohyphae and blastoconidia
Main regulator of depth and rate of respiration
Respiration center in medulla based on peripheral and central chemoreceptors
Carotid and aortic bodies are main site that monitor PaO2 during hypoxemia
Most common causes of COPD exacerbations
Viral or bacterial illnesses - usually rhonovirus, influenza, H. flu, moraxella catarrhalis, strep pneumo
MOA of hydroxyurea
Inhibits ribonucleotide reductase = myelosuppression
Also shifts beta globin expression to gamma globvin, increasing fetal hemoglobin
Vincristine MOA and toxicity
Inhibits formation of microtubules - effective in stopping M phase
Neurotoxicity (peripheral neuropathy)
Side effects of statins
Muscle toxicity
Hepatotoxicity - check transaminases before starting
Treatment for simple cystitis
Nitrofurantoin or trimethoprim-sulfamethoxazole
Skin manifestations in syphillis stages
primary - chancre
secondary - diffuse macular rash, condyloma lata
tertiary - gumma (panless, indurated, granulomatous lesion)
Medications for weight loss and MOA
Why is peripheral edema initially avoided in chronic heart failure
Increased lymph flow
MOA of 5-FU
Creates a complex between tetrahydropholate and thymidilate synthetase, causing an inability to get back to DHF
Drug used to “rescue” cells during methotrexate use
Leucovorin (folinic acid) - a tetrahydrofolate derivative that can yield DNA synthesis without DHF reducatse that is inhibited by methrotrexate
What is seen grossly in TB meningitis
- Thick, gelatinous exudate on basal portion of brain
- Tubular vasculitis causing multiple bilaterla brain infarctions
- Hydrocephalus causing ventriculomegaly
Desmosomes vs hemidesmosomes
Both are spot-like junctions made of keratin intermediate fillaments but desomosomes are between adjacent cells and hemi-desmosomes are with the basement membrane
Type of cell junction of the BBB
Tight junctions - only transport by diffusion across membranes or. transporters
Usual location of third degree heart block
Av or bundle of his - bundle of his usually able to take over but not under control of SA
What does the HIV env gene do
Codes for polyprotein gp160 that is extensively glycosylated. Cleaved in the golgi into gp 120 and gp41 which allow for virion attachment to target cells
Histologic features of legionella
Poorly gram stains and does not grow on conventional agar
Will silver stain
Grow on buffered charcoal yeast extract agar with l-cysteine and iron
What is length-time bias
Screening test is less likely to pick up those with very quickly progressing disease than those with a slowly progressing disease that already have a better prognosis
Falsely elevated survival time
What enzymes are inhibited in lead poisoning
ALA dehydratase and ferrochetalase
What drugs can trigger G6PD
Bactrim (TMP/SMX), dapsone, antimalarials, nitrifurantoin
Fava beans
What is countertransferance
A therapists concious or uncocnious response to a patient based on past personal relationships
Fucntion of methimazole and propylthiouracil
Decrease production of thyroid hormones
Block thyroid peroxidase which adds iodine to tyrosine in colloid
SX of vitamin E deficiency
Hemolysis
Neurologic symptoms - ataxia, loss of proprioception, loss of sensation, loss of deep tendon reflexes (looks like freidrichs ataxia)
What is thyroglobulin
large glycoprotein made in the thyroid that is used to contribute tyrosine residues. Released when thyroid productio is occuring
Innervation of teeth and lower lip
Branches of CN V3
Teeth - inferior alveolar nerve
Lower lip - mental nerve
MOA and side effects of sulfonylureas
Close K+ channels in pancreatic beta cells cause depolarization - insulin release due to calcium influx
Side effects: hypoglycemia, weight. gain
Symptoms of digoxin toxicity
Arrhythmias, vague sx, vision changes, hyperkalemia
What causes swelling of hands and feet in SC infants
Vasoocclusion - infarctions. in the. bone of the extremities causes swelling and pain. More commoninnfants because. still hematopoetic tissue
Pathophys of fragile X syndrome
Many CGG repeats on X chromosome leads to increased methylation of FMR1 gene - leads to impaired neural development
What is a delayed hemolytic transfusion reaction
Occurs when someone. has previosly been exposed to a foreign minor red blood cell antigen (non-ABO) like pregnancy or transfusion
After reexposure, B cells produce a large numebr of antibodies resulting in hemolysis - amnestic response
SX: often asymptomatic, hemolysis, positive coombs test
How is the lac operon regulated in E. Coli
- negatively. by the binding of repressor protein the lac operator locus
- positively by cAMP-CAP binding upstream from lac operon – inhigh levels of cAMP, CAP will bind upstream and turns on lac cAMP. low in the presend of glucose
Coagulation and nephrotic syndrome
Nephotic. syndromes cause a hypercoagulable state due to a loss of anticoagulant factors in the urine - especially antithrombin III
Can cause a renal vein thrombosis - would see flank pain, hematuria, elevated lactate dehydrogenase, possible left sided varicocele
Pathophys of postpartum thyroiditis
Autoimmune destruction of the thyroid gland - get release of thyroid hormine
Lymphocytic infiltrate with possible germinal centers
Medications associated with gout exacerbations
Reduced uric acid secretion - diurectics, cyclosporine, ACE inhibitors, salicylates
Increased production - cytotoxic chemotherapy (bc cell lysis)
Nerve most ofte injured during repair of inguinal hernias
Illioinguinal nerve - pain in anterior scrotum (labia majora), base of penis (mons pubis), medial thigh
Loading of MHC I vs MHC II
MHC I - proteasomes break down product and bring into ER via TAP proteins. MHC is assembled and sent to membrane
MHCII - MHC II is sent out from ER and fuses with lysosomes that contain bacterial products, MHC II forms within vesicle and then goes to membrane
What genes are affected by HPV
Decreased activity of p53 and Rb = unregulated cell proliferation
What is chronic granulomatous disease and common infections
Deficiency in NADPH oxidase, so cant turn O2 into radical to do oxidative burst in neutrophils
Can use H2O2 formed by catalase (-) bacteria, but catalase (+) bacteria remove H202
Staph aureus, burkholderia (pseudomonas) cepacia, serratia marcecens, nocardia, aspergillus
What is MGMT
Gene that helps to repair DNA damage, especially alkylating DNA damage
What happens to bicarb if chloride increases
Goes down - this is a NAGMA
Signs of cyanide poisoning and treatment
Reddish skin coloration, tachypnea, headache, tachycardia, nausea/vomiting, weakness
TX: Amyl nitrite
Converts iron (fe2+) to ferrous iron (fe3+) to make methemaglobin which binds to cyanide and sequesters it
How to treat heart valve infections
Vancomycin
Coagulase negative staphylococci are assumed to be methicillin resistent, otherwise would use nafcillin or oxacillin
Obstructions at the level of the larynx (epiglottitis) have _____ stridor
Inspiratory
What is mastocytosis
Abnormal proliferation of mast cells with increased histamine release
SX: hypersecretion of gastric acid by parietal cells, hypotension, flushing, urticaria, pruritis.
What is transpeptidase
A type of penicillin binding protein that penicillin or cephalosporins would bind to
First line therapy for atopic dermatitis
Topical glucorticoids - PLA2 inhibitor
Function of CN IX (hypoglossal)
Somatic motor: stylopharyngeus m (elevate palate during swallowing)
Parasympathetic: parotid gland (runs with V3)
General sensory: inner surface of tempanic membrane, eustachian tube, posterior 1/3 of tongue, tonsilar region, upper pharynx, carotid body and sinus
Special sensory: taste on posterior 1/3 of togue
Most common place for ulnar nerve damage
Fracture of the hook of the hamate as it passes through Guyon canal
MOA of PCP
N-methyl-D-aspartate receptor antagonism
Leads to dopamine dysregulation
Derivatives of ectoderm
Derivatives of mesoderm
Derivatives of endoderm
What is dilated cardiomyopathy
Direct insult to the myocardium leads to leads to ventricular dysfucntion and increased ventricular cavity size
Cause: viral, drugs, disease, idiopathic (familial - TTN gene)
What is titin
An elastic fiber that binds myosin heavy chain to the Z disk, contributes to passive myocardial tension
Examples of exocrine pancreatic enzymes
Lipase, elastase, amylase, trypsin, chymotrypsin
Low levels would indicate oancreatic insuffficiency
What is severe combined immune deficiency
Defect in T cell production - get loss of cellular and humoral immunity. B cells cant be activated
See: recurrent fungal, viral, bacterial, opportunistic infections. DIarrhea and failure to thrive
Cells involved in type IV hypersensitivty
Macrophages, CD4, CD8
NO B CELLS
DNA-binding proteins examples
Transcription factors, steroid hormone receptors, thyroid hormone receptor, fat-soluble vitamin receptors, DNA transcirption/replication proteins
Nerve most likely to be injured during thyroid surgery and muscle it innervates
External laryngeal nerve
Cricothyroid m.
Runs with superior thyroid artery and vein
Best rehydration for viral diarrhea
Hypotonic sodium-glucose solution
Sodium will pull water in
Treatment for nephrogenic diabetes insipidus
Water replacement and thiazide diuretic
Thiazide causes a mild volume depletion that leads to sodium and water reabsorption in the proximal tubule
What can lead to inactivation of fluoroquinolones
Chelating agents that contain calcium, iron, aluminum, magnesium
Antacids would be a common cause
MOA of heparin
Binds and induces antithrombin III, an anti-clotting facor
See prolonged thrombin time and PTT, decreased activity of factor Xa
What penicilins and cephalosprins are effective agaionst P. aurugenosa
Tcarcillin and pipercillin
cefepime and ceftazadime
SX of dissemenated histoplasmosis
Growi inside macrophages so can travel through reticuloendothelial system
hepatosplenomegaly, lyphmadenopathy, pancytopenia, tongue ulcerations
Contents of femoral triangle from lateral to medial
Femoral nerve, femoral artery, femoral vein, deep inguinal nodes
Pathophys of acanthosis nigricans
Caused by an increase in free fatty acids
Insulin insensitivity leads to lipolysis
Condition associated with HLA-B27 and what to monitor
Ankylosing spondylitis
Can limit chest wall mobility so monitor chest expansion
Can also cause dilation of the aortic ring and anterior uveitis
Cardiac problem associated with SLE
Fibrinous pericarditis - pleuritic chest pain that may radiate to shoulder, diffusely elevated ST segments
Would see fibrin-containing exudate
Nerves injured during prostatectomy that causes erectile dysfunction
Prostatic plexus in fascia of prostate - cavernousn nerves carry post-ganglionic parasympathetics to penis
Function of HIV gp120 and gp41
Gp 120 allows for attachment to T cell
Gp41 allows for fusion and insertion of viral core
What causes a mid-systolic crescendo decrescendo murmur
Aortic or pulmonary valve stenosis
Estrogen effects on epiphyseal growth plate
Initially triggers increased growth, but then causes epihphyseal growth plate closure
What is somatomedin C
Insulin like growth factor 1
Lung manifestation of RA
Pulmonary fibrosis - restrictive lung disease
Risks for diverticulitis
Dietary - high in red meat, fat, low in fiber
Obesity
Physical inactivity
Smoking
Most common cause of pericarditis
Viral illness
What usually causes serum sickness
Exposure to nonhuman proteins in antitoxins, antivenom, MABs, vaccines
Causes type III hypersensitivity with deposition in tissue - fever, urticarial rash, arthralgia
Segmented viruses
Bunya
Orthomixo
Arena
Reo
What ligament is often injury in radial head subluxation (nurse maids elbow)
Annular ligament
What do menotropin and hCG due for ovulation
Menotropin serves as FSH, allowing for the maturation of a dominant follice
hCG serves as the LH surge, inducing ovulation
Vitamin deficiency associated with measles
Vitamin A - can give occular complications so give. A
Histo of emphysema
Interalveolar septal destruction with bronchial wall inflammation
Function of leptin
Leptin is made by adipocytes and reduces appetite
Reduces production of neuropeptide Y (appetitie stimulant) and increases POMC (inhibits food intake), both in the arcuate nucleus of hypothalamus
Histo of poxvirus molluscum contagiosum
intracytoplasmic eiosinophilic inclusion bodies
Sensory innervation of the parietal pleura
Phrenic nerve: diaphragmatic and mediastinal pleura - get pain in neck and shoulder bc C3-C5
Intercostal nerves: Costal and cervical
Pathophys of febrile seizure
hyperthermia-induced diffuse neuronal injury
Toxicities of common chemotherapy agents
What is patiromer
Drug to treat hyperkalemia - binds to colonic potassium in exchange for calcium
When is alk phos elevated
In disorders of the bile ducts (stasis)
Disorders with high bone turnover (paget)
Most common cause of aminoglycoside resistance
Antibiotic modifying enzymes - add alkyl groups, phosphates, etc to stop binding with ribosome subunit
Embryonic origin of pituitary
Anterior - surface ectoderm
Posterior - neuroectoderm from diencephalon
AA precursor of serotonin
Tryptophan
Histo for hep B
Ground glass appearance - homogenous, pale, opaquepink cytoplasm
Councilman bodies - eosinophilic glovules of shrunken hepatocytes
TX for diabetic neuropathy
Glycemic control and foot care
If painful: SNRI, TCA, gabapentinoid
What causes neonatal hydrocele
Patent processes vaginalis - fluid accumulates in the tunica vaginalis
Tunica albugenia is what directly covers testicle and corproa cavernosa
What is the accumulation effect
A certain time period or level of exposure is needed to see benefits or detriments of a risk reducer or increaser
Benefit of hypothermia therapy
Decreases the formation of ROS (temp dependent), lowers cerebral blood flow, lowers O2 and glucose consumption
Pathophys of Ehlers-Danlos
Deficiency in the cleavage of the C and N terminals of procollagen
What crescendo is best heard leaning forward
Aortic regurgitation
Hear a decrescendo, best heard at C
MOA of nitrates
Vasodilation, mostly venodilation in the periphery, so preload is reduced (LV end diastolic volume) and afterload because easier to pump
Mild coronary artery dilation, overall less cardiac oxygen demand
Describe mechanism of nichotinic cholinergic receptor
Ionotropic recpetor - uses ion channels that open
Binding of two acetylcholine molecules opens channel that allows for influx of calciuma nd sodium and efflux of potassium, generating end plate potential
Cause of lateral medullary syndrome
Damage to PICA - branches off of vertebral artery
Conditions associated with atopic dermatitis
Things mediated by IgE
Allergic rhinitis, asthma, food allergies
Changes in ghrelin, leptin, and insulin during fast
Ghrelin goes up and stimulates appetit
Weight loss leads to less fat so lower leptin, and increase in insulin sensitivity to lower insulin
Relationship between nitrates and PDE inhibitors
Nitrates is converted to NO which leads to an accumulation of cGMP in cells
phosphodiesterase usually degrades cGMP but PDE inhibitor will lead to further accumulation of the cGMP = profound hypotension
How to reverse effects of warfarin
Fresh frozen plasma
Morphological changes seen in superficial burns
Mast cells release histamine and other facts that cause blanching erythema
Deeper burns will damage the endothelium that causes extravasation of fluid between gaps in cells (blisters)
Mutation seen in CF
delta F508
CFTR Chlroide channel is messed up - chloride and sodium remain in sweat = hyponatremia
How does shiga toxin work
Inactivates 60s robosome subunit - cell cant produce proteins and dies
Most common organisms seen in aspiration pneumonia
Facultative and strict anaerobic oral organisms
Bacteroides, prevotella, peptostreptococcus, fusobacterium
Prolactin effect on GnRH
Inhibits - so low GnRH, LH, and testosterone
SX of pituitary apoplexy
Associations with each part of the duodenum (1-4)
2- ampulla of vater where secretions from pancreas + bile come in
3- superior mesenteric artery
GI bugs that can cause disease with very low numbers
Shigella, campylobacter, entamoeba, giardia
What cells make up the alveolar capillary membrane
Type I pneumocytes
Complications of obstructive sleep apnea
Pulmonary hypertension (pulm vasoconstriction during hypoxia)
Systemic hyeprtension, right heart failure, Afib, arrhythmias, sudden cardiac death
Growth factors elevated in idiopathic pulmonary fibrosis
TGF-B, PDGF, VEGF, FGF
Perfinidone is against TGF-B
Nintedanib is against FGF, VEGF, PDGF
Mood stabilizers for bipolar disorder
Location of the greater and lesser omentum
Causes of insulin-induced weight gain
effects of beta thalesemia major and minor on HBa1c and HA2
To. compensate for a loss of beta chains, the HA2 will rise, while hemoglbin A will fall, so HBA1c will fall
In minor - slight elevation of A2 and decrease in HBA
In major - no HBA and large increase in A2
How does a HBa1c work
Hemoglobin A1c us produced by nonreversible glycosylation of N-termus of hemoglobin - lasts as long as RBC lives
Effect of 2,3-BPG
Decreases the affinity of hemoglobin for O2 - leads to offloading into tissue
What is mullerian agenesis
Hypoplasia/aplasia of the mullerian structures - fallopian tubes, uterus, cervix, upper vagina
Will have normal secondary sex chaarcteristics and are 46, XX
What AAs can lead to a buildup of proprionyl coA
VOMIT
Valine, odd chain fatty acids, methionine, isoleucine, threonine
SX of kawasaki disease
Conjunctivitis glossitis, fissured lips, rash, erhythema and edema of distal extremities, cervical lymphadenopathy
Risk for coronary aortic aneurysm
Somatic vs germline mosaicism
In somatic mosaicism, the individual posses phenotypic evidence of the mutation
In germline, they do not, but can pass the mutation on to offspring
EX: Turner mosaicism 45X/46XX
When is hospice an option
When less than 6 months prognosis and aggressive treatment is no longer beneficial or desired
Part of brain that if damaged would cause disinhibition, personality change, irritability
orbitofrontal cortex
Targets of the four antifungal classes
What happens to methotrexate and DHF/folic acid inside the cell
Polyglutamation - keeps them inside the cell
Most common site for vestibular schwanoma
Cerebellopontine angle - would affect CN VIII, VII, V
Blood supply of the liver
Right and left hepatic arteries which are branches of the celiac trunk
Blood supply to the SA/AV and bundle of His
Right coronary artery
Impact on preload, afterload, and CO during pregnancy
There is an overall drop in SVR during pregnancy, which causes a drop in afterload, and increase in preload
There is an increase in blood volume which causes increased CO and preload
Those at risk for serious infection with vibrio vulnificus
Liver disease, iron overload
What are neurophysins
They are chaperone proteins that carry vasopressin and oxytocin from the hypothalamus to the posterior pituitary
What type of drug to use for urge incontinence
Antagonist for muscarinic cholinergic receptors - M3 in the detrusor muscle
MOA of thiazide diuretics
Block the NaCl transport in DCT so less reabsorption
Also cause less excretion of calcium = good for osteoporosis
Autosomal dominant vs recessive polycystic kidney disease
Dominant presents later in life - cysts are very smalla t birth and then grow
recessive - presents as kidney masses at birth
Manifestations of Leischmania
Cutaneous - enlarging pinkish papule, nodule or plaque that ulcerates
Histo - Grows within macrophages as intracellular, round-oval amastigoytes with rod-shaped kinetoplasts
Bone cancer with small, round blue cells
Ewing sarcoma
What kind of channel is CFTR
ATP-gated
What activates platelets
thromboxane, ADP, decreased cAMP
What kind of hernia would travel through a patent tunica vaginalis
Indirect - passes through the inguinal canal
What is a stratum ovarii tumor
An ovarian germ line tumor that is comprised of 50% thyroid cells - produces thyroid hormone
Appears as an oily cystic mass
The middle meingeal artery is a branch off of ___
Maxillary artery, which comes off of external carotid
How is CO2 carried in the blood
Preodimately in the form of HCO3-
Carbonic anhydride in the RBC converts it, and then exchanges it for chloride – the chloride shift
What is retinitis pigmentosa
Gram negative rod that is lactose positive and indole positive
E. Coli – can convert tryptophan to indole
E. cloacae is indole negative
Venous drainage of the fundus of the stomach
Splenic vein - with thrombosis can get varices just in the fundus
Pathophys of a hypersensitive carotid baroreceptor
When slight pressure is applied, baroreceptor thinks there is a very high blood pressure - reduces sympathetics and increases pns to the heart
Rapid vasodilation with a sinus pause
What are the codes of intron splice sites
GU at the 5’
AG at the 3’
What is hypertrophic osteoarthropathy
Most common placenta for monozygotic and dizygotic twins
Dizygotic - Diamniotic/dichorionic
Monozygotic - diamniotic/monochorionic (division around day 4-8)
Where do carcinomas usually spread first
Regional lymph nodes
Head and neck - jugular nodes
Significance of viridans streptococci
Often found in dental carries, heart valve infections
Can adhere to tooth enamel and platelets on damaged heart valves because they produce insoluble extracellular polysaccharides (dextrans) from sucrose
What do nitrates predominately work
Large veins - decrease preload and myocardial oxygen demand
Most prominent surface marker for monocyte-macrophages
CD-14
Most important process in formation of shiggelosis
Mucosal invasion - Invades M cells and uses actin polymerization as it kills cells
What first activates trypsin
Enteropeptidase on brush border
How to measure the osmolar gap
Elevated in toxic alcohol metabolism
Signs and risks of placental abruption
Location of pacemaker and what can it cause
Can cause tricuspid regurgitation
Function and innervation of latissimus dorsi
Extension, adduction, internal rotation of the humerus
Innervation is thoracodorsal (C6-C8)
Three steps of normalk swallow
- Displacement of the larynx superiorly and anteriorly under base of tongue to direct food to posterior esophagus
- Tilting of eppiglotis to cover airway
- Adducting of vocal coards to cover glottis
What is DRESS syndrome
Drug reaction with eosinophilia and systemic systems
Reaction 2-8 weeks after starting a drug (anticonvulsants, allopurinol, abx) that shows widespread eosinophilia - lymphadenopathy, facial edema, rash
What tests are used to diagnose GAS
- Rapid antigen test for Group A antigen
- Culture and look for beta hemolysis if antigen test is negative
How to avoid ACE inhibitor first does hypotension
Stop all diuretics and start at low doses
Occurs more if angiotension II and aldosterone are high (like in volume depletion from diuretic)
What is Henoch Schonlein purpura
What is seen in loop diuretic overruse
Hypokalemic, hypochloric metabolic alkalosis
Fasciculus cuneatus vs fasciculius grascilus
Both in DCML
Gracile - medial, from below T6
Cuneate - lateral, above T6
What drugs can lead to higher levels of statins
CYP3A4 inhibitors
Macrolide abx, ketoconazole, non-dihydro Ca blockers, amiodarone, protease inhibitors
What is the late phase of a type 1 hypersensitivity
TH2 cells release IL-5 to activate eosinophils
Eos release major basic protein and other chemicals that cause tissue damage - indurated lesion 2-10 hours later
What is an infantile hemangioma
Endothelial cells
Methimazole vs propylthiouracil
Methimazole is preferred for hyperthyroidism in most patients over PTU because of hepatotoxicity
Methimazole is a teratogen so PTU is used in the first trimester of pregnancy, and then patient can be switched back to methimazole
MOA of amiloride and triamterene
Potassium sparing diuretics that block the sodium uptake channel in collecting duct
Function of homeobox (HOX) genes
Code for transcription factors that regulate gene expression of different segments of the embryo
Types of cells increased in COPD
CD 8 T cells, macrophages, neutrophils
What is deferoxamine
Iron chelation drug
What is Gerstmann syndrome
Stroke to the angular gyrus of the dominant parietal lobe
Finger agnosia, acalcula, agrpahia, L-R disorientation
Pressures on the right side of the heart
Budesonide MOA
A glucocorticoid
Binds to a cytosolic receptor that then travels to the nucleus and causes a tissue specific change in transcription - includes inhibition of proinflammatory transcription factors like NF-kB
What is seen in photoaging
Loss of production of collagen fibrils, caused by UVA
See more collagen cross-linking which causes wrinkles
What drug affects prostate volume
Finasteride - takes 6-12 months
Alpha 1 antagonists affect relaxation
What would cause air in the billiary tree
A large gall stone can herniate through a fistula into the intestine, intestinal gas then flows back into the billiary system
Phases of wound healing
Embryologic origins of the kidney
Metanephros - glomeruli, bpwmans space, proximal tubules, loop of henle, DCT
Ureteric bud - collecting tubules and ducts, major and minor calyxes, renal pelvis, ureters
Effects of muscarinic receptors on cardiovascular system
In vessels , M3 leads to vasodilation because increased NO
In cardiac muscle, M2 leads to decrease in heart rate (chronotropy) and decreased contractility (inotropy)
Obturator nerve function
Innervates thigh adductors and sensory over medial thigh
Exits through the obturator canal
Common causes of candida vaginosus
Reduction in the lactobacillus population that allows fop overgrowth
Can also be immunosuppression, diabetes, high estrogen
What causes exercise-associated collapse
A sudden drop in preload to the heart
During exercise, contracting muscles push blood back to the heart. But after stop, muscles relax and BV suddenly drops to the heart and there is not enough to meet cardiac demands – syncope, hypotension, collapse
First order vs zero order kinetics
First order - a constant proportion of drug is metabolized
Zero - a constant amount of drug is metabolized
Pregnancy affect on blood
Increased plasma volume, increased RBC (more erythropoetin), dilution causes lower hemoglobin
Nerve most likely compressed in an aneurysm of the internal carotid in the cavernous sinus
CN VI - abducens
Histo of chronic
Obliterative vascular wall thickening with tubular atrophy (kidney) and interstitial fibrosis
Mixed cell response - cell mediated and antibody mediated
What is the Reid index
Index of the size of submucosal glands
C/(B+C+D)
What accounts for the rubber-like properties of elastin
Desmosine cross links and the high content of. nonpolar residues like lysine
How does variation in gonococcal pilli occur
Antigenic variation through recombination
Not plasmid - that is abx resistance
What happens to blood volumes in the heart during inspiration
Suring inspiration, intrathoracic pressures drop allowing more blood to flow into the right heart
Drop in pressure also allows for more blood in the pulmonary circuit so blood volume to left heart falls
Right heart murmurs increase with inspiration
Function of the golgi tendon organ
Feedback mechanism that monitors and regulates muscle force - sensitive to change in. force but not stretch
Would cause sudden relaxation if something is too heavy
Most common site of aortic rurptures
Type A - sinotubular junction
Type B - close to origin of left subclavian artery
MOA of abciximab
GPIIb/llla inhibitor on platelets
Location of focal seizures that have a sensory prodrome
Medial temporal lobe - hipocampus, amygdala, parahippocampal gyrus
What are the common Na channel toxins
Pufferfish, red tide, moray eel
MOA of alteplase
Binds fibrin on clot and converts plasminogen to plasmin = clot lysis
Adverse event is hemorrhage
What is effect modification
When the effect of an exposure is modified by another variable
Different strata of the popualtion will have different measures of association
Neutropenia makes you suscpetible to what kind of organism
Gram negative
Medications associated with risk for osteoporosis
Best antiemetic for GI irritation
5HT3 receptor antagonists
GI irritation leads to release of more serotonin which activates the vomiting center
What is field cancerization
An area of cells are primed to form cancers because of widespread expsure to a carcinogen
Would be like all the cells in the mouth being primed due to chewing tobacco
Right vs Left colon cancers
Right - large, tend to bleed (iron deficiency, occult blood)
Left - smaller, invade the wall and decrease lumen size so cause obstruction (bowel changes, nausea)
Symptoms of Scleroderma (sysetmic sclerosis)
CREST
calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangectasia
What infusion to use for volume resuscitation
Isotonic crystalloid - 0.9% saline or lactated ringers
What does the musculocutaneous nerve innervate
Arm flexors (biceps) and lateral forearm sensory
Nerve control of peristalsis
Vagus before splenic flexture, S2-S4 after splenic flexture
Treatment for orotic aciduria if from PYRIMIDINE synthesis
Can supplement with uridine
Classical vs operant conditioning
Respiratory muscle innervation
What foods are common for Hep A
Shellfish, berries - tainted food or water
Nitrates dosing and reasing
Usually dont do an evening fose, or have a epriod of no admin
Bc vessels can become desensitized - develop tolerance
How soon does the heart stop beating in hypoxia
Within 60 seconds
30 minutes of ischemia = irreversible damage
What happens to blood flow in tension pneumothorax
The increasingly growing pleural space can collapse the vena cava and cause a decrease in venous return = hypotension
Conditions that promote RBC sickling
Low oxygen content (oxygen unloading), low pH, low blood volume
Drugs to give for malaria from chloroquine resistant areas
Atovaquone and proguanil
Give primaquin if P vivax or P ovale (liver)
Areas most susceptible to atherosclerosis
Lower abdominal aorta and coronary arteries - areas with bends and branch points that encourage turbulent flow
What is the arteriovenous concentration gradient for anesthetics
Difference between arteries and veins concentration - dictated by absorption into tissue.
If high, there is a large concetration in the tissues, so would take longer to have any effect on the brain
What causes permenet central DI
Damage to the hypothalamus
Damage to posterior pituitary causes transient DI
What is multiple myeloma
Why does bioavailability change with rectal drugs
Becuase less first pass metabolsim - only supply above dentate line goes to portal, below is to systemic
Most common cause of nephritic syndrome
Immune complex deposition
Who is most at risk for lactic acidosis on metformin
Low renal clearnace - should check creatinine before starting
How is fetal lung development measured
Amniocentesis looking at phospholipids
The lecithin the sphingomyelin ratio is calculated - greater than 2 is mature
Azathioprine metabolism to active form and inactive by what enzymes
